What I Wish I Knew: Getting the "Yes"

Dr. Tami Argo received her PharmD degree from the University of Iowa College of Pharmacy, and subsequently after graduation completed a 3-year specialty residency and research fellowship in clinical psychopharmacology there as well. In Dr. Argo’s previous work experience in the VA Health Care System she developed a new PGY2 Psychiatric Pharmacy Residency program while stewarding the development of her facility’s ambulatory care mental health pharmacy services. Her facility for about 40 years was supported by a sole psychiatric pharmacist practicing in inpatient care, and in three years grew to a team of four mental health Clinical Pharmacy Specialist positions providing innovative and much needed clinical pharmacy services in both inpatient and ambulatory mental health.

 

1. How have you organized your idea on paper?

Organizing the new service concept utilizing a written proposal can help you streamline your idea and help communicate the who, where, when, why and how of the new clinical service. We utilized written proposals for all of our new clinical services and prepared them in advance of our verbal presentations to key stakeholders, utilizing a common format:

• Goal of the service – it is important to explain the overarching gains of this new clinical service
• Qualifications of personnel providing the service – we delineated that clinical pharmacists who were board-certified or board-eligible psychiatric pharmacy specialists would be providing services, and at times would be overseeing services provided by student and resident trainees
• Clinic procedures, including structure of the service (chart review, face-to-face medication therapy management, consult-solicited), timeframe for completion (as applicable) or when services would be provided (e.g., Friday afternoons), note and consult titles for documentation, and structure for capturing workload – outlining clinic procedures in detail will provide the “meat” of your idea and show that you have conceptualized the step-by-step processes required to carry out the services
• Time in full-time employee (FTE) estimated to be needed to carry out the new service – this may be a very important part of a proposal, depending on the resources you have in clinical psychiatric pharmacists and how they are allocated to different clinical and administrative activities
• Brief justification for creation of the new service – some new services we described and presented were merely formalizing a service we had already been informally providing, which allowed for clinical documentation of the work we were doing and helping to generate workload credit and recording of pharmacist interventions which helped my department

2. Have you gathered needed collateral supports for your new clinical service?

Rarely will a new clinical service solely impact your Pharmacy department. It is important to consider clinical areas or departments that would utilize the service, and align supports from within those service lines or departments. If you can garner support of your new clinical service from those that would benefit from its implementation, that backing can help move the idea from concept to reality. Many of our services helped to collaboratively provide care to patients seen not only in mental health clinics but also primary care clinics, dual diagnosis clinic, and even specialty care services. Building your network of connections in those departments by utilizing opportunities to showcase your skillset as a psychiatric pharmacist, and displaying your value of and contributions to a multidisciplinary and collaborative approach to care can help you in building your professional network. I looked for opportunities to build my professional network in my facility through assigned administrative responsibilities including committee and workgroup involvement but also in daily clinical interactions with the health care team. We had an open door policy in our clinics -- meaning if we were not seeing a patient, we were available for consultation. Garnering supports from outside of Pharmacy in those service lines that would gain from implementation of your service and whom can be “allies” to clinical psychiatric pharmacy practice can be critical to the overall success of your eventual service pitch. If others want the clinical service to be provided, this can carry significant weight.

3. Have you done the research to back your idea?

Do your homework. Clinical experiences may help in identifying gaps in clinical care that may benefit from further pharmacist-led intervention. But further researching in the primary literature for detailed successes of implementation of services similar to your idea may help strengthen your proposal. As well, you may be able to save yourself from “reinventing the wheel” by calling out to others in the field who have implemented similar services and gain from their knowledge and past experiences. CPNP has an active and vibrant membership who are readily accessible through our email list. A simple call-out to our membership to ask for those who have implemented a similar clinical service to contact you off-list to share with you specific insights can save you time and effort. Sending a message to the CPNP email list may seem daunting if you are a resident or newer practitioner. However, you will find many a generous and supportive collegial response to your inquiries. Looking back to previous posted messages to see how others have posted similar inquiries may be useful. Keeping your email request short, to the point, and organized may also aid in facilitating replies. Many will share with you documents, note templates, and other tools they have created. In gaining these contacts, you can also find out what went well and what not-so-well in previous service development and implementation, and take those lessons learned by others who have gone through the “growing pains” already. This will help you improve upon your service proposal and procedures. As well, in my experience, being able to speak in some detail to other facilities’ successful implementation of clinical services similar to what I was pitching to my management team was helpful in navigating their support in moving forward with the new clinical service. If others have been successful in implementing at their facilities, why couldn’t we be just as successful?