Abstract
Introduction: Trust is vital for relationship building and the delivery of quality care. Trust has been described as ‘the glue that makes partnerships work’. ¹ But, developing trust takes time, and involves navigating different interests and priorities, imbalances in power, and vulnerabilities. ² Relationships are often developed under significant time and resource pressures inherent in implementation trials.
Intervention: The Rural Kids Guided Personalised Service (RuralKidsGPS) is a co-designed integrated model of care coordination implemented in four rural local health districts in New South Wales, Australia. ³ RuralKidsGPS aims to help families with children with medical complexity (CMC) to navigate healthcare by connecting local health services, coordinating care and care teams, and building families’ capacity for care navigation and self-management.
Aims: To explore the experiences of families and paediatric care coordinators (PCC) that enabled or hindered building trusting relationships and identify the trust-building practices and strategies employed by PCCs during the implementation of RuralKidsGPS.
Methods: A secondary thematic analysis was conducted on qualitative data gathered from semi-structured interviews with paediatric care coordinators (PCCs) and family members, during the implementation evaluation of RuralKidsGPS. Using an inductive analysis approach identified emergent themes that reflected factors influencing trust and trusting relationships between families and PCCs. The themes were then mapped to a novel author-developed theoretical framework comprising five core constructs of trust: Authenticity, Logic, Empathy, Vulnerability, and Reciprocity. ⁴ ⁵ ⁶
Results: Preliminary findings highlighted the significant role of trust in fostering relationships between PCCs and families during the implementation of RuralKidsGPS. Key enablers of trust included the PCC’s understanding of family circumstances, demonstrated competency to assist families, cooperative expectations, parental networks sharing service benefits, and empowering parental advocacy. Conversely, hindrances to trust involved inadequate communication and limited understanding of the PCC’s role scope, challenges related to PCC responsibilities and funding uncertainties, negative prior healthcare experiences, and the complexity of the health system.
Implications: This study underscores the critical importance of trust-building practices and strategies employed by PCCs in establishing effective relationships with families whilst implementing new models of care into practice. Trust was found to be fundamental to the successful adoption, implementation, and sustainability of RuralKidsGPS, significantly influencing family engagement with both the care coordination service and the wider healthcare system. The findings advocate for trust as a central element in promoting effective therapeutic relationships, championing change in service delivery and enhancing care integration within healthcare settings.
References:
1.Hunter et al 2012, https://pubmed.ncbi.nlm.nih.gov/22572716/
2.Poulsen et al 2021, https://ijic.org/articles/10.5334/ijic.5599
3.Lingam et al 2023, https://pubmed.ncbi.nlm.nih.gov/38020416/
4.The Center for Implementation, (2024). Cultiv8 tool [Web application]. https://thecenterforimplementation.com/cultiv8-tool
5.Brown, https://brenebrown.com/podcast/the-anatomy-of-trust/
6.Frei & Morriss, 2020, https://hbr.org/2020/05/begin-with-trust