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Becker’s Healthcare Podcast
Melissa Chase, PharmD, BCSCP, CPEL, Director of Pharmacy at Valley Children’s Healthcare
00:20:01
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- [00:00]
A
Welcome to the Beckers 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, and how you're involved in pharmacy operations planning?
- [00:32]
B
Hi, Good morning, Ella. My name's 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 healthcare to be going, especially in pediatrics, where safety and persistent are everything for our patients, our families, and our team.
- [01:33]
A
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?
- [01:48]
B
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, 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 parts 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, has you involved in that very early on. The other thing 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.
- [03:40]
A
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.
- [03:55]
B
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 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 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.
- [06:11]
A
Definitely. Thank you for sharing. And you know, aside from, you know, pharmacy leaders in general, you also mentioned, I want to say 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 bring the project to life and ensure its success?
- [06:36]
B
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 trailer or another IV room on campus or off campus work. So really engaging with your team to get their ideas. Many times find that when we work on a large project like this and we gain the best insight and knowledge and ideas from the people doing the work. And so 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 this 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 H VAC 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 5, 10, 15 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 into 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 challenges, challenging times.
- [09:31]
A
Definitely. That 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 factors matter most to you and why?
- [09:50]
B
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 for many years had robotics in our IV 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 going to be working with it. Automation should 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.
- [11:32]
A
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,
- [11:49]
B
Continuing to build on existing efficiencies are some of the areas it feels like in the Ivy 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 IV workflow solutions. And that's something we're going to be looking at as well. We're looking at partnerships. So what is the future with the partnerships with our 503 contractors? What is going to be, you know, the continued support that they'll provide versus the cost 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 we're using 30 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, there's a lot of technology now that can help with that and that really reduces the burden on 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 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 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,
- [15:18]
A
definitely speaking with other leaders. AI is at the forefront of a lot of people's minds. So it's exciting to hear and continue evaluating what those possible opportunities can be. I like to take a step back now. Looking back at projects you've worked on, what lessons have you learned when it comes to planning pharmacy models or ivy room upgrades or anything infrastructure wise? Were there any surprises during those projects that changed how you approach planning now?
- [15:47]
B
Absolutely. So over the 26 years of my experience, I've learned a lot. Sometimes I've had to learn it the hard way. One of the things is that these projects are never just pharmacy projects. So they may say pharmacy IV room on them, but 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 when are they going to clean, when are they not going to clean. 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 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 repermit 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, try 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 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 that any new space or technology, it doesn't automatically mean that you're going to 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 going to 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. Us.
- [19:19]
A
Yeah.
- [19:19]
B
Wow.
- [19:20]
A
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 want to thank Melissa again for sharing such great perspectives and we will see you guys next time. Thank
- [19:42]
B
you.