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Looking Back and Looking Ahead

Dec 20, 2011

Editor’s Note: Henri R. Manasse, Jr., Ph.D., Sc.D., retired Dec. 31, 2011, after a 15-year tenure as ASHP executive vice president and CEO. InterSections sat down with Dr. Manasse to ask him about some of the greatest challenges he faced during his time at ASHP as well as the most rewarding aspects of his job.

What were some of your top goals as CEO?
One focus was to have the ASHP become recognized and influential in the public policy sphere in areas such as institutional accreditation, patient safety and quality of care. I also concentrated on gaining influence with standard-setting organizations like the Joint Commission and the National Quality Forum, and to continue the legacy that had been developed by my predecessors to keep the organization respected nationally and internationally as a collective voice for hospital and health-system pharmacists.

Have you accomplished that?
I think we have. Over the years, we’ve become the “go-to” organization when it comes to standards of practice, technical information about drugs, quality issues in medication-use systems and safe medication use. As an organization that is the collective voice of health-system pharmacists, we are recognized by the outside world as being the expert organization. That’s been very gratifying.

You’ve engaged in some stiff battles during your career.  Would you describe yourself as a fighter?
That’s probably a true characterization given the nature of my background. I came to this country as an immigrant at 8 years old not knowing the language or culture. I began to develop survival skills. Maybe it’s also because I’m a social scientist and I see the world a little differently than most pharmacists might. I get indignant if I don’t see the profession responding in a way that I see as socially accountable. When there are challenges in the profession or to the profession that are exploitative, I get my haunches up.

Can you provide a couple of examples?
Some are caused by the profession itself, and some are brought on by external forces. For example—and I am indignant about this— we have a difficult, challenging, and in my view, a pathetic situation in the U.S., where we don’t have a consistent training requirement, licensure requirement or certification requirement for pharmacy technicians. These workers help pharmacists get the job done; we could not get by without them. They do almost everything pharmacists do, but we have none of those standards in place. The profession needs to find a resolution. The enemy of that issue is largely the private ownership sector, which interprets this wholly as a financial issue.

Another major concern is what the American Medical Association did several years ago in developing what they call the scope of practice analysis of pharmacists, which was not only totally inaccurate, but also stifling in the sense that they are in no position to define what pharmacists should and can do. Our licensure is not issued by the AMA. It is issued to us by a state government or a state’s department of professional regulation on behalf of the jurisdiction of relevance. Our first duty is to the patient.

What were some of the greatest challenges you faced as CEO?
In professional organizations, the needs of members are constant, while the resources to meet them are limited. I’ve continually worked with that tension, especially during recessionary periods when we had to cut programs and lay off staff. That was extremely painful.

Sometimes there are issues that are really frustrating, like the technician issue. I’m an idealist, and there are times when individuals or organization or the practice broadly may not be meeting my world view or ideal. That gets frustrating because I know that I expect a lot. Other times, you just don’t have any control over a situation. The current drug shortage problem is maddening and it should never occur in a country such as ours. Yet I don’t and ASHP doesn’t control production problems, the marketplace or corporate decisions.

What are some of the most notable changes in pharmacy practice you’ve witnessed over your career?
I’ve seen an immense increase in the number and types of medications used in the hospital. We’ve created a drug supply that’s much more extensive than when I started. There are clinical and financial issues that come as a consequence of that. One has been that pharmacy departments have become important clinical components of decision making because the intensity of the use of drugs across the entire hospital has changed so dramatically. In practical terms, that means pharmacy departments not only have to have enhanced clinical and technical expertise, they also need enhanced leadership and financial expertise. That’s been an immense change. Fortunately we’re seeing pharmacists become integral parts of patient-care and hospital leadership teams. The scope of pharmacist practice in hospitals has consequently changed dramatically over the four decades that I have been in pharmacy.

What words of wisdom can you offer your successor, Dr. Paul Abramowitz?
Paul will see challenges just like I saw challenges. Face those head on because there are a lot of good minds at ASHP, and the leadership ultimately will come up with good solutions. There is a welcoming atmosphere for the expanded role of pharmacists in hospitals and health systems with regard to patientcare accountability. Our organization provides a wonderful platform nationally and internationally to get its voice into that dialogue.

I’ve also tried to have the job be fun, not withstanding its complexity. Maybe it’s the professor in me, but I’ve found it particularly gratifying to see young people take on leadership roles and flourish in their own right.

Paul will bring a different dimension of expertise and interest than mine. That is healthy for the organization and for the profession. I wish him great success.

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