CCPP Module 8, Section 2: Building Trust and Communication Pathways
MODULE 8: INTEGRATION WITHIN THE HEALTHCARE TEAM

Section 8.2: Building Trust and Communication Pathways

An actionable guide to establishing credibility and opening effective lines of communication. We will cover proven techniques for making clinical recommendations, “managing up,” and becoming the go-to medication expert for your team.

SECTION 8.2

Building Trust and Communication Pathways

From a Voice on the Phone to the Most Valuable Player on Rounds.

8.2.1 The “Why”: Trust is the Currency of Clinical Influence

In the previous section, we deconstructed the roles and priorities of your new clinical colleagues. Now, we address the invisible, yet all-powerful, force that governs every interaction you will have: trust. In the hospital, trust is not a soft skill; it is the fundamental currency of clinical influence. Without it, your knowledge is academic, your recommendations are ignorable, and your potential to impact patient care is severely limited. With it, you become an essential consultant whose opinion is actively sought and highly valued.

You must accept a difficult truth: the automatic trust and authority you commanded in your community pharmacy do not transfer. In that setting, your white coat and the title “Pharmacist” were enough to establish your credibility with patients. In the hospital, you are entering an established ecosystem of experts who have already formed their own hierarchies and trust networks. You are, in effect, starting from zero. You are not just a pharmacist; you are ‘the new pharmacist,’ and you must earn your place at the table one interaction at a time.

Every action you take—every phone call, every recommendation, every time you solve a problem or fail to solve one—is either a deposit into or a withdrawal from your trust account with each member of the team. A physician who trusts you will approve your recommendations without hesitation. A nurse who trusts you will call you with a concern before it becomes a crisis. A care manager who trusts you will see you as a partner in preventing discharge delays. This section is your practical, step-by-step guide to making those deposits. We will move from theory to action, providing you with the specific techniques, scripts, and strategies to accelerate the trust-building process and establish yourself as an indispensable medication expert.

Pharmacist Analogy: Opening a New Pharmacy in a Small Town

Imagine you are a highly experienced pharmacist who has just bought the only pharmacy in a small, tight-knit town where the previous owner, “Old Man Fitzwilliam,” had run the store for 50 years. Everyone knew him, loved him, and trusted him implicitly. He knew every family, every allergy, and every financial hardship.

You walk in on your first day with your doctorate from a prestigious university and 15 years of experience. Does the town automatically trust you? No. They are skeptical. You are an outsider. Your knowledge and credentials are prerequisites, but they are not what will earn their loyalty.

  • When Mrs. Gable comes in, you don’t just hand her the blood pressure pills. You notice she seems unsteady, so you ask if she has a minute to talk. You discover she’s been getting dizzy. You check her profile, see she was recently started on another agent by a specialist, and identify a potential duplication. You call the doctor, clarify the regimen, and prevent a fall. You just made a trust deposit.
  • When the high school quarterback comes in with a prescription for opioids after a sports injury, you take the time to counsel him and his parents on the risks and proper disposal. You show genuine concern. Another trust deposit.
  • You learn that many seniors struggle to get to the pharmacy in winter, so you start a free delivery service. A huge trust deposit with the entire community.

Conversely, if on the first day you are dismissive, make a dispensing error, or can’t answer a simple question, you make a massive withdrawal that will be incredibly hard to recover from. Your clinical “skills” are irrelevant if the community doesn’t trust the person exercising them. The hospital is your new small town. The nurses, doctors, and other staff are the townspeople. You earn their trust not by announcing your expertise, but by demonstrating it through reliable, proactive, and helpful actions, day in and day out.

8.2.2 The First 90 Days: A Playbook for Establishing Credibility

The first three months in your new role are a critical probationary period, not with your employer, but with your clinical colleagues. During this time, they are forming their initial, and often lasting, impression of you. Your goal is to be seen as competent, reliable, and helpful. This is achieved through a series of deliberate, consistent actions.

Mastery 1: The Proactive Introduction

Do not be a faceless voice on the phone. The single most effective thing you can do in your first week is to leave the pharmacy and walk the floors of the units you cover. Your goal is to physically meet the key people you will be interacting with every day.

Your Introduction Script

Find the charge nurse or unit secretary. Wait for a moment when they are not overwhelmed. Keep it brief and respectful of their time.

To the Charge Nurse: “Hi, excuse me. My name is [Your Name], and I’m one of the new clinical pharmacists covering this unit. I just wanted to come up and introduce myself and put a face to the name. I know you all are incredibly busy, but please don’t hesitate to call me if you need anything at all. My extension is [Your Extension].”

To a Physician/Resident Team (if you see them at the workstation): “Excuse me, doctors. My name is [Your Name], I’m the new pharmacist for this floor. Just wanted to say a quick hello. Let me know if I can help with anything.”

This simple act does three powerful things: It shows initiative. It demonstrates you respect their environment enough to visit it. And it transforms you from an anonymous “pharmacy” caller into a human being and a colleague.

Mastery 2: Be Reliably Present and Visible

Out of sight is out of mind. If you only ever interact with the team from the central pharmacy, you will be perceived as an outsider—a logistical hurdle to be overcome. If you are physically present on the unit, you become an accessible, integrated resource.

  • Attend Rounds: Even if you just listen at first, being present for daily rounds is the single best way to understand the team’s thought process and anticipate medication needs. Your goal is to eventually contribute meaningfully, but in the beginning, your presence alone sends a powerful message.
  • Work from the Unit: If possible, find a computer in the nursing station or physician workroom to do your chart reviews for an hour or two each day. This makes you available for spontaneous questions and allows you to absorb the culture and rhythm of the unit.
  • Deliver Meds Personally: When a nurse is desperate for a critical missing medication, don’t just tube it. If you have a technician or volunteer who can watch the pharmacy, walking the medication up to the nurse yourself is an incredibly powerful trust-building gesture. It shows you understand their urgency and are willing to go the extra mile.

Mastery 3: Solve Small Problems, Fast

Grand, life-saving clinical interventions are rare. The daily currency of trust is built on your ability to quickly and efficiently solve the dozens of small, frustrating medication-related problems that plague a nurse’s or physician’s day. Be the person who makes their life easier.

The “Small” Problem The Standard, Passive Response The Trust-Building, Proactive Solution
A nurse calls because a patient’s home medication isn’t on the admission orders. “The doctor didn’t order it. You’ll have to page them.” “I see that. Let me look into it for you. [You investigate, find the med on the clinic list]. I’ll page the resident with the information and suggest they add it. I’ll let you know when the order is in.”
An intern orders an expensive, non-formulary antibiotic. Reject the order with a note: “Non-formulary, use cefepime.” Call the intern directly: “Hi, Dr. Smith, this is the pharmacist. I saw your order for Brand-X-amycin. Our hospital formulary alternative for that indication is cefepime. It has a similar spectrum of coverage and is readily available. Would you be okay if I switched it for you?”
A patient’s IV Tylenol order expires at midnight. Let it expire. Wait for the nurse or patient to complain about pain in the morning. In the afternoon, you message the provider: “FYI, Mrs. Jones’s IV acetaminophen order expires tonight. She has been using it consistently. Do you want to renew it, or would you like to switch to an oral option?”

8.2.3 The Anatomy of an Effective Clinical Recommendation

Once you have begun to establish a baseline of trust, the next step is to master the art of the clinical recommendation. How you present your expertise is as important as the expertise itself. A poorly delivered recommendation, even if clinically correct, will be ignored. An effective recommendation is a mini-consultation that is respectful, data-driven, and collaborative.

The Cardinal Sin: “You’re Wrong.”

Never, ever begin a conversation with a physician or APP by stating or implying that they made a mistake. Phrases like “That’s the wrong dose,” “You can’t use that drug,” or “Why did you order this?” are confrontational and immediately put the other person on the defensive. Your job is not to point out errors; it is to provide new information that leads to a better decision. Always frame your intervention as a collaborative effort based on changing patient data or a shared goal of safety.

Masterclass Table: Transforming Ineffective Communication into Effective Recommendations

Clinical Scenario Ineffective (Confrontational) Approach Effective (Collaborative) Approach
Renal Dosing
A resident orders vancomycin 1g IV q12h for a 75-year-old patient with a CrCl of 30 mL/min.		 “You ordered the wrong dose of vancomycin. It needs to be renally adjusted.” “Hi Dr. Davis, this is the pharmacist calling about the vancomycin for Mr. Peters. I calculated his creatinine clearance at 30 mL/min. For that level of renal function, a dose of 1g every 24 hours is recommended to avoid toxicity. Would you like me to adjust the frequency for you?”
Why it works: You lead with objective data (the CrCl), state the guideline, and offer to help.
Therapeutic Interchange
An NP orders rosuvastatin for a patient, but the hospital formulary is exclusively atorvastatin.		 “Rosuvastatin is non-formulary. You have to use atorvastatin.” “Hi, this is the pharmacist. I see the order for rosuvastatin. Just wanted to let you know our hospital formulary uses atorvastatin. The equipotent dose would be 40 mg of atorvastatin. I’m happy to make that switch if you’re comfortable with it.”
Why it works: You explain the situation, do the conversion work for them, and present it as a simple, helpful substitution.
IV to PO Conversion
A patient is eating well and their infection is improving, but they are still on IV levofloxacin.		 “This patient needs to be switched to PO.” “Hi Dr. Chen, it’s the pharmacist. I was reviewing Mrs. Garcia’s chart. I noticed she’s eating well and her white count is trending down. Since levofloxacin has excellent oral bioavailability, she seems like a great candidate to switch to the PO formulation. This would help us get her IV line out sooner. What do you think?”
Why it works: You provide the clinical rationale (eating, labs), state the pharmacologic principle (bioavailability), and frame it around a shared clinical benefit (removing the IV).
Questioning an Order
You see an order for allopurinol on a patient admitted for acute gout, which is contraindicated.		 “Why was allopurinol ordered for an acute gout flare?” “Hi Dr. Rodriguez, it’s the pharmacist calling about Mr. Kim. I saw the new allopurinol order. My understanding is that starting a urate-lowering agent during an acute flare can sometimes worsen the inflammation. The typical approach is to treat the acute flare first with colchicine or steroids, and then start the allopurinol in a few weeks. Can you help me understand the thought process for starting it now?”
Why it works: You frame your knowledge as “my understanding,” state the guideline gently, and ask a clarifying question instead of making an accusation. This opens a dialogue instead of starting a fight.

8.2.4 Closing the Loop: The Hallmark of a Reliable Colleague

Making a good recommendation is only half the battle. One of the most common frustrations among clinical team members is a lack of follow-up. A recommendation made without confirmation that it was received, implemented, and had the desired effect is a communication failure. Closing the loop is the final, critical step that cements your reputation as accountable and thorough.

The Communication Loop Playbook
  1. The Recommendation: You identify an issue and make a clear, collaborative recommendation via phone call, secure message, or in person.
    Example: “I recommend we switch to the PO levofloxacin.”
  2. Confirmation of Agreement: You get a verbal or written confirmation from the provider.
    Example: The resident replies, “Yes, that sounds great. Please change the order.”
  3. Action: You (or the provider) take the necessary action.
    Example: You discontinue the IV order and enter a new order for PO levofloxacin.
  4. Notification of Action (Optional but powerful): You inform the key stakeholder that the action is complete.
    Example: You message the nurse: “FYI – Mrs. Garcia’s levofloxacin has been switched to PO, so you can give the oral dose this evening.” This prevents the nurse from having to call and ask.
  5. Follow-Up on Outcome: The next day, you check to see if the action had the intended effect.
    Example: You check the chart. Mrs. Garcia tolerated the PO dose, her white count continues to trend down, and the nurse was able to have the patient’s IV discontinued. Success.

Consistently executing all five steps demonstrates an exceptional level of ownership and reliability. It tells your colleagues that when they entrust a problem to you, they can consider it solved. This is how you become the go-to expert.