I was very lucky. I had a good boss. He made me the pharmacy manager of the pharmacy in the main hospital. This was shortly after our hospital merged with a smaller hospital. He was the Director of Pharmacy at this smaller hospital.
He made a woman the pharmacy manager of the pharmacy at the sister hospital. He retained his title of Director of Pharmacy, but now he was over the pharmacy departments in both facilities. He also kept his office at the sister hospital, while I was stationed at the main hospital’s pharmacy.
Which was good, especially for me. He would call me each morning from the sister hospital. He would always ask how everything was. And he always hoped that I would say “fine” and let him get off the phone as quickly as possible.
This was because my boss knew I could do the job. He didn’t have to micromanage me or have me check in with him every time a decision needed to be made.
Each day that I came to work there were certain things that needed to be done. Some involved other departments while some involved individuals. Some involved face-to-face meetings while others involved emails. And some involved the day-to-day tasks of running a pharmacy department.
Everything got done. If I needed my boss for help or guidance— he was there. If not, he wasn’t. I kept him in the loop, but did things my way. But most important, I always let him know when things were accomplished.
There were many times when I worked with the other pharmacy manager. We had to prepare reports about a Joint Commission initiative or some quality control project. Our administrators required these reports and needed them by a certain date.
I remember going to my sister hospital’s pharmacy to work with my colleague. We would spend several hours carefully working on a report or designing a detailed graph. I must say that our projects were gorgeous. They always received raves and high marks from administration. Ours were the best!
There was one time when my boss, the Director of Pharmacy, came into our meeting. He wanted to see how we were doing. We kicked him out of the meeting until we were finished. This seemed to be the standard practice with my boss— don’t involve him unless you need him.
He didn’t have a problem with this arrangement. Neither did I.
Working With My Boss
Whether you’re a staff member, a manager, or a CEO of a corporation, everyone has a boss. In fact, unless you own your own business, everyone reports to someone.
I was very fortunate. I had several good relationships with the bosses that I had. They all respected me and I respected them.
Most of the time, my boss and I were on the same wavelength. For the most part, I would say that 90% of the time we saw eye to eye.
I considered 90% as a very, very good benchmark. Now I knew that it was unreasonable to expect it to be 100%. After all, sometimes a boss has to play boss. And I was fine with that. So I was very pleased with 90%.
One of the most important things I knew was to never embarrass my boss in public. I would never humiliate my boss at a meeting or in front of others. Only afterwards, when everyone had gone, could I look at my boss and exclaim, “Are you crazy!!...”
But again, that was only possible because of the respect and admiration that my boss and I had for one another.
Dealing With Administration
When I worked in my various hospitals, I answered to one boss. This was the Director of Pharmacy. He was the person directly above [my department and] me in the facility’s chain of command.
But he wasn’t the only one. Because even though it was unofficial, many times I felt that [my department and] I reported to the following individuals:
1. The Vice-President of Professional Services,
2. The Chief Medical Director,
3. The Chief Financial Officer (CFO),
4. The Chief Executive Officer (CEO),
5. The Pharmacy and Therapeutics Chairperson,
6. The Quality Control/Risk Manager,
7. The Hospital Lawyer,
8. The Vice- President of Human Resources,
9. Any Physician, and
10. Anyone else who wanted something from Pharmacy.
It was not usual for my boss (my real boss, the Director of Pharmacy) to call me and tell me that he had ten bosses and they all wanted him to do something.
Fortunately most of the time, it involved drug prices. Which was good. Because I was a numbers person.
I learned my craft from my former boss. She was Director of Pharmacy prior to the gentleman that I’ve been writing about. She had her Master of Business Administration (MBA) and had numbers and data on everything.
My former boss knew the individual price, usage, and total costs of every drug used in the pharmacy. She prepared detailed monthly and end-of-year budget statements where she broke down everything into specific categories. And she was very well versed in computer programs such as Microsoft Excel and Microsoft Powerpoint. This allowed her to create these beautiful graphs and presentations.
It’s no wonder that the chief financial officer (CFO) of the hospital often stated that my former boss knew more about finance than the Finance Department.
I was the same way. My former boss allowed me to enroll in several Microsoft Excel courses. Soon I was creating embedded charts and a variety of graphs in an array of pretty colors.
I kept data and compiled reports on:
1. Monthly and year-to-date antibiotic costs and usage,
2. Monthly and year-to-date chemotherapy costs and usage,
3. Top ten most expensive drugs, costs and usage,
4. Staffing, manpower, and FTEs,
5. Costs of drugs vs. patient days, and
6. A real-time tabulation of monthly costs.
In addition, I enhanced these reports with charts and graphs where appropriate.
All my data provided a good overview of the pharmacy department. But the information that was most admired was the “real-time tabulation of monthly costs.”
For this report, I created a spreadsheet. Whenever the pharmacy purchased medications, IVs, or supplies, I would list the date, company, invoice number, and cost of the items. This was done when the items were ordered, not necessarily when they came in.
The same thing was done when it came to credits. Items were logged when the transaction occurred, not when the were returned or posted to a company’s account.
Thus, the benefit was that at any time, I could provide an exact, real-time departmental expense of items purchased or credited in a given month.
Administrators loved this data— particularly the hospital’s chief financial officer (CFO). Previously, he would have to wait 5-7 days for the month’s invoices to post before he knew what the pharmacy’s expenses were. But because of my report, he had the information immediately.
He constantly praised myself and the pharmacy department.
Battling With Human Resources
My Human Resources Department had a Director of Human Resources. It had a Human Resources Manager. It had several recruiters and one or two secretaries.
My Pharmacy Department had a Director of Pharmacy. It had a Pharmacy Manager. It had several pharmacists and pharmacy technicians.
The Human Resources Manager and I (the Pharmacy Manager) were both on the same managerial level. Furthermore, there was no solid or dotted line on the hospital’s departmental flow chart. The Pharmacy did not report to Human Resources. But, it sure seemed that way!
Many times my boss and I would have to run something that we were about to do by Human Resources to see if it was appropriate. In addition, many times Human Resources would criticize my boss and me for not checking with them before doing something.
I didn’t mind being yelled at by my boss or some other person in the hospital’s administration. But to be berated by the Human Resources Manager— a person on the same managerial level as I was? Well, the didn’t seem quite right!
I often felt that the manager of a department is a lot like a parent. All parents are different. Just because one parent acts one way and another parent acts another way doesn’t mean that one is better than the other. Especially if both methods are getting good results.
I was the “nice” manager. I listened to my staff. I empowered my staff. I helped them out whenever I could and they helped me out whenever they could. We also respected each other.
I also protected my staff. I was there for them. I thanked my staff for everything they did. And I never threw my staff under the bus.
My staff and I got things done. Everyone knew that when things were achieved, it was due to a group effort. My staff and I shared the credit for these accomplishments. And we celebrated them together.
Most bosses weren’t like me. But then again, I wasn’t like most bosses. I always felt that it irked many of the other managers, because they wanted to have a relationship with their staff and run their department like I did. But they weren’t able to.
Fighting With Nurses
I never really knew why my pharmacy and the nursing staffs always clashed . Quite often we were always at odds with each other. Nursing often wanted something from Pharmacy. Or they wanted the pharmacy to do something. Yet, even when pharmacy cited valid reasons why something couldn’t or shouldn’t be done, nursing would never back down.
Nursing also had no problem pushing the issue up the facility’s chain of command. Pharmacy would never do this. My boss would never want his boss to become involved with a pharmacy-nursing issue, even if the pharmacy were totally correct. In fact, my boss would rather give in to nursing than have the problem escalate up the corporate ladder.
But nursing had no problem involving their superiors. Quite often they would contact their head nurses, nursing supervisors, or vice-presidents. They would even meet with the hospital's chief executive officer (CEO) or chief operating officer (COO) to make their case in order to get what they wanted.
I remember a time when a physician wrote for a drug that was ten times the correct medication dosage. The dose was supposed to be 25 mg., instead he wrote 250mg. It was clearly a mistake.
While we were attempting to contact the physician, in order to correct the medication order, we received a phone call from the patient’s nurse. She was demanding that the pharmacy send her the 250mg dosage.
I tried to explain to the nurse on the phone that the physician made an error and had written for a dose that was ten times the correct medication dosage.
The nurse wouldn’t listen to anything I said. She yelled and screamed. She insisted that the pharmacy send her the 250mg dosage or she would tell her head nurse, her nursing supervisor, and the vice-president of nursing.
I went upstairs and met with the nurse. I showed her one 25mg capsule. I explained to her that if she wanted to give her patient the 250mg dosage that she would need to give her patient ten capsules at one time!
She was quiet for a moment, but soon she understood. She told me to please have the physician change the medication order to the correct dosage.
I’ve fought with nursing many times during my career. And I’ve noticed something. Whenever there was a conflict between nursing and pharmacy and the issue was swept upstairs to a vice-president or administrative person— two things always happened. They were 1) nursing always got their way and 2) pharmacy was always the bad guy.
Yet, although these things always occurred, it never stopped the pharmacy from battling with the nurses.
In closing there are three reasons why various departments wanted to control the pharmacy:
1.They wanted to demonstrate their power over pharmacy,
2. They wanted the pharmacy to conform to their uniform standards, and/or
3. They were jealous of the pharmacy.
Regardless, I didn’t let them oversee my pharmacy, even for a little bit. I did my own thing. And in the end, I think that drove them crazy.
Daniel Shifrin, R.P., M.S. is a recently retired pharmacist who enjoys sharing his insights about hospital pharmacy. He is proud to own one of the largest collections of Pharmacy Stamp First Day Covers.