This was my first non-clinical rotation, and I think the timing of this rotation at the half-way mark of my residency is very fitting. It was very eye-opening to see the layers of management and leadership behind ensuring that all the operations, clinical services and strategic plans run smoothly.
Through shadowing Mits, and having discussions and daily reflections with Mits, I had the opportunity to learn and observe about his management and communication styles.
Some clinical pearls I learned were:
- Communicating with SBAR
Prior to this rotation, SBAR was something I had only seen on a nursing communication sheet at MSJ. SBAR stands for Situation, Background, Assessment and Recommendation – it follows a similar order that SOAP does. When addressing a management issue, Mits had me practice how I would explain this particular issue through SBAR and I was also able to observe how Mits used SBAR to explain the same issue to a medical director. One difference between the way I explained SBAR and Mits was that he included parts of the “R” in my “S” to allow the receiving end to understand the purpose of the conversation. I think this tool will be a very systematic and effective way for me to communicate issues to other health care team members and my colleagues.
- Communicating with OWTF and using “I” language
OTFW is communicating by talking about what I observed, what I think, what I feel and want. The order doesn’t have to exactly follow OTFW, but the key is to touch on all of them when bringing up an issue. Communicating with OWTF and using “I” language will help others understand your perspective, communicate in a non-confrontational manner and provide others with the choice of helping you (versus demanding for assistance on the matter).
Implementing and ensuring successful change requires going through all 5 steps of ADKAR. On my last day, we attended a leadership forum at Burnaby Hospital where managers, coorindators, PCCs, LPNs and executive directors presented and discussed about the health care report card, different initiatives taking place at BH, the successful patient stories and steps to take and are being taken to ensure successful change. This forum was also great example of another communication tip that Mits taught me and that was to ensure that everything communicated does a 360. If there is an issue, ensure that those who brought up the issue are made aware of the status of the issue (e.g. email, verbal communication, interim reports). This forum provided an opportunity for the leaders in BH to provide feedback and input, as well as, ask questions to president of Fraser Health, Michael Marchbank. Overall, it was a great end to my rotation to see ADKAR being applied in practice!
- The Donut Model
The Donut Model consists of 3 layers – the inner most represents what you can directly affect (e.g. what you can wear)?, the second layer represents what you can influence and the third layer represents what you can’t control (e.g. weather, the past). It is important, in my residency year and the rest of my career, to be aware of these different layers and avoid putting my energy into things I cannot control.
During my leadership rotation, Mits provided an analogy to describe the differences between leadership and management – on a road trip, a leader would be envisioning the destination; whereas, the manager would be planning the trip and figuring out how to actually get to the destination. Without a leader and a vision, the manager and team might be like a Roomba, which serves its function of cleaning but isn’t necessarily moving forward.
During my week with Mits, I was able to observe how he carried both the roles of a leader and manager – representing Pharmacy in interdisciplinary committees like the P+T, addressing human resources issues, meeting with the director and operations manager regularly to touch base and figure out how to move forward and guiding and teaching residents like me! While there is the thought that most leaders can’t make good managers and vice versa, I have had the opportunity of meeting numerous pharmacists who have exemplified both qualities of a great leader and manager. For me, being a leader is being self-aware of your strengths and areas of improvement, frequently self-reflecting and motivating yourself and others to be innovative, to challenge themselves and each other. On the other hand, being a manager is about managing the details to ensuring that the “leader’s vision” is attainable – such as, the quality of work, strength of the team, and organization and logistics of the plan.
Another tidbit I learned regarding this topic was from my one-day dispensary rotation at VGH with Jason Park: There are generally 4 styles of leadership – structural, political, symbolic, human resources. Structural and human resources are more management styles of leadership, while political and symbolic are more classic leadership styles. However, in general, it is difficult to function with only one type of leadership.
My Pharmacy Leadership mini-project consisted of reviewing the drafts for the Interdisciplinary and Pharmacy Policies, as well as, the Clinical Practice Guidelines for Medical Marihuana (MM) in the acute care setting. The main question that my project aimed to answer was whether or not these resources would be (1) sufficient in guiding front-line workers to assess and handle medical marihuana and (2) easy for front-line workers to navigate and utilize.
In order to evaluate the policies and guidelines, I had to first get a better understanding of the regulations and background behind Medical Marihuana. Medical Marihuana, which falls under the Controlled Drugs and Substances Act, can be legally obtained by patients, under the Access to Cannabis for Medical Purposes Regulations (ACMPR). Legal formulations include: fresh or dried marihuana or cannabis oil, and access to legal supply is only through a licensed producer, registering with Health Canada to make own supply or to designate a surrogate marker to grow the supply (NOT through storefronts/dispensaries; legal licensed producers will always mail to patient). From Sept 2015 to 2016, the use of MM has tripled (1) – further emphasizing the need to ensure that front line workers are equipped to assess and handle MM as more patients coming into the ER will likely be using medical marihuana.
Questions that my preceptor had me consider while making my presentation were:
- Are the documents enough to guide front-line workers in a situation where:
- Patients are self-treating?
- Patients are using MM illegally?
- Absence of a doctor prescription?
- Patient does not have a family doctor?
- Patients are getting illegal supply?
- What are health care worker’s legal obligations in the handling of MM?
- How do we ensure the rights of those who don’t want to be exposed second hand to marihuana (e.g. when either smoked or vapourized), as well as, the rights of those who do want to consume medical marihuana?
Management principles required to complete the project include:
- Change Management
- Patient Safety
This project provided a great opportunity for me to further understand the complexicity of the use and handling of medical marihuana, and the challenges behind communicating policies and guidelines to front line staff (e.g. the difficulty behind consolidating all the required information into one document, accounting for all the potential situations that could occur in the front-line, providing a user-friendly decision process algorithm), and evaluate the current drafts of these documents and come up with possible solutions.
FYI: Something I learned in my distribution rotation – MariHuana refers to the legal medical marihuana, and MariJuana refers to ilicit marijuana (e.g. smoking)!
- Procedure to accessing MM: http://www.hc-sc.gc.ca/dhp-mps/marihuana/access-acceder-eng.php#s2
- Authorized Licensed Producers for MM: http://www.hc-sc.gc.ca/dhp-mps/marihuana/info/list-eng.php
- Regulations for Access: http://www.hc-sc.gc.ca/dhp-mps/marihuana/law-loi/index-eng.php
- Sample Medical Document: http://www.hc-sc.gc.ca/dhp-mps/marihuana/info/med-eng.php
- Loss or theft report: http://www.hc-sc.gc.ca/hc-ps/alt_formats/hecs-sesc/pdf/substancontrol/substan/compli-conform/loss-perte/form_4010-eng.pdf
I will be doing my leadership rotation with Mits Miyata this week. The following are my learning objectives:
- Describe Mits’ role as manager of clinical services and his style of management and leadership
- List 3 differences between leadership and management