Pharmacy Leadership in Action: Perspectives from Rush and Orlando Health

Welcome to the Pharmacy Innovators Podcast brought to you by Vsont. We talk with forward-thinking leaders who are reimagining what's possible in health system pharmacy. Each episode delivers timely insights to help health systems optimize performance and transform healthcare through pharmacy. Welcome to the podcast. I'm your host Jim Georgensen and today I'll be talking with two pharmacy leaders from different practice locations. We're both someone due to the roles as chief pharmacy officers. We'll be taking a look at how they and their systems are approaching current practice challenges and opportunities. So welcome Dr. K. Chaff sum up vice president chief pharmacy officer for Russian version of health system. Dr. Jeff Oliver of the vice president chief pharmacy officer for Orlando health. Welcome guys. Thank you. Thanks for having us. Absolutely. Now let's start with a bit of your bios. Can you please share what you do now and maybe a little bit about how you got there. So let's go Kate first and then Jeff. Thanks Jim. So Kate's got some I've been with rush for the last year as vice president chief pharmacy officer. I am there an all-girl chief pharmacy officer. So as I join the team. I had the privilege to bring all of our teams together. Really leading pharmacy across the entire enterprise. So our hospital their ambulatory sites and our community services, which has been very exciting. Prior to this role, I started my journey at Butler University where I completed pharmacy school completed a two year HSPA L residency program at Madison over in Wisconsin at UW Health. And then for the last several years, I've been with freighter and data care in the Wisconsin area serving as a pharmacy leader in a variety of different roles well prepared me for my role here at rush. Thanks for having me. Thank you. Thank you. Oliver currently serving as the vice president chief pharmacy officer at Orlando Health. So I have been here with the organization for about two years. The last year of which has been serving as the inaugural chief pharmacy officer here for Orlando Health. So I join the organization in a strategy role really looking to grow our outpatient pharmacy businesses across specialty retail and infusion services. And through some a lot of work with our C suite and close engagement was asked to take out additional responsibilities. And so my career is spanned about two decades from traditional retail pharmacy mental health pharmacy as well as health system on the pediatric side on college and a number of leadership positions across some different organizations. Thank you. Thank you. Is you both have stepped into these chief pharmacy officer roles and wants to come maybe easier than you expected. I didn't kick us off. That's okay. Jeff. I think what's easier for what's easier than expected for me is really my organization paved the path very well for bringing on there an our role chief pharmacy officer. As I on board it everybody was extremely enthusiastic about having me on board and very welcoming to all the tables for both me and my leaders to join conversations provide expertise around medication safety, cost savings initiatives, value generation activities. And that is not something I expected. I thought I might have to open a few doors and I was pleasantly surprised to experience that. For me, I think it's just been the open arms with which things have been received as we went into this and created the CPO role. I don't think there was a lot of intentionality that led up to it. It was something that kind of came about through just a variety of different converging circumstances and identified need within the health system is we were. And I was amazed for some additional growth bringing in some new acquisition health systems as well as some other things are happening here in our main market of Florida. And so there wasn't necessarily a lot of communication within the organization prior to this role being created am I stepping into it. But folks as I've interacted and gone around the health system have been very welcoming and interested to learn more about what pharmacy services can do to help provide care to our patients. And I think it was interesting for both if you was there an external champion for this role before you got there on the Orlando Health side there wasn't I think we had done a really good job we had different verticals pharmacy services within Orlando health and each one head within their kind of vertical lane done a good job of advocating for pharmacy and we just I think got to a really. And I think it's a good reflection point that required us to bring all those things to work together. Yeah I think rush I believe based on hindsight I believe our position and our quality groups in addition to our operational leaders were really championing bringing on a system pharmacy approach and the system pharmacy leader. I really could probably say that for all of even strategy and some of the other groups I work with have also been championing so I almost wonder if it was a lot of different groups identifying the gap and once they were seeing some outside organization seeing the adoption of the chief pharmacy officer perhaps they also sell the value of bringing in my role in order to bring that those different channels like Jeff commented on bringing those different channels forward. So that we could find some systemization and synchronization across the organization. That's great because typically it's pharmacy pushing to try to get that role and to have others help you pave the way is really exciting. How about the other half of that coin what's been more challenging than you expected and maybe what you what would you have wanted to have more support in from mentors or maybe earlier in your career. I want to start that one off Kate so I think Jim no one's truly prepared for this type of a thing but I've what I found is I've leaned on my network a lot since moving into this role even in the discernment as the role was being created. And that network of other pharmacy professionals has been indispensable in helping to guide me and try to avoid some of the pitfalls that you might typically encounter in a in an overall position. I think going into it though from the system perspective one of the challenges has really just been getting people to understand the true depth and breath of pharmacy practice. And so while I've been very welcoming very interested in trying to learn what we're doing you're really looking to change some historical system norms and so that's been a little bit challenging at times as we try to get everyone kind of rolling in the same direction so to speak. But really I think leaning on my broader network has been extremely helpful extremely beneficial and it's been advantageous to bring in external experts as well we're appropriate to help move certain initiatives forward in a more timely fashion. Yeah, Jeff I can definitely relate to that I think understanding the historical norms understanding perspectives and spending the time to truly understand those and understand what it will take to help whether slowly or maybe we're being off the bandaid approach of changing that perspective. As a ton of value I think the other major challenge that I've experienced is and maybe it's because of the ease I experience coming to the organization but the pace of change and the demand to quickly pivot how and when we're going to introduce some of our strategic initiatives I feel like because the door has been so widely open that sometimes we want to pursue many of them at the same time and being able to strategically think through where do we start in order to set ourselves up for six months. So I think that's what I think it's really important to be able to set ourselves up for success down the road in addition to which partners need to be on board and a part of the journey as we explore that together. Well, I feel prepared to start some of those conversations when some of those curve ball their throne. I feel like like Jeff described leaning on the network and being able to reach out ask for guidance and digging back into some content that I haven't dusted off in a few years has been very a fun challenge but a challenge nonetheless. Extremely large operations with multiple service lines how you building and lining your teams in patient outpatient across the various disciplines at Orlando Health we've really tried to change some of our historical structure around councils committees things of that nature to really incorporate thought leaders from both of the various areas within our system. Historically we didn't really have great connectivity even though a majority of our retail pharmacies are in our hospitals we didn't necessarily have the level of collaboration we would hope we would have kind of between those inpatient outpatient pharmacy teams and so really linking those leadership teams making it one cohesive team has really helped we've brought all of our leaders together for an inaugural pharmacy summit to really try to understand what each other is going through what's happening on the hospital side where the pressures where they had success. Similarly on the outpatient side what are the things that the system is asking us to do and how do we collaborated that and so or last year we really put a lot of focus on how do we improve our transitions of care program which kind of forces our two teams to work together and really optimize medication outcomes for our patients who are transitioning either into or out of our facilities. I think maybe similarly Jeff so the way that we've structured our team today so as I joined we had very deep silos both between our hospital entities as well as within our ambulatory structures and so step one was really to bring those acute care teams under one leader and that acute care team is actively working very similar to what Jeff described around let's standardize our process let's look at our technology let's look at our even our formulary let's make sure that we can move to one of the areas that we can work together and we can see how we can do that. We can see how we can move to one formulary and then move together as we move forward and adopt or remove certain agents from our from our formulary or from our technology pipeline and then similarly on the ambulatory side that team historically worked a little bit more closely together but still had very distinct workflows and or leaders relationships with those outside of pharmacy and so bringing those ambulatory leaders and really everything from home and fusion retail specialty cancer. Together under one leader and then even shuffle in the deck a little bit between the leaders based on their skill sets based on the strengths of their teams and still growing those teams to be able to serve our ambulatory network across the enterprise. the third bucket that I'm looking to expand into. and this upcoming year is really the centralization. I know many of other health systems have dove in and really maximize centralization of services over the last several years and really looking forward to bringing some leadership onto our team to really expand that space over the next year. - That's great. Have you both approached setting the, maybe the overall direction for your pharmacy programs? - You can get a start at Jeff. I think for the overall direction perhaps, as I joined the organization, Rush was very focused on one rush. So systemization across the board, bringing our acute care entities together, bringing our ambulatory friends, even our medical group together. So I jumped on that wagon. I said, "Hey, let's, as a team, let's work towards a one rush pharmacy." And so really improving the operational or the organizational structure. And then we started to form our mission and vision as Jeff alluded to previous, in the previous question, we had a similar summit or retreat. And within that retreat, we focused on team building, we focused on relationship building and focused on the importance of us, not only understanding and getting to know each other, but as individuals, but also as a team, we are representing pharmacy at Rush. And as we show up to tables, we wanna be able to manage each other up. We wanna be able to build those linkages between team members, between sites, so that the end game is really for everybody at Rush and outside of Rush to prefer to come to the Rush pharmacy. And so we've really aligned with that mission and working through barriers and overcoming those barriers and door challenges that we face together and really encouraging consistently, which has been one of my themes of, have you talked to your peer about that? How can we work together? How can internally, and we do have some external partners as well, how do we always revert back to, instead of that leader thinking that they have to accomplish a big challenge by themselves? How do we partner within our own team? Now that we are one Rush pharmacy to be successful, and we've been able to overcome some pretty big challenges based on that orientation. - To Kate's point, I think one aspect that we really had to figure out is how do we get all of our pharmacy team on one page and really focused as one truly one pharmacy team, not ambulatory services, not infusion services, not acute care services, but really just one Orlando Health pharmacy team. And so we've had a work stream going on around that. A lot of that has been internal education, understanding kind of what your counterpart does across the aisle. And then at a system level, actually before I moved into this role, we had stood up a steering committee for pharmacy services, and we were really looking at opportunities across clinical practice, technology, medication use, formular management. And where did we have gaps, either in people, processes, or technologies? And so was doing a lot of education for our leadership team through that. And through some of that work, we've actually now created a strategic system pharmacy strategy council. It's made up of a number of our senior vice presidents, our chief strategy officer, some regional operators, the leader for our medical group. And that group really meets with me on a routine monthly basis, and really helps execute and remove barriers within the system for us to try to advance our pharmacy strategy. So Orlando Health realizes that we're not where we want to go with pharmacy services. And to in order to get there, since certain respects, we're going to have to move faster than maybe a health system would traditionally move. And so that's been hugely advantageous for us to really help all of our team members, whether they be at the technician level or at the leadership level, demonstrate the importance that pharmacy has within the organization, given the time that these other leaders are spending to help us advance the profession. That's excellent. Maybe take a look at the-- give us an overview of your health systems and what's on the strategic agenda for the big system. Maybe start with Cade and then Jeff. So Rush's a system is a three-hospital, multiple ambulatory site on the patient care delivery side. We have a clinically integrated network of physicians and hospitals that are really meant to help advance the delivery network and how we deliver both on wellness and treatment. And we also have a university that focuses on both medical and nursing. So that infrastructure is really geared towards coming together. So very similar to all of our service lines coming together and aligned for systemization, really bringing our values and our vision as an overall health system together. Through that, we have an anchor mission. That anchor mission is really focused on how do we improve the outcomes of the health of the communities we serve through adopting innovation, through adopting technology, leveraging our local workforce to advance the health of those communities that we serve. Based on that, really, mission and vision and what we're here for, we've cascaded some of those initiatives down through pharmacy. And really that, and it's so closely connected to what pharmacy I would say is well leveraged to do across our communities anyway around building an extending specialty pharmacy network, making sure that we're the convenient choice for where our patient, when they're being discharged, making sure that we can meet them at the bedside to get their meds, really trying to provide that service level at the continuum of care. How do we be that preferred pharmacy, regardless of where our patient is? And that extends into infusion as well. That's really where our strategy is leading us and where we're currently pursuing executing right now. Orlando Health today, we're 25 hospitals and 12 free standing ERs. We have four additional hospitals under construction with seven free standing ERs in development. So a lot of rapid growth. We've acquired seven of those hospitals in the last roughly 16 or so months. And so from a system strategy standpoint, there's been just a lot of general integration work, bringing folks in who worked in different systems to try to understand the Orlando Health way, and really getting them to adopt our strategic imperatives and improving quality in the communities that we have the privilege to serve. And so from a pharmacy perspective and how we're helping to support that strategy with those integrations, a lot of work going on around policy and procedure alignments, formula alignment within those new markets, and then really looking to expand our footprint from an outpatient services perspective within pharmacy. So we do have three outpatient pharmacies under construction. We have three others there in the planning stages. And so really looking to have a consistent level of outpatient pharmacy support in all different portions of the markets that we service, being able to provide that discharge support, embedded clinical pharmacy models in a number of our clinics, having the right level of support for our patients, for our physician providers, is really a key to help move the organization forward. Any particular programs that you're at the top of your agenda in terms of complementing those strategic agendas? I think the biggest thing we're trying to do to support all of that is really integrating pharmacy closer into our medical group, getting pharmacists in the clinics, providing a higher touch level of support outside of just our specialty pharmacy. So we're looking at a comprehensive diabetes care management program that we can use to support our both our specialists as well as our primary care physicians and really try to drive improvement in diabetes management both across our hospitals as well as in the outpatient space. And we're looking at similar models in a number of different clinical specialty areas. Yeah, very similar to what Jeff described as we think about the clinically integrated network as we think about integrating with our medical group beyond specialty. We have this unique opportunity of how to influence population health through diabetes type programs, cardiovascular programs, anti-coed programs, and really looking towards building and actively, I should say actively, working towards building, how do we position those pharmacists at the right time at the right place to influence those patient outcomes by making sure that they can access those medications? I definitely feel it rush. We have the right partnerships and we have the right innovation and now we're working together to make that happen. It's been a very exciting endeavor. Yeah, wow. You have a lot, both of you have a lot going on. What are some of the biggest challenges that you're facing right now? I think the biggest challenge right now, honestly, is being with across the leadership team. As we've, we've, we've touched on it earlier in the conversation. There are a multitude of things to go after and while the high level of organization support is great, we can't be approached every different initiative at the same time. And so really trying to align folks who have the right skill set in the right areas to drive impact, both short and long term, I think is improving challenging. It's a good growing pain, but it's certainly a growing pain nonetheless. Yeah, I think I do think leadership bandwidth and time to spend and coach individual so that my team is very talented. They have the skill set, sometimes building up that confidence to present their ideas and what they can bring to the table in a way that can help move a business plan forward, can be incredibly helpful. I think the leadership bandwidth, I would say ensuring that we have the analytics and the financial information at our fingertips, I think in the landscape it's changing, right? Like it changes quarterly, if not daily, sometimes on how to pursue a strategy and what area of that strategy might provide the most value to an organization and/or from a quality perspective, what may make the biggest impact on quality? And I think that magic that happens when you align those key things of the right leader with the right data set and their opening eyes across leaders that other parts of the health system as to how pharmacy can influence the outcome by being at the table. And I think, you know, going back to my earlier comment about so many doors are open, but then we're forced to go back and decide which door does it make sense to pursue first? And how do we then fully execute on that before shifting to the next door? I think really making sure that we execute to the fullest and then can maintain services. I do think that's an ongoing challenge. and with the landscape, with some of the payer networks changing, with 340B initiatives changing, and/or the courts changing things. We're always on a dime pivoting. And I think just remembering that we're humans, and we need to be agile, but also making space to take a deep breath in between. I think that's part of the team's biggest challenge right now is being able to quickly pivot based on all of those challenges. Definitely. Maybe picking up on one of those points. I think your perception of analytics being extremely important is right on target. We see so many organizations out there struggling to actually put the right analytics in place. How are you approaching your analytics? Yeah, I think as I started, had the opportunity to partner very closely with our chief quality officer who oversees our analytics team and call it to personalities that get along, but also we value the same thing in quality. And we know if we understand the data and we're asking the right question to get the right data that that will lead us to the right solution. I think building that partnership, relying on, honestly, on that individual's team to provide the expertise around what technology and tools will get us to the right analytics. We were able to partner on bringing in two skilled individuals to help build out those analytics, individuals who've had experience and also have exposure to pharmacy. They don't need to be experts in pharmacy, but they need to be experts on the analytics side and they need to be able and willing to be at the elbow with us to understand our questions to dig into the elements with us. And I think through that partnership, we have a roadmap in front of us to really be able to get the right data points when we need them. That strategy to date has been very successful. And I think even in the upcoming months here, it's going to be demonstrate to be even more valuable. Man, is Jeff how about Orlando Health with Analytics? For us, it's maybe been a little bit more stepwise. I don't think as we came into it, we really had necessarily one cohesive repository to go for all of our analytical needs. The organization at the time was still in the process of building out the system-wide platform. I would say we've had really great support. Yeah, and we've been able to go out similar to bringing in some additional resources to help support pharmacy analytics in particular. We've also leveraged different third parties. There are certain things that we just don't either have direct access to or simply take quite a while to stand up and build. And so we've leveraged both internal and external data sources for a variety of different initiatives. And I suspect in the short term, we'll continue to do so. Longer term aspiration would be certainly we'd love to be able to run all of that in-house and be able to control the tempo of that. A big shift within the system has been to do more forecasting. And so our analytics team originally was focused on dashboarding and getting some of the basic, the basic disabilities there for us, how the business is performing. Now we're really starting to move forward and try to look at being a little bit more prescriptive and understanding where the business is going and how can we make decisions either proactively or in real time as opposed to making them reactively to the data. That's great. I love that direction. I know you both have a lot going on. I want to be respectful of your time. So any last-tell system related thoughts before we wrap up? I think my biggest thought or maybe a recommendation to anyone who's moving into an inaugural role, whether it's a chief pharmacy officer or another leadership role within health system pharmacy, is just to make sure that you leverage your network, understand that we're all on a continuum. We're on different points in that continuum. And so you can certainly learn from people who are ahead of you. You can honestly learn from people who are behind you because we're all in different places in different points of that journey in different areas of our system. And so I think leveraging your network, learning from additional experts and things of that nature and just really staying in touch with the industry, not solely there's so much to do that you can easily just focus inward and get bogged down by that. But keep your head up. Keep your eyes open. Look what's going on with the industry and then try to bring that back into your health system to make sure that all of your decisions are as informed as possible. I think that's great advice, Jeff. I don't know that I can top that one. But I think it just hits home so much. I think sometimes we forget the great network that we have and how collaborative pharmacy by nature is. I think the other piece that I've come to terms with maybe is sometimes when you're feeling stressed or panicked about a like about a project, it's because of the timeline. And at least in myself, sometimes I put aggressive timelines that only I am doing to myself. And when I reflect on the timeline and the impact I want to have, it's amazing what we can do in a really short period of time. But it's perhaps more amazing if we commit to our strategy and fully, if you don't that of really how much we can commit to. And so I would challenge anyone in the other role to not attempt to move too fast, but instead to think about the larger impact that they can have by making sure they thoroughly addressed some of the foundational steps necessary to be successful in an other role. Well, okay, Jeff, thanks for spending some time with us today. And really congratulations and all the success you and your pharmacy teams are enjoying. And certainly best wishes for continued success. Thank you very much. Appreciate your time and allowing us this opportunity. Absolutely. Thanks everyone for listening.