CCPP Module 22, Section 4: Establishing Trust and Maintaining Partnerships
MODULE 22: PHYSICIAN RELATIONS AND NETWORKING

Section 4: Establishing Trust and Maintaining Partnerships

Trust isn’t built in a meeting; it’s earned through consistent excellence. This section covers the essential day-to-day behaviors—clear communication, reliability, and a collaborative spirit—that transform a skeptic into a champion.

SECTION 22.4

Establishing Trust and Maintaining Partnerships

From a Signed Contract to an Indispensable Colleague: The Daily Practice of Building Clinical Trust.

22.4.1 The “Why”: Trust as the Ultimate Therapeutic Alliance

You have successfully navigated the presentations, the objections, and the negotiations. A contract is signed. This is a moment of immense accomplishment, but it is not the destination. It is the starting line. The proposal and the meetings earned you a chance; it is your performance from this day forward that will earn you trust. Trust, in the context of a clinical partnership, is not a vague “soft skill.” It is the most valuable asset you will ever build. It is the active ingredient that transforms a transactional, fee-for-service arrangement into a deeply integrated, synergistic collaboration.

In your dispensing career, you understand the concept of a therapeutic alliance with a patient. It’s the bond that allows a hesitant patient to accept your counsel on a new medication or adhere to a complex regimen. The alliance you must now build with your physician partners is functionally identical. It is a professional therapeutic alliance, and its “pharmacology” is comprised of three key compounds: unimpeachable reliability, proactive communication, and demonstrated shared ownership. When you consistently deliver these “therapies,” you fundamentally alter your role. You cease to be the “pharmacist we hired” and become “our pharmacist,” an essential and indivisible part of the care team.

This section will provide a granular, operational deep dive into the daily, weekly, and quarterly behaviors that constitute the science and art of trust-building. We will move beyond theory into the practical, systematic actions that demonstrate your value and solidify your position. Forgetting this crucial phase is the most common reason new collaborative practices fail. Many pharmacists believe the hard work is over once the contract is signed. The truth is, it has just begun. The goal is not merely to keep the contract, but to make your services so valuable, so integrated, and so impactful that the practice cannot imagine going back to the way things were before you arrived.

Pharmacist Analogy: The Sterile Compounding Pharmacist

Imagine you are the supervising pharmacist for a hospital’s sterile compounding pharmacy, responsible for preparing complex IV chemotherapy and TPN orders. A new, brilliant oncologist, Dr. Evans, joins the staff. She has heard you’re good, but she doesn’t know you. Her trust is not a given; it must be earned with every single order.

How do you earn her absolute, unwavering trust?

  • Day 1: Flawless Execution. Her first chemotherapy order arrives. It’s complex. You and your team prepare it with meticulous, documented precision. It arrives on the oncology floor exactly when it was promised, perfectly compounded and labeled. This is reliability.
  • Week 1: Proactive Clarification. She writes an order for a non-standard electrolyte concentration in a TPN. Instead of just rejecting it, you call her directly. “Dr. Evans, this is the pharmacy. I see the potassium order. I just wanted to confirm this concentration, as it’s outside our standard stability data. We can make it, but the bag will only be stable for 12 hours. Would you prefer we use a more standard concentration, or is this intended for an acute, short-term bolus?” This is proactive communication and clinical collaboration. You didn’t just point out a problem; you understood her intent and offered a collaborative solution.
  • Month 1: Systemic Improvement. You notice that several of her complex orders require multiple manual calculations that increase the risk of error. You take the initiative to build a pre-approved order set or a calculator into the EHR. You present it to her: “Dr. Evans, to make ordering this regimen safer and faster, I’ve built a draft order set based on your common protocols. Would you be willing to review it with me?” This is demonstrated shared ownership. You didn’t just do your job; you improved the entire system for her and her patients.

By the end of three months, Dr. Evans doesn’t just send you orders; she calls you before she even writes them. “I have a patient with renal failure who needs chemo. What’s the best way to dose this for them?” You have transformed the relationship from a service provider into an indispensable clinical consultant. The daily, consistent application of reliability, communication, and ownership is the precise formula you will use to build that same level of trust with your new practice partners.

22.4.2 The Four Pillars of Professional Trust: A Deep Dive into Daily Practice

Trust is not a singular concept. It is a multidimensional structure built upon four distinct but interconnected pillars. A weakness in any one of these pillars can compromise the entire structure. Mastering the daily behaviors associated with each is the core work of maintaining and growing your partnership.

Pillar 1: Unimpeachable Reliability (The Foundation)

Reliability is the bedrock of trust. It is the simple, non-negotiable act of doing what you say you will do, every single time. In a chaotic clinical environment, being the person who is utterly dependable is a superpower. This is the easiest pillar to understand, but it requires relentless discipline to maintain. For a physician, reliability means you are a source of certainty in an uncertain world.

The Principle of the “Closed Loop”

This is the most important operational principle for demonstrating reliability. Every task, referral, or question sent to you is an “open loop” in the mind of the provider. It’s a task they’ve delegated but still feel a sense of responsibility for. Your job is to “close the loop” as quickly and clearly as possible, removing that cognitive burden from them. A provider should never have to wonder, “What ever happened with that patient I sent to the pharmacist?”

Masterclass Playbook: “Closing the Loop” Communication

Effective loop-closing communication is immediate, concise, and confirms both the action and the outcome. It should happen in the provider’s preferred communication channel (e.g., a specific EHR message folder).

Scenario “Open Loop” (The Provider’s Action) Poor Communication (Leaves Loop Open) “Closed Loop” Communication (Builds Trust)
Patient Referral for CMM Dr. Smith sends an EHR message: “Please see Mrs. Jones for med rec and diabetes management.” You complete the visit and write a long, detailed note in the patient’s chart. You don’t message the doctor. You message Dr. Smith back: “Loop Closed on Mrs. Jones. CMM complete. Full note is in the chart. Key recommendation: Discontinue glipizide, initiate Jardiance for CV/renal benefit. Draft prescription is ready for your signature. No other urgent issues.”
Question About Dosing Dr. Allen asks you in the hallway, “Hey, what’s the right dose of apixaban for an 88-year-old with a creatinine of 1.6?” You say, “It’s 2.5 BID,” and walk away. You answer in the hallway, then immediately follow up with a secure chat: “Dr. Allen, just to confirm our conversation, for your 88 y/o patient with Cr 1.6 mg/dL (assuming weight >60kg), the correct dose of apixaban is indeed 2.5 mg BID per the Beers criteria and FDA label. This closes that loop.”
Task to Handle a PA A nurse flags you: “Dr. Chen needs you to handle the prior auth for Ozempic for Mr. Wu.” You complete the PA. It gets approved. You do nothing further. You send an EHR message to Dr. Chen and the nursing pool: “PA update for Mr. Wu’s Ozempic: The PA was submitted and approved this afternoon. The prescription has been sent to the pharmacy. This task is complete.”

Pillar 2: Proactive, Concise Communication (The Currency of Collaboration)

If reliability is the foundation, communication is the framework you build upon it. In today’s healthcare system, the scarcest resource is a provider’s attention. They are inundated with alerts, messages, labs, and administrative tasks. Your communication must be a welcome signal, not more noise. To be valued, your communication must be proactive, concise, and clinically relevant.

The SBAR Supremacy and the “Headline” Method

You learned about SBAR (Situation-Background-Assessment-Recommendation) for urgent recommendations. For non-urgent daily communication, a simplified version called the “Headline and Details” method is invaluable. It respects the provider’s time by giving them the most important information first.

The Curse of the Unread Note: A Tale of Two Communications

A physician has 30 seconds between patients to check their inbox. Which of these two messages about the same encounter will actually be read and acted upon?

Version A: The “Brain Dump” (Ineffective)

“Hi Dr. Smith, I met with Jane Doe today for her follow-up visit. We discussed her medications. She is still checking her blood sugar twice a day and her log shows readings mostly in the 160-180 range. She is taking her metformin 1000 mg BID but admits to sometimes forgetting her glipizide 10 mg BID. She reports no symptoms of hypoglycemia. Her blood pressure in the office today was 138/88. We discussed diet and exercise. Her last labs from a month ago showed an A1c of 8.4% and an eGFR of 55. Based on the new guidelines for diabetes and CKD, it would be a good idea to think about other agents that might be better for her kidneys and heart. I think an SGLT2 inhibitor could be a good choice for her given her history…”

Version B: The “Headline & Details” (Effective)

“Headline: Recommend D/C Glipizide, start Jardiance for Jane Doe (uncontrolled T2DM, CKD3).”

Dr. Smith,

Met with Jane Doe today. Key points:

  • Assessment: Uncontrolled T2DM (A1c 8.4%) on suboptimal therapy, especially given her CKD3 (eGFR 55). High risk for hypoglycemia with glipizide.
  • Plan: Discontinue glipizide. Recommend starting Jardiance 10 mg daily for proven CV/renal benefits and improved glycemic control.
  • Patient is educated and agreeable. A draft prescription for Jardiance is in your inbox for signature.

Full CMM note is in the chart. Let me know if you have any questions.

Version B is not just shorter; it’s a completely different class of professional communication. It leads with the answer, uses formatting to be easily scannable, and provides a clear, actionable next step. This is how you build trust.

Pillar 3: Demonstrating Shared Ownership (The Partnership Mindset)

This is the most advanced pillar and the one that truly separates a good contractor from a great partner. Shared ownership means you care about the success of the practice as a whole, not just the tasks on your to-do list. It’s about thinking like a practice owner and proactively identifying opportunities and threats that fall outside your direct job description. This demonstrates that you are truly invested in their success.

Level of Engagement Pharmacist’s Mindset & Actions Impact on Trust
Level 1: The Contractor “My job is to complete the CMM visits I’m assigned.” You do excellent clinical work on your referred patients and document it well. Builds trust in your clinical competence, but the relationship remains transactional.
Level 2: The Team Member “My job is to make my service line successful.” You not only see patients, but you help the MAs refine the referral workflow and create patient education handouts. Builds trust in your work ethic and collaborative spirit. You are seen as part of the team.
Level 3: The Partner “Our job is to ensure this practice thrives.” You see that a new VBC program is launching in your state. You research it, realize the practice is eligible, and bring a one-page summary to the practice manager outlining the opportunity and how your services can help meet the program’s goals. Builds deep, strategic trust. You are no longer just a clinical expert; you are a business ally who is actively looking out for the practice’s future. This is the goal.

Pillar 4: Grace Under Pressure (The Mark of a True Professional)

In the dynamic environment of patient care, conflicts and errors are inevitable. A patient will have an adverse event. A provider will disagree with your recommendation. You, being human, will make a mistake. These moments of adversity are, paradoxically, your greatest opportunities to build profound trust. How you conduct yourself when things are not going perfectly is the ultimate test of your character and professionalism.

Playbook: Navigating Clinical Disagreement

A physician challenges your recommendation. Your clinical ego is bruised. This is a defining moment.

  • Step 1: Regulate Your Emotion. Do not get defensive. Your heart rate may increase. Take a breath. This is not a personal attack; it is a clinical debate.
  • Step 2: Seek to Understand. Start with a question, not a rebuttal. “That’s a fair point, Dr. Jones. Can you walk me through your concern about starting an SGLT2i on this patient?” This shows respect for their opinion and invites dialogue.
  • Step 3: Anchor on Evidence & Shared Goals. Frame the conversation around the data and the patient. “I hear your concern about the risk of GU infections. My thinking was based on the EMPA-REG OUTCOME trial, which showed such a strong mortality benefit. Our shared goal is to protect Mrs. Davis from another MI. Perhaps we can start the SGLT2i and I can proactively follow up with her in one week to screen for any potential side effects?”
  • Step 4: Know When to Concede Gracefully. The physician is the ultimate decision-maker. If they are not comfortable, you must respect their judgment. “I understand and respect your decision. Thank you for discussing it with me. Let’s stick with the current plan and continue to monitor her closely.” You have not “lost”; you have reinforced your role as a thoughtful, evidence-based collaborator who respects the team hierarchy. This builds immense trust.

22.4.3 Systematizing Trust: Your Relationship Management Protocol

Exceptional partnerships are not built on random acts of excellence; they are built on a systematic, deliberate protocol for communication and value demonstration. You must create a formal Relationship Management Protocol that ensures all stakeholders are getting the right information, in the right format, at the right frequency. This prevents trust from eroding due to simple communication breakdowns.

The Stakeholder Communication Matrix

This is your internal guide to ensure your communication is targeted and effective. You must communicate differently with different members of the care team, as their needs and priorities vary.

Stakeholder Primary Need Optimal Channel Optimal Frequency Content Focus
Physician Champion Clinical details, trust in your judgment. Secure Chat / EHR Message Daily / As Needed “Closed Loop” updates on mutual patients, quick clinical questions.
Other Physicians Concise, actionable recommendations. Formal EHR Note (Headline Method) Per Encounter Clear, evidence-based recommendations with a draft order ready for signature.
Practice Manager Metrics, ROI, efficiency. Email + PDF Dashboard Bi-Weekly / Monthly KPIs: # patients seen, CCM minutes logged, quality score progress, revenue generated.
Nurses / MAs Workflow clarity, scheduling, patient logistics. In-Person / Morning Huddle Daily “Here are the 3 patients on my schedule today. Mrs. Smith will need a follow-up BP check from you after her visit with me.”

The Quarterly Business Review (QBR): The Formal Trust-Building Event

The QBR is a non-negotiable, formal 30-minute meeting you schedule every 90 days with the practice leadership (physician champion and practice manager). This is your opportunity to step back from the day-to-day and present a high-level, data-driven account of your value. It demonstrates your commitment to accountability and reinforces that this is a professional partnership with measurable goals.

Masterclass Playbook: The Perfect QBR Agenda

Your QBR should have a standard, 4-part agenda. You come prepared with a 2-3 page report that you walk them through.

  1. (10 mins) Performance Against Goals: “In our proposal, we set a goal to improve the A1c control rate. As you can see from this chart, in the last 90 days, we’ve enrolled 45 patients in our program, and of the 20 who have had a follow-up A1c, their average has dropped from 9.3% to 8.1%. We are on track to meet our 12-month goal.”
  2. (5 mins) Financial & Operational Impact: “From an operational standpoint, we have successfully logged 950 minutes of CCM time, resulting in $X of new revenue. Anecdotally, Dr. Smith has reported spending approximately 2 fewer hours per week on medication-related messages.”
  3. (10 mins) “Big Win” Case Study & Challenges: “I want to highlight the case of Mr. Doe, who avoided a likely hospital readmission thanks to our transitions of care intervention. One challenge we’ve identified is the workflow for identifying recently discharged patients; I have a proposal for how we can work with the front desk to improve this.”
  4. (5 mins) Goal Setting for Next Quarter: “Based on this progress, my primary goal for the next 90 days is to expand the program to include patients with high-risk heart failure, in alignment with our goal to reduce readmissions. Are you in agreement with this focus?”