Restoring Trust: Gratitude vs. Apology in Healthcare Service Recovery
Date
Authors
Xu, Yingzi
Ling, I-ling
Supervisor
Item type
Journal Article
Degree name
Journal Title
Journal ISSN
Volume Title
Publisher
Emerald
Abstract
Purpose This study applies the Affect Theory of Social Exchange (ATSE) to examine how symbolic service recovery strategies, specifically apologies and gratitude expressions, influence patient empathy, forgiveness, and trust. It addresses the challenge of rebuilding trust following healthcare service failures through emotionally grounded mechanisms. Design/methodology/approach Five experimental studies (N = 1,221) were conducted to assess patients' emotional responses and behavioral intentions across varying levels of error severity, attribution, and history, as well as patient trait empathy. Findings Gratitude expressions elicited stronger patient empathy than apologies in isolated, low-severity errors, particularly among individuals with high trait empathy. In contrast, apologies were more effective in high-severity, system-attributed failures, where explicit acknowledgment of responsibility was expected. Practical implications The findings provide evidence-based guidance for tailoring recovery communications to the severity, attribution, and recurrence of errors, as well as to patients' empathy levels. Implementing these strategies can help healthcare organizations strengthen patient trust and promote more empathetic, relationship-centred care. Originality/value This research extends ATSE to healthcare service recovery by demonstrating how affective mechanisms drive trust restoration. It positions gratitude as an effective yet underused recovery strategy, offering theoretical clarity and practical relevance in contexts where providers may be constrained in offering apologies due to legal or reputational concerns.Description
Keywords
Healthcare service, Symbolic service recovery strategies, Empathy, Forgiveness, Trust, Affect theory of social exchange
Source
Journal of Service Theory and Practice, ISSN: 2055-6225 (Print); 2055-6225 (Online), Emerald, 36(7), 46-75. doi: 10.1108/JSTP-05-2025-0176
Rights statement
© Yingzi Xu and I-Ling Ling. Published by Emerald Publishing Limited. This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at https://creativecommons.org/licenses/by/4.0/