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Virginia Mason Kirkland Medical Center Wins ASHP Board of Directors’ Award of Excellence

Oct 29, 2020
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AN EFFICIENT PRACTICE WORKFLOW, allowing pharmacists and other clinicians to perform at the top of their licensure, and a culture of respect are three of the principles rooted at Virginia Mason Kirkland Medical Center in Washington. These factors have contributed to high job satisfaction among clinicians and helped the medical center become one of two recipients of the 2020 ASHP Board of Directors’ Award of Excellence.

Promoting Well-being

Richard Furlong, M.D

“The Virginia Mason Kirkland Medical Center implemented initiatives to support well-being and resilience and reduce burnout for its patient care providers,” ASHP said in a formal announcement. “These initiatives have been selected by the National Academy of Medicine to promote pharmacists as part of an interprofessional team to address clinician burnout and promote resilience.”

The medical center is one of nine locations for the Virginia Mason Health System, each with one or more primary care pharmacists. The Kirkland location is an outpatient clinic with 30 full-time clinicians, including two pharmacists, which since 2002, has embraced a team-based structure built around professional development and workflow optimization.

“This work, like almost all process improvement at Virginia Mason, leveraged our management method called Virginia Mason Production System (VMPS), modeled after the Toyota production system. It optimizes care delivery by eliminating waste, standardizing processes, and spreading the work to the right operators,” said Richard Furlong, M.D., section head and medical director of the center.

Promoting Engagement, Contentment

Well-being is promoted in several ways. One is the physical structure. The building is set up in two concentric circles. The inner ring has exam rooms while the outer ring has clinician workstations. Patients are brought immediately to an exam room when they arrive; there are no waiting rooms. Integrated care teams include pharmacists, advanced registered nurse providers, physician assistants, physicians, and medical assistants who able to move among the teams as needed. All employees are encouraged to submit ideas on improving processes, with suggestions reviewed weekly by leadership. Leaders promote a culture of engagement, teamwork, and respect for people, which includes making time for professional development.

Contentment is also promoted through pharmacists and other clinicians working to the full extent of their education and training systemwide.

“When pharmacists and other teammates help, and the work is evenly spread, it creates a collegial atmosphere that engages people and reduces burnout,” Dr. Furlong said. Pharmacists in the state have provider status and can bill for medication management appointments. They see some of their own patients between provider visits, answer all patient questions about medication, and have the authority to make changes to therapy.

Expanding Pharmacist Roles

In the early days, the pharmacist’s role was limited to anticoagulation management, noted Dr. Furlong. The team then started to look at other clinical conditions that could use pharmacists’ help, such as lipids and hypertension. They created a Heart Attack and Stroke Prevention clinic.

“We convinced our doctors that it was in everyone’s best interest to refer our patients for lipids and hypertension management to our pharmacists,” he said. It didn’t take long for data to accumulate, indicating their quality metrics were higher than other clinics not employing pharmacist management, so they continue to expand the pharmacists’ role.

Roger Woolf, Pharm.D.

Now, the health system’s 22 clinical pharmacists—all board-certified in ambulatory care— manage patients in additional areas such as chronic opioid therapy, hyperlipidemia, behavioral health management, anemia management, and smoking cessation. Practicing under the state’s collaborative drug therapy agreement, pharmacists can manage multiple conditions at once, easing provider workload by helping with direct and indirect patient care, said Jenny Park, Pharm.D., BCACP, a clinical pharmacist with the medical center.

“We refer to it as skill task alignment,” said Roger Woolf, Pharm.D., administrative director and chief pharmacy officer for the Virginia Mason Health System, of the team-based care model. “Our pharmacists manage drug therapy. They can prescribe, they can change doses, order labs and other diagnostics to ensure the patient’s medications are being used with the right intent or getting the desired outcomes. If you’ve got a full spectrum of patients coming in, some of whom need in the weeds medication management, who’s the best person? The majority of the time, that’s going to be the pharmacist.”

Adds Dr. Furlong, “What makes people feel engaged is not just giving a pat on the back or a reward, because eventually, if the work they’re doing is not meaningful, that reward will feel hollow. You respect people when you help them to develop professionally and to work at the top of their abilities.”

Increased Job Satisfaction

Jenny Park, Pharm.D., BCACP

Through this process, pharmacists have been able to help the health system achieve certain quality measures, Dr. Park said. For example, a few years ago, Washington State had depression management rates of less than 40%. Investigating, Dr. Park and colleagues discovered that some patients would abruptly stop their medications because of side effects or because they felt the drugs weren’t working fast enough. The health system began a process through which pharmacists would follow up with any patient started on medication for anxiety or depression after two weeks through a telehealth visit to assess side effects or reassure them to allow more time. From there, they reassess every six weeks, noting improvements in medication adherence and patient-reported outcomes.

The Kirkland workday also incorporates mandatory pauses. Pharmacists see patients for 20- to 40-minute visits throughout the day. They have one built-in 20-minute pause in the mornings and one in the afternoons that they can use to catch up on documentation or other indirect patient care tasks without feeling frenzied. Additionally, leadership supports activities like team discussions on being inclusive and honoring diversity, and quarterly workshops about empathetic communication skills. A Joy at Work team arranges outings to bowling alleys or potluck meals.

With all of these items in place, job satisfaction has been high, Dr. Furlong said. In a 2018 employee satisfaction survey, 93% of clinicians reported they were content or engaged.

Winning the ASHP award has been gratifying, he said. “It feels good, especially for the pharmacists who do so much work, to share this award with them.”

“I love my job, I love my profession, and I love bragging about Virginia Mason and sharing all that I do,” Dr. Park added. “To be able to do that on a bigger level nationally is amazing. The possibilities are endless for what pharmacists can do.”

Drs. Furlong and Park were part of a team that presented information on their model through a national webinar in January sponsored by the National Academy of Medicine (NAM). ASHP is an original sponsor of the NAM Action Collaborative on Clinician Well-Being and Resilience and is proud to represent pharmacy in interprofessional efforts to address the critical workforce and patient care issue of well-being and resilience.

By Karen Blum

 

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