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Contents vii
Section III Pharmacy and Clinical Operations 127 Chapter 11 Purchasing and Managing Inventory......163
Alicia S. Bouldin, Erin R. Holmes,
Chapter 9 Significant Laws Affecting Pharmacy
Dewey D. Garner, and Ann H. Devoe
Practice Management...........................129
Introduction.......................................................... 164
Kenneth M. Duke and Elizabeth A. Hall-Lipsy
Purchasing: The Art of Right Spending....................... 165
Introduction...........................................................131
Purchasing and Profit..................................... 165
Health Insurance Portability and Accountability Act.....131
Purchasing Decisions..................................... 165
Key Terms......................................................131
Procurement Procedures................................. 170
When and How to Disclose PHI:
Managing Your Inventory Investment..........................171
Notice, Consent, and Authorization.................. 132
Inventory Management Methods.......................171
HIPAA Training............................................... 133
Evaluation of Management Efficiency................ 172
Standardization of Information........................ 134
Other Factors in Inventory Management............ 172
Enforcement and HITECH Act
Technology Used in Inventory Management........174
Changes to HIPAA.......................................... 134
The Issue of Shortages.............................................174
Omnibus Budget Reconciliation Act of 1990................ 135
Basic Merchandising................................................174
Prescription Drug Marketing Act............................... 136
Summary................................................................176
Haight Act............................................................. 137
Case Scenarios .......................................................176
State Pharmacy Practice Laws.................................. 139
Abbreviations......................................................... 177
Defining the Scope of Pharmacy Practice.......... 139
References............................................................. 177
Licensure and Discipline................................. 140
Summary............................................................... 140
Case Scenarios........................................................141
Chapter 12 Justifying and Planning Patient
Care Services........................................ 178
Abbreviations..........................................................141
JoAnn Stubbings, Mary Ann Kliethermes,
References............................................................. 142
and Megan Wagner
Chapter 10 Pharmacy Operations: Workflow, Introduction.......................................................... 179
Practice Activities, Medication Needs Assessment...................................................181
Safety, and Technology.........................143 What Is the Patient Need or
Tad A. Gomez, Christy M. Norman, and Problem to Be Addressed?...............................181
Marie A. Chisholm-Burns How Large Is the Problem, and
Introduction.......................................................... 144 What Are the Trends?...................................... 182
Pharmacy Work Environment and How Well Are Patients’ Needs
Workflow Analysis................................................... 145 Currently Being Addressed?............................ 183
Pharmacy Practice Activities.................................... 146 Financial Justification............................................. 184
The Pharmacist and Liability........................... 147 SWOT Analysis........................................................ 185
Accreditation................................................ 148 Gaining Preliminary Approval................................... 185
Medication Safety................................................... 148 Service Planning..................................................... 188
Medication Errors.......................................... 148 Organizational Structure................................. 189
Performance Improvement.............................. 150 Collaborative Practice Agreement.................... 190
Medication Dispensing.................................... 152 Staffing........................................................ 190
Compounding Sterile Preparations................... 153 Documentation...............................................191
Patient Education and Counseling.................... 153 Program Evaluation.........................................191
Purchasing and Procurement.................................... 153 Payment................................................................ 192
Technology in Pharmacy Operations.......................... 154 Cost Terminology........................................... 192
Information Technology, Automation, Billing Models............................................... 192
and Medication Delivery Systems..................... 154 New Models of Payment and Care . .................. 194
Summary............................................................... 160 Summary............................................................... 195
Case Scenarios....................................................... 160 Case Scenarios....................................................... 195
Abbreviations..........................................................161 Abbreviations......................................................... 196
References..............................................................161 References............................................................. 196
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viii Contents
Chapter 13 Developing and Evaluating Clinical Abbreviations.........................................................233

References.............................................................234
Pharmacy Services................................199
Lisa Whittington Goldstone, Amy K. Kennedy,
John S. Clark, and Hanna Phan
Chapter 15 Achieving and Measuring Patient
Satisfaction......................................... 235
Introduction..........................................................200
Trina J. von Waldner and Steven R. Abel
Clinical Pharmacy Services...................................... 201
Introduction..........................................................236
Pharmacy Practice Models.............................. 201
Defining Patient Satisfaction....................................237
Examples of Clinical Pharmacy
Promoting Patient Satisfaction in Pharmacy......238
Services.......................................................202
The ECHO Model.............................................239
Needs Assessment for Services.................................203
Patient Satisfaction and Other Outcomes.......... 242
Resources Needed..................................................204
Measuring Patient Satisfaction.................................243
Personnel.....................................................204
Summary .............................................................. 247
Finances.......................................................206
Case Scenarios....................................................... 247
Opportunities for Academic
Abbreviations......................................................... 248
Collaboration................................................206
References............................................................. 248
Planning and Implementing Clinical
Pharmacy Services..................................................207
Service Assessment and Evaluation........................... 210
Section IV Finance 251
Categories of Outcome Measures .................... 210 Chapter 16 Third-Party Payment for Prescription
Summary............................................................... 212 Medications in the Retail Sector.......... 253
Case Scenarios....................................................... 212 Kavita V. Nair and Kenneth A. Lawson
Abbreviations......................................................... 214 Introduction..........................................................255
References . .......................................................... 214 Overview of Third-Party Payers for
Retail Pharmacy.....................................................255
Chapter 14 Quality Improvement............................216 Medication Supply Chain in the Retail Sector..............256
Marjorie Shaw Phillips and Retail Pharmacy Reimbursement Framework...............257
Marie A. Chisholm-Burns Prescription Payment.....................................258
Introduction.......................................................... 217 Prescription Cost and Utilization Control
Defining Quality and Quality Improvement.................. 218 Mechanism............................................................260
Measuring Quality................................................... 218 Payment Formulas.........................................260
Quality Assurance and Quality Control....................... 219 Formularies.................................................. 261
Continuous Quality Improvement..............................220 Rebates and Pharmacy Benefit Managers.......... 261
Quality Improvement Tools and Patient Cost Sharing......................................263
Analysis Techniques................................................ 221 Prior Authorizations.......................................263
Plan–Do–Study–Act Cycle................................ 221 Generic Substitution......................................264
Gap Analysis.................................................225 Quantity Limits..............................................264
Benchmarking...............................................226 Step Therapy.................................................264
Tools for Describing and Mail Service Options......................................264
Analyzing Data..............................................226 Medicaid...............................................................264
Medication Use Evaluation..............................227 Medicare...............................................................265
Quality Improvement Compared to Research...............228 Medicare Outpatient Prescription
External Mandates for Continuous Drug Benefit (Part D)......................................266
Quality Improvement...............................................228 Medication Therapy Management Services........268
Accreditation and Compliance Reimbursement Issues.............................................269
Standards..................................................... 231 Addressing Reimbursement Issues............................270
Pharmacists’ Role in Improving Summary............................................................... 271
Health Care Quality................................................. 231 Case Scenarios....................................................... 272
Summary...............................................................232 Abbreviations.........................................................273
Case Scenarios.......................................................232 References............................................................. 274

Contents ix
Chapter 17 Cents and Sensibility: Understanding Budgeting and Setting Financial Priorities................. 316
Setting Financial Goals................................... 316
the Numbers.........................................276
Keith Herist and Brent L. Rollins Credit Score..................................................320
Introduction.......................................................... 278 Basics of Investing................................................. 321
Accounting Fundamentals........................................ 278 Time Value of Money...................................... 321
Accounting Period..........................................279 Interest........................................................ 321
Principles of Going Concern, Objectivity, Current and Future Value of Money...................325
Conservatism, Consistency, Matching, Risk.............................................................326
and Materiality..............................................279 Major Investment Classes...............................326
Transactions.................................................280 Investment Strategies to Reduce Risk...............327
Balance Sheet and Income Defining and Calculating Net Worth...........................328
Statement Accounts.......................................280 Protecting Assets...................................................329
Accrual and Cash Basis Income Tax Basics..................................................329
of Accounting................................................280 Paycheck Stubs, W-2 Forms, and
The Accounting Equation................................. 281 Income Tax Forms...................................................330
Debits and Credits......................................... 281 Student Loan Repayments........................................ 331
Financial Statements...............................................282 Retirement............................................................332
The Balance Sheet..........................................282 College Education Savings Plans...............................333
The Income Statement....................................283 Financial Planners..................................................333
The Statement of Owner’s Equity......................283 Summary...............................................................334
The Statement of Cash Flows...........................284 Case Scenarios.......................................................334
An Example: Dawgtown Drugs...................................284 Abbreviations.........................................................336
Ratio Analysis........................................................286 References.............................................................336
Inventory Management............................................289
Budgeting..............................................................292 Section V Risk Management 337
Summary...............................................................296
Case Scenarios ......................................................296
Chapter 20 The Basics of Managing Risk................ 339
Kenneth R. Baker
Abbreviations.........................................................298
Introduction..........................................................340
References.............................................................298
Applying the Risk Management
Chapter 18 Integrating Pharmacoeconomic Process to the Enterprise........................................ 341
Principles and Pharmacy Step 1: Identifying Risks................................. 341
Management........................................ 299 Step 2: Prioritizing Risks and
Eleanor L. Olvey and Ivo Abraham Organizing the Plan........................................342
Introduction.......................................................... 301 Step 3: Selecting Techniques
Costs.................................................................... 301 to Manage Risks............................................343
Pharmacoeconomic Methodologies ..........................303 Step 4: Implementing the Plan.........................347
Cost-Minimization Analysis.............................303 Step 5: Monitoring and
Cost-Effectiveness Analysis.............................304 Adjusting the Plan..........................................347
Cost-Utility Analysis.......................................306 Protecting Near-Miss and Error Data.........................348
Cost-Benefit Analysis.....................................308 The Risk of Not Taking Risks....................................349
Summary............................................................... 310 Summary...............................................................350
Case Scenarios....................................................... 310 Case Scenarios.......................................................350
Abbreviations..........................................................311 Abbreviations......................................................... 351
References . .......................................................... 312 References............................................................. 351
Chapter 19 Personal Finance...................................314 Chapter 21 Insurance Fundamentals...................... 352
Keith Herist, Brent L. Rollins, and Kenneth R. Baker
Marie A. Chisholm-Burns Introduction..........................................................354
Introduction.......................................................... 315 Declarations Page...................................................354

x Contents
Common Policy Conditions.......................................358

Property Coverages.................................................359
Chapter 23 Creating and Identifying
Desirable Workplaces........................... 402
Commercial Liability Coverages................................360 Allison M. Vaillancourt, Marie A. Chisholm-Burns,
Insuring Agreements: and Diana I. Brixner
Four Liability Coverages.................................360 Introduction..........................................................403
Pharmacy Professional Liability Coverage..................376 Affiliation..............................................................405
Claims-Made or Occurrence Coverage........................377 Affiliation Strategy 1: Emphasize a Distinctive
Exclusions, Limitations, and Conditions.....................378 Organizational Mission...................................405
Risks Not Insurable.................................................378 Affiliation Strategy 2: Communicate
Umbrella Coverage..................................................379 a Compelling Vision........................................405
Judging the Reliability of Competing Affiliation Strategy 3: Be Explicit
Insurance Companies..............................................379 About Organizational Values............................406
Summary...............................................................379 Affiliation Strategy 4: Create a Culture
Case Scenarios ......................................................380 of Inclusion...................................................406
Abbreviations.........................................................380 Affiliation Strategy 5: Create a Safe
References.............................................................380 Work Environment..........................................407
Affiliation Strategy 6: Focus on Fairness...........407
Section VI Human Resources 381
Affiliation Strategy 7: Create Opportunities
Chapter 22 Employment Law Essentials................. 383 for Employees to Connect with Others Inside
Vicki Gotkin, Lauren S. Schlesselman, and Outside the Workplace..............................407
and Elizabeth A. Hall-Lipsy Work Content.........................................................408
Introduction..........................................................384 Work Strategy 1: Ensure a Match
Who Is an Employee?...............................................385 Between Employees and Their Jobs..................408
Beginning the Employment Relationship....................385 Work Strategy 2: Link Work
The Interview Process....................................386 Efforts to Organizational Mission.....................408
Additional Preemployment Work Strategy 3: Offer Autonomy.....................409
Screening Strategies......................................386 Work Strategy 4: Provide Regular Feedback.......409
Negotiating the Terms of Work Strategy 5: Provide Resources
an Employment Agreement..............................388 and Infrastructure Required for Success...........409
Laws That Affect the Employment Relationship...........389 Career...................................................................409
The Fair Labor Standards Act...........................389 Career Strategy 1: Offer Employment
Sexual and Other Forms of Unlawful for the Long Term..........................................409
Harassment..................................................390 Career Strategy 2: Promote from Within............ 410
Federal Educational Rights Career Strategy 3: Create
and Privacy Act.............................................392 Opportunities to Grow and Develop.................. 410
HIPAA and Employers.....................................392 Benefits.................................................................411
Workers’ Compensation, Occupational Benefits Strategy 1: Support
Safety and Health Administration Logs, Employees’ Work–Life Balance..........................411
and HIPAA.....................................................394 Benefits Strategy 2: Offer an Array
Occupational Safety.......................................394 of Benefit Options to Meet Employees’
Workers’ Compensation..................................395 Different Needs and Life Stages....................... 412
Evaluating Employee Performance.............................395 Benefits Strategy 3: Demonstrate
Terminating the Employee Relationship.....................395 a Commitment to Employee Wellness................ 412
Post-termination Issues..................................396 Benefits Strategy 4: Communicate
Summary...............................................................398 the Value of Benefit Offerings.......................... 413
Case Scenarios.......................................................398 Compensation........................................................ 413
Abbreviations.........................................................399 Compensation Strategy 1: Develop and
References.............................................................400 Communicate a Compensation Philosophy......... 414

Contents xi
Compensation Strategy 2: Performance Evaluation Methods..............................440

Use Pay Strategically..................................... 414 Evaluating Traits............................................ 441
Compensation Strategy 3: Evaluating Behavior....................................... 441
Pay Attention to Top Performers...................... 414 Evaluating Results.........................................443
Compensation Strategy 4: Multiple-Tool Performance Communication
Pay Attention to Pay Processes........................ 414 and Development...........................................443
Summary............................................................... 415 360-Degree Feedback.....................................443
Case Scenarios....................................................... 415 A “No Appraisals” Approach to Enhancing
References............................................................. 416 Employee Performance...................................444
Summary...............................................................450
Chapter 24 Successful Recruitment and Case Scenarios ......................................................450
Hiring Strategies...................................418 Abbreviations......................................................... 451
Christopher D. Lee and Lynette R. Bradley-Baker References............................................................. 451
Introduction.......................................................... 419
The Hiring Process.................................................. 419
Step 1: Evaluate Current Staffing Needs............420
Section VII Marketing and Promotion 453
Step 2: Define Position Requirements...............420 Chapter 26 Understanding and Applying

Step 3: Decide Who Will Be Marketing Strategies........................... 455
Involved in the Hiring Process.........................422 Glenn Rosenthal and Dana Reed-Kane
Step 4: Develop a Sourcing Strategy.................422 Introduction..........................................................456
Step 5: Design a Screening and Defining Marketing and Marketing Strategy................456
Evaluation Process.........................................425 Determining Needs, Wants, and Demands...................457
Step 6: Negotiate an Employment Offer.............429 The Four “Ps” of Marketing.....................................457
Step 7: Provide a Thorough and Welcoming Market Research and Analysis .................................459
Orientation Experience to Position Market Segmentation and Market Niches . .................460
the New Hire for Success................................429 Branding.......................................................462
Step 8: Evaluate the Effectiveness of the Hiring Relationship Marketing...................................463
Process After a Candidate Is on the Job............ 431 Summary...............................................................464
Summary............................................................... 431 Case Scenarios.......................................................464
Case Scenarios....................................................... 431 Abbreviations.........................................................466
Abbreviations.........................................................432 References.............................................................466
References.............................................................432
Chapter 27 Advertising and Promotion.................. 468
Chapter 25 Effective Performance Management.... 433 Melanie B. Oates and Prachi D. Bhatt
Mary L. Maher and Marie A. Chisholm-Burns Introduction..........................................................469
Introduction..........................................................434 The Purposes of Promotion......................................470
Evaluation Versus Ongoing Advertising............................................................470
Performance Management........................................435 Advertising Strategies
Barriers to Effective Performance Management...........438 and Venues...................................................470
Lack of Training.............................................438 Publicity................................................................472
Lack of Time and Information..........................438 Publicity Vehicles..........................................473
Failure to Link Individual Performance Web 2.0 and e-Commerce.........................................473
to Organizational Aspirations..........................438 Advertising and Promotion Channels......................... 474
Fear of Negative Consequences.......................438 Integrated Marketing Communications....................... 474
Developing Legally Defensible Performance The Purpose and Structure of Advertising
Evaluation Systems.................................................439 and Promotional Messages.......................................475
Withstanding Legal Challenges.........................439 Stages in the Consumer Decision-Making
Retaliation....................................................440 Process........................................................475
Discriminatory Language or Differentiation.......440 The Health Belief Model..................................477

xii Contents
Personal Selling.....................................................477
Word-of-Mouth Promotion........................................478
Chapter 30 Creating Your Personal Brand
and Influencing Others..........................510
Summary...............................................................479 Sharon Murphy Enright
Case Scenarios.......................................................479 Introduction...........................................................511
Abbreviations.........................................................479 Personal Brand....................................................... 512
References.............................................................480 Credibility of a Personal Brand................................. 513
Section VIII Professional Effectiveness 481 Communicating Your Brand............................. 515
Managing Your Brand..................................... 517
Chapter 28 Developing Professionalism.................. 483
Transforming Your Brand................................ 518
Dana P. Hammer, Rebekah M. Jackowski,
Brand Importance Revisited..................................... 519
Robert S. Beardsley, and Sara R. McElroy
Influencing Others.................................................. 519
Introduction..........................................................484
Establishing Credibility as an Influencer........... 519
Professionalism Defined..........................................485
Find Common Ground..................................... 521
Developing Professionalism as a Student Pharmacist...485
Building Compelling Evidence.......................... 521
Examples of Student Professionalism................486
Connect Emotionally......................................522
The Thin Line Between Personal
Presenting Persuasively..................................522
Life and Professional Life................................486
Summary...............................................................523
Intersection of Ethics and Professionalism.................488
Case Scenarios.......................................................524
Incorporating Professionalism into
Abbreviations.........................................................525
a Personal Brand....................................................489
References.............................................................525
Professional Interactions.........................................489
Interactions with Patients...............................489
Interactions with Fellow Professionals..............490
Chapter 31 Innovation and Entrepreneurship......... 527
Grant H. Skrepnek and Jesse C. Fishman
Cultivating Professionalism in Introduction..........................................................528
Practice as a Pharmacist Manager............................493 The Concept of Entrepreneurship..............................529
Staff............................................................493 Entrepreneurship and Intrapreneurship......................530
Services and Inventory...................................494 Entrepreneurial Success.......................................... 531
Physical Facilities..........................................494 Social Entrepreneurship.................................. 531
Assessment of One’s Professionalism........................495 Micro and Macro Views of Entrepreneurship......532
Summary...............................................................496 Process Approaches.......................................533
Case Scenarios.......................................................496 Starting or Purchasing a Business Enterprise.............536
Abbreviations.........................................................497 Business Valuation and Finance.......................536
References.............................................................497 Financing of a Pharmacy.................................536
Chapter 29 Ethical Decision Making....................... 499 Innovation.............................................................537
Amy Marie Haddad and Kathryn R. Matthias Innovation and Entrepreneurial
Introduction..........................................................500 Opportunities in Pharmacy..............................538
Three Concerns of Ethics......................................... 501 Practical Considerations Concerning
Context of Management and Organizational Ethics......502 the Timing of Innovation.................................539
Application of Ethical Approaches Promoting Innovation Through
to a Pharmacy Case Study........................................503 Structural, Cultural, and Human
Approaches to Ethics..............................................504 Resource Variables........................................540
Principlism...................................................504 The Learning Organization............................... 541
Virtue Ethics.................................................505 Considerations in Evaluating
Care-Based Ethics..........................................506 and Implementing Innovations..................................542
Summary...............................................................507 Summary...............................................................544
Case Scenarios.......................................................507 Case Scenarios.......................................................544
Abbreviations.........................................................508 Abbreviations.........................................................545
References.............................................................509 References.............................................................546

Contents xiii
Chapter 32 Managing Your Time............................. 548 Establishing Essential Rituals..........................559

Rafael Saenz and Allison M. Vaillancourt Using Delegation to Your Advantage.................559
Introduction..........................................................550 Reflect On the Way You Use
Barriers to Effective Time Management......................550 Your Time.....................................................560
Assessing Your Current Level Summary...............................................................560
of Effectiveness . ................................................... 551 Case Scenarios.......................................................560
Maximizing Productivity.......................................... 551 Abbreviations.........................................................562
Focusing on What Matters Most.......................553 References.............................................................562
Getting Organized..........................................555
The Power of Planning....................................555 Glossary 563
Adopting Effective Systems.............................556 Index 579
Minimizing Procrastination.............................559

Preface
In November 2011, the first edition of Pharmacy Manage collaboration with educational design specialists to
ment, Leadership, Marketing, and Finance received the enhance learning and retention. These features include
Medical Book Award, Healthcare Professionals Category, the following elements:
from the American Medical Writers Association. We •• Structured learning objectives: Listed at the begin-
credit this award to our outstanding team of authors, ning of each chapter, these statements help guide
reviewers, and assistants, who worked tirelessly to deliver learning.
a quality text and learning program. •• Key concepts: Designed to help focus learning, the
While countless volumes about leadership and manage- key concepts are also listed at the beginning of each
ment have been published, many of these works are writ- chapter. The textual material that develops these
ten specifically for the business professional and then concepts is easily identified by circle-shaped num-
applied to other industries or professions. We, as phar- bered icons ( 1 ) throughout the chapter.
macists and student pharmacists, have limited profession- •• Case Scenarios: Found at the end of each chapter,
specific works on these subjects available to us. Thus, the the case scenarios facilitate critical-thinking skills
Second Edition of this text, with updated content and and lend relevance to the principles provided.
enhanced features, is designed to prepare the next genera- •• Up-to-date literature citations: A comprehensive ref-
tion of pharmacists. Such preparation requires an integra- erence list for each chapter is provided to substanti-
tion of knowledge, skills, attitudes, and values that can be ate materials.
acquired and considered through multiple methods and •• Management Challenges: Provided within each
learning environments. chapter, these challenges describe a contemporary
The second edition of Pharmacy Management, Leader management dilemma that requires the application
ship, Marketing, and Finance contains several new chap- of concepts learned in the chapter.
ters, including “Quality Improvement,” “The Basics •• Generous use of tables and figures: These visual
of Managing Risk,” “Insurance Fundamentals,” “Inte features enhance understanding of leadership and
grating Pharmacoeconomic Principles and Pharmacy management principles.
Management,” and “Developing and Evaluating Clinical •• Glossary terms: The glossary is located at the end
Pharmacy Services.” All chapters from the previous edi- of this text; the first use of each glossary term in a
tion have been updated, and each contains new features. chapter appears in bold font.
•• Self-assessment questions and answers for each chap
As in the First Edition, each chapter is written in a con- ter: Visit the companion website at go.jblearning
cise and reader-friendly style that facilitates an in-depth .com/pharmacymanagement2CWS for interactive
level of understanding of essential leadership and man- study tools and other resources. These questions
agement concepts. Although this book is intended to are designed not only to evaluate student learning
be read in its entirety, as many chapters build on one but also to actively engage students in the learning
another, many readers will also find the text useful as a process.
reference tool. All chapters were written and reviewed
by academic pharmacy faculty, practicing pharmacy
The companion website provides self-assessment ques-
managers and leaders, human resources professionals,
tions with the ability to grade the answers and provide
and/or attorneys to incorporate both theory and real-
immediate feedback as well as reporting capabilities, an
world experiences and to ensure quality.
interactive glossary, crossword puzzles, flashcards, links
The learning features used in Pharmacy Management, to supplementary web-based materials including videos
Leadership, Marketing, and Finance were designed in and links featuring world-renowned experts on various

xvi Preface
topics addressed in the text, and other features and activi-

ties designed to support learning. In addition, it provides
Acknowledgments
lesson plans, PowerPoint Presentations, a sample syl- We appreciate the commitment and dedication of the
labus, and other downloadable materials exclusively for 63 contributing authors and 42 reviewers who shared their
instructors. advice and expertise to make this text a high-quality learn-
ing tool (lists of contributors and reviewers are included
This text and the companion website should be used as in the following pages). We also extend our gratitude to
tools to facilitate your management and leadership train- Dr. Christina Spivey for her insights and contributions and
ing. The first two chapters, “Management Essentials for to Jones & Bartlett Learning—especially Katey Birtcher, Maro
Pharmacists” and “Leadership Essentials for Pharmacists,” Gartside, Teresa Reilly, and Jessica Newfell—for their excep-
are designed to provide a basic overview of management tional guidance on this project. We thank our families for
and leadership and serve as the introduction for this text. their patience and support while we developed this text and
The chapters that follow build on the conceptual founda- the accompanying learning modules. The future of the pro-
tion provided by these two introductory chapters and focus fession depends on our students; thus, we want to thank the
on real-world application of management and leadership students—our future leaders and managers—for the many
principles, concepts, and practices in pharmacy-related contributions they will make to the pharmacy profession.
environments. Collectively, the chapters in this text and the Finally, we, the editors, thank those students, practitioners,
companion website for instructors and students provide a and educators who adopted and provided feedback on the
complete and enriched learning experience. First Edition to help us make the Second Edition even better.

About the Editors
Marie A. Chisholm-Burns, PharmD, MPH, FCCP, from the ASHP Foundation Literature Awards Program.
FASHP, is dean and professor of the College of Pharmacy Dr. Chisholm-Burns also is a Fulbright Scholar. She lives in
at the University of Tennessee Health Science Center. She Memphis, Tennessee, with her husband and nine-year-old
previously served as Professor and Head of the Department son, and she enjoys writing, cycling, and playing chess.
of Pharmacy Practice and Science at The University of
Arizona College of Pharmacy. Dr. Chisholm-Burns received Allison M. Vaillancourt, PhD, SPHR, is vice president for
her BS in psychology from Georgia College, her BS in phar- human resources at The University of Arizona and teaches
macy and doctor of pharmacy degrees from the University in the university’s School of Government and Public
of Georgia, and her master’s degree in public health from Policy. She received a BA in political science and an MA
Emory University. She completed her residency at Mercer in public policy and administration from the University
University Southern School of Pharmacy and at Piedmont of Wisconsin–Madison and earned a PhD in public pol-
Hospital in Atlanta, Georgia. Dr. Chisholm-Burns is the icy and administration from the University of Colorado–
founder and executive director of the Medication Access Denver’s School of Public Affairs. Dr. Vaillancourt is a
Program, which increases medication access to solid-organ co-principal investigator of a National Science Foundation
transplant patients. She has served in numerous elected ADVANCE grant designed to increase the number of
leadership positions in several different professional orga- women in the fields of science, technology, engineering,
nizations, has worked in multiple pharmacy settings, and is and math. She also is a weekly columnist for the Chronicle
a member of the National Academies of Practice. of Higher Education. Dr. Vaillancourt has held several lead-
ership roles in national human resources organizations, is
With more than 240 publications and approximately $8 mil- actively engaged in several Arizona public policy initia-
lion in external funding as principal investigator received tives, and consults and presents nationally on issues related
from organizations such as the National Institutes of Health to human resources, leadership, strategic planning, and
and several foundations, Dr. Chisholm-Burns is a prolific organizational culture and communication. Before begin-
scholar. She has published several textbooks that have been ning her career in human resources in the early 1990s,
adopted in many schools of pharmacy, medicine, nurs- Dr. Vaillancourt held positions as a journalist, research
ing, and allied health professions. In 2008 and 2011, text- administrator, and nonprofit executive.
books co-edited by Dr. Chisholm-Burns, Pharmacotherapy
Principles and Practice and Pharmacy Management, Marv Shepherd, PhD, MS, RPh, is the director of the
Leadership, Marketing, and Finance, respectively, received Center for Pharmacoeconomic Studies and chairman of
the Medical Book Award from the American Medical the Pharmacy Administration Division at the University
Writers Association. She has received numerous awards and of Texas at Austin, College of Pharmacy. He earned his
honors including the Robert K. Chalmers Distinguished BS in biology from Michigan Technological University, a
Pharmacy Educator Award from the American Association BS in pharmacy from Ferris State University, an MS from
of Colleges of Pharmacy, the Clinical Pharmacy Education the University of Rhode Island (1978), and a PhD from
Award from the American College of Clinical Pharmacy, Purdue University. Dr. Shepherd received a commission in
the Daniel B. Smith Practice Excellence Award from the the U.S. Army and was a Special Forces (Green Beret) offi-
American Pharmacists Association, the Rufus A. Lyman cer. He is president of the Partnership for Safe Medicines,
Award for most outstanding publication in the American a group dedicated to protecting the public from counter-
Journal of Pharmaceutical Education (both in 1996 and feit, diverted, and substandard medications. Since 1994,
2007), the Nicholas Andrew Cummings Award from the Dr. Shepherd has studied drug importation and distribu-
National Academies of Practice, the Award of Excellence tion of counterfeit medications. He has testified before
from the American Society of Health-System Pharmacists congressional committees four times, and his expertise
(ASHP), and the Pharmacy Practice Research Award on drug counterfeiting has been featured in such media as

xviii About the Editors
CNN News, NPR Radio: First Edition, Newsweek, The Wall and Science of the American Pharmaceutical Association.
Street Journal, Money magazine, Prevention magazine, US He is the chairman of the Editorial Advisory Board for the
News and World Report, The New York Times, USA Today, Journal of Managed Care Pharmacy. He received the Award
and The Washington Post. Dr. Shepherd has more than 100 of Excellence from the American Society of Health-System
publications, including six book chapters. He is a past presi- Pharmacists in 2006. Dr. Shepherd is married, has two chil-
dent and fellow of the Academy of Pharmaceutical Research dren, and lives in Austin, Texas.

Contributors
Steven R. Abel, PharmD, FASHP Lynette R. Bradley-Baker, BSPharm, PhD
Associate Dean, Clinical Programs Director, Professional Alliance Development
Bucke Professor and Head, Department of American Association of Colleges of Pharmacy
Pharmacy Practice Alexandria, Virginia
Purdue University College of Pharmacy
West Lafayette, Indiana Diana I. Brixner, RPh, PhD
Professor and Chair, Department of Pharmacotherapy
Ivo Abraham, PhD University of Utah College of Pharmacy
Professor Salt Lake City, Utah
The University of Arizona College of Pharmacy
Tucson, Arizona Debbie C. Byrd, PharmD, BCBS
Professor and Associate Dean, Professional Affairs
Kenneth R. Baker, BSPharm, JD University of Tennessee College of Pharmacy
Adjunct Assistant Professor Knoxville, Tennessee
Midwestern University College of Pharmacy and
University of Florida College of Pharmacy Nicholas A. Campagna, Jr., MBA
Attorney at Law Associate Professor, Pharmaceutical Sciences
Renaud Cook Drury Mesaros, PA, of Counsel Director, Pharmaceutical and Health Care Business
Phoenix, Arizona Massachusetts College of Pharmacy and
Health Sciences
Candace W. Barnett, RPh, PhD Boston, Massachusetts
Executive Associate Dean and Professor
Mercer University College of Pharmacy and John S. Clark, PharmD, MS, BCPS, FASHP
Health Sciences Clinical Assistant Professor
Atlanta, Georgia University of Michigan College of Pharmacy
Director, Pharmacy Services
Robert S. Beardsley, RPh, PhD Program Director, PGY-1 Pharmacy Residency
Professor University of Michigan Hospitals and Health Centers
University of Maryland School of Pharmacy Ann Arbor, Michigan
Baltimore, Maryland
Steven J. Crosby, BS, MA, RPh, FASCP
Prachi D. Bhatt, PharmD Assistant Professor, Pharmacy Practice
Critical Care Pharmacist Assistant Coordinator, Advanced Practice Management
Clinical Pharmacy Coordinator Massachusetts College of Pharmacy and Health Sciences
Taylor Hospital Boston, Massachusetts
Ridley Park, Pennsylvania
Ann H. Devoe, RPh
Alicia S. Bouldin, RPh, PhD Pharmacist
Professor, Pharmacy Administration Chaney’s Pharmacy
The University of Mississippi School of Pharmacy Oxford, Mississippi
University, Mississippi

xx Contributors
Joseph T. DiPiro, PharmD Tad A. Gomez, RPh, MS

Executive Dean and Professor Clinical Associate Professor
South Carolina College of Pharmacy University of Georgia College of Pharmacy
University of South Carolina and the Medical University Administrative Director, Pharmacy, Rehabilitation
of South Carolina and Respiratory Care Services
Charleston, South Carolina Georgia Health Sciences Health System
Augusta, Georgia
Kenneth M. Duke, RPh, MBA
Clinical Assistant Professor Vicki Gotkin, JD
The University of Georgia College of Pharmacy University Attorney
Athens, Georgia The University of Arizona
Tucson, Arizona
Stephen F. Eckel, PharmD, MHA, BCPS, FAPhA,
FASHP Amy Marie Haddad, PhD
Assistant Director and Director, Residency Programs Director, Center for Health Policy and Ethics
University of North Carolina Hospitals Dr. CC and Mabel L. Criss Endowed Chair
Clinical Assistant Professor in the Health Sciences
University of North Carolina at Chapel Hill Eshelman Creighton University School of Pharmacy and
School of Pharmacy Health Professions
Chapel Hill, North Carolina Omaha, Nebraska
Sharon Murphy Enright, RPh, MBA Elizabeth A. Hall-Lipsy, JD, MPH

President Assistant Professor
Envision Change, LLC The University of Arizona College of Pharmacy
Richmond, Virginia Tucson, Arizona
Joseph W. Ferullo, PharmD, RPh Dana P. Hammer, MS, PhD

Assistant Professor, Pharmacy Practice Senior Lecturer
Coordinator, Advanced Practice Management Director, Bracken Pharmaceutical Care
Massachusetts College of Pharmacy and Health Sciences Learning Center
Boston, Massachusetts University of Washington School of Pharmacy
Seattle, Washington
Jesse C. Fishman, PharmD
Consultant Pharmacist Keith Herist, PharmD, CPA, AAHIVE
Alethia Medical Communications Clinical Associate Professor
Atlanta, Georgia The University of Georgia College of Pharmacy
Athens, Georgia
Dewey D. Garner, RPh, PhD
Professor Emeritus Erin R. Holmes, PharmD, PhD
The University of Mississippi School of Pharmacy Assistant Professor, Pharmacy Administration
University, Mississippi The University of Mississippi School of Pharmacy
University, Mississippi
Lisa Whittington Goldstone MS, PharmD, BCPS
Assistant Professor, Department of Pharmacy Practice Rebekah M. Jackowski, PharmD
and Science Clinical Pharmacist
The University of Arizona College of Pharmacy Wilmot Pharmacy
Clinical Pharmacy Specialist–Psychiatry Oro Valley, Arizona
The University of Arizona Medical Center, South Campus
Tucson, Arizona

Contributors xxi
Amy K. Kennedy, PharmD, BCACP Kathryn R. Matthias, PharmD, BCPS

Assistant Professor, Department of Pharmacy Practice Assistant Professor
and Science The University of Arizona College of Pharmacy
The University of Arizona College of Pharmacy Clinical Faculty Pharmacist, Infectious Diseases
Clinical Pharmacist University Medical Center
El Rio Health Center Tucson, Arizona
Tucson, Arizona
Sara R. McElroy, MS, PharmD
Mary Ann Kliethermes, PharmD Seattle, Washington
Vice-Chair and Associate Professor,
Ambulatory Care Kavita V. Nair, PhD
Midwestern University Chicago College Associate Professor
of Pharmacy Center for Pharmaceutical Outcomes Research (CePOR)
Clinical Pharmacist Director, Graduate Studies (Pharmaceutical Outcomes
DuPage Medical Group Research Track)
Downers Grove, Illinois University of Colorado Anschutz Medical Campus, Skaggs
School of Pharmacy and Pharmaceutical Sciences
Kenneth A. Lawson, PhD, RPh, FAPhA Aurora, Colorado
Professor and Division Head, Health Outcomes and
Pharmacy Practice Division Christy M. Norman, PharmD, MS
The University of Texas at Austin College Clinical Assistant Professor
of Pharmacy The University of Georgia College of Pharmacy
Austin, Texas Pharmacy Manager, Therapeutic Policy and Formulary
Management
Christopher D. Lee, PhD, SPHR Georgia Health Sciences Health System
Associate Vice Chancellor, Human Resources Augusta, Georgia
Virginia Community College System
Richmond, Virginia Melanie B. Oates, MBA, PhD
Assistant Professor, Department of Business and
Mary L. Maher, MA Entrepreneurship
Assistant Vice President, Human Resources Chatham University
University of Baltimore Pittsburgh, Pennsylvania
Baltimore, Maryland
Eleanor L. Olvey, PharmD, PhD
Macary Weck Marciniak, PharmD, BCPS, FAPhA Fellow, Arizona Area Health Education Centers
Clinical Associate Professor (AzAHEC) Clinical Outcomes and Comparative
Director, PGY2 Community Pharmacy/Academia Effectiveness Research (COCER) Program
Residency Program The University of Arizona College of Pharmacy
Assistant Director, PGY1 Community Pharmacy Tucson, Arizona
Residency Program
University of North Carolina at Chapel Hill Eshelman Hanna Phan, PharmD, BCPS
School of Pharmacy Assistant Professor, Department of Pharmacy Practice
Chapel Hill, North Carolina and Science
Assistant Professor, Department of Pediatrics
Scott M. Mark, PharmD, MS, MEd, MPH, MBA, The University of Arizona Colleges of Pharmacy
FASHP, FACHE, FABC and Medicine
Corporate Vice President Clinical Pharmacy Specialist, Pediatric Pulmonology,
West Penn Allegheny Health System Allergy, and Immunology
Pittsburgh, Pennsylvania Residency Program Director, PGY-2 in Pediatric Pharmacy

xxii Contributors
The University of Arizona Medical Center, Diamond James M. Scanlon, BS, RPh
Children’s Adjunct Faculty
Tucson, Arizona Massachusetts College of Pharmacy and
Health Sciences
Marjorie Shaw Phillips, MS, RPh, FASHP Pharmacy Manager
Clinical Professor, Pharmacy Practice Target
The University of Georgia College of Pharmacy Boston, Massachusetts
Pharmacy Coordinator, Clinical Research and Education
Georgia Health Sciences Health System Lauren S. Schlesselman, PharmD, MEd
Augusta, Georgia Assistant Clinical Professor
University of Connecticut School of Pharmacy
Shaunta’ M. Ray, PharmD Storrs, Connecticut
Associate Professor, Clinical Pharmacy
University of Tennessee College of Pharmacy Grant H. Skrepnek, PhD, MSc, RPh
Knoxville, Tennessee Associate Professor
Dana Reed-Kane PharmD, FIACP, FACA, Tucson, Arizona
NFPPhC, FCP
Co-owner and Compounding Pharmacist Christina A. Spivey, PhD, LMSW
Reed’s Compounding Pharmacy Assistant Professor
Tucson, Arizona University of Tennessee College of Pharmacy
Memphis, Tennessee
Brent L. Rollins, RPh, PhD
Assistant Professor, Pharmacy Practice James G. Stevenson, PharmD, FASHP
Philadelphia College of Osteopathic Medicine, Professor and Associate Dean, Clinical Sciences
Georgia Campus, School of Pharmacy Chair, Department of Clinical, Social, and
Suwanee, Georgia Administrative Sciences
University of Michigan College of Pharmacy
Glenn Rosenthal, MA, MBA, EdD Chief Pharmacy Officer
Associate Dean of Academic Affairs University of Michigan Hospitals and Health Centers
Associate Professor Ann Arbor, Michigan
University of New England College of Pharmacy
Portland, Maine JoAnn Stubbings, BSPharm, MHCA
Clinical Associate Professor
Leigh Ann Ross, PharmD Manager, Research and Public Policy
Chair and Associate Professor, Department Ambulatory Care Pharmacy Department, Pharmacy
of Pharmacy Practice Practice
Associate Dean of Clinical Affairs University of Illinois at Chicago College of Pharmacy
The University of Mississippi School of Pharmacy Chicago, Illinois
Jackson, Mississippi
Trina J. von Waldner, RPh, BPharm, PharmD
Rafael Saenz, PharmD, MS Public Service Associate
Administrator, Pharmacy Services Director, Office of Postgraduate Continuing Education
University of Virginia Health System and Outreach
Assistant Dean Division of Nontraditional Education and Outreach
Virginia Commonwealth University School of Pharmacy– The University of Georgia College of Pharmacy
University of Virginia Division Athens, Georgia
Charlottesville, Virginia

Contributors xxiii
Megan Wagner, PharmD Donna S. West-Strum, RPh, PhD

Clinical Pharmacist Chair and Associate Professor, Department
Preceptor, PGY-1 Community Pharmacy of Pharmacy Administration
Residency The University of Mississippi School of Pharmacy
SUPERVALU Pharmacies University, Mississippi
Franklin Park, Illinois
Glenn Y. Yokoyama, PharmD
David Wamble, MBA, MS Associate Adjunct Professor
University, Mississippi University of California at San Francisco, School
of Pharmacy
Kurt Weibel, PharmD, MS San Francisco, California
Assistant Director, Pharmacy Services
The University of Arizona Medical Center
Tucson, Arizona

Reviewers
Erin Albert, BS, MBA, PharmD, JD Candidate (2012) Robert M. Cisneros, MS, MBA, PhD
Assistant Professor and Director, Ribordy Center for Associate Professor
Community Practice Pharmacy Campbell University College of Pharmacy &
Butler University College of Pharmacy and Health Health Sciences
Sciences Buies Creek, North Carolina
Indianapolis, Indiana
Nancy DeGuire, PharmD
Fadi M. Alkhateeb, BSPharm, MBA, PhD Assistant Dean, External Relations
Associate Professor Associate Clinical Professor, Pharmacy Practice
Director, EMBA Concentration in Pharmaceutical & University of the Pacific, Thomas J. Long School
Healthcare Management Program (PHM) of Pharmacy and Health Sciences
University of Charleston School of Pharmacy Stockton, California
Charleston, West Virginia
Natalie Ann DiPietro, PharmD, MPH
Keith Bailey, BSc (Pharm), MBA Assistant Professor, Pharmacy Practice
Regional Manager Ohio Northern University, Raabe College
Shoppers Drug Mart of Pharmacy
St. John’s, Newfoundland, Canada Ada, Ohio
Jack Brown, PharmD, MS, BCPS Arjun P. Dutta, BPharm, PhD

Assistant Professor of Pharmacy, Medicine and Public Associate Dean, Academic Affairs
Health Touro College of Pharmacy
University at Buffalo New York, New York
Infectious Disease Clinical Specialist
University of Rochester Medical Center Lea S. Eiland, PharmD, BCPS
Buffalo, New York Associate Clinical Professor and Associate
Department Head
Debbie C. Byrd, PharmD, BCPS Auburn University Harrison School
Professor and Associate Dean, Professional Affairs of Pharmacy
University of Tennessee College of Pharmacy Huntsville, Alabama
Knoxville, Tennessee
Joseph L. Fink III, BSPharm, JD
Ina Lee Calligaro, PharmD Professor, Pharmacy Law and Policy
Associate Dean, Education, Assessment, Faculty University of Kentucky College of Pharmacy
Development and Experiential Education Lexington, Kentucky
Temple University School of Pharmacy
Philadelphia, Pennsylvania Daniel Friesner, PhD
Professor, Pharmacy Practice
Chia-Hung Chou, PhD Associate Dean, Student Affairs and Faculty
Assistant Professor Development
Northeastern University School of Pharmacy North Dakota State University College of Pharmacy,
Boston, Massachusetts Nursing, and Allied Sciences
Fargo, North Dakota

Reviewers xxv
Lois A. Garland-Patterson, PhD, MBA, BSPharm Andrea L. McKeever, PharmD, BCPS

Dean Associate Professor, Pharmacy Practice
American University of Health Sciences School of Pharmacy Director of Drug Information Center and Residency
Signal Hill, California Program
South University School of Pharmacy
Dennis W. Grauer, PhD, MS Savannah, Georgia
Associate Professor and Graduate Program Director
University of Kansas School of Pharmacy Mary Monk-Tutor, BSPharm, MS Pharm, PhD, FASHP
Lawrence, Kansas Professor and Director, Assessment
Samford University, McWhorter School of Pharmacy
David L. Helgeland, BSPharm, MBA, EdD Birmingham, Alabama
Professor, Pharmacy Practice
South Dakota University College of Pharmacy Rashid Mosavin, RPh, PhD, MBA
Brookings, South Dakota Associate Professor and Department Chair,
Pharmaceutical Sciences
Donald G. Klepser, PhD, MBA Loma Linda University School of Pharmacy
Assistant Professor Loma Linda, California
University of Nebraska Medical Center, College of Pharmacy
Omaha, Nebraska Aisha Morris Moultry, PharmD, MS
Associate Professor, Pharmacy Practice
Anandi V. Law, BPharm, PhD Texas Southern University College of Pharmacy and
Associate Professor and Chair, Pharmacy Practice Health Sciences
and Administration Clinical Adjunct Faculty
Western University of Health Sciences College of Harris County Hospital District
Pharmacy Houston, Texas
Pomona, California
John E. Murphy, PharmD
Earlene E. Lipowski, PhD Associate Dean and Professor
Professor, Department of Pharmaceutical Outcomes and The University of Arizona College of Pharmacy
Policy Tucson, Arizona
University of Florida College of Pharmacy
Gainesville, Florida Roland A. Patry, DrPH, FASHP
Professor and Chair, Department of Pharmacy Practice
S. Suresh Madhavan, MBA, PhD, FAPhA Texas Tech University Health Sciences Center School
Professor and Chair of Pharmacy
West Virginia University School of Pharmacy Amarillo, Texas
Morgantown, West Virginia
Therese Poirier, PharmD, MPH
Leisa L. Marshall, PharmD Professor, Pharmacy Practice
Clinical Professor Associate Dean, Academic Affairs
Mercer University College of Pharmacy and Health Southern Illinois University–Edwardsville School of
Sciences Pharmacy
Atlanta, Georgia Edwardsville, Illinois
J. Russell May, PharmD, FASHP Anne Policastri, PharmD, MBA

Clinical Professor Clinical Assistant Professor, Department of Pharmacy
The University of Georgia College of Pharmacy Practice and Science
Clinical Pharmacy Specialist Director, Experiential Education
Georgia Health Sciences Medical Center University of Kentucky College of Pharmacy
Augusta, Georgia Lexington, Kentucky

xxvi Reviewers
Stacy Ramirez, PharmD Marie A. Smith, PharmD

Assistant Professor Professor and Assistant Dean, Practice and Public
Oregon State University College of Pharmacy Policy Partnerships
Consultant and Clinical Pharmacist University of Connecticut School of Pharmacy
Community Health Centers of Benton and Linn Counties Storrs, Connecticut
Corvallis, Oregon
Alan R. Spies, RPh, JD, MBA, PhD
E. Kristin Richards, PhD Director, Professional Development
The University of Texas at Austin College of Pharmacy Associate Professor
Austin, Texas University of Oklahoma College of Pharmacy
Oklahoma City, Oklahoma
Nathaniel M. Rickles, PharmD, PhD
Associate Professor, Pharmacy Practice and Angela Lowe Winegar, MS
Administration The University of Texas at Austin College
Northeastern University School of Pharmacy of Pharmacy
Boston, Massachusetts Austin, Texas
Nisaratana Sangasubana, PhD Keith Yoshizuka, PharmD, MBA, JD

Assistant Professor Assistant Dean, Administration
Nova Southeastern University College of Pharmacy Chair, Social, Behavioral, and Administrative
Fort Lauderdale, Florida Sciences
Touro University College of Pharmacy
Sujit S. Sansgiry, PhD Vallejo, California
Associate Professor
University of Houston College of Pharmacy Darla Zarley, PharmD
Houston, Texas Associate Professor, Pharmacy Practices
Roseman University of Health Sciences
Grant H. Skrepnek, PhD, MSc, RPh Henderson, Nevada
Associate Professor
Tucson, Arizona

Section I
Pharmacy Management
and Leadership
Chapter 1 Management Essentials for Pharmacists . . . . . . . . . . . . . . . . . . . . . . . 3
Chapter 2 Leadership Essentials for Pharmacists . . . . . . . . . . . . . . . . . . . . . . . 23
Chapter 3 Communicating Effectively in the Workplace . . . . . . . . . . . . . . . . . . 38
Chapter 4 Managing Conflict and Building Consensus . . . . . . . . . . . . . . . . . . . . 53
Chapter 5 Negotiation Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Chapter 6 Leading and Managing Change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
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Chapter
1
Management Essentials
for Pharmacists
Stephen F. Eckel, PharmD, MHA, BCPS, FASHP, FAPhA
Macary Weck Marciniak, PharmD, BCACP, BCPS, FAPhA
Scott M. Mark, PharmD, MS, MEd, MBA, FASHP, FACHE, FABC
Rafael Saenz, PharmD, MS
Learning Objectives
After completing the chapter, the reader will be able to:
1. Define management and list some management opportunities for pharmacists.

2. Cite factors that motivate pharmacy employees.
3. Describe techniques for providing effective feedback.
4. Differentiate the four basic elements of communication and describe how each relates
to effective communication.
5. Discuss the processes of principled negotiation and problem solving.
6. Assess strategies for managers to demonstrate support for the success of employees
and teams.
7. Explain the process of contingency planning and its utility in managing crises.
8. Discuss the importance of delegation and strategies for delegating effectively.
9. Define “managing up” and describe strategies to facilitate this process.
10. Identify ways to solicit employee input.
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4 Chapter 1 Management Essentials for Pharmacists
Key Concepts
These key concepts are designed to focus learning, and the textual material that develops these concepts is easily
identified throughout the chapter with circle-shaped icons indicating the key concept number (the end of each key
concept is also denoted with a circle-shaped icon).
1 Management is the art of maximizing productivity by or problems but also to get assignments back on track
using and developing people’s talent, while providing when problems arise or when mistakes are made.
them with self-enrichment and opportunities for Therefore, feedback is a critical aspect of managing
growth. Management is also concerned with the employees and accomplishing desired results. Failing
allocation and use of resources to accomplish tasks to provide feedback is a failure to manage.
and achieve objectives. 7 Communication is one of the most important
2 There is a shortage of pharmacist managers, so management competencies; it includes sharing
many career opportunities are available for those information through verbal means, body language,
who are interested in pharmacy management. Paths written documents, and compelling presentations.
to achieve a management career include formal Pharmacist managers who master communication
education through obtaining a management degree have a unique ability to connect with people to
(e.g., MBA, MS) and/or informal training through achieve organizational results.
on-the-job experience.
8 Effective managers are good planners who manage
3 Although management fundamentals may be similar their time well, establish reasonable budgets, deploy
from organization to organization, the most effective people appropriately, and prepare for contingencies.
managers are those who understand the context in Managers cannot possibly prevent all emergencies,
which their organizations exist, the organization’s but they can take steps to minimize surprises.
unique culture, and the industry- and organization- Although crisis-level events are generally considered
specific knowledge required to get things done. negative, they can open doors to opportunities.
4 Effective managers surround themselves with 9 Delegation is most effective when managers
talented people and develop those individuals into (1) entrust employees with a job; (2) give employees
high-performing team members who can translate adequate freedom to get a job done (the act of
vision into reality. empowering employees); (3) provide employees with
5 Although competitive and equitable pay matters, the appropriate level of support to get the job done
decades of research and hundreds of studies have well, including information, training, and resources;
demonstrated that, while money can be a demotivator, and (4) hold employees accountable to produce
it rarely matters most to employees. Many pharmacists desirable outcomes. Thus managers do not have to
enter the profession because they are interested in be “hands-on” for the right outcomes to occur but
providing patient care, but other motivation factors neither do they have to be uninvolved and unaware
also come into play, including interesting, challenging, of what is occurring.
and purposeful work; recognition and appreciation; a 10 “Managing up” is the process of consciously working
sense of accomplishment; and growth opportunities, with your manager to obtain the best possible results
including the opportunity to acquire new knowledge for you, your manager, and your organization.
and build connections with others. “Managing” in this context is not the result of formal
6 Feedback serves as both a preventive and a corrective authority over one’s supervisor but rather a method
measure; it is a mechanism not only to help identify for developing a positive and effective working
and develop solutions to potential work-related barriers relationship with him or her.
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Essential Management Competencies 5
Introduction
1 Management is the art of maximizing productivity which issues receive the most attention from leadership.
by using and developing people’s talent, while providing While people in senior positions are influential, there are
them with self-enrichment and opportunities for growth.1 many people on the front lines who can influence projects
Management is also concerned with the allocation and use and make things happen. To be competent practitioners,
of resources to accomplish tasks and achieve objectives. improve patient care, and achieve organizational goals,
Although beliefs about management have changed over managers read pharmacy- and medical-related publica-
time, there is general agreement that management should tions, attend professional meetings, and form and leverage
focus largely on human capital—the employees of an orga- relationships with colleagues. By analyzing their internal
nization—and should create structures and adopt practices and external environments, they are able to understand
that support their success. organizational decisions and pharmacy-related changes,
anticipate emerging needs, and help their employees make
2 There is a shortage of pharmacist managers, so many
sense of new directions.
career opportunities are available for those who are
interested in pharmacy management (see Table 1-1).2–5 Human Resources Management
Paths to achieve a management career include formal
education through obtaining a management degree (e.g., Most pharmacist managers are responsible for personnel
MBA, MS) and/or informal training through on-the-job management activities, including hiring, motivating, engag-
experience. This text addresses different competencies ing, establishing goals, providing feedback, evaluating per-
involved in pharmacy management, and this chapter pro- formance, and coaching employees. 4 Effective managers
vides a foundational review of the most critical and basic surround themselves with talented people and develop those
pharmacy-associated management competencies (some of individuals into high-performing team members who can
which will be expounded on in later chapters), including translate vision into reality. The most successful manag-
organizational knowledge, human resources management, ers hire people who complement their own skill set, providing
communication, organizing meetings, planning for contin- a diverse talent pool to accomplish activities.
gencies and crises, time management, “managing up,” and Hiring Excellent People
self-insight. This chapter provides the foundational concepts
discussed throughout this text. Organizational success is most likely when a manager
makes wise choices about the people who join his or her
Essential Management pharmacy team. Hiring the right people is critical to a
manager’s success, as the right employees are essential for
Competencies executing projects and achieving results. Many manag-
ers view activities related to the search and hiring process
Knowledge of Organizational Context as a distraction from their “real work” and begrudge the
and Environment time spent on this activity. This perception is unfortunate,
3 Although management fundamentals may be simi-
as hiring the wrong people wastes valuable time, thereby
lar from organization to organization, the most effective requiring managers to spend vital hours addressing the
managers are those who understand the context in which mistakes or bad behaviors of these individuals. Eliciting the
their organizations exist, the organization’s unique culture, right information during an interview is a skill, and plan-
and the industry- and organization-specific knowledge ning in advance which traits and experiences are needed
for the person to be successful is critical.
required to get things done. While much of this under-
standing is gained through time spent in an organization, Hiring the right person actually starts before the candidate
there are other means by which to learn how to conduct ever applies for a job. Chapter 24 (Successful Recruitment and
activities and accomplish goals. Effective pharmacist Hiring Strategies) addresses the various elements required
managers utilize formal and informal resources to learn to identify and select outstanding talent. Steps described
who is who, what matters, and how things work. How do include writing clear job descriptions, identifying essential
they obtain this knowledge? They may forge relationships competencies, employing targeted recruitment strategies,
with people throughout their organization, read corpo- developing effective screening tools, and making job offers.
rate reports, analyze who is promoted and why, and note As that chapter notes, the hiring process does not end once
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Table 1-1 Examples of Pharmacy Management Career Opportunities
Setting Managerial Role

Academia Director of experiential education Chair/vice chair of a division
Coordinator of pharmaceutical care skills lab Assistant/associate dean
Director of student admissions Dean
Director of graduate studies
Association management Manager Vice president
Senior manager Senior vice president
Associate director Chief financial officer/chief operating officer
Director Chief executive officer
Senior director
Community pharmacy Store pharmacist Regional manager
Pharmacy manager Vice president
Manager of clinical programs Store owner
District manager
Federal government Chief of regulatory affairs Clinical reviewer
Deputy chief, Centers for Disease Health scientist
Control and Prevention Drug Service Research support officer
Health-system Clinical pharmacist Assistant/associate director
Operations pharmacist Director of pharmacy
Residency program director Chief pharmacy officer
Clinical coordinator Corporate director of pharmacy
Operations manager Vice president of pharmacy
Home health care Pharmacy manager
Long-term care Consultant pharmacist Pharmacy manager
Managed care Pharmacist/clinical pharmacist Pharmacist manager
Nuclear pharmacy Nuclear pharmacist Pharmacy manager
Pharmaceutical industry Sales manager District manager
Medical writer coordinator Regional manager
Medical science liaison Director
Marketing manager Vice president
Research study coordinator
Sources: Data from American Pharmacists Association (APhA). Career option profiles. Available at: http://www.pharmacist.com/AM/Template.cfm?Section=
Pathways_Program&Template=/CM/ContentDisplay.cfm&ContentID=12183. Accessed November 18, 2011; Schommer JC, Brown LM, Sogol EM. Work profiles
identified from the 2007 Pharmacist and Pharmaceutical Scientist Career Pathway Profile Survey. Am J Pharm Educ 2008;72(1) Article 2; Nuclear Education Online.
Nuclear jobs. Available at: http://www.nuclearonline.org/curriculum/nuclearjobs.asp. Accessed November 18, 2011; and USAJOBS. Homepage. Available at:
http://www.usajobs.gov. Accessed November 18, 2011.
a new employee accepts an offer but rather continues until management theorists have attempted to determine exactly
the orientation process is complete. Once employees are on which factors promote employee motivation. Management
board, pharmacist managers must work to ensure they are scholar Victor Vroom is among them; he is best known for
motivated, engaged, satisfied, and successful. developing the expectancy theory, which asserts that an
employee’s likelihood of tackling a task is related to the
Motivating and Engaging Employees probability of the ability to complete it and the possible out-
While most believe good managers have the ability to come or consequence of doing so.7 According to Vroom’s
motivate employees, some have suggested it is a manag- expectancy theory, an employee’s motivation is influenced
er’s job simply to avoid demotivating employees.6 Several by three key factors:7
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Essential Management Competencies 7
•• Expectancy: Does the employee believe he or she can Given the positive potential of employee engagement, how
achieve the task? In a pharmacy setting, expectancy can pharmacist managers ensure their employees are fully
could be influenced by the level of pharmacy-related engaged? 5 Although competitive and equitable pay mat-
expertise the employee possesses, support and expec- ters, decades of research and hundreds of studies have dem-
tations of colleagues and the pharmacy manager, and onstrated that, while money can be a demotivator, it rarely
adequate information, equipment, materials, and matters most to employees.9 Many pharmacists enter the
other resources required to perform the work. profession because they are interested in providing patient
•• Valence: Does the employee believe that complet- care, but other motivation factors also come into play,
ing the task will be personally beneficial or that it including interesting, challenging, and purposeful work; rec-
will lead to unfortunate consequences? Examples ognition and appreciation; a sense of accomplishment; and
of positive valence in a pharmacy-related setting growth opportunities, including the opportunity to acquire
may include recognition by peers, appreciation by new knowledge and build connections with others.10,11
patients, opportunities to work on new projects, a pay Table 1-2 lists nonmonetary motivators.
raise, or even a promotion. Negative valence could
Most people—pharmacy personnel among them—are
include being assigned a disliked task, such as order-
motivated by one of six needs: (1) attainment, (2) power,
ing supplies just because one demonstrates attention
(3) belonging, (4) independence, (5) respect, and (6) equity;
to details, or suffering scorn from coworkers for
these factors are described in Table 1-3.12 As described in
being the one the pharmacist manager praises for
Chapter 23 (Creating and Identifying Desirable Workplaces),
constantly doing more than is required or expected.
these needs can be translated into elements of the employee
•• Instrumentality: What is the probability that complet-
value proposition—what an employer offers to its employees
ing the task will lead to the outcome desired by the
in exchange for their effort and commitment.13 The employee
individual? For example, a pharmacist in a hospital
value proposition comprises five key components:13
pharmacy setting may consider becoming certified
in oncology or in diabetes education to advance to a •• Affiliation: The feeling of belonging to an admirable
position in managing oncology or diabetes therapy. organization that shares one’s values
If the employee receives information that suggests •• Work content: The satisfaction that comes from the
hiring officials will not consider this certification in work one does
the selection process, he may choose not to pursue it. •• Career: Long-term opportunities for development
Similarly, if employees observe that other employees and advancement in the organization
who do the bare minimum at work are rewarded to •• Benefits: Programs that support health, wellness,
the same degree as those who consistently perform work–life balance, and financial security
at exceptional levels, high performers may cease to •• Compensation: Direct financial rewards
demonstrate extra effort.7
What is the best way to determine what motivates your
As experienced pharmacist managers know, motivating staff? Simply ask them.12,14 The importance of these factors
employees to complete tasks is not enough to build a suc- varies by individual, by profession, and even by organiza-
cessful organization that provides superior patient care; in tional affiliation. For example, a pharmaceutical sales rep-
addition, steps must be taken to engage employees. Engaged resentative may be motivated by opportunities associated
employees are excited about their work and see a clear link with the pharmaceutical industry (such as travel) more
between their efforts, their future, and the organization’s than a pharmacist who chooses to work for a pediatric hos-
long-term success. According to a 2011 BlessingWhite study pital to care for children or a pharmacist-clinical researcher
on employee engagement, engaged employees are enthusi- who enjoys translational science and the autonomy of an
astic and committed, using their talents and efforts to make academic setting. One’s life stage may influence moti-
contributions to their employer’s goal of sustainable busi- vational factors as well. New pharmacists may value the
ness success.8 Thus engagement enhances performance, opportunity to acquire new skills so that they can advance,
increases discretionary efforts, strengthens commitment, whereas senior pharmacists may be more concerned about
and supports retention. Refer to Chapter 23 (Creating and benefits and job security. Likewise, some employees may be
Identifying Desirable Workplaces) for more recommenda- content to focus on their specific work assignments, while
tions on engaging employees. others may want to understand how their work contributes
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Table 1-2 Examples of Nonmonetary Motivators
Method Description Examples in Pharmacy Practice

Recognition Recognize people’s achievements. This lets people Publicly recognizing the technician or pharmacist
know their efforts are appreciated and facilitates who routinely provides excellent customer
work for future recognition. service.
Celebration Celebrate victories along the way. Celebrations do Organize a potluck luncheon with your staff.
not have to be large scale—they can be as simple Everyone can participate in the celebration of
as tickets to a ball game or lunch coupons to a their own achievements.
local restaurant.
Compelling mission Create a mission that everyone adheres to. The Seek input from your pharmacy staff and
best creation process incorporates everyone’s others to develop a medication-use safety
input to develop a strong mission. mission statement for the department. Safety is
everyone’s job, and this will help everyone get on
board with achieving this critical task.
Balance of achievement People want to accomplish their goals while Involve your pharmacists and technicians in
and challenge still knowing there is room to grow. They need the strategic planning of the department and
achievements as much as they need new organization. By including them, you will produce
challenges. Give employees ways to exert control buy-in from them as they provide input into the
or influence over their work. Most people have direction of the pharmacy. They will be properly
a psychological need to shape their daily lives, challenged and rewarded as they take notice
rather than react helplessly in crises. You will not that their own input was acknowledged and has
only motivate your staff but also cut their stress provided challenges back to them.
level by respecting their ability to make decisions.
Increased responsibility One of the most often cited reasons for employees Create a department report card, and let the staff
to put in extra effort is having responsibility for choose the things they want to be measured on.
results. When employees are allowed to make Help them understand the importance of each
decisions and produce results on their own, they metric to the department. Then, make each of them
are more motivated to volunteer and go beyond responsible for achieving the best possible scores.
the call of duty.
Table 1-3 Factors Influencing Motivation
Factors
Influencing
Motivation Strategy
Attainment Motivate employees by constantly introducing new tasks that build on one another. Allow them to work
toward both short- and long-term goals, thereby creating a record of achievement and growth.
Power Treat employees like in-house experts, and frequently ask them for advice. This will instantly plug employees
into what makes them feel motivated because they will savor the chance to offer their opinions and see that
you take them seriously.
Belonging Because these individuals find the social aspects of their job to be the most meaningful, you can motivate
them by making them feel as if they are part of a larger group. For example, arrange meetings where they
can collaborate and share ideas, or assign them to project teams. Organize lunches to enable them to
connect with others.
Independence Provide clear goals and allow these employees to find the best way to produce results. When possible, offer
them the flexibility to set their own hours and choose projects.
Respect Recognize employees’ contributions and acknowledge the value of their opinions. Give them time to express
their perspective, and do not interrupt them while they are talking. Listen to them carefully and provide
them with undivided attention when interacting. If you choose not to follow one of their recommendations,
explain your rationale.
Equity Take care to be fair when making decisions about your staff’s work schedules, job titles, scope of
responsibilities, pay, and benefits to ensure there are no hints of inequities. Explain your rationale for
making decisions so that employees will understand the process you used to make choices. Invite employees
to speak up in the event they believe they have been treated inequitably.
Source: Data from Cohen WA. The Art of a Leader. Englewood Cliffs, NJ: Prentice Hall; 1990.
57253_CH01_Print.indd 8 9/13/12 11:49 AM

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DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI
Newala, too, suffers from the distance of its water-supply—at least

the Newala of to-day does; there was once another Newala in a lovely
valley at the foot of the plateau. I visited it and found scarcely a trace
of houses, only a Christian cemetery, with the graves of several
missionaries and their converts, remaining as a monument of its
former glories. But the surroundings are wonderfully beautiful. A
thick grove of splendid mango-trees closes in the weather-worn
crosses and headstones; behind them, combining the useful and the
agreeable, is a whole plantation of lemon-trees covered with ripe
fruit; not the small African kind, but a much larger and also juicier
imported variety, which drops into the hands of the passing traveller,
without calling for any exertion on his part. Old Newala is now under
the jurisdiction of the native pastor, Daudi, at Chingulungulu, who,
as I am on very friendly terms with him, allows me, as a matter of
course, the use of this lemon-grove during my stay at Newala.
FEET MUTILATED BY THE RAVAGES OF THE “JIGGER”
(Sarcopsylla penetrans)
The water-supply of New Newala is in the bottom of the valley,

some 1,600 feet lower down. The way is not only long and fatiguing,
but the water, when we get it, is thoroughly bad. We are suffering not
only from this, but from the fact that the arrangements at Newala are
nothing short of luxurious. We have a separate kitchen—a hut built
against the boma palisade on the right of the baraza, the interior of
which is not visible from our usual position. Our two cooks were not
long in finding this out, and they consequently do—or rather neglect
to do—what they please. In any case they do not seem to be very
particular about the boiling of our drinking-water—at least I can
attribute to no other cause certain attacks of a dysenteric nature,
from which both Knudsen and I have suffered for some time. If a
man like Omari has to be left unwatched for a moment, he is capable
of anything. Besides this complaint, we are inconvenienced by the
state of our nails, which have become as hard as glass, and crack on
the slightest provocation, and I have the additional infliction of
pimples all over me. As if all this were not enough, we have also, for
the last week been waging war against the jigger, who has found his
Eldorado in the hot sand of the Makonde plateau. Our men are seen
all day long—whenever their chronic colds and the dysentery likewise
raging among them permit—occupied in removing this scourge of
Africa from their feet and trying to prevent the disastrous
consequences of its presence. It is quite common to see natives of
this place with one or two toes missing; many have lost all their toes,
or even the whole front part of the foot, so that a well-formed leg
ends in a shapeless stump. These ravages are caused by the female of
Sarcopsylla penetrans, which bores its way under the skin and there
develops an egg-sac the size of a pea. In all books on the subject, it is
stated that one’s attention is called to the presence of this parasite by
an intolerable itching. This agrees very well with my experience, so
far as the softer parts of the sole, the spaces between and under the
toes, and the side of the foot are concerned, but if the creature
penetrates through the harder parts of the heel or ball of the foot, it
may escape even the most careful search till it has reached maturity.
Then there is no time to be lost, if the horrible ulceration, of which
we see cases by the dozen every day, is to be prevented. It is much
easier, by the way, to discover the insect on the white skin of a
European than on that of a native, on which the dark speck scarcely
shows. The four or five jiggers which, in spite of the fact that I
constantly wore high laced boots, chose my feet to settle in, were
taken out for me by the all-accomplished Knudsen, after which I
thought it advisable to wash out the cavities with corrosive
sublimate. The natives have a different sort of disinfectant—they fill
the hole with scraped roots. In a tiny Makua village on the slope of
the plateau south of Newala, we saw an old woman who had filled all
the spaces under her toe-nails with powdered roots by way of
prophylactic treatment. What will be the result, if any, who can say?
The rest of the many trifling ills which trouble our existence are
really more comic than serious. In the absence of anything else to
smoke, Knudsen and I at last opened a box of cigars procured from
the Indian store-keeper at Lindi, and tried them, with the most
distressing results. Whether they contain opium or some other
narcotic, neither of us can say, but after the tenth puff we were both
“off,” three-quarters stupefied and unspeakably wretched. Slowly we
recovered—and what happened next? Half-an-hour later we were
once more smoking these poisonous concoctions—so insatiable is the
craving for tobacco in the tropics.
Even my present attacks of fever scarcely deserve to be taken
seriously. I have had no less than three here at Newala, all of which
have run their course in an incredibly short time. In the early
afternoon, I am busy with my old natives, asking questions and
making notes. The strong midday coffee has stimulated my spirits to
an extraordinary degree, the brain is active and vigorous, and work
progresses rapidly, while a pleasant warmth pervades the whole
body. Suddenly this gives place to a violent chill, forcing me to put on
my overcoat, though it is only half-past three and the afternoon sun
is at its hottest. Now the brain no longer works with such acuteness
and logical precision; more especially does it fail me in trying to
establish the syntax of the difficult Makua language on which I have
ventured, as if I had not enough to do without it. Under the
circumstances it seems advisable to take my temperature, and I do
so, to save trouble, without leaving my seat, and while going on with
my work. On examination, I find it to be 101·48°. My tutors are
abruptly dismissed and my bed set up in the baraza; a few minutes
later I am in it and treating myself internally with hot water and
lemon-juice.
Three hours later, the thermometer marks nearly 104°, and I make
them carry me back into the tent, bed and all, as I am now perspiring
heavily, and exposure to the cold wind just beginning to blow might
mean a fatal chill. I lie still for a little while, and then find, to my
great relief, that the temperature is not rising, but rather falling. This
is about 7.30 p.m. At 8 p.m. I find, to my unbounded astonishment,
that it has fallen below 98·6°, and I feel perfectly well. I read for an
hour or two, and could very well enjoy a smoke, if I had the
wherewithal—Indian cigars being out of the question.
Having no medical training, I am at a loss to account for this state
of things. It is impossible that these transitory attacks of high fever
should be malarial; it seems more probable that they are due to a
kind of sunstroke. On consulting my note-book, I become more and
more inclined to think this is the case, for these attacks regularly
follow extreme fatigue and long exposure to strong sunshine. They at
least have the advantage of being only short interruptions to my
work, as on the following morning I am always quite fresh and fit.
My treasure of a cook is suffering from an enormous hydrocele which
makes it difficult for him to get up, and Moritz is obliged to keep in
the dark on account of his inflamed eyes. Knudsen’s cook, a raw boy
from somewhere in the bush, knows still less of cooking than Omari;
consequently Nils Knudsen himself has been promoted to the vacant
post. Finding that we had come to the end of our supplies, he began
by sending to Chingulungulu for the four sucking-pigs which we had
bought from Matola and temporarily left in his charge; and when
they came up, neatly packed in a large crate, he callously slaughtered
the biggest of them. The first joint we were thoughtless enough to
entrust for roasting to Knudsen’s mshenzi cook, and it was
consequently uneatable; but we made the rest of the animal into a
jelly which we ate with great relish after weeks of underfeeding,
consuming incredible helpings of it at both midday and evening
meals. The only drawback is a certain want of variety in the tinned
vegetables. Dr. Jäger, to whom the Geographical Commission
entrusted the provisioning of the expeditions—mine as well as his
own—because he had more time on his hands than the rest of us,
seems to have laid in a huge stock of Teltow turnips,[46] an article of
food which is all very well for occasional use, but which quickly palls
when set before one every day; and we seem to have no other tins
left. There is no help for it—we must put up with the turnips; but I
am certain that, once I am home again, I shall not touch them for ten
years to come.
Amid all these minor evils, which, after all, go to make up the
genuine flavour of Africa, there is at least one cheering touch:
Knudsen has, with the dexterity of a skilled mechanic, repaired my 9
× 12 cm. camera, at least so far that I can use it with a little care.
How, in the absence of finger-nails, he was able to accomplish such a
ticklish piece of work, having no tool but a clumsy screw-driver for
taking to pieces and putting together again the complicated
mechanism of the instantaneous shutter, is still a mystery to me; but
he did it successfully. The loss of his finger-nails shows him in a light
contrasting curiously enough with the intelligence evinced by the
above operation; though, after all, it is scarcely surprising after his
ten years’ residence in the bush. One day, at Lindi, he had occasion
to wash a dog, which must have been in need of very thorough
cleansing, for the bottle handed to our friend for the purpose had an
extremely strong smell. Having performed his task in the most
conscientious manner, he perceived with some surprise that the dog
did not appear much the better for it, and was further surprised by
finding his own nails ulcerating away in the course of the next few
days. “How was I to know that carbolic acid has to be diluted?” he
mutters indignantly, from time to time, with a troubled gaze at his
mutilated finger-tips.
Since we came to Newala we have been making excursions in all
directions through the surrounding country, in accordance with old
habit, and also because the akida Sefu did not get together the tribal
elders from whom I wanted information so speedily as he had
promised. There is, however, no harm done, as, even if seen only
from the outside, the country and people are interesting enough.
The Makonde plateau is like a large rectangular table rounded off
at the corners. Measured from the Indian Ocean to Newala, it is
about seventy-five miles long, and between the Rovuma and the
Lukuledi it averages fifty miles in breadth, so that its superficial area
is about two-thirds of that of the kingdom of Saxony. The surface,
however, is not level, but uniformly inclined from its south-western
edge to the ocean. From the upper edge, on which Newala lies, the
eye ranges for many miles east and north-east, without encountering
any obstacle, over the Makonde bush. It is a green sea, from which
here and there thick clouds of smoke rise, to show that it, too, is
inhabited by men who carry on their tillage like so many other
primitive peoples, by cutting down and burning the bush, and
manuring with the ashes. Even in the radiant light of a tropical day
such a fire is a grand sight.
Much less effective is the impression produced just now by the
great western plain as seen from the edge of the plateau. As often as
time permits, I stroll along this edge, sometimes in one direction,
sometimes in another, in the hope of finding the air clear enough to
let me enjoy the view; but I have always been disappointed.
Wherever one looks, clouds of smoke rise from the burning bush,
and the air is full of smoke and vapour. It is a pity, for under more
favourable circumstances the panorama of the whole country up to
the distant Majeje hills must be truly magnificent. It is of little use
taking photographs now, and an outline sketch gives a very poor idea
of the scenery. In one of these excursions I went out of my way to
make a personal attempt on the Makonde bush. The present edge of
the plateau is the result of a far-reaching process of destruction
through erosion and denudation. The Makonde strata are
everywhere cut into by ravines, which, though short, are hundreds of
yards in depth. In consequence of the loose stratification of these
beds, not only are the walls of these ravines nearly vertical, but their
upper end is closed by an equally steep escarpment, so that the
western edge of the Makonde plateau is hemmed in by a series of
deep, basin-like valleys. In order to get from one side of such a ravine
to the other, I cut my way through the bush with a dozen of my men.
It was a very open part, with more grass than scrub, but even so the
short stretch of less than two hundred yards was very hard work; at
the end of it the men’s calicoes were in rags and they themselves
bleeding from hundreds of scratches, while even our strong khaki
suits had not escaped scatheless.
NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAHUTA
I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.
MAKONDE LOCK AND KEY AT JUMBE CHAURO

This is the general way of closing a house. The Makonde at Jumbe
Chauro, however, have a much more complicated, solid and original
one. Here, too, the door is as already described, except that there is
only one post on the inside, standing by itself about six inches from
one side of the doorway. Opposite this post is a hole in the wall just
large enough to admit a man’s arm. The door is closed inside by a
large wooden bolt passing through a hole in this post and pressing
with its free end against the door. The other end has three holes into
which fit three pegs running in vertical grooves inside the post. The
door is opened with a wooden key about a foot long, somewhat
curved and sloped off at the butt; the other end has three pegs
corresponding to the holes, in the bolt, so that, when it is thrust
through the hole in the wall and inserted into the rectangular
opening in the post, the pegs can be lifted and the bolt drawn out.[50]
MODE OF INSERTING THE KEY
With no small pride first one householder and then a second

showed me on the spot the action of this greatest invention of the
Makonde Highlands. To both with an admiring exclamation of
“Vizuri sana!” (“Very fine!”). I expressed the wish to take back these
marvels with me to Ulaya, to show the Wazungu what clever fellows
the Makonde are. Scarcely five minutes after my return to camp at
Newala, the two men came up sweating under the weight of two
heavy logs which they laid down at my feet, handing over at the same
time the keys of the fallen fortress. Arguing, logically enough, that if
the key was wanted, the lock would be wanted with it, they had taken
their axes and chopped down the posts—as it never occurred to them
to dig them out of the ground and so bring them intact. Thus I have
two badly damaged specimens, and the owners, instead of praise,
come in for a blowing-up.
The Makua huts in the environs of Newala are especially
miserable; their more than slovenly construction reminds one of the
temporary erections of the Makua at Hatia’s, though the people here
have not been concerned in a war. It must therefore be due to
congenital idleness, or else to the absence of a powerful chief. Even
the baraza at Mlipa’s, a short hour’s walk south-east of Newala,
shares in this general neglect. While public buildings in this country
are usually looked after more or less carefully, this is in evident
danger of being blown over by the first strong easterly gale. The only
attractive object in this whole district is the grave of the late chief
Mlipa. I visited it in the morning, while the sun was still trying with
partial success to break through the rolling mists, and the circular
grove of tall euphorbias, which, with a broken pot, is all that marks
the old king’s resting-place, impressed one with a touch of pathos.
Even my very materially-minded carriers seemed to feel something
of the sort, for instead of their usual ribald songs, they chanted
solemnly, as we marched on through the dense green of the Makonde
bush:—
“We shall arrive with the great master; we stand in a row and have
no fear about getting our food and our money from the Serkali (the
Government). We are not afraid; we are going along with the great
master, the lion; we are going down to the coast and back.”
With regard to the characteristic features of the various tribes here
on the western edge of the plateau, I can arrive at no other
conclusion than the one already come to in the plain, viz., that it is
impossible for anyone but a trained anthropologist to assign any
given individual at once to his proper tribe. In fact, I think that even
an anthropological specialist, after the most careful examination,
might find it a difficult task to decide. The whole congeries of peoples
collected in the region bounded on the west by the great Central
African rift, Tanganyika and Nyasa, and on the east by the Indian
Ocean, are closely related to each other—some of their languages are
only distinguished from one another as dialects of the same speech,
and no doubt all the tribes present the same shape of skull and
structure of skeleton. Thus, surely, there can be no very striking
differences in outward appearance.
Even did such exist, I should have no time
to concern myself with them, for day after day,
I have to see or hear, as the case may be—in
any case to grasp and record—an
extraordinary number of ethnographic
phenomena. I am almost disposed to think it
fortunate that some departments of inquiry, at
least, are barred by external circumstances.
Chief among these is the subject of iron-
working. We are apt to think of Africa as a
country where iron ore is everywhere, so to
speak, to be picked up by the roadside, and
where it would be quite surprising if the
inhabitants had not learnt to smelt the
material ready to their hand. In fact, the
knowledge of this art ranges all over the
continent, from the Kabyles in the north to the
Kafirs in the south. Here between the Rovuma
and the Lukuledi the conditions are not so
favourable. According to the statements of the
Makonde, neither ironstone nor any other
form of iron ore is known to them. They have
not therefore advanced to the art of smelting
the metal, but have hitherto bought all their
THE ANCESTRESS OF
THE MAKONDE
iron implements from neighbouring tribes.
Even in the plain the inhabitants are not much
better off. Only one man now living is said to
understand the art of smelting iron. This old fundi lives close to
Huwe, that isolated, steep-sided block of granite which rises out of
the green solitude between Masasi and Chingulungulu, and whose
jagged and splintered top meets the traveller’s eye everywhere. While
still at Masasi I wished to see this man at work, but was told that,
frightened by the rising, he had retired across the Rovuma, though
he would soon return. All subsequent inquiries as to whether the
fundi had come back met with the genuine African answer, “Bado”
(“Not yet”).
BRAZIER
Some consolation was afforded me by a brassfounder, whom I

came across in the bush near Akundonde’s. This man is the favourite
of women, and therefore no doubt of the gods; he welds the glittering
brass rods purchased at the coast into those massive, heavy rings
which, on the wrists and ankles of the local fair ones, continually give
me fresh food for admiration. Like every decent master-craftsman he
had all his tools with him, consisting of a pair of bellows, three
crucibles and a hammer—nothing more, apparently. He was quite
willing to show his skill, and in a twinkling had fixed his bellows on
the ground. They are simply two goat-skins, taken off whole, the four
legs being closed by knots, while the upper opening, intended to
admit the air, is kept stretched by two pieces of wood. At the lower
end of the skin a smaller opening is left into which a wooden tube is
stuck. The fundi has quickly borrowed a heap of wood-embers from
the nearest hut; he then fixes the free ends of the two tubes into an
earthen pipe, and clamps them to the ground by means of a bent
piece of wood. Now he fills one of his small clay crucibles, the dross
on which shows that they have been long in use, with the yellow
material, places it in the midst of the embers, which, at present are
only faintly glimmering, and begins his work. In quick alternation
the smith’s two hands move up and down with the open ends of the
bellows; as he raises his hand he holds the slit wide open, so as to let
the air enter the skin bag unhindered. In pressing it down he closes
the bag, and the air puffs through the bamboo tube and clay pipe into
the fire, which quickly burns up. The smith, however, does not keep
on with this work, but beckons to another man, who relieves him at
the bellows, while he takes some more tools out of a large skin pouch
carried on his back. I look on in wonder as, with a smooth round
stick about the thickness of a finger, he bores a few vertical holes into
the clean sand of the soil. This should not be difficult, yet the man
seems to be taking great pains over it. Then he fastens down to the
ground, with a couple of wooden clamps, a neat little trough made by
splitting a joint of bamboo in half, so that the ends are closed by the
two knots. At last the yellow metal has attained the right consistency,
and the fundi lifts the crucible from the fire by means of two sticks
split at the end to serve as tongs. A short swift turn to the left—a
tilting of the crucible—and the molten brass, hissing and giving forth
clouds of smoke, flows first into the bamboo mould and then into the
holes in the ground.
The technique of this backwoods craftsman may not be very far
advanced, but it cannot be denied that he knows how to obtain an
adequate result by the simplest means. The ladies of highest rank in
this country—that is to say, those who can afford it, wear two kinds
of these massive brass rings, one cylindrical, the other semicircular
in section. The latter are cast in the most ingenious way in the
bamboo mould, the former in the circular hole in the sand. It is quite
a simple matter for the fundi to fit these bars to the limbs of his fair
customers; with a few light strokes of his hammer he bends the
pliable brass round arm or ankle without further inconvenience to
the wearer.
SHAPING THE POT
SMOOTHING WITH MAIZE-COB
CUTTING THE EDGE

FINISHING THE BOTTOM
LAST SMOOTHING BEFORE

BURNING
FIRING THE BRUSH-PILE

LIGHTING THE FARTHER SIDE OF
THE PILE
TURNING THE RED-HOT VESSEL
NYASA WOMAN MAKING POTS AT MASASI

Pottery is an art which must always and everywhere excite the
interest of the student, just because it is so intimately connected with
the development of human culture, and because its relics are one of
the principal factors in the reconstruction of our own condition in
prehistoric times. I shall always remember with pleasure the two or
three afternoons at Masasi when Salim Matola’s mother, a slightly-
built, graceful, pleasant-looking woman, explained to me with
touching patience, by means of concrete illustrations, the ceramic art
of her people. The only implements for this primitive process were a
lump of clay in her left hand, and in the right a calabash containing
the following valuables: the fragment of a maize-cob stripped of all
its grains, a smooth, oval pebble, about the size of a pigeon’s egg, a
few chips of gourd-shell, a bamboo splinter about the length of one’s
hand, a small shell, and a bunch of some herb resembling spinach.
Nothing more. The woman scraped with the
shell a round, shallow hole in the soft, fine
sand of the soil, and, when an active young
girl had filled the calabash with water for her,
she began to knead the clay. As if by magic it
gradually assumed the shape of a rough but
already well-shaped vessel, which only wanted
a little touching up with the instruments
before mentioned. I looked out with the
MAKUA WOMAN closest attention for any indication of the use
MAKING A POT. of the potter’s wheel, in however rudimentary
SHOWS THE a form, but no—hapana (there is none). The
BEGINNINGS OF THE embryo pot stood firmly in its little
POTTER’S WHEEL
depression, and the woman walked round it in
a stooping posture, whether she was removing
small stones or similar foreign bodies with the maize-cob, smoothing
the inner or outer surface with the splinter of bamboo, or later, after
letting it dry for a day, pricking in the ornamentation with a pointed
bit of gourd-shell, or working out the bottom, or cutting the edge
with a sharp bamboo knife, or giving the last touches to the finished
vessel. This occupation of the women is infinitely toilsome, but it is
without doubt an accurate reproduction of the process in use among
our ancestors of the Neolithic and Bronze ages.
There is no doubt that the invention of pottery, an item in human
progress whose importance cannot be over-estimated, is due to
women. Rough, coarse and unfeeling, the men of the horde range
over the countryside. When the united cunning of the hunters has
succeeded in killing the game; not one of them thinks of carrying
home the spoil. A bright fire, kindled by a vigorous wielding of the
drill, is crackling beside them; the animal has been cleaned and cut
up secundum artem, and, after a slight singeing, will soon disappear
under their sharp teeth; no one all this time giving a single thought
to wife or child.
To what shifts, on the other hand, the primitive wife, and still more
the primitive mother, was put! Not even prehistoric stomachs could
endure an unvarying diet of raw food. Something or other suggested
the beneficial effect of hot water on the majority of approved but
indigestible dishes. Perhaps a neighbour had tried holding the hard
roots or tubers over the fire in a calabash filled with water—or maybe
an ostrich-egg-shell, or a hastily improvised vessel of bark. They
became much softer and more palatable than they had previously
been; but, unfortunately, the vessel could not stand the fire and got
charred on the outside. That can be remedied, thought our
ancestress, and plastered a layer of wet clay round a similar vessel.
This is an improvement; the cooking utensil remains uninjured, but
the heat of the fire has shrunk it, so that it is loose in its shell. The
next step is to detach it, so, with a firm grip and a jerk, shell and
kernel are separated, and pottery is invented. Perhaps, however, the
discovery which led to an intelligent use of the burnt-clay shell, was
made in a slightly different way. Ostrich-eggs and calabashes are not
to be found in every part of the world, but everywhere mankind has
arrived at the art of making baskets out of pliant materials, such as
bark, bast, strips of palm-leaf, supple twigs, etc. Our inventor has no
water-tight vessel provided by nature. “Never mind, let us line the
basket with clay.” This answers the purpose, but alas! the basket gets
burnt over the blazing fire, the woman watches the process of
cooking with increasing uneasiness, fearing a leak, but no leak
appears. The food, done to a turn, is eaten with peculiar relish; and
the cooking-vessel is examined, half in curiosity, half in satisfaction
at the result. The plastic clay is now hard as stone, and at the same
time looks exceedingly well, for the neat plaiting of the burnt basket
is traced all over it in a pretty pattern. Thus, simultaneously with
pottery, its ornamentation was invented.
Primitive woman has another claim to respect. It was the man,
roving abroad, who invented the art of producing fire at will, but the
woman, unable to imitate him in this, has been a Vestal from the
earliest times. Nothing gives so much trouble as the keeping alight of
the smouldering brand, and, above all, when all the men are absent
from the camp. Heavy rain-clouds gather, already the first large
drops are falling, the first gusts of the storm rage over the plain. The
little flame, a greater anxiety to the woman than her own children,
flickers unsteadily in the blast. What is to be done? A sudden thought
occurs to her, and in an instant she has constructed a primitive hut
out of strips of bark, to protect the flame against rain and wind.
This, or something very like it, was the way in which the principle
of the house was discovered; and even the most hardened misogynist
cannot fairly refuse a woman the credit of it. The protection of the
hearth-fire from the weather is the germ from which the human
dwelling was evolved. Men had little, if any share, in this forward
step, and that only at a late stage. Even at the present day, the
plastering of the housewall with clay and the manufacture of pottery
are exclusively the women’s business. These are two very significant
survivals. Our European kitchen-garden, too, is originally a woman’s
invention, and the hoe, the primitive instrument of agriculture, is,
characteristically enough, still used in this department. But the
noblest achievement which we owe to the other sex is unquestionably
the art of cookery. Roasting alone—the oldest process—is one for
which men took the hint (a very obvious one) from nature. It must
have been suggested by the scorched carcase of some animal
overtaken by the destructive forest-fires. But boiling—the process of
improving organic substances by the help of water heated to boiling-
point—is a much later discovery. It is so recent that it has not even
yet penetrated to all parts of the world. The Polynesians understand
how to steam food, that is, to cook it, neatly wrapped in leaves, in a
hole in the earth between hot stones, the air being excluded, and
(sometimes) a few drops of water sprinkled on the stones; but they
do not understand boiling.
To come back from this digression, we find that the slender Nyasa
woman has, after once more carefully examining the finished pot,
put it aside in the shade to dry. On the following day she sends me
word by her son, Salim Matola, who is always on hand, that she is
going to do the burning, and, on coming out of my house, I find her
already hard at work. She has spread on the ground a layer of very
dry sticks, about as thick as one’s thumb, has laid the pot (now of a
yellowish-grey colour) on them, and is piling brushwood round it.
My faithful Pesa mbili, the mnyampara, who has been standing by,
most obligingly, with a lighted stick, now hands it to her. Both of
them, blowing steadily, light the pile on the lee side, and, when the
flame begins to catch, on the weather side also. Soon the whole is in a
blaze, but the dry fuel is quickly consumed and the fire dies down, so
that we see the red-hot vessel rising from the ashes. The woman
turns it continually with a long stick, sometimes one way and
sometimes another, so that it may be evenly heated all over. In
twenty minutes she rolls it out of the ash-heap, takes up the bundle
of spinach, which has been lying for two days in a jar of water, and
sprinkles the red-hot clay with it. The places where the drops fall are
marked by black spots on the uniform reddish-brown surface. With a
sigh of relief, and with visible satisfaction, the woman rises to an
erect position; she is standing just in a line between me and the fire,
from which a cloud of smoke is just rising: I press the ball of my
camera, the shutter clicks—the apotheosis is achieved! Like a
priestess, representative of her inventive sex, the graceful woman
stands: at her feet the hearth-fire she has given us beside her the
invention she has devised for us, in the background the home she has
built for us.
At Newala, also, I have had the manufacture of pottery carried on
in my presence. Technically the process is better than that already
described, for here we find the beginnings of the potter’s wheel,
which does not seem to exist in the plains; at least I have seen
nothing of the sort. The artist, a frightfully stupid Makua woman, did
not make a depression in the ground to receive the pot she was about
to shape, but used instead a large potsherd. Otherwise, she went to
work in much the same way as Salim’s mother, except that she saved
herself the trouble of walking round and round her work by squatting
at her ease and letting the pot and potsherd rotate round her; this is
surely the first step towards a machine. But it does not follow that
the pot was improved by the process. It is true that it was beautifully
rounded and presented a very creditable appearance when finished,
but the numerous large and small vessels which I have seen, and, in
part, collected, in the “less advanced” districts, are no less so. We
moderns imagine that instruments of precision are necessary to
produce excellent results. Go to the prehistoric collections of our
museums and look at the pots, urns and bowls of our ancestors in the
dim ages of the past, and you will at once perceive your error.
MAKING LONGITUDINAL CUT IN
BARK
DRAWING THE BARK OFF THE LOG
REMOVING THE OUTER BARK

BEATING THE BARK
WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

SOFT
MANUFACTURE OF BARK-CLOTH AT NEWALA

To-day, nearly the whole population of German East Africa is
clothed in imported calico. This was not always the case; even now in
some parts of the north dressed skins are still the prevailing wear,
and in the north-western districts—east and north of Lake
Tanganyika—lies a zone where bark-cloth has not yet been
superseded. Probably not many generations have passed since such
bark fabrics and kilts of skins were the only clothing even in the
south. Even to-day, large quantities of this bright-red or drab
material are still to be found; but if we wish to see it, we must look in
the granaries and on the drying stages inside the native huts, where
it serves less ambitious uses as wrappings for those seeds and fruits
which require to be packed with special care. The salt produced at
Masasi, too, is packed for transport to a distance in large sheets of
bark-cloth. Wherever I found it in any degree possible, I studied the
process of making this cloth. The native requisitioned for the
purpose arrived, carrying a log between two and three yards long and
as thick as his thigh, and nothing else except a curiously-shaped
mallet and the usual long, sharp and pointed knife which all men and
boys wear in a belt at their backs without a sheath—horribile dictu!
[51]
Silently he squats down before me, and with two rapid cuts has
drawn a couple of circles round the log some two yards apart, and
slits the bark lengthwise between them with the point of his knife.
With evident care, he then scrapes off the outer rind all round the
log, so that in a quarter of an hour the inner red layer of the bark
shows up brightly-coloured between the two untouched ends. With
some trouble and much caution, he now loosens the bark at one end,
and opens the cylinder. He then stands up, takes hold of the free
edge with both hands, and turning it inside out, slowly but steadily
pulls it off in one piece. Now comes the troublesome work of
scraping all superfluous particles of outer bark from the outside of
the long, narrow piece of material, while the inner side is carefully
scrutinised for defective spots. At last it is ready for beating. Having
signalled to a friend, who immediately places a bowl of water beside
him, the artificer damps his sheet of bark all over, seizes his mallet,
lays one end of the stuff on the smoothest spot of the log, and
hammers away slowly but continuously. “Very simple!” I think to
myself. “Why, I could do that, too!”—but I am forced to change my
opinions a little later on; for the beating is quite an art, if the fabric is
not to be beaten to pieces. To prevent the breaking of the fibres, the
stuff is several times folded across, so as to interpose several
thicknesses between the mallet and the block. At last the required
state is reached, and the fundi seizes the sheet, still folded, by both
ends, and wrings it out, or calls an assistant to take one end while he
holds the other. The cloth produced in this way is not nearly so fine
and uniform in texture as the famous Uganda bark-cloth, but it is
quite soft, and, above all, cheap.
Now, too, I examine the mallet. My craftsman has been using the
simpler but better form of this implement, a conical block of some
hard wood, its base—the striking surface—being scored across and
across with more or less deeply-cut grooves, and the handle stuck
into a hole in the middle. The other and earlier form of mallet is
shaped in the same way, but the head is fastened by an ingenious
network of bark strips into the split bamboo serving as a handle. The
observation so often made, that ancient customs persist longest in
connection with religious ceremonies and in the life of children, here
finds confirmation. As we shall soon see, bark-cloth is still worn
during the unyago,[52] having been prepared with special solemn
ceremonies; and many a mother, if she has no other garment handy,
will still put her little one into a kilt of bark-cloth, which, after all,
looks better, besides being more in keeping with its African
surroundings, than the ridiculous bit of print from Ulaya.
MAKUA WOMEN

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Pharmacy Management, Leadership,

Marketing, and Finance (Book Only)

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Chapter 13 Developing and Evaluating Clinical Abbreviations.........................................................233

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Common Policy Conditions.......................................358

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Compensation Strategy 2: Performance Evaluation Methods..............................440

Step 2: Define Position Requirements...............420 Chapter 26 Understanding and Applying

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Chapter 32 Managing Your Time............................. 548 Establishing Essential Rituals..........................559

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topics addressed in the text, and other features and activi-

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Joseph T. DiPiro, PharmD Tad A. Gomez, RPh, MS

Sharon Murphy Enright, RPh, MBA Elizabeth A. Hall-Lipsy, JD, MPH

Joseph W. Ferullo, PharmD, RPh Dana P. Hammer, MS, PhD

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Amy K. Kennedy, PharmD, BCACP Kathryn R. Matthias, PharmD, BCPS

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Megan Wagner, PharmD Donna S. West-Strum, RPh, PhD

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Jack Brown, PharmD, MS, BCPS Arjun P. Dutta, BPharm, PhD

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Lois A. Garland-Patterson, PhD, MBA, BSPharm Andrea L. McKeever, PharmD, BCPS

J. Russell May, PharmD, FASHP Anne Policastri, PharmD, MBA

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Stacy Ramirez, PharmD Marie A. Smith, PharmD

Nisaratana Sangasubana, PhD Keith Yoshizuka, PharmD, MBA, JD

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Chapter 1 Management Essentials for Pharmacists . . . . . . . . . . . . . . . . . . . . . . . 3

Chapter 2 Leadership Essentials for Pharmacists . . . . . . . . . . . . . . . . . . . . . . . 23

Chapter 3 Communicating Effectively in the Workplace . . . . . . . . . . . . . . . . . . 38

Chapter 4 Managing Conflict and Building Consensus . . . . . . . . . . . . . . . . . . . . 53

Chapter 5 Negotiation Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

Chapter 6 Leading and Managing Change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

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1. Define management and list some management opportunities for pharmacists.

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Table 1-1 Examples of Pharmacy Management Career Opportunities

Setting Managerial Role

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Table 1-2 Examples of Nonmonetary Motivators

Method Description Examples in Pharmacy Practice

Table 1-3 Factors Influencing Motivation

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Newala, too, suffers from the distance of its water-supply—at least

The water-supply of New Newala is in the bottom of the valley,

NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAKONDE LOCK AND KEY AT JUMBE CHAURO

MODE OF INSERTING THE KEY

With no small pride first one householder and then a second

Some consolation was afforded me by a brassfounder, whom I