(upbeat music) - 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 Carmen Gus, and I am the 340B Manager for ThetaCare and eight hospital health system in Northeast Wisconsin, and I will be your host. Today, we are sitting down with Jordan Dow, Vice President and Chief Pharmacy Officer for Fraterd and Medical College of Wisconsin, Chad Smith, Area Vice President Wisconsin Pharmacy Operations for Advaker Aurora Health, and Katherine Desanctis, Director of Pharmacy for Mass General Brigham. - We will discuss the title for our podcast, Post Pandemic, Have You Changed How You Lead? Welcome, and thanks for joining us today. - Thank you, Carmen. - Thanks for having us. - Great, happy to have you guys here. We have a great group to present on this topic. So we'll go ahead and get started with our first question today. What challenges did you or your team experience as a result of the pandemic? - I can take this first, Carmen. I think a lot of the acute changes that were felt by us, the staffing crisis, needing to aggressively roll out new therapies and the operations that support them. I think some of those challenges that we went through through the pandemic are still being felt from a leadership perspective. One of the challenges that our team has faced is just managing the pace of change when we pre-pandemic, many of the changes that we would roll out through pharmacy were well-scoped. We would take our time to research, sometimes taking years. We would involve a multidisciplinary share governance, work teams throughout the system, and then we would test them, we'd pilot them before scaling them up. So we were very used to just very methodical, taking our time to make sure everything worked and during the pandemic, we didn't have that luxury. The resources weren't there. We had time constraints. Our peers in nursing and medicine were also being challenged. So there was a certain sense of complacency towards the chaos at times because we were working so quickly. And that was there as designed during the pandemic to get through. What was challenging, though, is backing out of that. So as we now are post-pandemic, don't need to live at that pace anymore. Trying to get back to really focusing on greater attention to those change management principles when we're not under such acute duress to make changes. So that's been a challenge that we've experienced is just the acceleration and deceleration of the pace of change to make sure that we're doing things right by our employees. I couldn't agree more with what Chad has shared. I would add that it's created a bit of-- during the pandemic and the midst of it, there was uncertainty in your own workplace, right? I'm sure you were walking into the hospital and I'm sure what you were going to be met with because of that rapid change management that was needed. And I feel like it's lingered. I feel like it's not just pharmacy. It seems, at least in my experience, that it's almost created this kind of a culture for health care in general to try to move at this very quick, fast pace, which is not a bad thing, right? Like, I think we've seen agile management be successful in other realms. But I think to be more thoughtful and take a step back, if we are going to implement things like sprints and bursts or whatever it is you want to call it, I think it just needs to be done in a much more intentional manner than continuing that rapid change management, like Chad described. I think it's just created that sense of uncertainty and past it in a post-pandemic world. It's kind of maintained. I do think sometimes the frontline feels like they're still not sure what might be coming down the pipeline. And I think we as leaders can certainly help that. But sometimes it needs to be a top-down kind of cultural mentality shift, I think. Great, great answers. I think we all became experts at rapid process improvement through the pandemic. So that brings us to our next question. How have you changed your leadership or management style to incorporate more support for your employees? Thanks, Carmen. It's Jordan. Happy to lean in on that one. I think a great question. I think, at least as I reflect on leadership style, for me personally, I would say I don't think I've changed it. At least I certainly try and live out a servant leadership style in the way I approach work and hopefully my leaders and staff feel that every day. And that was the case pre-pandemic and still certainly the case post. I think when I think about management style, the other things that we're maybe focused on are doing differently to make sure we're supporting our employees today. Really a few things come to mind. I guess just as I reflect, as we were going through the pandemic, I think many of us, myself included, just paused a little bit to say, or maybe just realize, this life is precious and how are we spending our time and what mix of our time are we spending on work versus family or other things? And I think it caused a lot of us to maybe want to reset that a little bit as we stepped out of the pandemic and want to potentially spend more time away from work or engage in work differently and have a little more flexibility in relation to work. I know we heard from our staff a lot, certainly, and asked for more flexibility in their work schedule, as well as a desire to use their PTO, not buy it out or that sort of thing. Make sure they're getting that time away from work. So ultimately, that meant for us a need to re-look at our staffing models. Certainly, those modified a lot through COVID as we dealt with surges and other things. But as we came out of the pandemic, it wasn't, let's just go back to the way we were doing things. We had certainly different patient volumes in mix, but also, again, our staff wanting a different type of staffing model. So that's really prompted us to look at more work-from-home options, what more could we do virtually? Maybe rotate some staff through clinical shifts from home where they're doing work virtually, whether that's clinical monitoring your interventions, verifying orders, or even checking product. That kind of thing. So much of that can be done virtually now with the tools that maybe we're even there pre-pandemic, but we had to start using more quickly and efficiently, and a lot of those mature through the pandemic, as well as our staff just getting more comfortable using those tools. So that's a lot of what we focused on. It's really our staffing model, mostly in the context of trying to help our staff have more flexibility with how they work, how they choose to work, and when they work, and then ensuring that they're able to take PTO if they'd like to. The one other comment I'd make, of course, spent a lot of time on well-being, topic discussions, especially in conjunction with our residents and residency, but so many of our staff are plugged into those programs as preceptors. We really tried to engage as many of our staff as we could in conversations around well-being, resiliency, and just giving them tools and resources to help them be successful. So those are a few of the things that come to mind. Yeah, I'd piggyback off of what Jordan said. I look at, for me personally, my leadership style, going back pre-pandemic, very little was required on the remote side of support roles. And that's become much more commonplace now. And I look back at when our team within Aurora started first using video cameras, and it was so clunky, so awkward. But as time has gone on, that has become a skill set that has been absolutely necessary to keep in touch with the team and to make sure that they're supported. Now, I said that our leaders in health care have continued to be stressed, and the technology has grown to help some of that be to be reasonable. When I was in a very similar role to the role I am now pre-pandemic, I had four hospitals that I supported from an operations perspective. But we didn't use video conferencing, and I just drove to that one of the time. And then fast forward to now, I support 17 hospitals. There's no way that model works anymore. So you have to adapt. You have to make sure that you're keeping tension on the line with all of the sites, to make sure that you're there for them. And on the work balance side of things for the team, I think that has been a journey we've been on as well. And it's one thing just to tell the team, you need to use your PTO. You need to take the PTO. It's another to really make it a culture where that is accepted, and there's peers who can help. And so that had been a change in leadership style for me to focus less on solving individual concerns or challenges at the sites. But building that framework that the leaders at the different sites had peers that could let them step away, not just for PTO, but to step away for professional development opportunities to step away for project work on our enterprise level to continue developing their skill sets. So a lot has changed in the last four years. It's a lot with the support of remote roles. And if I could just add on to what Chad was talking about, I think one additional thing that I think I actually kind of struggled with as I was shifting my mindset and probably still to this day is modeling what it means to take PTO. If I tell my, especially for my managers, if I'm telling the managers, I want you to take your PTO, I want you to disconnect and kind of take time for yourself. But then when I do that, I'm still connected and answering emails and doing all that stuff when I'm supposed to be on vacation. It's not necessarily good for my own mental health, but it's also not modeling what I'd like them to do because then they probably feel that they need to do the same whenever they go on vacation. So it's also just a friendly, it was a friendly reminder to myself, well, I'm not setting a really good example of what it, you know, modeling what it means to kind of protect your time and what the goal of some of that work-life balances. And I've also seen, I haven't incorporated it this yet, but I've seen some, you know, to counter that, you know, maybe you have certain practices that just work with the way you've integrated work into your life, and you don't necessarily want to change that 'cause it works for you, but it might not work for others. I think what I've seen that's kind of nice, I've seen some leaders put in their kind of email signature, a disclaimer that says, "Hey, I'm emailing you "during off hours because it works for me, "but please don't make that, you know, "I don't want this to be that you, "you do feel like you have to respond "during these hours either." Which sounds kind of simple, but it is a nice reminder because you just, you know, I think we've all gotten that, that email at, you know, random hours of the day where you feel like, oh gosh, so-and-so is actively working, that means I need to be actively working, and that's not necessarily their intent. So I thought that was a nice takeaway that I'm starting to see across leaders that I work with. - Great, thank you, great points to point out. I have seen that in a lot more people's emails as well, Catherine, so I'm glad you pointed that out. That brings us to our next question, and we touched on this a little bit with your previous answers, but how has your view or support of remote work changed since the pandemic? - I can start us off. So when we were in the midst of the pandemic, I was overseeing pharmacy operations, which is kind of difficult for remote work options. We have to be where the work is, and so there wasn't too much of an option. And so that being said, our managers were always kind of tied to where the work is, and that was still my expectation, but I was more flexible with any remote work that they might want to do, maybe once a week, or whatever that kind of shaked out to be, so long as they were still maintaining availability. And I think that's kind of what Jordan and Chad were touching on before, with how maybe the landscape has changed in ways that we can still remain connected. So maybe they are still running their daily huddle, but if they're doing it virtually, or they have virtual office hours when they know that they're going to be working remotely. So it was a little bit more difficult again, for a team that really was tied to being physically at work, but I do think it was nice to allow, at least the management team, some sort of flexibility to still be there for their frontline team members, but allowing them to maybe have a day, or a couple days a month. - Yeah, I agree, Catherine. I think just a couple of maybe related comments, I'd tie in there. I think, you know, I touched on kind of our tools and our staff comfort, you know, just really maturing over the last few years with remote work, and sometimes I just work from home, I think, you know, sometimes it's work from, you know, other locations, maybe that you're not typically at, or, you know, maybe more central locations. I think Chad touched on it, as well as health systems continue to merge, you know, more emerging acquisition activity all the time. Often leaders are picking up more sites, or staff are being asked to cross cover to other sites. And, you know, it just makes sense to try and use virtual, you know, platforms when we can to do that work versus, you know, as Chad touched on, again, drive, you know, spend that kind of that downtime driving between locations and kind of that unproductive time. So, you know, it's interesting to see it continue to evolve. I know, you know, I personally pre-COVID really did not work remotely at all, or at least not from home. You know, through the COVID pandemic, I got a little bit of experience, and then even my current role lived kind of a hybrid role where I do periodically work from home. And one thing I found for me personally that just surprised me is honestly probably more productive at home in terms of actually getting stuff done. And I think, for me, reflecting on that, it's because I don't have as many kind of the, maybe the interruptions or the interactions with other colleagues and team members as much. And so, you know, I look at it in terms of productivity around maybe completing projects, delivering through on initiatives on the flip side, you know, not having those day-to-day interactions or connections, you know, is take away from the relationships and that sort of thing. And so, I think as we think about, you know, our staff working from home, potentially pulling clinical staff out of an inpatient unit and doing work from home or that sort of thing, that's just another thing for us to keep a close eye on and pay attention to that we want to make sure those who are on site, just as Catherine said, still have that easy connect to reach out to staff who are working from home and whether it's, you know, a virtual platformer, however that is, and just making sure they know who to go to for what. And then, you know, just continuing to track kind of progress productivity and ensuring that the relationships are maintained. So, I think one of the biggest, you know, things I still find, for me, it's easier to build trust, build relationships in person. I think, you know, seeing somebody on screen, camera is, you can still get some of the non-verbals, which is decent, but at least for early interactions, it's really helpful as you're working with a new team to see them look them in the eye and, you know, sit in a room with them and shake their hands. It's just a different level of connecting. So, I still certainly value that the most and think that's important. And yet, want to continue to meet our staff wants and needs around some flexibility with working from home or other locations from time to time. - Hi, I echo your sentiments, both Katherine and Jordan and I am actually at a conference this week. So, the virtual platform and model allows me to continue to do work in a different, completely different locations. So, I think you guys both have excellent points that I also enjoy and I find too that I'm more productive at home for kind of intentional work time, but still also like the hybrid model of going in and having those, you know, water cooler in person conversations for connection. So, the next thing I would like to ask the group is, how have you become a better role model for your team since the pandemic? And if so, in what ways? - I can get it started coming. I hope I continue to grow as a role model and not just for, you know, the team. I hope, you know, through the eyes of my kids and spouse and those who are close to me as continue to work on that work-life balance. And that's been something that has been hard. There were periods of time, you know, during the pandemic where it was a hundred percent. There's just so much going on and a week turned into, you know, two weeks which turned into a month and you get caught up in that too long, you get into dangerous territory. And I think as some of that has eased a bit, you know, there's been a lot of intentionalness with myself, other leaders on my team, to be talking about the work-life balance to talk about strategies, you know, so that people are finding joy in their work, they're finding joy in their life and that balance has helped. I think many of us continue to thrive. And, you know, to that extent, I don't shy away from, you know, sharing that with my team. I, you know, I've been the leader of our scouting program at my kid's school for the past seven years. This afternoon after I wrap up, I'm the head coach of a baseball team. I go do that, I've been doing that few springs and get involved with organizations. All that is part of what makes me who I am and it makes me really good at work too. So that I think has been something that I've tried to model and I've seen other leaders on my team also finding value in sharing their success stories and in how they've been able to model that. And I think that has helped other people be interested in, you know, health system, pharmacy and leadership knowing that, you know, you can strike that balance. It takes work. And then the other thing I would just say is, you know, big proponent of team building and really developing relationships. And I think that has been something I have tried to model over the past couple of years. It's super important to me, but you go so long without connections with your peers, with your team in person, you know, as Jordan had shared before, there's consequences to that. And so for our team, you know, we have a monthly operation call with all the sites as many organizations do, but we've no past year have a site, you know, that we would convene at. And those who want to take that live could, you know, take that live and we get together. There's some fellowship. There's connecting, networking. There's a real value, you know, to that. And so, you know, a lot of those type of things are, you know, going to a Brewer scheme tailgate, the kind of fun stuff that may not seem like it's connected as much to work is very intentional. And so I do try to model that as, you know, something that continues to foster the teamwork, you know, amongst the group. And so in that way, I hope I've become a better role model through the pandemic. - I really appreciate you sharing that chat. I couldn't agree more. And I think you're, you know, you're keying in on an important thing, which is if the department is trying to put on some sort of gathering or way to help people connect at a personal level, I think that's where being a role model is also really helpful. You know, even if it's something as simple as, oh, there's an ice cream social in the conference room, you know, taking the time to prioritize that, to role model that we want people to show up. The goal is to connect and have some time to decompress. And if you see that your boss isn't doing that, then, you know, that kind of gives office signal. That maybe it's not that important to do that. And so I can kind of stay in the pharmacy and not necessarily take the time to connect with other people. So I think one of the things that I was trying to do or continue to try to do is participate in a lot of those extracurriculars for the heck of a pattern where, you know, maybe the department's put on, has some runners that, you know, have come together to support whatever the charity is that they're working towards. And we, a group of people, is kind of getting together to cheer them on. That happens quite often in Boston. And so participating in little things like that, I think is one of the ways that you can role model what it means to have a good work-life balance and also just kind of integration, like a good integration of work and life. - Great, I love those answers. Thank you so much. That leads us to our final question. What have you incorporated to decrease the level of stress for you and/or your team? - Yes, this chat, I can get us going. May not seem obvious, but I would answer this one by, you know, what we've put a lot of effort into around strategic planning, not strategic planning. You may not think of with stress or anything like that. But in during the pandemic, you know, we were responding to a lot of external forces for a long time. And during that time, our process, you know, by which we, you know, churn up all the work that, you know, the team really wants to focus on. We then get together and we prioritize. We line it up with our organization strategic plan. We look at PA 2030 at the pharmacy forecast and that we put it all together into a real solid plan. That had been what we had done prior to the pandemic. But with all of the things coming at us, we took a few years off. We didn't take them off from not having a plan, but the plan was really, you know, execute on all of the operations and the clinical work going on to support the pandemic. So as we have come out of that, I have seen that the level of effort that we are putting back into designing our strategic plan for our organization reopening up all of those lines of communication so that our frontline or the leaders or, you know, the system leaders all have a way to, you know, participate in what are the things that are most important to them that can get on our plan for the upcoming year has really helped us stay proactive. And we have an on our team at least noticed that, you know, the there have been periods of disengagement periods of, you know, stress in the team. And a lot of that came from not having the feeling that you were controlling a lot of your own fate on things and introducing back into the formula now, this proactiveness, you know, it's like a bit of a fire. And so I think that has been something that we've reinvigorated coming out of the pandemic. And I have seen over the last, you know, year to have two years as we've gotten more into the strategic planning and execution. A lot of that stress has subsided to some degree. And so I would say that has been one of our tactics that with decrease in level of stress. - Chad, I absolutely love that. I think to your point, maybe not the first answer folks would think of, but I think it's so true. And, you know, it's kind of that intentionality, right? It gives us a chance to really work on the things that matter to the organization, the matter of the pharmacy department. And I think as you said, kind of you can see the progress. And if you have that clear roadmap and are kind of, you know, hitting the milestones along it, I think it just builds momentum within the team to know that you're collectively accomplishing those things. So anyway, absolutely love that. I think we've had a similar approach within our team at freighter at the last few years. And let's say, you know, especially we've had a couple of sub segments that have done it incredibly well. And I'd say they've had absolutely the most kind of, you know, engagement and excitement within their teams around the work that they've done. So really looking to make sure we do it comprehensively as one department here or this next year, which we're excited about. I think, you know, to me, that's kind of again, being proactive and intentional on a macro level. I think when I first, yeah, I saw this question, I thought of it and kind of a micro level on the same, with the same ideas though, in terms of being proactive. I think some of the things our team has tried to do is really look ahead at the operational work of the day and try and get ahead of it. And so maybe things that others are already doing are, you know, simple things. But things like, you know, advanced preparation of infusions, you know, chemotherapy others. We've really embraced that over the last couple of years and tried to, you know, do the work ahead of time. So our staff aren't, you know, having a nurse knocking on the window waiting for the medicine, but I haven't done ahead of time. So we're not, you know, kind of working under that, that stress pressure cooker, if you will. I think, you know, similarly trying to do medication histories for any planned admissions, ahead of time calling patients at home. Really again, with the same idea, it's not under the time crunch, which then just creates a different level of conversation and decreases the stress for our staff. You know, another maybe potentially related example is kind of asynchronous communication. So trying to use the portal through our health record more to message back and forth with patients where it makes sense. You know, and try and take on some of that and basket work away from our providers, I think that's been an area we've been leaning into a lot, partly to decrease the stress of the other physicians on the care team, but also to enable us to not, you know, need to kind of react to the maybe patient phone calls as much real time or that sort of thing and address simple questions. Again, when we have the time through that asynchronous approach. So I think, again, those are just a few of the things that came to my mind. Certainly we've had a lot more patients sign up for the portal and interact with us virtually out of the pandemic, which has been great for us to be able to leverage our health record for that. You know, probably like everybody, we're trying to use technology better, more efficiently. We do have five compounding robots I've rated today, which is, you know, kind of fun to talk about. There's certainly plenty of work still, but to, you know, reduce some of the kind of repetitive task burden on our technicians and others doing some of that work. And so we're hoping to continue to optimize and leverage those and then AI, of course, is probably top of mind for, you know, everyone everywhere feels like I'm sure within pharmacy departments and health systems. And, you know, we're optimistic about using it for prior-offs, refills, some other things. Don't have all those workflows baked yet, but excited for what's to come in the years ahead. And Carmen, I'll just maybe close out. I couldn't agree more with Chad and Jordan about trying to kind of have some sort of intake almost of, these are the projects that are coming down our pipeline, whether they're coming from an external customer or from an internal need. And then I think Jordan, talking about kind of operational excellence and effectiveness is something we did as well, you know, kind of taking a look at all of our processes and making sure that we're not, we're setting ourselves up for success rather than kind of digging our own holes with something that maybe we've done to ourselves and implemented and haven't necessarily taken a step back and done kind of like a PCA cycle, right? So that was kind of very intentional as well. I think from a maybe soft skills perspective, we also did a lot of, placed a lot of intentional importance on rounding and not losing sight of rounding and hearing what some of those stressors were. And, you know, some of it was just burnout because they would come back from being on vacation and they had tons of emails. And it wasn't email that they needed to actually sift through or read. So one of the things that was contributing to that just as an example is we used to have a shift report that would go out at the end of every shift and it would go kind of just blast the whole, almost the whole department. And we, I can see where if you go away for, you know, a week or a handful of days, that's three times per day that you're getting these emails that you might not necessarily need. And so we shifted something like that into like an active dashboard, for example, where people were still submitting shift reports and you can actively review, you know, the new shift report, each, you know, whenever it was needed, it just wasn't blasting out to everybody. It was just something that was just refreshing in the background that you can go and look into whenever you needed to. Which I, we got a lot of really great feedback. That's something seemingly simple. Helped with some of those little things that can cause stress when you're kind of logging in for the day and making you feel like you're already behind. So just wanted to share some other kind of like smaller. Again, it feels kind of small, much more micro level. But they do, you know, those little changes do add up to help support the wellness of your teams. - Excellent, thank you so much. As great leaders do, it seems that you have all found excellent ways to intentionally support not only your own wellbeing, but also your teams, as we all try to navigate work in this post pandemic life. So that's all the time we have today. I want to thank Jordan Dow, Chad Smith, and Catherine Desanctis for joining us today to discuss post pandemic. Have you changed how you lead? Find more member exclusive content, including resources for self development, leading pharmacy enterprises and teams, and practice management on the ASHP website. Thank you for joining us. And if you enjoyed this episode, be sure to subscribe to the @ASHPOfficial podcast. - Thank you for listening to ASHPOfficial, the voice of pharmacists advancing healthcare. 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 ASHPOfficial. (upbeat music) (upbeat music)
