Pharmacy

Management
Case Studies
PHM370

Muhammad Usama Arabi, BSc

PharmD Candidate, 2018 S
A Bit About Myself

S Completed Honours BSc in Biochemistry from University of

Ottawa, 2012

S Completed APPE rotations at:

S St. Joseph’s Health Centre (SJHC)
S Shoppers Drug Mart
S Leslie Dan Faculty of Pharmacy
S Canadian Armed Forces

S Currently employed as a Pharmacy Student at SJHC

Learning Objectives

S Understand how to use case studies as a learning tool

S Develop a process to resolve common operational issues

related to Pharmacy Management
Why Case Studies?

S Case studies engage students to see practice from an action

perspective and develop their analytical skills to deal with
ambiguous situations.

S Powerful cases are those that:

S Allow for several assessments of the same situation
S Lead to equally plausible and compelling conclusions
S Include information that is rich and makes the situation seem
credible yet not so complete that it leaves no room for exploration
S Have a clear problem statement

Case Learning: How does it work? Why is it effective?, Bonoma, V. T

Case Discussion: What is it like? What is its purpose?, Boehrer, J
Teaching Methods for Case studies, Michelle Schwartz
Questions to Consider

S What is the problem or decision?

S Who is the key decision-maker?

S Who are the other people involved?

S What caused the problem?

S What are some underlying assumptions or objectives?

S What decision needs to be made?

S Are there alternative responses?

Ideal Pharmacy
Service Model

S Adhering to all legal requirements and Standards of Practice (DPRA,

NAPRA)

S Professional image

S Designed for optimal patient care

S Friendly, competent, professional staff

S Efficient and accurate

S Practicing expanded scope

S Delivering professional services

S Continuous quality improvement

 Organizational
Knowledge

Emotional
Intelligence HR

Management
Competencies
Commu
Self-
Evaluation nication
Skills

Time
Management Planning
 Commu
Organizational nication
Knowledge Planning
Skills

Case: Compliance
Management Case:
Compliance

S Social History
S TW - 60 year old male, NKDA, Unemployed
S Restricted mobility using a walker
S Patient has not been compliant with his medications for the past few
months

S Past Medical History includes

S DVT
S Hypercholesterolemia
S Type II Diabetes
S Hypertension
S Osteoporosis
Management Case:
Compliance

S Current Medications
S Amlodipine 10mg po daily
S Fenofibrate 160mg po daily
S Gliclazide MR 60mg po daily
S Invokana 300mg po daily
S Komboglyze 2.5/1000 mg po bid
S Warfarin 12.5 mg po daily
S Ramipril 5mg po daily
S Fosavance 70mg/5600 IU once weekly
Management Case:
Compliance

S Approximate drug costs for 90 days supplies (including $11.99

dispensing fee)
S Amlodipine - $44.28
S Fenofibrate - $45.64
S Gliclazide - $18.82
S Invokana - $320.47
S Komboglyze - $156.71
S Warfarin - $19.28
S Ramipril - $25.22
S Fosavance - $90
S Total cost = Approx. $720
Management Case:
Compliance

S Physician is concerned about compliance

S Your staff pharmacist approaches you and offers to pay for

TW’s medication until he can afford it

S As the pharmacy manager what are your options to help

TW?
Questions to Consider

S What is the problem or decision?

S Who is the key decision-maker?

S Who are the other people involved?

S What caused the problem?

S What are some underlying assumptions or objectives?

S What decision needs to be made?

S Are there alternative responses?

 Communica- Emotional
Organizational
Knowledge HR tion Skills Intelligence
Planning

Case: Performance Review

Management Case:
Performance Review

S Background
S In preparation for the annual pharmacist performance reviews you obtain
feedback from the techs they work with
S You receive the following feedback for pharmacist, RZ:
S Fast when he wants to be
S Embraced professional services
S Talks down to customers, gets into arguments with them causing transfers out
S Staff is intimidated by him
S You meet with RZ, and he indicates he wants a raise and
eventually wants to become a manager as he feels things are going
great
Questions to Consider

S What is the problem or decision?

S Who is the key decision-maker?

S Who are the other people involved?

S What caused the problem?

S What are some underlying assumptions or objectives?

S What decision needs to be made?

S Are there alternative responses?

 Communica- Emotional
Organizational
Knowledge HR tion Skills Intelligence

Case: Conflict Management

Management Case:
Conflict Management

S Background
S New manager in corporate chain pharmacy x 1 month
S Unionized senior staff
S Created a Whatsapp group for quick communication
S You open the store on Saturday morning and dispensary is a mess
S You take pictures and send to the Whatsapp group
S Staff that worked Friday night leave the Whatsapp group
S Staff complains to District Manager
Questions to Consider

S What is the problem or decision?

S Who is the key decision-maker?

S Who are the other people involved?

S What caused the problem?

S What are some underlying assumptions or objectives?

S What decision needs to be made?

S Are there alternative responses?

Emotional Intelligence
(EQ)

S Self-awareness

S Self-management/Managing emotions

S Self-motivation

S Empathy

S Social skills/Handling relationships

Conflict Management
and Pharmacy

S Managing conflict among a variety of groups and people is a

necessary part of creating a high performance pharmacy

S It should be expected

S If conflict is avoided or mishandled, it can prove to be detrimental

to interprofessional collaboration and patient care

S A pharmacy managers’ success often depends on their conflict

management skills

Managing Conflict: A Guide for the Pharmacy Manager. Haumschild et al. 2015.
Sources of Conflict

S There are 3 overarching categories conflict:

S Relationship conflicts: typically arise from personal
incompatibilities though limited resources can also affect
relationships and processes.
S Task conflicts: disagreements that arise due to differing
viewpoints and opinions about a particular task
S Process conflicts: disagreements that arise due to differing
opinions about how to approach a task or utilize a resource

Managing Conflict: A Guide for the Pharmacy Manager. Haumschild et al. 2015.
Importance of
Communication

S Consequences of Conflict
S WHO and ISMP cite communication breakdown as one of the
most common causes of medication related patient harm.
S Data indicates that more than 60% of medication errors are
caused by mistakes in interpersonal communication
S Too often, well-intentioned professionals choose to not
effectively communicate potential risks to optimal patient care

Managing Conflict: A Guide for the Pharmacy Manager. Haumschild et al. 2015.
 Conflict Resolution
Strategies

S Competing
S Resolution via exertion of formal positional power
S Requires no further brainstorming on behalf of the manager but stifles outside
viewpoints or collaborative feedback
S Beneficial when individuals are unsure of how to respond and formal authority is
needed

S Accommodating
S The pharmacy manager satisfies the concerns of others while neglecting their own
S If a manager is too accommodating then employees might push for agendas not
beneficial to the organization
S Alternatively if an outcome does not negatively effect operations or patient
outcomes then accommodating will build team cohesion.

Managing Conflict: A Guide for the Pharmacy Manager. Haumschild et al. 2015.
Conflict Resolution
Strategies

S Avoiding
S Employees avoid a manager if they disagree with their policies
S Pro  reduces escalation of conflict;
S Con does not address the underlying issue

S Compromising
S The solution is partially satisfactory to both parties
S Helps settle the conflict though not necessarily the parties
involved

Managing Conflict: A Guide for the Pharmacy Manager. Haumschild et al. 2015.
Conflict Resolution
Strategies

S Collaborating
S Most successful approach as it involves the cooperation of both
parties.
S In the collaborative model the following steps should be taken
S Identify the problem
S Determine the Root Cause
S Identify all possible solutions
S Decide on the best solution
S Implement the solution
S Assess the outcome

Managing Conflict: A Guide for the Pharmacy Manager. Haumschild et al. 2015.
 Commu
Organizational nication
Knowledge Planning
Skills

Case: MMT Program

Management Case:
MMT Program

S FT is one of your MMT patients

S He rarely misses his daily methadone doses and is very polite to

the staff

S Recently, he started coming for his daily drink with a few of his
friends who are not your patients

S After receiving his drink, FT and his friends tend to loiter outside
the pharmacy, smoking and often keep returning to use the
washroom
Questions to Consider

S What is the problem or decision?

S Who is the key decision-maker?

S Who are the other people involved?

S What caused the problem?

S What are some underlying assumptions or objectives?

S What decision needs to be made?

S Are there alternative responses?

Management Case:
MMT Program

S FT and his friends get into an altercation with one of your

other methadone patients RK.

S Though you have strictly prohibited FT from bringing his

friends to the pharmacy, FT and RK are still hostile towards
each other. How do you resolve this issue?
 Commu
Organizational Emotional
Planning nication
Knowledge Intelligence
Skills

Case: Difficult Patient

Management Case:
Difficult Patient

S PP is a patient at your pharmacy who comes in monthly to

pick up his prescriptions worth $1000.

S Unfortunately, he is quite aggressive and always belittles the

staff and sometimes yells at them

S It has gotten to a point where the staff no longer want to

provide care for him and hesitate to approach him at the
pharmacy
Management Case:
Difficult Patient

S You are in the pharmacy when you hear a patient (PP)

yelling at your technician

S How do you approach this situation and resolve it? If not

resolved, can it be minimized?

S If PP refuses to come to an understanding would you ask

him to transfer to another pharmacy or ask your staff to put
up with his behavior? Why?
 Commu
Organizational
Knowledge Planning nication HR Time
Management
Skills

Case: HR Planning
Management Case:
HR Planning

S Manager of a busy community pharmacy, approx. 300 scripts per day

+ 90 blister pack patients

S Full-time PA gives you 4 week notice that she is going to work for
Central Fill site

S Full-time PA gives you 2 week notice that she is moving to another

province

S Full-time PA informs you that she’s pregnant will need go to on early

mat-leave in 6 months

S Flu season is 2 months away

Questions to Consider

S What is the problem or decision?

S Who is the key decision-maker?

S Who are the other people involved?

S What caused the problem?

S What are some underlying assumptions or objectives?

S What decision needs to be made?

S Are there alternative responses?

 Commu
Organizational nication
Knowledge Planning
Skills

Case: Discounting
Management Case:
Discounting

S BD is a 56 year old male comes in to fill a prescription for

tadalafil 20mg po once daily prn. Mitte: 4 tabs.

S Total price for the medication to $70 (cost $50).

S BD insists that at his previous pharmacy he only had to pay

$40 for the same medication.

S He wants the same price or will take his business elsewhere

Questions to Consider

S What is the problem or decision?

S Who is the key decision-maker?

S Who are the other people involved?

S What caused the problem?

S What are some underlying assumptions or objectives?

S What decision needs to be made?

S Are there alternative responses?

Thank you & Questions