This podcast provides an interview with one of the first pharmacist hospital CEOs, Bill Evans, retired CEO of St. Jude Children’s Research Hospital, and one of the first health system Vice Presidents of Pharmacy and author of the 2005 AJHP paper “Rationale for having a chief pharmacy officer in a health care organization”, Marianne Ivey. They will explore the evolution of pharmacy executives and the path of pharmacy practice and the opportunities still ahead.
The information presented during the podcast reflects solely the opinions of the presenter. The information and materials are not, and are not intended as, a comprehensive source of drug information on this topic. The contents of the podcast have not been reviewed by ASHP, and should neither be interpreted as the official policies of ASHP, nor an endorsement of any product(s), nor should they be considered as a substitute for the professional judgment of the pharmacist or physician.
What happens at the biggest and best pharmacy event in the world? Join the best and brightest pharmacy professionals in New Orleans this December for an energizing and riching, enlightening experience like no other. Simply put, there is nothing like it. ASHP's mid-year clinical meeting offers everything you need for your career to blossom, including countless professional development and career advancement opportunities. Just imagine what you can accomplish at an event that brings together 20,000-plus pharmacy professionals from across the globe. Special rates are available when you register and book your hotel before September 27th. Learn more at midyear.ashp.org. That's M-I-D-Y-E-A-R.ASHP.org. Welcome to the ASHP official podcast, your guide to issues related to medication use, public health and the profession of pharmacy. Thank you for joining us for the ASHP pharmacy leadership podcast. This series focuses on leadership topics within pharmacy practice, including the business of pharmacy, development of leadership skills, career transitions and more. My name is David Chen and I'm the assistant vice president for pharmacy leadership and planning at ASHP and I'll serve as your host. And today we are very fortunate to be sitting down with William Evans, Emeritus faculty and past CEO for St. Jude Children's Research Hospital and Marian Ivey, professor emerita at University of Cincinnati, pharmacy practice and administrative sciences. And we're going to be discussing today reflections on healthcare and the chief pharmacy officer role, 2004 to 2024. So everyone, thank you and welcome for being here and joining us. You're welcome. Glad to be here. My pleasure. Great. So to get things started started, I always like to ask a starting question to hear a little bit about your life journey. So if you could each share a little bit about your background, your career journey and an emphasis on those critical points in life that encourage you to pursue formal leadership roles in your careers, both in your work careers, as well as I know all the professional volunteering that you've done for our health care industry across the decades. Marianne, could I start with you? Sure. Thank you, David. So happy to be here with you to talk about leadership and both Williams and my journey. Mine started as a pharmacist student and it was my good luck, good fortune to always have an excellent role model mentor, whether I was in community pharmacy, which is where I started out for about a year after I graduated or hospital pharmacy or in academia. As a pharmacist, I always kind of had my foot in both academia and hospital, having working for academic medical centers. So my first bosses were Winderant and David Zills in the hospital and it was an exciting time for us because Winderant was president of ASHP and that brought a lot of energy and interest and contemporary discussions to our work on a daily basis. The other thing that was really very important to me was how much energy they both brought and their teams brought to taking care of patients. They had, it seemed to me, an unboundless energy for the profession and for the care of patients and making sure that our medication system was safe and that pharmacist had a role in it. That was pretty exciting for a new practitioner. I followed my husband to another place where he was getting his residency and that happened to be in St. Louis where Harvey A. K. Whitney, Jr. hired me. So as many of you would recognize that name, you would know that he had a network that was unbelievable that he began to introduce me to. So that was an important critical point in my early career. And then my husband took a residency, surgical residency at the University of Washington and once again I was fortunate to have as mentors and bosses people like Bill Campbell and Don Sorby and they were great role models too, gently guiding me into what was good thinking for both clinical practice and leadership. A colleague in practice, Don Williams recommended me for an ASHP council in those early years and that of course was another critical point for me. That activity with ASHP in the councils where I saw colleagues who had both expertise and an ability to communicate well was another great role model that I could observe and eventually I became a candidate for the board of ASHP and of course almost everyone would say being on a board of the stature of ASHP is a great learning experience. So that was particularly important for me and for my next step in my career because what I noticed was almost all of my board colleagues were directors of pharmacy. I was the lone clinician and while that was an important role to have on the board I also realized that the influence that the directors had was greater than the influence that I could have as a clinician. So I began to reflect on what it was that I needed to do and as part of my journey I enrolled in a master's of public health program and took the services delivery pathway which was designed for clinicians who were moving into leadership and that made really all the difference and in terms of what I learned and the people I was exposed to through that education and when I took my first job as director this little just little story here was that the organization that I was joining had had been in a bit of disarray and there was a pending vote for labor relations and representation of a union of the pharmacy department. What I had learned in my master's of public health program on labor relations and good administration management relations with staff really helped me and the vote which was two weeks after I took that job was against representation and I can tell you that that vote was heard across campus where I was working and made a huge difference. So I'll stop there because I think those are really some key aspects of my early career. I thank you for that Marianne and with striking for me is not only as you've noted being a clinician from your start and then as you moved into the director and leadership role but also your experience of seeing health care in different regions of the United States as well which I'm sure influenced how you saw practice and some of your leadership roles with ASHP. That's true David it's very true and it gave me a broader feel I think for different perspectives and so that that in itself was a learning experience as you point out. Yeah great well talk about different perspectives. William if we could turn to you if you could share a little bit about your journey and background and those critical points that helped you find yourself as the CEO at St. Jude. Yeah thanks David. Well as you'll hear Serendipity played a big role several times in my career and my career progression. I was a PharmD student in 74-75 at the University of Tennessee and back in those days we had to do a research project to get at our PharmD degree and that was really turned out to be very important for me because I was exposed to doing research. I had no idea that I would enjoy that or that I might be good at it and that project sort of introduced me to that career possibility and after doing it I realized I liked research to be part of what I was going to do in my career going forward. The other Serendipity was that the person I picked to do that project with was a faculty member at St. Jude Children's Research Hospital Larry Barker who was the Chief Pharmaceutical Officer, Director of Pharmacy and that introduced me to St. Jude and what I found was an organization whose mission I really felt was compelling. I really liked the people, I liked the culture of the organization and I knew it. If possible I wanted to work at that organization at some point in my career but when I finished my PharmD degree there wasn't a job for me at St. Jude. I let Larry know that if one were to become available and he thought I'd be a good fit to give me a call and I'd be right back and I joined the faculty at the University of Tennessee and spent 18 months there which was a very productive time for me but I got the phone call from Larry who invited me to come back and be a clinical pharmacist at St. Jude and to as he said go up on the floors and do what they've been teaching you to do in the PharmD program at UT and so that's what I did but I was also able to start a small research program as part of that early job that I had at St. Jude and that was going nicely we were building a clinical program the research was starting to get published and it was integrated extensively into patient care so it was translational research I think before that term was coined and then about eight years into that Larry Barker announced that he was leaving to join a pharmacy software company in Florida and and the next week I got a call from the CEO of St. Jude to come up for a meeting which I did I assumed he was going to ask me to sit on the search committee perhaps to have the search committee to find Larry's replacement and he surprised me and when he said Bill would you like to take that job and that wasn't in my plan I was enjoying the research I was enjoying developing expanding the clinical programs we were doing and but I couldn't just say no to Dr. Simone so I I asked him for a little time to think it over and came back about a week later and said I'll do it on one condition if you make pharmacy a clinical department at St. Jude that's at the same level of the same structure as the other clinical departments hematology oncology radiology diagnostic imaging infectious diseases pathology and all of those departments had a patient care mission and had a research mission and I said I will create a pharmacy department that has both that contribute to the organization if you'll if you'll give me the opportunity and you know it gave him a way to fill that position without much more work fortunately he thought about it a bit and agreed to do it and I was able to hire John Rodman from the University of Minnesota to come in and be the chief pharmaceutical officer and and I began to focus on further expanding the patient care and the research that we were doing now the reason that was important I think one was putting pharmacy on the same playing field as is all the other clinical departments the other was it put me on the executive committee of the institution so now I was in on the meetings where decisions were being made at an institutional level and and that really gave me an opportunity to not only contribute but to know what was going on across the organization and to make sure that you know the perspective of pharmacy and the care that we were providing the research we were doing was part of those big decisions that were being made and it was really true doing that for I don't know 10 or 12 years that ultimately led the CEO St. Jude at that time was Art Neenheis he asked me to become his scientific director for the for the organization he did that because I was almost leaving to become the founding dean at the University of California San Diego their new School of Pharmacy Mary and I were very close to moving to to California I was very excited about that possibility but Dr. Neenheis he didn't give me any more money to stay he just gave me more work and it really put me at an additional level within the organization of attending the board meetings with the chief executive and I became someone other than a name that the board knew and got to know over a number of years and so I think when ultimately Dr. Neenheis decided to step down as a chief executive officer and the sort search was formed for his replacement I didn't apply for the job it was really the faculty who came to me and asked me to put my name in the hat and it was the board who encouraged me as well and and we're very comfortable with me being appointed to that position even though I certainly have not set my educational path or my career objectives in becoming the chief executive St. Jude I never really tried to do that it just sort of organically happened over several decades but I think it was getting into a position where I was involved in institutional decisions and interacting with the board on a frequent basis that made that possible. Thanks for that William and in talking about expected and unexpected I guess to me it sounded a little bit more like preparation met opportunity and and when they've availed themselves you were there ready to take them so that was a great story I appreciate that and I'd like to hang on to the the comment you too that you mentioned about you know having the opportunity to be present with the hospital board as I ask you the next question as we continue our conversation that if if you could share your reflections on what were some of the the expected and unexpected experiences you had once you assumed your role as CEO at St. Jude and if you could include some specifics on what you felt were areas pharmacy leaders maybe didn't completely understand about how the C suite looked and and the what success looked like in the organization that would provide learnings for others for example you know having a presence with boards of hospitals. Yeah well that's a really good and interesting question I'm not sure there's a short answer or even a correct answer it's sort of multifaceted I think back on sort of how it happened to me David I do think being in those board meetings you know and our board was very engaged it was 50 people volunteers from across the country nobody was compensated for anything on our board including their travel to board meetings and they were three-day board meetings so this was like quite an unusual board that was quite large at comprised largely business people and attorneys and some private practice physicians but there was no one from academic medicine for example on that board over a few private practice physicians but I do think it was important that I was interacting with that group of people for a couple of years before I began to actually serve as their chief executive officer because there were a lot of nuances in sort of how the board made decisions and I think the more you can know about that going in in a leadership position the more likely you are to have on some level of success and getting things done that you think are important for the organization. I think perhaps you know pharmacist and this is not limited to pharmacist but I think sometimes we think that being a chief executive might be a much bigger job than it really is and you know I think on papers it is a big job on the other hand the kinds of processes one goes through to to make decisions or to develop plans or to organize strategy or to convey with your employees we're going to be the ones who make all of this happen. I think those are the same approaches and skill sets that one takes if you're reading a pharmacy as a chief pharmaceutical officer or leading other you know major programs within an organization within an entity. It was interesting after I reflected back on this that I had never taken a management class in college. I had never taken a finance course in college and never taken administrative or a leadership course so on paper if you look at my academic pedigree I didn't really qualify to become a chief executive officer but I had been making decisions and I had been communicating with the board as well as with the organization internally in a way that people felt like I might have the sufficient skills to be a chief executive in the absence of those credentials on my resume and I think for me it sort of all boiled down to common sense in terms of making big decisions and it was very very important to me as a chief executive that I surrounded myself with you know very very smart capable hard working people whether it was my chief financial officer or my cancer center director or you know leaders of the various academic departments including the pharmacy department. I never tried to be the smartest kind of room because a) I knew I wasn't and b) I had incredibly smart people around me and I could I could draw on them for input and you know try to find consensus. I was very committed to finding consensus if there could be one found that related to the topic that we were we were pursuing or considering or debating or the strategy we were developed and yeah there were sometimes when we just couldn't get a clear consensus and as chief executive I had to make a call on which way we were going and sometimes it made you know almost half the people unhappy but then the follow-up is getting everybody on board with the collective decision that has been made for the organization and I found communicating was a very important skill in being a chief executive obviously to the board more importantly probably to the employees of the organization and to the other leadership within the organization as well as the public you know St. Jude is a charity and we didn't charge patients for any of the care that they received and so we had to raise a lot of money telling our story to the public and as chief executive you know I had a role to play in that I wasn't my main job but it certainly I needed to be able to do and so I think those that sort of collective approach that I took and others have taken successfully in these kind of leadership positions I feel very comfortable with and I feel like you know they can work for pharmacists who might not have had you know a pedigree of business or finance or administration or leadership to step up and take on these kind of leadership positions very much appreciate that William and you know I'd like now to shift back to you Marianne you know William spoke to the importance of the position in an organization and being at the right tables and just finished sharing you know great description of those executive skill sets for success you know it's been almost 20 years since your seminal publication was published in age HP titled rationale for having a chief pharmacy officer in a health care organization and so much has been accomplished these past years and the effort to establish the role and the influence of CPOs has been quite significant including over the past decade of mergers and acquisitions requiring an often broader scope of responsibilities as pharmacy service lines have just continued to grow you know Marianne can you reflect on the vision you and those that help shape the ideas in that manuscript and your thoughts on where the profession is today and where there is still opportunity? Sure thank you David yes I am in preparation for our discussion today reread the article that you cite and I think it still holds a lot of value for our thinking but to answer your question about who helped shape that vision for the article really came out of what was then called the university health system consortium now a vision it was the pharmacy council executive committee that started talking about a chief pharmacy officer concept and we would have conference calls which we had regularly anyway as part of the council business but we set up some specific calls to talk about chief pharmacy officer we had seen nursing colleagues become chief nursing officers and wondered why that couldn't be true for the pharmacy profession as well and I have to give credit to a couple of people who were particularly articulate on our readiness and why it was a good time to think about it think about the chief pharmacy officer and give credit to Paula Bramowitz and the late Rick Demers there were definitely others on the calls whose names we all recognize Harold Godwin Sarah White, Tom Filke, Alicia Miller from Ohio State and was a representative of leaders across the country and what I think we all recognized was that we wanted to be at the table that William just mentioned we wanted to be there because we knew that that's where decisions were being made but we also knew that we were ready we had become very comfortable with the idea that we were both clinicians and administrators and we could speak the language of both our physician and nurse colleagues very well but also the chief financial officer of the organization and the CEO so I think we our confidence was was growing in that in that regard and and we talked about that and we talked about well let's let's document this discussion and and put it in an article and nobody wanted to write about it except I volunteered which was my good fortune that I did but I I do have a problem with saying yes but anyway that I think turned out very well I had my chief operating officer of our system which we'd already formed by then with the merger of major hospitals in my community I had that COO review the paper and he he said you know you really are as pharmacists much better prepared to do leadership at the level you're talking about than some of the administrators that are already in those positions and he went on to say why he said you manage a huge budget second only to the operating room in in hospitals you manage a multi-level human resource group from entry level to postdoc you have direct patient care and you and you influence that care experience of the patients you prevent us from having errors and and risk and costs related to errors and he said you have this business acumen that you keep growing whether you're talking about buying multi-million dollar automation or contracts with wholesale distributors he said really you are fit and so that that made me feel good of course and confirmed that our executive committee of the pharmacy council of UHC was truly on the right track you know in terms of what I learned as vice president of our system my boss at the time the same man who reviewed the paper said you're already chief pharmacy officer really your title is vice president of the system so that brought me to the table of course and I learned about systems thinking which was quite different than if you're managing an individual hospital when you're managing a system you're looking for economies of scale you're looking to make sure that all of your leaders from the different organizations have a say and I adapted a what I call a tight loose leadership style where we we set goals and a strategic plan but we also were I was certainly willing to hear an opinion about the individual hospital and its specific patient population and needs and that's the loose part of of that conversation so I think that the article really set the stage and explained why we should be chief pharmacy officers why we're ready and I was heartened as as I think all our colleagues were to see the movement in that direction so a lot of people became chief pharmacy officers or vice presidents of their pharmacy and within the system so I think I would recommend the reading of that article and then I'd pair it with the one that Steve Shafer wrote as part of his web award address about why clinicians pharmacy clinicians are ready for higher executive roles in their organizations so I think that that would be my comment to your question David thank you Marianne and at the risk of being repetitive I think I'll say it again I think you being the author for that paper was another situation if we're preparation met opportunity and so so very glad that you chose to pursue that and get that published because it's really been a a guide post for for a lot of the work that we've done within our health systems and leadership efforts so thank you for that so the next question because I always like to ask you some easier questions and move on to what they probably say don't ask a multifaceted question but I'm going to for this last question for you both and and this question is a big one and it's that in light of the quickly changing marketplace one that some may argue has become embattled with non-traditional patient providers and commercial interests and the continued struggle of the US health system to shift from sick care to health care can you both provide your reflections on the journey you've seen health care take in the United States and then what your thoughts are about what is needed next needed at the macro level needed is more pharmacist find opportunities in the C suite and needed to ensure the most effective advances in pharmacy practice continue and William if I could point to you first to tackle this question you know I I've had an interesting 40 plus year career at St. U children research hospital and that has given me a front row seat at an organization that's changed greatly over that period of time but you know there's certain elements of it that never changed and one is that nobody paid for anything in terms of patient care at St. Jude and that's that's a unique model it works because of good public support but what that model provided was a possibility to see what health care could be like if you didn't have money as part of the equation if people weren't expected to pay for an extra MRI if they weren't expected to pay for one medication versus another if all those decisions could be made on a level playing field for every patient in the same way and what I saw was that St. Jude had outcomes for many childhood cancers that did not differ by race or ethnicity when in fact across the country you were seeing worse outcomes for some diseases like most common cancer in children A.L.L. acute lymphoblastic leukemia that was always significantly worse than in children of African American ancestry or Hispanic ancestry of ethnicity and so our our approach to me is what I would like to see health care be across this country but of course it will never be that in my lifetime but if we could as implied by the nature of your question I think if we could shift health care in the US away from being a business or a business proposition toward becoming a professional service some refer to it as a human right but a service where it's delivered and rendered without questions about who's going to pay what for what part of that treatment you can think about other aspects of our country where that's true the military is a good example I think which provides security for this nation for everyone without asking individuals to pay for it sure we pay for it through our taxes but we are safe for country and everybody benefits uniformly I think from from the military or you can say education is another example in this country and there are many perturbations on that I know but there's a baseline education that's provided you know to everyone regardless to their resources or it could be simpler examples like the national parks or the interstate systems where it's not a pay-as-you-go function or service that's available to people that that live in this country and and today I think too many decisions are being made based on you know what money can be made by what organization within the health care enterprise and I think that often works against making the best and the most perhaps expedient and effective decisions for individual patients and I think the stats would say that our current system is a lot room for a lot of room for improvement I mean the our cost of health care in the United States is what 80-85 percent higher than the rest of the developed worlds and countries in the world US outcomes aren't so great and based on what statistics you look at in terms of life expectancy or infant mortality or the care of diabetes so I don't think we can justify maintaining the current system because it it's more effective certainly if you have money and have access to the best health care in this country you get the best health care in the world but the problem is a lot of people don't have that access or they don't have the money to be able to afford access to to health care so you know that's the big problem in front of us unfortunately the the political nature of this country at the moment is never even going to entertain the possibility of making health care less of a business and more of a a human right or a professional service in the country so then what can we do absent that and I think you know if we think about our profession and pharmacy and being among the most trusted professions in this country and the increasing role we're playing and ensuring effective and safe medication use and you know making sure patients are educated about their medications making sure our physician colleagues are educated about the best choices for for medications and just the increasing roles that pharmacists are playing in the delivery of health care I think there are lots of things that we can do to to move the needle in the right direction but we're going to be doing it in this in this structure of health care as a business and in too many circumstances in the United States at the moment right yeah thank you for that William and Marianne well yeah I would say that you know as pharmacists move into C-suite activities one of the things they have an opportunity for is to set values for the organization and to provide influence and just as Bill is talking about the business of health care I think we need to just keep in the center of our mission the patient and influence that as we rise in and leadership responsibilities we have to keep the patient the center of our mission and there's many things that get us off track as Bill said the finances which are very difficult in today's environment there are political issues that hospitals face town and gown issues are some of those political issues that can pull you off track and I think we've probably all heard sort of war stories and examples of the patient not being at the center and and how awful that feels in terms of what our real responsibilities are on behalf of the patient so I think you know teaching our colleagues and the students who come after us about how important it is to provide compassionate care provide helpful suggestions for the family for loved ones provide resources that's I think going to still hold sway with an awful lot of people that we take care of and while it'll be very hard to fight progress in many ways that are a little different than the model that we are currently seeing in health care that care that compassionate care individualizing to the patient's need I think is going to be very important and I think that C-suite pharmacists need to take that seriously and know that they can influence that I think in addition today's pharmacists have to be really open to innovation have to be thoughtful about resistance to change so they can bring their teams along it's it's impossible to work in the complexity of health care without a really talented team and communication becomes extremely important to that whole team to know what it is you're trying to do how you're trying to get there what progress you've made what gaps you still have and so as has been said before during this conversation today communication is really critical and I guess I would end my conversation here by saying I learned a lot by reading a book called team of teams by Stanley McChrystal and its emphasis on communication every which way and flattening the hierarchy that often occurs in any organization and just assuming that there are experts at every level and they need to have the information that the senior leaders have so David that would be what I think is the challenge for us and there's plenty of work for all of us to do that progress is is at the doorstep and some of it we won't like I am quite certain but if we remember the patient in the center of our mission I think it'll hold us in good stead Marianne this is Bill I think you're absolutely right and thanks for pointing that out I think keeping the patient in the middle of everything we're doing and the decisions we're making it is the key step here in doing the right thing and having the best outcomes so that's a very good point right wow well thank you both for that you too certainly provided us some wonderful perspectives on patient care organizations and just health care in general disperspectives that are continue to give us something to aspire to continue for all of us to contemplate and most importantly continue for all for all of us to actively pursue so thank you so much for this conversation today Marianne and William and it has been a really an honor and a privilege to be able to spend time with you both today I mean there's so much to celebrate and the advancements of pharmacy practice and the role and the influence of pharmacists in our nation's hospitals and still as Marianne as you mentioned more opportunity for us as we continue to grow and Bill you sharing the influences and some of those skill sets as we rise in the executive ranks so again both of you thank you so much for your time today and for our audience that is all the time we have today and again I want to thank William Evans and Marianne Ivy for joining us today to discuss reflections on health care and the chief pharmacy officer role 2004 to 2024 please find more member exclusive content including resources for self-development leading pharmacy enterprise and teams and practice management on the ASHP website thank you for joining us today and if you enjoyed this episode be sure to subscribe to @ASHP official podcast thank you very much and have a wonderful day thank you for listening to ASHP official the voice of pharmacists advancing health care be sure to visit ashp.org/podcast to discover more great episodes access show notes and download the episode transcript if you loved the episode and want to hear more be sure to subscribe rate or leave a review join us next time on ASHP official
