Trust matters. This one word – so loaded with meaning and impact – drives competitive market share and pricing in industry after industry where outputs are hard to assess or delivered as a service. Moreover, if a customer doesn’t trust a company, loyalty will be fickle.
Trust should not be taken for granted. In a 2022 survey, PwC found that nearly 90% of business leaders believed consumers trusted their companies, while only 30% of consumers surveyed said they did.  That’s a dangerous disconnect.
The problem is that the nature of trust can change over time. It’s not enough to gain a customer’s trust and keep it. Goalposts move. Consider grocery stores, for instance. Fifty years ago, trust in a grocery store might have been based on whether the produce and meats were fresh and the store was clean. Now, customers may want to trust the quality of a grocer’s private label goods, how animals were raised, and even the store’s labor policies. Earning trust on those dimensions requires quite a different set of capabilities than the stores of yore required.
Organizations that see where the nature of trust is headed can gain major competitive advantages. Because trust often stems from multiple factors, it can take time to align those factors to produce the intended impact. Further time passes as customers start referring to the company as a trusted supplier, and the long-term benefits of enhanced loyalty can take years to materialize. If an organization chases the changing nature of trust too late, it loses the ability to adapt to those shifting sands in a timeframe that’s actually relevant.
Trust in Healthcare: A Leader’s Experience
Consider the experience of a leading US academic medical center, which had a powerful legacy and reputation for medical excellence. While it was proud of its history, it knew this was not enough. The institution recently studied its patients, and it observed that expectations for their health system are changing. It’s no longer sufficient to effectively treat complex and serious illness and produce leading-edge medical knowledge. Given that patients choose their health network largely on trust, the institution recognized that it had to shape its proposition and patient experience to where the notion of trust was headed.
The four-step process it used is one that firms in any industry can follow:
1. Determine the strategic role of trust
Is the organization pursuing trust to attract new customers, keep its current ones, get a greater share of their business, or increase revenue? Perhaps the answer is all of the above, but understanding the priority of each imperative is critical. This institution couldn’t use trust to increase revenue – the great majority of reimbursements are paid by third-party insurance companies. It has excellent retention of current patients who stay in its geographic area. However, for all of its reputation for medical excellence and quite literally “writing the books” on academic primary care, the institution was operating a mostly one-size-fits-all approach for patients, despite the trends in medicine and in other industries towards hyper-personalization. Common sense presumes this level of aggregation means suboptimal experiences for both consumers and caregivers alike, threatening quality, outcomes, and viability of health system-based primary care. Meanwhile, new primary care providers had begun to spread in its primary service market, offering a bevy of products and experiences that were digital-first and purpose-built for specific consumer segments or even subsegments.
This served as one key imperative – reorient how to assesses loyalty and satisfaction around the ability to gain and nurture trust with a specific consumer.
2. Dig deep to uncover definitions of trust and drivers of change
The institution then used a technique called Jobs to be Done, pioneered by Harvard’s Clayton Christensen, to understand what really motivates patients to choose a primary care network. Jobs looks beyond stated preferences and behaviors to uncover the root causes of customer choice. These Jobs varied. Some patients wished for their network to be as accessible and convenient as possible, whereas others cared most about having a real dialogue with physicians about their care, and others yearned for a feeling of personal connection with their doctor. Trust wasn’t just about the doctor getting the patient better, but about the experience of that care.
3. Quantify who trusts what and why
With such a complex picture, the institution needed to unravel which patients cared most about what, and why. For instance, it found that many women in their 30s cared quite a lot about having a personal connection with their physician, and these women were also evaluating a health system not only for their own medical needs but for how it would care for potential childbirth. Conversely, people who were recent immigrants or from poorer socio-economic backgrounds prioritized being treated with respect, more so relative to other segments. Of course these imperatives aren’t mutually exclusive, but they’re distinct and have differing implications for service design.
4. Make Choices (and trade-offs)
It is relatively easy to identify attractive consumer segments and develop a strategy to acquire and retain them. An inherent flaw in that approach is that it can define “attractive” within the context of the current system, making it harder to innovate towards what could/should be possible in the future. Through the trust analysis, consumers described where this institution was best positioned to engender trust as well as the circumstances in which others like retail clinics or concierge practices might be as good or even better. Further, secondary research identified a gap among other options that could engender trust for some patient segments due to their complexity or insurance coverage mix, making it even more important for the institution to serve these groups. Knowing what segments to purpose-build for doesn’t mean only serving them at the expense of others; rather, the organization could now focus on building and/or scaling the handful of care delivery models that most influence the main drivers of trust, as opposed to an untenable laundry list of improvements and initiatives.
A New Form of Competitive Strategy
Much of the writing on competitive strategy focuses on how competition will change in the future. But changing customer expectations, especially around broad and meaningful concepts like trust, can matter even more than a shifting competitive picture. If you know where your customer’s definition of trust is headed, you can win that trust in an enduring way.
 PricewaterhouseCoopers, “Trust: The New Currency for Business,” PwC, June 15, 2022,