Introduction
Thank you for taking a few moments to read this ASHP Presidential Inaugural Address. While I wish I were up on stage delivering this as a live speech while we are all gathered together in Seattle at the Summer Meetings; alas, I am not.
In these unprecedented times, let me first wish all of you well in your challenges with the novel coronavirus (SARS-CoV2) that causes COVID-19. When we first started hearing about the virus just a few (but very long) months ago, it was hard to imagine how this would all play out and continues to play out across the world. It seems like we have been living in a movie or a novel, not our actual lives. Yet here we are.
As I wrote and rewrote this inaugural address over the last several weeks, I realized that nothing I could say would assuage the challenges, fear, anxiety, grief, and other emotions that so many are feeling, working through, or have already overcome.
This pandemic is challenging us to transform personally and professionally in ways that we could never have imagined. Today I’d like to talk to you about transformation and its many forms, how the role of pharmacy services has transformed (and continues to transform) during and following the COVID-19 crisis, and how ASHP is poised to support these growing and evolving pharmacy roles.
Transformation
We certainly all transform over time, sometimes whether we like it or not. Notice that I am using the term transformation instead of change. Change, to me at least, is just doing something differently. Transformation is beyond that — it is about fully altering your approach, how you see the world, and how you work to grow and develop.
At my core, I am still a farm kid from Minnesota, who went to school as part of the Bison family at North Dakota State University, and who has lived and worked in South Dakota for over 20 years. But while that core is still intact, my ideas, opinions, thoughts, and approaches are different at this point in my life as a formal leader and administrator, as compared to other points in my life as faculty and critical care specialist, for example. It’s certainly different from that 4-H kid leading Holsteins (dairy cows) around the yard — yes I have pictures, just ask me.
Transformation is something that we will all be faced with as we work through and recover from this pandemic. Whether it be the virus itself, or the economic and system changes that have or will occur in society, we will all be transformed.
Servant leadership
Servant leadership is a key element of transformation, so first and foremost, let’s discuss the impact of servant leadership as a stepping stone to transformation. As I have reflected on the last several weeks, I am reminded of a story that my mother told me about her dad (my grandfather), which was probably the first story I ever really heard (or understood) about gratitude, servant leadership, and ultimately transformation.
Grandpa was always someone who could just figure things out. He worked hard as a farmer and a welder, and he was actively involved in his church and rural community. As a kid, I was pretty convinced he walked on water, so this story has always held a special place in my heart.
As the story goes, as a kid, my mom (her nickname was Boo — it still is) noticed that her dad was always doing something for someone else. People brought things by their farm to be fixed or asked him to come over to help them with something, or they borrowed tools or equipment that they needed. But she noticed that it didn’t always go both ways. Most of the time, she never saw some of those same people returning the favor.
So one time, she asked him, “Dad, why do you keep doing all these things for other people when they don’t pay you back?” His answer was, “Well Boo, I don’t worry about that because I know I will get my reward later.” What a lesson in servant leadership.
Demonstrating how you should serve others ahead of your interests transforms your approach to life and your family. Grandpa’s faith and his servant approach made him who he was, and that’s certainly one of the reasons I looked up to him and ultimately transformed into the person I am today.
Servant leadership is what many of us have witnessed, displayed, and championed during these critical times. I’m sure we all have our own stories of servant leadership that have transformed our approach to patient care over these last several months.
ASHP has shared stories from members who were some of the first pharmacists to encounter the trials and challenges of managing COVID-19 patient surges in places like New York City and Detroit. There have been daily podcasts dedicated to COVID-19. In addition, through a special live webinar series, ASHP members like Frank Sosnowski, Joe Pinto, Edward Szandzik, and Michael Peters gave the pharmacy community a direct view into the challenges faced by their hospitals at the peak of the surge. Their stories of servant leadership during a time of great challenge were remarkable and provided enormous support to their staff.
ASHP members have demonstrated servant leadership by collaborating with healthcare partners to develop COVID-19 policies, procedures, and protocols for a range of patient needs, including sedation, analgesia, anticoagulation, and antibiotic/antiviral dosing. Many members are working to ensure that the extreme demands of medication preparation and compounding support the immense surge of patients and significant medication use by COVID-19 patients.
As COVID-19 cases continue to escalate, our members are working as part of the patient care team to select appropriate and sometimes alternative medications, manage sedation targets, and safely adjust dosages to respond to kidney and liver dysfunction in the most critically ill patients. In the face of a highly challenging drug shortages environment, pharmacists are continuously managing the drug supply chain. Further, novel solutions such as curbside prescription pickup optimize physical distancing while allowing pharmacists to provide patient education. Telehealth visits and remote technologies enable pharmacists to support the continuity of care for clinic visits.
These are just a few of the countless ways ASHP members across the country became the servant leaders they needed to be to transform and support teams caring for unprecedented numbers of patients. Pharmacy teams have clearly lived up to the words of George Washington when he said: “Perseverance and spirit have done wonders in all ages.”
Personal Transformation
Personal transformation, in my opinion, is the first step to broader professional or even societal transformation. Over these last several months, I have often been reminded of the advice of Sister Mary Thomas, our Vice President of Mission at Avera McKennan Hospital. She has been a steady and guiding presence for so many at Avera over the years.
She encourages us all to be honest with ourselves about who we are as people, as professionals, as servants, and as healthcare providers. We shouldn’t make ourselves out to be more than we are, but we also should not sell ourselves short. Simply, she says, “Stand in your truth.” This advice has been key for my transformation.
Several months ago, when I first sought her counsel about this inaugural address, she referred me to the book Transformational Presence by Alan Seale. This book was what I needed to read, and I would recommend it to all of you. In his book, Seale challenges you to be the leader you need to be in the moment to ensure the best possible outcome.
He uses the words of Theodore Roosevelt, “Do what you can, with what you have, where you are,” to describe how to be the best leader you can be by first intentionally being present in a situation. Nothing like a worldwide pandemic to cement these words in a person’s mind.
He suggests that instead of pushing against changes or obstacles to affect change, we should work with the change or barriers to achieve the outcomes we seek.
He reframes Roosevelt’s words to state, “If we pause to gain some clarity about where we are and what we have, then what we can do will start to reveal itself.” He contends that initial self-reflection and clear assessment can reveal a path to success.
These words not only apply to our daily challenges and constraints, but they may particularly apply to greater issues faced during crises. If we can be the person we need to be in the moment to work with the change that needs to occur, we will be successful.
Transformation of our pharmacy presence
Thomas Jefferson once said, “If you want something you’ve never had, you must be willing to do something you’ve never done.” The COVID-19 pandemic has demonstrated that pharmacy services are a vital link in the entire healthcare system.
Our ability to compound various products like hand sanitizer and viral transport media when they were in short supply cemented our skills as the ‘can-do’ experts in compounding and product development.
Our ability to find and recommend alternative therapies when first-line agents became unavailable demonstrated our value in the face of significant and rapid changes in the marketplace.
Our commitment to evidence based medication use compelled us to work with our colleagues to direct emerging therapies into appropriate research protocols ensuring optimal patient monitoring and safety while determining overall benefit.
Our physician and nursing colleagues insisted that we be present as part of the care team and planning conversations, further cementing our status as key caregivers.
By demonstrating these skills, we have further established our pharmacy presence. Now, as we adjust to whatever our “new normal” might be as this pandemic progresses and ultimately recedes, it is time for us to act on our truth.
Our truth is that we are the medication experts on the team, and our presence improves patient safety and optimizes outcomes.
Our truth is that our education and training around medication use is unparalleled in the medical professions.
Our truth is that we are trained to ensure patient safety through evidence-based medication practices.
Our truth is that we have a tremendous opportunity to provide many forms of primary care that our patients need, including testing and medication administration.
Our truth is that we have often been limited because of outdated financial and practice constraints.
Our truth is that opportunities to embrace new models of care are right in front of us. Let us act to seize those opportunities.
Embracing opportunities
We have learned many valuable lessons about what is truly important these last few months. We have learned about the value of networks of friends and colleagues. We have learned about the importance of human interaction. We have learned to be innovative with technology. We have learned which rules and regulations are beneficial and which ones don’t make much sense.
Sometimes worldwide events challenge us to transform in ways that we would have never thought necessary or even possible. Our profession has undergone rapid transformation over the last few months with almost daily health policy changes.
State governors are issuing executive orders that expand pharmacists’ ability to provide high-quality care to patients during this crisis. This includes permitting pharmacists to dispense emergency medication refills for an extended time, substitute medications in response to drug shortages, and order point-of-care testing, including ordering and administering COVID-19 tests.
You, as ASHP members, and your institutions, have transformed to meet the patient care demands of this pandemic. As we emerge from the crisis to assume our new normal, pharmacy services will have demonstrated value in multiple ways. First is our ability to rapidly adapt to changing scenarios while relying on evidence-based practices to help guide conversations about the best use of medications.
Next, we will have demonstrated our core value to the team by rapidly identifying and recommending alternative treatment recommendations. We will have demonstrated our ability to step into public health roles relative to vaccinations, testing, and public education as one of the most accessible healthcare providers.
ASHP supports members
Transformation is something that we will all be faced with as we work through and recover from this pandemic. Throughout the crisis, ASHP has supported members by developing new tools and disseminating important clinical guidance for those working in current hot spots and preparing others for potential patient surges.
ASHP has engaged with federal and state policymakers to advocate for improved access to critical medications and to increase the production and supply of personal protective equipment for pharmacists.
When the worst is behind us, ASHP will be poised to support the growing and evolving role of pharmacy services. ASHP’s strong relationships with other professional organizations will further advance our ability to make a difference on national, state, and local levels.
As we individually develop relationships and demonstrate our value, ASHP will serve as our collective voice. ASHP will continue to advance educational and professional initiatives that bring pharmacists closer to our patients.
We will continue to drive the message of transformation through our policy and advocacy processes, and by directly talking with all of you about the resources available through ASHP to assist your transformation.
Act on your truth
Our call to action today is not to develop a brand new strategy for the future. Nor to insist on returning to the exact jobs and roles we once had.
Our call to action is to act on our truth. To recognize the opportunities that are in front of us and seize them — to work with others to affect the changes in the system that we know are needed. To guide and build our future ourselves — not to have others create it for us. To be truly present in the moment as leaders to ensure the best possible outcomes.
My challenge to each of you is to stand in and then act on your truth. Mold the opinions of your patients, your healthcare colleagues, administrators, and the public based on that truth so that we can truly transform ourselves and the pharmacy profession.
Conclusion
To conclude today, I am reminded of the words of Abraham Lincoln when he said: “I’m a success today because I had a friend who believed in me, and I didn’t have the heart to let him down.”
So I would like to take a moment to thank those friends who have been so instrumental in my career and my service to ASHP. First, my wife Jodi, the love of my life and my rock of support. Thank you, Jodi, for always being there and supporting me through everything.
I also want to thank my parents, Jim and Betty, who taught me about hard work and sacrifice and encouraged me to be anything I wanted to be. Thank you, Mom and Dad.
And finally, my very long list of mentors, colleagues, and friends in pharmacy. There are so many that I hesitate to try to list names, as you have all meant the world to me, even if you didn’t realize or know it at the time. Thank you to all of you.
Thank you for spending some time with me today, and remember to act on your truth! I appreciate everything you are all doing for our patients, for each other, and for society. Thank you, and I look forward to seeing you soon!
