Pharmacy Service Initiation: Steps for New Clinical Pharmacy Leaders. Professional Practice Advisory Group

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1 Pharmacy Service Initiation: Steps for New Clinical Pharmacy Leaders Professional Practice Advisory Group 1

2 Objectives Define clinical leadership Identify qualities of clinical pharmacy leaders List challenges facing pharmacy leaders / new practitioners Describe step-wise approach for implementing new clinical services Discuss key steps in each phase: Assessment Planning Implementation Summarize key points for effective execution

3 One important key to success is self-confidence. An important key to self-confidence is preparation. - Arthur Ashe

4 Clinical Leadership The essence of clinical leadership is to motivate, to inspire, to promote the values of the (NHS), to empower and to create a consistent focus on the needs of the patients being served. Leadership is necessary not just to maintain high standards of care but to transform services to achieve even higher levels of excellence. - NHS, 2007 Lindsay Hadley KSS Deanery School Leadership, United Kingdom

5 Leadership in Pharmacy Director of Pharmacy Clinical Managers Operational Supervisors Clinical Specialist Experienced clinical pharmacists Faculty, dean, etc.

6 Essential Qualities of Pharmacy Leadership Thorough knowledge of practice /administrative key points Constant self assessment of abilities / knowledge life-long learner Positive personality Evidence-based therapeutic outcome knowledge drug-acquisition cost not enough Quick independent learner accurate recall of information Actively engaging other healthcare professionals in weekly meetings, grand rounds, etc

7 Challenges Facing Pharmacy Leaders Status quo of pharmacy profession Pharmacy department staff complacency Professional confidence (e.g. clinical services require clinical judgment) Pre-conceived notions of other health care professionals Lack of resources, justification of personnel Sustainable resources and justification

8 Challenges for New Pharmacy Practitioners Understanding the administrative structure of a department, clinic, unit, etc. Understanding the political history Possessing the knowledge base / clinical judgment Work ethic (i.e. consistent hard, long hours) Chasing the ideal balance between professional / personal lives Gaining respect as a clinician

9 Jason Schafer, PharmD, BCPS, AAHIVE New Practitioner Perspective: The Community Hospital Experience

10 Phases of New Clinical Pharmacy Service Development at a Community Hospital Assessment phase Planning phase Implementation phase Reflections: Lessons Learned

11 Assessment Phase Identifying a service line in a community hospital Evaluate current clinical services Evaluate the need to meet clinical initiatives Consider your patient (and physician) population Consider your environment

12 Assessment Phase Identifying a service line in a community hospital Evaluate the clinical skills of fellow pharmacists Determine the level of support for clinical services from pharmacy administration Consider potential sources of collaboration

13 Assessment Phase Completing a needs assessment Provide a complete description of proposed clinical service Describe how the service fits the needs of patients in your hospital Evaluate resources currently available or required for implementation and maintenance

14 Assessment Phase Consider administrative issues, personality conflicts, and financial challenges that you may encounter Administrative: new programs need to be reviewed and approved by appropriate committees (P&T) Personalities: You may need to earn their trust an advocate can be helpful Financial: Your service may cost money and you may need to consider the pharmacy budget

15 Assessment Phase Generate a sense of urgency for your service Provide a compelling reason for why this service is necessary Support this compelling reason with data from your hospital Additional support can be provided by the literature

16 Planning Phase Identify specific goals to achieve with your service Clinical, economic and/or research Example: Antibiotic pharmacokinetic monitoring service Specific goals Decrease sub-therapeutic concentrations in patients receiving vancomycin (clinical outcome) Improve clinical outcomes of infections treated with vancomycin (clinical outcome) Reduce the number of serum levels obtained (economic outcome)

17 Planning Phase Gather support from major providers and stakeholders Physician leadership Nursing leadership Medicine residency/fellowship leadership Hospital or health system administrative leadership

18 Planning Phase Provide education to all who will be impacted Example A new pharmacokinetic monitoring service is implemented, who will be impacted? Clinical and staff pharmacists Pharmacy technicians Attending physicians Medical residents Nursing Nurse practitioners and physician assistants Laboratory and phlebotomy How will these individuals be informed and educated?

19 Planning Phase Plan to monitor outcomes to demonstrate continual justification of your clinical service Specific goals of service previously identified Monitoring these outcomes will also provide you with: An assessment of the success/failure of the service Opportunities for improvement or expansion Data for cost-benefit analyses Information on how to create future clinical services Information for presentations and/or publications

20 Implementation Phase Choose a start date and a feasible timeline Pilot programs are valuable tools An opportunity to test your service and gain some practice prior to full scale implementation One patient population, one physician group, or one hospital unit Help assess feasibility and identify flaws in the design/delivery of service

21 Implementation Phase Consider your transition from current duties to the new responsibilities of your service Take inventory of your current responsibilities Can you (realistically) perform these tasks, while adding a new clinical service to the list? Communicate with pharmacy administration Having too many tasks may compromise your ability to be successful clinically

22 Implementation Phase Sustaining your new job description Directly corresponds with the success of your service Dependent on your preparation prior to implementation How to quickly gain (and maintain) credibility Be accountable Ask for and listen to feedback Collect data and demonstrate an impact Present or publish your data

23 Implementation Phase Components necessary for a successful publication Know the current literature What can an evaluation of my service add to the literature? A research question, a hypothesis with specific aims, and a plan for data collection and analysis

24 Reflections: Lessons Learned Communication is key Education of other disciplines is essential A physician champion can play an important role Consider a pilot prior to full service implementation Plan to improve and/or expand, not just maintain

25 John Patka, PharmD, BCPS Seasoned Practitioner Perspective: : The Academic Hospital Experience

26 Phases of New Clinical Pharmacy Service Development at Academic Hospital Assessment phase Planning phase Implementation phase Reflections: Lessons Learned

27 Assessment Phase How to identify a service line? Involve leadership Front-line staff What a needs assessment should include, and who should be consulted to assist with financial facts, i.e. FTE and physical resources? Patient volume and timing Types of services offered

28 Assessment Phase What administrative issues, personality conflicts, and financial challenges to consider? New vs. established service Duplication of services How to generate an effective sense of urgency? Regulatory issues Adherence to standards

29 Planning Phase What other providers and stakeholders should be convinced? Administration What consumer advocacy or accrediting organizations support? Grant funding source available?

30 Planning Phase What objectives and projects should be planned to achieve with service? Patient safety Employee satisfaction Cost-savings What should be monitored to show continual justification of the service? Medication errors Interventions Medication usage

31 Implementation Phase Choosing a start date and a feasible timeline? Don t delay Allow for progress How should transition from traditional duties or roles transpire? Participate in all aspects of pharmacy

32 Implementation Phase How to sustain a new job description, different from older duties? Build on success Time investment What is the quickest way to gain and lose credibility? Consistency Timely response What aspects should be in place for a successful publication? Relevance

33 Reflections: Lessons Learned Patience Celebrate successes Value other disciplines

34 Key Notes on Clinical Service Initiation Have fun and enjoy! Maintain pharmacy foundation Clinical services build upon Consistency

35 Take-Home Points for New Practitioners Need a clinical service physician champion Knowledge of ALL operational aspects of pharmacy for staff support / credibility Expert knowledge of core clinical aspects related to practice area for support / credibility of physicians, nurses, and administrators Pilot program, analyze, and adjust as necessary Celebrate achievements Publish your hard work!

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