.: Community Pharmacist :. Special Feature :.

“Everybody knows” that getting information in an organized manner from customers and key suppliers makes sense. But, what they sometimes wonder is if the time and expense of convening a formal advisory board is really necessary. “After all,” they say, “our people are well connected and know what is going on.”

Over the course of my career I have authorized, sat on and facilitated a number of industry advisory boards and strategic planning sessions. Some of them have been great, most of them have been okay, and yes, a few have been a complete waste of time. But, I am still a believer that a well run meeting can provide much value and therefore postulate three ways they can benefit you.

Several months ago, I facilitated a Supplier Advisory Board (SAB) for Vital Care Inc., a franchisor to home infusion pharmacies. During the meeting staff members were discussing problems associated with keeping their franchised pharmacies up to date on regulatory changes, reimbursement issues, purchasing contracts and other time critical items. The company printed a monthly newsletter and mailed it to each of their locations. But it was apparent that many pharmacies were not taking advantage of the information they were getting from the home office.

Staff came to the SAB with a plan to change to an electronic newsletter. This, they said, would let them know which locations had opened the newsletter. The idea was well thought out and well presented. Under normal internal operating procedures the switch from the printed version to the new electronic version would have been a “no brainer.”

But, as the SAB discussed the issue and started asking questions of the franchise owners in the meeting, a better idea emerged. Everyone agreed that electronic documents rarely got printed-out or forwarded from one person to the other. Then it was mentioned that various home office departments wrestled with coming up with copy that was new or important in conjunction with publication deadlines. Finally, one SAB member who needed to communicate with hundreds of independent pharmacies said they still found no better way to get information into the hands of pharmacists than via fax.

The result: Vital Care designed a new faxable newsletter and important information was sent to each franchise location as soon as the information could be written up by the department that had the information. Chuck Bell, former CEO of Vital Care Inc. says, “The idea for a faxable newsletter would never have come from our staff. And the new procedure resulted in less work for us and improved communications with our franchisees.” He further indicated the new process also meant no one needed to produce content to just meet a deadline, and that since every pharmacy is accustomed to checking their fax machine several times a day, no important information went unnoticed.

Think about it. How many times have you and other members of your team come up with good ideas but never really found the time, energy or were able to marshal the internal resources to do it? Getting the power of an advisory board behind such an idea can often be just what you need to get going.

A few years ago, I had the privilege of running a strategic planning session for the Chain Drug Marketing Association (CDMA). The agenda called for discussing the findings of a special member survey I had done along with conducting a SWOT analysis and then moderating a brainstorming session.

It was well known to the CDMA staff that one of the key functions of the organization was to help its retail members more effectively manage the front-end of their drugstores. Indeed, of the 80 members that took the survey, 79 of them answered yes to the question “is CDMA having a front-end focus important to you?”

So, it was no surprise that at the conclusion of the two-day strategic planning session, the board instructed the staff to concentrate on finding sources of general and promotional merchandise and to re-energize their efforts on traditional drugstore front-end operations. Coming out of the meeting, the senior management staff came away with a clearer vision of what it was they needed to do to insure CDMA remained important to its members.

Shortly thereafter, the association’s monthly newsletter changed its name to The Front End Focus and all membership and marketing documents where redesigned with front-end related graphic and content changes. The organization has continued to prosper, and despite the economic downturn and the sale of some regional drugstore chain members to national chains, Jim Devine, CEO of the association says, “This year will be the most successful financial year in the history of our organization.” It appears that the simple fact of confirming what was already known and being given marching orders to move in that direction gave CDMA staff the “umph” they needed to refocus and re-direct their programs and services.

Earlier this year, after several months of wavering on the idea, Smith Drug invited me to help organize a Retail Advisory Board (RAB) meeting with about a dozen of their customers. The meeting went well and provided Smith Drug with an opportunity to listen and learn from store owners about things they liked about the company.

The internal management team took away several actionable ideas on ways to improve their marketing programs and boost attendance at their annual meeting. But, after the meeting was over and the minutes and follow up items had been tabulated, there was one thing that really seemed to stand out — the customers were honored to have been asked to serve and they left with a much stronger commitment to their host.

A few weeks later, in talking with Rick Simerly, senior vice president of Business Development, he said, “Now that the meeting is over, I think the most important thing we got out of the meeting was a more positive and productive relationship with those that participated.”

During the meeting it was interesting to watch the RAB members compare notes and share ideas on how they had tackled various issues. It was clear all the pharmacy owners left the meeting having gained a better understanding of all the support programs Smith offered. They also knew more about the legal and regulatory problems distributors face. Several attendees told me that when they got back home they planned to work more creatively with their sales representative to solve their problems by taking fuller advantage of their wholesaler’s programs.

Let me close by mentioning one important caveat — advisory boards are much more effective if they have a carefully articulated purpose and proposed outcome. As I have worked with clients to prepare for these kinds of meetings, I have insisted that the executive upon whose authority the meeting was to be convened agree to spend time with me and create a formal charter.

The charter defines if the meeting will be a one and done event, or if it is expected the board will “take on a life” and continue to operate with tasks assigned and reported on over time. The charter also outlines how members are to be selected, how long they will serve, how they will be invited to participate and if any compensation or honorariums are to be awarded. The most important element of the charter is that it needs to be circulated internally with all the managers whose responsibilities will be impacted by the board and get their buy-in. Only after these things are done can you be comfortable that the time, effort and resources you devote to your advisory board or planning session will prove productive.

About the Author: Bruce Kneeland is the president of PharmacyConnections, a firm that provides assistance to wholesalers, health care product suppliers and health care service providers. The company offers various services that focus on the needs of drugstores and consumers. Kneeland can be reached at 610-792-2477 or at bruce@pharmacyconnections.com.

This article is about a taboo subject, a subject that we do not talk about ¾ suicide.

This is dedicated to all pharmacy professionals who have lost their lives due to chemical dependency and/or suicide. It is especially dedicated to one Iowa pharmacist who, through the tragedy of his death, has inspired all of us involved in recovery in Iowa to be aware of what we are doing with pharmacy professionals.

This pharmacist was suspected of diverting medications at a chain pharmacy. The loss prevention department was called in to investigate. They caught his diversion on tape. He was confronted late at night at the end of his shift with all of the evidence. He was fired and he was arrested. He was released from jail sometime in the middle of the night. He got into his car and drove across the state of Nebraska and checked into a hotel. He committed suicide.

I heard through mutual friends of another pharmacist who had died. He was a casual acquaintance and I was saddened by the loss. I didn’t know him well. It was about four months later when someone almost whispered to me that he had died of suicide. Why is it so hard to talk about suicide? Why do we keep these facts a secret? Why is there so much shame about this topic?

The purpose of this article will be to give us language to break the shame and silence about suicide within the pharmacy profession. To begin the discussion, the statistics from the Center for Disease Control reveal that more than 32,000 suicides occurred in the United States in 2005. This is the equivalent of 89 suicides per day; one suicide every 16 minutes of 11.05 suicides per 100,000 in population. Males take their own lives at nearly four times the rate of females. Firearms are the most commonly used method of suicide among males and poisoning is the most common method of suicide for females.

The number of deaths from suicide reflects only a small portion of the impact of suicidal behavior. In 2002, more than 90,000 people were hospitalized following suicide attempts. More than 32,000 were treated in hospital emergency departments for deliberate self harm. Deaths and injuries from suicidal behavior represent a substantial drain on the economic, social, and health resources of the nation.

There are no agencies that are keeping records by profession of those who are committing suicide. The CDC does not keep these statistics. Some professions have attempted to compile this data for their profession, but due to the silence, guilt and shame of suicide, it has been a difficult, if not impossible, task. Health care professionals are considered to be at high risk.

u Long hours ¾ How many of us have worked 12 hours without a break? Have you worked more than that? How can someone take care of themselves when they are working that much?

u Lack of personal interests ¾ How can personal interests take the forefront when the profession demands so much?

u High stress ¾ We truly have other people’s lives in our hands. The consequences of making a mistake can be life and death.

u Perfectionism ¾ We have to perform perfectly. There is no room for error. We spend hours on quality control, hours trying to figure out how to do our jobs perfectly.

u Knowledge of medications ¾ You would not think of this as a liability, but it may be. We may think that we know everything about medications, possibly even better than doctors. This thinking may put us at risk for addiction, believing that we are not at risk, and consequently suicide.

u Knowledge of disease states ¾ Facing a possible terminal illness and all of its consequences, knowing the path a person has to take when confronting this illness, suicide becomes an option.

u Co-dependency ¾ taking care of others rather than yourself. Pharmacists are always focusing outside of themselves, putting others’ needs ahead of your own.

Professional shame is a term that we use to describe the feelings professionals feel about harming their profession. Professional shame occurs when the professional makes a mistake.

There is no room for mistakes so the person starts to believe he or she is a mistake.

Professional shame manifests itself in pharmacy professionals who are addicted to drugs and alcohol. We are the experts for medications, so when we violate this trust by using drugs, we are susceptible to professional shame. Professionals hold themselves to a higher standard. We can recognize addiction in the general public but not around an addict within our midst. Addicts in our field are not forgiven.

There is a difference between guilt and shame. Shame is about who you are and guilt is about what you did. Guilt can be remedied through acknowledgement and restitution. Shame is more difficult to confront.

The signs of “acute risk” for suicide by the American Association of Suicidology are threatening to hurt or kill him/herself, or talking of wanting to hurt or kill him/herself; looking for ways to kill him/herself by seeking access to firearms, available pills, or other means; and/or, talking of writing about death, dying or suicide, when these actions are out of the ordinary. If someone actually has a plan for committing suicide, and they are expressing this plan, we have to take it seriously. This is considered ideation.

I continue to bring up the topic to individuals in the IPRN program. What I ask is “Are you thinking about harming yourself?” “Are you suicidal?” “Do you have a plan for harming yourself?” “Are you feeling hopeless?” Just talking about the subject can take the power away from it. Many times I will have them make a contract with me and promise not to harm themselves. I will say, “will you promise to call me before you harm yourself.” Getting someone to make this commitment may give them that moment to think before acting on their suicidal thinking. Knowing that someone else is aware of your decision and that you have made a promise to them can take the power out of that decision.

We need to start to talk about suicide and ask those difficult questions. You do not have to be an expert to ask.

We need strategies, especially when pharmacy professionals are being confronted at their jobs due to impairment. We need to directly talk about this risk. No one is responsible for the actions of the person who chooses suicide over life, but we could at least provide hope in a seemingly hopeless situation. I hope no pharmacists, student pharmacist or pharmacy technician has to go through what the Iowa pharmacist who died in that hotel had to go through. I hope we can provide hope for those who believe the only way out is suicide.

Emily Dykstra, RPh, is the monitor for the Iowa Pharmacy Recovering Network. IPRN is a monitoring and advocacy peer-review program for the purpose of assisting pharmacy professionals who struggle with addiction or disabilities that are potentially threatening to professional performance and public safety. Services provided by IPRN are intended to be in the best interest of the professional and the public. IPRN’s activities are designed to preserve the involved professional’s reputation and ability to render competent and quality pharmaceutical care. Emily can be contacted at Emily@proheights.com.