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

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

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

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

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

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

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

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

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

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: 2297-310. Zilz DA, Woodward BW, Thomas ST, Shane RR, Scott B. Leadership skills for a high-performance pharmacy practice. Am J Health-Syst Pharm. 2004; 61:2562-74. http://www.ashpfoundation.org/MainMenuCategories/CenterforPharmacyLeadership.aspx Center for Health-System Pharmacy Leadership Initiative: Management and Leadership Competencies Various reference articles on Leadership http://www.ashp.org/s_ashp/sec_topic.asp?CID=1472&DID=1514&KID=58&KWD=Management 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 http://www.jimcollins.com/ 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.

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.”

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

Other VA Opportunities Joint Medical Executive Skills Institute (Joint EES/DOD) http://jmesi.army.mil/courses/homepages/pages/courses.asp Supervisors Toolbox http://vaww.sites.lrn.va.gov/supervisor/supervisor_toolbox/index.htm Pharmacy Mentor Certification Program http://www.pbm.va.gov/MentorCertificationProgram.aspx Various VA Pharmacy Conferences University of Wisconsin Federal Pharmacy Programs VA Clinical Pharmacy Programming Conference National Pharmacy Conference VISN level conferneces Literature resources http://www.books24x7.com/login.asp?ic=0 Institute for Management Studies Seminars www.ims-online.com/Washington

Non-VA Programs ASHP Foundation Pharmacy Leadership Institute http://www.ashpfoundation.org/MainMenuCategories/CenterforPharmacyLeadership/TrainingEducationalOpportunities/PharmacyLeadershipAcademy.aspx ASHP Foundation Pharmacy Leadership Academy Latiolais Leadership Institute http://www.latiolais.org/ UCSF Leadership Institute http://futurehealth.ucsf.edu/Program/pli/Default.aspx?tabid=123 Annual ASHP Conference for Leaders in Health-System Pharmacy http://www.ashpadvantage.com/leaders/ Various Administrative Residencies and Masters programs American Mangement Association http://www.amanet.org

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

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

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

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 1108.04 Investigational Drugs and Supplies * VHA Handbook 1108.05 Outpatient Pharmacy Services * VHA Handbook 1108.06 Inpatient Pharmacy Services * VHA Handbook 1108.1 Controlled Substances (Pharmacy Stocks) * VHA Handbook 1108.2 Inspection of Controlled Substances * VHA Handbook 1108.3 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)

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

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

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.

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

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

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

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!

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

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

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

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

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

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

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