Latest / Becker’s Healthcare Podcast / Melissa Chase, PharmD, BCSCP, CPEL, Director of Pharmacy at Valley Children’s Healthcare

Transcript

Melissa Chase, PharmD, BCSCP, CPEL, Director of Pharmacy at Valley Children’s Healthcare · Becker’s Healthcare Podcast

• 0:00
  Welcome to the Becker's pharmacy leadership podcast. I'm
• 0:03
  Ella Jeffries, pharmacy reporter with Becker's healthcare.
• 0:06
  Today, I'm joined by Melissa Chase, director of
• 0:08
  pharmacy at Valley Children's Healthcare.
• 0:10
  In this episode, we'll be discussing how pharmacy
• 0:12
  leaders plan for acute care models, IV room
• 0:14
  repairs, and automation decisions, and what it takes
• 0:17
  to maintain safe and efficient operations during major
• 0:20
  infrastructure changes.
• 0:21
  Melissa, thank you so much for joining me
• 0:23
  today. To start us off, can you please
• 0:25
  introduce yourself and share a bit about your
• 0:27
  role and how you're involved in pharmacy operations
• 0:29
  planning?
• 0:31
  Hi. Good morning, Ella. My name is Melissa
• 0:34
  Chase, and I am the director of pharmacy
• 0:35
  at Valley Children's Healthcare. My role here really
• 0:38
  sits at that intersection
• 0:40
  between clinical care
• 0:42
  and operations.
• 0:44
  And
• 0:45
  I oversee our pharmacy services
• 0:48
  here, which includes
• 0:49
  acute care hospital, about 358
• 0:52
  licenses,
• 0:53
  ambulatory
• 0:54
  services.
• 0:55
  And in that ambulatory services, it includes our
• 0:58
  home care pharmacy services.
• 1:00
  A big part of what I do
• 1:03
  is,
• 1:05
  making sure that our infrastructure,
• 1:07
  our workflow design,
• 1:09
  and,
• 1:10
  that we're evaluating new technologies.
• 1:12
  A lot of my focus is making sure
• 1:14
  our pharmacy spaces, our systems are built not
• 1:17
  just for today, but also for where we
• 1:20
  anticipate health care to be going,
• 1:22
  especially in pediatrics
• 1:24
  where safety and precision
• 1:26
  are everything for our patients, our our families,
• 1:29
  and our team.
• 1:32
  Definitely. Thank you so much for that context.
• 1:34
  And with that, I'd like to go into,
• 1:36
  you know, when a hospital begins planning a
• 1:39
  new acute care model or major pharmacy infrastructure
• 1:42
  project, what do you think are the first
• 1:45
  operational questions pharmacy leaders should be asking?
• 1:48
  So one of the things with pharmacy
• 1:50
  leaders is that we always feel like we're
• 1:53
  not
• 1:54
  at the table from the very beginning of
• 1:56
  a project. It seems sometimes that we get
• 1:59
  engaged
• 2:00
  a little bit after the scope of the
• 2:03
  building
• 2:04
  is designed, and so then we're on the
• 2:06
  backside saying, oh, no. That space that's dedicated
• 2:09
  for us isn't big enough or it doesn't
• 2:11
  meet our needs for these reasons.
• 2:13
  So I really try to ensure that,
• 2:17
  our voice is heard very early on, say,
• 2:21
  for instance, when they're just initially meeting with
• 2:23
  an architect to determine
• 2:25
  space planning or the size and scope of
• 2:28
  a building, really trying to get pharmacy's voice
• 2:31
  from the very beginning because that's a lot
• 2:33
  easier
• 2:34
  than to try and
• 2:36
  change space, which can be very expensive
• 2:39
  if,
• 2:39
  certain ports of
• 2:41
  the architectural design are already in place.
• 2:44
  And then you're coming in and saying, okay.
• 2:46
  This is what pharmacy needs for this workflow,
• 2:49
  and it was never considered from the beginning.
• 2:51
  So really trying to get involved very early
• 2:54
  on and making sure that any decisions that,
• 2:58
  your executives are making about new pharmacy space
• 3:01
  or new space in general that may or
• 3:03
  may not include pharmacy,
• 3:05
  it has you, involved in that very early
• 3:07
  on.
• 3:09
  The other thing is is learning to understand
• 3:12
  the dialogue
• 3:14
  between
• 3:15
  contractors
• 3:16
  and architects,
• 3:18
  is critical. So
• 3:20
  understanding,
• 3:22
  space planning and being able to review blueprints
• 3:25
  and CAD drawings,
• 3:26
  that took me a minute. And so working
• 3:28
  at that and trying to learn,
• 3:31
  will really help you as a pharmacy leader
• 3:33
  with these major projects
• 3:35
  as things,
• 3:37
  progress.
• 3:39
  Yeah. That was a really helpful perspective. Thank
• 3:41
  you for sharing. And I'm curious, you know,
• 3:43
  you mentioned making sure pharmacy has a seat
• 3:45
  at the table right from the very beginning.
• 3:47
  What would you say are some barriers that
• 3:49
  pharmacy leaders experience that prohibit that from happening
• 3:52
  sometimes?
• 3:55
  Usually, I find that it's
• 3:58
  an unconscious bias. They just don't realize
• 4:02
  sometimes the importance of engaging pharmacy from the
• 4:05
  very beginning. It's not that they didn't,
• 4:09
  you know,
• 4:10
  or they didn't
• 4:12
  reach out on purpose. It's just that it's
• 4:14
  not something that they thought of from the
• 4:15
  very beginning. They're looking at
• 4:18
  land. They're looking at,
• 4:20
  you know,
• 4:22
  building size structure. Is it going to be
• 4:25
  so many stories? Is it going to be
• 4:27
  so, you know, large?
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  What are some of the different,
• 4:31
  pieces that they're going to put into the
• 4:33
  building?
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  So they look at scope sometimes. Say, for
• 4:36
  instance,
• 4:37
  a ambulatory surgical center.
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  They know how many suites they're going to
• 4:42
  need, but they don't always anticipate all the
• 4:44
  ancillary services that are going to need to
• 4:46
  be involved,
• 4:48
  in that building and then the scope of
• 4:50
  those needs. How much data will they need
• 4:52
  for Pyxis machines or power, and is it
• 4:55
  emergency power?
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  How much space will they need? Will they
• 4:59
  be compounding,
• 5:00
  any medications? Do they need an IV room
• 5:03
  in that space? So
• 5:04
  we think about things very differently,
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  when it's just at an architectural
• 5:10
  phase
• 5:11
  versus an operations planning.
• 5:13
  And so making sure that
• 5:16
  they understand
• 5:18
  that I'm not going to be trying to
• 5:20
  change the overall scope, just making sure that
• 5:22
  what the scope is determined
• 5:25
  has the right support for all of the
• 5:27
  ancillary services and especially in my role for
• 5:30
  pharmacy.
• 5:32
  But
• 5:33
  barriers
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  to reiterate, it's it's mostly making sure that
• 5:37
  you're not forgotten about,
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  or that you have that seat at the
• 5:41
  table from the very beginning. So a little
• 5:43
  bit of strategy sometimes is the squeaky wheel,
• 5:46
  or to keep your ears open when you
• 5:50
  think that they're about to engage with an
• 5:52
  architect or you think that they're about to
• 5:53
  engage on a big move,
• 5:55
  just asking, hey. Is it possible for me
• 5:57
  to join you? Is it you know, when
• 5:59
  you start having those meetings, do you think
• 6:01
  you can invite me even if you don't
• 6:03
  think that there's, you know, a need at
• 6:05
  the moment? It's just really important for pharmacy
• 6:07
  to be involved from the very beginning.
• 6:11
  Definitely. Thank you for sharing.
• 6:13
  And, you know, aside from, you know, pharmacy
• 6:15
  leaders in general, you also mentioned,
• 6:18
  I wanna say it was the contractors and
• 6:20
  architects.
• 6:21
  But, you know, aside from those two groups,
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  who are the key stakeholders that you would
• 6:24
  say need to be involved early to make
• 6:26
  these projects successful, and how do you coordinate
• 6:29
  across these teams to, you know, to bring
• 6:31
  the project to life and ensure its success?
• 6:35
  One of the key priorities is your team.
• 6:38
  You really need to engage with your team,
• 6:40
  whether it's,
• 6:42
  the technicians working in an IV room or
• 6:44
  who are going to be displaced and what
• 6:46
  other alternative locations they'll be displaced to,
• 6:49
  whether it's a a trailer or another IV
• 6:52
  room on campus
• 6:54
  or off campus,
• 6:55
  work. So really engaging with your team to
• 6:58
  get their ideas.
• 7:00
  I many times find that when we,
• 7:04
  work on a large project like this and
• 7:07
  we gave we we gained the best insight
• 7:11
  and knowledge and ideas from the people doing
• 7:13
  the work.
• 7:14
  And so, what there's been a variety of
• 7:16
  ways that we've done that. We've been able
• 7:18
  to take architectural drawings when they're not finalized,
• 7:21
  but they're maybe 50 through,
• 7:23
  tape them up on a dry erase board,
• 7:25
  and just tell the team,
• 7:28
  tell us what you see. Tell us what
• 7:30
  you think needs to be changed. Tell us
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  what you would like to see in that
• 7:34
  space. We've also done it where we've taped
• 7:36
  off certain spaces,
• 7:38
  and tried to walk through them.
• 7:40
  We've also
• 7:42
  engaged,
• 7:43
  outside consultants. So when you're designing a new
• 7:46
  IV room,
• 7:47
  we didn't go to pharmacy school to become
• 7:50
  architects or
• 7:51
  HVAC technicians. And so working with consultants have
• 7:55
  helped us to also be successful to
• 7:58
  know not just what do we need to
• 7:59
  design this for today,
• 8:01
  but what are those potential changes in USP?
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  What are those potential changes in regulations? What
• 8:06
  do we need to plan so that this
• 8:08
  sustains us five, ten, fifteen years out?
• 8:11
  And making sure that we build it to
• 8:13
  those standards and not just to today. Sometimes
• 8:16
  we have limited space, and we need to
• 8:18
  make the absolute best use out of the
• 8:21
  smaller spaces.
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  And sometimes consultants have seen many other ideas
• 8:26
  or many other technologies, and they can, share
• 8:29
  those with us and with our team. We
• 8:31
  can take that back to our team, and
• 8:33
  we can make decisions as to would you
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  rather have x or y.
• 8:37
  And then they buy in to what that
• 8:39
  solution will be and what that,
• 8:42
  future remodel or what that new space is
• 8:45
  going to bring for them. And they're excited
• 8:48
  and they're engaged. And so when they're displaced
• 8:51
  or when they're having to work through more
• 8:53
  challenging operations,
• 8:55
  they still have that inspired shared vision that
• 8:58
  they can look towards
• 8:59
  knowing that
• 9:01
  this is difficult and challenging now, but it's
• 9:03
  for the good, and we're going to have
• 9:05
  this wonderful new space and opportunity
• 9:08
  in the future.
• 9:09
  So really getting them engaged from the very
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  beginning, having their buy in, including their ideas,
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  which many of them are the best and
• 9:17
  the brightest ideas to help drive the project,
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  and then having them to really
• 9:22
  buy in and be excited about the future
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  really keeps that engaged
• 9:27
  team during those challenging
• 9:30
  times. Definitely. That collaborate collaboration piece is very
• 9:34
  key, and I'm glad you brought that up.
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  And now I'd like to turn to, you
• 9:38
  know, touching more back on, like, the evaluation
• 9:42
  aspect of these changes. When you're looking at
• 9:44
  automation solutions, what factor factors matter most to
• 9:47
  you and why?
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  Thanks for asking. I love automation,
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  but I love automation only when it makes
• 9:54
  sense.
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  So the biggest factors for me are always
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  safety,
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  and we usually ask, does it reduce risk?
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  What risk does it reduce?
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  Does it add meaningful checks in the process?
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  And right after that, it's workflow. If a
• 10:08
  piece of technology doesn't fit into how our
• 10:10
  team actually works, it's just going to create
• 10:12
  frustration instead of value, and then they'll start
• 10:15
  working around it instead of working with it.
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  So we really look at,
• 10:22
  uses of automation
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  that
• 10:25
  incorporate a wide variety of strategies.
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  For us, space is always a challenge. So
• 10:30
  we've looked at automation that,
• 10:33
  help with space and inventory control
• 10:36
  and also things that help with safety. So
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  we fully invested in gravimetrics in our IV
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  rooms, and we have also,
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  room,
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  and
• 10:49
  those also incorporate gravimetrics.
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  And so we have tried to focus on
• 10:55
  reducing
• 10:56
  repetitive injuries for our staff
• 10:59
  and ensuring
• 11:00
  safety for our patients and making sure that
• 11:04
  any technology that we bring on or any
• 11:06
  automation that we bring on
• 11:08
  fits with all of these goals for our
• 11:11
  team and is the right piece for our
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  size, for our workflow, and for the team
• 11:19
  that's gonna be working with it.
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  Automation just feel like a support system for
• 11:24
  your staff, not something that they have to
• 11:26
  work around or find a way to deal
• 11:28
  with it in other ways.
• 11:31
  Definitely. I couldn't agree more.
• 11:34
  And, you know, looking ahead to the future,
• 11:36
  where do you see the biggest opportunities for
• 11:38
  automation or also, you know, broader pharmacy infrastructure
• 11:41
  in general to improve
• 11:43
  not only patient care but just operations for
• 11:45
  your staff?
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  Continuing to build on,
• 11:50
  existing efficiencies,
• 11:53
  are some of the areas. It feels like
• 11:56
  in
• 11:57
  the IV workflow
• 11:58
  systems, we're taking a bit of a step
• 12:02
  backwards with two of the major,
• 12:05
  companies,
• 12:07
  bringing their products to end of life.
• 12:10
  And so that's a big challenge. I know
• 12:12
  many people are looking to EHR solutions,
• 12:15
  for incorporating
• 12:17
  the ID workflow solutions,
• 12:19
  and that's something we're gonna be looking at
• 12:21
  as well.
• 12:23
  We're looking at,
• 12:25
  partnerships.
• 12:26
  So what is the future with the partnerships
• 12:28
  with our five zero three b contractors?
• 12:30
  What is going to be, you know, the
• 12:33
  continued,
• 12:35
  support that they'll,
• 12:36
  provide versus the costs,
• 12:39
  instead of maybe making everything
• 12:42
  ourselves
• 12:45
  and with the use of our IV room
• 12:47
  automation.
• 12:48
  I think automation
• 12:50
  is going to continue to progress.
• 12:53
  We now see more adoption
• 12:55
  of robotics for delivering
• 12:58
  products to our nurses and at bedside.
• 13:02
  So we're just continuing to see where are
• 13:05
  those inefficiencies,
• 13:06
  where are the tasks that are,
• 13:10
  not value add, where are
• 13:14
  times where, you know, we're using
• 13:17
  thirty minutes of our time when there's a
• 13:18
  piece of technology that might be able to
• 13:20
  do something in five minutes? An example of
• 13:22
  that
• 13:23
  is,
• 13:24
  RFID tagging for your trays or,
• 13:28
  kits. And instead of manually
• 13:32
  refilling and checking them and documenting, you know,
• 13:35
  there's a lot of, technology now that can
• 13:37
  help with that, and that really,
• 13:39
  reduces the burden on,
• 13:41
  your your
• 13:43
  people,
• 13:44
  for doing those tasks. So what
• 13:47
  additional
• 13:48
  automation,
• 13:49
  is available? The other thing I really think
• 13:52
  that we're all on the tipping point of
• 13:55
  is
• 13:56
  AI. What is AI going to bring? What
• 13:58
  is that additional level of data, and what
• 14:01
  are we going to be able to do
• 14:03
  with all of that data and information? How
• 14:06
  can we bring it together into
• 14:08
  one location? How can we
• 14:10
  divide that data? How can we analyze that
• 14:13
  data? And how do we use that data
• 14:15
  to really streamline our operations,
• 14:18
  drive more efficiencies,
• 14:20
  and make the best decisions possible?
• 14:23
  We are seeing AI adoption in health care,
• 14:26
  as an industry,
• 14:28
  and it's moving rapidly. And so I think
• 14:31
  that's an area that as pharmacy leaders we're
• 14:33
  all trying to evaluate and figure out how
• 14:36
  do we incorporate that into our software and
• 14:39
  learning systems. I know we're using it in
• 14:41
  our drug diversion,
• 14:43
  analysis,
• 14:44
  but there's many other,
• 14:46
  I think, software
• 14:48
  opportunities, not necessarily the hardware, the remodel, or
• 14:51
  the the direct automation, but
• 14:54
  developing those systems that incorporate AI in order
• 14:57
  to bring those efficiencies,
• 14:59
  and yet still being careful,
• 15:02
  and keeping safety,
• 15:04
  at the
• 15:05
  at the core front of anything that we're
• 15:08
  doing to adopt AI. I think there's still
• 15:10
  a little risk in that, and we're still
• 15:11
  trying to learn,
• 15:13
  how to manage the AI in the future.
• 15:17
  Definitely. Yeah. Speaking with other leaders, you know,
• 15:20
  AI is at the forefront of a lot
• 15:22
  of people's minds, so it's exciting to to
• 15:25
  hear and continue evaluating what those possible opportunities
• 15:28
  can be.
• 15:30
  And I'd like to take a step back
• 15:31
  now. You know, looking back at projects you've
• 15:33
  worked on, what lessons have you learned about,
• 15:35
  you know, when it comes to planning pharmacy
• 15:37
  models or IV room upgrades or anything infrastructure
• 15:40
  wise? You know, were there any surprises during
• 15:42
  those projects that changed how you approach planning
• 15:45
  now?
• 15:47
  Absolutely.
• 15:48
  So over the twenty six years of my
• 15:50
  experience, I've learned a lot. Sometimes I've had
• 15:53
  to learn it the hard way. One of
• 15:55
  the things is is that these projects are
• 15:57
  never just pharmacy projects. So they may say
• 16:00
  pharmacy IV room on them, but you you
• 16:03
  have so many different teams,
• 16:05
  that are involved in these, whether it's IT,
• 16:09
  finance,
• 16:10
  legal,
• 16:11
  infection prevention,
• 16:13
  construction
• 16:14
  teams,
• 16:15
  your EVS team,
• 16:17
  as to, you know, when are they going
• 16:19
  to clean, when are they not going to
• 16:20
  clean.
• 16:23
  It's so many different teams that you really
• 16:25
  need to engage people early, and you need
• 16:27
  to keep them engaged. When you engage
• 16:30
  with or you forget somebody,
• 16:33
  and you bring them in later, that late
• 16:35
  feedback,
• 16:36
  kind of alluded to earlier, it can be
• 16:39
  expensive. It can lead to,
• 16:41
  a change. It can lead to feedback that's
• 16:43
  critical that didn't get incorporated into the planning,
• 16:47
  and now you have to pivot.
• 16:49
  And so really ensuring that
• 16:52
  you've reached out, you have the right people
• 16:55
  at the meetings.
• 16:56
  They all understand what their roles are and
• 17:00
  what you need from them.
• 17:03
  Who's the project lead? Who's the expert? Who
• 17:05
  do we defer to when, you know, there's
• 17:07
  differences of opinions? How are the decisions going
• 17:10
  to be made?
• 17:12
  And then really trying to limit those changes.
• 17:16
  Change orders in construction
• 17:19
  really,
• 17:21
  can delay projects
• 17:23
  if you have to go back and re
• 17:24
  permit something,
• 17:26
  or can add significant expense and rework. And
• 17:29
  so I really tried to
• 17:32
  with the engagement of the teams from the
• 17:34
  very early on stages,
• 17:36
  trying
• 17:37
  to make sure that we get it right
• 17:39
  the first time,
• 17:40
  which is sometimes very difficult. But I think
• 17:42
  the only way that we've ever been successful
• 17:44
  with that is keeping everybody engaged and at
• 17:46
  the table from the very beginning.
• 17:49
  The last thing is is never forget your
• 17:51
  frontline staff. Your frontline staff are some of
• 17:53
  your most important stakeholders. They are the ones
• 17:56
  living in these spaces every day. You have
• 17:58
  to include them early.
• 18:00
  You're going to miss things. You don't know
• 18:03
  what you don't know. And from their perspective,
• 18:06
  that's what really matters.
• 18:09
  The other thing is is that any new
• 18:10
  space or technology
• 18:13
  doesn't automatically mean that you're gonna have better
• 18:16
  outcomes.
• 18:17
  You have to bring your team along through
• 18:19
  that transition because if they don't understand the
• 18:22
  why or if they don't buy into
• 18:25
  or if they don't understand the transition or
• 18:27
  they don't fully understand the new automation or
• 18:29
  technology,
• 18:30
  then they're gonna struggle in the new space.
• 18:34
  And change management
• 18:36
  with their adult learning or their understanding
• 18:39
  of the operations, their understanding of the new
• 18:43
  technologies,
• 18:44
  That takes time. So you have to build
• 18:46
  in the opportunity
• 18:47
  for them to learn
• 18:49
  the new space, to learn the new technologies
• 18:52
  in order to
• 18:53
  implement and go live successfully.
• 18:56
  So making sure, just to recap, you engage
• 18:59
  with all of the teams, keep them at
• 19:01
  the table,
• 19:03
  avoid changes as much as possible,
• 19:05
  and then really have a plan for that
• 19:07
  go live, making sure that your team is
• 19:09
  fully engaged and they have time to practice,
• 19:12
  they have time to learn, and they have
• 19:14
  time to develop in order to ensure success.
• 19:19
  Yeah. Well, great. That was awesome advice. Thank
• 19:21
  you so much for sharing, and I think
• 19:22
  a lot of pharmacy leaders,
• 19:24
  that will be helpful to to hear. So
• 19:26
  thank you.
• 19:28
  Unfortunately, that is all the time we have
• 19:30
  for today's conversation.
• 19:31
  I wanna thank Melissa again for sharing such
• 19:34
  great perspectives,
• 19:36
  and, we will see you guys next time.
• 19:38
  Thank you.