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6/3/2003

New ASHP President Calls for Pharmacists to Recommit to Their Communities

Donna Young

The following inaugural address was delivered today by new ASHP President Daniel M. Ashby, M.S., FASHP, at ASHP's Summer Meeting in San Diego. 

It is such a pleasure to be standing before you today as I begin my year of service to you and to ASHP.

This organization has been an important part of my career over the years, serving as a valuable resource at key moments in my professional life. 

For 60 years, ASHP has dedicated itself to supporting practitioners in hospitals and health systems. I have firsthand knowledge of the value of membership in ASHP—from my first position at Grace Hospital in Detroit, later at Methodist Healthcare in Memphis, and now in my current position as director of pharmacy at The Johns Hopkins Hospital in Baltimore, Maryland.

I couldn’t have asked for a better place to start my career than southeastern Michigan. It truly was a great place to "grow up in pharmacy."

I was exposed to an innovative culture of pharmacy practice through the Southeastern Michigan Society of Health-System Pharmacists. Its longstanding dedication to members, coupled with the establishment of the Harvey A.K. Whitney lecture award, honed my sense of the pharmacy community. Pharmacy leaders in Michigan were committed to standards-based practice. They adopted a “can-do” attitude in improving the scope and quality of services.

Colleagues like Ronald Lukasiewicz, Richard Lucarotti, Terry Rehder, and Lyle Moore provided support, camaraderie, and guidance in my career. I appreciate their contributions and friendship more than words can express.

The list of those I would like to acknowledge could go on and on, but I’d like to specifically thank William Greene, Jennifer Reddan, Richard Faris, and David Solomon—all from Tennessee—and Todd Nesbit from Baltimore. These folks are true leaders whose encouragement continues to mean a great deal to me.

My decision to pursue a career in pharmacy was influenced most by my father. I was a high school senior when he gave me some information that explained the role of a pharmacist. The information was an article in Consumer Reports magazine. Can you imagine choosing your career from that? Nevertheless, it was a great decision.

The support I’ve received in my career is only surpassed by the support I receive every day from a caring family. They include my exceptionally tolerant wife Barbara; my two sons, Timothy and Bryce, who would make any father very, very proud; two wonderful in-laws, Bill and Kitty Janes; and a terrific Uncle Meredith.

I’m also blessed to have lifelong friends who we met during our time in Michigan. Bryce and Suzie Smith and their children Erich and Natalie have become our extended family. These folks have been instrumental in my journey and essential in my life.

In the months following my election last summer, I spent many hours pondering what I wanted to say to you today. I thought about where we have been as a profession and where we are going. And then I thought about the people I just told you about.  My mentors, my peers and colleagues, my family. Taken together, they represent my personal community--just as we, all of us here today, have our own personal communities, and just as all of us share the community of health–system pharmacy.

So what I’d like to do today is to expound a little bit on the significance and vitality of the concept of community, and also to rely on the strength and sense of community that is reflected in this hall today--my personal community, yours, and ours collectively within ASHP--in appreciating the richness of our lives and our profession; in contemplating the challenges that we face; and in setting out some simple but vital goals and objectives for the coming year and beyond.   

Community, as I define it, reflects a cooperative spirit. This notion of community within our profession is certainly not a new one. Pharmacy was founded on communal values, indeed, the very nature of our work is based on it.

A sense of community requires that we strive for unity even in our diversity. It conveys certain rights, and it requires certain responsibilities.

Let’s consider just how powerful community can be.

Great historical events took place in Baltimore after the founding of this great country; events that I really did not fully understand until I first came to work at Johns Hopkins Hospital.

Most Americans are familiar with the fact that Francis Scott Key wrote the words to our national anthem as he sat captive on a British ship in Baltimore’s harbor. But the events leading up to this moment in history are often overlooked in the telling of the story.

After burning the nation’s capital in the summer of 1814, the British moved on to Baltimore, planning an attack by both land and sea.

They made one mistake: They didn’t count on the heroism and communal spirit of the people who lived in the city. Men and women, young and old, free and slave, rose up together as a community to repel the invaders.

These citizens fortified the city and took up arms against the greatest army in the world. And, to everyone’s surprise, they succeeded in driving off the Redcoats. It was a watershed moment in American history. A moment when we realized that communal effort can change the outcome of what had looked like a sure thing.

The response of the entire community of Baltimore made the difference.
What I’d like to share with you today is my fervent belief that the community of pharmacy can accomplish a similar feat. By coming together for the common cause of patient care, we can meet the challenges that face us:

• Medical errors

• Regulatory burdens, and

• Changing technology

We can embrace the need for change rather than cower in fear before it. Change confronts us everywhere. Even the word “health care” itself is being transformed. From the changing nature of professional relationships to specialization to emerging standards of care to the problems of high medical costs and the challenge of the uninsured, we truly do live in a complex time. It’s anyone’s guess what America’s health care system will look like in 10 years, let alone 50.

But we do know that pharmacy, in particular, faces some very real challenges that will require all of us to work together.

The great philosopher Yogi Berra once said, “If you don’t go to somebody’s funeral, they won’t come to yours.” Yogi was referring, of course, to the unspoken norms of reciprocity that provide the very foundation of social networks.

In other words, if you participate in a community, you have responsibilities to others as well as rights. This reciprocity, or bank of favors, pays dividends to the wider community as service meets service. The premise is that individuals have faith in each other we know that we’ll find help, empathy, and the bonds of fellowship within these circles.

Unfortunately, in recent years there has been an erosion of what we’ve traditionally defined as “community.” According to sociologists, civic engagement of all sorts — from neighborhood bridge clubs to the local PTA--has declined sharply over the last two decades.

The widespread nature of the problem is best summed up in the book, The Spirit of Community: “Americans expect to be tried before a jury of their peers, but are reluctant to serve on one.”

We in pharmacy cannot afford to turn a blind eye to the decline of community. We risk losing too much. You see, social capital pays off in a number of ways that are critical to our success. 

In health-system pharmacy, this concept of community exists within a universe of individual relationships and social networks. For our purposes today, perhaps we can think of this concept as a set of nesting boxes that fit together, one inside the other. 

Individual relationships, of course, start with the pharmacist and patient.  These relationships are represented by this small box.  Even though this is the smallest box, it is the core of the set because it is the most important community that exists in pharmacy.

We are bound by professional ethics and the public’s trust to help patients achieve better health through the appropriate and rational use of medications. To strengthen this relationship, we reach out with ongoing dialogue and understanding to create positive outcomes. Through these interactions, we are able to build bridges to the larger community as a whole.

The obvious question now is, What comes next?

The second, slightly larger, box represents professional relationships. One of the most important professional relationships, in my view, is that of a preceptor and resident. This bond is a covenant marked by a series of obligations and responsibilities.

Preceptors act as mentors and sounding boards, leaders and gentle persuaders, revealing by example how to create the pharmacist-patient connection.

Residents, in turn, expand on that knowledge through their friendships with each other and with younger students. In this way, the individual relationship fosters an ever-widening circle of influence.

I am especially committed to the value of residency training because of my experience at Harper Hospital under the leadership of Ronald Turnbull. Even though it’s been 16 years since I last worked with Ron, his practice philosophies are always with me, including his belief in the importance of residencies. Ron is here in the audience today as a personal favor to me. Thank you Ron for all of your contributions to pharmacy and to me personally.

Up until my inauguration today as ASHP President, my most fulfilling ASHP experiences involved residency accreditation as a member of the Commission on Credentialing.  Don Letendre and Sister Mary Louise Degenhart helped me to see that residencies define the possible. That is, they offer a glimpse into the future of pharmacy.

This type of communal experience helped us reshape the residency program at Johns Hopkins Hospital. Today, 16 residents help care for patients – they are part of a professional relationship that continually energizes and challenges preceptors.

Another example of a vital professional network is that of the pharmacist-technician team. I strongly believe that the evolution of this relationship could determine just how successful we are in moving into new roles.

Ensuring that our technician partners are properly educated and trained is one of the best ways we can make sure this social network becomes even more effective. ASHP has put in place a number of policies and recommendations in this area, but only you can make this vital relationship work.

Therefore, I challenge everyone here to go back to your institutions and complete the effort of re-defining the technician’s role within your own departments so that pharmacists can focus on clinical practice issues. Not sure where to begin? Check out ASHP’s Web site to access the white paper on technician roles. It can provide a valuable roadmap to help you get started.

Another, slightly larger, box in the series of communal relationships represents our social networks. The key component in a social network is a sense of mutual obligation and reciprocity. 

Social networks maximize cooperation, trust, support, and institutional effectiveness. There is a strong sense of working together toward a shared future, of undertaking duties that may not have personal payoff. Nevertheless, this work is an investment in our collective futures.

My distinguished predecessor Deb Devereaux made reference to the expansive reach of social networks in her own inaugural address last year. She said that if each of us as practicing pharmacists served as medication experts for 20 to 30 close friends and family, through that activity alone, we could demonstrate our core mission to over 5 million people. Now that’s an incredible social network!

Because we spend so much time on the job, work-oriented social networks are some of the most powerful we have today. In fact, I would venture a guess that some of your best friends are current or former colleagues. Our shared sense of purpose with other pharmacists and health care professionals makes an ideal environment for fostering close ties.

Several studies support this theory. A recent workforce study sponsored by ASHP showed that workplace connections foster retention and job satisfaction.

A colleague of mine at Johns Hopkins Hospital can attest to this finding. As associate director of operations, Carla Gill has discovered over the years that on-site friendships are prime indicators of retention. This makes so much sense, really, if you feel energized by the relationships at work, you’ll look forward to being there.

There are also economic incentives to staying connected. Extensive research now points to the positive influence social ties have on who gets a job, a bonus, a promotion, and other employment benefits.

At another level, work-related social networks provide people with advice, job leads, and organizational information they might not be able to access otherwise.  

In hospitals and health systems, social networks often appear in the context of teaming.  More and more pharmacists are becoming key members of rounding teams—a relationship that fosters interdependency, mutual respect, and a greater understanding of pharmacist’s valuable patient-care role.

To continue expanding our responsibilities and influence on rational medication use, there are a number of other challenges that require our attention. The first, of course, is to abolish the silos that limit our growth and keep us isolated from the health care community at large. These silos exist within our profession, separating practice from academia. As a practitioner who also works in academia, I understand well, the silo phenomenon.

A key example can be found in our educational process. In recent years, we have rightly focused on the clinical aspects of pharmacy practice. While this concentration develops important expertise in drug-product chemistry and clinical effects, it does little to expose students to the realities of practicing within a constantly changing health-care environment.

We simply are not teaching our students how to create effective social networks or communities.

If we neglect community in our educational process, I fear we will turn out new practitioners who struggle with the very human side of what we do every day.

Therefore, I challenge our nation’s pharmacy schools, hospitals, and health systems to expand their curricula, to integrate classes on socialization and to offer more experiential learning.

The educational challenge to our profession extends to postgraduate residency training.

As a profession, we must support standards-based accreditation of all residency-training programs. As a profession, we must increase both the number of accredited programs and the number of students who pursue residency training. As a profession, we must continue to build on ASHP’s 40 years of experience in residency accreditation by making the process more effective and universally accepted.

Of course, social networks exist at the organizational, institutional level as well.  This is represented by the largest box of the set. A great example of institutional communities can be found right here, at this meeting. Look around at your many colleagues from across this great country. It's pretty impressive, isn’t it?

Communities of like-minded professionals such as ASHP serve as fertile breeding grounds for new ideas, positive energy, and interpersonal communication. Without access to this gathering of professionals, including outstanding ASHP leaders like Mick Hunt, Bruce Scott, Marianne Ivey, Steve Sheaffer, Deb Devereaux, David Zilz, and Henri Manasse and Bill Zellmer, I know that my practice would be far less effective.

Joining together in a society such as ASHP offers great rewards. After all, collective action has far more impact than individual activity. Our sheer numbers allow us to move the profession in new and better directions.

Think about what we can achieve together. We can better influence public perceptions of who we are, what we do, and why it’s important; we can make our voices heard when policymakers create laws and regulations affecting health care and pharmacy; and we can expand our professional horizons by reaching beyond our smaller social and professional circles.

You know, we all personally grow and benefit from contributing to the improvement of pharmacy. And there are many ways ASHP can help you do just that. For example, with the Society’s new membership structure, practitioners with similar interests and experiences can create their own communities. You’ll find dozens of opportunities under this new structure to align yourself with like-minded practitioners at ASHP.

Today, we’ve talked about the components of community: Individual communities, professional communities, social- and work-related networks, and institutional/organizational communities. The community of health-system pharmacy fits together perfectly.

I’d like to leave you with one important concept. And that is this: You are an essential member of pharmacy’s vibrant community. Community only works if individuals participate. There is no room for passivity. There is no time to wait for others to take up the cause.

I feel a real urgency about this need for a return to the values of community and volunteerism. My wife Barbara and I have seen the value firsthand through our son Bryce’s involvement as a Peace Corps volunteer in Honduras.

Bryce dedicated himself to helping improve the quality of life for the people of San Francisco de Soroguara while working with other Peace Corps volunteers as a larger community.

Each of us has special gifts and perspectives and experiences that can benefit someone else. We need to share this bounty with others through the many communities in which we travel.

John F. Kennedy captured this philosophy beautifully in his inaugural address. He said, “United, there is little we cannot do in a host of cooperative ventures. Divided, there is little we can do—for we dare not meet a powerful challenge at odds and split asunder.”

This passage preceded JFK’s famous “ask-not” quote. Taken together, this represents a philosophy that invites us to reverse our thinking, to begin to live in an altruistic, outwardly focused way.

In practical terms, this means taking some fairly specific actions. For instance, join or renew your membership in ASHP and with your state affiliate; sign up for one or more of ASHP’s new membership sections; or volunteer and get involved in the life of your ASHP community.

Sociologist Robert Putnam acknowledged the exponential nature of becoming attached to an effective social network. He said, “a well-connected individual in a poorly connected society is not as productive as a well-connected individual in a well-connected society.”

ASHP is that well-connected society. When you choose to take part in this community, you connect directly to the experience found in its membership.

Along the way, you can expect to make new friends, to teach and to learn from practitioners in your region, and, perhaps most importantly of all, to come away from the experience with the satisfaction of knowing that you’ve made a valuable contribution to your colleagues, to your friends, to your family and neighbors, and to yourself.

After all, community is truly a gift to self.