Phar 566 Exam 1 PDF

PHAR 566 Exam 1 WEEK 1: INTRO TO MANAGEMENT – SIMON LO: Discuss the evolution of “pharmaceutical care” and medication therapy management through the 20th century and the major forces that have shaped the practice of pharmacy, pharmacy management and pharmacy education EARLY 20TH CENTURY (BEFORE 1940...

PHAR 566 Exam 1 WEEK 1: INTRO TO MANAGEMENT – SIMON LO: Discuss the evolution of “pharmaceutical care” and medication therapy management through the 20th century and the major forces that have shaped the practice of pharmacy, pharmacy management and pharmacy education EARLY 20TH CENTURY (BEFORE 1940s) Pharmacy Practice “Soda Fountain Era” - Role: handling & preparing remedies - 1° activities: procurement of drug products & compounding - Minimal legislative and ethical codes Reimbursement d/t product ⊗ services to pts MIDDLE 20TH (40-60s) LATE 20TH (70, 80, & 90s) “Lick, Stick, and Pour Era” - Implementation of SSA and Medicaid: ⬆ use of pharmaceuticals - Technology Adv: mass production of prefabricated drugs - Durham Humphrey/Food Drug Cosmetic Act 1951 - legend OTC drug (vs Rx) shift from compound/ product-related → pt care services Pharmacy - Profitable business WITHOUT - Role: Dispenser of prepared Manage-ment evidence of safety or efficacy products - Sharp business acumen needed to survive - Time management skills to accomplish all tasks Pharmacy Education - Apprenticeships - AACP created 4-year BA degree ⬆ focused on pharmaceutical, ⊗ dx or tx EVOLUTION OF PHARMACY (past 20 years) - MTM - Immunizers → progression of our profession - Medicare Modernization Act of 2005 - Rx drug coverage for seniors - MTM - pharmacist included in list of providers → can get reimbursed - ACA (Healthcare Reform): always Δ healthcare - Population Health Management - Illinois Collaborative Pharmaceutical Task Force: focus on progression of profession - ⬆ number of - Changes in reimbursement – “shrinking margins” - Compensation for pharmacy services “independents” & - ⬆ of supermarkets, chain and mass merchandiser - Mail order & internet pharmacies - 5th year of school added - 6th year added (PharmD curriculum) - Proposed in 1984, Adopted in 1989 - Community Pharmacy Residencies - ⬆ info on physical/ chemical drug properties ⬆ push for higher education - Continuously updated curriculum d/t ACPE accreditation standards LO: Discuss current issues in healthcare and describe barriers and enablers to the provision of pharmaceutical care/ medication therapy management within the management context CURRENT ISSUES Changes in reimbursement – “shrinking margins” - Shift from price-based reimbursement (AWP) → cost-based reimbursement (ASP or AMP ?) 340B – Discount Program for eligible outpt pharmacy - Questioning if pts are benefitting and negative implications of 340B for patient care - Reduction on Medicare Part B Reimbursement - Manufacturers withholding 340B pricing - VIDEO: 340B for low-income and rural communities, but in July 2020, some drug companies denied 340B discounts on drugs (i.e., insulin) dispensed to community pharmacies → breaking the law COVID19 Pandemic - Patient/employee safety/risk mitigation - Workflow changes/testing/immunizations - Negative impact on pharmacy revenue/potential for new revenue streams? Pharmacy Performance Metrics - Adherence – if pt NOT ≥ 80% compliant, then 3rd party payers penalized pharmacies (🡡 stress) - DIR Fees: retroactive “take backs” Restrictions on Specialty Pharmacy - Restricted Distribution & Third-Party Lock-out Good management practice + Pharmaceutical care = Winning combo To achieve excellence in implementation of clinical pharmacy services: - Obtain & properly allocate resources Design efficient distribution systems Select & train adequate support staff Develop systems for dissemination of information on new drugs & technology - Document & evaluate cost effectiveness of services provided Assure that the pharmacists roles and activities are aligned with overall methods of healthcare delivery LO: Discuss the managerial sciences and how they relate to the provision of pharmaceutical care CLASSICAL MANAGEMENT MODERN MANAGEMENT - HIERARCHY: AUTHORITY = top to bottom - Industrial revolution created ∆ from manpower to mass production which brought change in management principles - Product oriented – mass production of tangible goods (similar to pharmacy before 1950’s) Shift from hierarchical top-down → empowerment of employees to reach goal Energize: vision, what to create and how to make it happen; good managers have the energy and enthusiasm to attract motivated people Empower: allow employees to do what needs to be done Support: provide feedback, resources and discipline as needed Communicate: create an environment of choice that encourages sharing of ideas and information We give 3 times more services than goods compared to classical management Managerial Sciences and Relevance to Pharmaceutical Care - Accounting/Finance o Determine if profit was made - Marketing o Market different services provided to acquire → pts and sustain business - Operations Management o Need clear cut policies, procedures, responsibilities to guide employees - HR Management o Hire and retain, create a culture where ppl want to come o Benefits, bonuses LO: Describe the management process within the contexts of what managers do, resources that they manage and levels at which managers make decisions LO: Recognize the key management activities, resources and levels of decision making in delivery of pharmacy care MANAGEMENT DEFINITION Different Elements of Managements - Role: Boss/person in charge - Process: METHOD of getting things done, accomplishment of goals - Modern management: energize, empower, support, communicate Different than Leadership: ability to guide, inspire, or direct individuals MANAGEMENT PROCESS (PLOC) POLL QUESTIONS 1) Plan: predetermining a course of action based on goals and objectives 2) Organize: arrangement and relationship of activities and resources for the effective accomplishment of a goal or objective; structure 3) Lead/Direct: bringing about purposeful action toward some desired outcome (aka goal of organization) o Responsible to implement the mission and vision o Ex: meeting with an employee to discuss absenteeism and tardiness 4) Control: review progress towards the objectives that were set out in the plan LEVELS AT MANAGEMENT (MANAGERS MAKE DECISIONS) - Individual: self-management → starts from within - Interpersonal: interacting with other people - Organizational: actions that affect groups of people Resources Managed Scenario: Management task- meeting with employees to discuss absenteeism and tardiness. Q: What type of management activity? - A: Direct - Wrong: plan, organize, control Q: What resource is being managed? - A: People - Wrong: money, info, materials Q: What level of decision making is performed by the manager? - A: Interpersonal People Money, time Materials, info MANAGERIAL SKILLS TECHNICAL CONCEPTUAL HUMAN “things and method” “ideas” “people” Ability to use knowledge, methods, techniques, and equipment necessary for performance of specific pharmacy-related/ managerial tasks acquired from experience, education, & training Ability to understand complexities of overall organization or external environment and where one’s profession fits in, ability to put many ideas together to form new approaches Various organization & functional components depend on or are interrelated with one another such as pharmacy & nursing Development over time/experience Ability to work well with other people to achieve tasks - Includes understanding of motivation, - Ability to work as a group, - Application of leadership Ex: if you are an accountant, you can pivot cell in excel Ex: from Cerner → Epic MOST important skill As you ⬆ in management skills - ⬆ in conceptual skills - ⬆in technical skills - HUMAN skills must remain HIGH for all lines of management **Leadership = inspiring people to do a task. Management = allocating resources and directing resources to complete a task. WEEK 2: THE WORLD OF HR - GRIDER LO: Elaborate on the impact of HR management in providing high quality pharmacist services & positive work climate Human Resource Management: the process of achieving organizational objectives through the management of people - Includes: recruitment, placement, training/organizational, retention, performance review, dismissal (termination) Impact of HR management allows for provision of quality pharmacy services: - Staffed appropriately - Monitored for performance-competency - Compliance with regulatory agencies - Meets budget targets - Productivity - All can contribute to a safer practice - Without it, staff can lack direction and guidance Pharmacy Specific Issues -- Pharmacists are often poorly managed resulting in: - Overwork and stress due to unclear direction - Poor teamwork - Insufficient training - Inadequate feedback about performance - Medication errors can be the result of poor management: quantity over quality, poor work habits, inappropriate tech supervision LO: Define and apply the laws involved in hiring and managing a pharmacy team Civil Rights Act of 1964 Title VII of the Civil Rights Act of 1991 1) Prohibits discrimination in hiring, promotion, compensation, and treatment of protected employee groups. - Gender identity, race, age, sex, religion, etc. 2) Illegal to RETALIATE against a person who complained of discrimination. There are multiple ways discrimination can occur. 1) Prohibits discrimination on the basis of race. Burden of proof on employer. 2) Prohibits sexual harassment as a form of sex discrimination - Does not need to be of a sexual nature – can include offensive remarks about a person’s sex ADDITIONAL LAWS Color discrimination (not synonymous with race) National origin Pregnancy Discrimination Act of 1978 Equal Pay for Equal Work Act Age Discrimination Act of 1967 o Protects discrimination for those over age 40 Americans with Disabilities Act (ADA) of 1990 - Prohibits discrimination against qualified individuals labeled as disabled - Have to be able to make a reasonable accommodation - Ex: Employee cant stand all day → get a stool Family and Medical Leave Act (FMLA) of 1993 - 12 weeks unpaid leave for family needs/illness (continuous or intermittent) - Keeps insured - Ex: if employee misses work for severe family member illness, they can’t get dinged for it EEOC - Monitors the Act. fair processes expected. A hostile work environment can be based on any of these discriminatory categories (ethnic slurs, foreign accents, illness, pregnancy) OSHA - Monitors workplace safety, hazardous chemicals, blood borne pathogens - Ex: sharps Access and Equity (previously called Affirmative Action) - ⬆ misperceptions - Mandates a fair selection process - GOAL: Most qualified candidate is selected o If a minority candidate has the same qualifications as the most qualified → minority would be selected - Department makes the final choice based on job specific criteria → but can be subjected to review (if someone makes a complaint stating they were the most qualified, then company would have to respond in court) LO: Define quid pro quo and hostile work environment 2 TYPES OF SEXUAL HARRASSMENT QUID PRO QUO Something for something (this in exchange for that) Ex: “I’ll give you a raise if you go to dinner with me,” negotiating to get ahead HOSTILE WORK ENVIRONMENT less overt, unwanted sexual behavior or communications are a pattern or are pervasive enough to disrupt the employees work. Not a one time thing; it’s continuous LO: Identify critical steps in the recruitment and selection of employees RECRUITMENT Many ways to attract: - Career fairs - Professional meetings - Networking - Ads (online of course are BIG!) - Current staff - Positive Imagine Meeting as many people as you can PLACEMENT SELECTION - Following laws in place - Applications (screening must be consistent) - Choosing wrong person can be expensive in turnover costs and conflict with problematic employee - Application: provides background for the interview - Screening: criteria and/or tests for basic qualifications - Interviewing: asking candidates questions in a purposeful/organized manner - Selection: reviewing and identifying the best candidate - Hiring: extending the offer to the best candidate - Retention: LO: Compare and contrast job orientation, training, and development ORIENTATION - Multifaceted Welcomes new employees Gives positive first image Provide with info and expectations for position Checklists for each: - Organizational orientation - Department orientation - Specific assignment o Good for performance reviews TRAINING DEVELOPMENT - Cannot be overlooked - Must demonstrate that staff are competent - Required by TJC to meet standards o establish competency standards for each classification of employee o Documentation for performance follow-up - Fulfills current needs o Used to improve performance w current tasks & jobs - Can make the job more interesting and meaningful and lead to greater morale - Organization and personal responsibility - Requires a long-term focus by preparing staff for future needs - Maintain and expand competencies - Adds value to staff - Improves job satisfaction - Allows different employee classifications to share info and learn from each other - Prepares employees for new responsibilities and positions - Fulfills future needs – LONG TERM FOCUS - Job rotation or cross training – ⬆ skill mix, job interest, self esteem - If not trained, then staff doesn’t know: what and when, why and how, conflicting priorities, rewarded for NOT doing it, NO positive consequences for doing it right, punished for following policies Performance Feedback (not a learning objective, but here's a few important points) - Necessary for improvement - Day-to-day feedback o MBWA – management by walking around o Listening to staff o Make your presence helpful - Annual performance reviews: formal and scheduled - Ad hoc performance reviews: as needed, good or bad - Performance tool should be shared with new staff so they know what will be assessed o Should include both organizational and job specific criteria LO: Discuss strategies for retaining employees HOW to keep good people - Competitive salary/benefits Good development programs Consistent and fair employment practices Work environment is important o Clear policies/procedures o Expectations are delineated clearly o o o o o Management is responsive to staff issues Communication is effective Staff is empowered to make decisions Staff should feel SAFE Cohesive team effort WHY Turnover is expensive A staff mix with experience is beneficial LO: List the steps involved in PROGRESSIVE DISCIPLINE Stepwise progression towards termination Purpose: NOT to punish but to CHANGE behavior Documentation for every step May be grieved at any step along the way (unless probation but still must document performance) Dismissal (AKA firing) should NEVER be a surprise – performance tool assists with this STEPS: 1) Initial verbal discussion on performance 2) Written warning 3) Suspension 4) Termination (final step) WEEK 3A: STRATEGIC PLANNING - DONNELLY WHY DO WE PLAN? - Defines what we want to accomplish - Can dictate future success - One of the main functions of a manager o Planning, organizing, leading, controlling - Many types of planning o Strategic, Resource, Contingency, & Business planning STRATEGIC PLANNING DEFINITION PURPOSE CHARACTERISTIC - Ensures organization will be doing the right things in the future - Determine long-term goals for the organization - Addresses what business the organization is in or should be in - Long-term (2-5 years) o Usually 3 years, so plan stays current - Includes all aspects of an org - Viewpoint is internal and external → can bring an outside consultant - Financial investment LO: List the general process of strategic planning OVERALL STRAGETIC PLANNING PROCESS 1. 2. 3. 4. Define the planning purpose or desired result (vision/mission) Assess the current situation (SWOT) Establish SMART goals Identify strategies to reach those goals 5. 6. 7. 8. Establish objectives for each of the strategies Define responsibilities and timelines for each objective Write and communicate the plan Monitor progress toward meeting goals and objectives An organization’s strategic plan should include: a defined purpose, an assessment of the current climate, and a description of goals and objectives that includes a timeline for completion. STEP #1: DEFINE THE PLANNING PURPOSE OR DESIRED RESULT (VISION/MISSION) LO: Differentiate between a vision and mission statement VISION STATEMENT MISSION STATEMENT - Defines: org WANTS TO BECOME at SOME FUTURE POINT - Defines: what the organization DOES For strategic planning, vision statement is MORE important! - Serves as the starting point and end point for strategic planning - GOAL: to inspire - Concise - Creates a sense of purpose for customers and employees - GOAL: Meant to differentiate between other companies that do the same thing - Concise Examples: - UI Hospital: “to be the preeminent healthcare provider known for improving the health and wellness of our communities, providing exemplary care for our patients and advancing the knowledge to do so” - CVS: “to help people to live longer, healthier, happier lives” - Walgreens: “to be America's most-loved pharmacy-led health, well-being and beauty company” Examples: - UI Hospital: “To advance healthcare for everyone through outstanding clinical care, education, research, and social responsibility.” - CVS: “Supporting people on their journey to better health.” - Walgreens: “To champion the health and well-being of every community in America.” LO: Describe tools used during strategic planning STEP #2: Assess the current situation (SWOT Analysis) SWOT Analysis - SWOT = Strengths, Weaknesses, Opportunities, Threats - A SWOT analysis can help an organization identify internal and external factors important in determining its competitive position. - Identifies where, what, and how the organization is in the present - By comparing the results of the situation (SWOT) analysis with desired future state (vision), extent and nature of gap between two becomes clearer POSITIVE NEGATIVE INTERNAL Strengths What do you do well? What unique resources can you leverage? What do 3rd parties see as your strengths? Weaknesses What needs improvement? What do competitors do better? What resources do you lack? EXTERNAL Opportunities What market opportunities are present? How can you leverage your strengths? What trends can you take advantage of? Threats What is your competition currently doing? What threats can hurt your business? Do your weaknesses expose your business? Opportunities (external, positive) Threats (external, negative) Strengths (internal, positive) Strength-opportunity strategies Ex: which of the company’s strengths can be used to maximize the opportunities you identified? Strength-threats strategies Ex: how can you use the company’s strengths to minimize the threats you identified? Weaknesses (internal, negative) Weakness-opportunity strategies Ex: what actions can you take to minimize the company’s weaknesses using the opportunities you identified? Weakness-threats strategies Ex: how can you minimize the company’s weaknesses to avoid the threats you identified? STEP #3: ESTABLISH GOALS (SMART) Once know gap between current and desired state, develop goals that will help attain vision - SMART goals should be consistent with the vision. - Goals should capitalize on the organization’s strengths and opportunities - While minimizing the threats and mitigating weaknesses STEP #4: IDENTIFY STRATEGIES TO REACH THOSE GOALS Once goals identified → next step is to identify strategies that will accomplish goals STEP #5: ESTABLISH OBJECTIVES FOR EACH OF THE STRATEGIES Last step is to determine objectives for each of the strategies STEP #6: DEFINE RESPONSIBILITIES AND TIMELINES FOR EACH OBJECTIVE *IMPORTANT: Assign responsibility and determine timelines for each objective → often times strategic plans fail d/t the responsibility to actually make things happen is not delegated appropriately & timelines are not given in terms of when things need to be done Relationship between vision, goals, strategies, and objectives - To reach a certain vision, or future state, the organization must set and reach one or more goals. - Each goal is associated with a specific strategy or method of reaching that goal. - The strategy can be defined by the objectives that are necessary intermediate accomplishments toward the goal. - A set of tasks, or actions, may be associated with each objective. Collectively, these tasks are also called tactics that the organization employs to meet an objective STEP #7: Write and communicate the plan STEP #8: Monitor progress toward meeting goals and objectives LO: Identify barriers and limitations to strategic planning BARRIERS TO PLANNING LIMITATION TO PLANNING - Failure to commit sufficient time to planning - Lack of planning skills → OK to bring in outside consultant - Failure to plan far enough into the future → 1 year for strategic plan is NOT enough, maybe for another type, usually need ~3yrs - Interpersonal issues (i.e., resistance to change) - Constantly changing environment → HAS to be fluid and adjust strategic plan periodically to keep current - *BIGGEST & MOST COMMON: FAILURE TO IMPLEMENT due to lack of time AND resources - Failure to monitor progress - Lack of support from top executives - Planning is to some degree guesswork o even though based on evidence, risk involved, nothing is certain - Plans and predictions only as good as the data and information that go into them – poor data results in poor strategy - Planning not a substitute for action – must take action dictated - Plan should not be considered static – planning should be a continuous process, plans should change as environment dictates Summary - An organization’s strategic plan should include: a defined purpose, an assessment of the current climate, and a description of goals and objectives that includes a timeline for completion. - Once an organization’s strategic plan is determined 🡪 it is essential to write and communicate the plan as well as monitor its progress post implementation to determine its successfulness. - A vision statement is future-focused describing what a company wants to become, and a mission statement describes what a company does. - A SWOT (strengths, weaknesses, opportunities, and threats) analysis can help an organization identify internal and external factors important in determining its competitive position. - SMART goals should be consistent with the vision. - Barriers to strategic planning include lack of planning time and skills, interpersonal issues, failure to implement, and lack of support from top executives. WEEK 3B: LEADERSHIP - DONNELLY LO: Define leadership LEADERSHIP DEF: Leadership is a process by which one person influences thoughts, attitudes, and behaviors The leader sets the direction, sees what lies ahead, visualizes what can be achieved, encourages, and inspires Qualities of an effective leader: role model, passion, mentor, honesty, motivating, creativity, empowering, ethical, guiding, courage, coaching, positive attitude, vision, confidence, integrity, empathy, commitment, team spirit LO: Differentiate between leadership and management LEADERSHIP MANAGEMENT FOCUS: getting people to commit to a common vision, goals → ship is committed to a goal/final destination FOCUS: getting people to take action toward that goal → implement programs to make that goal happen Pharmacy directors have BOTH LEADERSHIP AND MANAGEMENT responsibilities → key is to balance both Most people are NOT born leaders, but every person can build themselves into an effective leader LEADERSHIP THEORIES TRAIT THEORY Greatest predictor of leadership effectiveness and success are the traits and dispositions with which people are endowed at birth or develop early in life BEHAVIORAL THEORY Greatest predictors of leadership effectiveness are the behaviors and abilities that people learn over time LO: Describe 6 styles of leadership STYLE DEFINITION EFFECTIVE? Influences behavior: rewards & punishment COERCIVE Mobilizes people toward a vision articulated by a leader; TRANS-FORMATI Clearly define how work fits into larger vision for org ONAL Influences others: by relying on charismatic power Focuses more on the follower than the task - keep staff happy, engaged, & meets emotional needs AFFILIATIVE Influences others: positive feedback vs negative feedback - enhance communication, loyalty, trust DEMOCRATIC PACESETTING COACHING EXAMPLES LEAST effective: most situations May be SUCCESSFUL: crisis ONLY use when necessary Ex: make this happen or people will start to lose jobs MOST effective: : ⬆ of situations Good but relying only on this style = negative effects - Followers who hear ONLY praise will not know when they need to improve their behavior - Poor performances can go uncorrected if followers feel that mediocrity is acceptable Gives staff a say in decisions that affect work lives - Generates sense of ownership - Nurtures ideas, builds trust & respect → Democratic = Decision INEFFECTIVE: crisis Ex: PM shift team knows how to redevelop the PM shift flow better than the AM shift staff Set extremely high-performance standards for BOTH followers & themselves Leader leads by example MOST concerning Ex: leader expects the entire staff to be working on wknds bc they do Strive to develop abilities of their followers INEFFECTIVE: crisis - Works best when staff wants to be coached & motivated - Quick actions necessary to learn more and improve performance Often underutilized bc → time consuming & managerial demands do not permit leaders sufficient time for the work Leaders should NOT just pick one leadership style The more styles mastered= better one can adapt to changing leadership situations Leaders = mastered ≥ 4 styles [transformational, democratic, affiliative, and coaching (TDAC)] establish & maintain best work environment & show better business performance Must be able to switch b/w styles as situation demands 4 PHASES OF LEADERSHIP DEVELOPMENT 1) UNAWARE and INEFFECTIVE Underdeveloped leadership skills 3) AWARE and EFFECTIVE Must work hard to apply their leadership skills; becoming more effective 2) AWARE and INEFFECTIVE Accepted leadership roles, make mistakes, relatively ineffective 4) UNAWARE and EFFECTIVE Leadership less of a conscious act; becomes automatic * GOAL: where you want to end up LO: Discuss 7 habits of highly effective people 7 HABITS OF HIGHLY EFFECTIVE PEOPLE 1. Be proactive - Take responsibility for your life, - Focus time and energy on things you can control 2. Begin with the end in mind - Focus on what you want to be and do o What do you want to do with my career? o Have a plan - Develop a personal mission statement 3. Put first things first - Focus on your highest priorities - OK not to do everything that comes along 4. Think win/win - Agreements and solutions are mutually beneficial and satisfying (not if I win you lose) 5. *IMPORTANT: Seek first to understand, then to be understood - Listen so you deeply understand the other person, - Most people listen with the intent to reply and not to understand 6. Synergize - “two heads are better than one” 🡪 teamwork - Better results can be achieved than could be individually 7. Sharpen the saw - Having balanced program for self-renewal in the four areas of your life: o physical, o social/emotional, o mental, o spiritual LO: Describe formal & informal leadership opportunities Leadership Evaluate Tools Helpful leadership tools: - increase self-awareness, - interpersonal communication skills, - identify thinking skills Ex: Myers-Briggs, Strength Deployment Inventory, etc. FORMAL OPPORTUNITY (TRAININGS) ASHP Programs ACCP Certificate Program APhA INFORMAL OPPORTUNITIES Students: pharmacy orgs/work Work setting - Big L leaders: informal leadership roles (director, assistant director, manager) - Little L leaders: all pharmacists are leaders in their workplace during their shifts Provide education to health care providers about new medications Local → state → national pharmacy WEEK 4A: PHARMACY OPERATIONS MANAGEMENT - GIMBAR OPERATIONS (OPS) MANAGER ROLE In ANY business: ensure smooth functioning to achieve both its public and private missions aka keep the wheels efficiently turning The manager in public-service institutions faces the same tasks as the manager in a business: 1. Perform the fx for the sake of which the institution exists 2. Make work productive and keep the workers achieving 3. Manage the institution’s social impacts and to discharge its social responsibilities Focuses: on what must be done today - to accomplish the long-term goals Activities must align with the vision, mission, and values of the org Must understand the org goals and the results of potential actions to ensure success LO: Describe the basic decisions an Operations Manager must make BASIC DECISIONS BIGGEST CHALLENGES 1. What must be done right now? 2. Who needs to be doing it? 3. What resources do they need? 4. When is the work finished? OPPORTUNITIES Staffing Workflow Problem Solving Conflict Resolution Developing lasting relationships through shared experiences Developing policies, procedures, and protocols for pharmacies and staff Delivering quality pharmacy services Collaboration with other HCP to improve patient outcomes Evaluations, supervision and coaching Involvement in 🡡decisions - Spread too thin LO: Understand how pharmacy is distinguished from “production worker” businesses MANAGER’S 1° ROLE AT ALL TIMES: - Managing HR and tasks derived from the pharmacy’s goals to produce quality customer service. What distinguishes pharmacy from most “production worker” styles of business? - The transformation of human resources and physical goods → into a custom solution for each individual patient TASKS, PRIORITIZATION, & COMMUNICATION Goals derived from the overarching pharmacy vision Daily tasks are developed from these goals Tasks should be clear, concise, and measurable Clear and Unambiguous Command Intent - Tasks = prioritized for completion - Not everything can simultaneously be accomplished - Changing circumstances change the order in which tasks need to be approached - Allows employees flexibility to accomplish specific tasks Inspiring engaged employee - Key to creating engaged and loyal customers! Daily work of the operations manager is to get the tasks: done right, in a timely fashion, consistent with the values of the organization, in a way that creates long-term value for stakeholder in the business LO: Review critical decisions a manager must face *GIMBAR said to read on own CRITICAL DECISIONS THAT NEED TO BE MADE UNDER THE PURVIEW OF OPERATIONS MANAGEMENT Designing goods and services What should be offered for sale and at what price? How should the business arrange the price and service component of the product to maximize perceived value using the relative value theorem? Process strategies What is the best workflow methodology to ensure productivity? Managing quality How do we provide sufficient productivity while maintaining impeccable quality? Location strategies Where is the best location for this service to be offered? Layout strategies What is the best physical layout to ensure productivity? Does this layout fit with the workflow process? Human resources How do you motivate and inspire people to do excellent work? How can you develop engaged employees that represent your brand and develop relationships with your customers? Scheduling When and where should each employee be when our customers need service? Supply chain Mgmt Which suppliers will best help the company meet the needs of our customers? Inventory Mgmt How does the business insure that it will have enough without having too much or too little inventory? Maintenance How can the business keep all the equipment and facilities in good working order? LO: Review the concepts of Command Intent and Professional Authority COMMAND INTENT 1 of the most challenging part of managing a pharmacy’s ops: - managing people Requires good communication and relationship building - Communication must be brief - Promote flexibility 🡪 so resources can be most efficiently utilized Command Intent = useful strategy to accomplish managing people - Must think critically and change tactics (in short-term), - while still working toward the ultimate goal works in BOTH directions - (EX: pandemic crisis management; starts from or ends with OP manager) TASK COMPLETION & PRIORITIZATION: - Tasks should be accomplished as efficiently and effectively as possible - Changing circumstances = makes it difficult staff to know the best task to perform at any given moment OVERALL: CI allows employees to understand and know what the prioritized task is at any given time without facing discipline If managers don’t provide command intent context: - Make employees feel powerless to make changes - Psychologically relieves employees of any responsibility that they might have felt to rectify a faulty directive and do what they know to be the real mission of the business. - Creates inefficient operations Actions to Results: - Executive-level management sets mission and vision for the long-term value strategy of an organization 🡪 - Then, Ops Managers (use the vision & mission) to create the goals or command intents of the business and turn them 🡪 into actions that create results - View on mental processes: o Executive team: “set the goals to direct the actions,” o Staff: “complete the actions to achieve the goals.” 1° challenge for OPS Managers is to bridge the 2 points of view to create success PROFESSIONAL AUTHORITY - There is no practical way in which an administrator can oversee or direct every event in a pharmacy All pharmacists from admin to staff must have some degree of management skills If the Pharmacy Supervisor is not present or able to provide guidance, a staff pharmacist must take over the management role In health care professions, the professional authority bestowed upon practitioners does NOT allow them to abdicate authority over the patient care process When choices must be made to keep the daily activities (e.g. appropriate patient care) aligned with the command intent of the org (e.g. efficient drug delivery), the health care professional on duty should have the authority to make that call OPERATIONAL GOALS Goal 1: Improving the speed and efficiency of patient service. - Are there bottlenecks in the workflow? - Is the staff time being used efficiently? Goal 2: Offering more services to patients. - Is there a service that a pharmacy’s customers want or need that they are not currently providing? - Can they provide this service at their traditional standard of quality? Goal 3: Creating and maintaining a collegial work environment for employees. - Do employees enjoy working at the pharmacy? - Does the team work well together when it matters? Goal 4: Improving the knowledge of health care team members. - Can the pharmacy staff use their talents to improve the efforts of others? - By identifying problem areas and resolving those problems, can the pharmacy improve their efficiency? EMPLOYEE ENGAGEMENT: The quality of the operations manager is a critical ingredient in creating a highly productive workplace. Managers who consistently keep their employees engaged produce superior results. WEEK 4B: INTERVIEW – GRIER LO: What is the importance of a cover letter PURPOSE: get the prospective employer to read your CV and offer you an interview → this is your handshake PREPARE: - Personal inventory, keep running file, - REVISE –< continuous process CONTENT - Well-organized - NO less than 10-point font - ALWAYS customize/targeted the content to the position - ACTIVELY written FORMAT - 1st paragraph: Identify the interested position and how you learned about it - 2nd paragraph: Specifically relate your experiences to your experiences/skills and your goals/objectives - 3rd paragraph: Reiterate interest, express that your resume is enclosed, and close with a statement about how to contact you LO: How do you select references - Always ask you references for permission - Provide references w details about the position & copy of CV - Have a variety of references ready: o Superiors from pharmacy positions o Professors from pharmacy school o Clerkship preceptors o Organizations - CUSTOMIZE the reference list to fit the position o Clinical position-clinical expert is best! - Do NOT need to o automatically provide w CV, (be ready to provide upon request) o include ‘references available upon request’ line on CV LO: Describe different methods of interviewing METHOD DEFINITION Does NOT give you insight → bc it can be well rehearsed “Tell me about yourself …” “What are your plans in 5 years” “What are your strengths & weaknesses” NOT VALID - Imaginary situation “How would you react to…” - Interrupt, unsettle “Why would we want you?” Interviewer may answer phone in interview MOST RELIABLE - Focus: Desired characteristics for position (compassion, “Tell me a time you….. dealt with difficult pt” “Give me an example of a busy day at work” TRADITIONAL SITUATIONAL STRESS BEHAVIORAL EXAMPLE teamwork, leadership, ethics) - Draws on your background, experience, & behavior o Know where you are coming from - Gives indication where they are going forward - Allows for conversations vs stock answer - Different criteria for each position USE: STAR Method - S: What is a situation that relates to the question - T: What were your tasks - A: What action did you take - R: What was the result FIND YOUR SPARKLE: - What makes you special - Your unique Qualities LO: Describe how the interviewer must be prepared - - Identify interview objectives, when a candidate is needed → criteria list Review positions description and performance tool Develop questions Review applications & CV → to see if need to follow up → makes it be more conversational - Schedule interrupted time to interview applicant Schedule others if they are to be involved bc they are all part of the team Take Notes INTERVIEW MISTAKE COMMENTS ON INTERVIEWING CURRENT THOUGHTS ON INTERVIEWING Inappropriate dress Lack of knowledge of position or org Tardiness or excessive rescheduling Unengaged attitude or flat affect Poor response to predictable questions Poor body language Unclear or irritating speech patterns Focus on self-interest → how many sick days Showing under or over confidence Pay attention to others in the area, front desk for example - Need to prep but that should make for more conversational tone. - Learn something about the organization (like UI Health helps the underserved) - Share your passion and knowledge and learn from the interviewer as well. - Know your chemistry, spontaneity - Assess the interviewer - Google: “Take the time to hire the best…do NOT RUSH a hiring decision” - Tribune: “be YOURSELF…you are your biggest selling point” - Dynamic Solution: “Hire somebody real” - Advisory Board: “Non-verbal aspects are noticed first, energy, posture, and professional dress. Then behavior-based tools are used to drill down to details” DECISION TIME Can this person do the basic job? Think clinical versus operational skills. Will the candidate make my job easier? - Problem solver? Problem maker? Would I want to work with this person? SIMPLE RULES FOR HIRING Hire for attitude…skills can be taught NEVER hire someone with questionable habits → what you see is what you get Go for a sense of humor Fill in the needs for your company-balance - ⊗ have all new grads Listen Start Practicing NOW Engage in conversations w people you don’t know well. - ⬆ your comfort level! Lost art form. Pay attention to body language…that can “say” a lot! Be assertive by communicating in a direct manner, not aggressive or passive. WEEK 5A: MOTIVATIONAL THEORIES – GRIDER LO: Define motivation, why it is important, how it is manifested in the workplace, and it’s relative role in performance MOTIVATION HOW DOES IT WORK? MOTIVATION: processes that account for an individual’s intensity, direction & persistence of effort toward attaining a goal. Individual needs → Drives/Motives (incentive to act) → Performance/Achievement (reward) - People basically are driven or motivated to behave in ways they feel will lead to rewards (satisfy needs/wants) - A motive is an incentive to act - IMPORTANT → “Things that get rewarded get done.” If you want the best from your staff, then you need to provide an environment that has many motivating factors that fit the needs of staff as individuals! You can observe that people will exert the effort (be motivated)… - IF they believe they can do (& feel empowered) what is asked (e.g. trained appropriately) - IF they believe that doing so will lead to rewards - IF they value those rewards WHY IS MOTIVATION IMPORTANT Staff will have: - Renewed morale and meaning at work - Improved personal performance - More appreciation for internal/external customers - ⬆ energy and resilience to stress The Organization will see: - Better staff retention - ⬆ absenteeism, burnout, and turnover - Improved customer care and service delivery - Enhanced teamwork…more trust and more fun at work - Enriched quality of work - ⬆ creativity and good humor MOTIVATION MODELS POSITIVE NEGATIVE LACK OF Being rewarded, involved, challenged Having a purpose, Being respected & honored Anger, revenge, stress “I’ll show you” Forced (no choice), Resentment No hope, being idle, Feeling rejected, Worthless, not understood Accomplishment, ability to prove you could Fear of failure, not wanting to compete Being stubborn, apathetic, no self-worth LO: Differentiate variable-cost, low-cost and no-cost rewards (cost and managerial control) and relate to the content theories (Maslow and Herzberg) VARIABLE COST Raises Bonuses Promotions Incentive systems for innovations Extra time paid off Trips Subject to budget constraints & fair distribution is important to validate MASLOW LOW-COST NO-COST Pizza/donuts for volunteers Advanced training Support professional activities: - Pay Conference fees - Support presentations at symposia - Donate department resources for community activities Verbal Praise Ask opinion/advice Job rotation - Prompt feedback on perform improvements - Increased autonomy - Increased visibility in organization HERZBERG No, low, & variable-cost rewards At what cost can you influence motivation once hygiene factors are satisfied? Many options! Managerial control: you can only use rewards you have control over (and can afford). LO: Describe, compare, and contrast the Maslow and Herzberg theories of motivation, including assumptions and practicality. THEORIES OF MOTIVATION MASLOW’S HERZBERG HIERARCHY OF NEEDS HYGIENE & MOTIVATIONAL FACTORS We seek to satisfy our CURRENT needs, and those needs change at each level of motivation Must satisfy hygiene (dislikes/dissatisfaction) factors 🡪 to move to motivation (likes, job satisfaction) Hygiene = dislikes = dissatisfaction Motivation = likes = job satisfaction - Within every person there exists a hierarchy of 5 needs → famous pyramid (PSSES): 2-FACTOR THEORY Some job characteristics/features lead to motivation (satisfaction) Others make employees comfortable but not necessarily motivated (prevent dissatisfaction) Job satisfaction is 2 dimensional (= not on the same continuum) Man has 2 sets of needs: 1) as an animal to avoid pain 2) as a human to grow psychologically Physiological = hunger, thirst, shelter, and other physical needs - Basic needs to survive Safety = security & protection from physical/emotional harm - Job security for benefits for family Social = affection, belongingness, acceptance, and friendship Esteem = Internal Factors: self-respect, autonomy, achievement External Factors: status, recognition, and attention Self-actualization = growth, achieving potential, and self-fulfillment CONSIDERATIONS MUST fulfill CURRENT level of needs first → then climb the pyramid LOWER order needs: physiological/shelter/safety/social & other needs are satisfied EXTERNALLY MUST resolve HYGIENE factors first 🡪 then proceed to motivation Hygiene: (Maintenance or Environmental) dislikes = “dissatisfiers” - EX: salary, benefits, job security, company policies/admin, supervision, work conditions, relationships with others - Extrinsic or NOT inherent to the work/behavior itself (relationship with organization) but the consequences associated with the behavior HIGHER order needs: belonging, self-esteem & self-actualization are satisfied INTERNALLY *IMP: if @ high level and a lower level need again emerges (job security) → will descend + lose motivation until that need is satisfied Motivation: Motivating factors/likes = “satisfiers” - EX: achievement, recognition for achievement, growth & advancement to higher level tasks, challenging work, responsibility for enlarged task - Intrinsic or inherent in doing the work/behavior itself; job content IMPLICATION/PRACTICALITY - Everyone has different needs to be satisfied. - Allows an understanding that what motivates X, ⊗ apply to Y - Tool to better understand the vast array of needs and how there is a need to attempt to assess staff to determine where they might be. - Climate/org can keep a person fixed at a level o ⊗ sense of belonging, ⊗ opportunities to grow - Need to create a climate where a person can develop/grow (i.e. “move up” the hierarchy) - Uses terms managers can understand (pay, promotion, etc) - Refines a list of job features so managers can focus on a select group which tend to lead to motivation - Points out job features to that need to be in place to keep employees (avoid job turnover) - Employees with exciting jobs may tolerate unpleasant circumstances; LIMITATIONS Assumes all workers are similar in needs/preferences → In pharmacy there are multiple roles to consider Difficult to tell what people’s needs really are Individual differences regarding methods of satisfying needs Some needs may be met or several needs might function at the same time FOCUS OF UNIONS Satisfy hygiene factors-conditions (“dissatisfier”) of employment. - however, if there are 🡣🡣 possibilities for growth/fulfillment, the greater the number of hygiene factors needed in compensation. Formation of union = → likely in orgs where hygiene factors = NOT satisfied Not involved in the area of motivators. COMPARISON OF BOTH THEORIES BOTH identify needs satisfaction as a link to motivation. - Maslow’s physiological/safety/belong needs = Herzberg hygiene - Maslow’s self-actualization = Herzberg’s motivators BOTH teach ethical management principles to org for the good of employee - wanted to inject humanity into the workplace. - ideas related strongly to ethical management and social responsibility. - both concerned for the well-being of staff at work Businesses that lack “humanity” still struggle to grasp the importance of the impact of these theories on staff motivation LO: How do Maslow and Herzberg theories of motivation relate to unions and Theory X&Y management? X MANAGERS Y MANAGERS Staff must be managed with THREATS bc they’re unambitious/lazy Enlightened manager who allows growth and development. This style ignores the concepts of motivation and frequently leads to poor results. More in line with the motivational theory concepts LO: What are the components of the Holland-Nimmo Practice Change Model? What major professional initiative can benefit from learning and applying this model? HOLLAND-NIMMO PRACTICE CHANGE MODEL An approach to motivating staff to change: Practice Advancement Initiatives (PAI) Comprised of 3 components: 1. Conductive practice environment: - Societal (national/state) level for practice acts/interdisciplinary work, health system level for resources and support, and departmental level for workflow, redesigned responsibilities, training, and monitoring 2. Appropriate learning resources: - Ensure staff has access to learning resources to develop appropriate skills 3. Effective motivational strategies: - Change would ask two questions: Can I do it? And do I want to do it? “practicing at the top of your license” *this model is effective if implementing a new program at job STEPS TO IMPROVE MOTIVATION Simple steps but involves time and effort from management! 1. Assess hygiene factors: Policies, compensation, work environment, supervisors 2. Solve hygiene factor issues: Recruit staff to assist with identification and act 3. Recognize achievements: Remember, different needs from different staff-different awards. Spontaneous, specific, timely, public. 4. Investigate other options to motivate people What works for your staff within your profession. New responsibilities, team events, suggestions taken, work space issues 5. Build and implement your plan 6. Take action! This is the job of a manager and everyone in a profession has responsibility for others around them! THEORIES OF MOTIVATION MASLOW’S THEORY OF MOTIVATION HERZBERG THEORY OF MOTIVATION Hierarchy of needs We seek to satisfy our current needs & those needs vary by level of motivation. Hygiene & Motivational Factors. Job satisfaction (motivational) and dissatisfaction (hygiene) Must satisfy hygiene factors to move to motivation. Within every person there exists a hierarchy of five needs-the famous pyramid (PSSES): Physiological=hunger thirst, shelter, and other physical needs Safety=security protection from physical/emotional harm Social=affection, belongingness, acceptance, and friendship Esteem= Internal/External Factors Internal Factors: self respect, autonomy, achievement External Factors: Status, recognition, and attention Self-actualization=growth: achieving one’s potential, and self -fulfillment Job satisfaction (motivational factors) and dissatisfaction (hygiene factors) 2-FACTOR MODEL Hygiene = job dissatisfaction Motivation = job satisfaction Unions Satisfy hygiene factors-conditions of employment. Formation of union likely in those organizations where hygiene factors are not satisfied. Not involved in the area of motivators CONSIDERATIONS Lower order needs: physiological/safety/social & other needs satisfied externally. Higher-order needs: self-esteem, & self actualization are satisfied internally. You cannot climb the pyramid until the current level of needs is fulfilled. CONSIDERATIONS Cannot proceed to motivation until the hygiene factors are resolved. ¨In summary: Some job characteristics/features lead to motivation (satisfaction) However, if at a high level and a lower level need again emerges (job security)you will descend again and lose motivation until that need is satisfied Others make employees comfortable but not necessarily motivated (prevent dissatisfaction) Job satisfaction is 2 dimensional (not on the same continuum) “Man has 2 sets of needs; one as an animal to avoid pain, and two as a human being to grow psychologically”. IMPLICATION Everyone has different needs to be satisfied. Allows an understanding that what motivates one may not motivate another. This is a tool to better understand the vast array of needs and how there is a need to attempt to assess staff to determine where they might be. Climate/organization can keep a person fixed at a level Need to create a climate where a person can develop/grow (ie “move up” the hierarchy) IMPLICATION Uses terms managers can understand (pay, promotion, etc) Refines a list of job features so managers can focus on a select group which tend to lead to motivation Points out job features to avoid job turnover Employees with exciting jobs may tolerate unpleasant circumstances; however, if there are few possibilities for growth/fulfillment, the greater the number of hygiene factors needed in compensation. LIMITATIONS Assumes all workers are similar in needs/preferences In pharmacy there are multiple roles to consider Difficult to tell what people’s needs really are Individual differences regarding methods of satisfying needs Some needs may be met or several needs might function at the same time ***COMPARISON OF BOTH THEORIES**** Both theories identify needs satisfaction as a link to motivation. Maslow’s physiological, safety, and belongingness needs are what Herzberg refers to as hygiene factors Maslow’s esteem and self-actualization fit into what Herzberg describes as motivators. Both attempted to teach ethical management principles to organizations for the good of employees. At the time , they wanted to inject humanity into the workplace. These ideas related strongly to ethical management and social responsibility. They were both concerned for the well being of staff at work. ¨Businesses that lack “humanity” still struggle to grasp the importance of the impact of these theories on staff motivation. WEEK 5B: PERFORMANCE REVIEW - GRIDER WHAT ARE PERFORMANCE REVIEWS? WHAT IS A GOOD PHARMACY EMPLOYEE? FORMAL assessment of how well staff is performing but also: - Formally communicates organizational mission and goals (or the command intent) - Establishes communication - System to base rewards 🡪 MORE FAIR - Tool to improve performance, improve morale, reward performance Promptness, dedication, hard work or collegiality and amicability? Quantity over quality? Does preferential treatment happen due to shared interests? How do other staff feel? How does this contribute to a safe, efficient and quality work place? LO: Discuss the rationale behind the implementation of a systematic performance appraisal system RATIONALE FOR PERFORMANCE REVIEWS Necessary to demonstrate FAIRNESS in promoting and discharging (firing) (Title VII). For discharge, must document and demonstrate that employee could not perform essential job duties - If not, employee can file grievance LEGAL COMMUNICATIVE Decrease role stressors when expectations are known. Role ambiguity → employee is not sure what the expectation or priority is - Must express command intent Role conflict → unsure what the priorities are Communicate organizational values PRODUCTIVITY Established direction, self-motivation, satisfaction and decreases turnover. EQUITY IN REWARDS MANAGEMENT FINANCIAL Promotions and salary increases are NOT ARBITRARY → goes back to legal, must be FAIR Provides data/deficiencies → if one manager scores all employees low on attendance Reduce costs and litigation LO: Identify various types of performance appraisal processes and evaluate the strengths and weaknesses of each type 3 TYPES OF PERFORMANCE APPRAISAL PROCESSES ABSOLUTE Determine if established criteria met Behaviorally Anchored Rating Scale (BARS): - scale for tendencies - Ex: Scored 1-10 - *CONSIDERED the BEST* - Absolutely compared to a standard for organization and specific job - Central Tendencies = (AVG) - Burdensome - Not as specific as graphic rating GRAPHIC RATING: - # scores on traits - Ex: score 0-4 on a standard Manager-based PROBLEMS (inconsistency): - Leniency: everyone is a perfect 4 - Halo Effect: personal connection that negates actual behavior (personal bias) - Central Tendencies: everyone is AVERAGE Critical Incident: counts kept Checklist: yes or no Essay: written for each person - Burdensome - 🡣detail/ precision - Not objective RELATIVE OUTCOME-ORIENTED RANKING compared to other staff Goals set for END results/outcomes Example: Compare best vs worst Compare with each other CONS: - Perception of bias - Less subjective Example: Management by Objectives (MBO): establishes goals for staff and CONS: - staff can be evaluated by different standards. Put into groups based on performance Limited feedback - Can skewer evaluation by achievement Work Standards: rater sets a standard and compares each employee Maybe applies for sales (something substantial), but hard to apply to accountability, safety, integrity - may view standards as unfair Ex: score 80% nursing satisfaction LO: Discuss the difficulties in implementing a performance appraisal system within a pharmacy organization NEW CHANGES - Complexity in systems – 🡡 technology - Emphasis on pharmaceutical care Automated dispensing Third party reimbursement (340B) Higher volumes Hospital with higher intensity patients (bc insurance wont approve admission unless pt is really sick) - Values: dependability, dedication, and altruism - In addition to performance system bias, other types of bias: o Race/ethnicity, intergenerational, and gender SUPPORT PERSONNEL - Very important to the effectiveness of a pharmacy o Must acknowledge - ⬆ opportunities for responsibilities (tech levels = stepping stones) - For most, BARS is a good quantitative measure PHARMACIST - Greater levels of autonomy - Many disparate roles within the company - Capture position specific - Social relationships b/w managers and staff → so ⊗ halo effect LO: Discuss the issues of reliability and validity within the context of evaluating a performance appraisal system How is performance monitored? - Ideally all aspects of a job will be captured. Must be reliable and valid. - Many different types of tools available - BARS are considered the best. - Many different approaches are possible - New hires need to review the performance tool 🡪 clear from the start on expectations - Decide when to implement-annual at raise time? - How to monitor effectiveness through improved performance. - Monitor managers and their ratings All aspects of a job should be: - RELIABLE = consistent - VALID = measure what it’s supposed to measure o Many orgs use BARS (Behaviorally Anchored Rating Scale) → gradient from 1-10 LO: Describe HOW to conduct a performance appraisal interview & how to handle disagreements that may arise during or subsequent to the interview HOW TO CONDUCT Prepare employee: Provide job description & copy of the performance tool in advance. Any specific questions to answers such as goals met. Plan for the interview: Know the job expectations, past performance, strengths, weaknesses, need for resources. Conduct the interview: Review, discuss, highlight strengths, note deficiencies, discuss future performance. → Agree on a plan of action WHY MANAGERS DON’T LIKE THIS Many challenges to implement and monitor Difficult to discuss deficiencies → they don’t want to judge May not want to deal with a particular staff member. Don’t know how to encourage Very time intensive HANDLE DISAGREEMENTS - Sandwich Feedback: good → needs improvement → good - Do it in a conversation-based - If employee is angry → have them fill out performance tool separately → then compare in a conversation PROBLEMS WITH PERFORMANCE REVIEW NOT including all aspects of a position Weights assigned to particular components may be inappropriate Not enjoyable by many Different approaches possible Inconsistent managers, especially with a graphic rating. - Issues: Central tendency, halo effect, leniency Difficult staff: May benefit from a different approach REWARDS AND MOTIVATION WHY THE CONNECTION WHAT IS THE PURPOSE “Things that get rewarded get done” …motivated to behave in ways they feel will lead to rewards.” #1 MOST IMP TO EMPLOYEE: APPRECIATION of work being done - Managers thought it was wages Maslow describes needs as motivation Need to keep allowing growth Herzberg-dissatisfiers and satisfiers LIMITATIONS Can vary depending upon individual need. - Increase job satisfaction - Improve morale - Improve job performance - Facilitate buy in for program growth WHO BENEFITS Difficult to tell what people’s needs really are Assumes all staff are similar in what they need and value ANY reward MUST be VALID and EQUITABLE Staff Management Organization Ultimately the patients REWARDS FOR GOOD PERFORMANCE ARE A GOOD THING Motivate and encourage Acknowledge staff Allow others to say thanks Encourages “good will” Reward systems- simple or as complex as an org chooses LO: Discuss the linkage of performance appraisal results with the proper allocation of organizational rewards. TYPES OF REWARDS INTRINSIC REWARDS EXTRINSIC REWARDS Internal to the individual and derived from involvement in the job Those controlled and distributed by the organization. Achievement, Accomplishment, Satisfaction, Status, Informal recognition Formal recognition Incentive pay, Fringe benefits, Promotions MERIT PAY ISSUES INTERNAL EQUITY Pay compared to other staff → ⊗ bring in a new person and pay them more than senior staff EXTERNAL EQUITY Pay compared to staff at OTHER institutions → conduct annual market surveys INDIVIDUAL EQUITY Tied to performance for individual contributions Must correspond w appropriate behaviors to VALIDATE system in place - Include: promotions, pay increases, formal recognition (certificate) Reasons: - Working extra hours - Volunteering for difficult tasks - Filling in for others - Providing good customer service ALLOCATION OF REWARDS - Important that valid measures of performance are in place - Management/Organization support of programs important. - Staff enjoy praise in addition to other reward options - Management must be aware that all staff want autonomy and personal growth opportunities. - Other benefits available: conferences, membership, meetings, certification cost, lunch, tickets, more responsible task assignments INFORMAL FEEDBACK - Should be consistent - Improve performance but also ⬇ employee uncertainty - Correct behavior immediately but appropriately - Praise a job well done - Formal appraisal should not be a surprise - Develops a positive relationship and that results in a positive reaction WEEK 6: QUALITY METRICS & MEDICATION SAFETY - BURSUA LO: Justify the need for alternatives to voluntary error reporting for the assessment of safety WHY Measure Safety & Quality? 1. To see if we are doing a good job *MOST IMPORTANT 2. Prioritize our actions - new diabetes pharmacist or anticoag pharmacist? 3. Gain support for additional resources - measurement informs resource allocation 4. Provide impetus for action 5. Compare your organization with peers (usually process metrics) 6. Gain recognition from external entities To GET resources… we need MEASUREMENTS LO: Differentiate a process measure from an outcome measure *KNOW* HOW Do We Measure Safety & Quality? TYPES OF MEASUREMENTS OUTCOME MEASURE PROCESS MEASURE Reflects: the impact of health care service or intervention on the health status of the patient - The things we REALLY care about Reflects: what a provider does to maintain or improve health, either for healthy people or for those diagnosed with a health care condition - Typically reflect generally accepted recommendations for clinical practice Gold standard for determining if delivery of healthcare is successful Help us understand how effective our institution is at reliably taking steps to increase chances of a good outcome → how effective is management of hospital & execution on “best practices BUT difficult to measure and sometimes negative outcomes happen even with high quality, exemplary care Only surrogates for the outcome, but these are key measures to understand how well we execute on the best practices Ex: mortality rates, surgical site infection rates, ADEs, renal failure rates, amputation rates in DM, bleeding, cancer death rates.. etc Ex: % of pts who have sedation monitored before receiving an opioid med Ex: % of patients whose initial heparin dose is appropriate for their weight, indication, & renal function Ex: how often we check PTT for heparin Usually go after process measures vs outcome bc they’re much easier to measure… even though outcome measures are what really matter! OUTCOME MEASURE Are we treating these patients well? PROCESS MEASURE The things we do that we think will affect those outcomes Warfarin Use Percentage of patients who experience a blood clot or a bleed - Percentage of time patient’s INR is measured to be in the “target” range - Percent of warfarin patients who received anticoagulation education at discharge from the hospital. Insulin Use Incidence of symptomatic hypoglycemia. - Percentage of patients who received the appropriate dose of sliding scale insulin. - Percentage of patients who received mealtime insulin doses even when they were “NPO”. Teratogenic Drugs Number of patients who suffered fetal abnormalities from use in pregnancy - Percentage of patients who had a negative pregnancy test prior to initiation of drug. - Percentage of patients counseled on pregnancy risks at the time of medication dispensing. DM Management Death – DKA admissions, # of diabetic foot infections, amputations, retinopathy, heart attack, renal failure - Percentage of patients in goal A1C range - Percentage of DM patients eligible for statin therapy on a statin (prevent heart attacks) - Percentage of patients on ACE/ARB (prevent nephropathy) Management of MI MI related death, 5 year survival rate - Percentage of patients receiving correct dual antiplatelet therapy at discharge - Percentage of patients enrolled in cardiac rehab Management of Breast Cancer Remission rates, 5 year survival, incidence of treatment related ADEs - Percentage of patients receiving correct antiemetic before chemotherapy - Percentage of eligible patients compliant with mammogram screening - Percent of patient undergoing genotype testing to be on right treatment LO: describe how safety and quality data can support individual and organizational improvement efforts WHAT Resources Do We Have? (3) (1) VOLUNTARY ERROR REPORTS - Voluntary error reporting = pillar of patient safety - Want a “just culture” so people feel free to report - Helps us identify system-oriented problems that threaten patient safety What does it ACTUALLY measure? → Does NOT help to measure safety - Monitoring medication error reporting trends only tells you that if there is an increase = got more reports → do not know what that means quantitatively (e.g. if we made more errors) - ISMP & NCCMERP agree → DO NOT USE voluntary reporting as a benchmark to measure safety - BUT still a pillar of patient safety provides us examples of when things went wrong so we can qualitatively analyze the processes that broke down that led to the event - EXERCISE: Q: Imagine you are a nurse in the ICU of your hospital. In an effort to improve safety, your hospital has started to publish the number of voluntary error reports on each unit. How would that change your attitude about reporting errors? A: When people see higher errors correlated with their unit they feel shame – would not want to report because they do not want their unit to look bad Voluntary error reporting is not an accurate error rate Q: Describe how using voluntary error reporting data to measure/benchmark safety could compromise the identification of system risk? - A: Publishing voluntary error reporting will likely cause voluntary reporting to go down over time – fewer opportunities for qualitative analysis. We need people to report errors so that we can see systematic errors! LO: Justify the use of a “trigger tool” for measuring safety and quality (2) Adverse Event Detection Systems “TRIGGER TOOLS” Trigger tools: clues that can be used to identify an ADE - DO NOT rely on voluntary error reporting for ADE detection - uses “breadcrumbs” in patient chart or other clues in EHR to identify situations in which ADE is likely to have occurred - Trigger tools we care about are ones pertaining to PREVENTABLE ADEs (the first example is not really preventable if giving a new drug to someone) - IDEALLY trigger tools both highly sensitive and highly specific for ADEs; even low sensitivity or specificity can be useful to measure effectiveness of patient safety improvements SENSITIVITY Ability to detect an adverse event when it HAS OCCURRED → Perfectly sensitive = captures ALL adverse events (-) test = ability to rule OUT ADE EX: Admin of IV Benadryl for the detection of drug allergy ADE EX: Admin of naloxone for the detection of opioid related ADE EX: WBC < 3000 for detection of drug induced leukopenia SPECIFICITY Likelihood that when a trigger is detected, it’s indicative of an ADE → Perfectly specific = has no “false alarms” (+) test = ability to rule IN ADE EXERCISE: You are considering developing a trigger tool for identifying all warfarin related bleeding ADEs. You want to use the administration of Vitamin K as your trigger, since you know that Vitamin K can be used to reverse the effects of warfarin. Q: How sensitive do you think this tool will be? (What percent of warfarin related bleeding events will be identified by using this trigger?) A: Likely highly sensitive - we almost always use Vitamin K for a warfarin related bleed Q: How specific do you think the tool will be? (Whenever vitamin K is used, what percent of the time do you think it is used to treat a warfarin related bleeding event?) A: Likely not super specific - we use Vitamin K for a bunch of other things than warfarin related bleeds Q: How might you change the design of this trigger tool to detect more warfarin-related bleeding events (i.e. improve the sensitivity) A: Add PCC to the trigger tool since this may be used instead of Vitamin K for severe warfarin bleeds A lot of times when we increase sensitivity we decrease specificity – we now will get all patients we use PCC to reverse bleeds which is more than just warfarin related The things we do to increase specificity sacrifices sensitivity and vice versa Why are Trigger Tools Important? 1. Provide a consistent measurement how often ADE occurs → depending on sensitivity/specificity WAY more effective than voluntary error reporting a. Can measure overtime if we are getting better or worse at preventing this ADE – from a safety standpoint* 2. Effectively identify ADEs - can supercharge Root Cause Analysis to help identify common contributing factors to ADEs Retract & Reorder Trigger Tools Searches EHR in specific pattern to detect a “wrong patient error” - Clinician enters order for one patient 🡪 within 5 minutes D/C the order and enters exact order for another patient - Ex: temporary baby name change to prevent this type of error or photograph in EHR chart Region - Beta Paradox “Sometimes really terrible situations are paradoxically better than just sort of bad situations” BEING IN A WORSE SITUATION IS ACTUALLY BETTER - People sometimes only act when they “cross” a certain threshold of badness – can cause you to be stuck in region “beta” o Ex: your job kinda sucks but like the benefits are okay and it isn't terrible… so you don’t leave compared to a super terrible job you gtfo ▪ Better off in a WORSE situation because it creates ACTION o Ex: UI Health CMS rating is a 1 out of 5 so they are going through major changes currently… probably would not be if they were a 3 out of 5 (3) BEST PRACTICE PUBLICATIONS (EX: ISMP Action Agendas and Targeted Best Practices) END OF STUDY GUIDE Polling Questions Violations of standards may: a. Affect the licensure status of a pharmacy site and/pr it's pharmacists b. Result in litigation if a patient is harmed subsequent to a violation c. May result in monetary penalties and/or criminal prosecution d. All of the above Which of the following is NOT a criteria for assessing healthcare quality? a. Safe b. Patient-Centered c. Marketable → “STEEEP” with 3 Es for Assessing Healthcare Quality d. Timely What SWOT category would the COVID 19 pandemic fall under? a. Strengths b. Weaknesses c. Opportunities d. Threats → COVID is external (SWOT=strengths, weaknesses, opportunities, threats) What SWOT category would high technician turnover fall under? a. Strengths b. Weaknesses → Internal problem c. Opportunities d. Threats What SWOT category would pharmacist recently gaining provider status fall under? a. Strengths b. Weaknesses c. Opportunities → opportunity external to organization, but could be a strength if organization is leveraging provider status d. Threats Which is not a quality of an effective leader? a. Role model b. Blames others when things go wrong c. Honest d. Motivating e. Positive Attitude ONLINE ASSESSMENTS Week 3: 1. The purpose of strategic planning is to assure that the organization is doing the right things now and in the future. 2. The vision statement is what the organization wants to be at some point in the future. 3. Leadership is the process through which an individual attempts to intentionally influence another individual or group in order to accomplish a goal. 4. Coaching leaders strive to develop abilities of their followers. 5. Management focuses on getting people to take an action toward achieving a goal. Week 4: 6. The importance of HR management in pharmacy provides for: AMMCP a. Appropriate staffing, monitoring performance, meeting budget targets, compliance, productivity 7. The Federal Civil Rights Act of 1964 prohibits discrimination in hiring, promotion, compensation, and treatment of protected employee groups. TRUE 8. Which of the following is primarily designed to prepare for future needs of individual staff and pharmacies? a. Staff development 9. The job interview question, “tell me about a time when you needed to juggle multiple priorities,” is an example of a behavioral based interview question. 10. The steps in progressive discipline are: Verbal warning → written warning → suspension → termination VWST Week 5: 11. Maslow’s theory of motivation is graphically drawn as a: a. Pyramid 12. Higher level needs according to Maslow include: a. Autonomy 13. Herzberg’s theory looked at: a. Hygiene factors, motivating factors, satisfiers, and dissatisfiers 14. The diagram for Herzberg demonstrates: a. Factors are two dimensional, one does not lead to the next 15. The Holland-Nimmo model is useful for implementing: a. PAI 16. Performance review a. Formally communicates organizational mission and goals b. Is a system to base rewards c. Is a tool to improve performance, improve morale, and reward performance 17. Rationale for doing performance reviews includes all but one of the following: a. Managers favorite thing to do 18. Motivation theories help explain the link to rewards for performance a. True 19. The absolute type of performance appraisal is a performance ranking based on comparisons to other staff a. False, observational 20. The steps to conduct a performance review include: a. Preparing employee, planning interview, conducting interview Week 6: 21. Your pharmacy recently offered a coupon for $5 off flu shots. This type of promotion is known as: a. Sales promotion 22. Which of the following is NOT a characteristic of a service? -- Quality of service is easy to measure 23. When patients choose to pay “out-of-pocket” for brand Lipitor© instead of generic atorvastatin, this is an example of a: demand 24. The four “P’s” of marketing goods and services include all except: professionalism 25. You are implementing a diabetes education service. You want to inform the physicians in a nearby medical group of your new service and ask them to refer their patients to your service. Which method of promotion would be most effective in establishing a long term relationship with the physicians? a. Personal selling