Stepping Stones: Build Organization-Wide Support for a Clinic-Based Specialty Pharmacy Model

Published 07/25/2019
by Tony Zappa

Adopting a comprehensive, clinic-based specialty pharmacy model across a health system’s outpatient clinics requires support from many individuals. Thus, the success of health system specialty pharmacy initiatives depends heavily on the ability of pharmacy leaders to engage stakeholders across their organizations.  

Driving system-wide alignment for a clinic-based specialty pharmacy model often proves challenging. Health systems are typically large, complex organizations with difficult-to-navigate politics and financial relationships. Additionally, pharmacy leaders may not have strong relationships with or direct influence over leaders in other departments or service lines.  

Pharmacy leaders can overcome these barriers by using a tool called stakeholder analysis. When executed effectively, it can accelerate specialty pharmacy success by providing an actionable framework to identify key stakeholders, understand their interests, and gain their support. 

Here are three steps to get started: 

    1. Identify stakeholders: First determine what people, resources, or processes are required to build and operate your specialty pharmacy program. Remember to include back-office and administrative functions like contracting, revenue cycle management, physical plant, and program promotion. Implementing a specialty pharmacy is complex, so expect this to be a time-consuming exercise.Next, identify what departments control those people, resources, or processes. For example, to operate a clinic-based specialty pharmacy, you must integrate a specialty pharmacy technology solution with your EMR. Accomplishing this will require buy-in from IT leaders.At this stage in the process, I also recommend mapping out your relationships with stakeholders. Where you don’t have existing relationships, identify colleagues who do. This is especially critical when inpatient-focused leaders need to work with outpatient-focused service lines and facilities. Their insights will be critical as you proceed to the next step.
    2. Determine stakeholders interests and influence: Once you identify stakeholders, you should determine their interests and consider their influence. To uncover interests, ask how the project may impact a stakeholder’s personal or professional goals. For example:
      • What pain-points could clinic-based specialty pharmacy services address for this stakeholder? How could this project help him succeed personally or professionally?  
      • What concerns might this stakeholder have about our initiative? How could the program create risk for her business or personal goals?  
      • Does this stakeholder’s interests compete with another stakeholder’s interests? 
    3. Build a plan for stakeholder engagement and communication: I have found using a “RACI” framework helpful in building an effective engagement and communication plan for health system specialty pharmacies. Armed with information about stakeholders’ interests and level of influence, you can map out who should be “responsible,” “accountable,” “consulted,” or “informed” for various components of the program launch and ongoing operations. For example, a specialty pharmacy project may include:
      • Responsible: Pharmacy leader 
      • Accountable: Person who the Pharmacy service line reports to 
      • Consulted: Clinic managers, Providers, IT leaders, CFO, Marketing leader, Payer contracting, HR leader 
      • Informed: CEO, Chief Nursing Officer, Chief Medical Officer, Supply Chain, Facilities

      People in the “Consulted” category should be included on a project team and provided with a detailed implementation plan. Meetings should be held regularly, as often as weekly in some cases, to ensure that all tasks are clear, scheduled, and completed as planned. Updating “Informed” people is often best handled via a governance committee that meets on a monthly or quarterly basis. Data and information on program progress and performance, both financial and clinical, can be presented, along with requests for help where needed. 

I often remind pharmacy leaders that a health system specialty pharmacy must be a system-wide initiative, not a pharmacy program. Stakeholder analysis is an effective tool that enables pharmacy leaders to build organization-wide support to accelerate success. Learn more about stakeholder analysis from the Project Management Institute or read our recent Stepping Stones article for best practices on integrating specialty pharmacy workflows into outpatient clinics.