By: Toni Fera and Dee Melnyk Evans
Slice of PIE takes its name from the “Partners in Excellence” (PIE) program, which recognizes outstanding contributions to patient health within a defined health plan. Slice of PIE is a separate but related research and learning collaborative, supporting community pharmacists in their efforts to improve patient health through chronic care management and optimized medication use. Previous blog posts provide more details on the components of the Slice of PIE initiative including the PIE program, implementation science, and the learning collaborative.
One unique aspect of the Slice of PIE program is the role of a coach for each organization participating in the research collaborative. An experienced pharmacist coach from the Alliance for Integrated Medicated Management was assigned to each designated PIE team. The coach and team met regularly, usually with one touch point each month during the 12-month engagement cycle. Coaches focused on working with teams to address barriers to implementation, design action plans, and create a constancy of purpose-achieving engagement and clinical outcomes.
The coaches reflected on the key insights that lead to success, including how barriers to implementation were addressed to achieve clinical and engagement goals. Five key insights that are applicable to implementation of medication management programs for patients and pharmacists in all settings include:
- BE DETERMINED. “Energy and persistence conquer all things”-Benjamin Franklin
- Irrespective of the size of the organization, there needs to be a committed champion or team of champions who are passionate and connected to the cause.
- Champions are individuals who, when faced with a challenge or barrier, persevere by finding solutions.
- Champions need not come from just organizational leadership; champions may be any member of the care team or a combination of clinical and operational leaders.
- SEEK TO UNDERSTAND THE PROCESS
- Pharmacists need to be proactively working to understand all aspects of the CMM/MTM program, then, if indicated, redefine their patient care processes to efficiently optimize outcomes
- Pharmacies should consider a baseline needs assessment to determine additional resources needed and additional resources should be allocated.
- Pharmacies may find that their current processes are not optimal for intervention delivery and need to be refined. Simply adding patient care services may not be efficient or feasible. Organizations may need to consider adapting new care models to be more efficient and to enhance feasibility given resources available. This could include delegating technical tasks to students and pharmacy technicians.
- WHEN LIFE THROWS YOU CURVE BALLS (OR A PANDEMIC), BE PREPARED TO PIVOT
- Community pharmacists often have to balance new opportunities to support patient care with existing responsibilities. Pharmacists need to be flexible and prepared to pivot and re-set priorities.
- In addition to usual responsibilities, Slice of PIE teams had to balance providing CMM/MTM services during the height of a pandemic, a public health crisis that brought its own unique implementation and care delivery challenges.
- Teams were still able to make progress by setting achievable goals, sharing ideas with others, and being willing to try new approaches. For example, during the COVID pandemic, teams pivoted to delivering the intervention via telephone visits to reach goals and meet patient needs.
- YOU CAN’T IMPROVE WHAT YOU DON’T MEASURE
- To determine if change is indicated or a change has been successful, pharmacies had to establish goals, outline an action plan and evaluate outcomes that measure progress toward the goal.
- It is critical to build in accountability and regular touch points to review progress toward the goal and keep focused on continually improving.
- YOU’RE NOT ALONE
- A particularly important aspect of Slice of PIE was that it was a collaboration, not a competition. For pharmacists and teams, support from colleagues across community pharmacies has been invaluable to the success of individual teams to make meaningful impacts for patients.
- Although coaching offered another layer of support in this collaboration, some of the greatest learnings appeared to come from pharmacists helping each other. Learning from other colleagues as well as the field experts has been invaluable in this project effort.
Toni Fera, Pharm.D.
Toni Fera has led several health-system pharmacy consulting engagements, facilitating improvements in pharmacy operations, leadership development and strategic planning, project management, accreditation compliance and supply chain management. Recently she has served as consultant to the Pittsburgh Regional Health Initiative’s Primary Care Resource Center Project, funded by the Center for Medicare and Medicaid Innovation. Toni was formerly the Senior Director for Patient Self-Management Programs with the American Pharmacists Association Foundation, providing consultation to health plans and pharmacy network providers for the implementation of the Diabetes Ten City Challenge.
Toni previously served as the Senior Director, Pharmacy Services, at Allegheny General Hospital in Pittsburgh, Pennsylvania. She also served as Director of an ASHP-accredited residency program, as well as adjunct clinical faculty with the Duquesne University School of Pharmacy. Toni received her BS (Pharm) and PharmD degrees from the Duquesne University School of Pharmacy, and completed an ASHP-accredited Residency in Hospital Pharmacy at the Mercy Hospital of Pittsburgh.
Dee Melnyk Evans, PharmD, MHS
Dee Evans graduated from the University of North Carolina at Chapel Hill with a Doctor of Pharmacy, completed 2 years of ASHP-accredited residency training with a concentration in ambulatory care practice and academia. She also received a Master of Health Science in Clinical Research Practice from Duke University School of Medicine. Previously, Dee served as a clinical pharmacist specialist at the Durham VA Medical Center and a Clinical Assistant Professor at the UNC Eshelman School of Pharmacy. She led transformation initiatives to establish collaborative practice agreements and comprehensive medication management programs at her organizations. In addition, she served as a Senior Research Scientist in Health Services Research and Development with Veterans Affairs as a primary, co-investigator and interventionist of multiple studies focusing on medication adherence and clinical pharmacy interventions to improve patient outcomes.