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6/22/2004

New ASHP President Urges Nurturing of Professional Growth, Renewal

Kate Traynor

The following inaugural address was delivered today by new ASHP President T. Mark Woods, Pharm.D., FASHP, at the ASHP Summer Meeting in Las Vegas.

It is such an honor to be standing before you today. More than that, it is an incredibly humbling experience to follow in the footsteps of some of my personal and professional role models.

Their names are certainly familiar to most of us here: people like Harold Godwin, Sara White, Tom Garrison, John Murphy, Bruce Canaday, Bruce Scott, Mick Hunt, Steve Sheaffer, Deb Devereaux, and Dan Ashby.

These people are true humanitarians, serving their patients, their fellow pharmacists, and the profession itself through their dedication, vision, and collaboration.

I have also been blessed to develop a number of enduring friendships through my work in professional organizations. People of note include Jill Martin, Cindi Brennan, Kevin Colgan, Janet Silvester, Phil Schneider, Dave and Jane Henry, Dennis Sherman, Doug Lang, and Lynnae Mahaney.

And, of course, I wouldn't be here before you today without the guidance and assistance of some wonderful mentors, including Jim DuBe, Don Kishi, Mike Winter, Steve Kayser, Mary Ann Koda-Kimble, and Joe Guglielmo. Thank you for helping me to see the way.

I couldn't begin this talk today without acknowledging my family, who provides the foundation for everything I do. My parents, Hugh and Jo Woods, helped me understand at an early age that the only place that "work" comes before "success" is in the dictionary.

My brother Mitch's dangerous work as a police officer provides me with perspective whenever I've had a bad day at work. My brother Mike, who is a surgeon and patient safety advocate in his own right, serves as a personal role model. His wonderful family includes his wife, Marsha, son Ian, and daughter Jenna.

My sister Wendy, her husband Pete Belen, and their son Elian are constant sources of support and encouragement. And Fred and Karma Dungan are absolutely the best in-laws one could ever hope to have. I truly feel like I have a second set of parents.

Finally, I would like to salute my son Chris, the best buddy any father could ever want; my daughter, the magnificent Megan who brings so much light to all our lives; and my wife, Toni, the glue that holds everything together. She has nurtured and supported me in the pursuit of my dreams every step of the way. Thank you for your love and encouragement. I love you very much and look forward to the continuation of our journey together.

You know, when you fly into Las Vegas for the first time, it's quite striking how brown everything is. It always makes me grateful for the seasons we experience back in Midwest. It's true that in Kansas it can take awhile for summer to actually take hold. But for me, the changes in weather have always been a comfort. The seasons provide predictable change ... a sure way to mark the passage of time.

Those of you who are gardeners know the importance of understanding seasons. Gardeners are optimists. They never give up. They understand that there will always be another season for planting, another sunny day, more rain on the horizon.

Gardening and the seasons are great examples of the predictability of change. Today I'd like to spend some time talking about how we can manage the remarkable changes that have been happening in pharmacy.

Several years ago, I read a powerful book by John Gardner, the founder of Common Cause. He talked about the predictable factors that cause deterioration within a society. This made me think about the immense pressures facing health-system pharmacy. You and I are facing challenges today that our predecessors never could have imagined. And that is a good thing, for the most part.

After all, we now have more opportunities than ever to provide direct patient care. And we're able to improve medication use like never before.

But there are downsides, as we all know.

Consider the persistent questions we are facing about the integrity of the nation's drug supply. Can you imagine the pharmacists of the '60s and '70s wondering if the drug product they were handling had been tampered with or counterfeited? Yet this is a challenge we face every day.

How about the complex and changing world of payers and pharmacy benefits, a system that makes it hard for people to get the medicine they need?

Consider the intricate network of Joint Commission and HIPAA requirements that add complexity to an already difficult job.

What about the constant flow of new technologies such as CPOE and automation, challenging us to find and pay for the "ideal" system?

And, of course, there is the constant struggle to close the gap between what we know is the best drug therapy for our patients and what is actually done.

In my hospital, we struggle every day with an almost insatiable desire by our nursing and medical colleagues for pharmacist services. They want pharmacy services to be added to our ambulatory clinics, the emergency department, and our community clinics.

It's quite wonderful to be wanted and needed. And everyone knows that pharmacists improve patient care. But the reimbursements don't meet the need.

Yet it seems to me that our ability to overcome these challenges ultimately depends on our perspective—our collective ability to see the glass as half full.

To put it another way, we need to view that the rain that's falling as essential for growth rather than as the weather that's flooded your garden.

Like you, I have experienced the profound affects of change. During my 20 years at Saint Luke's Hospital, my career has changed dramatically. Perhaps my favorite adjustment was when I became residency program director.

This is because the needs of residents are unique and unlike those of any other pharmacy staff. Residents are naturally curious. They tend to be less encumbered by tradition. And they are not afraid to challenge the status quo. And every year when our residents graduate, I have to prepare myself to work with an entirely new group of bright, eager practitioners coming into the program. These special people have all contributed to my own lifelong learning.

Constantly striving for renewal helps me to fight stagnation. It allows me to stay flexible enough to deal with continuous change. This is why I believe that we will pay a high price if we fail to address change in the pharmacy profession. We are seeing vast transformations in the attention paid to patient safety, pharmacy's public influence, sterile compounding, the reliability of the nation's drug supply, and even the attractiveness of our profession to young people.

We must address these issues clearly and decisively.

If we assume that pharmacy will look differently tomorrow than it looks today, how, then, can we manage that change?

I believe that there are some critical steps to coping with change that will help us experience professional renewal and growth. But, first, we must have a sense of the "big picture"—a world view that allows us to preview and plan for the future.

Gardeners know this intuitively. First, they decide what it is that they want to harvest. Then they till the soil.

Now, you can simply till the soil in the first place you find and cast seeds to the wind—but the outcome would be haphazard at best and disastrous at worst.

Instead, good gardeners assess the lay of the land. They carefully choose their plants based on sunlight, water, and nutritional requirements. They consider how they want the garden to look and what they want to get out of it each season. They determine the personal and financial costs of their goal and develop a plan for getting there. Only then do they proceed to buy plants and sink their roots into the earth.

This is a perfect example of goal orientation, a methodical approach to controlling what is perhaps the most uncontrollable of all forces-Mother Nature.

In the same way, we need to look forward, to gauge the world of health-system pharmacy and the wider context of health care in which our profession resides. Once we've established this "world view," what is the next step? I believe it lies in a specific kind of optimism.

I'm not talking about blind optimism. That type of hopefulness sets us up for failure, allows us to easily get discouraged when challenges get in the way.

I'm talking about tough-minded optimism—an approach that makes long-term investments in potential outcomes. It recognizes that nothing worth having happens immediately, and it requires us to brace ourselves for the long haul and have confidence in positive results.

Let me tell you a story that illustrates this point. Several years ago, I served as the interim director of pharmacy for St. Luke's. It was a particularly difficult time for our department. Shortly after I took the job, we lost several staff members and were down by five pharmacists, including both of our midnight-shift pharmacists.

We had a new operations manager who started the week my predecessor left. I was expected to step up to the plate as director even though my prior role was as clinical coordinator.

And the Joint Commission was on its way for a visit.

You can imagine that morale was low, and times were tough. Now, during this period, several job opportunities came up that would have allowed me to escape the chaos and uncertainty. But I chose to stay, in large part because of the great people I work with and their steady belief that better days were ahead. My colleagues exemplified what I mean by tough-minded optimism and commitment to a worthy cause.

I have been so blessed to work with a number of bright, motivated, and dedicated people in a variety of capacities throughout my career. These friends and colleagues have made me a better pharmacist, and they lift our profession through their good work. Please indulge me for a moment as I thank my boss Doug DeJong; members of our leadership group—Mark Steinbeck, Leslie Brookins, and Leigh Ann Milburn; and current and former staff members Ron Haller, Dan Fiala, David Gaugh, Lisa Gersema, Jill Robke, Jeanne Cave, Jennifer Quinlan, Jennifer Nazworthy, and the rest of our staff at Saint Luke's.

Let me give you an example of investing in potential outcomes as it relates to ASHP. Over the 60-plus years that the Society has advanced patient care, we have relied on a core group of pharmacy leaders who seemed to step up to the plate naturally. But times have changed dramatically.

Pharmacy students, who represent a vast and renewing source of optimism about the future, are not automatically moving toward traditional routes of involvement. But we need them!

They have new and exciting ideas about what pharmacy should look like in the future. They want to practice at the patient's bedside. They want to be involved in hospital leadership. They want to learn everything they can about new technologies to enhance patient care.

And we need to make a concerted effort to tap into that optimism.

I don't want another student to come up to me in their final year of pharmacy school and say, "If I had only known about the opportunities in health-system pharmacy, I never would have taken that chain drugstore job."

That is why I am committed to working with state affiliates to establish an ASHP student society on every pharmacy school campus in the nation.

I also have big plans for pharmacy residencies. At a minimum, I believe that all graduates who want to practice in an institutional environment should complete a residency.

Therefore, I recommend that ASHP triple the number of accredited residencies that are currently available in the U.S. by the year 2015.

Of course, this means that our health-care institutions need to demand residency-trained individuals. So, I ask you—does your health system require residency training? If it doesn't, it should. Why? Because if you don't have residency-trained pharmacists in your institution, you are not providing your patients with the best possible care.

Setting realistic goals is one of the best ways to manage change. Gardeners know that a variety of factors control any outcome, including weather, soil conditions, wildlife, and the viability of the plant material itself. Some of these factors the gardener can control. Others he can't. <./p>

In the same way, we need to recognize what we can do to impact the challenges that face us.

For example, ASHP's Health-System Pharmacy 2015 Initiative helps us focus on realistic patient-health targets. This is a perfect example of the tough-minded optimism and goal setting that is the basis for professional renewal.

The 2015 Initiative forces us to confront some crucial questions:

  • First, are we involved in direct patient care? Most of us are not today, but I believe we will be in the future as more and more patients demand pharmacists' services.
  • Second, do our pharmacy departments have a strong commitment to lead continuous improvement in medication use in the application of best practices? Perhaps not yet, but we will someday soon because we write the standards. We are the experts.
  • Third, are our departments engaged in improving the overall public health of their communities? To do so, we must change our focus from clinical intervention to disease prevention.

Overall, this initiative, and the vision on which it is based, will fundamentally improve the way health-system pharmacists care for patients.

It will fundamentally bolster patient safety, advance public health, and enhance the public we serve.

As we look at the elements that characterize a vital society, one cannot underestimate the importance of staying power.

In America, we rarely celebrate the trait of devotion to a cause—it's not the most exciting personal or professional quality. Yet our ability to stick to the task at hand—to work together toward a common goal with other people who share our values—is the foundation upon which true change is built.

Up until this point, I've been talking to you about managing change. But ironically, the key to managing change is a commitment to purpose.

ASHP is an excellent example of the importance of shared values and deep commitment to a higher purpose. I ask you:

  • Are American families and children healthier because of our devotion to fail-safe medication use? You bet they are.
  • Has hospital care improved dramatically because of the influence of ASHP's published standards on the Joint Commission? Absolutely.
  • Who's been pushing the FDA for years about the need for machine-readable coding on all drug products? We have.
  • Have our contributions to the IOM reports helped to improve quality in America's health systems? Without a doubt.
  • Who supported states in their struggle to create collaborative drug therapy management legislation? We did.
  • Who pushed Congress to include medication therapy management services in the new Medicare law? Again, we did.
  • Who continues to advocate for Health Care Provider status for pharmacists? We do. These victories demonstrate how critical it is to stay the course. We must be tireless. We must be relentless. And we must be focused.

In his bestselling book Good to Great, Jim Collins says that "breakthroughs require a simple ... understanding of three intersecting circles: What an organization can be the best in the world at, how its economics work best, and what best ignites the passions of its people."

Representing the interests of pharmacists who work in hospitals and health systems is what ASHP is all about. Our resources are strategically and efficiently applied to advance those interests. And we continually work on the issues that members are most passionate about.

There's no denying that health-system pharmacy is a distinct area of the profession. Our practice is set apart by a number of unique characteristics, including:

  • The complexity of the medication-use systems in hospitals and health systems,
  • The intensity of medication use by our patients,
  • Our close collaboration with other health-care professionals,
  • Our focus on improving outcomes through evidence-based drug therapy decisions, and
  • Our compliance with professional practice and accreditation standards.

Because ASHP is so focused on health-system pharmacy, we have always been committed to working with other organizations on issues of common interest. But I believe the time has come to move more boldly into new circles of collaboration. I believe that other medical organizations, quality improvement groups, regulatory and legislative bodies, and consumer groups will help us take the giant leaps we need to improve patient care in America.

Our very own Executive Vice President and CEO Henri Manasse is a great example of this concept. The list of high-level committees and boards on which he sits is as long as my arm. Thanks to his involvement, your voice and the issues you care about most are being heard at the Food and Drug Administration, the Joint Commission, the National Patient Safety Foundation, the National Academy of Sciences' Institute of Medicine, the American Medical Association, and the U.S. Department of Veterans Affairs, just to name a few.

ASHP makes it possible for you to do what it is you love to do—care for patients. And we are absolutely dedicated to nurturing the dreams and future aspirations of our members.

To use another gardening metaphor, tending so carefully to one plant can only help to raise the health of the entire garden—or profession. Because what we learn and what we bring to the table, in the end, improves care for all patients and betters the profession for all pharmacists.

In conclusion, I'd like to urge you to think like a gardener as you consider the challenges ahead.

Let's face it. Change, like the seasons, is inevitable. Sometimes we will have very cold winters, and sometimes we will have awfully hot summers. There will be seasons of scarcity, and there will be seasons of bounty.

To extend the analogy to pharmacy, we must look forward with optimism and a sense of resilience, having faith that our commitment to the cause of safe medication use will create a better health care system in this country.

We must invest ourselves in the future by encouraging the youngest among us to get involved in professional leadership.

We must stay the course when we have identified issues of importance, raising our voices loudly and often to be heard.

Someone once said, "To create a garden is to search for a better world. This hope for the future is at the heart of all gardening."

Indeed, pharmacy's ability to be a force of good in our society and in our world depends on this same commitment to what is possible.