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There’s an old (and probably apocryphal) notion that if you try to put a frog in boiling water, they will immediately jump out. But if you put that same frog in a pan of cold water and slowly bring it to a boil, the frog will simply sit there and cook to death. As ugly as that metaphor is, I find it seems to describe traps we get into with automation, in which we willingly adapt to inadequacies in system design, and eventually lose track of the notion that we ever found them inadequate. Indeed, in my experience, pharmacy staffs often struggle to envision doing anything that is more than one or two steps removed from their current process, even when that process drives them crazy. I suspect that this occurs, in part, because we build up a procedural infrastructure of workarounds that we would have to undo if that inadequacy was addressed.

In their book, Idealized Design, authors

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General : Informatics, Leadership, Mentorship, PPMI, Technology

As a new practitioner, do you have a greater preference for clinical, direct patient care or more of the traditional operational functions?

Although the answer may be obvious (or may be not) I ask this question because it’s important for pharmacists, in all settings, to be on the same page. As we continue to advance our profession, especially in the midst of gaining provider status, unity among our attitudes will only help contribute to the development and implementation of practice models that involve pharmacists in more direct patient care activities.

In April, our workgroup will be holding a Journal Club discussion on how New Practitioners can help advance PPMI and it will be accompanied by a Facilitator's Guide that includes quick references to: Advocacy, PPMI, Healthcare Reform, and Government and Law Basics.

Stay tuned--we hope to hear from you then!!

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While still waiting patiently for DC/Maryland to thaw out, this week I got to meet the second extern at ASHP, Kit, from North Dakota State University.  It was interesting to learn about the similarities and differences in our experiences in pharmacy school.  I was really impressed with some of the opportunities Kit was involved, such as tele-medicine and extensive MTM work.  In Hawaii, our school is still quite new, so many programs haven’t been as developed but there are many rewarding learning/outreach opportunities for the motivated student. 
Plus this is what Hawaii vs Fargo, North Dakota look like right about now:

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Joseph McCormack in Brief Make a Bigger Impact by Saying Less has advice for us.  Consult the whole book for more ideas.

  • Busy people expect you to respect their time by getting to the point of your communication quickly and ensuring that your message is delivered with maximum impact.
  • A 2013 study on Internet trends found that people check their smartphones 150 times a day.
  • The new brutal reality is we are drowning in information and it floods us everywhere we go.
  • These days it’s no longer possible to get by on the merit of your idea, title or allotted time. You have to put it in a smaller package and make it easier to consume and digest
  • To be brief doesn’t just mean being concise which may be superficial and lacking in substance
  • Brevity starts with deep expertise as only with thorough knowledge can you accurately make an effective summary.
  • The B. R. I. E. F. approach stands for Background/beginning, Relevance/reason, Information-key, Ending-intended and Follow up expected questions.
  • Create mental muscle memory to be brief by using
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Dear Fellow Members:

I'm undertaking a research study on the differences between hospital formulary lists. More than 80 hospital pharmacy directors have sent their lists. If you're interested in participating (and being well compensated for providing a copy of your institution's hospital formulary list), kindly reach out to me at the following address: 

I look forward to hearing from your soon. 

Dan Jacob

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Fostering Women Leaders in a Knowledge Café 

March 4, 2015 4:00PM – 5:30PM ET

A roundtable discussion featuring recognized leaders for change . . .

Noelle Chapman

Christopher Fortier

Desi Kotis

Mike Powell

Sara White

Sharon Murphy Enright, Moderator

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My first week (albeit an abbreviated week) at ASHP headquarters provided many lessons.  Living in Hawaii’s 80 degree sunny weather for most of my life, I did a lot of research before my 11hr flight to the DC area.  I was mentally preparing myself for 30-40° weather, little did I know I would arrive in the midst of winter storms bringing the coldest temperatures in MD since last winter.

Lesson 1:  Always be prepared for the unexpected.  Good advice for any pharmacist.

I spent my first ever “snow day” learning how city workers manage snow covered roads.  I was interested in learning about the salting of roads (this does not happen in Hawaii) and was reminded of pharmaceutics class learning about colligative properties, freezing point depression, and eutectic mixtures.  It was refreshing to see application of science into our daily lives.

Lesson 2:  Application of what we learn is important.

At first I was a little worried about using one of my electives for a rotation in national association management, wondering if I should have done another clinical rotation.  I am now convinced I made the right decision and am so excited for what the next 5 weeks will bring.  I am confident the lessons I learn at ASHP will have significant applicability wherever my pharmacy travels take me. My goal at the end of this rotation is to have a better understanding of what trending topics and new innovations are important for the pharmacy profession.  Learning what issues are most important to practicing pharmacists and how they are effectively managing these emerging problems is essential to all pharmacists.  Hopefully, I can bring some of these answers and ideas to my first job site.

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(Written by Allie Sturm*) As little "L" (every pharmacist) and big "L" (formal) leaders, there is constant pressure to always be your best. How do we make sure we are being our best selves every day for our employees, colleagues, patients, and loved ones? In Becoming Your Best, Steve Shallenberger shares 12 principles and tools to help us as leaders turn our thoughts into actions, inspire and motivate ourselves and others, and to wake up every morning prepared to be at our best.

  1. Be True to Character
    • Be strong when faced with tough decisions and be open to making corrections if you blow it. Have courage to be true to your principles and values.
  2. Lead with a Vision
    • A vision is not the same as goals or objectives, which are created after a vision. The value of a vision is what it communicates to you and to others. It should set a positive and meaningful direction with a purpose and a cause.
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Ever since I entered pharmacy school, I have continued to hear about the value of extracurricular activities. Most of us are aware of the importance of getting involved throughout our training and as new practitioners. Not only does it help develop our extracurricular education and leadership skills, it also prepares us to manage a well-balanced career.

As an incoming first year student I found it quite overwhelming to suddenly be exposed to so many leadership opportunities. I wasn’t familiar with any of the events or pharmacy organizations. I knew I needed to get involved but didn’t know where to start. Coming from an athletic environment, I wasn’t familiar with these kinds of extracurricular activities. However, during my undergraduate degree, I did have the opportunity to gain some experience with research and I wanted to help with another project as a Pharm.D. student. This past semester I decided to pursue a project seeking to develop therapeutic interventions in patients with non-resolving inflammatory conditions such as cystic fibrosis and chronic obstructive pulmonary disease.

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Eric Douglas in The Leadership Equation. Practices That Build Trust, Spark Innovation, and Create High-Performing Organizations has the following advice for us as pharmacy leaders.  This post is not intended to be a complete summary of this book but rather selected points.

  • When trust levels are high teams like pharmacy operate at maximum efficiency. Communication flows. Innovation thrives unfettered by the fear and consequences of failure. Individuals strive to become their best because they trust that their efforts will be rewarded.  When trust is broke, performance levels drop in response. What is the trust level in your workgroup or department?
  • To build trust start with yourself as the leader
    • Honor
      • Honorable leaders live up to their commitments
      • Make no promises you can’t keep
      • View your word as a bond with your people so they will reciprocate
      • Take responsibility, give credit where credit is due, behave morally and ethically
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On February 3-4, 2015, ASHP hosted more than 40 student pharmacists from all around the country to meet with lawmakers in the U.S. House of Representatives and U.S. Senate in support of provider status legislation. These eager young leaders and the energy they brought with them as they prepared to meet with their elected officials was incredible, and they were poised, motivated, and professional. There is no doubt in my mind that the future of our profession is in good hands! 

On the first day of this inaugural event, the students participated in an orientation session with ASHP’s government relations team as well as a number of outside guests, including the chairperson of the ASHP PAC Advisory Committee and former ASHP President Diane Ginsburg, M.S., Ph.D., and former ASHP President Kathy Schultz, Pharm.D., M.P.H., FASHP. On the second day, the students heard from Jaymi Light from Congressman Todd Young’s (R-Ind.) office, who shared perspectives on the most effective ways to discuss the legislation and make the most out of their visits to the Hill.

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A little less than 8 years ago, I started out wide-eyed and naïve struggling to master the top 200 drugs during pharmacy school. My challenges today are new drug approvals, those on the horizon in drug development, and the increasing use of off-label therapies. Pharmacy and medicine are continuously evolving disciplines where conflicting thoughts occur of reveling in the progress of the past to identify directions for the future, while also simultaneously being dissatisfied with the status quo to help advance treatment paradigms and outcomes. At times, even during the course of graduate studies, certain disease state algorithms have changed from when you learned it to the time your professors are teaching those a year behind you depending on the timing of drug discoveries, landmark trials, and/or new guideline releases.

My first experience of being impacted by a new category and drug approval was with ivacaftor for the treatment of cystic fibrosis. Fortunately, I was on a pulmonary/academic rotation at the time and the narrow yet specific niche of the drug made it easier to incorporate into my mental cystic fibrosis treatment template. In the hematology and oncology world, the rate of new drug approvals is even more exponential leading to constant shifting and restructuring of known treatment standards.

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Many of us began our journey with ASHP as pharmacy students involved in our school’s Student Society of Health-system Pharmacy (SSHP).  As students, we benefited from the career resources, networking opportunities, and residency preparation resources.  I remember the vital role that ASHP and my school’s SSHP played in my preparation for residency training.  From leadership opportunities to navigating The Match process, I had an abundance of resources and support from ASHP.  After obtaining a job or completing residency, many of us begin to reevaluate our involvement in organizations.  Which organizations offer benefits that meet my current needs?  What is the return on investment with maintaining a membership with this organization?  As a new practitioner in Ambulatory Care pharmacy, I found that ASHP’s mission and goals aligned with my career goals and my vision for the future of pharmacy.  Below are a few of the ASHP resources I find valuable.  Feel free to comment on this post with the ASHP resources you love and what resources you hope to see ASHP offer in the future.

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Adaptive Leadership. Evolving to Thrive in Complex Environments Mind Tools Club offers us the following suggestions.

  • Pharmacy leaders need to continually adapt to the rapidly changing healthcare environment by keeping what is essential and letting go of those things that are no longer necessary rather than just layering on more things.
    • Observe events and patterns
    • Interpret and develop needed changes
    • Design interventions
    • Lead with empathy
      • Create a shared sense of purpose/vision and lead through influence rather than command/control
      • See the world from others perspective by asking them for their views/assessments
      • Use emotional intelligence to develop rapport with your people
      • Reward accomplishment through recognition
      • Foster a learning environment by viewing failure in how our work is organized and processed (not in drug therapy) as acceptable and expected
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You just landed your first job out of residency!  Your first step to a new beginning!

So, where do we go from here? Last year, when I was finishing up my pharmacy residency,  I had the privilege of speaking with a great pharmacy leader and asked what advice she would give to pharmacy residents who were starting their first career job. “Working on one’s emotional intelligence”, she responded.  I was a bit surprised, since, although I knew it was important, didn’t really find it crushingly crucial. However, she went on to elaborate, “An ill-tempered response, a quick burst of anger, can easily destroy your current and future credibility”.  

What is emotional intelligence? You may have heard discussions regarding a person’s “personality” or “character”- those are just a few of the names that fall under the category of emotional intelligence. It’s comprised of both social and personal competence. I wanted to share a high level overview of each of these areas. Hopefully, this will help you as you take your first steps out the door.

Personal competence can be divided into three categories.

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As a final year pharmacy student last year, I was somewhat overwhelmed with the residency application process.  Letters of intent, The Midyear and the Residency Showcase, and hearing from some of my hopeful residency programs for an interview while being turned down from others, all made for an exciting and anxious period of time for myself and my career.  I was fortunate to receive several interview opportunities and was Matched on that fateful day to a great program. 

Possibly the most difficult aspect of the whole process last year (outside of waiting) was really understanding what I wanted to get out of my PGY-1 residency.  I had a general idea of what I wanted to experience, but I didn't really know a lot of specifics.  What has made a huge difference for me this year has been my experience as a PGY-1 resident - this year, I know exactly what I want from a PGY-2 residency program.

Through the first half of my residency, I have experienced and learned a tremendous amount about pharmacy practice, my career direction and goals, and how I directly help my patients and their families.  During these months, I have recognized that what's most important to me for my career and how I provide care to my patients is to pursue a PGY-2 residency.  A PGY-2 residency will continue to help me advance my clinical and practical skills as a pharmacist while allowing me to focus more within a specific area of pharmacy and prepare me to become a clinical specialist.
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My current rotation is a bit of a change from pharmacy practice; I’m on a teaching rotation at the pharmacy school. It is interesting to see all the work that goes into each class behind the scenes. Even simple things, like labeling saline vials with lot numbers and expiration dates for vaccine injection practice, take time. Writing multiple-choice questions was more challenging than I expected. It took several minutes to come up with each well-balanced answer choice that wouldn’t give the answer away. I had the opportunity to teach SOAP notes to 2nd year students and review SOAP notes with 3rd year students. I was impressed to see how much more sophisticated the 3rd years’ notes were because they could apply more rotation experiences and clinical knowledge. I hope the students found the wisdom I shared about my SOAP note experiences beneficial.

            One of the assignments for my teaching rotation was writing a Teaching Philosophy Statement. The statement is suppose to 'clarify one’s goals, guide one’s behavior, catalyze one’s scholarly dialogue about teaching, and organize one’s evaluation of one’s activity' (Goodyear and Allchin). It’s a documentation of a teacher’s values and beliefs about teaching to create a vision of the type of teacher he/she wants to be and how to accomplish that. It’s a work-in-progress to be regularly adapted and changed. Since many of us will become preceptors, teach classes, or teach coworkers in the near future, now is a good time to start thinking about teaching philosophies and what kind of teacher you want to be. 

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General : APPE, rotations, teaching  Audience : Pharmacy Students

(Written by Allie Sturm*) With the rapidly changing landscapes in industries from healthcare to technology, experienced leaders face questions, such as “will my knowledge and skills become obsolete and irrelevant?” “How will I keep up?” Seasoned pharmacy leaders moving into leadership roles outside of pharmacy likely ask themselves, “how can I be at my best when I know very little about this area?” Liz Wiseman, author of Rookie Smarts, explains the key to stay fresh and keep learning is to think like a rookie.

Wiseman urges us to “live on the learning curve.” Her research studied almost 400 workplace scenarios, comparing how rookies (someone who had never done that type of work) vs. versus veterans (someone who has done that type of work) tackled work assignments – regardless of age. Here are some of the findings:

  1. Rookies are strong performers
    • −Rookies outperformed veterans in innovation and time to completion.
  2. Rookies have a unique success profile
    • −Top-performing rookies sought out expertise in others, connected dots, experimented, learned from mistakes, and focused on incremental gains. Top-performing veterans were fast to act, marshaled resources, found simple solutions, focused on solving the right problem.
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They say time flies when you are having fun… and they (whoever they are) could not be more right.  I cannot believe I am ending my 4th week here on rotation at ASHP.  The experiences I have gotten to be a part of, the people I have met and the friends I have made will always be a part of my life.  To reference my first blog about this rotation, I was very nervous coming into ASHP.  As a student, I did not know what to expect from a rotation in “association management.”  What I did not realize is just how much of a blast this rotation would be.

While on rotation here at ASHP, the most important thing I have learned is that pharmacy is a small, small world – don’t burn any bridges.  The person you sat next to at a meeting could be your boss one day.  The person you did a project for could be the one hiring you one day.  Everyone knows everyone in pharmacy, so take every opportunity to learn from some of the most influential people in our profession and to soak in as much information as you can as a student to leave a lasting impression.

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I was privileged to attend the Informatics Institute at the ASHP Summer Meeting in Las Vegas. Let me first assert that, as an experienced informaticist, this programming was some of the most advanced, and most useful that I have experienced. Please join me in congratulating ASHP and the Section on Pharmacy Informatics and Technology for an excellent series of sessions.

There was a session early Sunday morning that caught my attention, delivered by two scientists from the Office of the National Coordinator for Health IT (ONC) regarding human factors.

The presenters identified that Human Factors issues fall into two "bins":

1) User interface issues
2) Understanding of the cognitive tasks that need to be performed by all the affected parties.

We are accustomed to thinking about the first bin. However, much of what has been known to occupy our attention on user interface design was fundamentally dismissed by the speakers as of secondary importance. Of most significance were:

Maintaining context - when scrolling or paging causes important contextual information (like who is the current patient, or what task am I doing, or what is the current date/time) to be lost, errors tend to increase. This is especially important when the user is switching context to do what they think of as

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General : Informatics, Medication Safety, Technology