A Step by Step Guide to Establishing and Maintaining a Special Center of Excellence

Specialty pharmacy can benefit from having definitive a center of excellence model that caters to respective therapies and disease states.

Centers of Excellence (CoE) have been around for decades and exist within many industries and companies. However, these days it seems as though every business has their own version of this concept.

In fact, a quick Google search of the term will pull up CoE in a variety of industries, such as technology, education, medical centers, and even homeland security. As I research information on the topic, I find myself digging into articles related to engineering and academia and I wonder how this all translates to the world I know: the world of specialty pharmacy.

The term CoE seems to invoke an air of exclusivity and higher quality, like purchasing a premium luxury good. The truth is that there is no standard template and, in fact, most centers are self-proclaimed. CoE seems to be developed in various organizations for various reasons, which raises the question of how they compare against each other. Are these centers truly excellent or only just claiming to be excellent?

Defining the CoE

Most simply put, a CoE is a department or team that is dedicated to identifying and establishing key processes and expertise related to a specific area of focus. This area of focus can be a particular skillset, technology, application, disease state, or other discipline within an organization.

The CoE itself can be set up in a physical location or may exist virtually. Although the subjects themselves may differ significantly across industries, the concept of a CoE remains the same. It is a centralized effort devoted to advanced process mapping, knowledge sharing, and leadership regarding a certain topic, while simultaneously increasing efficiency.

CoEs can be permanent or temporary depending on the situation and team members may perform routine tasks while focusing on specific subject-related tasks. At the very core of any CoE, however, is a primary purpose. Furthermore, expanding upon a purpose, a reputable CoE should have a clear strategy and vision regarding the reason for separation from other activities.

Why Specialty Pharmacy is Poised for the CoE Model

Specialty pharmacy can certainly benefit from having definitive a CoE that caters to respective therapies and disease states for a variety of reasons. Although employees may be equipped to work in many specialty disease states, there is value in carving out areas of clinical expertise. When I first began working in specialty pharmacy myself, I was enamored with the clinical variety that it presented. I had no interest in being pigeonholed and working with only one type of therapy, instead I wanted to know everything. Learning about different therapies and disease states was exciting, fresh, and I was constantly learning.

However, looking back now and seeing the progression of where I began in my specialty career and how my knowledge base has evolved after spending time in concentrated areas, I can clearly see the merit in mastering a disease state. Not only did I become an expert in the subject matter itself, but I grew into a better clinician for my patients, their prescribers, and a respected resource for my fellow colleagues.

Turning a Weakness into a Strength

CoEs are usually established to handle a critical subject, new therapy, or in an effort to resolve an existing deficit that has been recognized within an organization. Although this may sound harsh or even somewhat negative up front, it is in no way a reflection on the organization itself.

Specialty pharmacy is not a one-size-fits-all model and to assume such would be a gross oversimplification of the types of rare diseases and high-touch patients that we handle. We deal with highly complex therapies and disease states. Even the most well-managed and adequately trained pharmacies can encounter a drug that requires extra parameters when dispensing.

The more unique specifications surrounding a drug, disease, payer, or type of patient, the more likely that gaps exist in your current standard workflow. CoEs can help prevent patients and orders from slipping through the proverbial cracks and are an opportunity to introduce pockets of dedication and customization into larger, more rigid processes.

Chances are that in your organization, you don’t have a choice of different computer systems for various disease states or drugs. It seems as though no system in specialty pharmacy truly allows for the flexibility that is required for the multitude of complex therapies and disease states that we see on a daily basis.

A well-formed and well-executed CoE can add tremendous value to your organization by building trust with patients, instilling confidence in prescribers, garnering self-assurance among staff, and establishing a reputation of superiority for your organization among manufacturers, payers, and within the industry.

Even in large organizations, carving out CoE teams can add a white glove feel to your service when it really matters most. Furthermore, if you have multiple sites, CoEs can be a strategy for directing certain patients or therapies to one central location and team of experts.

This not only creates efficiencies, but also allows for the better management of patients and, more importantly, outcomes. The team within a CoE can provide an array of valuable services. Some areas in which specialty pharmacy CoEs excel include ensuring accurate dosing, proper risk evaluation and mitigation strategies documentation and counseling, adherence services, tracking clinical interventions, mitigating adverse effects, and limiting drug waste while advising on proper disposal.

Step 1: Identify the Need

First and foremost, an organization needs to define the purpose around instituting a CoE. Will it be built around a particular drug, disease state, process, technology, patient, or payer type? Before you break ground, identify what the CoE is attempting to achieve. Establishing a clear purpose early on will allow you to develop a solid strategy for execution and management of your CoE.

Additionally, as you are outlining goals of what the CoE will deliver, it is also equally important to identify what activities will not be conducted by the CoE. Too often, these centers can serve as a dumping ground for problems that no one else wants to deal with. Defining the scope will help limit distractions and set clear expectations for your staff and the rest of the organization. (Anastasia)

Step 2: Gather & Govern Your Tribe

A CoE team is typically comprised of a group of highly trained individuals, whether functional or cross-functional, possessing an expertise in a certain subject matter. As you are setting the objectives of the CoE, consider what types of skills will be required to carry out these goals and then begin assembling your tribe.

In the realm of specialty pharmacy, it is more than likely that your CoE will consist of a team with varied skillsets. Some members might be able to cross-train in various tasks while others will have a definitive role or professional expectation associated with their job function.

If your team has pharmacists on board, make sure you are developing their clinical expertise in the subject area and maximizing the time they are able to dedicate to pharmacist-only tasks. Members with good communication skills who are flexible will bolster communication and thrive in a team environment.

Within the COE, there should be direct leadership and process oversight. The team must feel supported and proficient in their skills and knowledge base. Identify at least one point-person or supervisor who can oversee the CoE and work to establish best practices, coordination of efforts, and implementation of new processes.

Operational efficiency is also key to the success of a CoE. Focus on setting performance benchmarks and creating an environment of accountability. Employees should be well informed of what is expected of them and how their performance will be measured. These metrics will also help to illuminate inefficiencies and areas for improvement. (Anastasia)

Step 3: Align the Vision

The vision of the CoE should align with the overall vision of the organization. In specialty pharmacy, most simply put, this typically comes down to getting the right medication, to the right patient, at the right time. Aligning the vision will set forth a clear path for you staff and provide meaning behind the work they are doing. (Anastasia)

Step 4: Be Flexible and Aim for Continuous Improvement

CoEs should strive for continuous improvement and remain agile. New drugs, regimens, guidelines, and standards of care can all affect the way in which a specialty pharmacy needs to handle their patients and a given therapy. Additionally, established protocols must also remain adaptable in light of system changes and technological advancements. The CoE should work to identify, capture, and share best practice techniques and these should continue to evolve as the CoE becomes more proficient.

Within the CoE, leadership and support should be maintained so that team members also continue to develop and increase their skill level. Documenting improvements over time can help to illustrate the organization's investment in the CoE.

Step 5: Deliver Excellent Service…and REPEAT!

Although most CoEs endeavor to incorporate a similar structure and approach, simply establishing a CoE doesn’t necessarily guarantee a performance of excellence. In fact, it is probably more detrimental to have a declared CoE that only delivers mediocre services at best.

Poorly designed CoEs can end up costing the business more than just money. If your CoE isn’t delivering excellent service, it reflects poorly on your organization as a whole and chips away at your reputation as a specialty pharmacy. This can result in patient escalations and grievances, the loss of contracts with payers or manufacturers, and distrust in your prescriber base. These non-tangible losses can be much more difficult to recover in the long run.

After establishing a CoE, it is imperative that the service you deliver is in fact excellent. Best practices and continuous improvement can help to set these parameters. Quality metrics associated with service level and turnaround time can take your service from good to great. Finally, as hindsight is always 20/20, frequently revisit lessons learned from past CoE implementations. Use failures as opportunities to strengthen your approach and remain flexible. Following these steps will ensure that your next CoE is nothing short of…excellent.

References

  • Anastasia (2016). How to Set Up a Center of Excellence. Cleverism. Retrieved from https://www.cleverism.com/how-set-up-center-excellence/

  • Centers of Excellence (CoEs). The Disciplined Agile (DA) Framework. Retrieved from http://www.disciplinedagiledelivery.com/people/centers-of-excellence/

  • Price, R. (2014). How to Build More Impactful Centers of Excellence. Industry Week. Retrieved from https://www.industryweek.com/operations/how-build-more-impactful-centers-excellence

  • Schechter, J. (2017). Center of Excellence (Why Create One?) OneSpan. Retrieved from https://www.esignlive.com/blog/center-of-excellence-why-create-one

About the Author

Jacqueline Hanna earned her Bachelor of Science in Biological Sciences from the University of Pittsburgh before earning her Doctor of Pharmacy degree from Duquesne University in 2011. She recently received her Master of Science in Pharmacy Business Administration (MSPBA) program at the University of Pittsburgh, a 12-month, executive-style graduate education program designed for working professionals striving to be tomorrow’s leaders in the business of medicines. Jacqueline has spent the last 4 years working in Specialty Pharmacy, initially as a clinical pharmacist and most recently working on a variety of high-profile Specialty Operations Projects. In her current role, she is able to channel her passion for patient care into innovation and process design while being part of a concerted effort to transform Specialty Operations and improve the patient experience.