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Pharmacists in the C-Suite Offer New Perspectives on Patient Care

Jan 09, 2015
As pharmacists move into leadership positions, their ability to influence the conversation about the critical patient-care role of pharmacists is growing.

Pharmacists in executive leadership positions have unique opportunities to demonstrate pharmacists’ patient-care roles and medication expertise.

AS HOSPITAL AND HEALTH SYSTEM MERGERS and acquisitions increase, pharmacy directors have begun to step into executive positions that allow them to tap into their skills as leaders, team-builders, and strategic thinkers. They also bring a unique understanding of the importance of safe and effective medication use in patient care to their new jobs.

In some cases, pharmacists are moving up within their own hospitals into positions such as vice president, where they may or may not oversee pharmacy services, or they fill top spots such as president or chief executive officer.

In other cases, pharmacists move into positions where they serve as corporate pharmacy leaders for multi-hospital health systems.

A Perfect Fit for Pharmacists’ Skills

Pharmacists are well-suited to leadership positions for several reasons, said David Chen, B.S.Pharm., M.B.A., ASHP’s senior director, Section of Pharmacy Practice Managers.

“At the hospital level, pharmacy directors are trained care providers who also have unique skill sets as astute financial and business managers because of the expense and complexity of the technologies and departments they manage,” he said.

“Their clinical experience helps them get recognized among other health professionals providing the opportunity to move into leadership positions beyond solely the pharmacy department.”

At the multi-hospital level, mergers and acquisitions result in a need for system-wide oversight of pharmacy and medication-related activities, Chen added.

“There is a need for leaders who can identify the changes necessary as health systems grow in size and complexity and coordination of medication management services across many entities and patient care settings becomes critical. We need leaders who can determine where pharmacy fits into that equation,” he added.

Pharmacists should be prepared to take advantage of opportunities created by mergers, said Roy Guharoy, Pharm.D., chief pharmacy officer at Ascension Health, a non-profit system with 138 hospitals and over 1,500 clinics spread across 22 states and the District of Columbia.

“Today, everyone is open to hearing about how to improve patient care, and pharmacists can make a huge difference in that,” he noted. “If we come forward with good plans and show positive outcomes, it’s not hard for pharmacists to attract the attention needed to step into high-level roles.”

The Case for Pharmacists in Leadership

Moving into the C-suite offers a unique opportunity to promote changes that not only improve patient care, but benefit the profession of pharmacy.

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Karl Kappeler, M.S., R.Ph., FASHP

When administrators at Nationwide Children’s Hospital in Columbus, Ohio, spoke with Karl Kappeler, M.S., R.Ph., FASHP, then director of pharmacy, about becoming vice president of operations and professional services, a position that is largely responsible for surgical practice, he said he wouldn’t take the job unless he could somehow keep the pharmacy in his chain of command.

Given his 15-year track record at the hospital, the administrators agreed to his request, and Kappeler was able to hire a new pharmacy director who reports directly to him. Keeping pharmacy under his umbrella has two key advantages, Kappeler said.

“I anticipate an opportunity to foster pharmacist and surgeon relationships for better continuity of care for patients,” he noted. “But also, I’ll be better able to keep administrators aware that the pharmacy has a huge impact on patient clinical outcomes and hospital finances.”

A C-suite pharmacist’s experience in the day-to-day challenges of patient care can be useful in clarifying for other executives how pharmacy can assist in times of crisis or change, said Bonnie Levin, Pharm.D., M.B.A.

Levin is assistant vice president of pharmacy services at MedStar Health, a system comprising more than 120 entities in the Baltimore-Washington, D.C. region, including 10 hospitals and nine retail pharmacies.

Bob Ripley, Pharm.D., BCPS

Bob Ripley, Pharm.D., BCPS

“Having worked through drug shortages or developed programs to help reduce readmissions, you can make the case for how pharmacists can play an innovative role in addressing those issues,” Levin said. “The important work gets done when pharmacists collaborate with other clinicians, and at the executive level, we can form teams that include pharmacy.”

Bob Ripley, Pharm.D., BCPS, vice president and chief pharmacy officer at Trinity Health in Livonia, Mich., agrees. Trinity Health is a national health system with 86 hospitals and 128 continuing care facilities and home health and hospice programs spanning 21 states.

“I think one of the most important things I do is to see problems not only from the pharmacist’s point of view, but from the perspective of patients, nurses, physicians, and other providers,” Ripley said. “Once I see the problems from those different angles, and the people who work with me see I’m not only looking at it just from a pharmacist’s point of view, that takes down walls. Then, we can begin to see how pharmacists can assist with a solution.”

Attitude Adjustment

As exciting as the C-suite can be, it’s not without its challenges. Moving out of direct patient care requires a change in mindset that newly minted executives sometimes find jarring.

“As with any other promotion, you can’t continue to behave like you did in your previous position,” said Tom Woller, M.S., FASHP, senior vice president of pharmacy services at Aurora Health Care, a system of 15 hospitals, 159 clinic sites, and 70 retail pharmacies in Wisconsin.

Tom Woller, M.S., FASHP

Tom Woller, M.S., FASHP

“One big adjustment is in understanding when you should jump in vs. when you should step back and provide guidance.”

For former pharmacy directors stepping into executive roles in which they will oversee pharmacy operations in several hospitals, delegating can take some getting used to, said Woller, who is also chair of ASHP’s Section of Pharmacy Practice Managers’ Advisory Group on Multi-Hospital Health-Systems.

“You know what needs to be done in pharmacy, but you need to learn to step away and let the good people you’ve hired do the work you’ve hired them to do,” he said, adding that being a member of the C-Suite helps him to advocate for pharmacy.
“It’s anyone’s job in a leadership position, formal or otherwise, to look at how to improve patient care, but the percentage of time spent advocating for how pharmacy contributes to better care is increased” at this level, he said.

Pharmacists taking on high-ranking leadership positions for one hospital may not experience the same internal struggle, but that’s in part because they’re diving into a pool of culture shock. And with so much to learn, they simply won’t have the time think about micromanaging, said Michael Sanborn, M.S., R.Ph., FACHE, president and CEO of Baylor Medical Center at Carrollton in Texas.

“The biggest area that was completely foreign to me was physician contracting and its associated legal aspects. As a pharmacy director, you aren’t exposed to that,” said Sanborn.

“It’s a totally different set of responsibilities when you expand into the realm of influence outside of pharmacy. You don’t have a choice but to be an effective delegator.”

Pharmacists may also have to engage in some silo-breaking, especially when it comes to initiatives involving medication management, said Guharoy.

“There are gaps in the continuum of care in health systems around the country. Physicians do their jobs, pharmacists do their jobs, but no one is managing the whole process.”

It can be an uphill battle, he added. “Typically, healthcare is very traditional, so changing the culture is a big challenge. You have to figure out ways to address it, but it starts with having good credibility. If you have leadership qualities and clinical skills, you have a tremendous opportunity to improve patient care.”

Multiple Paths to Upward Mobility

Pharmacists can take any number of paths en route to a corner office. Kappeler was the director of pharmacy at Nationwide Children’s, and the vice presidency was a straight promotion. Levin held positions in clinical pharmacy, informatics, and then administration. Woller knew in pharmacy school that he wanted to go into administration, so he pursued an administrative residency as the best route to becoming a director of pharmacy and went from there.

Whenever Sanborn saw an opportunity to serve in another department as an interim director, he took it. In fact, immediately prior to his current position, he served as the corporate vice president of cardiovascular services for all Baylor entities, ultimately going from a multi-hospital role to a single-hospital role.

Ripley began his career as a staff pharmacist, and with each successive position, his role grew in breadth and depth until administrators were coming to him with openings.

Regardless of their individual paths, these experts agree that pharmacists who wish to enter the executive track should focus on relationship-building.

“You’ll have to be extremely comfortable interacting with large and small groups made up of all kinds of personalities, so the more you do that early in your career, the more comfortable you’ll be with it later,” said Sanborn.

That means face-time, said Kappeler. “My relationships are not through electronics, but in-person communication. Younger pharmacists will be used to communicating electronically via texting or other modes, so they need to be mindful of the importance of speaking face-to-face, or those same relationships won’t be forged.”

The Value of Networks

“This is where ASHP is vital to us,” said Woller. “You can start developing networks through ASHP early in your career, people whom you can bounce ideas off of or have discussions with about projects or initiatives you think are worthwhile.”
Levin stressed that once a pharmacist is in the C-suite, influence depends on presence as much as expertise.

Roy Guharoy, Pharm. D.

Roy Guharoy, Pharm.D.

“Showing up is half the battle. It’s important to be visible to the other ‘Cs,’ like the chief financial officer or the chief medical officer and show them that you’re a problem-solver and a strategic thinker,” Levin said.

Guharoy agrees, urging pharmacists to align themselves with leadership within their organizations.

“I’ve seen situations in which there may be a great partnership among physicians and clinicians, but the CEO’s, CMO’s, and others in the C-suite are completely disconnected,” he said, reminding clinicians that the C-suite is filled with decision makers.

Levin added that there is strength in numbers.

“At this level in a health system, it’s more of a strategic focus, and the planning that I get to do with pharmacy directors gives them a voice,” she said. “It’s one thing if one pharmacy [in the system] needs a piece of technology, but if 10 sites are saying it, that is more powerful.”

Kappeler knows that along with the visibility of the position comes a responsibility to his profession.

“I want to do well and demonstrate that pharmacists are highly capable, engaged, knowledgeable within the organization and leadership,” he said. “I want to do a good job so that everybody sees a pharmacist doing a good job.”

–By Terri D’Arrigo

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