When building pharmacy department value, it pays to think outside the box

Improve your communication skills

When a chief goal is to build the pharmacy department's value within a health care system, one of the primary roles pharmacy directors play is that of communicator.

"We convince people all day long to do things they might not want to do," says Susan D. Bear, PharmD, director of clinical pharmacy services for Carolinas HealthCare System in Charlotte, NC.

"The pharmacy department commands a large portion of expenses in hospital and revenue," Bear says. "We're integral in everything in a health care organization, and so we have to advocate for our interest, as well as for our department's interest."

Pharmacy directors need to network with human resources managers, information technology staff, as well as clinicians, says Robert Carta, assistant vice president of the division of pharmacy services at Carolinas HealthCare System.

"One way you learn is through networking," Carta says.

Pharmacy directors need to observe meetings in which other department heads ask for changes, learning from their proposals and how they are received, he adds.

"It's how you ask for it and how you present things in a way that your senior leadership thinks in that direction," Bear says.

Also, an important goal is to develop credibility, and this takes both communication and action.

"You have to be successful operationally," Carta says. "You have to build a solid distribution system and develop credibility in terms of pharmacist expertise and distribution of product."

Once a pharmacy demonstrates excellence in this area, then it's time to build clinical roles, he adds.

"Once you build your foundation, the next thing you know the human resources department hears about how you've done, and they call you in and ask you to sit in on their benefit meeting," Bear says. "And information technology people call and want to hear your input on design of the pharmacy information system."

Carta spent years building credibility and a good reputation as a leader before asking the health system's top executives to consider letting his department build a system for handling employee medications rather than continue to send this role to a third party.

The goal was to bring the whole function in-house to save money on the health system's medication benefit costs.

"When I was proposing this I was invited to employee hospital system committee meetings, and I was invited through an e-mail outlook exchange," Carta says. "I kept showing up at the meetings and automatically became a member of the committee."

Sometimes pharmacy directors have to put themselves in places that might be a little awkward, but if they speak up intelligently, then they eventually will become a member of the committee, he adds.

"It goes back to thinking outside the box," Carta says. "We need to zero in on all of these expenses, and identify other opportunities."

This is an example of achieving success by identifying influential people, getting to the table with them, and, over time, establishing a personal track record with them, Bear notes.

A good pharmacy leader, like Carta, knows what various other health care system leaders will propose and what they'll say "yes" and "no" to, Bear adds.

Carta's plan was to bring employee medication fulfillment in-house, so he presented it as a way to benefit the human resources department to meet their goals, she says.

"And we came out the winner," she adds.

In another example, a pharmacy leader might desire to have a pharmacist be the point person for a new chronic disease management program, such as a diabetes management initiative.

Others sitting at the table believe their own staff could take the lead, so the nursing department proposes that a nurse heads the project, physicians propose having a doctor take the lead, and quality improvement leaders want to be in charge, as well.

"You have to go in and steer the question in your direction," Carta says. "Pharmacy should be the point person."

So when Carta was in this situation, he promoted clinical pharmacy by showing that pharmacists are in the best position to make the new project happen quickly and most efficiently, while maintaining relevant pieces for other disciplines.

"We decided pharmacists will take a lead role and start out with diabetic patients," Bear says.

"We start with small successes, getting those under our belt, and then develop a good personal track record," Bear says.

"So when administrators say revenues are down, expenses are up, and we need to cut costs, that's when a good pharmacy director says, 'Wait a minute, only 20% of my total pharmacy expenses are in salaries, so you won't get a big bang by cutting staff,'" Carta says. "You have to cut drug costs, and to do that you hire more pharmacists."