Good working relationships: how healthcare system proximity influences trust between healthcare workers

Figures & data

Table 1. Provider roles and proximity with respect to the referring primary care provider (n = 39)

Participant role	Proximal (n)	Distributed (n)	Total (n)
Primary care (physicians and APPs^a)	Ref	Ref	6
Podiatry (podiatrists and medical assistant)	3	4	7
Diabetes education (nurses and dietician)	3	0	3
Wound care (physician, nurses, nurse case manager, medical assistant, hyperbaric oxygen technician)	2	5	7
Home health (nurses)	0	2	2
Infectious disease (physicians, APP, and case manager)	0	4	4
Administrative support (schedulers and referral coordinators)	1	2	3
Vascular surgery (physicians, APP, nurses, and social worker)	0	7	7
Total	9	24	39

^a Advanced Practice Providers

Table 2. Major themes with supporting quotations

Theme	Supporting Quotations
Communication	“Communication is key. Keeping it open, so they know what we’re doing, and we know what they’re doing. I think that will bring trust.” – Podiatrist “Just a willingness to communicate [helps build trust].” – Primary care provider “When you get to know each other, then you have each other’s cell phone numbers and you can start texting … That’s better because then you can start to trust.” – Podiatrist
Working together	“Being in a small community, you work very closely together. And you build trust that way.” – Wound clinic physician assistant “The culture of trust comes from experience and working together.” – Vascular surgery physician assistant
Fulfilling individual provider responsibility	“They trust me. They know I’ll work on it.” – Referral coordinator “The biggest way to build trust is to prove you know what you’re doing.” – Home health nurse
Timeliness	“Seeing that pattern from referring doctors builds up a good level of trust, especially if they consult in a timely fashion.” – Vascular surgeon “When someone says ‘I’ll start working on that right away,’ and they follow through, that’s huge for me. Timeliness. That’s what builds our trust.” – Referral coordinator
Responsiveness	“Why do they trust me? It’s because I listen.” – Nurse case manager “I think [trust] is a two-way street. You know what your needs are, what you need from us, and vice versa. If they call and say, ‘Hey, we have a patient who really needs to get in.’ OK, we will do it. We will get them in. If they are going to be seeing a different provider that same day, can we work with the appointments? We can move ours, you can move yours. We kind of figure out what is the least amount of effort.” – Wound clinic staff
Time	“I think that I’ve gained their trust over the years. They know I’m taking good care of their patients. So yeah, we do have a team.” – Wound care nurse “Having a lot of mutual patients together, over time, helps build trust, too.” – Vascular surgeon “I think [trust] just comes from time, repetition.” – Home health nurse

Figure 1. Conceptual model outlining the general process of how provider-to-provider trust is built, and quotations highlighting how this process differs based on proximity