Building Trusting Relationships with Investigators
Building relationships with key study staff are essential to the success of any clinical trial.
As CRAs, how often have you asked yourself the following questions:
How can I get access to my investigators and study nurses
more?
How can I get investigators less focused on price?
How can I get my investigators to follow the guidelines?
The answer to these questions is Trust.
Trust is about relationships. At the core of earning an investigator’s trust is convincing them that you are dealing with them as a human being, and not as a member of a group (not all investigators are the same). Accordingly, as you listen to the investigator talk ask yourself “What makes this person different from other investigators? What does this mean for how I should behave or what I should say?”
If you want to influence an investigator, you must find out what influences them. The best way to do this is to ask them lots of questions, and even more questions. When they say “I think this”, the appropriate response is not “Well, I think that”. Instead you need to find out why they think what they do. The more they say in response to your questions the better you will understand them.
These questions flow naturally if you have a genuine interest in the other person.
Winning trust requires that you are credible and reliable.
Having credibility is more than just having technical expertise. It is technical expertise plus ‘presence’ - which refers to how you look, act, react and talk about your technical expertise. It also depends on the experience of the person doing the perceiving. You must find ways not only to be credible, but also to give the investigator the sense that you are credible. You must illustrate, not assert.
Reliability is about whether investigators think you are dependable and can be trusted to behave in consistent ways.
Judgements on reliability are affected by the number of times an investigator has interacted with you - we trust people we know well. Reliability is the repeated experience of links between promises and actions and is judged with due dates and quality levels.
Business interactions with investigators can be intensely personal. There are human emotions around such charged issues as poor recruitment, investigator compensation and closing down trials.
Intimacy is needed to make a connection to the internal, emotional state of the investigator. This does not mean that private lives are necessarily shared, however it does mean that personal issues, related to the business at hand, get shared. It is possible to have an intimate relationship with an investigator and not to have anything to do with their life outside of work. Intimacy is about emotional closeness, a willingness to expand the bounds of acceptable topics, whilst respecting the boundaries and maintaining mutual respect. This is achieved by mutually increasing risk, with one party offering a piece of themselves and the other party either responding (thereby deepening intimacy) or not responding (thereby drawing an intimacy line). Appropriate behaviour requires knowing when to take a risk, and realising when a risk has been declined and knowing how to behave when this happens.
Investigators will not trust CRAs who appear to be more interested in themselves rather than in trying to be of service to either the investigator or the study staff.
Excessive self-orientation can be seen through such behaviours as: a tendency to give answers too quickly; a need to appear to be clever and witty; offering solutions to problems before fully hearing the investigator’s problems and not providing visual or verbal cues that indicate the investigator is being heard (ie passive listening). Earning trust is an activity that can be managed and improved, without trivialising or mechanising the investigator/CRA relationship.
Trusted CRAs have the following attributes:
1. They focus on the investigator rather than themselves. They have enough self-confidence to listen without prejudging; enough curiosity to inquire without supposing an answer; a willingness to see the investigator as a co-equal in a joint journey and enough ego-strength to subordinate their own ego.
2. They focus on the investigator as an individual, not a person fulfilling a role. They believe that a continued focus on problem definition and resolution is more important than technical mastery.
3. They are motivated more by an internalised drive to do the right thing rather than by their organisation’s rewards.
4. They believe that success in investigator relationships is tied to the accumulation of quality relationships. As a result they seek out, rather than avoid, investigator-contact experiences.