Managed Care
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From Pharmacist to Manager, With Many Hurdles Along the Way

MANAGED CARE October 2006. © MediMedia USA

From Pharmacist to Manager, With Many Hurdles Along the Way

Dealing with that most volatile chemical mix, human beings, means being challenged every day
Maureen Glabman
Contributing Editor
MANAGED CARE October 2006. ©MediMedia USA

Dealing with that most volatile chemical mix, human beings, means being challenged every day

Maureen Glabman

Contributing Editor

At the start of the Vietnam War, Steven Gray, PharmD, JD, was attending college in Fresno, Calif. when the Army came calling. Since he had a science background, the Army thought the draftee could serve best by working in a military hospital as a pharmacy specialist, dispensing medication, making intravenous solutions, and compounding products for burn victims.

Though he had not previously considered a pharmacy career, Gray, now 59, was hooked. After earning a PharmD, he landed a job as an outpatient and hospital pharmacist at Kaiser Permanente, working his way up to his present post as Kaiser's California pharmacy professional affairs leader. Gray finds ways to maximize use of the training of Kaiser's 2,600 California pharmacists who prepare medications for 6 million members statewide.

The path to his current position was not easy. His first administrative job required him to manage a large pharmacy with 35 employees. "Most of the pharmacists accepted my role. They saw me as a bridge — a champion of their cause to administration," Gray says. "I spent a lot of time developing personal skills to perform that role."

Others might be described as passive-aggressive, quietly refusing to follow his direction, feigning forgetfulness. "That was hard to deal with," he recalls. "It wasn't insubordination; it was deeper. It could be they had aspirations for the same job, they may have liked the previous boss and felt a loss, or they just didn't like change.

"If it's jealousy and they resent you, there are various ways to deal with it, like helping them attain another position — give them hope that there are higher options for them. If they liked the previous boss, you have to reach out and be as personable as you can be. If they just don't tolerate change well, this resolves over time. You are leading a group but you must never forget the group represents individuals. Don't treat everyone the same. Some need freedom, some need encouragement and so on."

"Suit" colleagues could also be challenging, he says. "But there were other things I knew as well as they did or better," he says. "There are a lot of unions at Kaiser. I had union experience and knew the culture. I brought that to the administration."

One of the best educational tools he discovered was a professional course in negotiation.

"Culturally, most Americans don't have these skills that they have in countries where barter is a way of life," Gray says. "In negotiation, information is vital. You have to know the background of the people you are dealing with, their critical issues. You have to listen and acknowledge where they are coming from before stating your point of view. Most people want to be heard first before they listen to you."

What will it take?

Gray had to use that skill recently when he sought to convince Kaiser doctors that an elite group of pharmacists had the capability to follow cardiovascular patients after diagnosis. It was a pilot project where pharmacists would speak to patients about diet and potassium levels and adjust their medications as necessary. He asked the physicians: "What is it going to take to convince you to let pharmacists try this program?" They agreed to it if nurses, cardiologists, and pharmacists wrote a protocol that included regular monitoring and reporting. What did Kaiser get out of it? "Everyone is used to their best capacity," Gray says.

After more than two decades in management, Gray, who is also president of the Academy of Managed Care Pharmacy and a past president of the California Pharmacists Association, continues to try to win over his former pharmacy colleagues and administrator coworkers with lessons learned through supplementary courses. "There are two vital skills that are not taught in pharmacy school: project management and meeting management. In the former, you learn that nonadministrators see only their priorities. They don't understand you have to build a foundation, gain financial support, and then start the project. You have to make them see there is a bigger picture. If you understand this and can explain this to clinical people, it goes a long way to having them believe you are committed to what is important to them."

Above all, Gray advises executives to show respect to pharmacists for their role and clinical expertise. "If you can make them believe you are supportive of them as professionals and of their patients, you can have a great working relationship."