The vendor relationship starts before you sign.
Every vendor relationship either works by luck or by design. Luck happens sometimes, but you can't repeat it. Design is what you do before you sign the contract, and in every interaction with a vendor thereafter.
You've worked with marketing agencies. You've worked with virtual assistants. You've stood up a CRM. You've hired a direct mail vendor. You've signed a contract with a patient communication system. Some of those relationships went well. Some of them didn't.
The pattern across all of them: every vendor relationship either works by luck or by design. Luck happens sometimes, but you can't repeat it. Design is what you do before you sign the contract, and in every interaction with a vendor thereafter. The vendor relationships I've kept for years are the ones I designed at the start. The ones I parted ways with were the ones I picked too fast and let drift after.
The failures you see are not where the failure happened
The vendor relationship is an iceberg. The visible failures, the missed deliverables, the drift, the adversarial monthly reviews, are the tip above the water. The real mass sits below it, in the selection conversation you had before you signed and the onboarding you ran in the first weeks. Almost everything that breaks later could have been surfaced there. We just don't look there, because by the time the problem is visible, the problem feels like the vendor.
Most teams treat vendor selection as a research project. They get a recommendation from someone in their network, take the sales call, ask a few questions, sign. The thinking is that the real work begins after the contract is in place. That's backwards. Selection is the work. Everything that happens after the signature is execution of the choices you made before it.
This is the part most operators get wrong. They underweight selection because it feels like overhead. Three meetings to evaluate vendors feels slower than one meeting to pick the one your friend recommended. And it is slower, in that moment. But the cost of a bad selection is months of friction, a relationship that turns adversarial, and eventually a contract you have to exit. Compared to that, three meetings is nothing.
What a good selection actually involves
1. Get really clear about what you want
That means actual requirements. Not a multi-page document, but a written list of what has to be part of this and what doesn't. Without that list, you can't objectively score vendors against anything. Selection becomes a vibe check, and the vendor with the best sales rep wins.
2. At least three vendors evaluated against that list
You do want to compare price. You operate within a budget, and price tells you something. But the point isn't to pick the cheapest vendor. It's to understand the spread. My favorite vendor might be ten times the cost of the cheapest. The middle vendor often has most of what I want at a middle price. That comparison is the real decision, and you can't have it until you've evaluated three.
3. Incentives aligned wherever you can structure them
This doesn't always mean pay for performance, though sometimes it does. It means making sure the vendor's internal scorecard points the same direction yours does. If they win when you win, the relationship is collaborative. If they win when they hit their internal activity metric regardless of whether you do, you're already drifting.
4. Ongoing management against your core objective, not their activity KPIs
Clicks, leads, impressions, campaigns launched. Those are indicators, not the objective. Your objective is the thing that drives revenue, patient care, access, whatever the business actually needs to produce. The best vendors want to be held to that. They want skin in the game on the outcome, even when the outcome isn't fully within their control. They know your call center, your lead funnel, and your nurture sequences all play a role too. They want to be part of the team that moves the number, not just the function that delivered against a contract.
5. An onboarding that installs the agreement, not just the access
Most onboardings focus on logins, tools, and introductions. They skip the harder work of walking the vendor through the outcome, the weekly cadence, the metrics that will be reviewed, and what success looks like in their first thirty days. Onboarding is your last clean opportunity to make selection real. If you treat it like setup, the drift starts on day one.
Two scoreboards, one outcome
Here's where most relationships break, and it's worth saying clearly. For a vendor to be their best, they have to be supporting you. They can't support you if you haven't told them what you need. So if you haven't named the objective in plain terms, they will default to their own scorecard. Theirs is leads delivered, impressions served, campaigns launched. Yours is patients in the chair. They show up to the monthly review proud of the leads. You show up frustrated that the schedule isn't full. Both of you are right, from where you're standing.
You and the vendor will always be looking at two different balls. Your job at selection is to pick one who can see yours. Your job after selection is to keep reminding them which one matters.
When you select well, the management part gets simpler. Whoever owns the relationship on your team translates your outcome into the vendor's deliverables every week. The moment the conversation drifts toward their scorecard, you reset. The right vendor welcomes the reset, because they want to win against the right scoreboard. If they fight the reset, you have a different problem than the one you thought you had, and the contract gives you a way out.
Most of the vendor problems I see aren't really vendor problems. They're expectation problems. The expectation wasn't named clearly enough at the start. The vendor you picked didn't really want to partner against the objective the way they said they would. The expectation slipped quietly over time and nobody reset it. By the time the friction shows up, the original conversation about what success looked like is two years gone and nobody can remember what was actually promised.
Set the expectation clearly. Find the vendor who wants to partner with you on it. Reset it whenever it slips. Get those three right and the rest is execution.
Where I come in
If you're about to sign a vendor contract and want a second set of eyes on the selection, that's work I do. Start the conversation, or read more about how engagements are structured.