Monthly Archives: February 2015

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Dispensing Pride

The terms ‘pharmacy’ and ‘dispensing’ go hand-in-hand. Prescribers diagnose disease and approve treatment. We fill the treatment orders and dispense the therapy, along with any important educational points, to patients and their families. This has been our role for generations. We are known as some of the most trusted and most accessible health professionals in the world.

I admit to being a proud dispenser, but my priorities are beginning to shift. Medication has always held a fascination for me: the clever brand names (remember Desyrel? I still have ‘DEpressive SYmptom RELief’ bouncing in my skull somewhere), the odd shapes of certain tablets and the splashy marketing campaigns. Sometimes missing however, was the proper transfer of information to others. My counseling skills took time to develop, and early on I felt robotic and scripted when interacting with patients.

As a student, I recall basic functions such as writing up manual credits to Blue Cross or the now defunct Maritime Medical. We made funky compounds with Anthralin powder that stained everything a heinous shade of yellow ochre that would make Bob Ross proud. We were the gatekeepers of all things pharmaceutical and sometimes a cursory counseling session was all that a patient received. Sure, in classes and labs we were coached on communication styles and higher standards but the reality was a bit disheartening; dispensing was the main focus and any clinical intervention seemed like an exciting ‘Eureka’ moment for the team to share instead of the norm.

Doing pharmacy relief immediately after graduation had it’s advantages and disadvantages. Although leaving work at work when a shift was over was nice, ensuring patient follow-up and continuity of care was extremely inconsistent from one site to the next. Every interaction was a point-in-time and documentation was rather erratic from one pharmacist to the next. We were however excellent at monitoring days supply of benzos and narcs. I may not have had the relevant history or familiarity with the tools to best determine your pain control but I could certainly attest that those sixty OxyContin 40mg were triple-counted by three different people.

My, how times have changed…

So, there is less of a focus on pack sizes and pricing (still important, but more of a management focus as opposed to pharmacist); better prescription software has lessened the need to manually update every drug file or pricing strategy. Now it’s more empowering to take a deeper look at interactions and latest research guidelines. The volume of calls to the third-party plan to correct date of birth issues are tasks that now may be delegated. We are becoming more intimately involved with special authorization criteria and therapeutic substitutions. Cognitively, we have more opportunity to apply ourselves; with prescribing rights, we can now identify certain DRPs and be able to solve them for a patient. Things like INR and renal adjustments may now feature a pharmacist’s name on the order as we get other health professionals to recognize our new-found decision-making abilities. In fact, just the other day, I was able to halve a sulfamethoxazole dose for an elderly resident with a compromised creatinine-clearance.

The paradigm shift started long before my degree, but the visionaries who foresaw such radical changes had their work cut out for them. The baby-boomers were heading into retirement, and the aging population needed more medications to combat heart disease, diabetes and high cholesterol. In lockstep with that, they were also going to need more clinical care, and more than what general practitioners would be able to handle, especially in rural areas. I look forward to plugging some gaps through medication reconciliation, minor ailment prescribing, and lab requisitions.

To sum up: I am proud of my dispensing hat, I am proud of my expanded clinical duties now, and trust that I will enjoy however the role evolves from here. I guess I’m just proud to be a pharmacist.

Disclaimer: The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of any agency, employer or affiliation.

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My Managing Theory – Qualities of a Good Manager

I’m always looking to push myself. In taking my new role, the reflection process has begun and lists are being made to prioritize the skills I need to leverage, and the ones I need to work on.

Management is a different animal, no matter what the setting. Be it a physician’s office or a warehouse, a restaurant or a bank branch, a manager is someone who manages resources to make an operation run. Many have arrived at that level as people who know the business intimately and show an aptitude for producing results. Others are brought in because of certain qualities that have been identified as lacking, even if their practical expertise is weak (i.e. a human resource background running an IT division, etc.)

I’ve been managing people for most of my pharmacy career, and it’s something I quite enjoy. I am far from perfect but have had mentors in the past who have given me tips on creating a positive culture in the pharmacy. Over time, I have distilled three main qualities that I feel make a well-rounded manager. They are in areas of administration, human resources and vision. In the past, I have used this thought process to help set goals for people in management positions. It can help to highlight their individual strengths and weaknesses by asking specific questions:

 

1) Administration – This is the detail-oriented piece. Are you able to be responsive via email or phone? Do you meet deadlines for audit responses and status updates? Are policy/procedure systems in place and followed?

Pharmacy examples: Timely responses for College audit action plans, preparation for quarterly/bi-annual inventory counts.

2) Human Resources – This theme centres around people management. For both paying customers and staff, how well are tense situations defused? How consistent is the communication (do all team members get the same message and training)? How consistent is the service provision (do all customers receive the same level of care)? For teams, are evaluations being done? Have goals been clearly set and carried through? Are individuals given opportunities to expand roles or prepare for possible promotions? Do people feel they’re treated fairly and maintain positive morale?

Pharmacy examples – Setting up regular conference calls or staff meetings to keep everyone informed and addressing issues as they arise, using job descriptions to determine if employees are challenged to their full potential.

3) Vision – This one is the toughest to quantify but is really about long-term planning. How do you see the team in 6 months to a year? What future events impact the operation and how will that impact be mitigated? Do employee goals reflect the expected needs for a given role should it evolve?

Pharmacy examples – Evaluating a site to implement expanded scope for pharmacists. This involves assessing readiness of the clinicians, identifying training opportunities, and determining appetite for new prescribing services among customers.

 

All managers possess a strength that fits well in one of these buckets. Usually when a person is described, phrases like 1) ‘They are always on the ball’, 2) ‘Their staff love her/him’ or 3) ‘He/She always has great ideas to improve things’ are used to generalize. Individuals with two strengths out of the three are harder to find. The qualities an individual possesses help to shape a professional development action plan. I’ve divided the three main combination types of managers into larger buckets that I’ll outline below:

Admin/HR – These folks have the day-to-day management down pat. Staff love them, patients love them. They are timely with communication and know their team and operations extremely well. Training is a priority, so day-to-day functioning is excellent. Employees developed in these environments are high-functioning and autonomic. In this case, suggested change can cause discomfort as it may upset the current dynamic but usually once given a plan of attack, the execution is excellent.

Admin/Vision – Managers with this strength combo are analytic and methodical. They have excellent planning skills and really enjoy the organization piece of their role as manager. Any ideas are well-thought out and articulated. I have found that they tend to be introspective in nature and may need additional support and coaching to train and sell their ideas to staff.

HR/Vision – These are the motivators and idea people. They are able to aim high for their customers and team and have an infectious, boundless energy. The menial administration tasks are often put on the back-burner in lieu of the next exciting project. I’ve found that this type of management style can be a challenge and is often dependent on the strength of the core team: if another pharmacist or assistant possesses the admin savvy they can often complement a relative weakness, although their experience is often gained in a previous role with a different mentor.

 

I’ve simplified these buckets to make them easier to digest. I use them to coach others but also for myself. I would put my relative strength in the HR group, with vision being second. My administrative skills are solid, but not my passion compared to the other two. I am lucky to know mentors and current managers (not just in pharmacy) that are much stronger than I in each of these areas. As much as possible, I try to absorb their strategies to help create structure and accountability for my staff.

Properly executed change doesn’t happen overnight. I need to manage expectations for my superiors and my team, but most importantly, I need to manage my own.

 

Disclaimer: The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of any agency, employer or affiliation.