Customer Reviews

Pharmacy Management: Essentials for All Practice Settings, Second Edition

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I'm preparing for my FPGEE as I am a foreign Pharmacist graduate & licensed. Pharmacy Management was one of the areas on FPGEE blueprint. This book gives you a detailed knowledge on how pharmacy operation on US. But sad to say no question & answer at the end if eachchapter which I needed the most for my exam as challenge on the subject matter. Although at the end of each chapter there is a question for further discussions so it ask you what is your answer to think about. The book gives you a real scenario what was going on on the real world of pharmacy settings. I have the book 2005 copyright I thought I'm buying the latest edition but it's not so but with the price of $8.00 something includes tax & shipping it's a good bargain & it's said used book but looks so brandnew.

This is a review of the SECOND edition of "Pharmacy Management".

Co-editors Deselle and Zgarrick have assembled an impressive caste of thirty-six co-authors to present a reasonably thorough overview of management, as it relates to the profession of pharmacy. All authors seem to have firm foundations in academic and/or community pharmacy practice, but have also esteemed themselves as masters of various areas of management theory, particularly as it pertains to healthcare. No one textbook could possibly explain all of management theory and practice in any setting, but the authors do as good a job as any I have seen. In my search of Amazon.com, I could only find at most seven books published in this century that may cover the same wide territory.

My perspective is that of a Canadian physician, certified in lab medicine and primary care, with a master's degree of science in computer engineering, who has recently taken management courses in general management, human resources, marketing and accounting. My current thrust is an entrepreneurial venture that initially did not involve pharmacy but I hypothesized would work better if pharmacy was included in the marketing mix. That led me to read this book. "Pharmacy Management, Second Edition" is the management textbook for the pharmacy school nearest me (the last Canadian book on this topic was published in 1998). My own benchmarks for this review/book report are: "Fundamentals of Management" by Stephen Robbins et al and "Basic Marketing" by William Perrault et al. These are Canadian editions of highly-regarded American textbooks, with Canadian and American co-authors.

I learned a lot from reading this textbook even after taking as many management courses as I have. (I did not take a management course from the pharmacy school or any other healthcare-related faculty, just general business courses from a local college). The authors touch on many of the same issues as general textbooks; re-affirming for me the point that there are established universal principles of management (it's not voodoo) and even covering important topics neglected by some mainstream texts (e.g; risk management). The use of examples from pharmacy were still germane to me as a healthcare professional.

The editors have set out to give the final-year pharmacy student and the uninitiated pharmacy practitioner a bird's eye view of the essentials of management theory. It provides an excellent frame of reference for the time-challenged busy healthcare professional who has not studied management sciences before in a formal setting. Caveat emptor! It is impossible for just one book on management to produce a competent manager by itself, and the student of management is advised to take more specific courses as the next step (e.g; human resources, marketing, accounting, etc). This does not necessitate obtaining a MBA, although this would be a commendable approach.

The book consists of thirty-four chapters organized into eight sections, with one or two sections covering an individual managerial science of import.The editors use a combination of didactic instruction and case method. In the first few sections, each chapter is built around a case divided into two parts. The first half of the case is presented at the beginning of the chapter as a challenge, then a particular management theme is presented, then the resolution of the challenge, based on the material presented, closes the chapter. Towards the end of the book, the case method takes over with more scenarios woven tightly into the text of each chapter. Goals are established at the beginning of each chapter and open-ended questions of varying depth are posed to the reader at the beginning and the end.

The book almost seems to have been written and re-written three times: 1) universal management theory is discussed 2) it is presented in the context of pharmacy as a service industry (useful for any health professional wanting to learn about management) 3) the editors steer the discussion not only towards how application of good management can bolster the pharmacy profession but also outline a set of specific strategies they hope will advance the profession in these trying times of great external pressures (more on this later).

My initial criticisms are the text could be less wordy and use more illustrations and diagrams to make its points (see my two benchmark texts mentioned above for examples). The charts and tables that are presented are largely very good and to the point. As is pretty much the case of all multi-authored textbooks, there is overlap with repetition of material, some awkward imbalances (e.g; marketing planning is not listed on the chart on p. 34, but gets several chapters of its own later on), and a tendency for each author to include as much as they can about their speciality area in their assigned chapters.

Two chapters, Chapter 13 Time Organization and Chapter 19 Personal Finance, do not belong in this book. The editors seem to have included them in an effort to develop better pharmacists as individuals, thus hoping to get a better manager. A laudable goal if I am right, but this has nothing to do with the management sciences proper. They belong in a separate text and course which might be called: "Self-actualization for the Pharmacy Graduate" which could cover these and many more related topics.

Chapter 2 gives a concise summation of what the management function is, and is congruent with what non-healthcare management academics have written. Chapter 3 on Strategic Planning is also well-done.

Chapter 4 Business Planning was welcome for me. Most books on business planning are over-inclusive and make it difficult to know where to start and what to work on. Drs Shumock and Wong tighten the focus for service industries in general and pharmacy in particular. The list on p. 60 was most helpful for me.

Chapter 5 General Operations Management addresses most operation issues as seen through the lens of pharmacy. This chapter would also be a useful guide for drafting the operations plan (which is usually its own section in a business plan).

Chapter 6 is the Information Technology (IT) chapter, arguably the fastest changing area of all management. The two co-authors have given a good overview of IT especially as it relates to specific pharmacy points. They have also included some very useful references and websites. Mercifully, unlike other management authors, the co-authors have not tried to show how to design a website (it is now more appropriate to think in terms of "developing a web presence" of which a website is just a part), a discipline that requires exacting detail to do well and is beyond the scope of a management textbook. In my view, important and relevant IT developments since the publication of this book (as of this writing, the fall of 2011) are the explosive growth of cloud computing, the rise of tablet computing, even more powerful smart phones, the proliferation of mobile and tablet "apps" and the sudden affordability (for small businesses) of enterprise resource planning (ERP) software in the form of open-source applications. All of these combine to create the most powerful and efficient mobile virtual organization yet. Search engine optimization and the social media marketing are not covered, but have grown exponentially in profile since the publication of this edition. These would merit discussion in the context of pharmacy in a future edition, as well as a discussion of the differences between management information systems and ERP.

Chapter 7 covers Quality Assurance. This can be a vexing and ethereal discipline because it seems to always require painstaking customization for every scenario. Dr. Warholak provides the reader with an overview of the major established approaches framed to meet the peculiarities of pharmacy. Surprisingly, she makes a throwaway reference to Six Sigma, a quality assurance approach more suited for large-scale manufacturing than most pharmacy situations. So-called Human Sigma (see 2007 book by John H. Fleming and Jim Asplund) would be more relevant to labour-intensive healthcare organizations. I also wonder if this chapter could have been combined with the section on risk management.

Chapter 8 Organization Structure and Behavior is solid. It addresses classic and contemporary approaches to this topic in a way I recognize in other more general textbooks. Dr. Gaither explains it well, framed in the context of pharmacy.

Chapter 9 Human Resources Management must rise to the challenge of covering the pertinent facets of managing the most important pharmacy resource. All management textbooks must orient the student to HR, but in my view this can never be learned adequately without taking at least one dedicated course in HR. Dr. Holdford does a good job, and more information about HR comes out in the Applications section at the end of the book.

Chapter 10 Performance Appraisal. Dr. Deselle does a great job on an area everyone seems to loathe doing and avoids. General human resources textbooks usually lay out the long list of methods of appraisal as a buffet, and leave it for the reader to choose an approach. Dr. Deselle offers guidance as to what works best in pharmacy.

Chapter 11 Customer Service is often not directly addressed in many management texts (examples are often of a good, not of a service) so this chapter is a gem for the healthcare professional.

Chapter 12 Contemporary Workplace Issues is a pot-pourri of important issues that are hard to classify but demand attention.

Chapter 14 Leadership examines the anatomy of leadership, like most texts do, trying to lead the reader into insights about this abstract management issue. Its a tough area to tackle because it is so abstract, but Dr. Scott does this well, drawing on human resources science and contemporary writings. I have never before seen the evaluative tools he presents. The discussion is mostly a general one, with the chapter bracketed by a pharmacy case.

Chapters 15 - 18 Managing Money introduces the reader to the different financial statements, as well as cost accounting and Medicare Part D. It made me want to go back and take more courses, as I see one accounting course alone did not cover enough for me. The chapter on third party considerations offers excellent instruction in the use of financial analysis tools to evaluate third-party contracts. If all this information were kept in an ERP, the pharmacist would be well-served by being able to quickly and easily do analysis and future projections. The chapter on Medicare Part D analyzes the impact of this relatively-new legislation on the pharmacist, does this well, and sets the stage for what will be a theme in this book: pharmacist as clinician-in-evolution. As of this writing, Medicare Part D was modified under the Patient Protection and Affordable Care Act of 2010, so this chapter is out of date.

Marketing. Sections V and VI (150 pages and eight chapters, fully a quarter of the book) are devoted to this one management science, despite the fact marketing is not in the section names. I concur with this emphasis. In my own education, as I took my courses I realized just how important this was and proceeded to take two marketing courses and a marketing research course. In contemporary business practice, a successful company is the market-driven one, finding out what the customer wants and needs, then delivering it, at a profit.

There is much to commend these sections, but also much that deserves criticism.

The first two chapters layout the fundamental building blocks of marketing science. The principles are mostly congruent with my benchmark text, although Dr. Doucette (and later Dr. McDonough) cannot resist adding to the four time-honoured Ps of the marketing mix to make eight. Illustrations and diagrams, as used in the book "Basic Marketing", would really help the student get a feel for how this process should flow. The presentation called "Preparing a Marketing Plan" mostly just reviews the strategic marketing process and is not too helpful. I found the exposition on implementing the marketing plan fresh and more useful. These two chapters could be better organized.

The chapter on inventory management is mostly an operational issue and partly a supply channel (marketing) issue, but it is indispensable for pharmacists. The chapter on merchandising is tailored to pharmacy; it is really an in-depth exposition of part of the promotion component of the marketing mix.

Section VI Value-Added Services is where the authors push the envelope on the expansion of the pharmacy, and push it into non-traditional areas. I speculate their motive is concern with the external pressures on their profession (declining revenue sources, the need to burnish the prestige of pharmacy, increasing regulatory stress, the encroachment of automation and so on) and have adopted an aggressive posture to re-position pharmacy services. Fair enough; I hope improved patient care results from it. But this posture has adversely affected the quality of the instruction of marketing science for the student.

When undertaking a new marketing project, the correct approach is to form a hypothesis as to the marketing mix and target market segments, do (the easier) secondary research first, then do (the harder) primary research by conducting focus groups to test the hypothesis and also to discover if there are better ideas out there. Finally do market analysis (usually market surveys) to see if the target market segment is large enough to eventually turn a profit. This justifies investing resources in the project.

The case scenario of Dr. Zgarrick's chapter shows the fictitious Dr. Brouchard making the classic mistake of trial-and-error market research at first, but he eventually gets it right after, we are told, doing some vaguely-referenced primary and secondary research. Dr. Zgarrick's presentation of this should be more detailed and systematic with the methods I outline above. I found the presentation "Evaluating the Market for Pharmacy Services" disorganized and too wordy, although much good informaton for pharmacists is there.

Dr. Zgarrick sees developing the business plan as a marketing research tool. I disagree. The correct order of steps is to utilize the marketing strategy planning process, as discussed in "Basic Marketing" by Perrault et al (with excellent diagrams). This leads to a marketing plan and then a marketing program, which is then incorporated into the business plan. The business plan is the road map for the intra/entrepreneur, as well as the tool that will be used for procurring financing.

Chapter 25 Implementing Value-added Services gave me a long pause for thought. Dr. McDonough is steering the student towards subsuming primary care responsilibities, usually the province of doctors, all in the name of better healthcare but coincidentally expanding the influence of his profession by stealth. The potential for conflict and problems with patient care are glossed over. The endorsement of medication therapy management by Medicare Part D and the legal protections inherent in the Omnibus Budget Reconciliation Act of 1990 are salubrious to his efforts, but I envision pharmacists taking on jobs they are not trained for. Dr. McDonough encourages the pharmacist to look after chronic stable disease but stops short of disease management of acute conditions that require more sophisticated skills, such as composing a differential diagnosis, physical examination, and investigative planning. The division of these can be very subtle and artificial, and the competent clinician must be equipped to deal with both. Some pitfalls for the pharmacist are: was the (doctor's) initial diagnosis correct, what to do when an acute-on-chronic event occurs, what are the liability issues (and malpractice costs)? Just how will the pharmacist work with the patient's doctors on directing disease management? Too many cooks spoil the broth, and there is no formal mechanism in the community for shared patient management between pharmacist and doctor. How will disputes be resolved? It's not as simple as the pharmacist joining morning hospital rounds.

The authors encourage pharmacists to access Medicare Part B funds with CLIA-waived labs. Will this drive up health costs still further, and result in competition with physicians for Medicare funds? After all, they may want CLIA-waived labs too. As of this writing, Congress looks set to cut Medicare funding to help deal with the Great Recession. A co-operative arrangement with community physicians is taken for granted, but the pharmacy does not offer any value proposition to the doctor other than a loose promise of better patient care which may really turn into an administrative headache for the over-stretched physician. The proposed Collaborative Practice Agreement seems one-sided, essentially a written personal sales program designed to bind the doctor, if only psychologically. Liabilites issues are explicitly assigned to the doctor. I cannot see a malpractice defense lawyer recommending it to a physician-client.

In terms of offering lab services, this invites regulatory issues as well. How will a pharmacy-based phlebotomy station handle blood draws for non-CLIA waived tests? Will it absorb the costs? Will it refuse to do them? What quality assurance steps will it follow if it is not tethered to any of the three big lab regulators (CAP, CLIA and JCAHO)?

How far can pharmacy extend itself into primary care? Will it purchase portable ultrasound to monitor stable abdominal aortic aneurysms? Will it perform periodic mental status exams on the elderly, or periodic Beck's scores for depression on everyone, or just those on anti-depressants? Will pharmacists ausculate the heart, record heart sounds and perform computer-interpreted sonograms to monitor stable bicuspid aortic valves? Will a pharmacist be able (or even required) to follow approved clinical practice guidelines for all these new clinical undertakings that are in the guise of value-added services? How will duplication of services be addressed and how will duplicate Medicare billings be re-conciled? Physicians will be upset if procedures and tests they perform and bill Medicare for are scooped by the pharmacy.

Now, despite my concerns, all of this may really improve patient care at the end of the day. But the editors thrust towards value-added clinical services is too strong; too many eggs is one basket. I encourage the budding pharmacist to use marketing science to research and explore any possible strategic marketing idea that may meet the customers need and wants, and ethically bolster profits. Chain pharmacies have adopted many of the marketing and merchandising tactics of supermarkets and convenience stores. Opening a de facto clinical practice, so emphasized by the editors, is just one possibility. Reborn as a marketing-oriented enterprise the pharmacy should be continuously evaluating a wide range of possibilities.

I would like to address the motto of the marketing concept and the ethics in healthcare. Two suggestions of the authors, the promotion of "herbals" and of homeopathy, are to be condemned. There is no support, from peer-reviewed journals or evidence-based medicine, that these are efficacious, and in fact may do harm. Homeopathy is junk science and "herbals" is junk pharmaceutical science. I aver that it behooves the pharmacist to apply evidence-based medicine to be ethical (especially if they want to be clinicians), and development of the marketing mix must be constrained by ethics. No marketing drugs to kids. No combining nicotine gum sales with cigarettes. No promotion of ineffective drugs, like "herbals". And so on. The marketing concept is said to be: the organization is aimed at satisfying its customers and thus the organization realizes a profit or other measure of long-term success. For healthcare professionals engaged in marketing, I would modify this by appending: the marketing mix must promote health entirely, effectively, efficaciously and ethically, based on evidence.

Chapter 26 Compensation for Value-added Services is a comprehensive review of just about every available tactic for finding a payor for offering clinical services. It's focus is confined to clinical services.

Chapter 27 Outcome Evaluation is well-done, and offers a systematic approach to evaluating outcomes using ECHO. This is labour-intensive and may be difficult to do thoroughly day-in-and-day-out, but could be organized and automated online with an EMR where everyone contributes to.

There are two other important elements I think should be included in the marketing section. Sales is one. Not many people seem to like personal selling, professionals tend to think they are above it, but it is an essential skill for any enterprise. This field has been codified and can be taught. In the YouTube videos presentations "What they didn't teach you in Business School" the lack of sales instruction is hi-lighted by entrepreneurs from both Darden and Stanford Business Schools.

The other is Branding. This is a hot topic these days. The pharmacist would be well-served in a competitive environment not just by creating value-added services but by creating unique (branded) ones.

Reading about Value-added services did make me think about the value of Project Management, an academic management subject I have yet to study and the co-editors did not include. It would dovetail well with section V! and might merit inclusion in a future edition.

Section VII Risk Management does a good job of addressing virtually all the general issues a pharmacist may face, developing principles of risk management and reviewing the high points of specific USA legislative acts that a pharmacist must follow. Despite the necessary tilt towards American laws any student will find these chapters instructive. As I mentioned earlier, it may have been useful to combine this with the discussion of quality. The chapter on preventing medication errors is mandatory reading for doctors. I hope in the future, sophisticated e-prescribing software combined with robots (like Pack-Med and Pill-Pick from UCSF) will reduce this to near zero.

Section VIII Management in Specific Settings tells the graduate what management issues to expect in different employment circumstances, and at the same time cleverly fills in other academic management points from previous chapters (e.g; human resources, organization structure, and so on). A chapter on entrepreneurship is not only included but is the first chapter of the section, re-affirming my earlier assertion about the editors' ambitions for their book. I believe the editors have emphasized entrepreneurship to encourage creative pharmacists to come forward and help re-fashion and strengthen the profession. I doubt many fresh graduates with student debt will embrace entrepreneurship right off, but established pharmacists will gain from this chapter. It overlaps considerably with the chapter on Independent Community Pharmacy. General management texts tend not to include entrepreneurship, buI learned a lot about it from this text.

Dr. Bonnarens list of page 564 "How to get Started" needs to be re-ordered. Business plan development should be second last (before the operation of acquiring licences, etc). It's the road map the previous points are building up to. The management philosophy (meaning the mission statement, vision and goals) is first, not last. The general discussion of ownership structures is as relevant to Canadians as Americans, although the specifics are different. Overall this is a good chapter.

Drs. Deselle and Zgarrick have created an important book that I doubt is emulated by many other healthcare curricula. I hope it fosters a new breed of pharmacists who can meet the ever-changing challenges of the future, and serves as a stimulus for other heathcare faculities to teach management and apply its principles to themselves.

Book was in great condition. Took a little longer than expected in receiving the book but overall great service

Got the book within a week, great job with the shipping. As the label said, it was brand new (still is =))....

Product was great the delivery time was outrages, took 3 weeks to get