Are pharmacists being innovated out of existence?
Friday, May 15, 2015
The CAPE 2013 Educational Outcomes for pharmacy education created a buzz throughout the academic pharmacy industry. As a result, we must decide how to develop the nonclinical soft skills that have been incorporated into the accreditation guidelines. One of these important new skills is the ability to become an innovator (Guideline 4.3).
While the Center for the Advancement of Pharmaceutical Education committee generally believed that innovation is a good thing, the reality is that innovation comes in two distinct forms, according to noted Harvard business professor Clayton Christensen. And only one of those forms will lead to more jobs for pharmacists.
When most people think of innovation in the practice of pharmacy, they seem to be referring to such things as automated dispensing cabinets, robotic dispensing devices, automated phone messaging systems and computerized workflow systems.
While these products are innovative, they are actually intended to make existing business models work more efficiently and less expensively. The key ingredient that drives the cost down is that less labor is required to get the work done.
As a business owner, lowering expenses is a good thing. As an employee, replacing labor with automation can lead to unemployment. In fact, most sustaining innovations are actually intended to reduce the need for pharmacist labor.
The argument has been made that freeing pharmacists from the dispensing role will allow them to perform more clinical services, but it is not clear that this actually occurs in most instances. The result is more prescriptions being filled by fewer pharmacists.
This ratio reduces the expense per prescription so the business can profit in an era of declining gross margins. Some new services have been added, but I doubt seriously whether the revenue from these new services has found its way into pharmacists' net income.
The goal of many large employers is to reduce their labor expense in order to boost profits. Thus, when we speak of innovation, we need to make the distinction between innovation that is designed to eliminate the need for pharmacists with innovation that is designed to propel pharmacists into new valuable roles in the healthcare system.
Sustaining innovations, as defined by Christiansen, will not accomplish this lofty goal. The type of innovation that is required to spur of the expansion of pharmacists into more patient care roles is called disruptive innovation.
When the personal computer went mainstream in the middle 1980s, it was a disruptive innovation. Prior to that time, the data-processing department of any large organization wielded tremendous power.
Any executive in the organization who wanted to use the mainframe computer to crunch data needed to negotiate with the data-processing department for time on the computer. Business plans and marketing innovations were continually stalled because they had to queue up for access to data processing.
When the personal computer put data-processing power in the hands of individuals, it totally disrupted the power structure of organizations. An individual employee no longer needed permission from the data-processing department to create databases or run reports. This disruptive innovation then spurred numerous changes that led to the demise of the secretarial pool, the demise of the centralized print shop, and the demise of centralized data-processing professionals.
In turn, this gave rise to a new breed of thought leader who could manage and manipulate data to develop creative solutions to all kinds of problems. Millions of new jobs were created in order to serve this new style of leader. And an entire new industry was born that spawned the development of hundreds of products and business models that previously did not exist.
The key questions pharmacists must ask
Who is going to develop the disruptive innovations that will stimulate expansive opportunities for pharmacists to practice their profession as primary healthcare providers? And where will these innovators develop the professional business skills required to capitalize on this opportunity?
Since the move to PharmD-only as the entry-level degree began, the business side of pharmacy has been squeezed out of professional education in order to make room for sophisticated clinical education. Perhaps this pendulum has swung too far, and it's time to reintroduce reverence and respect for the business side of profession.
Pharmacy store owners are not the only ones who need these skills. As anyone working in hospital systems knows pressure is continually put on pharmacists to justify their payroll budgets. And even our ambulatory-care pharmacists are increasingly being called on to develop, implement and market new professional services.
The key to success for the next generation of pharmacists is going to be the ability to create, market and sustain valuable services in the marketplace. Will you be the one pharmacist who develops a disruptive innovation that will increase the need for professional pharmacist services? If so, I would love to hear what you have in mind.
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