Rita Shane and Charles Daniels discuss the clinical aspects of health care and its fundamental role in effective leadership.
Date recorded: January 23, 2018
Rita Shane, Pharm.D., FASHP, FCSHP, is Chief Pharmacy Officer for the Department of Pharmacy Services at Cedar Sinai Medical Center and Assistant Dean of Clinical Pharmacy at the University of California, San Francisco School of Pharmacy.
Charles Daniels, B.S.Pharm., Ph.D., is Associate Dean and Professor of Clinical Pharmacy at the Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of California, San Diego. He is also Pharmacist-in-Chief for the UC San Diego Health System.
TIME-STAMPED SHOW NOTES
Rita Shane (01:20): I think we wanted to start by talking about why we came up with this title and theme and why it's so important. From my perspective, I really do think that the clinical aspects of healthcare are fundamental to everything we do. And certainly given that our profession is a clinical profession, those of us in leadership roles absolutely have to have a solid foundation not only in clinical pharmacy but in the clinical aspects of patient care. When I think about what our staff does on a daily basis from storing drugs, to delivering and dispensing them, to using automated devices to manage orders in the context of a patient, there isn't anything we do that doesn't have a clinical foundation to it […]. Every dose that you as a technician put away into stock matters because that dose is going to go to someone's loved one.
Rita Shane (02:23): When I think about interacting with the C-suite, more and more physicians are joining executive management and leadership roles. We really do think we're going to see CEOs who are physicians. When we look at the current economic pressures in our health systems and the need to look at how we can reduce the total cost of care, we have to have a very strong understanding of the drivers and how those drivers, whether they be disease states or procedures or new devices, overall impact, the total cost of care and what we as pharmacists and pharmacy leaders can do to identify and target therapeutic opportunities to reduce costs, in the areas of transitions of care, understanding the clinical aspects of the patients course as they transition from the ambulatory to the acute care to long-term care or a skilled nursing facility or back home, requires a fundamental understanding of clinical practice.
Charles Daniels (03:46): Pharmacy has evolved into a clinical patient-facing profession that's much different than in the eighties and the nineties, or before that even when there was a more singular focus on innovation and oversight related to the drug distribution process. Because pharmacy is a clinical profession, it's important that our leaders that go into those spots understand what we are about or essentially what their team is doing and how they can impact the organization. Eighty percent, approximately, of my department budget is drug costs. […] So I have to figure out and the leaders that work in my organization need to understand what drugs and what drug use is about. That's difficult to do if we don't have that sort of clinical experience that goes with being a pharmacist. That in my mind is the single most important reason why leadership really requires clinical expertise and the specialties that goes along with that.
Charles Daniels (06:57): I think there are plenty of examples that are out there and I know you see them on a regular basis as do I, real life examples of sort of where the clinical ability or expertise needs to come into play. And say people call that intuition, the ability to be able to recognize a situation in a quick time and be able to respond to it and that comes from repetition. So, I think in the way I perceive it, the challenge is frequently to get the people early in their career, the young, new pharmacists, to be able to have experiences that allow them to be able to read the situation quickly from clinical perspective. And that's a challenge and something that needs to happen. Now, there are dozens of examples every day of sort of the difference between a clinical focus and what I'll call an administrative focus.
Rita Shane (10:05): Yeah, I think that this whole notion of clinical problem-solving happens every day in our organizations. And what I think a lot of individuals who are so effective at their roles on a daily basis who are really, really leaders of their practice may not always recognize that it's the same skill set that one needs to ascend through the organization. And in fact it's essential to be able to, as you said, create opportunities and initiatives that are relevant to our organization […]. What would you recommend to new leaders and maybe we should expand it, what would you recommend to students and residents who are early on in their career and may not even be considering leadership because they don't recognize how much they can make a difference in advancing what we do for our patients?
Charles Daniels (23:08) Rita, can I potentially add one more dimension to this conversation? I believe firmly that we need a path to bring more experienced pharmacists into formal leadership roles. Historically, you were either in early on or you never came back. The opportunity didn't present itself […]. There are plenty of people out there that are smart enough to pick up new sets of skills midway through their career. And I would like to encourage those people to be able to say, that in a way represents the concept of a clinical specialist that comes back in to help lead the department […]. And so I want to encourage listeners of the podcast to remember that mid-career people that thought they were going to be a clinical specialist for their whole life might be high-quality candidates to go into formal leadership roles.
Rita Shane (24:56): I actually think that that we should put a call out for individuals who want to consider a career change at some point. Maybe even plan for one by kind of demystifying what leadership is because they're essentially, as you said, leaders in their environment may be either intimidated or for whatever reason think that acquiring these new skills is just going to be too difficult. So we have to kind of demystify or debunk the fact that it's not that difficult to learn these things. Now, it does create a level of commitment that is significant but I think, obviously, you and I have been doing this for a long time, so we think the rewards are worth it.
Charles Daniels (30:38): I also want to remind everybody that whatever skill set it is that you're learning, whether it's a bedside patient management or managing budgets, it's a progressive activity. Nobody knows everything when they first get started and takes a while to feel comfortable with that. I just want to make the case that while I respect and appreciate all of our pharmacy leaders, it is important that we think about a model for the future that encourages pharmacists to be really good as pharmacists and feed that clinical curiosity that they express when they came into the professional pharmacy and by following that, that will make them candidates to be strong leaders in the future.
Outbound Links & Resources Mentioned
Learn more about ASHP’s Women in Pharmacy Leadership Steering Committee at: https://www.ashp.org/Pharmacy-Practice/Resource-Centers/Leadership/Women-In-Pharmacy-Leadership
Letters from Women in Pharmacy: Stories on Integrating Life and Career: https://store.ashp.org/Store/ProductListing/ProductDetails.aspx?productId=654768232
Takeaways in Today’s Episode
- There should be a pathway to bring experienced pharmacists into formal leadership roles.
- Pharmacists in leadership roles need a solid foundation in clinical pharmacy and the clinical aspects of patient care, especially given the innovation of medications and emerging drug therapies.
- The number of medical personnel that are taking on executive, management and leadership roles at their respective healthcare facilities/systems is increasing.
- It is critical that young, early career pharmacists have experiences that allow them to assess a situation quickly from a clinical perspective and resolve it effectively.
- Small group projects that build critical-thinking and problem-solving skills are a beneficial part of the learning curve for residents and young/new pharmacists as they begin to tackle system-related and other issues.