pharm admin & pharm Econ exam 1 Flashcards
Types of Change
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
Early 20th Century (Before 1940)
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?
The push for change
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
Middle 20th Century (1940-1960)
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?
The Diminishing Pharmacist
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
Changes to pharmacy curriculum
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
Late 20th Century (After 1960’s)
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?
Millis Commission Report in 1975
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
Mirror to Hospital Pharmacy
Published by ASHP
Suggested that pharmacy had lost its purpose
Suggested that pharmacy was not enduring the changes to healthcare
The clinical pharmacy movement
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
Pharmaceutical Care
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?
Pharmaceutical Care Domains
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
From pharmaceutical care to MTM
Why is the term pharmaceutical care not enough?
Medication Therapy Management (MTM)
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
All Pharmacist are Managers
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
Drug Delivery
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
Managerial Sciences in Pharmacy
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
What is a Manager?
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
Leadership
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
Exercise
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
Management Views
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
Management Views
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
- Organize - the arrangement and relationship of activities and resources necessary for the effective accomplishment of a goal or objective
- Command
- Coordinate
command and coordination are combined into leading or directing. This involves bringing about purposeful action toward some desired outcome - Control (or evaluation) - involves reviewing the progress that has been made toward the objectives that were set out in the plan
Management Views
Fayols 14 principles of organizational design and effective administration (Table 2-1):
- 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
- Authority with corresponding responsibility - people with responsibility also have sufficient authority within an organization to ensure that a task is performed
- Discipline - people should follow rules with consequences for not following rules
- Unity of Command - the organization has an administrator who is recognized as having the ultimate authority (ex: CEO or president)
- Unity of Direction - the organization has a sense of direction or vision that is recognized by all members ( ex: mission statement)
- Subordination of individual interest to general interest - the goals of the organization supersede the goals of any individuals within the organization
- Remuneration of staff - employees should be paid appropriately given the market for their skills and level of responsibility
- Centralization - performing similar tasks at a single location is more effective than performing these tasks at multiple locations
- Scalar chain/line of authority - each employee has one, direct supervisor
- Order - tasks should be performed in a systemic fashion
- Equity - supervisors should treat employees with a sense of fairness
- Stability of tenure - benefits should go to employees who have stayed with an organization longer
- Initiative - organizations and employees are more effective when they are proactive, not reactive
- Esprit de corps - teamwork, harmony
Both Fayol’s 5 management functions and 14 principles of organizational design are still used today
Management Views
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
Management Process
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
Management process
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
Resources Managed
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
Levels of Management
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
Integrating Modern & Classical Views
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
Planning in General
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
Types of Planning/Steps in the Planning Process
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
Strategic Planning
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
Strategic Planning
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
Vision Statement
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
Vision Statement
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
Mission Statement
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
Mission Statement
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
Mission Statement
Exercise: Develop a mission statement for the hospital pharmacy you work at or manage
Strategic Planning
Vision
Goals - 6
Objectives - with measurable data
Strategy to achieve objectives
Once the plan is finalized
Implementation once finalized
Post implementation analysis
Documentation
Plan, do, study, act cycle
Strategic Planning
In community pharmacy
In hospital pharmacy
In response to changes in the practice environment
Barriers to Planning
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
Limitations to Planning
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
Exercise: back to the objectives
Provide examples of strategic planning in pharmacy organizations
- Community pharmacy
- Hospital pharmacy
Identify barriers and limitations to planning
table 6-1
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.
table 6-2
- Define or orient the planning process to a singular purpose or a desired result (vision/mission).
- Assess the current situation.
- Establish goals.
- Identify strategies to reach those goals.
- Establish objectives that support progress toward those goals.
- Define responsibilities and timelines for each objective.
- Write and communicate the plan.
- Monitor progress toward meeting goals and objectives.
