MentorVIEW With Steve Spravzoff,
Director of Pharmacy, Flagstaff Medical Center (Arizona).

It's very important for the management staff as well as the pharmacists, technicians and secretaries, to be pulling the same direction.          _{Steve Spravzoff}

PNOW: What has been the attraction to stay in smaller rural hospital settings?

SS: I think it’s the ability in your career to do things you may not be able to do in a larger facility. For example, in a smaller facility you have more of a generalist perspective and have the opportunity to participate on committees. In a larger hospital where you have significant specialization, you may not have those same opportunities. In a smaller, progressive hospital, you need to be aware of all of the things out there and limit yourself because there are so many things you can do. You find yourself having to pare those down and focus on your specific practice interest areas. I enjoy the broad range of opportunities in a smaller facility.

PNOW: When you talk about a “progressive” facility, what does that mean to you?

SS: I look at the whole mindset of the medical community. We have physicians and other health care providers who, even though geographically we may be in a rural area, do not limit their thinking. They’re always focusing on issues or ways of providing care that may be on the leading edge. Our medical community is expanding into cardiovascular, women’s, infants’ and neonatal care - many services which are not typically done in smaller hospitals. We have the support to develop into more of a regional medical facility rather than just stay a small community hospital and do typical general things.

PNOW: To what degree does a strong working relationship with other medical professionals in your facility help retain or attract staff?

SS: It’s one of the most important factors. It’s important to cultivate future leadership and present people with opportunities. I feel a personal responsibility to be vested in every single employee in the department. My most important job is to create conditions for success with the other people we have working in the department. At the same time, I think I’ve been very fortunate and very blessed to work with many people in upper-level administration who have done that same thing for me. Whether you call that mentoring or building future leadership, we need to recognize we all play a role in adding value to the other people we’re working with.

PNOW: Do you actively seek opportunities for your technicians and pharmacists to get involved with other activities within the hospital?

SS: That’s correct. Specifically, we have a very focused planning process that has been in place for the last 12 to 18 months. We do what I call bottom-up goal setting where we start with the interests of each employee. With traditional goal setting, you start with the strategic plan of the hospital and have that trickle down to the department. You try to recognize the skills and competency sets of each employee and plug them somewhere into the plan. We do the opposite. We ask a set of questions to each of our staff in regard to their personal interests. Based upon the responses to the questions, we try to the best of our abilities to interface the employees interests and goals with the departments current objectives. It’s pretty exciting. We have a very high level of energy because people are involved in this participatory process.

PNOW: What are some specific things you’re doing with bottom-up goal setting? How can a pharmacy director in Montana or Wisconsin or even in a small hospital in Chicago bring about the bottom-up goal setting as effectively as you are at Flagstaff?

SS: It’s all pretty simple stuff. We basically start out with a set of questions and ask each pharmacist or technician in the department what are their professional work-related interests. What areas do they feel they have some strengths in? That’s were we begin. We also ask what other areas would you like to be involved in, and then we look at what types of personal training and educational development would benefit you within the next year. Finally, you need to ask what resources or support will be needed from the hospital in order for the personal plan to be successful. That brings it back around to the director. At that point, the director or whoever is facilitating this goal-setting process can decide if it looks realistic to support the staff member at this level or if their interests look like they’ll fit in with moving a particular program forward. We also use a general survey a couple of times a year to gauge the overall feeling in the department. Some typical questions focus on whether the employees know what is expected of them at work, if they have the materials and equipment they need to do their jobs, whether they have the opportunity to do what they do best every day and if their supervisor is someone who is encouraging their development. We, as supervisors, want to get feedback in regard to how well we’re doing. We want to know if there’s something that needs to be improved or some significant problem going on so we can take corrective action and move forward.

PNOW: Flagstaff is facing some of the same retaining and recruiting challenges as many other hospital pharmacies. While the facilities may be progressive, they may not be geographically close to a major city or perhaps are undersized in comparison to some of the bigger facilities. How do you attract staff?

SS: We’ve recently shifted our mindset to focus on recruiting as a continuous process. We recognize that everyone on our staff is being recruited and are also recruiters. We always have to be on the look out for quality people to join our staff. I may have a heads up at church or in the grocery store. One of our board members has a high level of awareness of the shortage of pharmacists and nurses and different health care professionals. Because of that, she indirectly does recruiting when she hears people might be interested in moving to town. She always asks if they’re in the health professions. You never know where you may get that lead. I think it is important for everybody to have an ongoing recruiting plan, but beyond that, I think indirectly you may be fortunate when some of the seeds you’re potentially planting might bear fruit.

PNOW: Can you give an example of when this method has worked?

SS: Sure. There is a pharmacist I have known for 10 years through various professional meetings. I never thought this pharmacist would be considering leaving his current employer because he had been there for about 15 years. When I interacted with him recently, I offered him a summary description of the position we were currently offering. I told him to call me if he ever considered relocating to Flagstaff. I can’t say he was a warm recipient of the information. But about two weeks later he called and he said he and his wife were tired of the large metropolitan area, the crime, the smog, the downsides of where they lived. He said he’d like to visit Flagstaff. Within a week after that interview, we had hired him. He has just been an outstanding hire, very easily trained and a fantastic addition to the staff from a teamwork perspective. It’s been a win/win hire.

PNOW: Please tell us about some of the groups you’ve developed to involve your staff in the hospital.

SS: We break down into smaller groups where we can have dynamic discussions on areas that are important to each person. We’ve recently started holding a clinical meeting each month for staff pharmacists. We get together to specifically discuss patient care issues. As part of that process, we’re having one pharmacist prepare a case study each month on a specific actual case they have encountered. That creates an environment of continuous learning throughout our employees. Also, a group was created to give the pharmacists an opportunity to self-schedule. Scheduling is so important to many of the people. The small group, rather than the supervisors, take in scheduling requests and serve as a catalyst for working out problems and looking at opportunities on the schedule. We’ve also created a task force on increasing the utilization of technicians. We have another task force working with creating new work systems in response to our increasing demands and growth. The task forces might be in existence for a month, two months, or three months, depending on the complexity of the issue. Currently I have a group working on communication methods - including point people, cell phones and Palm Pilots. We provide every pharmacist we hire with a Palm Pilot and the supportive software.

PNOW: What are the advantages for creating a participatory environment where pharmacists are entrusted with significant involvement with decision-making?

SS: It’s very important for the management staff as well as the professional staff, pharmacists, technicians and secretaries to be pulling the same direction. That is the dynamic that creates the synergy in the department. I spend far less time resolving conflict issues. The rest of the staff is more motivated and interested in taking on additional commitments. It’s not all about doing more; it’s about having a focus. I really like to see people maintain balance at work, not necessarily have to add more, but to have that focused attention to do the things that mean the most.

PNOW: As Pharmacy Director at Flagstaff, what advice would you give to pharmacy directors or young pharmacists?

SS: My advice for directors is to leave no stone unturned and to exploit the opportunities that might be available to you. Engage your staff in that process to see if there is something else you could be doing. Focus on looking at creative new ways and change. To the new pharmacists, I would suggest creating opportunities that could be win/win. Identify your expectations and let management know. Recognize that your practice setting is going to have a significant amount of influence on your ability to be happy and to create success in your career. I know money and benefits and those core things are very important, but it’s also very important to interview the facility and find a director or supervisor who demonstrates interest in developing your career. Find a team that will be supportive of your career goals and be willing to put in the energy for you to develop into the type of pharmacist you want to be.

Favorite book: Fishing Lessons, by Paul Quinett.
Fun/leisure activities: I spend my recreational time fly fishing, hiking the Grand Canyon and snow skiing. I also believe that it is important for me to give back generously to the profession by being involved in professional organizations and to be a volunteer for various activities that benefit our community.
Favorite quote: "Response is everything!"