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3/8/2004

Pharmacists Share Experiences of Corporate Roles

Donna Young

Bruce E. Vinson, system pharmacy director for Baptist Memorial Health Care Corp. in Memphis, Tennessee, acts as an educator, a facilitator, a counselor, a communicator, an observer, and a negotiator for pharmacy directors in his health system's 17 hospitals in Arkansas, Mississippi, and Tennessee.

The health system's facilities are located in rural and urban communities and range in size from a 30-bed hospital to a 900-bed acute care facility, he noted.

Large health systems, especially those that have facilities in more than one state and must deal with various state laws, need someone to coordinate activities for pharmacy directors who may not have the time, resources, or knowledge to handle those functions on their own, Vinson said.

For instance, he said, as part of his corporate role, he keeps pharmacy directors well informed about changes in state pharmacy laws or regulations, and the latest standards from the Joint Commission on Accreditation of Healthcare Organizations.

"You can't talk too much about Joint Commission and different twists and interpretations," Vinson said. "There may be only two pharmacists in a facility and they may not be able to get away to attend meetings" where compliance issues are discussed.

Emergency preparedness, he added, is another area in which health systems need someone to oversee and coordinate pharmacy departments' roles in each facility's plan.

Vinson's responsibilities include standardizing and integrating best practices in clinical and operational duties "where it makes sense" for the health system's pharmacy departments, he said.

"I say 'where it makes sense' because what works at one place may not work at another," Vinson explained.

But oftentimes, he added, one pharmacy department's solution to a problem that could potentially work for all of a health system's pharmacies goes unshared, and it takes someone to observe a situation to recognize the broad applications of that solution.

Vinson also oversees supply-chain issues for pharmacy departments in his health system and evaluates whether a hospital that qualifies to purchase drug products under the federal 340B drug-pricing program is in compliance with requirements for that program.

Congress created the 340B program in 1992 to provide certain hospitals and federally funded grantees access to low prices on pharmaceutical products.

Wayne Russell, corporate office pharmacy director for Bon Secours Health System, which has 24 acute care hospitals in the Eastern United States and has headquarters in Marriottsville, Maryland, said he is helping 6 of his organization's hospitals that qualify for the 340B program through the process of adopting the program.

The hospitals have long qualified for the program, he said, but for various reasons had never implemented 340B.

Russell meets weekly by teleconference with the pharmacy directors of the six hospitals.

He is also helping a number of the health system's facilities apply for prescription drug assistance programs offered by manufacturers.

Russell meets monthly with pharmacy directors by teleconference, but the directors do not report to him.

"They have a dotted line to me" on the staff organization chart, he said.

He also meets regularly by phone with pharmacy subcommittees, such as the 340B subcommittee.

He communicates by e-mail "almost daily" to at least one pharmacy director about various issues. Russell also visits each facility when needed.

His corporate responsibilities include developing processes to lower supply-chain costs, working with pharmacy directors to identify and implement technology that would improve pharmacy effectiveness and efficiency and enhance patient safety, and helping develop a future model for pharmacy across the organization that would enhance pharmacy department operations and clinical services.

Russell said his health system's corporate structure is a "hybrid centralizeddecentralized model where the local facilities and the local directors of pharmacy have a lot of input into the initiatives we're working on."

But, he added, "those initiatives are being driven by the corporate office to make sure that we achieve our goals."

Russell's role, he said, is to look at "what is the best direction . . . that we need to go as a health system and then figure out how to basically customize or modify that overall goal so that we could achieve it in each of the local hospitals."

One of the projects Russell is coordinating is Bon Secours' plan to implement a point-of-care bar-code-scanning system in each hospital.

The health system plans to use one vendor systemwide for the technology.

"With our volume and the size of our organization we should be able to get better pricing rather than everybody buying something different," Russell said.

Bon Secours is "working very diligently" to standardize not only its technology, he added, but therapeutic categories of drugs, medical and surgical supplies, and capital equipment.

Russell initiated a project with his group purchasing organization, Premier Inc., to establish a quarterly meeting of pharmacists serving in broad corporate roles, such as his, to share knowledge.

Wayne S. Bohenek, vice president of pharmacy effectiveness and safety for Catholic Healthcare Partners (CHP) of Cincinnati, Ohio, a health system with 31 hospitals spread over five states, said he is charged with overseeing quality and patient safety issues for his health system.

One project he coordinates is his health system's participation in the Centers for Medicare & Medicaid Services's National Voluntary Hospital Reporting Initiative.

Under the initiative, hospitals voluntarily report outcomes for 10 quality measures covering three clinical disorders.

A provision in the Prescription Drug, Improvement and Modernization Act of 2003, requires that, starting October 1, 2004, those hospitals failing to voluntarily report these 10 measures will see a 0.4% smaller update to their Medicare payments.

"We have a system goal to consistently improve with respect to those 10 measures," Bohenek said.

He is also working with one of CHP's facilities, St. Rita's Medical Center in Lima, Ohio, which is partnering with 3M Corp. to develop a "Six Sigma" quality control demonstration project on surgical-site infections.

Another project Bohenek is coordinating for Catholic Healthcare Partners is its adverse-drug-event collaborative, in which six hospitals used the Institute for Healthcare Improvement's "trigger tool" to identify potential problems with the medication-use process.

Vicki S. Crane, vice president of pharmaceutical services and engagement director for transforming care for Parkland Health & Hospital System in Dallas, Texasthe county's only public hospitalsaid she spends a lot of her time educating the board of county commissioners about why it is necessary to fund the health system's pharmaceutical budget, which accounts for 10% of Parkland's total operating costs.

More than 80% of the health system's pharmacy services are provided to outpatients, most of whom are low-income and indigent persons.

In her strategic leadership role, Crane said, many of the health system's issues that she deals with are "far outside of pharmacy."

But, she added, she has learned a lot of "Ah ha" lessons.

One strategy Crane has been working on at the health system is implementing "appreciative inquiry"where hospital managers acknowledge what a unit is doing right instead of pointing fingers and focusing on blame when errors occur.

"It's identifying that somebody has a world-class standard and replicating that, rather than focusing on the terrible thing that unit A has done and firing someone, which really resolves nothing, except for when there is reckless behavior involved," she said.

Crane said that her health system is trying to move to a culture of transforming care and away from assigning blame when an error occurs.

"No one, in most cases, had the intention of doing harm to the patient," she said.

Much of her role is facilitating communication between departments and analyzing various problems.

One problem the transforming care team discovered involved Parkland's finance and anesthesiology departments.

A finance department employee kept receiving wrong codes from the anesthesiology department and had assumed that whomever was entering the codes was entering the information in error.

In the meantime, the anesthesiology employee who was entering the codes was certain the codes were being entered correctly.

"Both thought the other person was wrong," Crane said. "Both had a position, and both were not willing to come out of the position."

An analysis of the system found that, because of a "computer glitch," the wrong code was being transferred from the anesthesiology system to the finance department's system.

"The key is communication," Crane said, "and not assuming that the other party is to blame."