Management Consultation

Management Consultation Promoting pharmacy business success through the implementation of a departmental operating review series

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ssential to the continual developmental competence of the pharmacy management practitioner is the acquisition of knowledge in the business of pharmacy. Pharmacy management practitioners acquire, share, and continually reinvest in the management and leadership of themselves, their team, and their business enterprise. The business aspects of pharmacy have traditionally centered on issues involving pharmacy billing and reimbursement. While those aspects remain critical to running a successful pharmacy department, progressive pharmacy healthcare stressors such as increasing medication and practice model cost control continue to mount. In order to illustrate how the pharmacy department supports and contributes to the larger mission and vision of the organization, the pharmacy management practitioner must position himself or herself to effectively market to peers and executive leadership the intrinsic value of pharmacy services. Given the large

expenses incurred and revenue generated and managed by the pharmacy department, it is only logical that the pharmacy

management practitioner demonstrate a broad understanding of and be able to effectively communicate the core business value within the pharmacy and its embedded businesses. The creation of a

The Management Consultation column gives readers an opportunity to obtain advice on common management problems from pharmacists practicing in health systems. The assistance of ASHP’s Section of Pharmacy Practice Managers and its Advisory Group on Manager Development in soliciting Management Consultation submissions is acknowledged. Unsolicited submissions are also welcome. Readers are invited to submit topics for this column to [email protected] or ASHP c/o David Chen, Director, Pharmacy Practice Sections, 7272 Wisconsin Avenue, Bethesda, MD 20814 ([email protected]).

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pharmacy departmental operating review (PDOR) series ensures that the department’s leaders, from pharmacy manager to senior vice president, know that the core business of pharmacy is running as intended. The University of North Carolina (UNC) Medical Center, an 843-bed academic medical center in Chapel Hill, is the flagship hospital for the UNC Health Care System. Providing and leading in the provision of medication management and delivery of patient-centric pharmacy care is the medical center’s department of pharmacy. The mission of the medical center’s department of pharmacy is to provide the highest quality patient-centered care through efficient, innovative, and collaborative service while developing leaders. The medical center’s department of pharmacy consists of approximately 321 full-time equivalents, including pharmacists, pharmacy technicians, and pharmacy support staff members. The department of pharmacy operates with an annual drug budget exceeding $120 million, and provides clinical, operational, financial, and teaching services spanning 21 geographically diverse pharmacy cost centers. PDOR series. The medical center’s department of pharmacy instituted a PDOR series in August 2013. An organizational departmental operating review series is an in-depth and objective review of an organization or department within an organization, allowing leadership to define and discuss key areas of focus.1 The purpose of creating the PDOR series was to establish a Continued on page 612

Management Consultation Continued from page 610

defined framework for pharmacy-specific presentations while ensuring continual cost-center readiness and preparedness for quarterly organizational department operating reviews held with senior medical center leadership. Topical agendas for the PDOR series were developed and include pharmacy finance, employee engagement, clinical practice, ongoing clinical and operational projects, and initiatives that affect the department. The department and its leadership created the following five central governing and anchoring series tenants: 1. Define area-specific goals as a means to improve operational standards under the organization’s six pillars of excellence: finance, growth, innovation, people, quality, and service. 2. Provide pharmacy leadership with routine performance reports for defined operational groups while promoting and demonstrating connectivity across all cost centers housed within the department. 3. Promote the creation of dashboards illustrating best practices and current standards within the department. 4. Serve as a venue to plan and discuss future avenues for revenue growth and expansion of the medical center’s department of pharmacy practice model. 5. Encourage staff involvement in operational objectives and initiatives by having them take part in the PDOR series presentation, both in assembly and conveyance of the final presentation. Series schedule for the operating review. The PDOR series is a recurring monthly meeting with defined areaspecific pharmacy presentation groups that present to the pharmacy leadership team and pharmacy staff on a rotating basis (every four months). This allows pharmacy leadership to evaluate the performance of these department areas over the previous four months and gives other pharmacy management practitioners the opportunity to learn about ongoing and

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potential future projects and initiatives occurring throughout the department. Presenting teams for the area-specific PDOR series represent four main groupings: (1) administrative services and acute care services core operations, (2) ambulatory care services, (3) acute care services and medication-use advancement, and (4) pharmacy hospital and clinic affiliates not directly housed on the main campus that report to leaders within the medical center’s department of pharmacy. Senior medical center leadership holds a quarterly organizational departmental operating review. Using the cumulative pharmacy-specific business data and trends presented over the past four months, senior pharmacy leadership assembles the pharmacy department presentation using many of the thematic trends and area-specific data to highlight the department and forecast trends. The monthly PDOR series allows senior pharmacy leadership, their teams, and their staff to be in an ever present and readied state to review and discuss the department’s business. Ideally, each member of the pharmacy leadership team should know, understand, and be able to articulate the functional metrics of each cost center within the department. At the same time, the PDOR series serves as an effective tool for pharmacy leaders to market the accomplishments of their team, creating an open and inviting environment for other pharmacy leaders to ask questions, give suggestions, and understand the complexities of different operational areas within the department and across the continuum of each cost center. Planning for the PDOR series. The PDOR required a planning phase for pharmacy management practitioners. With a scheduled go-live month of August 2013, pharmacy leadership reached consensus on three phases to ensure go-live readiness and PDOR series success. In phase 1 (May 2013), associate and assistant directors met with pharmacy management practitioners to discuss and perform an area-specific supervised mock PDOR before presentation to the cost center team leadership. The mock review

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provided a framework of suggestions that worked within the organization’s six pillars of excellence. At the conclusion of the mock review, the associate and assistant directors reviewed and provided assistance with the development of areaspecific dashboards and provided general recommendations on presentation and handout etiquette, where needed. During phase 2 (June 2013), associate and assistant directors reviewed and reported the area-specific PDOR series objectives each pharmacy management practitioner planned to present. Pharmacy management practitioners displayed, if readied, their area-specific dashboards and performed a second mock PDOR. At the conclusion of the mock review, directors and pharmacy management practitioners discussed and incorporated, where recommended, PDOR series contentspecific refinements and provided final recommendations on presentation and handout etiquette, where needed. In phase 3 (July–August 2013), pharmacy management practitioners met with the cost center leadership team to finalize area-specific PDOR series presentations and area-specific dashboards. After final changes and recommendations were approved, the pharmacy management practitioners prepared for the PDOR series go-live date based on the approved schedule. Each operational area is tasked with creating and maintaining functional areaspecific dashboards that are highlighted throughout the PDOR series. These functional dashboards target key areas of pharmacy performance within the six pillars of excellence in addition to providing a visual business reference for review during the PDOR series meetings. Illustratively, performance metrics for an area-specific PDOR series presentation may include budget updates and variance explanations (finance), expansion of clinical services (growth), deployment of a new inventory management system (innovation), employee engagement updates (people), medication turnaround time performance (quality), and Hospital Consumer Assessment of Healthcare Providers and Systems score updates (service).

Management Consultation

As departments of pharmacy grow in size, number, and complexity, it becomes increasingly difficult for members of the leadership team to stay updated on the performance metrics of areas outside of their respective cost centers. In the past, each pharmacy management practitioner singularly focused on his or her cost center and area of influence, and cost center–specific expectations were known only by the pharmacy management practitioner who oversaw them. The PDOR series has allowed each member of the pharmacy leadership team to broadly and inclusively discuss key areas of focus within the organization. Moreover, the PDOR series allows for the creation of transparency across the department and helps pharmacy management practitioners market all of the services that pharmacy is providing. Conclusion. A successful PDOR series raises the bar for the pharmacy management practitioner by creating one

standard presentation model that promotes business unity. A well-developed PDOR series promotes departmental peak performance, promotes a culture of excellence, and develops emerging pharmacy management practitioner leaders to speak in an articulate and well-informed manner regarding their pharmacy business. The culmination of the recurring monthly area-specific schedule allows for a more thorough and comprehensive quarterly departmental presentation to senior medical center leadership, allowing the effective marketing of pharmacy services, its brand, and legacy to the organization’s executive leadership. 1. Puckett WH. Recruiting a manager for financial activities in pharmacy. Am J Health-Syst Pharm. 2008; 65:2014-5.

Robert P. Granko, Pharm.D., M.B.A., Associate Director of Pharmacy Moses H. Cone Memorial Hospital Greensboro, NC [email protected]

Adjunct Associate Professor Division of Practice Advancement and Clinical Education University of North Carolina (UNC) Eshelman School of Pharmacy Chapel Hill, NC Matthew H. Lamm, Pharm.D., M.S., BCPS, Clinical Manager—Central Inpatient  Pharmacy UNC Health Care System Assistant Professor Division of Practice Advancement and Clinical Education UNC Eshelman School of Pharmacy

At the time of writing, Dr. Granko was Associate Director of Pharmacy, UNC Medical Center, Chapel Hill.

The authors have declared no potential conflicts of interest. DOI 10.2146/ajhp140248

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Promoting pharmacy business success through the implementation of a departmental operating review series.

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