pharm admin & pharm Econ exam 1

Question 1

Types of Change

Answer 1

Waves or shifts
- Education or workforce

Professional Identity
- How we see ourselves and how other healthcare professionals view us

Healthcare
- A change within healthcare that ripples over to pharmacy

Question 2

Early 20th Century (Before 1940)

Answer 2

Pharmacist
- Education – apprenticeship

• Role – manufacturer, wholesaler, distributor, and business owner
  —Management of inventory of bulk chemicals and supplies, product dispensing, accounting, and multi-tasking
  —-Take raw materials and produce a remedy
  —- Prescriptions not required for the remedies
• Not considered a healthcare worker

What did pharmacy management look like?

Question 3

The push for change

Answer 3

Flexner Report 1915
- Conducted by the US government to assess the roles of healthcare workers, pharmacist included

• Report critical of educational requirements of healthcare workers, including pharmacists
• American Association of College of Pharmacy (AACP) conducts a second study on just pharmacists

Lead to a push for pharmacists to complete a
4 year Bachelor’s degree

Question 4

Middle 20th Century (1940-1960)

Answer 4

Era of Expansion
- Hospital Survey and Construction (Hill-Burton) Act of 1946
—- Funding to renovate and expand hospitals in underserved areas – inner-city and rural areas

• Durham-Humphrey Amendment to the Food, Drug, and Cosmetic Act
  —–Created a prescription drug, “legend” category, pharmacist must now have an order from a licensed prescriber in order to dispense to patients
  —- Demand by patients for uniform medications
  Lead to mass production of medication

How did these surveys/acts affect pharmacy management?

Question 5

The Diminishing Pharmacist

Answer 5

During this time period we saw changes to the role of the pharmacist, what about pharmacy management?

Role
- Dispenser of mass-produced products
- Less need for the pharmacist to compound medications
- Business ownership
- Movement from business owner to employee begins to happen

Code of Ethics
The pharmacist could not discuss drug therapy with patients

Question 6

Changes to pharmacy curriculum

Answer 6

The pharmacy curriculum became more technical, scientific and content-driven

Pharmacology, pharmaceutics, and physical chemistry matured as disciplines

Courses in the business aspect of pharmacy took a secondary role

Education in patient care (communications and therapeutics) was non-existent

Question 7

Late 20th Century (After 1960’s)

Answer 7

Health Maintenance Act (1973)
- Lead to the development of HMO’s due to the big rise in healthcare expenses

Two Reports:
- Millis Commission
- Mirror to Hospital Pharmacy

What did these studies demonstrate?

How did they affect pharmacy management?

Question 8

Millis Commission Report in 1975

Answer 8

Suggested pharmacists were inadequately prepared in systems analysis and management skills

Suggested pharmacists were deficient in communication skills with patients, physicians and other healthcare workers

Subsequent report suggested including behavioral and social sciences in pharmacy curricula

Question 9

Mirror to Hospital Pharmacy

Answer 9

Published by ASHP

Suggested that pharmacy had lost its purpose

Suggested that pharmacy was not enduring the changes to healthcare

Question 10

The clinical pharmacy movement

Answer 10

Evolved in the 1970’s

Promoted the pharmacist’s role as therapeutic advisor

Eventually led to pharmacy curricula moving to 6 years with the final year being devoted to therapeutics and disease-oriented courses and educational experiences

Led to the standardization of care using evidence-based medicine and protocols, treatment algorithms, and clinical pathways

Question 11

Pharmaceutical Care

Answer 11

Developed as a practice philosophy in the 1990s

Not a list of clinically-oriented activities

A new mission and way of thinking taking advantage of pharmacists’ accessibility

Encouraged the pharmacist to take responsibility for managing pharmacotherapy to resolve current and prevent future medication-related issues

How did the movement toward the provision of pharmaceutical care change the role of the pharmacy manager?

Question 12

Pharmaceutical Care Domains

Answer 12

Developed through a nationwide panel of experts identifying standards of practice for the provision of pharmaceutical care

• Risk Management
• Patient Advocacy
• Disease Management
• Pharmaceutical Care Services Marketing
• Business Management

Question 13

From pharmaceutical care to MTM

Answer 13

Why is the term pharmaceutical care not enough?

Question 14

Medication Therapy Management (MTM)

Answer 14

An approach to help patients maximize drug benefits through
- Improving patient compliance
- Educating the patients
- Providing wellness checks
- Providing disease management and monitoring

Management

Medicare Prescription Drug, Improvement and Modernization Act of 2003
—-Allows for payment for MTM services to providers who supply the service

Question 15

All Pharmacist are Managers

Answer 15

Managing
- Technicians and staff
- Drug delivery/distribution
- Medication safety
- Budgets
- Medication therapies

Managing successfully is an expectation
- Decrease stress
- Increased job satisfaction
- Decrease career burnout
- Decrease in alcohol and drug abuse

Question 16

Drug Delivery

Answer 16

Safe and efficient drug delivery is the primary goal of every pharmacy manager

Factors affecting drug delivery
- Patient demographics
- Attitudes and belief systems
- Third-party payers and coverage issues
- Competitive markets
- Technology

Some of these can be managed and others cannot

Question 17

Managerial Sciences in Pharmacy

Answer 17

Accounting
- Keeping the books, record transactions

Finance
Determine need, operational budget

Economics
Determine ratio labor to capital, optimize output

Human Resources Management
Job analysis, personnel – hire, fire, reward, review

Marketing
Identify your niche, strategic promotion of goods and services

Operations Management
Design workflow, inventory control -day to day

Question 18

What is a Manager?

Answer 18

Manager:
- People who perform management activities
- These are the people who we think of as the boss
- Those with administrative appointments within an organization
- Anyone who has a task to accomplish or a goal to achieve is a manager as well

Question 19

Leadership

Answer 19

Leadership can be confused for management because individuals may think people who are in charge are leaders

Leadership is a different skill than management

Leadership involves being able to inspire or direct others

Managers may have leadership skills but being a manager doesn’t mean you are a leader

Question 20

Exercise

Answer 20

Think of someone who has been your manager in the past

What traits do they have

Think of someone who has been a leader in the past

What traits do they have

Are they the same person

Question 21

Management Views

Answer 21

Before the 18th and 19th century, most people lived and worked alone or in smaller groups

To have larger groups of people work together effectively, some hierarchies and systems allowed large organizations to set and complete goals

Around the 20th century the views of management were observed to be classical

Question 22

Management Views

Answer 22

Classical management theory (Fayol)

Fayol’s 5 management functions:
1. Forecasting and planning - predetermining a course of action based on one’s goals and objectives

2. Organize - the arrangement and relationship of activities and resources necessary for the effective accomplishment of a goal or objective
3. Command
4. Coordinate
   command and coordination are combined into leading or directing. This involves bringing about purposeful action toward some desired outcome
5. Control (or evaluation) - involves reviewing the progress that has been made toward the objectives that were set out in the plan

Question 23

Management Views

Answer 23

Fayols 14 principles of organizational design and effective administration (Table 2-1):

1. Specialization/division of labor - people should perform tasks specific to their skills. no one should be expected to perform all the skills needed to run an organization
2. Authority with corresponding responsibility - people with responsibility also have sufficient authority within an organization to ensure that a task is performed
3. Discipline - people should follow rules with consequences for not following rules
4. Unity of Command - the organization has an administrator who is recognized as having the ultimate authority (ex: CEO or president)
5. Unity of Direction - the organization has a sense of direction or vision that is recognized by all members ( ex: mission statement)
6. Subordination of individual interest to general interest - the goals of the organization supersede the goals of any individuals within the organization
7. Remuneration of staff - employees should be paid appropriately given the market for their skills and level of responsibility
8. Centralization - performing similar tasks at a single location is more effective than performing these tasks at multiple locations
9. Scalar chain/line of authority - each employee has one, direct supervisor
10. Order - tasks should be performed in a systemic fashion
11. Equity - supervisors should treat employees with a sense of fairness
12. Stability of tenure - benefits should go to employees who have stayed with an organization longer
13. Initiative - organizations and employees are more effective when they are proactive, not reactive
14. Esprit de corps - teamwork, harmony

Both Fayol’s 5 management functions and 14 principles of organizational design are still used today

Question 24

Management Views

Answer 24

Workforce of the late 20th century and early 21st century evolved into something different than the earlier workforce

More than five times the number of people are involved in provision of services than production of goods

The workforce today is better educated and better skilled

The classical management theory has a place in our personal lives as well as in pharmacy

Question 25

Management Process

Answer 25

There are three dimensions of management: 1. Activities that managers perform 2. Resources that manager needs 3. Levels at which managers make decisions (?) Every action taken by a manager uses at least one aspect of each dimension

Question 26

Management process

Answer 26

Fayols 5 management functions have been used to describe the 4 activities all managers perform 1. Planning 2. Organization 3. Leading or directing 4. Control or evaluation

Question 27

Resources Managed

Answer 27

Managers must use resources to achieve their goals and objectives, should be regardless of level in an organization Resources are not available in an unlimited supply The most challenging resource managers require is often financially based People & time are an important resource

Question 28

Levels of Management

Answer 28

Self-management is the most frequent level of management After self-management, managers find themselves performing at the interpersonal level - Occurs between manager and another person Least frequently used level of management is organizational management - Involves action that affect groups of people

Question 29

Integrating Modern & Classical Views

Answer 29

Classical view: - A hierarchy between administrators and workers Modern view: - A partnership between administrators and workers Managers must adapt their management activities to their workers - These occur in addition to classical management functions Today's managers also need to: 1. Energize 2. Empower 3. Support 4. Communicate

Question 30

Planning in General

Answer 30

Defined as the purposeful efforts taken by an organization to maximize future success One of the four key functions of a manager - next to leading, organizing & control/evaluation Often involves employees at all levels The most common types of planning are business planning, financial planning, operational planning, resource planning, organizational planning and strategic planning if effective, will involve employees at all levels

Question 31

Types of Planning/Steps in the Planning Process

Answer 31

Refer to Table 6-1 in text For exam: Be familiar with the purpose and characteristics of each type of planning Refer to Table 6-2 in text For Exam: Be familiar with the steps in the planning process

Question 32

Strategic Planning

Answer 32

The purpose is to evaluate how the organization is performing currently and ensure it does the right things in the future Helps to determine long-term goals and how to reach those goals Involves determining the policies and programs (strategies) necessary to meet specific objectives

Question 33

Strategic Planning

Answer 33

The goal is to increase the likelihood that the organization will survive and thrive in the future *Proactive* strategic planning enables an organization to control its environment in contrast to *reactive* strategic planning where the environment controls the organization Often referred to as long-term planning Includes creation of vision and mission statements

Question 34

Vision Statement

Answer 34

it is short Example: CVS Caremark. ”to improve the quality of human life” Exercise: Take a few minutes and develop a personal vision statement To provide the best educational experience to my students both in the classroom and at my practice site

Question 35

Vision Statement

Answer 35

What the pharmacy organization wants to be in the future The vision may be complex but the vision statement should be short, make people think, and motivate people to strive for something greater Used during strategic planning as both the beginning point and the endpoint

Question 36

Mission Statement

Answer 36

bigger statement The mission is the *purpose* of the company Defines what the company does and is A statement of the present going ahead into the near future A statement written to create a sense of purpose for customers and employees Should differentiate the company from others that provide the same services

Question 37

Mission Statement

Answer 37

Suggested elements of a mission statement for a community pharmacy include - Target customers - Core values of the pharmacy - Key services and products - Benefits incurred by customers - The desired public image of the pharmacy

Question 38

Mission Statement

Answer 38

Exercise: Develop a mission statement for the community pharmacy you work at or own - Exercise: Develop a mission statement for the hospital pharmacy you work at or manage

Question 39

Strategic Planning

Answer 39

Vision Goals - 6 Objectives - with measurable data Strategy to achieve objectives

Question 40

Once the plan is finalized

Answer 40

Implementation once finalized Post implementation analysis Documentation Plan, do, study, act cycle

Question 41

Strategic Planning

Answer 41

In community pharmacy In hospital pharmacy In response to changes in the practice environment

Question 42

Barriers to Planning

Answer 42

Time Interpersonal issues (power struggles, resistance to change) Lack of planning skills Constantly changing environment (economic and in healthcare) Lack of resources Ownership Monitoring progress Lack of support from the administration

Question 43

Limitations to Planning

Answer 43

Planning is not a cure-all Planning is uncertain, involves educated speculation about the future Limited or inaccurate data available Implementation is often difficult and meets resistance from employees/customers

Question 44

Exercise: back to the objectives

Answer 44

Provide examples of strategic planning in pharmacy organizations - Community pharmacy - Hospital pharmacy Identify barriers and limitations to planning

Question 45

table 6-1

Answer 45

Strategic planning - purpose: To ensure that the organization is doing the right things. Addresses what business the organization is in, or ought to be in, and provides a framework for more detailed planning and day-to-day decisions. - characteristics: Long-term (5–20 years); scope includes all aspects of the organization; viewpoint is external—how the organization interacts with or controls its environment. Operational planning - purpose: To ensure that the organization is prepared, and performs the immediate tasks and objectives to meet the goals and strategy of the organization. To ensure that the organization is doing things right. - characteristics: Short term (1–5 years); scope is specific to the immediate actions that need to be taken to move the organization forward; viewpoint is internal—day-to-day accomplishment of tasks. Business planning - purpose: To determine the feasibility of a specific business or program. Business planning is used to make a decision about investing in and moving forward with a program. - characteristics: Short term (1–5 years); can be used to make decisions to start a new business, expand a business, or terminate a business. Resource planning - purpose: To ensure the resources necessary to achieve the goals and strategy of the organization. Resource planning can be comprehensive (all resources needed to achieve goals and strategic plan of the organization) or can focus on a specific type of resource. - characteristics: Midterm (1–10 years); scope is specific to the resource or resources defined in the plan—specific resources may include human resources, information/technology resources, financial resources, capital and facilities, and others; viewpoint is internal—the resource needs of the organization. Organizational planning - purpose: To ensure that an organization is organized appropriately to meet the challenges of the future. Key elements include reporting relationships, definition of responsibilities, and definition of authorities. - characteristics: Midterm (1–10 years); scope specific to the structural aspects of the organization, including divisions, reporting relationships, coordination, and control; viewpoint is internal—how the company organizes itself. Contingency planning - purpose: To provide a fallback option or direction should the original strategy of the organization fail or something unexpected occur. Contingency planning can occur for a specific anticipated situation, the most common of which are business-related crises (such as a labor strike) and changes in management personnel. - characteristics: Short- to long-term (1–20 years); scope is specific to the particular situation that may occur; viewpoint is both external (if the situation is created in the environment) and internal. Emergency planning - purpose: To address emergencies that may be expected in the workplace. These can include fires, tornadoes, floods, and “active shooter” situations. Plans should be in place that describes what staff at the workplace should do in emergencies. - characteristics: Midterm (1–10 years); scope specific to the particular situation that may occur; viewpoint is both external and internal.

Question 46

table 6-2

Answer 46

1. Define or orient the planning process to a singular purpose or a desired result (vision/mission). 2. Assess the current situation. 3. Establish goals. 4. Identify strategies to reach those goals. 5. Establish objectives that support progress toward those goals. 6. Define responsibilities and timelines for each objective. 7. Write and communicate the plan. 8. Monitor progress toward meeting goals and objectives.