Pharmacy Practice Management Exam 1

What are some recent healthcare news you’ve seen or heart about?

US spends much more per person on healthcare than other countries, as well as a larger percent of Gross Domestic Product

Drug Pipeline development

1. rare/orphan disease states

2. expansion of indicaiton

3. targeted therapies

4. accelerated approvals

5. HCP adminstered → self admin

6. new delivery systems

7. combination/ER products

8. vaccines

Specialty Pharmacy Trends

1-2% of Americans use them but it represents 40% of total drug cost

largest driver: specialty drugs

top concerns for payers: gene and cell therapies and oncology

pipeline continues to be filled with drugs in specialty categories

medication related problems contributing to growing healthcare cost

1. off label use

2. fraud and waste

3. improepr drug selection (under/overprescribing)

4. wrong dosage

5. adverse drug rxn

6. drug disease interaction

7. inadequate drug monitoring

8. lack of adherence

9. breakdown at the transition of care

Impact on Healthcare

1. reevaluating tradiational processes

2. focus on appropriate utilization

3. focus on customer patient need s

4. focus on outcomes and ROI

5. data analytics

transition to value based care goal

reduce duplication of services, improve health outcomes and decrease cost of care

1. pay for performance, at risk shared savings, penalties

2. focus on quality of services

3. balancing length of stay and readmission reductions

4. episode of care, long term focus

5. population utilization and cost

SEQ Payer’s Perspective

1. provide access to quality healthcare

2. clinical gap closure/programs

3. opportunities for collaboration and innovation

4. improve health outocmes

5. manage total cost of care

what are challenges for health plans?

1. become a trusted health wealth advisor

2. better access to information by providers and consumers

3. reward safety, quality and innovation

4. “wholesale” (business to business) → retail (business to consumer) mindset

5. invest in data; to be progressive

what are challenges for providers?

1. focus on wellness and prevention rather than treating acute conditions

2. provide personalized care

3. consistently provide cost effective care

What is consumer centric care?

1. right care at the right place at the right time

2. MD/patient relationship is enhanced by anticipating timely interventions to prevent or mitigate the impact of otherwise serious events

What the 4 qualities of population health management?

1. facilitate car delivery across an entire population or group of individuals

2. goal: improve outcomes and reduce cost/utilization for pt populations at highest risk

3. involves strong analytical approach to stratify patients and identify actionable opportunities for intervention

4. multistakeholder approach among payers, providers, employer groups and pharmaceutical companies

What are the pharmacy management trends to watch in 2026?

1. patient care and services

2. health care affordability

3. digital technology

4. push to recognize and act on social determinants

5. increased patients’ connectivity to behavorial health services

6. leveraging applied analytics

7. alternative sites of care and virtual care

patient care and services

1. personalized medicine

2. direct to consumer trends

3. ex[anded clinical services

4. improved patient access

health care affordability

1. medication cost burden shifting to members

2. increased federal actions to manage healthcare

3. increased regulatory focus on drug transparency

Digital technology

1. increased offerings focused on clinical care management (wt loss, BH)

2. wearable health technology

3. growth in AI and automation

4. augmented and virtual reality

5. telepharmacy

push to recognize and act on social determinants

address socioeconomic stressors like housing instability, food insecutiy and transportation

• circumstance w direct effect on mental and physical health

increased patients’ connectivity to behavorial health services

more partnerships between traditional medical and behavioral health carriers on smaller, targeted and personalized solns; aligned incentives

leveraging applied analytics

actionable data will facilitate the major trends

need for practical data sets presented in a simple, actionable framework to be used to assess opportunities

alternative sites of care and virtual care

1. health care servies that are accessed digitally at home and outside the traditional 9-5

2. increasingly important to consumers as they prioritize convenience

what will healthcare continue to look like?

1. more patient centric, value based healthcare system

2. collaboration with providers for integrated healthcare/stronger ecosystem collaboration

3. safety, quality and innovation will be reawarded

4. operational and administrative processes will be optimized

5. information technology will be improved

During the mid to late 20th century, what did professional norms limit? what changed after the PharmD in the late 20th century?

limited counseling which reinfoced the product dispender identity

• new barriers emerged, making managements skills essential

From pharmaceutical care → MTM → CMM/CoMM. what happened in the early 2000s?

pharmaceutical care emphasized responsibility for managing drug therapy to resolve/prevent medication related problems

What is important about management skills?

converts intent into reliable systems: workflow, staffing, documentation, and quality

bottom line: good patient care and good business are mutually dependent

define business management

use technicians to free pharmacist time; billing reimbursement opportunities

What are the realities of business vs patient care?

1. ethical practice and sustainability can align

2. business functions ar egoverned by rules and regulations

3. wuality enables trust, outcomes, and viability

4. management constraints affect clinical effectiveness

in operations management, what is the first step in workflow?

define tasks, roles and handoffs to reduce bottlenecks and error risk

What is the human resources management cycle (HRM)?

1. job analysis

2. hire

3. train

4. motivate

5. appraise

6. reward

what is the difference ebtween classical and modern management styles?

1. classical era: hierachial comand and contorl in mass production settings

2. Modern era: service economy + highly educated workforce; managers may have less technical expertise than staff

What are the 4 emphases of modern management?

1. energize: create vision and momentum

2. empower: provide training/resources, then trust execution

3. support: coach, give feedback, remove barriers

4. communicate: build trust and choose the right channel for the message

What are the 3 dimensions of the management process?

1. activities managers perform: plan, organize, lead, control, repeat

2. resources managers manage: money, people, time, materials, info

3. levels where decisions occur: self, interpersonal, organizational

Define planning vs organizing as management activities

1. planning:

   1. predetermine actions based on goals and environment

   2. set goals and objections: consider internal/external nevironemnt

   3. formal (strategic/business) or informal (daily workflow choices)

2. Organizing:

   1. determine and arrange activies and resources to accomplish plan

   2. define roles, task relationships, and timing (who/what/when/where)

Define Leading/Directing vs controlling/evaluating as management activities

1. leading/directing

   1. bring about purposeful action by doing work and/or guiding others

   2. motivate self and others toward desired outcomes; required communication

   3. requires coaching and empowerment

2. Controlling/evaluating

   1. review progress toward objectives and determine why results occurred

   2. compared reselts to goals and as what happened and why

   3. use results/feedback to improve the next planning cycle (continuous improvement

what are the 5 components of resource management?

1. money: measures performance and enables acquisition of other resources

2. people: staff, pts, interprofessional partners — collaboration is essential

3. time: most limiting; self management supports managing others

4. materials: medications, supplies, equipment, control and availability

5. information: technology and data support safe dispensing and clinical decisions

What are the 3 levels of management? top to bottom

1. organizational (group/policy decisions)

2. interpersonal (one to one; counseling, training)

3. self management (personal priorities and time)

Given the scenario, what is the level, activity and key resource? choose education to advance career ladder

level: self

activity: planning

key resources: time information money

Given the scenario, what is the level, activity and key resource? train a med rec technician on initial patient interview data

level: interpersonal

activity: leading, organizing

key resources: people, information, time

Given the scenario, what is the level, activity and key resource? review financials for diabetes care center goals

level: organizational

activity: controlling

key resources: money, information

What is leadership vs management?

Leadership: sets direction

Management: executes plans

• positional vs non positional leadership

• leadership does not require a title

What is the difference between technical and adaptive

Kotter’s 8 steps for leading change

1. create urgency

2. build guiding coalition

3. form vision and strategy

4. communicate the vision

5. remove barriers

6. generate short term wins

7. sustain acceleration

8. institute change

what are the keys for sustainability?

1. coalition

2. communication

3. barrier removal

4. culture reinforcement

apply kotter to management case

1. urgency: link HbA1C outcome to contract and patient impact

2. coalition: pharmacy, clinical leadership, techs, nursing, prescribers

3. short term wins: early HA1C improvement, adherence gains, visit completion

4. culture: embed workflows for ongoing CMM/diabetes management

What are the 4 clifton strengths leadership domains?

1. executing: turn ideas into action, deliver results

2. influencing: advocate and persuade, gain buy in

3. relationship building: create connection, build cohesion

4. strategic thinking: see patterns/options plan ahead

What is emotional intelligence (EI)?

1. self awareness, self regulation, empathy, motivation, relationship skillls

2. support trust and psychological safety—preconditions for teaming

What are the 5 dysfunction fo a team (lencioni) building from the bottom?

1. trust

2. conflict

3. commitment

4. accountability

5. results

what are examples of trust building behaviors?

1. talk straight: honest feedback, avoid spin

2. demonstrate respect: assume dignity, address issues not people

3. create transparency: explain decisions, share data

4. keep commitments: reliable follow through

5. listen first: seek to understand before responding

6. practice accountability: own outcomes; avoid blame

Why is creating value important?

pharmacist job growth has increased in recent years

• hired by past work experience, communication skills, problem solving, ability to work effectively with others

• articulating value, market yourself

How will the profession of pharmacy serve the needs of patients, health care prof, the health care system and society?

***

Relative Value Theorem Equation

RV = (P + S) (PV)

V = value

PV = perceived value

P = price

S = Service

What does P, S, and PV stand for?

P = price; monetary and non monetary factors

S = service; quality and marketing of service

PV = perceived value; what you get vs what you give up to obtain

• benefits of drug vs cost/time to obstain

• services vs salary

Define Value

desire to obtain high quality goods and services to meet our needs and wants and what we need to sacrifice to obtain them (money, time, etc)

• RV = what is the desire to obtain a good/service compared to its alternatives

Describe 5 healthcare stakeholders

Patients and caregivers:

• focused on quality of care at an affordable price

• Med counseling, accessible point of care, immunizations, preventative meds, patient advocates

Providers:

• focus on patients, practice and profitability

• provide drug regimen recs, prevent med errors

Payers:

• focus on cost-effectiveness of providing care to overall group

• formulary, prior auth, outcomes based eval

Regulators:

• write and enforce rules/laws to protect public interest

• drug safety surveillance, REMs, controlled med report, policy development

Suppliers:

• affect cost and productivity of healthcare workers

• clinical trial design and execution, drug development, scientific communication, medical information

What are the 3 parameters of medication taking behavior? How can you improve PV?

1. initiation

2. implementation

3. discontinuation

How can you increase PV?

P: willing to spend money/time/effort on med adherence

S: patient understands what they get in return

PV: patient values med adherence

What is a service based pharmacy? When does it work?

pharmacists provide professional services, less profitability of dispensing prescriptions

• works if service is consistently high quality: high emotional patient satisfaction → high PV → higher profit

• con: pricing

Define RVT

P = salary

S = clinical skills, work ethic

PV = does the employer believe James’ service will outweigh the price of salary

What is BPS? What makes you eligible?

Board of Pharmacy Specialties: certification in a specialty area

Eligibility: within the 7 years… (any of 3)

• PGY2

• PGY1 and >2 yrs of practice experience

• >4 years of practice experience

Must take exam

Ethical Dilemma

choice betw competing ethical standards to determine the morally appropriate action or decision

What are the 10 steps for individual decision making

1. could decision hurt someone?

2. is it legal question?

3. facts of case?

4. who has a stake in the outcome?

5. what are the options?

6. what can we learn with ethical considerations in mind?

7. which option is best in this situation?

8. what would a respected critic say about my choice?

9. what will the implementation of the decision look like?

10. what did i learn from this situation?

What are the 7 steps of the PLUS EDM model?

1. Define the problem in terms of outcomes

2. seek guidance on policies and statutes

3. ID alternatives

4. evaluate alternatives (apply PLUS filters)

5. Make the decision

6. implement

7. evaluate

What does PLUS stand for?

Policies: consistent with organizational policies?

Legal: consistent w law/regulation?

Universal: aligns w organizational values?

Self: satsifies personal definition of right, good and fair?

What does PLUS vs Markula ensure?

PLUS ensures ethical elements aren’t lost in bureaucratic processes

Markula ensures personal integrity isn’t lost in compliance

What are the 3 stages in the psychology of ethics

1. Stage 1: preconventional

2. Stage 2: conventional (Law & Order, follow HIPAA)

3. Stage 3: post-conventional (universal principles, protect privacy to respect human dignity)

(stage 1 bottom of pyramid, stage 3 is top)

What is the implication of the non-rationalist (intuitionist) approach?

be aware of your gut rxn but verify it against facts to avoid bias

What should you use sensemaking?

1. Rational models (PLUS/MARKULA) work for puzzles with clear rules

2. mysteries (ambiguity)

3. goal: create a mental model to define the problem before trying to solve it

What are the 4 tactics to improve sensemaking?

1. emotional regulation: mange fear/anger to maintain clear judgement and avoid impulsive rxns

2. Self reflection: analyzing past outcomes, “what do i take away from this experience?”

3. Forecasting: envision multiple futures to offset bias (alternative outcomes)

4. Information Integration: reassess new data, take broad perspective

Descibe the Learn Plan Act Cycle for developing your professional identity

1. learn (sensemaking): seek diverse data, consult others, avoid predetermined assessments

2. plan (decision making): create new schemes, use EDM models to create plan

3. Act (implementation): implement w care and attention to stakeholders, feedback loop (did it work/what did we learn)

What are 3 foundations of organizational structure?

1. span of control: (how big teams are, how many people pharmacists oversee)

2. Centralization: standard protocols, high efficiency

3. Decentralization: pharmacists integrated into med teams

What is the Just culture model?

Distinguish between:

• human error: managed through system changes

• at risk behavior: managed through coacing

• reckless behavior: managed through discipline

Review Just Culture Model

What is the Thomas Kilmann Model?

a conflict resolution style that involves competing, collaborating, compromising, avoiding, and accomodating

Organizational structure must be ____ to survive

Adaptable

focus: dynamic mvt over time

drivers: internal and external factor s

process: top down, bottom up, reciprocal

What are 3 types of environment shifts that change organizational structure?

1. Market & Industry: shift in consumer demands, competitive pressure

2. Regulatory & Political: new laws need new structure

3. Technology: adoption of new systems

What are the 3 internal drivers of change in organizational structure?

1. Resources: scarcity(force efficiency); ambulance (allows expansion)

2. Strategy: shift from volume based dispensing to value based care requires new reporting lines and teams

3. Structure: start ups add hierarchy to manage growth, mature systems reduce hierarchy to gain agility

How does increasing vs. decreasing formalization change organizational structure?

Increasing formalization: Adds structure (e.g., M&A, more hierarchy levels, modularization).

Decreasing formalization: Removes layers (e.g., delayering, downsizing, simplification) to improve agility and communication speed.

What is the Top-Down Process (Directive)?

1. senior leadership

2. design

3. execution

4. assessment

• initiated by senior leadership: planned discrete phases often used for major strategic pivots

What is the Bottom Up (Emergent) Process?

1. Frontline staff

2. localized behaviors

3. cascading traces

4. formalization

• initiated by frontline staff: gradual, rooted in social networks

  • ex. technician invents new inventory workflow that gets adopted globally

What are the 3 parts of inertia forces

1. cognitive barriers: staff view that current structure is only way to practice safely

2. external sources: board of pharmacy says…

3. internal sources: founder’s original design persisting despite market reality

organizations with high inertia have reorganization speed slower than rate of environmental change: very bad

How can you build adaptable structures in organization?

1. structured flexibillity: embed things that guide adaptive change wo chaos

2. simplification cycling: add/eliminate structure to prevent bloating when coping with contingencies

3. modular design: units that can be activated or dissolved (pop up clinics)

constraining factors

personal, situational, or environmental factors that can impede sensemaking

• have negative fx on ethical decision making like personal bias, time stress, unethical work culture

Moral Reasoning

type of developmental process that shapes ethical decision making, representing the cognitive steps taken to resolve an ethical situation

moral disengagement

process where an individual convinces themself that professional ethical standards do not apply to them → lack of awareness of an ethical issue

Organizational structure

defined by Daft 2015, multi-faceted concept that:

• designates formal reporting relationships

• ID grouping of individuals into departments

• includes design of systems for effective communication, coordination, and integration

Founder imprinting

lasting influence of a founder’s experiences, vlaues, and design principles on an organization’s structure, which can either enable or inhibit future structural changes

What is reactive panning (survival mode) vs proactive planning (control)

1. reactive: response to rapidly changing environment. Necessary but leaves organization controlled by external forces

2. proactive: gold standard that enables organization to control its environment and define its own future

Strategic Planning (purpose, time horizon, scope, perspective)

1. purpose: direction, positioning, survival/thrive (effectiveness)

2. time: 3-5+ yrs

3. scope: entire organization

4. perspective: external environment + internal capabilities

Business planning (purpose, time horizon, scope, perspective)

1. purpose: feasibility of a specific program/project (effiiciency)

2. time: 1-5 yrs

3. scope: single service/product/program

4. perspective: market, operations, financials for the proposal

What is the importance of strategic planning?

1. clarifies what the organization should be

2. sets priorities for resource deployment within environmental constraints

3. provides the framework that guides all other plans (including business plans)

What is the difference between mission and vision statement?

1. mission statement (present purpose): defines what the organization does today, tells story of current operations

2. vision statement (future): defines what the organization wants to become, must be concise, inspiring and momentum building

What are the SMART objectives?

Specific: state exactly what is to be achieved

Measurable: capable of measurement, must be able to determine if it was achieved

Aggressive but attainable: should challenge team but not impossible

Results-oriented: specify a result not just an activity

Time-bound: specific realistic deadline

What are 6 common barriers of why plans can fail?

1. lack of leadership/endorsement

2. insufficient time/resources

3. people: internal politics, power struggles, resistance to change

4. communication: jargon/plan-speak prevents staff understanding and buy in

5. implementation: most common poor monitoring and measurment, analysis no action

6. lack of long term priorities (management by crisis)

When is SWOT analysis done during strategic vs business planning?

1. strategic: early to define current situation and inform strat

2. business: later, after market research and financial projections inform assumptions

What is SWOT analysis?

Internal Origin (Controllable):

• positive: strengths

• negative: weaknesses

External origin (uncontrollable):

• positive: opportunities

• negative: threats

What is the purpose, audience, key components, and output of a business plan (for a specific program/service)?

1. Purpose: Decide whether to start, expand, modify, or terminate a specific program/initiative.

2. Audience: Decision makers (e.g., CEO, CFO):

   1. focus on viability & ROI (avoid heavy technical jargon).

   2. Core Question: “Should we invest in this proposed business?”

3. Typical Components: Target market, value proposition, staffing/workflow, budget/pro forma, risk assessment.

What are the key elements of an operations plan?

1. staffing: FTEs and Board Certification requirements

2. Reporting: lines of authority

3. Workflow

Cost analysis

component of financial plan that is fixed (do not change with volume vs variable)

What does the Gantt chart signify? (chat)

A Gantt chart visually represents the project timeline by showing tasks, their duration, sequencing, and key milestones over a set period.

How long should the wait time be for monitoring signs?

>30 minutes and increasing

What are the 4 questions you should ask in operations management?

1. what must be done right now?

2. who needs to be doing it?

3. what resources do they need?

4. when is the work finished?

What does command intent focus on?

it focuses on the desired end state and adapts to the battlefield

(micromanagement focuses on specific steps, fails when battlefield changes)