Managers, health care professionals

With the Code of Ethics suggesting that pharmacists not discuss drug therapies with their patients, the profession lost sight of the need for pharmacists to communicate effectively with patients and other health care professionals. As the number of hospital and chain pharmacies expanded, resulting in pharmacists being more likely to be employees rather than business owners, the importance of practice management skills was not stressed in schools of pharmacy. Ironically, studies such as the Dichter Report commissioned by the APhA revealed that consumers regarded pharmacists more as merchants than as health care professionals (Maine and Penna, 1996). 

The Millis Commission s report in 1975, Pharmacists for the Future The Report of the Study Commission on Pharmacy (Millis, 1975), suggested that pharmacists were inadequately prepared in systems analysis and management skills and had particular deficiencies in communicating with patients, physicians, and other health care professionals. A subsequent report suggested including more of the behavioral and social sciences in pharmacy curricula and encouraged more faculty participation and research in real problems of practice (Millis, 1976). 

Another resource that is very important to managers is people. In pharmacy practice, there is very little that any one person can accomplish on his or her own, regardless of the practice setting. Pharmacists must work with other employees in their pharmacies, other health care professionals, and especially the patients and customers they serve. Given the importance of this topic, an entire section of this book (Chapters 8 through 14) is dedicated to the management of people. 

Health care demands both the suppression and expression of emotion and skills to know and manage feelings appropriately (Ovretveit, 2001). Emotional regulation in the workplace has been termed emotional labor and is particularly important to health care professionals. Emotional labor is defined as expressing organizationally desired emotions during service transactions (Hochschild, 1983). The difference between the emotions that an individual expresses and those he or she actually feels can be the basis of emotional exhaustion. 

Applebaum SH, Rohrs WF. 1981. Time Management for Health Care Professional. Rockville, MD Aspen Systems. 

About the Author Dr. Doucette is a Professor in the Division of Clinical and Administrative Pharmacy at the College of Pharmacy of the University of Iowa. He received a B.S. in pharmacy, an M.S. in pharmacy administration, and a Ph.D. in social and administrative sciences in pharmacy from the University of Wisconsin. He has managed several community pharmacies. His teaching interests are in pharmacy management and marketing of health care, whereas his primary research interest is evaluating pharmacy services and collaboration between pharmacists and other health care professionals. Dr. Doucette has published his work in many pharmacy journals. 

Medicaid is supervised by CMS but is administered by each individual state. In Medicaid, each state determines the list of health care professionals who can be considered as providers. For pharmacists to be considered providers of patient care services for Medicaid, the state can develop a Medicaid demonstration project (Snella, 1999). One example of a demonstration project is the Mississippi Medicaid project in which pharmacists were compensated for services such as asthma, diabetes, and hyperlipidemia management (Anonymous, 1998 Landis, 1998). 

A STATE PRACTICE ACT/BOARD OF PHARMACY PROVISION Trudy Hamilton, Pharm.D., is a licensed pharmacist and is currently the manager of a hospital pharmacy department. In the state where Dr. Hamilton is licensed, nonpharmacist personnel are prohibited by both statute (the state pharmacy practice act) and state board of pharmacy regulation from engaging in activities defined as the practice of pharmacy. The specific activities that fall within the definition of the practice of pharmacy are limited to being personally performed by licensed pharmacists only. Such activities include counseling patients about their medications and responding to drug information requests from other health care professionals (e.g., physicians and nurses). 

In professional bureaucracies, fhe patient is the central focus. All members of the organization, or team, have a primary goal in mind — for health care professionals this is improvement in the health and well-being of the patient. As such, health care professionals and not the managers develop the standards by which the patient is cared for. However, one of the drawbacks to this model is the potential for conflict among the professionals themselves, because many of fhe professionals will exercise expert or charismatic power and (most likely) the physician has primary legitimate power. 

Women health care professionals may also experience unique sets of challenges and expectations within their work environments. It has been found that women see work as a means of self-fulfillment and professional autonomy and consequently may hold higher expectations for their careers than men (Muldary, 1983). Moreover, women health professionals who manage families in addition to their jobs have expectations to fulfill as professionals as well as wives or mothers. Expectations from each role can carry over into the other contexts and can result in little time for women to meet their personal needs. Another problem that can be experienced by women professionals is real or perceived sexism. Although beyond the scope of this chapter, real or perceived sexism can result in added frustrations and resentments that could further contribute to burnout. 

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