What was the leadership challenge for this case? Describe two or three
striking characteristics of Crystal's understanding/description of leadership and why they caught your attention. Summarize and discuss two takeaways, from Crystal's story, you think are valuable. Justify the chosen takeaways.
Biographical Sketch Prior to joining The Joint Commission, Dr. Riley's work history consisted of clinical pharmacy work in a variety of settings, including inpatient hospital and ambulatory facilities. She gained experience in performing medication reconciliation studies in two large suburban hospitals, which ultimately led to the creation of a reconciliation tool designed to assist medication tracking throughout the patient's stay in the facility. Dr. Riley was also involved in the implementation of an electronic health record (EHR) and computerized physician order entry (CPOE) system in a 600-bed hospital, which allowed her to gain additional insight into medication management and reconciliation issues within hospital settings. She has had the opportunity to work with national consumer safety organizations and has had experience working for a large payer of healthcare services, providing drug information services, and adjudicating pharmacy claim grievances and appeals for state assistance programs. Additionally, Riley served on the medication reconciliation cluster workgroup for a large pharmacy quality alliance and participated on a committee focused on the utilization of health information technology to reduce disparities in health care. Dr. Riley earned her doctorate of pharmacy from Howard University in Washington, D.C., and a master's degree in Healthcare Administration and Business from the University of Maryland University College. Current Position Currently, Dr. Riley is the Associate Director, Federal Relations at The Joint Commission, where her portfolio of responsibilities includes data-driven performance measurement and quality improvement/patient safety within hospital settings, including outpatient services. On the measurement side, Dr. Riley has knowledge of issues surrounding measure development, risk adjustment, application, and data collection. In addition to acting as a drug information resource within The Joint Commission enterprise, she is actively involved in outside medication safety councils that work to reduce the prevalence of medication errors and avoidable adverse drug events. Furthermore, she monitors pharmacy-centered issues such as novel drug development and pharmacotherapy related to Centers for Medicare and Medicaid Services (CMS)-focused disease states. Recently, she had the opportunity to act as a clinical reviewer for updating nationally recognized venous thromboembolism treatment guidelines and has also served on a technical expert panel reviewing medication management measures for CMS. Thoughts on Leader Characteristics Early on in my career, the term leader seemed ridiculously straightforward. It was someone who told others what to do, and they did it. Through work experience and additional education, I came to understand that being a leader encompasses so much more than issuing directives to others. It really is more of a mindset, an attitude, and a hunger for change that will encourage others to align with you and help you achieve your end results. My own observations have shown me some common characteristics of people I believe to be some of the most effective leaders. Chief among these traits is passion. You recognize those people who truly believe in their missions; they are dynamic when they speak, and when they fall silent, you think that you can be a part of their movement that will change the world. There is a spark in them that radiates through those that listen, and their desire to act is infectious. You feel their momentum and want to move along with them because they've made you believe. Many of the best leaders that I have seen are also believers in transparency. They recognize that there are few to no actions that are without consequence, and they do what they can to give a global view of all considerations. They carefully outline processes, concerns as they arise, and outcomes of activities, regardless of success or failure. And they are capable of acknowledging when they have been wrong. One of the most important characteristics that a leader can have, particularly in the healthcare arena, is a collaborative spirit. Health care itself is changing from a siloed practice model to one of integrated care; in order to keep up, leadership must follow. Leaders must recognize that they cannot make changes without engaging and working collaboratively with others. Limited support from stakeholders will almost ensure that initiatives remain stagnant and no change occurs. Leadership in Practice: Riley Case 1 Pharmaceutical Inconsistencies Describe the leadership challenge of your case. During my last year of pharmacy school, I leveraged my drug information rotation into a job that I started immediately after graduating and passing my state licensing exam. As a part of my position, I would be a contracted clinical pharmacist/drug information specialist that split time between two large community hospitals that operated under the same healthcare system. Included in my daily duties were rounding with physician teams, performing IV to oral medication conversions, making dosage and medication adjustments, tracking adverse events, and providing educational services to staff. For a new graduate, it was exciting and frightening at the same time. However, I was ready to take on the challenges and was hopeful that I would find someone to guide me through the learning process. A short time into my tenure at the two hospitals, I noticed that, in the course of reviewing patient charts, there were many inconsistencies in the manner in which patient medications were recorded and tracked throughout patients' stay in the facility. I approached pharmacy leadership with my concerns and was given the green light to start researching medication reconciliation processes within the hospital system. Health care at the time was still largely paper-based; computerized systems were extraordinarily expensive and were limited in their use. I spent the next few months examining old patient records to see exactly how patient medications were noted in patients' charts. The results were disheartening. Out of the nearly 200 records that I reviewed, only approximately 20% of them had complete reconciliation of patient medications from patients' arrival at the hospital to their discharge home or to another facility. The lapse in continuity was particularly evident during the times when patients were transitioned from one level of care to another. I presented my findings to leadership and was told to find a solution. Issues Encountered Although I was excited to have an opportunity to make a difference in hospital processes, my project didn't go as smoothly as I would have hoped. The information gathering process was all done by hand and recorded on paper with no backup system in place. So when I arrived at work after a weekend and retrieved my documents only to find that they had been altered and, in some areas, completely whited out, I had no recourse but to start over from the beginning. Once I did have the results and the analysis completed, the reception to the presentation of my findings was less than warm. The meeting turned into something of a "blame game" with fingers being pointed and responsibility being shifted from one department to another and many ill feelings toward me for presumably insulting staff for not doing their jobs properly. The intricate medication reconciliation form that I had created to be included with all patient charts received strong negative feedback, with committee members citing concerns of burden and questions on who would bear the responsibility of ensuring that the forms were completed correctly. Resolution and Outcomes At the end of the process, and after several revisions to the medication reconciliation document, a version was finally agreed on for integration in the patient charts. The form was quite simplistic, requiring a minimal amount of information to be provided, and the effort would be shared by the patient's caregivers. There were no additional processes put in place to ensure that the form was being filled out properly or consistently, and everyone seemed satisfied that this was a reasonable solution to the medication reconciliation process. Lessons Learned Looking back over the past near-decade since my foray into the medication reconciliation process, I can both appreciate and curse my naiveté during that time. I was truly excited to have the opportunity to be a part of change, something that would improve hospital systems and patient safety and care at the same time. But I forgot to consider stakeholders outside of myself and the patients. I did not have an appreciation of truly collaborative efforts or the concept of burden. Nor could I have imagined the resentment that the implications of my work could cause because of implied blame. The need for a new process was apparent and the research was sound, but there were many things that, if I had the same task to complete now, I would do much differently. I would engage people that have the potential to be affected by my work. In this case, physicians, nurses, and pharmacists all bore responsibility in ensuring that patients' medications remained correct throughout their duration of stay. It would have been better for all involved to be aware of what I was doing and why I was doing it and for me to gain some of their insights on how the problem could be addressed. I would have framed my results in a manner that would have felt less accusatory. The outcome of the research may not have changed, but the delivery may have been accepted better if it had not seemed as though the staff were not performing their duties properly. It was not until I was fully immersed in health care and my master's degree studies that I understood the consequences of being an ineffective leader. Dissent, resentment, and potential sabotage are all sequelae of ill-leveraged leadership, and transparency, engagement, and openness would all have served me well in the quest to better health care in my hospitals. I did not realize it then, but it has been a lesson well learned over time.
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