Jesse McCullough, PharmD

Several years ago, I was attending a pharmacy conference and the keynote speaker came out to address an audience of approximately 500 people from practically every corner of the pharmacy world. The speaker opened by asking, “How many of you work for a company with core values?”

Nearly every hand went high into the air. He then asked how many of those with their hands raised knew what those core values are. Just about every hand came down.

That had a major impact on me as I began to ponder on the topic presented that day.

Within about a month, I found myself in a position to lead a clinical team at a large chain over the next several months through flu season. We had an expression back then which rings even more true today.

The expression was if you have been through one flu season, you have been through one flu season—as each year brings its own challenges and learning opportunities.

Our team of 25-plus people limped through that flu season with me and we learned a great deal. One of the things I became more aware of was the company’s core values.

As we were closing in on the Thanksgiving holiday, the entire team traveled to the corporate office to share our findings from the current flu season and begin planning the next flu season.Yet in the back of my head, the questions from the keynote speaker still echoed.

So, when the whole team arrived, I asked them these questions:

The team quickly agreed we did indeed have a set of core values. So, I asked this follow up question:

Around the room all sorts of numbers were called out ranging from 5 to 13. Being the fledgling leader I was at the time, I divided the room into 2 teams and we set out to play a game of Family Feud.

With about a dozen people on each team, the question was simple, The top 5 to 13 answers were on the board and the question was to name a core value of our company.

Oh, how I wish I could tell you that the team knocked it out of the park, but I cannot.

Three strikes kept coming for each side. After everyone in the room had given an answer, we sadly had only identified 1 out of 9 core values the company had at that time. I don’t know whether to call it sad or pathetic. But I can say that I got the attention of this group.

Now let me be clear, this was in no way a failure of the corporate office to communicate these core values. As a matter of fact, as I was guiding the team through the office to the conference room where the meeting happened, we passed several posters outlining our core values and even banners suspended from the ceiling.

I thought perhaps this little game show of mine would be a colossal disaster, but instead it become a key leadership experience for all of us. The lack of knowing the core values was not a function of corporate communicating them. The lack of knowing the core values was a function of my (poor) leadership and the leadership of my colleagues on the team.

Beginning the following day, changes were made. We started the next day with a review of core values and day 2 was much better than day 1. We did have some bumps but we were able to rattle them all off.

Then I started a new journey with my core team and every week, we would start our meetings by reviewing the core values. Each person on the team had to list a value and the last person to the meeting had to fill in whatever was missed.

As we did this week after week, several new findings about values became more apparent to me. First, I began to notice that we had fewer problems. That isn’t to say that we had no problems, but we were better able to navigate different issues that came up because we viewed the situations through the core values.

As we discussed different solutions we could come up with to address a problem, we would also comment on whether it supported any of the core values. Things ran so much more smoothly.

Second, I came to realize that every group has a set of core values. Yes, we had the corporate core values, but we also had some of our own as well. Perhaps the most notable addition that we made to our team’s core values was this value: Be yourself, unless you’re a jerk.

Although this value brought several smiles to the meeting, it also affirmed the individual perspectives each member of the team brought to the table. The only caveat was how that perspective was presented to the group.

Third, the limitations in knowing the values were not limited to our team. The lack of knowing the values was widespread and it included the stores and field leaders.

Fourth, and this may be the most important, once you know the values you cannot “un-know” them. Once you know the values, you see when they are upheld. Unfortunately, you also see when they are violated and you cannot un-see or un-know those violations.

Now let me transition from my story to your story. What about you? Do you work for a company with core values? If so, what are they? If your experience is a fraction of the experience I had with my team, you cannot not know your core values.

And if your core values have not yet been identified, take a closer look to observe what they are. Whether the values have been defined or not, you have them. You simply need to take the time to identify them.

Then you need to communicate them and you need everyone to be on the same page with the values because it will take your operations to the next level.

Your values carry over to the community and you will become known for your values. This can work for the good or the bad. We can probably all think of some businesses in our communities that have poor reputations. This is because their poor values have been repeated time and again to the community through their actions. Similarly, good values that are repeated create a positive reputation in the community.

So, take some time today to review your core values. If you don’t know your core values, take some time to learn them and if you don’t have them, take some time to define your core values.

Articles

Well-defined core values can take pharmacy operations to the next level. 

The Value of Core Values in Pharmacy

If you were to come to my office, you would find a binder I still keep on my shelf with materials from a Pharmacy Quality Alliance meeting that I attended more than a decade ago. Little did I know when I attended that meeting what impact it would have on my career.

During this 2008 meeting, the conversation centered on how we define quality in health care around appropriate medication use. One of the notes I took during this meeting was “Quality is value divided by cost.” Mathematically it looks something like this: quality = value/cost.

This little equation captured my imagination. As an amateur math nerd, I could see how quality could be improved by increasing value and/or decreasing costs.

Immediately, strategies that we had used in the pharmacy took a whole new meaning. Products and services that were considered “value adds” now factored into this quality equation. If we used these services (and at the time, the “IF” was in capital letters) we were directly impacting quality.

Believe it or not, even back then the conversation was around decreasing reimbursements, and I could also see how this action could impact the quality equation. When costs go down and the value remains the same, the quality would go up.

Ralph Waldo Emerson said that “a mind, once stretched by a new idea, never returns to its original dimensions.” I can tell you that I have found that quote to be so true. My mind was blown as I began to consider this new dimension of pharmacy and how quality could be measured.

Further down the road, I came across a similar equation involving quality. Only this time, it was structured differently. This equation was set up as value is equal to quality divided by cost (value = quality/cost).

Again, I could see the various levers and how they would relate to each other, though the amateur math nerd in me could not solve the mathematical proof of the equation in relation to the first one I encountered.

So, if you would look past this conundrum with me, we can find some common ground and come to an agreement that value, cost, and quality are related in direct and inverse relationships.

While the conversation can quickly (and understandably) focus on the cost aspect of quality and value, I will submit that an elevated emphasis on quality and value should have equal, if not greater, exploration. Why? Because that is where we have the most control, influence, and impact.

I will follow up with these 2 thoughts to consider:

We all have a definition of what pharmacists do. My definition is that pharmacists monitor drug safety and efficacy throughout the health care system. Our primary role is to make sure that the drugs patients get are safe and ultimately provide the desired effect. I will suggest that we, overall, do a fantastic job on the safety aspect; however, I would also suggest that we can improve in the efficacy aspect of this statement.

W. Edwards Demings proposed a framework of 14 principles for quality management. To be explicit, management would include improvement. One of these principles states, “Cease dependence on inspection to achieve quality.” On behalf of my colleagues who started to twitch reading this statement (and I am twitching with you), let me unpack this a bit more. Demings identified that inputs are the primary driver for quality. When you inspect an item for quality at the end of a process, the quality is either there or it isn’t. If it isn’t, it is because of something that happened beforehand—the input.

To improve quality and add value to the health care system, we need to focus on the inputs. When those inputs are aligned the right way, we can expect reliable consistent results.

To connect this back to the beginning when I was just learning about quality measures, there is some relationship between quality, value, and cost. Up to that point, the primary lever to improve the perception of quality and value was to reduce cost. There were occasional and random products and services that would attempt to add value and improve quality, but it was not focused or consistent.

There was a need to define and standardize how quality could be measured—it needed to be in some objective, repeatable, and standardized format. Once those definitions can be described, strategies can be employed to improve the score. This is a big topic to consider, but knowing how something is measured is a key ingredient in delivering value and improving quality.

Evaluating the need to define and standardize how quality can be measured in pharmacy.