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