1. Green Square Consensus Team
What management roles, skills, and abilities will be necessary for future pharmacy services?
Green Square Consensus Team

2. Flashback!
11TH VA NATIONAL PHARMACY CONFERENCE “Aiming for Excellence” September 11-15, 2006

3. The Initial 2006 Plan Question: Goal: End product:
What management roles, skills, and abilities will be necessary for future pharmacy services?
Goal:
“Develop Super Hero Managers/Leaders with the skills & abilities necessary to thrive in EVOLVING pharmacy practice”
End product:
Cyber-based Leadership/Management training program for employees at ALL LEVELS

4. Essential Management Roles necessary for future pharmacy services
Essential Management Roles necessary for future pharmacy services. What Factors were essential for this decision?
Proactive, adaptable and conducive to change both nationally and globally
Technological
Strategic Planning
Medical advancements
Changing pharmacy world
Mentoring program (ongoing)
Across Pharmacy
Across Disciplines
Across locations
Private sector/Outside organizations
Core competencies/Managerial development
Clinical
Pharmacoeconomics
Personnel management
Automation
Assessment/credentialing
Understand and teach the VA system
Multi-cultural
Political processes
Committee structure
Networking
Public Relations
Incorporate Individual Facility and VISN practices into “One National VA”
Measures/Monitors
Cost containment strategy
Patient focused care that is consistent, reliable, and accessible across VA facilities and partners
Recruitment
Internal
Super Hero
External
Pharmacy residents/students
Emergency Preparedness

5. Essential Management skills and abilities necessary for future pharmacy services. What Factors were essential for this decision?
Informatics
Decision making
Prioritization/Juggling
Reactive
Clinical
Communication
Negotiation
Marketable
Dispensatory
Political
Confidence
Liaison
Sales
Leadership
Open minded
Patient focused

6. More Roles, Skills, and Abilities….
Future pharmacy services:
Fail-safe medication use
Qualified managers, RPh., Technician
Practice/develop evidence based medicine
Affordable and accessible pharmaceuticals
Health executive (outside pharmacy) education and awareness
Research and assessment of essential competencies
Training opportunities
Virtual Leadership development
Educate
Find more ways to build other things into pharmacy practice
Let executives know how pharmacy can help
Biomonitoring and therapeutics
Nanotechnology
EMR & Risk simulation
Pre-clinical assessment
Biosystems
Genetic sequences
Proteomics
Global health records
Global drug discovery clerkship
Therapeutic imaging
Computational Drug Design
Outcomes Research
Manage HCS resources
Promote health improvement and disease prevention
Authority and automitity
Pharmacy is essential to the prevention health care
Develop a VA credential
Embed pharmacists into leadership positions
Prove more money spent on pharmacy decreases overall costs
Patient centered
Interdisciplinary
Quality improvement
Medical Informatics

7. Post conference reality check: What can we realistically accomplish?
Goal:
“Develop Super Hero Managers/Leaders with skills & abilities necessary to thrive in EVOLVING pharmacy practice”
Objectives:
Further refine and define the list of Roles, Skills, and Abilities
MUST BE USABLE
Examine the options to develop these in all employees
VA and Non-VA sources
Recommend a means to the goal
End product:
Cyber-based Leadership/Management training program for employees at ALL LEVELS
What can we accomplish in our free time? Are we on the correct path to begin with?
Step 1: Examine the roles, skills, and abilities more in depth.
2. Define and Refine them into something we can use

8. Defining and refining the list… Back to our roots!
Informal survey within the squares and of VA pharmacy leaders
Review of initial list
Establishment of new elements
Review of leadership and management literature
Establishment and definition of elements
Review of established programs
VA and Non-VA programs
Concurrence with established ideas
Potential Utility

9. Key Concept
“Develop Super Hero Managers/Leaders with skills & abilities necessary to thrive in evolving pharmacy practice”
One of the big challenges in this process is that there are two critical elements.
Two clearly different elements
Leadership
Management
Not every leader wants to manage
Very different resources available

10. Literature and other resources
Nold EG, Sander WT. Role of the director of pharmacy: The first six months. Am J Health-Syst Pharm. 2004;61:
Zilz DA, Woodward BW, Thomas ST, Shane RR, Scott B. Leadership skills for a high-performance pharmacy practice. Am J Health-Syst Pharm. 2004; 61:
Center for Health-System Pharmacy Leadership Initiative: Management and Leadership Competencies
Various reference articles on Leadership
Managing & Leading: 44 Lessons Learned for Pharmacists
Staff Development for Pharmacy Practice
Handbook of Institutional Pharmacy Practice 4th ed.
Competence Assessment Tools for Health-System Pharmacies, 4th ed.
Best Practices for Hospital and Health-System Pharmacy
Assuring Continuous Compliance with Joint Commission Standards, 7th ed.
The University of Kansas: Department of Pharmacy Leadership Assessment Form
Good to Great AND Good to Grear and the Social Sectors
Jim Collins
Breaking the rules…..
Sharon Castle, never taught me during my residency NOT to be too wordy on my slides, so I blame this one on her.
If anyone is evaluating me you can mark me NOT ADEQUATE for this Criteria Based Check list.

11. VHA Workforce Development & Succession Model
“VHA launched a complete leadership continuum and established programs to prepare employees at all levels of the organization for leadership positions.”

12. New employee orientation HPDM awareness and development
All Employess
New employee orientation
HPDM awareness and development
VHA mentor and coach program
Cultural Health Initiative
Frontline Employees
TCF program
VAMC Leadership Institute
Graduate Health Admin. Program
Supervisory/Team Leader
Supervisors Training
VISN Leadership Institute
Advanced TCF training
Nurse Manager Development
Middle Management
ECF Candidate Development
Service Line/Chief Orientation
LVA
Executive Career Field
HCLI
VA SES CDV
SELI
Senior Executive Orientation
Nurse Executive Orientation
Senior Leadership Academy (1-VA)
Senior Management Conference
ELP
Provided by Nancy Fadel in association with VA EES

13. Other VA Opportunities
Joint Medical Executive Skills Institute (Joint EES/DOD)
Supervisors Toolbox
Pharmacy Mentor Certification Program
Various VA Pharmacy Conferences
University of Wisconsin Federal Pharmacy Programs
VA Clinical Pharmacy Programming Conference
National Pharmacy Conference
VISN level conferneces
Literature resources
Institute for Management Studies Seminars

14. Non-VA Programs ASHP Foundation Pharmacy Leadership Institute
ASHP Foundation Pharmacy Leadership Academy
Latiolais Leadership Institute
UCSF Leadership Institute
Annual ASHP Conference for Leaders in Health-System Pharmacy
Various Administrative Residencies and Masters programs
American Mangement Association

15. After all this, What roles, skill, and abilities are needed?

16. 8 core competencies of the High Performance Development Model: http://vaww.va.gov/hpdm/

17. Personal Mastery: Process of self-managed continuing professional development through setting of personal goals, self-assessment, and change
Accurate assessment of personal capabilities and appropriate reaction to strengths/weaknesses
Continuously strive for personal development
Define realistic goals and accomplish them through self motivation
Advocate for growth of the profession and its professional associations
Actively pursue balance of professional and personal life
Efficiently prioritize duties through effective time management
Stay abreast of new technology and advances in information technology
Identify, recruit, coach, and transfer knowledge to potential future pharmacy leaders
Routinely participate in education & training opportunities to maintain/expand knowledge in pharmacy competencies
Well versed in VHA training portals and contributes to their development
Volunteer in group activities as a consensus workgroup leader/facilitator
Identify, research & conquer challenging areas in VHA; share success with others through poster presentation
Use VHA employment as a means to expand leadership opportunity through collateral duties, federal scholarship programs, and affiliate/community relations

18. Technical Knowledge and Skills: Maintains the knowledge and skills required to be effective in their role
Professional knowledge in pharmacy operations, medication distribution systems, sterile preparations and mixtures
Profit vs non-profit vs cost based health care systems and co-managed care
VHA Policy and procedures
* VHA Handbook Investigational Drugs and Supplies
* VHA Handbook Outpatient Pharmacy Services
* VHA Handbook Inpatient Pharmacy Services
* VHA Handbook Controlled Substances (Pharmacy Stocks)
* VHA Handbook Inspection of Controlled Substances
* VHA Handbook Self Medication Program (SMP)
Informatics/Software architecture (Vista, CPRS, BCMA, Microsoft - Office, ProClarity, SharePoint, LiveMeeting, VSSC)
Legal aspects of pharmacy practice
Program Management, Competency Assessment, Scope of Practice, Functional Statement
Information Security - cyber training, HIPAA
Purchasing and Inventory Control
Pharmacy layout and design, workflow analysis
Reporting systems and metrics
Human Resource (Title 5, Title 38, hybrid T-38)
Health Care Recruitment and Retention Office (EDRP, EISP, VALOR, SEEP)
VHA Service and Support Center (VSSC)

19. Interpersonal Effectiveness: Ability to develop and maintain working relationships with everyone
Build effective relationships with internal customers for mutual problem resolution
Respect differing philosophies and negotiate common ground between them
Show appreciation to other services and consider what impact your actions have on them
Realize everyone has a bad day now and then; put differences aside and move forward
Identify mutual goals of pharmacy with other Service Chiefs, Chiefs of Medicine, Chief of Staff
Be precise, articulate, and honest when selling your service
Leadership coaching to build organizational talent
Executive presence and articulate communication (oral, written, listening)
Foster team work and respect for all individuals
Empower employees/colleagues and appropriately delegate responsibility
Serve as a role-model for others and lead through vision and value
High moral and ethical integrity
Recognize achievement, celebrate success, and reward staff
Share gratitude and be accountable for set-backs
Understand Human Resource and Union philosophy
Cherish diversity
Maintain composure and self-control
Frequently interview customers and listen to their perspective
Willing to negotiate positions

20. Customer Service: Maintains customer focus (patient, colleague, providers, etc.) in the appropriate elements of the service
Recognize diverse group of costumers within VHA and understand their unique needs
Provision of drug information with communication specific to customer's level of comprehension
Foster buy-in to formulary management through gold standard clinical pharmacy services
Maximize employee satisfaction through development, coaching, recognition
Champion educational programs within department and beyond
Conduct quality improvement exercises targeting your costumers’ perspective
Understand and facilitate cohesive business relationship with Industry
Set the bar, then aim to raise it
Listen to and treat all customers equally

21. Flexibility/Adaptability: Ability to adapt quickly to change, handle multiple inputs and tasks, and accommodate new or emergent situations
Accept that unexpected things happen, usually at the most inopportune moment
Understand that Emergency Preparedness, Joint Commission inspections, and staff shortages will occur
Expect unforeseen incidents and cope with changes in daily routine
Manage urgent information requests and assemble response in short time frame
Contingency plans for loss of automation, printers, technology
Manage scheduling changes due to staff illness/unexpected absences
Work well under pressure and able to resolve issues in a crisis
Handle drug conversions secondary to shortages, formulary/contract changes, etc.

22. Creative Thinking: Ability to develop innovative strategies, solutions, and plans
Hold brainstorming sessions/focus groups
Annual assessment of state of pharmacy service
Problem Solving/Critical thinking workgroups
Promote and reward creative thinking from others
Strategic planning events for pharmacy services

23. Systems Thinking: Ability to develop processes and solutions within your department that consider the impact on the entire system of your department and facility
Business Acumen: Ability to assess and improve a business model
Change Leadership: Promoting advances in practices and change from the status quo
Establish strategic direction that compliments medical center goals
Consider intentional and unintentional outcomes of changes or decisions
Evaluate new processes, their outcomes, and actions needed to improve service
Establish action plans to support to senior administration initiatives (Network Director ECF plan)
Promote Residency training/teaching environment
Maximize efficiency in areas of automation, Computerized Physician Order Entry, Bar Code Med Administration
Dedication to processes of oversight
Controls over prescription drugs - controlled substance management
Staffing/Workload analysis
Optimize fiscal resource management:
* Understand pharmaceutical contracting (NAC, PBM, FSS, Big4, NC, BPA)
* Pharmacy Budget, supplemental funds
* PPV & Reverse Distributor
* Account Level Budgeting (DSS cube)
Role of pharmacy services in investigational drug usage and outcomes research

24. Organizational Stewardship: Commitment to the VA/VHA mission and advocates as such and remembers this and places it in the context of their service
Comprehend VA & PBM organizational structure (President, Department, Secretary, PBM Service (Washington/Hines), CMOP, VISN, HCS, clinics, affiliations)
Plan for workforce succession needs and identify innovative recruitment & retention strategies
Astute in committee functionality
Continuous readiness with oversight standards (JC, OIG, SOARS)
Role of VA in Disaster planning/Emergency response
Commitment to patient/medication safety
Concerted effort to transfer knowledge and foster leadership
Support VA mission, philosophy, and objectives
Understand significance of facility leadership goals and objectives
Develop/expand student education/affiliations
Guidance in evidence based medicine, pharmacoeconomics
Actively involved with creation and achievement of pharmacy measures & goals
Engage dialog with stake holders in cross-cutting issues

25. THERE IS NO SINGLE PROGRAM THAT CAN MEET THE ENTIRE LOT!
Evaluation
Pharmacy Directors/Managers/Leaders do A LOT
When they are done with A LOT they still have more to do
Ultimately the job is never done!
THERE IS NO SINGLE PROGRAM THAT CAN MEET THE ENTIRE LOT!

26. Summary of observations
Leadership training
Much of what is available in VA is non-pharmacy specific
Is that critical?
Pharmacy specific opportunities
Often not completely focused but they clearly promote
Improving outside program availability
ASHP foundation
Goal of 100 people trained per year in academy
Other university programs
Come with a cost
Evolving literature with potential crisis in pharmacy
May not need additional leadership programs if we can take advantage of what is available
Strong interest to assure broad availability

27. Summary of observations
Management training
Literature availability
Mentoring availability
Required supervisors training/orientation
Not pharmacy specific
Overall limited focused programs

28. Roles, Skills, and Abilities
We’ve defined A LOT of roles, skills, and abilities
These are continuously evolving with pharmacy and will continue to do so
Current list if utilized in some fashion would require periodic re-review and revision to keep current with practice
To be further utilized by the Pharmacy Leadership/Administrative Training Committee

29. Cyber-based Leadership/Management training program for employees at ALL LEVELS
Still an idea with potential, HOWEVER
Time intensive to develop
Require extensive dedicated resources
Similar modules exist (EES/DOD, JMESI)
Does their program work?
Do people use it?
No literature support that such a program will produce the desired results
If focused on the gaps in training, may be of benefit

30. Final thoughts There are opportunities! There are some gaps
Identification of personnel interested in leadership and management is CRITICAL
Should be done EARLY in career
Opportunities must be widely identified for these individuals
Central source of information
Opportunities should help to serve as qualifiers for promotion
VA Pharmacy specific programs may help fill in the gaps
National, VISN conferences
Workshops
Site Visitation
Mentoring
TIME IS A MUST

31. What else could be done?
Organize an easy to use leadership/management resource guide that is specific for pharmacy
Define a method to identify those with interest in pursuing leadership and management positions
Define a course for interested candidates
Opportunities needed from the front-line on up
Development of self-assessment tool for pharmacy managers/leaders to identify needed education

32. Team Members and Special Contributions
Bechdol, Ruth A.
Brown, Jeanne Bedford
Evans, Frank
Friend, Amy
Gardner, Bryan J.
Garza, Arnold
Gray, David R
Herr, Elizabeth A
Johnson, Jill R.
Koons, Kevin A.
Larsen, Linda L.
Leibfried, Elmar
Lopez, Julio
Minard, Patrick
Palkuti, Marisa
Semla, Todd
Stein-Gocken, Julie
Steinwandt, Stephan M
Stroup, Tim
Yunker, Frank J