Amanda Brower, Senior Editor, Centralized Content Group

Retail pharmacists know how to provide the best care for their patients but often find themselves taxed by prescription volume (spurred in part by low-cost or no-cost generics), inadequate staffing, and heavy administrative demands. These demands often are compounded when the retail pharmacist works with a store manager who may have little knowledge of how to run a pharmacy.  

One of the biggest sources of conflict between pharmacists and store managers is a misunderstanding about their respective roles and goals. Store managers may not understand the strict rules governing the pharmacy department and pharmacist practice. They may resent new pharmacy graduates earning high salaries that few other store personnel will ever receive. On the flip side, pharmacists may not understand that they are part of a larger team or appreciate the many years managers have spent developing management skills instead of earning an advanced degree. 

Misunderstandings between pharmacy and store managers can stem from how the two view their roles in providing service. Store managers often do not recognize customers as patients. Similarly, when a pharmacist does not recognize each patient as a store customer, conflict can arise.  

John Michael O'Brien, PharmD, MPH, assistant professor of clinical and administrative sciences at the College of Notre Dame of Maryland, said the kettle is set to boil back in pharmacy school, when pharmacists are taught that patients aren't customers.  

"Pharmacists may have learned that financial targets and customer satisfaction are barriers to patient safety and health quality," he said, adding that pharmacists need to recognize that patient care and customer satisfaction aren't mutually exclusive and are both important to the success of the store.  

To help his students understand the importance of good relations between pharmacists and store managers, O'Brien requires them to take a pharmacy-management course developed in collaboration with the Food Marketing Institute; the curriculum includes leadership and human-resource skills.  

"Our students will learn to resolve management conflicts instead of retreating from them and see how that yields a more rewarding experience for the pharmacist and the patient," said O'Brien. "Our graduates will understand they aren't just working in a store; they're part of a health-and-wellness team."  

A Midwestern Walmart store manager who asked not be identified told 

 that the pharmacy is a very profitable entity of his store and a true customer-driver. Any store manager who wants to grow the business needs to develop a good relationship with the pharmacy manager," he said. 

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The retail pharmacist who runs a pharmacy inside a big-box store can improve departmental operations by understanding the point of view of the retail store manager. Although pharmacist and manager have different focuses and priorities, they can work together to improve delivery of services when they understand each other's needs.

Retail pharmacists, store managers can learn from each other

For specialty-drug infusion centers to be successful, pharmacists must be part of the planning. 

That would seem to go without saying, but according to Fred Pane, RPh, senior director of pharmacy affairs at Premier Inc., an alliance of hospitals and health systems, it doesn't always happen.  

Poor planning can result in compromised patient care, he said. 

According to Pane, effective communication between physicians, hospital administrators, pharmacists and nursing staff is key. 

He often sees critical construction and planning decisions made without the input of those responsible for running and managing the center, which he said often results in operational inefficiencies.  

Patient flow in particular needs to be evaluated. "If patient volumes are going up, you need to look at building something out," Pane said. 

It's important to think ahead, he added, and to pay close attention to how long it takes to deliver drugs to the infusion center. For example, if the pharmacy is located a significant distance from the infusion site, there will be delays. This can be crucial if a patient needs infusion at a specific time, such as with antinausea drugs that must be given at an exact time to counter the effects of chemotherapy.  

Outpatients should be viewed as customers, said Teri Guidi, president and CEO of Oncology Management Consulting Group in Pipersville, Pa. 

"The whole idea of turnaround time can be foreign to a pharmacist who has been primarily inpatient-focused," Guidi said. "Hospital pharmacy staff does not necessarily have experience with the fact that customer expectations are very different." 

Many specialty drugs require significant lab results before the drugs can be administered. Consequently it is necessary for workers in ancillary departments such as laboratories to join pharmacy staff in changing how they provide patient care.  

Hospital labs operate on a first-in, first-out philosophy, which will not work in an outpatient setting when patients have scheduled appointments and do not have the luxury of waiting. 

"Make sure the systems are in place [to address this]; do not leave patients dangling," Guidi said. Also when "a lab is used to responding to inpatient demand, they run it when they run it - they can mix the drug at noon or at two, because the patient will still be there." 

In addition to good internal communication, dialogue with referring physicians or those who may make referrals in the future needs to be part of the planning. 

"Hospital administrators and pharmacists together need to be having conversations with referring physicians - rheumatologists, oncologists, gastroenterologists, any [prescribers] who give an infusion in their office," Pane said. "Find out if they are planning on sending patients to an outpatient specialty drug-infusion center, [which provides information needed] to answer the question,  'Do we need to build an outpatient center?'" 

Guidi agreed. "Remember, 60 percent or so of outpatients are being infused in doctor's offices, not in hospital infusion centers. But that is changing, making this a timely subject."  

To ensure quality patient care, the pharmacy staff needs to work closely with hospital schedulers to meet patient needs. If they are not prepared for the change in patient volume, patient satisfaction may suffer. 

Also, in a new center, pharmacists need to plan how they will obtain access to labs and protocols.  

"Be an advocate for the patient," Pane said.  

Steven Zielinski, RPh, pharmacy associate with the healthcare consulting company theFranaGroup, said that finding enough qualified pharmacists with specialty-drug expertise is a challenge. He recently set up an outpatient infusion center, but it cannot infuse specialty drugs because there is not a qualified pharmacist available to staff it.  

"I have a clinic that I set up, with a room set up to do infusion, but [we] don't have a pharmacist who is eligible currently to infuse patients," he said. 

The pharmacist shortage needs to be considered in the planning of a new specialty infusion center.  

"If you are short on pharmacists to begin with, and now you are taking them out of the pharmacy where they are taking care of the inpatient case load, you now have a pharmacy that is understaffed and one that is barely staffed," said Zielinski. 

One of the spillover benefits of an outpatient specialty pharmacy is the collaboration in patient care that will naturally develop between physicians and pharmacists, Guidi said.  

"The interaction between pharmacists and physicians cannot be overvalued," she said. "The more that pharmacists and physicians or other prescribers can interact, the fewer the opportunities for errors." 

Pharmacy should be part of any team evaluating an outpatient center. Effective communication between physicians, hospital administrators, pharmacists, and nursing staff is crucial to whether the infusion center will succeed.