Navigating the Horizons: Pharmacy's Dynamic Role in Healthcare

Key Responsibilities

As a University of California San Francisco health pharmacy director responsible for leading a significant portion of a contemporary pharmacy enterprise, my responsibilities are multi-faceted. The pharmacy services under my oversight are oncology, infusion (inclusive of non-oncology), and the investigational drug service. UCSF Health has a strong cancer care program, ranked seventh in the nation by US News and World Report in the 2023-2024 report. The organization also receives the most research funding from any public university's National Institutes of Health. Finally, capacity management and serving patients in the most appropriate location at each point of care, such as the right infusion center, are major focus points for the organization.

I continue to gain an immense appreciation for the level of diligence and coordination required to operate effectively in a highly matrixed healthcare organization and pharmacy department of our size (about 475 FTE). Each week starts with a simple yet effective huddle, where the leaders in each area of my areas of oversight provide essential updates and escalate the unexpected. Effective communication for my teams starts with checking in with the people who know the work best. I am passionate about ensuring the members of our teams are trained in essential skills, such as lean process improvement methodology. The ability to effectively identify, diagnose, and address problems allows us to be nimble, safe, and responsible with the resources we are afforded. Finally, we are all dedicated to the next generation of learners through our teaching responsibilities. We stay curious and challenged by researching and training future pharmacy leaders at all levels. 

Pharmacy’s Diverse and Essential Contribution to Healthcare

While pharmacy can be seen as a support service that should fit into an organization's ‘vertical,’ like laboratory or imaging services, pharmaceutical care touches almost every aspect. Medications are deployed and utilized across all episodes of care and for most treatment modalities. Many contemporary and effective pharmacy leaders across patient-focused organizations, such as hospitals and health systems, must leverage strong clinical expertise, financial acumen, analytical skills, management of automation and technology, creative business strategies, and good old-fashioned operational know-how and change management. Consideration of pharmacy as a core service that reaches horizontally across departments, like medicine, is more useful when developing a highly effective pharmacy enterprise with maximum contribution potential.

Major Challenges and Trends

One of our major priorities is furthering our capacity management strategy across all episodes of care while preserving what sets UCSF Health apart – the patient experience. One contributor to this strategy is an ongoing initiative requiring pharmacists, pharmacy technicians, nurses, providers, and others to smooth our approach to treating our infusion center patients efficiently and patient-centered. A busy infusion center consists of many checkpoints, both for operational and safety purposes, that must be completed before a patient receives therapy. We identified a significant amount of duplicative work occurring among our various healthcare team members, along with gaps in the process resulting in patient delays and subpar experiences. We are working together to assign the most appropriate roles to the right team members to promote efficiency and elevate each team member to the top of their respective practice. Similarly, we intensely focus on ensuring the patient has an even better experience by decoupling provider and infusion visits when patients live in a reasonable proximity to the infusion center while allowing those traveling from further away to retain the convenience of a single visit.

While the initiative mentioned above demonstrates standardizing common goals across almost 200 infusion chairs (and growing), we must also be nimble in the face of change. One major trend affecting health care is the behavior of health plans and insurance companies intending to lower their total cost of care. One such approach is forcing patients to receive an infusion or other treatment in a site of care where the insurance company knows the reimbursement to the health care provider is lower, such as a doctor’s office or the patient home rather than a hospital-based infusion center. Blanket policies such as these can have unintended negative consequences for the patient when this decision is not made in collaboration between the patient and provider but rather mandated by an insurer. Additionally, a sudden shift in policy can result in fragmentation of care when a health system’s infrastructure is not ready for such a shift, requiring a patient to seek care from another organization. Healthcare will continue to be dynamic, and it is incumbent upon healthcare leaders to regularly update their strategies to maintain optimal patient care.

Considerations for the Future Workforce

If there is an area in healthcare that keeps me up at night, it would be the future of our workforce. The full effects of the COVID-19 pandemic on career shifts, burnout, and changes in care delivery models are yet to be seen. However, we are already seeing the following trends. Increases in chronic disease, an aging population, and increasing demand for services contribute to a deficit in essential healthcare workers. I believe embracing technology will partially help this issue. Despite how difficult it is for me to wrap my brain around artificial intelligence and other advanced technologies headed our way, I believe embracing this technology wave is the easy part. The aspect of our workforce that makes me lose sleep is how many talented people leave their jobs in healthcare every day. Close friends of mine have decided to hang up their license, something that took as many as ten years of school and training to achieve, for something else. While I support and encourage anyone to find their true passion, I firmly believe there is no greater calling than caring for others. Leaders must get creative to ensure essential healthcare workers have the tools they need to feel like they are advancing and contributing in ways that are meaningful to them.

There are two ways in which I believe our healthcare workforce might further find their calling within the field. First, career pathways must be better defined for prospective professionals earlier. Early education (probably starting as early as high school) on healthcare roles, the associated responsibilities (both the glamorous and not-so-glamorous), and how each role contributes to healthcare is lacking. Too often do I hear someone’s original ‘why’ had to do with a stable job outlook or prestigious title. This leads me to the second essential, which is the development of the most important general and transferable skills, no matter the healthcare role. In my opinion, healthcare roles are specialized by nature and sometimes too specialized. While the care of a patient by their intensive care nurse can make all the difference in an outcome, who ensures that the nurse's interests are fostered? When the nurse identifies a safety or quality improvement or has an idea for a revised care model requiring the input of multiple stakeholders, where is she getting the skills to justify her proposal? Healthcare workers often either settle into what they consider 'dead-end’ roles for the long haul while losing engagement or leaving healthcare entirely.

"While pharmacy can be seen as a support service that should fit into an organization's ‘vertical,’ like laboratory or imaging services, pharmaceutical care touches almost every aspect of an organization."

While the above might paint a bleak picture, I believe healthcare organizations are well-equipped to address these problems. Time and time again, we demonstrate we can overcome the most complex issues ever to face human existence through creative and collaborative problem-solving. In addition, healthcare contains vast amounts of empathy and "human-ness" within its ranks. It is simply a matter of prioritizing this workforce issue alongside the other issues we consider highly important.

Leadership Advice

My leadership advice is simple and serves me well in my daily work. Most importantly, I listen to my team and do my best to understand their perspective. Rather than feeling pressured to decide on their behalf, I will often ask for their advice as I work out ways to remove obstacles for them. Listening to and empowering those who know the work best is a recipe for success. Secondly, I do my best to embrace a learner's mindset. Our roles have too much complexity for anyone to know everything. While learning from the experts and applying the change management tools, I typically can identify how an initiative can move forward successfully (or if it should be eliminated). The final piece of advice I will leave here is for any leader to encourage fearlessness. When people stop communicating or raising concerns, safety can be compromised, and engagement can wane. It is important that my team views me as visible and accessible, feels comfortable reaching out, and knows how to debate productively. It is through these characteristics of a highly effective team that I know we will get to the right solution, no matter the challenge.