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Pharmacy Management: Pharmacy Management: Optimizing the Use of Optimizing the Use of
Technicians and TechnologyTechnicians and TechnologyJohn Pedey-Braswell CPhTJohn Pedey-Braswell CPhT
Pharmacy 334Pharmacy 3341 March 20041 March 2004
Objectives:Objectives: Recognize that regardless of job title, all Recognize that regardless of job title, all
pharmacists are managers.pharmacists are managers. Recognize that SOP Curricula should Recognize that SOP Curricula should
assure some level of managerial assure some level of managerial proficiency in graduates.proficiency in graduates.
Identify health system factors impeding Identify health system factors impeding pharmaceutical care.pharmaceutical care.
Identify areas to access managerial Identify areas to access managerial education for pharmacists.education for pharmacists.
Describe traits of a successful Describe traits of a successful supervisor.supervisor.
Discuss reasons for problematic Discuss reasons for problematic employee behavior.employee behavior.
About MyselfAbout Myself Pharmacy Technician 1993-2001; 2 years as a Pharmacy Technician 1993-2001; 2 years as a
lead.lead. Supervisory Skills Certificate from UW Training Supervisory Skills Certificate from UW Training
and Development.and Development. Editor of Medical Records for Large Home Editor of Medical Records for Large Home
Health Pharmacy. Health Pharmacy. Experience Outside Pharmacy Managing Experience Outside Pharmacy Managing
Projects, Staff, Inventory, and Money.Projects, Staff, Inventory, and Money. Developed Technician Job Description and Developed Technician Job Description and
Participated in Technician Hiring for Refill Participated in Technician Hiring for Refill Authorization Center.Authorization Center.
Research with Dr. Hammer in Management, Research with Dr. Hammer in Management, Education, and Pharmacist-Technician Education, and Pharmacist-Technician Relations.Relations.
Career Objective: Education and Improving Career Objective: Education and Improving Access to Health Care.Access to Health Care.
Management is…..Management is…..
Getting things done (through Getting things done (through people).people).
The successful utilization of the 3 The successful utilization of the 3 Ms: Materials, Money, and Ms: Materials, Money, and Manpower (Person power).Manpower (Person power).
Using “buzz words” and industry Using “buzz words” and industry lexicon to explain common sense lexicon to explain common sense ideas.ideas.
Different than leadership. How?Different than leadership. How?
Why Should I Learn About Why Should I Learn About Management ?Management ?
• American Council on Pharmaceutical Education American Council on Pharmaceutical Education (ACPE) proscribes professional competencies that (ACPE) proscribes professional competencies that should be achieved through the College or School of should be achieved through the College or School of Pharmacy’s curriculum. Graduates should have the Pharmacy’s curriculum. Graduates should have the ability to:ability to:
• 10b) manage systems for storage, preparation, and 10b) manage systems for storage, preparation, and dispensing of medicines, and supervise technical dispensing of medicines, and supervise technical personnel who may be involved in such processes;personnel who may be involved in such processes;
• 10c) manage and administer a pharmacy and 10c) manage and administer a pharmacy and pharmacy practice;pharmacy practice;
• Outcome expectations for student performance in Outcome expectations for student performance in the professional competencies stated above should the professional competencies stated above should be set forth and measured by the College or be set forth and measured by the College or School.School.
• Standard 11 delineates that the curricular core shall Standard 11 delineates that the curricular core shall contain social and administrative pharmacy contain social and administrative pharmacy sciences including practice management.sciences including practice management.
Why Should I Learn About Why Should I Learn About Management (2) ?Management (2) ?
American Association of Colleges of American Association of Colleges of Pharmacy (AACP) Center for the Pharmacy (AACP) Center for the Advancement of of Pharmaceutical Advancement of of Pharmaceutical Education (CAPE) Advisory Panel Education (CAPE) Advisory Panel revised Educational Outcomes 1998.revised Educational Outcomes 1998.
Outcome 2) Manage the Practice. Outcome 2) Manage the Practice. 2a) Manage Pharmacy Operations. 2a) Manage Pharmacy Operations. 2c) Manage Human Resources. 2c) Manage Human Resources. ““Apply principles of personnel Apply principles of personnel
management to recruit, hire, train, management to recruit, hire, train, develop, supervise, motivate, retain, and develop, supervise, motivate, retain, and evaluate support staff.”evaluate support staff.”
Why Should I Learn About Why Should I Learn About Management (3) ?Management (3) ?
Approximately 80% of graduates Approximately 80% of graduates will work in community pharmacies, will work in community pharmacies, often in an environment where they often in an environment where they are the only pharmacist on duty.are the only pharmacist on duty.
Between 60 - 75% of graduates will Between 60 - 75% of graduates will have managerial duties within 2 have managerial duties within 2 years of graduation.years of graduation.
Pharmaceutical CarePharmaceutical Care
Pharmaceutical care is the Pharmaceutical care is the responsible provision of drug therapy responsible provision of drug therapy for the purpose of achieving definite for the purpose of achieving definite outcomes that improve a patient’s outcomes that improve a patient’s quality of life. These outcomes are:quality of life. These outcomes are:
1. Cure of Disease,1. Cure of Disease,2. Elimination or Reduction of a 2. Elimination or Reduction of a Patient’s Symptomatology,Patient’s Symptomatology,3. Arresting of Slowing a Disease 3. Arresting of Slowing a Disease Process, orProcess, or4. Preventing a Disease or 4. Preventing a Disease or Symptomatology.Symptomatology.
Pharmaceutical Care (2)Pharmaceutical Care (2)
Pharmaceutical Care involves the Pharmaceutical Care involves the process of through which a pharmacist process of through which a pharmacist cooperates with a patient and other cooperates with a patient and other professionals in designing, implementing, professionals in designing, implementing, and monitoring a therapeutic plan that will and monitoring a therapeutic plan that will produce specific therapeutic outcomes for produce specific therapeutic outcomes for the patient. This in turn involves three the patient. This in turn involves three major functions:major functions:
1. Identifying Potential and Actual Drug-1. Identifying Potential and Actual Drug-Related Problems, andRelated Problems, and2. Resolving Actual Drug-Related 2. Resolving Actual Drug-Related Problems, andProblems, and3. Preventing Potential Drug-Related 3. Preventing Potential Drug-Related Problems.Problems.
Pharmaceutical Care (3)Pharmaceutical Care (3)
Pharmaceutical care is a necessary element of Pharmaceutical care is a necessary element of health care, and should be integrated with other health care, and should be integrated with other elements. Pharmaceutical care is, however, elements. Pharmaceutical care is, however, provided for the direct benefit of the patient, and provided for the direct benefit of the patient, and the pharmacist is responsible directly to the the pharmacist is responsible directly to the patient for the quality of that care. The patient for the quality of that care. The fundamental relationship in pharmaceutical care fundamental relationship in pharmaceutical care is a mutually beneficial exchange in which the is a mutually beneficial exchange in which the patient grants authority to the provider and the patient grants authority to the provider and the provider gives competence and commitment provider gives competence and commitment (accepts responsibility) to the patient.(accepts responsibility) to the patient.
The fundamental goals, processes, and The fundamental goals, processes, and relationships of pharmaceutical care exist relationships of pharmaceutical care exist regardless of practice setting.regardless of practice setting.
Hepler and Strand. AJHP March 1990.Hepler and Strand. AJHP March 1990.
Obstacles to Pharmaceutical Obstacles to Pharmaceutical CareCare
National Association of Chain Drug Stores (NACDS) National Association of Chain Drug Stores (NACDS) predicts that approximately 4 billion prescriptions will predicts that approximately 4 billion prescriptions will be filled in the United States in 2004, up from the 3 be filled in the United States in 2004, up from the 3 billion filled in 1999 – a 33% increase.billion filled in 1999 – a 33% increase.
The number of practicing retail pharmacists is The number of practicing retail pharmacists is expected to increase from 119,000 to 127,000 – expected to increase from 119,000 to 127,000 – only a 6% increase.only a 6% increase.
1999 NACDS activity cost and productivity study 1999 NACDS activity cost and productivity study (data tabulated by Arthur Andersen LLP).(data tabulated by Arthur Andersen LLP). Pharmacists spend 2/3 of their time on non-Pharmacists spend 2/3 of their time on non-
clinical and nonjudgmental activities. They only clinical and nonjudgmental activities. They only spend 31% of their time on more substantive spend 31% of their time on more substantive activities, e.g. reviewing and interpreting activities, e.g. reviewing and interpreting prescriptions, contacting doctors about approvals prescriptions, contacting doctors about approvals or clarification, and counseling patients.or clarification, and counseling patients.
Source: Drug Topics 1/3/2000Source: Drug Topics 1/3/2000
Linwood F.Tice, Dean, Linwood F.Tice, Dean, Philadelphia College of Pharmacy Philadelphia College of Pharmacy and Science (1966)and Science (1966)
““The counting and pouring now often The counting and pouring now often alleged to be the pharmacist’s chief alleged to be the pharmacist’s chief occupation will in time be done by occupation will in time be done by technicians and eventually by technicians and eventually by automation. The pharmacist of automation. The pharmacist of tomorrow will function by reason of tomorrow will function by reason of what he knows, increasing the what he knows, increasing the efficiency and safety of drug therapy efficiency and safety of drug therapy and working as a specialist in his own and working as a specialist in his own right. It is in this direction that right. It is in this direction that pharmaceutical education must evolve pharmaceutical education must evolve without delay.”without delay.”
Quoted in ASHP/APhA White Paper Quoted in ASHP/APhA White Paper on Pharmacy Technicianson Pharmacy Technicians
How Do I Obtain Managerial How Do I Obtain Managerial Skills?Skills?
In pharmacy, many of us learn on the job In pharmacy, many of us learn on the job and/or through mentorsand/or through mentors
BA 472 Offered Tuesdays or Thursdays BA 472 Offered Tuesdays or Thursdays Spring QuarterSpring Quarter
Training and Development classes offered Training and Development classes offered through University of Washingtonthrough University of Washington
Continuing Education programsContinuing Education programs Pharmacy practice residencies have Pharmacy practice residencies have
administrative component; content and administrative component; content and quality varyquality vary
ASHP administrative residenciesASHP administrative residencies Additional degree programs, e.g. BS/BA in Additional degree programs, e.g. BS/BA in
Human Resources Mgmt, MHA, MBA, Human Resources Mgmt, MHA, MBA, MPH, MS Pharmacy Admin, PhDMPH, MS Pharmacy Admin, PhD
What Are the Traits of a Good What Are the Traits of a Good Supervisor?Supervisor?
Please take a few minutes to Please take a few minutes to discuss this with the person next discuss this with the person next to you.to you.
What are the characteristics that What are the characteristics that make your favorite employer make your favorite employer great?great?
What has made an employer What has made an employer miserable to work for?miserable to work for?
Qualities of an Effective Qualities of an Effective LeaderLeader
Motivate employees to accomplish great things.Motivate employees to accomplish great things. Set positive example for other employees.Set positive example for other employees. Encourage teamwork and participation.Encourage teamwork and participation. Direct, sincere, and honest.Direct, sincere, and honest. Good communicators.Good communicators. Make sure that employees know what is expected of them.Make sure that employees know what is expected of them. Are proactive in planning, setting priorities, and making Are proactive in planning, setting priorities, and making
decisions.decisions. Skilled in the art of shaping behavior through positive Skilled in the art of shaping behavior through positive
reinforcement.reinforcement. Delegate work when they need to.Delegate work when they need to. Well organized.Well organized. Welcome change – they are flexible with new ideas and new Welcome change – they are flexible with new ideas and new
people.people. Finish what they start.Finish what they start. Involve employees in problem recognition and problem Involve employees in problem recognition and problem
solving.solving.
Source: Effective Pharmacy Management.Source: Effective Pharmacy Management.
ASHP’s Five Characteristics of ASHP’s Five Characteristics of Successful Hospital Pharmacy Successful Hospital Pharmacy
AdministratorsAdministrators1.1. They are open with peopleThey are open with people. They are . They are
comfortable sharing their thinking and feelings comfortable sharing their thinking and feelings with workers, and they encourage their with workers, and they encourage their employees to do likewise. employees to do likewise.
2.2. They use a team approach to managementThey use a team approach to management. . They believe that better decisions result from They believe that better decisions result from group discussion than from individual thinking. group discussion than from individual thinking.
3.3. They give people important work to doThey give people important work to do. They . They give their assistants substantial responsibility for give their assistants substantial responsibility for ongoing operations and future planning. ongoing operations and future planning.
4.4. They avoid crisis through good planningThey avoid crisis through good planning. In a . In a crisis, even the best managers tend to retreat to a crisis, even the best managers tend to retreat to a more autocratic style, often to the detriment of more autocratic style, often to the detriment of morale in the department.morale in the department.
5.5. They do not suffer from the curse of self-They do not suffer from the curse of self-perfectionismperfectionism. All bosses will make mistakes in . All bosses will make mistakes in dealing with people. dealing with people.
The Wisdom of Bear BryantThe Wisdom of Bear Bryant
““I’m just a plow hand from Arkansas, but I have learned 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 hold a team together; how to lift some men up; how to calm down others; until finally they’ve got one how to calm down others; until finally they’ve got one heartbeat together – a team. There’s just three things I’d heartbeat together – a team. There’s just three things I’d ever say:ever say: If anything goes bad, I did it.If anything goes bad, I did it. If anything goes semi-good, then we did it.If anything goes semi-good, then we did it. If anything goes real good, then you did it.If anything goes real good, then you did it.
That’s all it takes to get people to win football games for That’s all it takes to get people to win football games for you.”you.”
6 Common Causes of 6 Common Causes of Employee DissatisfactionEmployee Dissatisfaction
1.1. Inefficient AdministrationInefficient Administration. People want . People want administration that is efficient and just. Do not administration that is efficient and just. Do not keep people waiting – it is a sign of disrespect.keep people waiting – it is a sign of disrespect.
2.2. Incompetent SupervisionIncompetent Supervision. Supervisors must know . Supervisors must know the details of the work they are supervising.the details of the work they are supervising.
3.3. Poor Interpersonal RelationsPoor Interpersonal Relations. Consult coworkers . Consult coworkers for advise on issues, and do NOT play favorites.for advise on issues, and do NOT play favorites.
4.4. Personal Qualities of the LeaderPersonal Qualities of the Leader. Integrity, . Integrity, fairness, and competence are all valued in a fairness, and competence are all valued in a leader.leader.
5.5. Inadequate PayInadequate Pay. Be fair in regards to market . Be fair in regards to market conditions. Realize that increases in salary often conditions. Realize that increases in salary often result in increased productivity and quality of result in increased productivity and quality of work, but only for a short time.work, but only for a short time.
6.6. Poor Working ConditionsPoor Working Conditions. Provide a physically, . Provide a physically, and psychologically comfortable environment for and psychologically comfortable environment for employees to work.employees to work.
Source: Effective Pharmacy Management.Source: Effective Pharmacy Management.
What Causes Employees to What Causes Employees to Misbehave?Misbehave?
It is not clear to the employee what behavior is It is not clear to the employee what behavior is expectedexpected
The consequences of compliance and The consequences of compliance and noncompliance haven’t been made clearnoncompliance haven’t been made clear
The consequences are exaggerated and not The consequences are exaggerated and not believablebelievable
The consequences seem inconsequentialThe consequences seem inconsequential The employee isn’t capable of performing the task The employee isn’t capable of performing the task
as requiredas required There are work obstacles beyond the employee’s There are work obstacles beyond the employee’s
controlcontrol The employee is undergoing temporary stress or The employee is undergoing temporary stress or
frustration due to circumstances beyond his or her frustration due to circumstances beyond his or her control.control.
Source: Ken Matejka, Why This Horse Won’t DrinkSource: Ken Matejka, Why This Horse Won’t Drink
Motivation According to Motivation According to MaslowMaslow
MotivationMotivation: Inner impulse that induces a person to : Inner impulse that induces a person to act in a certain way. A series of internal drives act in a certain way. A series of internal drives within a person at different levels:within a person at different levels:
Level OneLevel One. Obtain the necessities for life itself – . Obtain the necessities for life itself – food, shelter, clothing, rest, and safety.food, shelter, clothing, rest, and safety.
Level TwoLevel Two. Satisfy social needs such as . Satisfy social needs such as companionship, love, and a position of respect.companionship, love, and a position of respect.
Level ThreeLevel Three. Develop a measure of personal . Develop a measure of personal satisfaction. People need to feel comfortable with satisfaction. People need to feel comfortable with themselves and with what they make of their lives, themselves and with what they make of their lives, their talents, and abilities.their talents, and abilities.
Needs at lower levels must be met before higher Needs at lower levels must be met before higher needs can be addressed.needs can be addressed.
How to Successfully Work How to Successfully Work with Ancillary Staffwith Ancillary Staff
Unless you own the pharmacy, never refer to another Unless you own the pharmacy, never refer to another human being as “my” technician, cashier, custodian, human being as “my” technician, cashier, custodian, etc.etc.
Never confuse education with intelligence.Never confuse education with intelligence. Have a basic understanding of the job expectations for Have a basic understanding of the job expectations for
each technician assignment in the pharmacy.each technician assignment in the pharmacy. Help others when done with work assignments – this Help others when done with work assignments – this
includes helping the technicians.includes helping the technicians. Treat everyone with common the common courtesy Treat everyone with common the common courtesy
that you expect to be treated with – never treat that you expect to be treated with – never treat technicians in a condescending or demeaning manner.technicians in a condescending or demeaning manner.
Make sure that technicians feel a part of patient care Make sure that technicians feel a part of patient care team – provide them patient contact, encourage them team – provide them patient contact, encourage them to look for medical errors, and foster an environment to look for medical errors, and foster an environment where their input is welcome.where their input is welcome.
Source: AJHP 7/92, and numerous conversations with Source: AJHP 7/92, and numerous conversations with technicians.technicians.
A Pharmacist Shall Not Delegate the A Pharmacist Shall Not Delegate the Following Professional Responsibilities Following Professional Responsibilities
(WAC 246-863-095):(WAC 246-863-095): Receipt of a verbal prescription other than refill Receipt of a verbal prescription other than refill
authorization from a prescriber.authorization from a prescriber. Consultation with the patient regarding the prescription, Consultation with the patient regarding the prescription,
both prior to and after the prescription filling and/or both prior to and after the prescription filling and/or regarding any information contained in a patient regarding any information contained in a patient medication record system provided that this shall not medication record system provided that this shall not preclude a pharmacy assistant from providing to the preclude a pharmacy assistant from providing to the patient or the patient’s health care giver certain patient or the patient’s health care giver certain information where no professional judgment is required information where no professional judgment is required such as dates of refills or prescription price information.such as dates of refills or prescription price information.
Consultation with the prescriber regarding the patient and Consultation with the prescriber regarding the patient and the patient’s prescription.the patient’s prescription.
Extemporaneous compounding of the prescription Extemporaneous compounding of the prescription provided that bulk compounding from a formula and IV provided that bulk compounding from a formula and IV admixture products prepared in accordance with WAC admixture products prepared in accordance with WAC 246-871 may be performed by a level A pharmacy 246-871 may be performed by a level A pharmacy assistant when supervised by a pharmacist.assistant when supervised by a pharmacist.
A Pharmacist Shall Not Delegate the A Pharmacist Shall Not Delegate the Following Professional Responsibilities Following Professional Responsibilities
(WAC 246-863-095):(WAC 246-863-095): Interpretation of data in a patient medication record Interpretation of data in a patient medication record
system.system. Ultimate responsibility for all aspects of the Ultimate responsibility for all aspects of the
completed prescription and assumption of completed prescription and assumption of responsibility for the filled prescription, such as: responsibility for the filled prescription, such as: accuracy of drug, strength, labeling, proper accuracy of drug, strength, labeling, proper container and other requirements.container and other requirements.
Dispense prescriptions to a patient with proper Dispense prescriptions to a patient with proper patient information as required by WAC 246-869-patient information as required by WAC 246-869-220.220.
Professional communications with physicians, Professional communications with physicians, dentists, nurses, and other health care dentists, nurses, and other health care practitioners.practitioners.
This does not preclude delegation to an intern or This does not preclude delegation to an intern or extern.extern.
Functions of Pharmacy Functions of Pharmacy TechniciansTechnicians
Information ManagementInformation Management Medication PreparationMedication Preparation Medication DispensingMedication Dispensing Check the Work of Other TechniciansCheck the Work of Other Technicians Medication Inventory ManagementMedication Inventory Management TrainingTraining
Train Other Technicians and InternsTrain Other Technicians and Interns Orientation to Procedural Activities for New Orientation to Procedural Activities for New
PharmacistsPharmacists
Source: ASHP Manual for Pharmacy Technicians Source: ASHP Manual for Pharmacy Technicians 22ndnd Edition Edition
ASHP Archives July 1987ASHP Archives July 1987
“ “The status of technicians in pharmacy is The status of technicians in pharmacy is influenced greatly by pharmacist attitudes influenced greatly by pharmacist attitudes and technician self-perceptions. These and technician self-perceptions. These mindsets are difficult to change. mindsets are difficult to change. Pharmacists need to be secure enough in Pharmacists need to be secure enough in their own work to encourage technicians to their own work to encourage technicians to develop their skills and enhance their develop their skills and enhance their contribution to pharmaceutical services. contribution to pharmaceutical services. More technicians need to view their jobs as More technicians need to view their jobs as career pursuits and make the necessary career pursuits and make the necessary investment in developing their abilities in investment in developing their abilities in ways that yield satisfying and stimulating ways that yield satisfying and stimulating workwork.“ – R.W. Anderson.“ – R.W. Anderson
Typical Prescription Filling Typical Prescription Filling ProcessProcess
Rx Presentation
Verified Rx Entered Into Computer
Rx Filled
Rx Checked
Patient Counseling
Collect Payment for Prescription
Patient Brings Rx to Pharmacy or Calls with
Refill Request
Phone or Fax New Rx from Prescriber
Third Party Resolution
Prescriber Contacted for Therapeutic Clarification
Prescriber’s Office Contacted for Refill
Request
Assessment of Therapy (Interactions, allergies,
duplication)Pour, Count, Lick, and Stick
Routine Compounding
Assess level of disease knowledge
Assess Adherence and Identify Barriers
Counsel to Overcome Barriers and Provide
Education
Verify Disease Severity and Document
Outcomes
Every Successful Team Recognizes Every Successful Team Recognizes and Utilizes Specialization and Division and Utilizes Specialization and Division
of Laborof LaborRx Presentation
Verified Rx Entered Into Computer
Rx Filled
Rx Checked
Patient Counseling
Collect Payment for Prescription
Patient Brings Rx to Pharmacy or Calls with Refill
Request
Phone or Fax New Rx from Prescriber
Third Party Resolution
Prescriber Contacted for Therapeutic Clarification
Prescriber’s Office Contacted for Refill Request
Assessment of Therapy (Interactions, allergies,
duplication)Pour, Count, Lick, and Stick
Routine Compounding
Assess level of disease knowledge
Assess Adherence and Identify Barriers
Counsel to Overcome Barriers and Provide Education Verify Disease Severity and
Document Outcomes
Rose = Pharmacist Must Do
Yellow = Technician Can Do
In ConclusionIn Conclusion
We have discussed:We have discussed: What management isWhat management is Why it is important for pharmacistsWhy it is important for pharmacists Where to find additional trainingWhere to find additional training Traits of effective leadersTraits of effective leaders Common causes of employee Common causes of employee
dissatisfaction/misbehaviordissatisfaction/misbehavior Importance of properly utilizing Importance of properly utilizing
technicians and other ancillary stafftechnicians and other ancillary staff
Questions??Questions??
