Pharmacy Management: Optimizing the Use of Technicians and Technology

1. Pharmacy Management: Optimizing the Use of Technicians and Technology John Pedey-Braswell CPhT Pharmacy 334 1 March 2004

2. Objectives: • Recognize that regardless of job title, all pharmacists are managers. • Recognize that SOP Curricula should assure some level of managerial proficiency in graduates. • Identify health system factors impeding pharmaceutical care. • Identify areas to access managerial education for pharmacists. • Describe traits of a successful supervisor. • Discuss reasons for problematic employee behavior.

3. About Myself • Pharmacy Technician 1993-2001; 2 years as a lead. • Supervisory Skills Certificate from UW Training and Development. • Editor of Medical Records for Large Home Health Pharmacy. • Experience Outside Pharmacy Managing Projects, Staff, Inventory, and Money. • Developed Technician Job Description and Participated in Technician Hiring for Refill Authorization Center. • Research with Dr. Hammer in Management, Education, and Pharmacist-Technician Relations. • Career Objective: Education and Improving Access to Health Care.

4. Management is….. • Getting things done (through people). • The successful utilization of the 3 Ms: Materials, Money, and Manpower (Person power). • Using “buzz words” and industry lexicon to explain common sense ideas. • Different than leadership. How?

5. Why Should I Learn About Management ? • American Council on Pharmaceutical Education (ACPE) proscribes professional competencies that should be achieved through the College or School of Pharmacy’s curriculum. Graduates should have the ability to: • 10b) manage systems for storage, preparation, and dispensing of medicines, and supervise technical personnel who may be involved in such processes; • 10c) manage and administer a pharmacy and pharmacy practice; • Outcome expectations for student performance in the professional competencies stated above should be set forth and measured by the College or School. • Standard 11 delineates that the curricular core shall contain social and administrative pharmacy sciences including practice management.

6. Why Should I Learn About Management (2) ? • American Association of Colleges of Pharmacy (AACP) Center for the Advancement of of Pharmaceutical Education (CAPE) Advisory Panel revised Educational Outcomes 1998. • Outcome 2) Manage the Practice. 2a) Manage Pharmacy Operations. 2c) Manage Human Resources. • “Apply principles of personnel management to recruit, hire, train, develop, supervise, motivate, retain, and evaluate support staff.”

7. Why Should I Learn About Management (3) ? • Approximately 80% of graduates will work in community pharmacies, often in an environment where they are the only pharmacist on duty. • Between 60 - 75% of graduates will have managerial duties within 2 years of graduation.

8. Pharmaceutical Care Pharmaceutical care is the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life. These outcomes are: 1. Cure of Disease, 2. Elimination or Reduction of a Patient’s Symptomatology, 3. Arresting of Slowing a Disease Process, or 4. Preventing a Disease or Symptomatology.

9. Pharmaceutical Care (2) Pharmaceutical Care involves the process of through which a pharmacist cooperates with a patient and other professionals in designing, implementing, and monitoring a therapeutic plan that will produce specific therapeutic outcomes for the patient. This in turn involves three major functions: 1. Identifying Potential and Actual Drug-Related Problems, and 2. Resolving Actual Drug-Related Problems, and 3. Preventing Potential Drug-Related Problems.

10. Pharmaceutical Care (3) Pharmaceutical care is a necessary element of health care, and should be integrated with other elements. Pharmaceutical care is, however, provided for the direct benefit of the patient, and the pharmacist is responsible directly to the patient for the quality of that care. The fundamental relationship in pharmaceutical care is a mutually beneficial exchange in which the patient grants authority to the provider and the provider gives competence and commitment (accepts responsibility) to the patient. The fundamental goals, processes, and relationships of pharmaceutical care exist regardless of practice setting. Hepler and Strand. AJHP March 1990.

11. Obstacles to Pharmaceutical Care • National Association of Chain Drug Stores (NACDS) predicts that approximately 4 billion prescriptions will be filled in the United States in 2004, up from the 3 billion filled in 1999 – a 33% increase. • The number of practicing retail pharmacists is expected to increase from 119,000 to 127,000 – only a 6% increase. • 1999 NACDS activity cost and productivity study (data tabulated by Arthur Andersen LLP). • Pharmacists spend 2/3 of their time on non-clinical and nonjudgmental activities. They only spend 31% of their time on more substantive activities, e.g. reviewing and interpreting prescriptions, contacting doctors about approvals or clarification, and counseling patients. Source: Drug Topics 1/3/2000

12. Linwood F.Tice, Dean, Philadelphia College of Pharmacy and Science (1966) “The counting and pouring now often alleged to be the pharmacist’s chief occupation will in time be done by technicians and eventually by automation. The pharmacist of tomorrow will function by reason of what he knows, increasing the efficiency and safety of drug therapy and working as a specialist in his own right. It is in this direction that pharmaceutical education must evolve without delay.” Quoted in ASHP/APhA White Paper on Pharmacy Technicians

13. How Do I Obtain Managerial Skills? • In pharmacy, many of us learn on the job and/or through mentors • BA 472 Offered Tuesdays or Thursdays Spring Quarter • Training and Development classes offered through University of Washington • Continuing Education programs • Pharmacy practice residencies have administrative component; content and quality vary • ASHP administrative residencies • Additional degree programs, e.g. BS/BA in Human Resources Mgmt, MHA, MBA, MPH, MS Pharmacy Admin, PhD

14. What Are the Traits of a Good Supervisor? • Please take a few minutes to discuss this with the person next to you. • What are the characteristics that make your favorite employer great? • What has made an employer miserable to work for?

15. Qualities of an Effective Leader • Motivate employees to accomplish great things. • Set positive example for other employees. • Encourage teamwork and participation. • Direct, sincere, and honest. • Good communicators. • Make sure that employees know what is expected of them. • Are proactive in planning, setting priorities, and making decisions. • Skilled in the art of shaping behavior through positive reinforcement. • Delegate work when they need to. • Well organized. • Welcome change – they are flexible with new ideas and new people. • Finish what they start. • Involve employees in problem recognition and problem solving. • Source: Effective Pharmacy Management.

16. ASHP’s Five Characteristics of Successful Hospital Pharmacy Administrators • They are open with people. They are comfortable sharing their thinking and feelings with workers, and they encourage their employees to do likewise. • They use a team approach to management. They believe that better decisions result from group discussion than from individual thinking. • They give people important work to do. They give their assistants substantial responsibility for ongoing operations and future planning. • They avoid crisis through good planning. In a crisis, even the best managers tend to retreat to a more autocratic style, often to the detriment of morale in the department. • They do not suffer from the curse of self-perfectionism. All bosses will make mistakes in dealing with people.

17. The Wisdom of Bear Bryant “I’m just a plow hand from Arkansas, but I have learned how to hold a team together; how to lift some men up; how to calm down others; until finally they’ve got one heartbeat together – a team. There’s just three things I’d ever say: • If anything goes bad, I did it. • If anything goes semi-good, then we did it. • If anything goes real good, then you did it. That’s all it takes to get people to win football games for you.”

18. 6 Common Causes of Employee Dissatisfaction • Inefficient Administration. People want administration that is efficient and just. Do not keep people waiting – it is a sign of disrespect. • Incompetent Supervision. Supervisors must know the details of the work they are supervising. • Poor Interpersonal Relations. Consult coworkers for advise on issues, and do NOT play favorites. • Personal Qualities of the Leader. Integrity, fairness, and competence are all valued in a leader. • Inadequate Pay. Be fair in regards to market conditions. Realize that increases in salary often result in increased productivity and quality of work, but only for a short time. • Poor Working Conditions. Provide a physically, and psychologically comfortable environment for employees to work. Source: Effective Pharmacy Management.

19. What Causes Employees to Misbehave? • It is not clear to the employee what behavior is expected • The consequences of compliance and noncompliance haven’t been made clear • The consequences are exaggerated and not believable • The consequences seem inconsequential • The employee isn’t capable of performing the task as required • There are work obstacles beyond the employee’s control • The employee is undergoing temporary stress or frustration due to circumstances beyond his or her control. Source: Ken Matejka, Why This Horse Won’t Drink

20. Motivation According to Maslow Motivation: Inner impulse that induces a person to act in a certain way. A series of internal drives within a person at different levels: • Level One. Obtain the necessities for life itself – food, shelter, clothing, rest, and safety. • Level Two. Satisfy social needs such as companionship, love, and a position of respect. • Level Three. Develop a measure of personal satisfaction. People need to feel comfortable with themselves and with what they make of their lives, their talents, and abilities. • Needs at lower levels must be met before higher needs can be addressed.

21. How to Successfully Work with Ancillary Staff • Unless you own the pharmacy, never refer to another human being as “my” technician, cashier, custodian, etc. • Never confuse education with intelligence. • Have a basic understanding of the job expectations for each technician assignment in the pharmacy. • Help others when done with work assignments – this includes helping the technicians. • Treat everyone with common the common courtesy that you expect to be treated with – never treat technicians in a condescending or demeaning manner. • Make sure that technicians feel a part of patient care team – provide them patient contact, encourage them to look for medical errors, and foster an environment where their input is welcome. Source: AJHP 7/92, and numerous conversations with technicians.

22. A Pharmacist Shall Not Delegate the Following Professional Responsibilities (WAC 246-863-095): • Receipt of a verbal prescription other than refill authorization from a prescriber. • Consultation with the patient regarding the prescription, both prior to and after the prescription filling and/or regarding any information contained in a patient medication record system provided that this shall not preclude a pharmacy assistant from providing to the patient or the patient’s health care giver certain information where no professional judgment is required such as dates of refills or prescription price information. • Consultation with the prescriber regarding the patient and the patient’s prescription. • Extemporaneous compounding of the prescription provided that bulk compounding from a formula and IV admixture products prepared in accordance with WAC 246-871 may be performed by a level A pharmacy assistant when supervised by a pharmacist.

23. A Pharmacist Shall Not Delegate the Following Professional Responsibilities (WAC 246-863-095): • Interpretation of data in a patient medication record system. • Ultimate responsibility for all aspects of the completed prescription and assumption of responsibility for the filled prescription, such as: accuracy of drug, strength, labeling, proper container and other requirements. • Dispense prescriptions to a patient with proper patient information as required by WAC 246-869-220. • Professional communications with physicians, dentists, nurses, and other health care practitioners. • This does not preclude delegation to an intern or extern.

24. Functions of Pharmacy Technicians • Information Management • Medication Preparation • Medication Dispensing • Check the Work of Other Technicians • Medication Inventory Management • Training • Train Other Technicians and Interns • Orientation to Procedural Activities for New Pharmacists Source: ASHP Manual for Pharmacy Technicians 2nd Edition

25. ASHP Archives July 1987 “The status of technicians in pharmacy is influenced greatly by pharmacist attitudes and technician self-perceptions. These mindsets are difficult to change. Pharmacists need to be secure enough in their own work to encourage technicians to develop their skills and enhance their contribution to pharmaceutical services. More technicians need to view their jobs as career pursuits and make the necessary investment in developing their abilities in ways that yield satisfying and stimulating work.“ – R.W. Anderson

26. Rx Presentation Patient Brings Rx to Pharmacy or Calls with Refill Request Phone or Fax New Rx from Prescriber Verified Rx Entered Into Computer Prescriber’s Office Contacted for Refill Request Prescriber Contacted for Therapeutic Clarification Third Party Resolution Assessment of Therapy (Interactions, allergies, duplication) Rx Filled Pour, Count, Lick, and Stick Routine Compounding Rx Checked Patient Counseling Assess Adherence and Identify Barriers Assess level of disease knowledge Counsel to Overcome Barriers and Provide Education Verify Disease Severity and Document Outcomes Collect Payment for Prescription Typical Prescription Filling Process

27. Rx Presentation Patient Brings Rx to Pharmacy or Calls with Refill Request Phone or Fax New Rx from Prescriber Verified Rx Entered Into Computer Prescriber’s Office Contacted for Refill Request Prescriber Contacted for Therapeutic Clarification Third Party Resolution Assessment of Therapy (Interactions, allergies, duplication) Rx Filled Pour, Count, Lick, and Stick Routine Compounding Rx Checked Patient Counseling Assess Adherence and Identify Barriers Assess level of disease knowledge Counsel to Overcome Barriers and Provide Education Verify Disease Severity and Document Outcomes Collect Payment for Prescription Rose = Pharmacist Must Do Yellow = Technician Can Do Every Successful Team Recognizes and Utilizes Specialization and Division of Labor

28. In Conclusion • We have discussed: • What management is • Why it is important for pharmacists • Where to find additional training • Traits of effective leaders • Common causes of employee dissatisfaction/misbehavior • Importance of properly utilizing technicians and other ancillary staff • Questions??

29. THANK YOU • John Pedey-Braswell, tafkab@u.washington.edu