Allison Kooijman ^1* Carolyn Canfield ²

• ¹ University of British Columbia, Okanagan Campus, Kelowna, Canada
• ² University of British Columbia, Vancouver, British Columbia, Canada

This perspective article shares the viewpoints of two long-standing patient safety advocates who have witnessed the evolution of patient engagement in healthcare quality and safety. Their involvement is motivated by a rejection of institutional betrayal that compounds harm when patient safety fails. They explore how fractured trust spreads predictably after harm, undermining healthcare values and effectiveness at interpersonal, systemic, and structural levels. They argue that authentic care transcends mere service delivery, embodying a commitment to mutual well-being, compassion, and generosity. The advocates highlight the impact of social determinants, such as culture, identity, and socioeconomic status, on trust formation, exacerbating existing inequalities. They call for a shift from transactional to relational, trust-based interactions, advocating for restorative justice principles to repair harm and rebuild trust, fostering dialogue, mutual understanding, and systemic improvement. Trust, they assert, is born in relationships, not transactions. Bureaucratic, legal, and resource constraints that impair meaningful interactions also cause moral distress to healthcare providers and poor care quality for patients. Central to the current healthcare crisis is the need for genuine connection and trust, framed as both a practical necessity and a confirmation of humanity in healthcare. The advocates envision a future where patient engagement is integral to patient safety, prioritizing epistemic justice, mutual respect, and compassionate care, restoring healthcare as a cohesive, supportive, and deeply human endeavor. They query how a restorative approach could center trust as essential for cultivating the conditions for care in our healthcare system.