MANAGEMENT AND LEADERSHIP ROTATIONS

Jason Glowczewski, PharmD, MBA

CASE

N.S. is a pharmacy student on week two of his management and leadership APPE rotation. Like many others, the day begins with a meeting. During this meeting, someone wearing a suit asks N.S. how engaged he believes the pharmacy’s employees are and how the culture differs from other hospitals that N.S. has experienced. After he answers, the preceptor whispers, “That was the hospital president.” Later in the day, N.S. delves into the 10 projects on his prioritized to-do list but gets stuck trying to fix a complex formula in a newly developed spreadsheet looking at the financial impact of adding a new drug to the formulary. N.S. works out a solution, finishes the project, and e-mails the result to his preceptor, who appreciates the hard work and already has two additional projects that need urgent attention.

WHY IT’S ESSENTIAL

Although a management or leadership rotation is often an elective experience, the lessons learned can immediately be applied to other APPE rotations and eventually be helpful in your role as a pharmacist, where you must be comfortable supervising and managing others, regardless of their practice setting or level of experience. When the pharmacy manager is not immediately available, the pharmacist is in charge of all nonlicensed personnel. The ability to supervise and provide guidance to nonlicensed personnel impacts daily workflow as well as patient safety. Knowing how to provide constructive criticism, motivate others, and handle conflict are all skills that pharmacists must command. In many ways, managing others is both science and art. Like clinical information, management styles and techniques can be researched and learned through peer-reviewed published data, although practice is crucial to properly execute these techniques.

The management rotation offers you additional benefits beyond experiencing the daily activities of a management-level preceptor. As a manager or director, your preceptor is often a key decision maker in the organization’s hiring process and likely knows others in similar positions within affiliated or competing organizations. With significant experience interviewing candidates for jobs, your preceptor can be an excellent resource for practicing interview skills or even participating in mock interviews. Another important management task is providing feedback and employee evaluations. Once understood, employee evaluation skills can help the practicing pharmacist be prepared for his or her own evaluation and better envision how managers view goals, success, and raises.

“Career success often depends on how people manage themselves and interact with others—and possessing these skills is a significant factor in differentiating the good performer from the outstanding performer. A management rotation also helps students understand the ‘big picture’ view of the environment in which they practice so they can align their contributions to best meet the needs of the department, the organization, and the patients we serve.”—Preceptor

ARRIVING PREPARED

To take full advantage of all of the opportunities a management rotation can offer, you must arrive prepared. Contact the preceptor a few weeks before the start of the rotation to confirm start time, location, suggested reading, professional attire, and any supplies needed. Although white lab coats are commonly worn on clinical rotations, they may not be appropriate on a management rotation, depending on the management setting. When preparing for the rotation, it is important that you thoroughly understand the practice setting that you are about to enter. An online review of the business, including location, mission statement, financial performance (if publically traded), and services offered, may be helpful. Also, information may be available about the preceptor, such as publications, research interests, awards, or activities in professional organizations. It is further advisable for you to evaluate your own social media to ensure that tech-savvy preceptors do not have an unfavorable first impression before the rotation begins (see Chapter 1). APPE rotations are the gateway to residency and independent pharmacy practice, so it is best to be prepared with the optimal outward online projection of one’s experiences.

To cultivate and project a level of confidence in the management and leadership realm, it may be necessary to review terminology commonly used by pharmacy leadership. This terminology is often learned on the rotation, but arriving prepared presents an excellent opportunity to thrive on the rotation, rather than merely survive. Important management concepts that should be reviewed prior to starting the rotation include the following:

• Employee engagement
  
• Six Sigma
  
• Full-time equivalent (FTE)
  
• Productivity
  
• SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis
  
• FMEA (Failure, Mode, and Effects Analysis)
  
• Root-cause analysis
  
• Gap analysis
  
• Culture (as it relates to business)
  
• Management, leadership, and the difference between the two
  
• The Joint Commission, Centers for Medicare & Medicaid Services (CMS), and Core Measures (in the hospital setting)
  
• SCIP (Surgical Care Improvement Project) and HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) (in the hospital setting)

Equally important to arriving prepared for the rotation is learning about your preceptor on day one. Like many clinical preceptors, a manager will be very busy onsite and attending meetings away from the rotation site. You may be asked to join your preceptor for some of these meetings, although this may not always be the case. Learn your preceptor’s preferred communication method, such as office phone, cell phone, e-mail, text message, or contacting an administrative assistant. Knowing the best communication method can mean the difference between getting an instant answer and getting no response to an important question.

CASE QUESTION

When N.S. answers the hospital president’s question about employee engagement in the department, is he putting the department or preceptor at risk in any way? Is 1 week enough to be able to assess a department’s culture or engagement level?

A TYPICAL DAY

Management rotations may vary considerably depending on the practice setting, as well as the experience level and position of the preceptor. Although day-to-day activities can fluctuate greatly, fundamental lessons in leadership and management will help you to develop similar core management and leadership skills. For example, a chief pharmacy officer or vice president may have directors and managers directly reporting to the position, whereas a manager may have staff pharmacists as direct reports. Each of these leaders will likely be responsible for maintaining a budget, evaluating and motivating employees, attending meetings, giving presentations, and contributing to the organization’s goals and success.

You must be prepared for significant day-to-day variation in the rotation experience, with rapidly changing priorities and projects. If a typical student day could be constructed, it might look like the following schedule:

• 8 a.m.—Arrive at the hospital and work on quality dashboard
  
• 9 a.m.—Attend pharmacy and therapeutics committee meeting
  
• 11 a.m.—Free time to work on projects (finish quality dashboard and begin to analyze end-of-month performance)
  
• Noon—Eat lunch and work on audit of surgery billing
  
• 1 p.m.—Attend management meeting with preceptor, focusing on annual hospital goals
  
• 2 p.m.—Meet with preceptor in preparation for staff meeting
  
• 3 p.m.—Assist running the department staff meeting and take meeting minutes
  
• 4 p.m.—Continue working on billing audit and begin reading handout on servant leadership for discussion the next day

Moving from a highly structured academic life to a more practical setting during APPE rotations can be a substantial adjustment. When considering the typical day on a management rotation, be prepared to be flexible and to receive project instruction with limited details. Communicate with the preceptor to confirm expectations, goals, and priorities for projects to help ensure success on the rotation.

MEETINGS

An integral part of management rotations is meeting attendance. Although attendance is important, knowing the intended level of participation in the meeting is even more crucial. Some meetings will require active participation, whereas others will be for observation only. You may even lead meetings, such as small-group staff meetings or brainstorming sessions to solve departmental issues. Strategies for running specific meeting types may be found in a number of reputable sources, including those listed in the Suggested Reading section of this chapter.

General tips for running effective meetings include the following:

• Ensure that all key participants are invited to the meeting.
  
• Send out a meeting agenda in advance of the meeting.
  
• Start meetings by discussing the purpose and goals of the meeting.
  
• Begin and end the meeting on time.
  
• Take accurate meeting minutes and send them out after the meeting has ended.
  
• Ensure that everyone in the meeting is an active participant.
  
• Clearly delineate people responsible for action items as well as a timeline for completion.
  
• Summarize the meeting and set the next meeting time and location.

Once you have a plan for the level of participation within the meeting, it is important to keep in mind some inappropriate actions that must be avoided. Meetings can be long and, when you do not have a vested interest in the outcome, the experience may seem boring. Falling asleep is never acceptable. Remember that your preceptor not only fills out your evaluation but also could be a critical job reference. If drowsiness occurs, consider that falling asleep on the job for a pharmacist can result in immediate termination. Of a similar nature, you may believe that it is acceptable to check e-mails and send text messages during meetings because preceptors and other managers are doing so. The difference is that the managers are sending work-related e-mails and handling work-related emergencies. You must use extreme discretion with all mobile communication.

CASE QUESTION

N.S. is halfway through the rotation and has lunch with another APPE student, C.C., from a different school. After eating, C.C. asks the management student to wake her up in half an hour. The intent is for C.C. to sleep in the cafeteria during lunchtime. Is this acceptable? What should N.S. do? Could sleeping in the cafeteria create the wrong initial impression at the site?

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