Think you know hospital pharmacists? Think again.

Hospital pharmacists are shaping the way we see treatment innovation and patients’ outcomes.

By Selene Camargo Correa, PhD — Senior Researcher at A Piece of Pie

This is the third time I am interviewing Daniel. We originally met years ago in, what I recall, an improvised conference room. To reach the room I needed to go 2 levels underground in a hospital building and walk through a maze of hallways full of yellowed shelves with medical supplies. This time around, meeting for an interview is easier and with few clicks we are online about to discuss the role that hospital pharmacists play with regards to patients with autoimmune diseases.

It is Friday, late in the afternoon, and he quickly apologizes for rescheduling our meeting twice this week. Dealing with his daily duties as chief pharmacist is becoming increasingly challenging due to COVID-19, with little time left to take part in, well, everything else. A few minutes later I discover what he means by “daily duties” and how intensely things have changed since our first encounter.

By the time we met for this interview at 5 pm, he had already:

• led the daily meeting with his team to set work priorities and meet the emergencies that arise during the night shift (nothing new here),
• attended to a hospital committee to evaluate a biological drug,
• revised Patient Reported Outcomes questionnaires with team members and another multidisciplinary committee,
• answered the calls of two Regional Hospital Access Managers,
• managed and ordered new drugs stock,
• tracked the monthly expenditure of this hospital division,
• hosted the monthly meeting with a workgroup from his professional association and,
• reviewed an academic publication written with another pharmacist and a group of rheumatologists from the hospital next door.

I was his last scheduled meeting for the day.

This is not the story of a busy day in the life of a hospital pharmacist, rather it is one of it a profession that has evolved dramatically in the last 10 years. Hospital pharmacists are now specializing in many subfields, embracing new challenges, and shaping the way hospital managers and the medical community think about treatment innovation and patients’ outcomes.

There are about 368 hospital pharmacies in Spain (1). They are normally located in hospital basements, far from doctor’s offices. In small-size hospitals there can be up to two to three pharmacists who multitask and manage everything from validating medical prescriptions to assessing the cost-efficacy of new treatments as well as managing stocks to dispensing inpatients and outpatients’ medication. In large hospitals there can be up to 30 pharmacists who do the former and specialize in specific areas of care. In response to this evolution, groups of clinical hospital pharmacists have been pushing new professional frameworks in countless meetings and collaborative projects supported by the Spanish and European professional associations.

I have spotted another change here. They are using a fresh narrative, going beyond their well-established interest in securing the most cost-effective use of drugs. My interviewee talks about patients in a way that is becoming increasingly common in the conversations we had with other 45 hospital pharmacists last year.

“In the 20th century, pharmacists became experts in treatments, but in the 21st century we must become experts in the relationship that a patient has with her treatment. As hospital pharmacists, we must focus on how to engage with patients, what improves clinical outcomes, how to measure these outcomes and how to effectively collaborate with a variety of healthcare disciplines”.

This is not just a statement; it is the tip of the iceberg of an emerging professional agenda. It represents a major shift from being treatment centric to being patient centric. More importantly, it is the expression of a new understanding of their role in hospitals. Let me stress that witnessing such a professional shift in a brief period is quite exceptional.

Not everybody sees it this way, however. Frequently, hospital pharmacists are seen by doctors as “gatekeepers”. They are seen responsible for hindering access to cutting-edge treatments, both highly effective and pricey, or requiring medical doctors to justify their treatment decisions for seriously ill patients when they diverge from hospital guidelines and protocols. These views certainly highlight the many pressures that hospital pharmacists face in the context of stressed public health systems. Think about the tremendous budgetary challenges that healthcare systems bear over their shoulders today. A population aged 65 and over with new medical needs that grows faster than any other age group, the constant flux of effective but also expensive therapeutic innovations or the rise of continuous treatment regimens for patients with chronic diseases (not to mention the pandemic battle that will be raging here for a while and the cost of dealing with its aftermath).

By talking to hospital pharmacists, I have realized that the task of improving quality of care and patient experience is a team sport. It requires a deep understanding of the many aspects of clinical care and having honest conversations with everyone. Hospital pharmacists are becoming a strong and necessary stakeholder in the healthcare ecosystem and pharmaceutical companies need to learn how to work with them as they already do with doctors. A good start is revisiting what keeps them awake at night, what gives them headaches.

At A Piece of Pie, we embrace a holistic understanding of healthcare professionals. We believe that in order to partner with someone first we must understand not only what they do on a daily basis but also their desires, wishes, and projections to themselves and their peers. In our experience, the keys to succeed in partnering with hospital pharmacists are:

• Embrace continuous learning. Hospital pharmacy will keep on evolving over the next few years and their professionals will presumably face new challenges –especially in these pandemic times. Teach your team to follow their interests and frustrations, and forge alliances to support their new endeavors.
• Be part of their web of trusted parties. Hospital pharmacists are well connected to a web of disciplinary and multidisciplinary teams, and thanks to that they are early adopters and supporters of best practices. Strive to be part of their trusted circle by building long-term, value-based relationships.
• Be aware of a wide range of work motivations. Due to the increasing complexity of their job, chief hospital pharmacists pursue different paths. Some specialize in treatment’s logistics, or in managing head of services’ demands, or in pushing translational research, while others multitask. Quite often, what they love to do has little to do with budgetary control. Keep meaningful conversations with them to know their true interests.

The “living” nature of professions is what makes them gain or lose influence inside and outside professional boundaries. As Andrew Abbott –the most prominent sociologist of occupations– puts it, professional boundaries “are not absolute or permanent, […] from time to time, tasks are created, abolished, or reshaped by external forces, with consequent jostling and readjustment within the system of professions” (2). This is a fitting description of the evolution of the hospital pharmacy profession over the last decade. It is quite likely that it will keep on changing, partly driven by groups of professionals with a mission to optimize patient care and partly driven by the innovation efforts in the healthcare sector. Pharmaceutical companies can become trusted partners if they support hospital pharmacists in redefining their role. Are you ready to follow their steps?

Looking for a change?

At A Piece of Pie, we specialize in the definition and implementation of meaningful commercial strategies, based on a robust understanding of your customers. By means of our social sciences studies of the medical field, we understand what really matters to people, what will connect with them and how to achieve the best outcome out of that connection.

If you want to engage with your partners and to ensure that thinking is put into action successfully, get in contact with us at info@piecepie.com.

References

1. Perez Encinas, Montserrat. 2020. “El Libro Blanco de La Farmacia Hospitalaria. Situación de los Servicios de Farmacia Hospitalaria en España: Infraestructura, Recursos y Actividad.” Available at https://cutt.ly/Ikz4bDG

2. Abbott, Andrew. 1988. The System of Professions: An Essay on the Division of Expert Labor. Chicago: University of Chicago Press.