Past, Present, and Future Pharmacy Practice - Pharm management, Approaches to management, Managerial decision making ex. 1, Organizing, Directing and Controlling, Authority and Supervision, Medication errors: managing and preventing, Marketing

Line and staff

- A line function's activities advance the accomplishment of the organization's work while A staff function activities provide support to the line functions.

Place (4 P's of Marketing)

-What supplies -Delivery of products to customers -How much inventory Image - as seen by the patient/consumer Location Physical Plant • Exterior • Interior Atmospherics Pharmacy staff dress Professionally Space Management mage can be a strong marketing tool. Need to be consistent in projecting a good image. Image of the pharmacy also reflects on your reputation. Every once in a while, reverse roles, and see the pharmacy as a patient would see it. "You can observe a lot by watching" (Yogi Berra). Ultimately, want to convert customers of convenience to customers of conviction. Customers who trust and respect you and don't want to go anywhere else which is loyalty. Location - Needs to be convenient location. What is convenient? Elderly said geographical location was very important, but patronized the 3rd closest pharmacy to their home. Pharmacy patronage is very complex with regard to convenience. Visits to the pharmacy are usually part of a multipurpose trip, so other factors come into play like where their doctor is or where they work. Physical plant (exterior): Is the exterior of your pharmacy attractive? Physical plant (interior): • Called "atmospherics" in the business world. Is it cluttered? What colors do you use? Are there holes in the carpet? Is there a waiting area for patients? Is the environment pleasing to the customer? Does it convey that this is a health care environment? • All pharmacy staff should dress PROFESSIONALLY (e.g., white lab coat, and nametag). Project an image of competency and professionalism. Make the experience a pleasant one for patients. If they are in a good mood, they will be more satisfied with what they are receiving. A customer that is treated badly will tell at least 10 people of their experience. Positive customer experience doesn't reach as many people, but is free advertising. Remember they have some type of disease/problem and need help, compassion and genuine concern. They want personal service. • Space management - be aware of how things are organized in your pharmacy. Do you have good traffic flow? Monitor which aisles the patients walk through. Place - other issues Elevated pharmacies Space around cash register Inventory Staff A good image is your strongest marketing tool Why was the pharmacy area often elevated? Security (detect shoplifting), makes it more prominent, and decreases interruptions from unrelated questions ("Where is the shaving cream?"). Not used as often as in the past because it gives the appearance that the pharmacist is talking "down" to the patient. • Space around cash register is where you can have the highest sales per square foot. Many pharmacies will put items there to sell more. This clutters the area and can impair patient consultations. Better to put items that reflect your professionalism around your register (if any). Don't place nickel and dime stuff (gum) by the register. You may prefer nothing by the cash register but a business card and services offered by the pharmacy. More effective in the long run to promote yourself and your services. • Inventory: assortment and quality of products you have project an image of you and your pharmacy. Can be negative or positive. Choose your products carefully. • Staff: Have consistency in your staffing. This will affect your image. Dress does not make the person, but it does impact the pharmacy's image. White uniforms with nametags are appropriate attire. Avoid turnover if at all possible. Hire the right people up front, train them, motivate them, and compensate them fairly to keep them. Important that staff become familiar with the patients including their nicknames, pronunciation, etc. - very important. Increases the likelihood that they will perceive having a good experience at your pharmacy. • "A good image is your strongest marketing tool." Some of the things that determine what people think and believe include things such as your proximity to patient, how you look, the tone of your voice, eye contact, personal attitude and word selection.

marketing strategy (Apart of marketing strategy)

1) Market segmentation - the act of dividing a market into distinct, meaningful groups of customers who might use products or services. Based on: demographics, volume or purchasing characteristics, perceived benefits, sensitivity to price, customer experience. Market segmentation - this is the recognition that every market is made up of distinguishable segments or subgroups. Each of these segments consists of buyers with different needs, different buying habits, and different responses to offer variations. No single approach will satisfy all segments. This is sometimes where pharmacies fail. They don't recognize there are multiple subgroups that will respond differently, purchase differently, etc. They try the "one size fits all" philosophy, and that won't work. Each segment represents a somewhat different opportunity. You need to study opportunities in those market segments before you decide to take a position. This concept is simple, yet some graduate marketing students struggle with it! Demographics: gender, age, income, education, etc Volume or purchasing characteristics: The elderly market segment will purchase more volume than other age groups. As a result of senior citizens purchasing a lot, they usually want a discount. Be careful in making a decision on what % discount to give them. Remember that it is important to be even-handed in the way you treat you clients/customers/patients. Perceived benefits: benefits that people believe they will receive. The health food industry is based on this concept. Sensitivity to price: we have people that are very sensitive to price - burn up a tank of gas to save a nickel. Others are essentially not sensitive to price. You can make anyone sensitive to price if you raise it high enough. Customer experience: Example: We can segment on the basis of a person having a lot of experience with drugs and those with no experience. People who know more, usually want a limited service pharmacy. Those that need the information and want your time, may be willing to pay more. Question: Are we shooting ourselves in the foot, by educating our patients? Answer: NO. People who have benefited from your expertise are more likely to return to you as their pharmacist because they can see the value to their health for doing so.

Outsourcing

A decision by a corporation to turn over much of the responsibility for production to independent suppliers. Useful when there is a temporary shortage of employees or a temporarily high workload, or for economic reasons.

orgazational chart

A graphical representation of how an organization is put together. Shows how managers are linked to their subordinates Shows different levels of authority and formal span of control SHows lines of communication Independent pharmacy usually has a relative flat organizational chart Hospital organizational chart is usually more complex and multi-tiered Clinical supervisor - On some organizational charts, the clinical supervisor does not have anyone working under him/her. How is he/she supposed to get anything done? Look horizontally to pharmacists from the inpatient and outpatient areas for help. Violates "unity of command principle." However, this can be successful when working with professional people (highly trained). They are more likely to accept this violation. However, there must be good communication and clear objectives. There must also be a clear understanding of the authority that each person in the chart holds.

Decision Making Process

Arriving at a choice or judgment between two or more alternatives. Seems straightforward, but in reality it is much more complex. You need to be aware that a decision needs to be made. Be sensitive to what is going on around you. Management by memo is not being sensitive to your environment. Need to be interacting. Define the problem, not just the symptoms of the problem. This step may be the most important aspect of the decision-making process. Employee turnover is a symptom of a problem. Base these solutions on personal experience, advice gleaned internally and externally Awareness Definition Analysis Development Selection Execution Follow-up -= develop a control/feedback mechanism to determine if everything is going according to plans - often this step gets ignored. - helps you know if you are achieved what you set out to achieve Mek a choice as to the best solution. Convert the decision into an efficient and effective action. Effective = want to accomplish the goal. Efficient = accomplish that goal with the optimum utilization of resources.

Present day issues

Balance between patient safety and productivity/efficiency Organizations reward pharmacists who can manage a pharmacy - promotion to pharmacy manager/clinical coordinator early in career - high level positions achieved within 5-10 years after graduation ALL PHARMACIST MANAGE THEIR PRACTICE - technicians, clerks, and others - manage workflow - impact on job satisfaction

Contingency approach to management

Can stand alone Concerned with the relationship between relevant environmental variables and appropriate management concepts and techniques that lead to effective and efficient goal attainment Overall criticism: NONE It does bring management theory and practice together Integrates the environment as a vital part of management theory

Define and differentiate among hierarchy and chain of command

Chain command - the line of authority that vertically connects all levels of an organizational hierarchy; the path from top to bottom from where orders and instructions may be expected to flow.

Systems Approach to Management

Considers all the parts of a given situation as being interrelated and interdependent - an attempt to unify management theory and practice - an attempt to bring the 4 approaches previously discussed together Organization is viewed as an open system Management must interact with the environment Organizational objectives must encompass efficiency and effectiveness. ORganizations contain a series of subsystems There are many avenues to the same outcome Synergies exist where the whole is greater than the sum of its parts Pharmacy MOSTLY uses a systems approach -in issues of quality, use deming approach. - When dealing with pharmacist employees, involve the pharmacists in the decision-making. Overall criticism: same as others. Cannot stand alone It still doesn't bring them all together. For example, consider an inpatient hospital setting using 24-hour unit-dose. Make cart exchange at 7 a.m., for example. What is the reasoning for making the cart exchange at that time, and what other things do you have to consider? When do the doctors make changes in orders or write new orders for medications (mornings)? Also, what about considering when meals are served? Many meds must be taken with food. Also need to consider the patients who need to sleep. Those carts are noisy. Also consider shift changes of nurses, staffing in the pharmacy, when surgeries take place (and when patient comes back), and when admissions are the heaviest. This is a complex decision, so a manager needs to take a systems approach in making this decision.

Pharmacist supervision of techniques

Delegation steps - role taking - role making - routinization Perceived good performance - increased by job performance, job satisfaction, organizational commitment, motivation, retention Perceived poor performance - increased shows turnover - decreased shows job performance, Quality of work life, engagement - leads to training, mentorship, trust building or termination.

Identify and explain key steps in the process of organizing

Departmentalization - the process of grouping activities or tasks that are to be performed in your organization to achieve a common purpose: 1)Function - Various departments like HR, radiology, medical records, IV room, etc. 2) Product - Usually done in community pharmacies with prescription and non-prescription departments 3) Location - Base departmentalization on the location of what we are talking about. 4) Customer - base departmentalization on the type of customer served. Not very applicable for community or hospital pharmacy. Done by drug manufacturers. Representatives may call only on hospitals or only on community pharmacies for instance.

Marketing pharmacist's professional services

Dispensing prescriptions has had decreased profitability Pharmacists' development of professional services - CPESN Community Pharmacy Enhanced Service network Changes to health care system Clinical knowledge is not enough Understanding how to create value is equally if not more important. Pharmacists must apply the concepts of RVT to succeed in a competitive marketplace. Pharmacists must embrace economic, business, and marketing concepts in their professional practice. Many students and pharmacists have underemphasized the importance of business and management skills in creating value for patients Realities in today's market 1) transition from dispensing to patient-care services 2) tightened job market for pharmacists 3) changes resulting from healthcare reform such as value based reimbursement 4) Pharmacists will need to demonstrate they provide value and provide benefit to their employer in order to get a rewarding job or continue to get paid a competitive salary.

Process Approach to Management

Focuses on the management five universal functions of planning, organizing, commanding (directing), coordinating, controlling Also called the functional, universal traditional, or classical approach to management Identifies management functions and fundamental principles of management - both are held to be universal for all managers under all conditions Basic tenets of the process approach: - Specialization/division of labor improves efficiency - Unity of command - an employee should receive orders from only ONE superior - Compensation should be fair and should provide satisfaction to both the employees and the employer - Employee turnover has a negative impact organizational efficiency - Harmony or esprit de corps among personnel is a great strength to the organization Overall criticism - the process approach cannot stand alone as the only way of managing in today's complex environment. Some aspects are applicable and appropriate, but it cannot stand alone as the only way of managing.

Pharmacy Examples

Full-serve community pharmacy (independently owned) - Take the time to talk to their patients - Usually deliver medications to patients - Will have private charge account available if needed - May offer enhanced services like adherence packaging, comprehensive medication reviews, medication synchronization program, medication reconciliations, 24 hour emergency on call, compounding, etc. Limited-service community pharmacy - chain, mass merchandisers - patients pick up medications themselves - often pharmacists have fewer or shorter interactions with patients - private charge accounts are not available - In Nebraska, pharmacists are required by law to at least make a verbal offer to counsel for all new OR renewal prescriptions - Prices are not always lower in a limited service pharmacy

Define management

How operations, relationships, organization, and all around operations are taken care of

Behavioral approach to management

Human relations approach or participative management Uses behavior modification, various motivation techniques, group dynamics, and management by objectives (MBO) Very powerful approach to management Revolves around the assumtpion that if we can make employees happy, max performance will result How can you make employees happy? - job security - benefits - work environment - salary Overall criticism: - same as others. - Cannot stand alone as the only managing process

Myths concerning confluence of business practice and pharmacy

In business, quality of care is secondary to generating profits - misconception is due to efforts to control costs by payers and managers - if a company in health care cannot pay its workforce and cover other costs, it will have no choice but to close its doors. - Even not-for-profits have to pay bills The good pharmacists is one who is a "clinical pharmacist" - myth - complex modern therapies do not allow concern for other matters - truth - lack of knowledge about how to manage resources will impede a pharmacist from providing patient care services

Selling Concept

Includes the product concept, but also an aggressive selling and promotion campaign. Still not enough for pharmacy

Controlling

Influencing how the work is to be done (emphasis on the process) Performance is measured and corrective action is taken to ensure the accomplishment of organizational goals True controlling is information and action Types of control: 1) Preventative - hire the right people - purchase the right software - Activities are designed to prevent undesired performance before it occurs. For example, think of a personnel management process where we have policies and procedures in place to hire the right people, etc. Want to hire the right people because it is expensive and time-consuming to have to go through the hiring process all over again. 2) corrective - examples: poor student performance or inventory control. - Activities designed to adjust situations in which an undesirable performance has already occured. Stages of the control process: 1)Determination of performance standards - performance standard is statment of expected levels of accomplishment. For example the veterans administration VA system had systematic internal reviews (SIR) They evaluated the waiting time for patients at the outpatient pharmacy. They had a standard that patients should wait no longer than X minutes. If the waiting time standard was exceeded, they performed an evaluation to determine why. Keep in mind the standards must be pertinent to the task at hand, measurable, achievable and realistic 2) Measurement of performance - Can do by keeping logs of activites that have standards outlined. COmpare with standards set for that activity. Can do surveys - some pharmacies conduct patient satisfaction surveys 3)Comparison of actual against desired performance - You could have a positive or negative deviation. Is a positive deviation always god? no. It could result in a negative deviation in another area. 4)Implementation of corrective action - do this to obtain desired performance. Effective control system: - well communicated - well coordinated - timely - flexible - economical

Define the management function of organizing

Involves determining how the work of an organization is to be divided into specific jobs, departments, and levels of authority, Departmentalization - the process of grouping activities or tasks that are to be performed in your organization to achieve a common purpose. - Function - Product - Location - Customer

Identify and differentiate between basic line and staff relationships

Line and staff - A line function's activities advance the accomplishment of the organization's work while A staff function activities provide support to the line functions.

Market Concept

MAY BE THE MOST IMPORTANT CONCEPT OF THE SEMESTER The key to achieving organizational goals consists of determining the needs and wants of target markets and delivering the desired satisfactions more effectively and efficiently than competitors. You know your customers so well that the customer is ready to buy because it is what they need/want

Contextual considerations for pharmacy practice and medication error prevention

Macro perspective (Societal level) - practice within the law - uphold professional standards - Federal law: Society has mandated that drugs be safe and effective. Examples include: must have adequate directions for use without professional supervision • Rx-Only drugs require prescriptions because they are considered safe only when used under the supervision of a licensed prescriber • Packaging of drugs must be child-resistant to reduce the incidence of accidental poisonings in children • Consider the process and outcomes involved in developing names for products - U.S. Adopted Name (USAN) of drug products https://www.ama-assn.org/about/usan-council State Law: Society has mandated that state statute and regulations be enacted to control who may care for patients and what the behavior of those caregivers should be. • Only licensed professionals may prescribe, dispense or administer prescription drugs • Healthcare professionals are subject to regulation and discipline by their licensing bodies Meso perspective (organizational level) - work to meet requirements of employment - manage operations of pharmacy as required Micro perspective (Individual level) - provide care to individual patients - supervise support staff - work in cooperation with other pharmacists and/or health care professionals Practice organizations: Provide context for professional practice • Allocate resources to professionals working in organization • Provide physical facilities • Latent failures due to weak organizational structure (faulty information management; poor training); incomplete patient information (allergies; diagnosis); poor communication; lack of a double check; lack of a computer warning; ambiguous drug reference; drug storage problems; LASA • At the extreme they seek to: - maximize profit - minimize risk

Market Entry (Apart of marketing strategies)

Market entry: - purchase an existing pharmacy or build a new one. Planning to acquire an existing community pharmacy - advantages includes: have records of past financial performance, have established relationships with suppliers, established relationships with suppliers, established relationships w doctors and patients, little if any lag time before realizing a profit, overall, fewer unknowns, therefore, less risk of failure. - Disadvantages: Layout of store, fixtures and equipment may be outdated and inefficient• Inventory may be obsolete or deteriorated• May inherit ineffective or inefficient personnel, policies, and procedures• May inherit bad image as to price, service quality, and atmosphere• Lease may not be desirable• Location may be less than desirable Planning to open a new community pharmacy: - advantages include: Can design layout and get new fixtures and equipment • Can stock with inventory that you want • Can hire personnel of your choosing • Can develop own policies and procedures • Can establish reputation as to pricing and atmosphere (want it to be a pleasant experience) • Can select location and negotiate lease - DISADVANTAGES INCLUDE: No records of past financial performance • Don't have established relationships with doctors and patients • Don't have established relationships with suppliers • Can be a significant lag time before realizing a profit • Overall, there are more unknowns, and therefore, a greater risk of failure ♦ Deciding whether to provide centralized versus decentralized inpatient pharmacy operations in a hospital Centralized Advantages include: • All orders come to one location. (Some hospital pharmacies are like this during the overnight shift.) • Decrease overall inventory costs and decrease overall personnel costs. Centralized Disadvantages include: • Usually a higher number of medication errors. • Increase in turn-around time to get medications to patients and the pressure this puts on staff to get the work out quickly. ♦ Deciding whether to provide centralized versus decentralized inpatient pharmacy operations in a hospital Decentralized Advantages include: • Many hospitals are like this during the day • Usually a decrease in the number of medication errors • Can significantly decrease turn-around time Decentralized Disadvantages include: • Usually have higher increase in inventory and personnel costs

societal marketing concept

Marketing concept plus something else- something that preserves or enhances the consumer's and society's well- being. For example, we live in a throw-away society. Is that good for society? No. Consider some detergents that get clothes cleaner, but are bad for the environment. From a pharmacy standpoint, should you as a pharmacist do everything that patient asks you to do? No. What about an OTC consultation? It is easy to sell a product and make a profit, but if it is not in the patient's best interest - don't do it.

Marketing concept components

Marketing research (part of marketing concept) - systematic design, collection, analysis, and reporting of data and findings relevant to a specific marketing situation or problem facing an organization - Determining what the wants and needs of our customers are. The information gained, is used to make decisions. THose decision are - what kind of products/services will we provide Marketing Strategy (part of marketing concept) - we will cover this in the next 2 classes Doing that which is legally and ethically in the best interest of the patient

Process (4 ps + 2)

Methods used to create, produce, and deliver a good or service Service blueprint Process of dispensing an Rx • Presentation of Rx....verification of patient understanding of their meds • Impact on wait times Process of patient care - many pharmacies need to develop this!

Deming Approach to Management

More concerned with quality and long-term results aka total quality management (TQM) or continuous quality improvement (CQI)..."applied common sense" key point: people always want to do their best, however process gets in the way Create constancy of purpose - the most important - you need goals: where are you going - What do you want to accomplish - teamwork - people all going in the same direction Need to drive out fear - employees being afraid of their manager is no way to function when dealing with professionals - need employees to think outside the box Eliminate barriers to joy in work - employees should enjoy their work - leads to fewer errors, more satisfied patients. Institute a program of education and self improvement for everyone W. Edwards Deming (1900-1993) was a mathematical physicist who was primarily responsible for Japan's success after WWII (rebuilding). He was also "the man most responsible for setting American business on a new course toward quality." Criticism of American businesses - too many are concerned with quantity rather than quality. Another criticism of American business - too concerned with short-term results rather than long-term results. Deming was more concerned with quality and long-term results. Sometimes referred to as TQM (total quality management) or CQI (continuous quality improvement). Deming called it "applied common sense." Key point - people want to do their best, however, processes get in the way. You don't manage people, you manage processes. Very important to realize from the standpoint of medication errors. Medication errors and/or adverse outcomes are influenced more by medication system failures than by carelessness and negligence on the part of practitioners. Often the procedure is the problem, not the employee. Employees follow protocol and something goes wrong. Another key point of Deming: "variation exists in everything we do." "If we can decrease this variation, then the process should improve. Therefore the process should become more reliable and people can count on it." Therefore, quality improves. Bottom line: what happens when we improve quality? - Improved patient satisfaction, which may improve market share. - costs should decrease because: fewer mistakes, fewer delays, less reworking, if you dont have time to do it right in the first place, how are you going to find time to do it again? - Productivity should improve Overall criticism: - same as other approaches, but is the most useful approach that we've talked about so far.

Group versus individual decision making

More info available More knowledge available Spreads the risk Generates more alternatives Increases subordinate acceptance of the final decision Group decision making disadvantages: - takes a longer time to reach a decision - more costly (especially in terms of time) - May create "group think" - Personality conflicts; people trying to dominate a meeting; persons who absolutely must have things done their way etc. Individual decision making advantages: - Takes less time - Costs less - Avoids group think - Dont have to deal with interpersonal obstacles. Individual decision making disadvantages: - less information available in general, so will have fewer alternatives - subordinates may be less likely to adapt.

Promotion (4 P's of Marketing)

Objectives • Develop an image of the pharmacy • Attract new customers/patients • Maintain the patronage of your current customers. Important for maintaining competitive advantage • Gain acceptance of a new service or line of products • Convince both new and old customers to purchase more NEEDED products and services Methods of Promotion Advertising • Product advertising • Institutional advertising Sales Promotion Publicity Personal Selling Advertising - In order for an advertisement to be effective, it must attract attention, it must appeal to the consumer's self- interest, and it must be memorable (key point). Each day a consumer is bombarded with hundreds of advertising messages and only retains 7% of them to act on. Advertising is expensive, but you HAVE to advertise. About 20% of people will be moving out of or coming into the area near a community pharmacy each year. Difficult decision is WHERE to put advertising dollars and how much money to spend? • Direct mail can be very effective. Can get addresses for a certain market segment. One that is not listed in the table that is very effective is advertising in church bulletins. Independents usually advertise by radio and newspaper. If a large chain, usually newspaper, internet and television. Methods of Promotion (cont.) Sales Promotion Publicity Personal Selling Sales promotion - Primarily done internally. Can include product promotion and promotion of attributes (e.g., a sack stuffer, shelf talker (sign on shelf), or shelf extender (add on to the shelf for extra products)). Announcements over the loudspeaker are also examples. Also, banners and posters. Closed-circuit TV, business cards by the register, flyers for patients, brochures, etc. • Publicity - You can have positive and negative publicity. Usually, no cost involved for you. Good would be that you have reached out and helped with the Girl Scouts or Poison Prevention Week, etc. TV stations and Radio stations may give you a spot for these. Involving yourself with local charities and groups could end up in a newspaper story which is free, positive publicity for you. • Personal Selling - VERY important area as far as promotion is concerned. Ranges from the everyday activities of your sales clerks to a consultation with a patient by either a pharmacist or intern. These are "moments of truth" ... they can make a lasting impression on the patient. Important that your clerks know what your expectations of them are. Tell them what you want to accomplish and what you want to provide for patients (compassion, respect, and genuine concern). Important practice note: You also need to train your non-pharmacist personnel to know what types of questions they MUST pass on to the pharmacist. Often, well-intentioned non-pharmacists can drift into the arena of giving professional advice. Giving professional advice regarding medication use is part of the "practice of pharmacy". (Example: "What cough & cold product do you recommend for my 2-year-old?"). Remember that as a pharmacist you are ultimately responsible for the actions of non-pharmacist personnel you supervise. Personal Selling - Fundamental steps • Need to know yourself • Need to know your patient • Know your products • Understand purchasing motives • Project empathy • Always act in the best interests of your patient!

Authority Restrictions

Organizational position - the amount of authority an individual has is limited to the authority that is granted to the position that s/he holds in the organization Legal and Contractual Mandates - for example: laws, union contracts, and corporate rules Social Limitations - example: social expectations, societal values Physical limits, technological constraints and economic constraints - this concept is rather straightforward. A manager cannot expect people to perform tasks that are 1) physically impossible for them to perform. 2) beyond their technological sophistication, equipment or abilities, or 3) beyond the financial limits of the department and/or organization Zone of acceptance - even though a superior-subordinate relationship is not a democracy, there are times when a manager's legitimate authority can be diminished and the issuing of a direct order may be counter productive if not accepted as reasonable by the employees.

Personnel/people (4 ps + )

Personnel/People Provide most services • Selection • Training • Motivation All who interact with patients • Pharmacists • Pharmacy technicians • Clerks/cashiers • Students • Non-pharmacy staff People: Customers/patients • Seek medications and advice • Understanding of lives in broader context • Form a part of service experience for other

Pharmacy Practice Future

Patient care vs. Distributive services Overall job decline: 2020 - 2030: -2.2% Ambulatory care, 2020 - 2030, highest rate of job growth: 15.7% Hospital, 2020 - 2030, highest overall growth: 6,300 jobs Community, 2020 - 2030: 10% reduction in jobs Median pay in 2021: $128,570 Factors impacting pharmacy distributive services - declining reimbursement - DIR fees - automation - pharmacy techs - mail service pharmacy: Amazon - Less independent pharmacies - Chain pharmacies on defense Less need for pharmacists - pharmacist glut predicted since mid 1990s Factors impacting pharmacist patient care - education and training - pharmaceutical care idea is now decades old - greater acceptance by physicians - medical home model - provider status (Only in some states) - Greater demand for patient care pharmacists (expected increase of 21% in employment)

Behavioral dimensions of control process

People resist controls. Dont like to have behavior monitored Controls can cause inter-group or interpersonal conflicts Excessive controls limit flexibility Legal implications of your control process Consider also the human aspects of the management function. Managers who are technically expert but devoid of basic decency in the way they interact with staff are not likely to receive much support from their employees. A manager doesnt have to be a friend to his/her employees, but should work to genuinely earn their respect. This creates another win-win situation

Approaches to management

Process Approach Quantitative Approach Behavioral approach Deming Approach SYstems ApproACH Contingency Approach

Authority and Supervision

Power - attaches to people, not to official positions Authority - at the conceptual level is derived from the position of authority holder in the organization and can be defined as legitimate power - Formal authority derives from position in the organizational hierarchy. A person's formal authority is embodied in their position. (i.e its in their job description) formal authority may exist all by itself or it can be enhanced by authority that comes from informal sources such as personality, expertise, etc) Influence is more subtle. When someone influences another person, s/he can get the other person to comply voluntarily A key point to keep in mind is how you think about the relationships among the concepts of power, influence and authority. While they are separate at the conceptual and theoretical levels, in the reality of everyday practice they seem to overlap and are very much related to each other.

price (4Ps of marketing mix)

Price (4th of the 4 "Ps" ) Accepted by patients Competitive in the marketplace Profitable to the pharmacy ♦ Pricing of prescription products is very complex Price = an expression of value as communicated in the exchange process, whether for products or services. Trend for products is payment from 3rd parties (Medicaid, Medicare Part D, PBMs, etc.) - today more than 90% payment is this way. With 3rd party payment, you have no control over the price. This means usual and customary is focused on cash-paying customers, and this group is very important to pay attention to. Prescription pricing is very complex - Why? There are thousands of different drugs with different quantities being dispensed for each drug. Also, manufacturers raise prices several times a year. Is there a magic formula that is universal? Absolutely NOT. There is a lack of education in the area on how to price. Can cause a pharmacy to fail. ♦ Quality of our pricing decisions depends on Clarity of our objectives Understanding of consumer behavior Understanding of competitor behavior ♦ Pricing objectives Occasionally meeting the price of the competition Price above the competition if you are adding value that the customer can perceive Occasionally beat competition for short periods of time, and not often or will go out of business Increase market share ♦ Understanding competitor behavior ♦ Understanding consumer behavior: • May have to take a loss on an individual product to be competitive. Consumers are very sensitive to the prices they pay for products and services. Can this sensitivity be decreased? • Find someone else to pay for it! Be an advocate for the patient. Some major manufacturers will provide drugs free for indigent patients who can't pay, but need the medication. • Copays help lower the sensitivity to the overall price • Maybe the patient feels uncomfortable going on Medicaid. Counsel them about that • Maybe the patient doesn't understand their prescription benefits, and pays for medications out of pocket because they don't know their benefit plan will pay. This can be especially true of some military veterans who have never been to a Veterans Administration facility. • Provide the patient with full value for the product/service they are paying for. • Build the consumer's trust in you. If they trust you through your consistent actions, then they generally won't be as sensitive to price because they perceive the added value you are providing. • Good communication, especially with regard to expensive medications, can be very helpful. • Use a competitive pricing strategy. This is where you look at the average profit margin made for ALL of the products you dispense. Look at the whole picture and decide whether or not you are going to make it. Don't make that decision based on each individual medication price. Occasionally, you may have to take a loss on an individual product to be competitive. ♦ Make a higher profit margin when sensitivity is lowest Pricing system considerations: ♦ Pricing Rx drugs ♦ Pricing OTC drugs dispensed on a prescription ♦ Pricing compounded Rxs ♦ Minimum charge for Rxs ♦ Discounts Senior citizens Social security Employee Controlling a pricing system ♦ Periodically review pricing data ♦ Periodically analyze competitors' pricing ♦ Periodically assess patients' perceptions ♦ Periodically audit pricing practices to make sure you comply with all 3rd party contracts Pricing services: ♦ Obtain a Medicare or other payer supplier/provider number ♦ Obtain CMS-1500 and other claim forms ♦ Develop data collection and documentation systems ♦ Establish professional fees ♦ Develop a marketing plan Contemporary issues of pricing services: ♦ Enhanced Pharmacists Services Establish business associate agreements with physicians Contract to provide services in patient-centered medical homes Contract to provide services in accountable care organizations (ACO) Bill for Enhanced Pharmacy Services • Self-funded employer groups • Private third-party insurance • Medicaid • Medicare

Delegation

Process of assigning tasks and responsibilities and granting the authority to make sure these tasks are done. When you delegate a task, tell those to whom you delegate why you want it done. Extremes of delegation - delegate everything. Dont come to me with your problems only come with solutions. - Managers under these types learn to solve problems on their own. - Delegate nothing Parity Principle Authority delegated should be equal to the responsibility given You should not be responsible for completing a task when you do not have the authority to carry it out. This frequently gets violated. Puts the employee in a bad position, and they will get very frustrated. ♦ Span of Control Number of subordinates that a manager is directly responsible for Evaluate if the manager's span of control is reasonable This is why Nebraska has the ratio of technicians/interns to pharmacists (3:1) *see next slide for supplemental notes*see next slide for supplem - Type of work (inpatient setting can supervise more techs than in community) - Amount of managerial experience - more experienced manager capable of having a larger span of control - Need for coordination between tasks (the more complex the task, the smaller the span of control) - Educational level of the person(s) you supervise. - Experience of techs/people you supervise.

Marketing philosophies

Product Orientation Sales Orientation Market Orientation Societal Orientation

Marketing mix

Product, Price, Place, Promotion Personnel, physical facilities, and process management Textbook definition: the particular blend of controllable marketing variables the firm uses to achieve its objective in the target market. Working definition: the set of controllable variables that one may use or adjust to influence buyers Controllable Variables are The Four "Ps" of the marketing mix: These are product, place, promotion and price. You are likely going to have significant influence on what your patients buy. Many pharmacists use this as their entire marketing program, and don't use marketing research, look at segmentation, or decide on the segment(s) of the market to serve. In today's environment it is becoming less and less likely that pharmacy operations can be successful with doing ONLY this part of the process. It is probably a much better idea to go through the whole marketing process, including market research, etc. Note: The "Four Ps" represent a more traditional way of thinking about these controllable variables that is mostly applied to discussions of the marketing of physical goods. When we think about marketing professional services we must consider the Seven "Ps" (the first Four "Ps" plus 3 more: Personnel, Physical facilities, and Process management). External Variables, which you may have no control over State and federal regulations (However, it is possible to have some impact on them through state and national professional organizations.) Overall economic climate Cultural climate or social climate Political climate Competitors' actions • These can significantly impact what happens to your pharmacy operation • Must stay on top of what your competitors are doing

product (4Ps of marketing mix)

Product: Always keep this in mind. Anything capable of rendering a service can be called a product. Keep in mind when a patient comes into your pharmacy - why are they here? They are really purchasing it for the service that it provides them (i.e., symptomatic relief). The same is true of purchasing a prescription. Bundled with that prescription are: treatment of the physical problem and your services involved in educating the patient about how to use the physical product (drug) safely and effectively. Levitt said there are essentially four products. We have something that we call the generic or core product. This is not the same as the generic product we talk about in pharmacy in relation to brand name products. Also have the expected product. This includes the generic product plus some other things. Also have the augmented product. This includes the expected and generic products plus some other things. Finally, we have the potential product, which includes all the other three, plus that which remains to be done. Often, too much time is spent on the generic product and not enough time is spent on the others. Core (generic) product: That which is required for participation in the market. What is absolutely required in pharmacy? The minimal standard is the correct medication or drug dispensed to the patient on a prescription that meets all statutory and regulatory guidelines (keep records, do prospective DUR, verbal offer to counsel in NE, etc.). Regardless of which pharmacy a patient goes to in Nebraska, this core product must be labeled and packaged in a certain way. It is an undifferentiated product (i.e., unbundled). It is the same from pharmacy to pharmacy. Product Something that is viewed as capable of satisfying a want or a need Something that is of value to someone else May be a physical object or a service which is packaged with that physical object (e.g., symptomatic relief) ♦ Total product concept (Levitt, 1983) Core (generic) product Expected product Augmented product Potential product PRODUCT: PRESCRIPTION DRUGS Characteristics -n Majority are for systemic use and will affect the structure or the function of the body They are usually potent with potential for side-effects Cannot just sell to anyone. Need 3rd party intervention (prescriber). Nobody really wants to take medications, and they really don't want to spend money on them Every time they buy, it is a reminder to them that there is something wrong with them They don't like having to talk with a prescriber about their problems and have a prescriber tell them they must take a drug Many patients don't understand their medications The overall perception is that prescription drugs are too expensive Differentiated product One where differences in quality, packaging, service, style, performance, etc. may exist♦ Non-price Competition Creating an awareness of the differences in quality, packaging, etc. in the mind of the consumer through advertising and promotion, even though no TRUE difference may exist. An example is automobile advertising.♦ Importance of Patient/Customer Perception ♦ Expected Product - Bundle or add services to the core product to provide the expected product, which is now a differentiated product - Adding the minimum that the consumer expects. This can vary from patient to patient • Competitively priced • Delivered right - prompt and courteous service, reasonable business hours, and delivery, mail out, drive-through, emergency after hours service, etc. • Payment terms - 3rd party accepted, charge accounts available, etc. • Technical support - patient counseling and monitoring ♦ Augmented Product Also a differentiated product Includes the generic product and the expected product • includes more than what the customer expects (expected product), and it includes more than what is required by law (generic product) Also includes something else Things that are not a given; things that make your business unique ♦ Potential Product What else is there that is not being done, but could be done to help differentiate yourself from the competition? Anything potentially feasible to attract and hold customers Whatever remains to be done within the realm of ethics, statutory and regulatory constraints, your own capabilities, and your education 80/20 rule: 80% of what you do as a pharmacy, most other pharmacies do just as well. It's the 20% that you do that is unique

Types of decisions

Programmed: - based on established policies and procedures - routine and repetitive in nature - usually concerned with day-to-day operations. Order replacement product, finding a replacement for a sick employee, etc. Pharm techs usually perform programmed types of decision Non-programmed: - Unstructured, no set policies or procedures to be allowed. - it is usually unique and/or non-repetitive in nature. - Their scope is usually beyond day-to-day operations - Usually there are much more complex, and there is much more uncertainty - The cost of a wrong decision is higher here - Pharmacists make both programmed and non-programmed decisions

Future role and success of the pharmacist

ROle of pharmacist - continue to develop and solidify - very dynamic profession - dual role of managing the dispensing process and providing patient care Direct patient care (pharmaceutical care) - academic view - Pharmacist practitioner view - Physician view - third party Direct Patient Care: Academic view is different than layperson's view. Academic definition is finding and responding to the drug therapy problems of patients and acting in the patient's best interest Pharmacist practitioner view: Practice adjustments might have to be made to provide direct patient care in the future; for instance, the mind-set of pharmacists already out there, adding space for counselling and/or other services, decrease clutter, increase necessary patient access to pharmacists, add new technology and stay on top of it, etc. Pharmacists are educated and able to have a significant impact on patient adherence, medication errors, and cost containment. These problems alone can lead us to think there will continue to be demand for pharmacists' services in the future! Some physicians are concerned about more patient-pharmacist interaction. Why? Their perceptions of pharmacists begin with interactions between medical students and pharmacy students, etc. Act and perform professionally on your clerkships and with other students. Interprofessional activities in academic health education has reduced this, however, it can still be a problem for some pharmacists. Pharmacists should not have to get involved with third party issues. Delegate and train technicians to do it. (Admittedly easier said than done in some practice environments!!) Financial success - premise of this course Change in demographics - primarily means age of patient. Continued increase in the number of elderly which will stress the health care system significantly due to growth in long term care, etc. Rise of prescription numbers by 5.14 billion by 2022. ALso an increase in people self medicating with OTC meds. Increased use of technology - Increased use of robotics continue with the goals of increased accuracy and efficiency while reducing errors. For several years now, many pharmacy companies have been looking into possible technological solutions to problems associated with workflow design. The number of companies offering robotic systems has increased during the past decade as well. Do a better job of managing information - Especially for patients. Primary reason pharmacists don't counsel is because a perceived lack of time. Patients want to know about side effects most of all. Point out major and common side effects Need to charge for the services provided - structuring of a third party prescription benefits will continue to provide financial incentives to use generics whenever possible Continued growth in the use of generics Continued growth of specialty drugs - n 2017, specialty drugs were about 1% of all drugs dispensed BUT REPRESENTED 30% OF ALL DRUG COST. Electronic prescribing - GETTING RID OF PAPER PRESCRIPTIONS Unit of Use packaging - Great way to reduce errors. Used everywhere but USA> Prescribers only have the option of writing for pre-packaged amounts; eliminates counting. Just pull it off the self and label it. Ophthalmic products are already unit of use in the U.S. We will see more use especially in the use of capsules and tablets in the future. Overall, this will be more efficient, cost effective, and reduce errors. More prescriptions paid for by a third party - Third party coverage of prescription drugs is already over 90%, this percentage will likely increase. There is current state legislation to have standardized/universal benefit card. Should the U.S. go to a single-payer nationalized health care system? Consider the pluses and minuses seen in other countries like Sweden, Canada, and Great Britain. How will this impact prescription drug coverage? Greater utilization of pharmacy technicians and increasing pharmacy technician ratios. Liability exposure will increase - odds of pharmacists being sued increase as practice becomes more clinical and complex

Past role and success of the pharmacist

Role of pharmacist - pharmacist were primarily compounders and dispensers of drug products. - It was unethical to counsel patients. Financial success - community and institutional pharmacies did well financially

Present roles, environments, and challenges

Role of pharmacist: - dual role of managing the dispensing process as well as providing patient care. - Patient care = pharmaceutical care, medication therapy management (MTM), immunizations, and disease state management Financial success: - much more difficult today to achieve financial success - management skills are important - need a sound financial basis in order to continue to provide services to patients - Market research/marketing concepts that he will discuss and apply a bit later in this course are essential to the achievement of financial success by a pharmacy Community pharmacy is very competitive - likely the most competitive component of the entire health care system - current health care system environment strives to minimize more costly institutionalized patient care wherever possible - more demand created for ambulatory services and providers, including pharmacies - financial pressures to be efficient in order to survive Pharmacy practice is not clearly understood - misconception about pharmacists Pharmacist image is excellent - gallup poll ratings are high Pharmacist are the most accessible health care resource Pharmacists are the overall expert on drugs Prescription drugs are a health care bargain Accessibility: especially true for the independent community pharmacist because independent is generally not as busy and focuses on making time for the patients. becoming more true for chain pharmacies - In the community setting, you are the first health professional sought out. Expertise: You become an expert only when your knowledge is transferred and becomes useful to other providers and patients. Communicate with others on their level of understanding. - Resist the temptation of doing a knowledge dump when being asked a question by patient or physician. Bargain: - drug therapy is still the most cost effective way to treat disease today. not as expensive as staying in the hospital or going to the ER Patients' medication non-adherence remains a challenge Pharmacy practice is a unique combination of profession and business Number of prescriptions filled is increasing 90% of prescriptions are paid for by a third party Use of outsourcing to manage pharmacy services Medication errors are a problem Internet pharmacies present a challenge for customers Role of pharmacy technicians is a challenge. Use of technology... changing the industry Credentialing of pharmacists Direct to consumer advertising of legend drugs (DTCA) Nutritional/herbal products YOUR bottom line for pharmacy practice

Market positioning (apart of marketing strategy)

Select a specific pattern of concentration that will allow us as a company to achieve our objectives. We want to select those segments that will give us the max opportunity to achieve our objectives. It is impossible for you to serve all market segments. You have to make a decision on who you are going to serve. If you try to serve everyone, you may fail. It is impossible to satisfy everybody Multiple segment concentration - serving multiple market segments, where strengths in one segment will be of benefit in other segments. Choice of market concentration will give you a tarket market. This will determine several things: products or services that you will produce, offer for sale or provide, customers that you are going to serve, competition you are going to face. Key questions to ask• Is market segment currently of sufficient size?• Does the market segment have potential for further growth?• Is it over-occupied by existing competition?• Does it have some unsatisfied needs or wants that you can serve well? This is very important. Single segment concentration Multiple segment concentration Target marketing compared to market segmentation Market segmentation is where you break up the market into different groups of customers that have different buying habits and needs, etc. Target marketing is choosing which segment or segments you will serve.

Behavioral dimensions of decision making

Stereotyping Examples - older pharmacists are not clinical, because they dont have the education that you do - A BS pharmacist is not clinical - Im a hospital pharmacist, therefore, im clinical. Community pharmacists are retail, not clinical. A lot of hospital pharmacists feel this way. They think they are more professional and clinical - People who look different cannot perform satisfactorily. Do not fall into these traps. Halo effect - when a person allows one characteristic of an individual to overshadow other characteristics either positively or negatively. This often occurs in job interviews, performance appraisals, etc. If applicant shows up in shorts and a t-shirt, that affects your view of them. Another example could be a terrific pharmacist, but s/he has unusual personality characteristics that could overshadow his/her performance evaluation.

Directing

Telling employees what work is to be done Leading and motivating employees to get work done correctly and on time. Equity theory - a major aspect of job performance and satisfaction is the degree of equity or inequity that people perceive in their work situation Employees look at the input they give and the output (rewards of the job). THen they compare that to other employees. You get what you reward. If you reward goofing off then thats what youre going to get.

Marketing strategy

Textbook definition: Selection of a target market(s), the choice of a competitive position, and the development of an effective marketing mix to reach and serve the chosen customers Working definition: A design for getting where you want to go. It consists of five concepts: market segmentation, market positioning, market entry, marketing mix, and timing 1) Market segmentation - the act of dividing a market into distinct, meaningful groups of customers who might use products or services. Based on: demographics, volume or purchasing characteristics, perceived benefits, sensitivity to price, customer experience.

Leading

Theories - Great person theory - leadership skills are a matter of birth - big bang theory - great events make leaders of otherwise ordinary people. - Traits theory: 1) honesty 2) competency 3) forward looking vision 4) ability to inspire others Leadership - can mean the difference between success or failure. The inner workings and specific traits of an effective leader cannot be precisely spelled out. Studies have been done, and they dont know exactly. People tend to agree that leadership is the ability to inspire and influence others to contribute to the attainment of an organization's goals and objectives.

Motivating

Use the employees value system when deciding on how to motivate that employee

Medication error prevention: the pharmacist's role

What does error prevention have to do with management? - Goes to the core of the goals of effective management - Pharmacist goal is to provide safe and effective pharmacy services - Preventing errors is much more than admonishing employees to be careful and to not make mistakes - Good managers learn to recognize strengths and weaknesses of an organization in terms of how care is provided and in how it works to prevent errors

Managerial decision making

What management is all about - the essence of management Distance between being a manager and not being a manager Decision making: may range from complex, costly, infrequently made decisions to simple decisions that are almost automatic Decision-making steps: 1) problem definition 2) formulation of alternatives 3) Evaluation of alternatives 4) commitment 5) continuing assessment (follow up) RIsk and uncertainty: - part of every true decision - always some risk that something may be lost or not gained if the decision is inappropriate - Why? perfect information does not exist - Experimentation, research, and analysis can reduce uncertainty before implementation Judgment: - always required if any decision, regardless of level of complexity - Not needed if perfect information existed. The "No Decision" option: - deciding by procrastination or default - consciously deciding not to decide - Has-far reaching consequences Importance of follow up: - often the weakest parts of the decision process - many decision makers fail to recognize that anything requiring time (days, weeks, months) to implement is also subject to continually changing circumstances - "Fine-Tuning" is essential to the follow up process

Marketing Philosophies

Why is it important to have satisfied customers? Societal marketing concept Bottom line - yes, we need to following the marketing concept, but we must always do what is ethically and legally in the best interest of the patient - Pharmacists may refuse to sell something to a patient because it is not in their best interest

Importance of leadership style when exercising authority

Work assignment - The leadership style adopted can depend on the type of work that is being supervised. Routine, repetitious work requires less close supervision than a new or complicated task Employee's personality and ability - Participative leadership often works best with professional employees. Its best to adopt a leadership style that seems the most logical to you as a manager once you have a sense of what the employees involved really prefer/need. Being adaptive here can produce the best results. Employee's attitude toward manager - In some situations, a leadership style that sells the employees on the importance of accomplishing goals works the best. In this way, the manager's authority is better accepted by the employees involved. An autocratic leadership style that leaves employees unconvinced of the directive's concordance with organizational goals can be counterproductive. manager's personality and ability - If a manager is sincere in soliciting employee input and shows that s/he values therse contributions from employees, there can be positive effect on performance. If, however, the manager just goes through the motions in soliciting input and then responds with an autocratic style, results will likely suffer. Be consistent in style in such circumstances

marketing channel

a group of individuals and organizations that direct the flow of products from producers to customers within the supply chain Includes organizations or intermediates who are involved in making a product available to consumer/patient - manufacturer (who does not sell direct) --> wholesaler --> community pharmacy --> patient - Manufacturer (who does sell direct) --> Community pharmacy or wholesaler to community pharmacy --> patient What other organizations or intermediaries can affect which drug reaches the patient? - Prescriber - PBM - Pharmaceutical sales rep - Direct-to consumer advertising - Government

Quantitative approach to management

a perspective on management that emphasizes use of a group of methods in managerial decision making, based on the scientific method Scientific approach or management science. Uses various mathematical modeling techniques such as EOQ (economic order of quantity) - this is a technique used to make sure you never run out of essential life saving drugs, for example - Just plug in the variables and it will tell you how much to buy at a given time - Also can use stimulation, cost-benefit analysis, and break even analysis Overall criticism - same as for process approach - cannot stand alone as the only way of managing in today's complex environment

Sources of power, influence, and authority

acceptance or consent - this theory makes the assumption that acceptance of a manager's decision by subordinates is what really confers authority. - Zone of indifference: that area in which an individual accepts orders without conscious questioning - Zone of acceptance: an area established by subordinates within which they are willing to accept the decisions made for them by their superior. patterns of formal organization - Charismatic authority based on attributes of the individual - traditionalism - routinization of charisma; concept of succession in leadership - Rational-legal - consistent with legal and social norms of the larger society Cultural expectations - similar to the xpectations found in society ; i.e. respect for legitimate authority technical competence and expertise - especially important for you to think about as an emerging professional. In classic discussions of professionals and professional work, this type of authority was conferred upon professionals by society at large. This expert authority forms the basic for the covenant professionals have with society. Society as a whole knows little about the highly technical aspexts of a professional's knowledge and therefore must trust professionals to do the right thing. characteristics of authority holders

product concept

consumers will favor products that offer the most in quality, performance, and innovative features. Not enough by itself for pharmacy

Types of Marketing Research

formal - structured measurement of satisfaction - this sort of technique is an example of customer service. - ANother way is focus groups - groups of people who are asked open ended questions to gain insight on where you want to go with your business. - Shop and/or observe the competition - secret shopper. See what the comp is doing informal - Done mostly in community pharmacies - FOr example, when the hours of a pharmacy are changed, often the pharmacist has already asked patients about changing the hours before doing it. Could also be done before adding a delivery charge. Talk to patients and ask their opinions. Example: if you like our pharmacy tell a friend or neighbor. If you dont, tell us.

Pharmacy Technicians

working under the supervision of pharmacists, help prepare medications for dispensing to patients, label medications, perform inventories and order supplies, prepare intravenous solutions, help maintain records 2018: 26 states regulated practice - mandating certification PTCB Roles: - dispensing - medication reconciliation in transitions of care - patient medication adherence - patient safety and medication access - public health - point of care testing - taking med histories - accepting verbal rx orders - assisting with MTM - TECH-check-tech not really allowed n most states