At the recent ACCP Annual Meeting, I shared my theme for the year: “Stay the Course.” The phrase probably originated with sailors who had to endure harsh weather conditions at sea. More recently, the phrase has been used in the context of pursuing a goal regardless of any obstacles or criticism. I selected this theme because it builds on ACCP’s recent decision to launch a comprehensive initiative that will pursue legislative and regulatory changes to the U.S. Medicare program and relevant sections of the Social Security Act to recognize the direct patient care services of qualified clinical pharmacists as a covered benefit under the Medicare program. This initiative has launched ACCP on a long and difficult journey for an unknown period with an unknown likelihood of success. It is truly uncharted territory for the pharmacy profession because no pharmacy association has ever undertaken such an effort.
ACCP should stay the course only if we, as an organization, are certain this is the right course. Has ACCP carefully considered this new initiative? We should not seek recognition as providers of collaborative comprehensive services under Medicare without first answering what services we are asking clinical pharmacists to provide. Only after answering that question can we begin to consider the qualifications of the clinical pharmacists who will provide those defined services. The ACCP Board spent more than a year discussing and debating the “what” and the “who” as it related to the Medicare initiative. The ACCP leadership did this because we knew we had to have a focused and well-thought-out approach.
ACCP is prepared and committed to stay the course, despite criticism and obstacles. The legislative process is unpredictable and can be highly political. Any proposed change to the Medicare program will be a tough sell in the current political and economic environment. ACCP may have to stay the course alone without support from other pharmacy organizations. The process will likely require several years and consume considerable financial resources. However, we believe that our message of working collaboratively with other health care providers to “get the medicines right” resonates with patients, other health care professionals, and both Democrats and Republicans.
Finally, ACCP has the necessary experience to succeed. Because many members may not be aware of ACCP’s involvement in developing the Board of Pharmacy Specialties (BPS) petition that led to the approval of pharmacotherapy as the second pharmacy specialty (after nuclear pharmacy), a brief history follows. In 1980, only 1 year after ACCP was formed, ACCP formed a task force to explore the possibility of submitting a BPS petition to recognize clinical pharmacy as a specialty. Following the recommendation of that task force, a committee was formed in 1981 to start developing a BPS petition. Under the leadership of Dr. John Rodman, the committee met for the first time in November 1981. Think about where ACCP was in 1981. The number of ACCP members in 1981 was slightly more than 100, which included the 29 founding members! ACCP had no staff and no headquarters. After almost 5 years, the petition was submitted to BPS. In July 1987, ACCP was informed that BPS had denied recognition of clinical pharmacy as a specialty because it was “too broad and too general.” However, BPS noted that “an area of practice referred to as clinical pharmacotherapy may be such a specialized area of pharmacy practice as to justify consideration of it for specialty recognition.” The petition was modified to recognize pharmacotherapy as a specialty and was submitted in January 1988. Despite opposition from the American Pharmaceutical Association and the American Society of Hospital Pharmacists, BPS approved the ACCP petition to recognize pharmacotherapy as a specialty in October 1988. The first pharmacotherapy exam was offered in conjunction with the ACCP Annual Meeting in Minneapolis in August 1991, almost 10 years after the committee initially met to begin work on the petition. To date, almost 16,000 pharmacists have become board-certified specialists in one or more of the six current BPS specialties. Of note, ACCP’s decision to develop a BPS petition stimulated other pharmacy organizations to pursue the development of the additional BPS petitions that now recognize ambulatory care, nutritional support, oncology pharmacy, and psychiatric pharmacy.
Although few of the founding members are still involved in ACCP leadership, they made a lasting contribution to the association. The founding members’ most important contribution is that they established a culture for the association. You could say that the founding members provided ACCP with its organizational DNA. In a Harvard Business Review blog, the success of an organization is expressed as a function of purpose, talent, and culture1:
Success = (Purpose x Talent)Culture
Purpose denotes when people come together because they believe in what they are there to do. Talent is what Jim Collins describes as “getting the right people on the bus.” And culture is defined as the “invisible stuff that holds organizations together.” If an organization has purpose and talent, limited success will occur, even if culture is zero. Culture is an exponential term, so the likelihood of success increases dramatically as culture improves, and there’s no limit to how successful the organization can be. Although the early members of ACCP were extremely talented and were united in their purpose, I believe the culture of the founding members was the “secret sauce” in ACCP’s recipe.
Dr. Bill Evans, one of ACCP’s founding members, was honored last year as the recipient of the Remington Medal, one of the highest honors in pharmacy. In his Remington Lecture, titled “Culture Trumps Strategy,” he shared about his experience at St. Jude Children’s Research Hospital and suggested that some of those lessons be applied to pharmacy.2
We can influence the culture of our institutions and our profession. We must take advantage of that and take steps to ensure the next generation of pharmacists finds a culture where they, too, can flourish and where they see beyond current boundaries. Help them see the limitless possibilities that we have as pharmacists and tell them that their current vision of what they can do is not sufficient to see all the possibilities that lie ahead.
From the beginning, the founding members of ACCP had a vision for clinical pharmacy that included specialty recognition. Thanks to their leadership, an entire generation of clinical pharmacists has the opportunity to advance their careers by pursuing board certification. ACCP must now “look beyond current boundaries” and develop a new vision for clinical pharmacy. That new vision includes the provision of direct patient care by qualified clinical pharmacists, in team-based care environments, as a covered benefit under Medicare. This is the opportune time to explore changes in the health care delivery system as payers move away from fee-for-service reimbursement and toward accountable care organizations, patient-centered medical homes, and team-based care. To fulfill that vision, however, ACCP needs the support of every member. Remember the simple equation showing that success is a function of purpose, talent, and culture? ACCP has the culture and the talent. The only thing missing is purpose: inspiring people to come together because they believe in a common goal. ACCP needs every one of its members to share its vision and support its Medicare benefit initiative.
References:
- Merchant N. The success equation. Harvard Business Review Blog Network, June 20, 2011.
- Evans WE. 2012 Remington Lecture: culture trumps strategy. JAPhA 2012;52:450-3.