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New ASHP President Calls on Members to Move Profession Forward

Donna Young

The following speech was delivered yesterday by new ASHP President Steven L. Sheaffer, Pharm.D., FASHP, before the Society's House of Delegates in Los Angeles.

As president, I am moving into a new, more active role in the leadership of ASHP. I'll be working to focus ASHP's messages to the public, to other health-care providers, to public-policy makers, and to the many other audiences we need to reach in this new world.

I don't use the phrase "New World" lightly, for we really are in a new world of practice in hospitals and health systems. Many questions present themselves today.

How do you provide optimal care for patients while keeping costs reasonable? How do you treat a patient's disease with the appropriate drug therapy when there is a shortage of the best therapeutic agent? How do you properly staff the pharmacy when highly skilled practitioners have become so scarce?

As a former pharmacy director in a community health system, I have felt all of these pressures keenly. A day hasn't gone by in the last 13 years when I wasn't balancing the challenges of cost-efficient, safe, effective medication therapy.

But I'm not here today to state the obvious: We all are juggling.

What I am here to do is to spark some discussion and enthusiasm about how we can effectively map out our futures as health-system pharmacists. I am here to challenge everyone to provide better, accountable, comprehensive patient care services.

I always find that it's helpful to have some context when you're listening to someone speak publicly as I'm doing here today. After all, it's hard for you to know where I am coming from if you don't know where I came from. In looking back over my 25 years as a hospital pharmacist, I decided to ask myself a very basic question: Why did I become a pharmacist?

Now that might seem like it has an obvious answer. But when you've been in practice as long as I have, the reasons why you entered the profession can be superceded by day-to-day challenges. So I want to examine with you here today my rationale for choosing this profession. And I want to help you remember why you chose to practice pharmacy in hospitals and related health-system settings.

Let me tell you about some pharmacy leaders I met at the start of my career who forced me to re-examine my own vision of what I would be doing. These people committed themselves to a new vision that honed in on the patient, not just the product. They believed that they could change the profession and transform how we are viewed by our health care colleagues and patients.

You may know some of these folks: Peter Vlasses, Tom Cali, Barbara Korberly, Don Phillips, and Judy Deglin. Or perhaps you've met John Gans, Joe Smith, or Herb Flack, leaders who empowered others to live their vision. For me and for many others, these practitioners fundamentally altered the path of my career.

But what about you? Why are you here today? Perhaps you're here at this meeting for very practical reasons, to fulfill a commitment to your residency preceptor or to enhance your resume. Perhaps you're here because you want to learn from the experience of colleagues, to participate in an ongoing dialogue about pharmacy. Almost certainly, you came because of ASHP's outstanding continuing education.

The fact that you're participating here in the House shows that you believe ASHP's policy process contributes in a valuable way to your own practice and your vision for the future. I can speculate that you also believe as I do that our involvement here has made—and continues to make—a difference in patient care in this country.

We've established some of the reasons why you're here today. But let me ask you a more fundamental question. Why are you a member of ASHP?

Is it because ASHP has an inspiring vision for the future of the pharmacy profession? Maybe you value the fact that ASHP gives us the tools to do our jobs better. Perhaps you appreciate the governmental and regulatory advocacy work ASHP is doing on your behalf. You may value the way the Society is educating consumers and the media about the contemporary roles of health-system pharmacists. You might point to the way ASHP pushes us to take pharmacy to the next level, such as our continuing pursuit of fail-safe medication-use systems.

All of these reasons are compelling. Again, I submit to you that we choose to participate in ASHP because it allows us to make a difference in patient care.

But I still want you to go a little deeper with me today. No matter when you entered the profession, you were aware of the incentives offered by the community and pharmaceutical industry worlds. Why, then, did you choose hospitals, or outpatient clinics, or educational settings in which to practice?

I would again speculate that we all chose this practice environment because we can provide a more comprehensive approach to patient care. That we are able to work closely with colleagues within and outside of pharmacy who are focused on quality, practice standards, use of cutting-edge technology, and achieving optimal, cost-efficient patient care.

Many of you may know that I recently became vice-chair for experiential learning at the University of the Sciences in Philadelphia. After practicing within Mercy Health Systems for 13 years, I am very excited about working with practitioners and students in clerkship programs in a variety of settings, especially in hospitals and health systems in the Philadelphia area.

Moving to a new job was not an easy decision for me. But I must be candid about the changes within my health system that made me examine how I could effectively fulfill my responsibilities both as ASHP president and as a hospital pharmacy director. New fiscal realities, fewer staff, higher expectations...these changes are not unique to Mercy. I'm sure you're experiencing them, too. We are all, really, in the same boat.

The same professional values that kept me in hospital practice for the past 25 years will serve me well in my new job. I still believe very strongly that health-system settings allow us to practice our profession in an optimal way. They let us focus our talents on the types of patients who are in greatest need of our services. They expose us to the newest medical technologies. They help us help people make the best use of medicines.

These reasons get at the heart of my primary question today, which is "Why did you become a pharmacist in the first place?"

Although our profession has traditionally been widely respected, pharmacists have never been able to boast as high a profile as physicians or nurses. We know how slowly the public perception of pharmacy is changing from one of a product focus to one that focuses on the patient. We operate at all times on a high-wire act, balancing budgetary pressures with providing safe, optimal drug therapies. It can be an exhausting, all-consuming effort. But if we keep in mind the reasons we entered pharmacy in the first place, we can re-ignite our "first love" and know that we do make a difference in the lives of our patients.

So, you may be wondering why I have challenged you to take a look back at your motivation for entering this profession. As I said earlier, we work in trying times. ASHP's own staffing surveys found that pharmacist and technician vacancy rates in hospitals are reaching critical levels. This year, 70 percent of respondents called the shortage of experienced practitioners "severe." We are all working longer hours under tighter deadlines.

Harold Godwin, in a December 2000 commentary in the Journal, lamented the fact that ASHP's practice standards and guidelines are not in place in the majority of hospitals and health systems in the U.S. He said that "closing this practice gap is critical for our profession and should be a priority for the Society."

If we don’t begin to close this gap, we risk losing a new generation of practitioners who have come into pharmacy looking for patient-care responsibilities. We risk their disenchantment with the outmoded way that many of our pharmacists still practice today.

Now, let me tell you about Joy Cho, a colleague of mine at Mercy Health System who taught me a lot about how to balance these paradoxes. Joy, who agreed to let me share her story with you today, has always been an outstanding pharmacist, committed to her work, her fellow practitioners, and her patients.

But Joy experienced a life-changing event over the last year—she was diagnosed with non-Hodgkin's lymphoma and shortly thereafter began a grueling, six-month course of treatment.

Becoming a patient changed Joy in ways neither she nor I could have anticipated. She now knows how it feels to be constantly poked and lose your sense of privacy and be treated like a medical case instead of a person with thoughts and feelings. She knows about pain and recovery...the effects of powerful medications...the uncertainty of treatment outcomes.

Because of Joy's experience and her newfound knowledge, she can no longer look at herself as simply a cog in the health care machine. As a pharmacist, she can no longer approach her job mechanically or dispassionately.

Joy now challenges everyone around her now to try to see through the eyes of a patient. To understand the far-reaching and sometimes devastating effects of illness and recovery.

Joy's experience made me rethink many of my own values in pharmacy and whether we really are as patient-focused as we say we are. Joy is quick to point out that no matter how many pressures we are under, we must never forget that patients are ultimately impacted by all of our decisions and actions.

As a manager, Joy struggles daily with inadequate reimbursement for new drug breakthroughs. Yet she is quick to tell you how erythropoietin and Neupogen allow her to maintain her work schedule and quality of life. And she has no patience for pharmacists who complain that a patient did not receive a medication because the physician did not return his page when a non-formulary medication was ordered.

What has impressed me the most is how Joy has changed her approach to what we often think of as "the little things"—such as pausing long enough in our busy schedules to answer patients' questions or explain why a problem occurred and then taking responsibility for resolving that problem.

While I believe pharmacists in hospitals and health systems have done a great job in selling our value to administrators, medical staff, and nurses, Joy's experience has shown me that we still have a long way to go in expanding our sphere of influence from the medication cassette to the patient's bedside.

So, given our current situation, what are we to do? We face a fork in the road, each choice complex and difficult. But one path leads to a re-engineering and revitalization of our profession. It leads to a rebirth, if you will, of our mission to use our knowledge and experience to help patients use medications wisely. The other path is certainly the safer one—a road that doesn't demand anything new or different from us. But this safer road, it seems to me, is one that will dead-end. It is a road that brings us no new vistas and few opportunities to positively affect patient care.

Being here in California for the Annual Meeting is truly an experience filled with irony. This is a state that offers a full expanse of microclimates, from the desert to snow-covered mountains to spectacular beaches. But it also tends to be visited by a wide array of natural disasters, including earthquakes, mudslides, and wildfires. Residents have a simple answer for why they stay in California and endure the occasional calamity. They highly value the state's laid-back lifestyle, beautiful weather, and recreational opportunities. They have carefully balanced the pros and cons of living in such a volatile place and decided that the benefits outweigh the risks.

I think for most of us here today, the benefits of staying in pharmacy far outweigh the risk of medication errors, drug shortages, or misunderstanding of our role by colleagues. But as your new president, I must say that this might not always be the case if we don't commit ourselves to making a sea change in the way we work. Whether it's the medication-use processes we work with each day. Or the evolving patient-care roles we assume in our institutions. Or the isolation we often work under as part of a system that doesn't fully value the contributions we make. We desperately need a change. And we need to make that change happen!

You may be asking, what can I do about this state of affairs? I would suggest that you can contribute in a number of ways. Think of a tidal wave. It starts as a mere rumble as the seafloor moves under pressure from the earth's core. The energy in that underwater earthquake launches a chain of events. A small wave rolls along, building into a crescendo, an all-powerful force that moves across miles of ocean. As it reaches shallow water, the wave gains height, dwarfing the coastline. A tidal wave doesn't end until it hits land with incredible force, moving objects like buildings and cars that would have seemed permanent at any other time.

This massive energy began with a barely perceptible rumble underwater.

Your individual and collective efforts, supported by ASHP's work on your behalf, can be like that tidal wave. Whether you serve as a preceptor for pharmacy residents. As a state delegate acting on behalf of your pharmacy colleagues. In your day-to-day efforts to influence the safe and effective use of medicines. You can help us turn the tide in health-system pharmacy. As the American poet Henry Wadsworth Longfellow once said, "If you only knock long enough and loud enough at the gate, you are sure to wake up somebody."

On Monday, members of the House of Delegates knocked long and loud, working together to enhance the proposed vision statement for pharmacy forwarded by the Board of Directors. I applaud each and every delegate for that effort. The fact that you all worked together on refining this document means that you recognize the critical juncture we face at this point in our history. It means that you understand that the vision statement is not just a pie-in-the-sky wish list or simply a new way to deliver patient care.

It represents a vision for success.

This far-sighted set of goals is a critical road map for our future. It is our tidal wave—a powerful catalyst that will sweep away the remnants of an outdated system and allow for construction of a new way of practicing pharmacy.

The first element in this glimpse of the future is significant improvement in our patients' health and quality of life. This would be a natural outcome as pharmacists lead and collaborate in improving both individual use of medications and the overall medication-use process.

It's obvious that patients need our drug therapy knowledge and skills more than ever. A recent ASHP survey found that Americans are taking an average of two medications per day. A study we just completed shows that one-third of seniors are taking medications prescribed by two or more physicians. There is a real need in the patient community for our medication-management expertise.

A second element is that pharmacists will spend their time managing patient medication therapy and providing related patient-care services. On the face of it, this statement might seem radical to some practitioners. It really shouldn’t be.

With our education, training, and wide-ranging knowledge of the hundreds of drug therapies available today, it seems amazing to me that we haven't already reached this goal.

But many barriers exist, not the least of which is the compensation structure. Until we are recognized as health care providers under the Social Security Act, many of our health systems won't deploy us where we could make the most difference—in monitoring and managing patients' medication therapies.

ASHP is on a fast track to change the Social Security Act. Just last week, we succeeded in introducing legislation in Congress that could conceivably help us start this tidal wave of change in pharmacy. The Medicare Pharmacists Services Coverage Act will elevate our ability to help high-risk patients optimize their use of medicine.

But we need the assistance of every member to accomplish this goal...To host site visits with legislators...To get out the message to the public about contemporary roles of pharmacists...To send a letter to your Congressman about what you do and how you contribute to improving patient outcomes.

On Monday, Kevin Colgan from Illinois brought forth the new element of the vision, reminding us that we can't lose control of our historic, professional responsibility for the entire medication-use process. This includes everything from assuring the quality of the purchasing managing information systems that influence medication patient medication management. All elements of medication use would be under the control of pharmacy.

The fourth element of the vision is one in which patients will value the services of pharmacists so much that they begin to ask us directly to help with their drug therapies. This partnership assumes that we've educated consumers so well that they wouldn't think of going into a hospital or other setting without availing themselves of our medication-use knowledge. And it is based on the elimination of compensation barriers that separate deserving patients from the knowledge and expertise of pharmacists.

The fifth element of the vision asserts that pharmacists and other health professionals will redesign the medication-use process to achieve significant improvements in patient outcomes...sensible use of human resources...and increased efficiency. This vision asks us—and other health professionals—to transcend the boundaries of our traditional roles in coming up with better ways to handle medications.

This vision assumes that we will be working together for the common good. It moves the conversation off of blame into dispassionate assessment. It brings us to the ultimate goal: safe, effective, and efficient medication use.

From my point of view, the sixth part of the vision is the foundation on which all the other elements are built. It looks to the future and assumes that pharmacists will lead a national data-driven and evidence-based program to foster best practices in medication use.

To accomplish this, we need to collect and analyze information on prescriber behavior and patient outcomes.

We need to heed the call to ensure optimal medication handling and distribution procedures in our own settings.

We need to fundamentally alter pharmacy education to focus sharply on learning to work on teams in collaboration with others.

We need to construct new research agendas, particularly as they relate to "what works" vs. evidence-based practice.

The final aspect of the vision is that patients, health professionals, and administrators will come to view pharmacists as caring, compassionate, medication-use experts. That patients would feel empowered to consult with us when they have questions or concerns. That physicians and other caregivers would demand that we be on their patient-care teams and rely on our expertise to make informed clinical decisions. That administrators would turn to us in establishing medication-use standards and devising safe and reliable medication-use systems.

To realize this vision, we must continue to assemble outcomes data that illustrates the value we bring to the bedside and in our clinics.

You may be sitting there thinking, "What does a vision statement have to do with me?" Well, just like the saying, "All politics is local," I want you to focus on what you can do every day to move practice forward.

You may remember the group of pharmacists I mentioned at the beginning of my talk today who had a different vision for pharmacy. They were often the subject of questions, doubt, and even, sometimes, ridicule, from both fellow pharmacists and other health care professionals. But they kept pushing the envelope. They stuck to their vision of pharmacists as patient-care advocates. They didn't give up.

Let me now share something interesting about the U.S. space shuttle that I think has application to what I'm talking about today. The shuttle weighs 4.5 million pounds and is as high as a 15-story building. People who have witnessed its takeoff say that it is a magnificent thing to behold.

After the final rockets are fired, and the shuttle is freed from its moorings, it inches and claws its way skyward. It burns up massive amounts of fuel and exerts millions of pounds of thrust to break gravity's bonds. The shuttle expends 85 percent of its energy during the lift-off phase alone, just to get this super structure one-twelfth of the way to its cruising altitude.

Likewise, the intensity of our efforts over the next five years to alter the path of pharmacy may feel difficult. Implementing this vision may seem like an enormous expenditure of energy and time.

However, if we succeed, the next five years will determine our profession's "cruising altitude" for the foreseeable future. So, as you can probably tell, I am very committed to helping launch this vision during my term.

What I'm asking you to do—to help ASHP as it works toward a new vision for pharmacy—is not going to be easy. It will challenge much of what you know about practice today. But it will preceptor at a time. We will change the future.

As the biologist David Starr Jordan once said, "The world stands aside to let anyone pass who knows where he is going."

With this vision, we can know where we are going. And we can change pharmacy and our future.