INTRO TO COMMUNITY PHARMACY PRACTICE MANAGEMENT (PHAR 660)

David Holdford, RPh, MS, PhDProfessor, School of PharmacyVirginia Commonwealth University

How to Thrive in a Competitive Pharmacy

Environment

This presentation is to be viewed at your own pace. It is without audio.

LEARNING OBJECTIVES (L.O.)

1. Describe course goals

2. Link skills learned in this course to becoming an excellent community pharmacist

3. Describe how this course can help you have more job security in a turbulent health care market

L.O.1. COURSE GOALS

4

Students who complete this course will:

Meet ACPE accreditation standards and AACP CAPE Outcomes relating to community pharmacy practice management

Be better prepared to effectively serve patients in a sustainable way

Content & learning activities in Community Pharmacy Practice Management are evidence-based & guided by:

ACPE Accreditation Standards & Guidelines

CAPE Recommendations

Current literature from pharmacy, medical, & business

Student feedback from surveys & performance in class exercises

Assessment of student achievement of learning objectives

Preceptor & pharmacist feedback

Professional & research experience of instructors

Accreditation Council for Pharmacy Education (ACPE) Standards linked to course objectives

ACPE Standards

ACPE Standards

Domain Subdomain Key Elements (From ACPE) PHAR 660 Learning Objectives: Community Pharm Practice Management Common barriers to learning1. Founda-tionalKnowledge

1.1 Learner The graduate must be able to develop, integrate, and apply knowledge from the foundational sciences (i.e., biomedical, pharmaceutical, social/ behavioral/ administrative, and clinical sciences) to evaluate the scientific literature, explain drug action, solve therapeutic problems, and advance population health and patient-centered care.

1.1.1. Develop & demonstrate depth & breadth of knowledge in Community Pharm Practice Management.1.1.2. Articulate how it is integral to clinical practice, innovations in MTM, health & wellness initiatives, & delivery of contemporary pharmacy services.1.1.3. Integrate knowledge from Community Pharm Practice Management to explain how to serve the health related needs of individuals & populations in sustainable ways.1.1.4. Apply knowledge in Community Pharm Practice Management to solve practice related problems & advance patient-centered care.1.1.5. Critically analyze the delivery of pharmacist and pharmacy services to enhance their effectiveness.1.1.6. Identify & critically analyze emerging theories, information, & technologies that may impact patient-centered & population based care.

Lack of student understanding of the relevance of Community Pharm Practice Management to medication therapy management or health outcomes. Assumption that "management" is not what pharmacists do. Overconfidence in perceived capabilities.

2. Essentials of practice & care

2.1 Patient-centered care

The graduate must be able to provide patient-centered care as the medication expert (collect & interpret evidence, prioritize, formulate assessments & recommendations, implement, monitor & adjust plans, & document activities).

2.1.1. Collect subjective & objective evidence related to customer needs, behaviors, and preferences2.1.2. Interpret market evidence & customer data.2.1.3. Formulate evidence based business plans, market assessments, & recommended strategies.2.1.4. Interview customers to assess needs and market potential.

Limited knowledge of complexity of human behaviors and psychology. Lack of knowledge reinforced by a resistance to learning about any not related to drugs.

2.2 Medication use systems management

The graduate must be able to manage patient healthcare needs using human, financial, technological, & physical resources to optimize the safety & efficacy of medication use systems.

2.2.1. Compare & contrast medication use systems in different pharmacy practice settings.2.2.2. Describe the role of the pharmacist in impacting the safety, effectiveness, & value when serving patients' medication related needs.2.2.3. Evaluate the role of technology in medication use systems.2.2.4. Identify & utilize human, financial, & physical resources to optimize the medication use system.

Lack of life and work experience that prevents an understanding of the complexity of systems.

2.3 Health & Wellness

The graduate must be able to design prevention, intervention, and educational strategies for individuals and communities to manage chronic disease and improve health and wellness.

2.3.1. Discuss strategies to design and manage health and wellness programs.2.3.2. Evaluate personal, social, economic, and environmental conditions to maximize health and wellness.

Lack of life and work experience that prevents an understanding of human behavior when it comes to health and wellness.

2.4 Population-based care

The graduate must be able to describe how population-based care influences patient-centered care and the development of practice guidelines and evidence-based best practices.

2.4.1. Assess the healthcare needs and wants of a targeted patient population.2.4.2. Develop and provide an evidence-based approach that considers the cost, care, access, and satisfaction needs of a targeted patient population.

Thought and problem solving processes that are not evidence based.

Links between

ACPE standards

& Learning

Objectives

Domain Subdomain Key Elements (From ACPE) PHAR 660 Learning Objectives: Community Pharm Practice Management Common barriers to learning1. Founda-tionalKnowledge

1.1 Learner The graduate must be able to develop, integrate, and apply knowledge from the foundational sciences (i.e., biomedical, pharmaceutical, social/ behavioral/ administrative, and clinical sciences) to evaluate the scientific literature, explain drug action, solve therapeutic problems, and advance population health and patient-centered care.

1.1.1. Develop & demonstrate depth & breadth of knowledge in Community Pharm Practice Management.1.1.2. Articulate how it is integral to clinical practice, innovations in MTM, health & wellness initiatives, & delivery of contemporary pharmacy services.1.1.3. Integrate knowledge from Community Pharm Practice Management to explain how to serve the health related needs of individuals & populations in sustainable ways.1.1.4. Apply knowledge in Community Pharm Practice Management to solve practice related problems & advance patient-centered care.1.1.5. Critically analyze the delivery of pharmacist and pharmacy services to enhance their effectiveness.1.1.6. Identify & critically analyze emerging theories, information, & technologies that may impact patient-centered & population based care.

Lack of student understanding of the relevance of Community Pharm Practice Management to medication therapy management or health outcomes. Assumption that "management" is not what pharmacists do. Overconfidence in perceived capabilities.

2. Essentials of practice & care

2.1 Patient-centered care

The graduate must be able to provide patient-centered care as the medication expert (collect & interpret evidence, prioritize, formulate assessments & recommendations, implement, monitor & adjust plans, & document activities).

2.1.1. Collect subjective & objective evidence related to customer needs, behaviors, and preferences2.1.2. Interpret market evidence & customer data.2.1.3. Formulate evidence based business plans, market assessments, & recommended strategies.2.1.4. Interview customers to assess needs and market potential.

Limited knowledge of complexity of human behaviors and psychology. Lack of knowledge reinforced by a resistance to learning about any not related to drugs.

2.2 Medication use systems management

The graduate must be able to manage patient healthcare needs using human, financial, technological, & physical resources to optimize the safety & efficacy of medication use systems.

2.2.1. Compare & contrast medication use systems in different pharmacy practice settings.2.2.2. Describe the role of the pharmacist in impacting the safety, effectiveness, & value when serving patients' medication related needs.2.2.3. Evaluate the role of technology in medication use systems.2.2.4. Identify & utilize human, financial, & physical resources to optimize the medication use system.

Lack of life and work experience that prevents an understanding of the complexity of systems.

2.3 Health & Wellness

The graduate must be able to design prevention, intervention, and educational strategies for individuals and communities to manage chronic disease and improve health and wellness.

2.3.1. Discuss strategies to design and manage health and wellness programs.2.3.2. Evaluate personal, social, economic, and environmental conditions to maximize health and wellness.

Lack of life and work experience that prevents an understanding of human behavior when it comes to health and wellness.

2.4 Population-based care

The graduate must be able to describe how population-based care influences patient-centered care and the development of practice guidelines and evidence-based best practices.

2.4.1. Assess the healthcare needs and wants of a targeted patient population.2.4.2. Develop and provide an evidence-based approach that considers the cost, care, access, and satisfaction needs of a targeted patient population.

Thought and problem solving processes that are not evidence based.

Problems I have

seen with

student learning

in previous

classes

Domain Subdomain Key Elements (From ACPE) PHAR 660 Learning Objectives: Community Pharm Practice Management Common barriers to learning3. Approach to practice & care

3.1 Problem-solving

The graduate must be able to identify problems; explore and prioritize potential strategies; and design, implement, and evaluate a viable solution.

3.1.1. Identify and define a practice-related problem in a defined population.3.1.2. Define goals and alternative goals.3.1.3. Explore multiple solutions by organizing, prioritizing, and defending each possible solution.3.1.4. Anticipate positive and negative outcomes by reviewing assumptions, inconsistencies, and unintended consequences.3.1.5. Implement the most viable solution, including monitoring parameters, to measure intended andunintended consequences.3.1.6. Reflect on the solution implemented and its effects to improve future performance.

Perceptual and cognitive biases. Simplistic thinking. Impulse to come to quick and simple solutions. Desire for a "correct" answer. Lack of a systematic problem solving framework.

3.2 Educator The graduate must be able to educate all audiences by determining the most effective and enduring ways to impart information and assess learning.

3.2.1. Present a business model to an audience for feedback and critique.3.2.2. Use a pitch deck to guide the presentation of information in an efficient manner to an audience.3.2.3. Adapt the presentation and delivery to the intended audience.3.2.6. Assess audience comprehension.

Lack of preparation. Not focusing on audience comprehension.

3.3 Patient advocacy

The graduate must be able to represent the patients’ best interests.

3.3.1. Advocate for patient-centered medication therapy to payers, employers, and other health care providers.3.3.2. Frame arguments for the benefits and value of medication therapy that gives patient full understanding of their options.

Unwillingness to challenge the status quo. Not speaking truth to power. Being self-centered instead of patient-centered.

3.4 Interprofes-sionalcollaboration

The graduate must be able to actively participate and engage as a healthcare team member by demonstrating mutual respect, understanding, and values to meet patient care needs.

3.4.1. Establish a climate of shared values and mutual respect necessary to meet patient care needs.3.4.2. Define clear roles and responsibilities for team members to optimize outcomes for specific marketing assignments.3.4.3. Communicate in a manner that values team-based decision making and shows respect for contributions from other areas of expertise.3.4.4. Foster accountability and leverage expertise to form a highly functioning team.

Poor team habits. Working as a group of individuals instead of a team. Not relying on each team member's strengths. Focusing on completing assignments quickly instead of the learning objectives.

3.5 Cultural sensitivity

The graduate must be able to recognize social determinants of health to diminish disparities and inequities in access to quality care.

3.5.1. Recognize the collective identity and norms of diverse customer groups without overgeneralizing (i.e., recognize and avoid biases and stereotyping).3.5.2. Demonstrate an attitude that is respectful of diversity.

Seeing patients as homogeneous (e.g., "Patients only care about how fast you fill their prescriptions.")

3.6 Communica-tion

The graduate must be able to effectively communicate verbally and nonverbally when interacting with individuals, groups, and organizations.

3.6.1. Interview potential customers and partners using an organized structure.3.6.2. Actively listen and ask appropriate open and closed-ended questions to gather information.3.6.3. Summarize findings for use in a business plan.

Not interviewing actual people. Not getting out of the classroom and into the real world.

Domain Subdomain Key Elements (From ACPE) PHAR 660 Learning Objectives: Community Pharm Practice Management Common barriers to learning4. Personal & professional development

4.1. Self-Awareness

The graduate must be able to examine and reflect on personal knowledge, skills, abilities, beliefs, biases, motivation, and emotions that could enhance or limit personal and professional growth.

4.1.1. Use metacognition to regulate one’s own thinking and learning.4.1.2. Maintain motivation, attention, and interest (e.g., habits of mind) during learning and work-related activities.4.1.3. Identify, create, implement, evaluate and modify plans for personal and professional development for the purpose of individual growth.

Not taking the time to think. Lack of personal introspection.

4.2 LeadershipThe graduate must be able to demonstrate responsibility for creating and achieving shared goals, regardless of position.

4.2.1. Develop a business case for the value of innovative pharmacist services.4.2.2. Work in teams to develop a business plan for implementing a new clinical service.4.2.3. Develop relationships, value diverse opinions, and understand individual strengths and weaknesses to promote teamwork.4.2.4. Persuasively communicate goals to the team to help build consensus.4.2.5. Empower team members by actively listening, gathering input or feedback, and fostering collaboration.

Not recognizing the value of leadership as a skill desired by employers. Not realizing the transferablility of leadership skills to those desired in excellent pharmacists.

4.3 Innovation & Entrepreneurship

The graduate must be able to engage in innovative activities by using creative thinking to envision better ways of accomplishing professional goals.

4.3.1. Demonstrate initiative when confronted with challenges.4.3.2. Develop new ideas and approaches to improve quality or overcome barriers to advance the profession.4.3.3. Demonstrate creative decision making when confronted with novel problems or challenges.4.3.4. Assess personal strengths and weaknesses in entrepreneurial skills4.3.5. Apply entrepreneurial skills within a simulated entrepreneurial activity.

Fear of being different. Fear of making a mistake. Fear of embarrassment.

4.4 Professionalism

The graduate must be able to exhibit behaviors and values that are consistent with the trust given to the profession by patients, other healthcare providers, and society.

4.4.1. Demonstrate altruism, integrity, trustworthiness, flexibility, and respect in all interactions.4.4.2. Display preparation, initiative, and accountability consistent with a commitment to excellence.4.4.3. Act consistently in a manner that is legal, ethical, and compassionate.4.4.4. Recognize that one’s professionalism is constantly evaluated by others.4.4.5. Engage in the profession of pharmacy by demonstrating a commitment to its continual improvement.

Thinking and acting like a student instead of a health care professional.

L.O.2. Link skills learned in this course to becoming an excellent community pharmacist

14

Pharmacy

"Icons in this presentation adapted from or made by Freepik from Flaticon.com"

Whatever happens outside of the pharmacy

has nothing to do with me.

I control the drugs. Deal with it.

I am the expert. Listen to me.

Talk to the Tech. I’m busy.

THE OLD MINDSET

NO LONGER WORKS

Step 1

ATTITUDE

Step 2

KNOWLEDGE & SKILLS

Step 3

ACTION

BECOMING AN EXCELLENT COMMUNITY PHARMACIST

Step 1: ATTITUDE

Is this car owned or

being rented by this

man?

DUH…Of course it’s owned by the man.

People take better care of things that they own. Ownership is associated with pride and responsibility.

Renting does not. No one ever washes a rented car.

In pharmacy, some pharmacists take ownership of their practices.

Others are just employees and take no pride or responsibility of ownership.

They are the pharmacists who take no responsibility for their patients’ health or the financial success of their practice setting.

They just work there.

After graduation, do you plan to own or rent your pharmacy practice?

Step 2: KNOWLEDGE

AND SKILLS

http://teaching.uncc.edu/best-practice/goals-

objectives/writing-objectives

Blooms taxonomy is used

By educators to develop

Course learning objectives.

It breaks learning into

Domains associated with

1. Knowing,

2. Analyzing, &

3. Doing

Domain 3

Domain 2

Domain 1

http://teaching.uncc.edu/best-practice/goals-

objectives/writing-objectives

If you read assignments &

take class quizzes, YOU

WILL KNOW

If you fully engage in

class exercises, YOU WILL

UNDERSTAND

If you fully engage in

developing business

models and business

plans, YOU WILL BE ABLE

TO DO

Domain 3

Domain 2

Domain 1

Each of us fits

Somewhere on

The line in this grid.

The goal of this course

Is to move you further

On the line.

Step 3: ACTION

ACPE expects all pharmacy students to be able to manage a pharmacy practice after graduation

They also expect all graduates to be able to write a business plan

I have found that learning to write business models and business plans is one of the best ways to prepare yourself to think like an owner of a pharmacy practice

BUSINESS MODELS & PLANS

DESCRIBE HOW A BUSINESS (OR

ELEMENT) SERVES CUSTOMERS IN A

SUSTAINABLE WAY

Plan for achieving your mission

Revenue equals or exceeds expenses

Sustainable

Expenses exceed revenues

Unsustainable

Term Definition

Business Model A rough description of how customers are served sustainably

Business Model Canvas

A one-page overview of the business model

Business Plan A more detailed and formal document about elements of the business model

Organization's Operation -

Specific background about the

organization where the

product/service will be provided

Strengths, Weaknesses -

Your capabilities to serve targeted

customers

Service/Product – What is your specific product/service?

Secondary Customers -

Who else may want/ benefit

from your product?

Partners – Who might support

you?

Value Proposition – Why should customers use your product and

not something else?Opportunities,

Threats -Potential for success or

failure in the market

Competitors –What might

customers use instead of you?

Primary Customers – Who do you think is the right customers to

target?

Costs – What financial and nonfinancial costs will be

needed?

Pricing & Reimbursement – Wherewill the money come from?

Communication Plan – What do you want to say? How do you want to say it? What do you

want to happen?

Implementation – What critical things do you need happen for success to occur?

Source: (adapted) Osterwalder A, Pigneur Y. Business Model Generation: A Handbook for Visionaries, Game Changers, and Challengers. Hoboken, NJ.: John Wiley and Sons; 2010.

Business Model Canvas for Pharmacy Services

MAJOR ELEMENTS OF BUSINESS PLANS

Executive Summary

Product or Service Description

The Pharmacy's Operation

SWOT Analysis

Primary Targeted Segments/Markets

Partners

Competitors

Revenue, Pricing, & Costs

Promotional Plan

Implementation Plan

Appendices

All students in this course will learn how to put together the building blocks of business models and business plans

L.O.3. Describe how this course can help you have more job security in a turbulent health care market

To be truthful, there is no such thing as job security anymore

However, you can manage your risk of obsolescence to employers

The best way to be competitive for pharmacy positions is to…

Make more money for your employer than it cost to employ you

I SAID, “MAKE MORE MONEY FOR YOUR EMPLOYER THAN IT COST TO EMPLOY YOU!!!!”

The higher the return of investment (ROI) of employing you, the more secure your job and the greater your compensation potential

ROICosts of

employing youBenefits of

employing you

ROICosts of

employing youBenefits of

employing you

Often correlated

with your level of

professionalism as

a student

The more you know about the business of community pharmacy practice, the better you can increase your ROI to employers

BE MORE ENGAGED

• No sleep walking through work day.

• Actively seek ways to serve patients.

ACCEPT PRACTICE OWNERSHIP

• Totally committed to the health & happiness of patients & employees of the pharmacy.

• Actively seek ways to help the practice thrive and be financially successful.

CHANGE PHARMACY PRACTICE

• Innovate & disrupt the status quo.

• Possibly get filthy rich while making a difference.

What I want from VCU pharmacy school graduates

I want preceptors to say, “VCU graduates are amazing. I want more of them to do rotations at my pharmacy.”

I want employers to say, “My best pharmacists are VCU graduates. I want to hire more of them.”

It is up to you to make this happen