Kenn Finstuen

Pharmacy Executive Leadership Issues and Associated Skills, Knowledge, and Abilities

OBJECTIVESnTo identify challenges that current and future pharmacy executives are facing or will face in the future and to define what skills, knowledge, and abilities (SKAs) are required to successfully negotiate these challenges.nnnDESIGNnDelphi method for executive decision making.nnnSETTINGnCivilian pharmacy profession.nnnPARTICIPANTSn110 pharmacists who graduated from the GlaxoSmithKline Executive Management Program for Pharmacy Leaders.nnnINTERVENTIONSnTwo iterations of the Delphi method for executive decision making separated by an expert panel content analysis.nnnMAIN OUTCOME MEASURESnRound 1--participants were asked to identify five major issues they believed to be of greatest importance to pharmacy leaders in the next 5-10 years and name specific SKAs that might be needed by future leaders to successfully deal with those issues. An expert panel reviewed the issues, classified issues into specific domains, and titled each domain. Round 2-participants rated the SKAs on a 7-point scale according to their individual assessment of importance in each domain.nnnRESULTSnFor Delphi rounds 1 and 2, response rates were 21.8% and 18.2%, respectively. More than 100 total issue statements were identified. The expert panel sorted the issues into five domains: management and development of the pharmacy workforce, pharmacy finance, total quality management of work-flow systems, influences on the practice of pharmacy, and professional pharmacy leadership. Five of the top 15 SKAs-and all four highest ranked items--came from the professional pharmacy leadership domain, including ability to see the big picture, ability to demonstrate the value of pharmacy services, ability to lead and manage in an ethical manner, and skills for influencing an organizations senior leadership.nnnCONCLUSIONnThrough successful integration of communication skills, critical thinking, and problem solving techniques, future public-sector pharmacy executives will be better equipped to effectively position their organizations and the profession for the challenges that lie ahead.

Dosage effects of pulsed steroid therapy on serum cortisol levels in oral and maxillofacial surgery patients

The purpose of this study was to determine the effects of two dosage regimens of dexamethasone on the serum cortisol levels of a group of patients undergoing major maxillofacial surgical procedures. Analysis of the data demonstrated that the use of dexamethasone, 10 to 20 mg intravenously given every 3 hours intraoperatively and every 4 hours postoperatively over 24 hours, followed by a repository dose of 80 mg of intramuscular methylprednisolone, causes short-term serum cortisol suppression. The maximum depression occurred on postoperative day 3; normal levels were restored by postoperative day 7. Therefore, pulsed therapy can be considered relatively safe when known contraindications have been considered.

Building from within: identifying leadership competencies for future navy nurse executives.

The purpose of this research is to forecast the relevant competencies and important skills, knowledge, and abilities (SKAs) for Navy nurse executives in the next 5 to 10 years. Using 2 iterations, Wave I and Wave II, of the Delphi technique, 6 competency domains emerged: business management, executive leadership, professional development, global awareness and interoperability, communications, and personnel management. For Wave I, 38 (19%) of 200 nurses identified what they considered to be the 5 most relevant competencies and skills, knowledge, and abilities. Reviewed by an expert panel, the results were used to develop the Wave II questionnaire to determine SKA importance ratings. Using the same respondent pool, 93 (47%) of the 200 nurses rated 100 SKA items. The top 3 rated SKAs were as follows: “Maintains the utmost integrity: has the trust of all members inside and outside of the organization,” “Communication skills: ability to communicate in all forms,” and “Ability to lead and mentor junior personnel.” The Cronbach coefficient α was used to assess internal consistency. All results were above the recommended and acceptable level of .70. The results will provide the foundation for a leadership education continuum enabling the critical link among educational offerings, role-based experiences, timely mentoring, and specific career milestones.

Executive Competencies of Nurses in the Veterans Health Administration

This study identifies competencies and accompanying skills, knowledge, and abilities (SKAs) required by the Veterans Health Administration (VHA) nurse executives. Using the Delphi decision-making method, 144 VHA directors of nursing identified five top competencies necessary for nurse executives. An expert panel sorted competencies into the eight core domains of the VHA high-performance development model. Next, nurse executives rated SKAs by using a 7-point importance scale. Response rates were 34% and 48.2% for Delphi rounds 1 and 2, respectively. Round 1 generated 245 unique nurse executive competencies. In round 2, the highest rated SKAs involved ethical conduct, decision-making, abilities to continuously learn and lead, staffing, and conflict-resolution skills. Competency list outcomes are expected to be useful for executive self-assessment, professional development, and identification of continuing education needs. Specific SKAs can provide a means for development of job requirements and career performance criteria.

Patient satisfaction in military medicine: model refinement and assessment of Department of Defense effects.

A sample of 154,893 patient responses from the Customer Satisfaction Survey database was drawn for 1999 to 2000. Average patient satisfaction levels consistently appeared to be high (between 6, very satisfied, and 7, completely satisfied, on the 7-point rating scale). Hierarchical regression results essentially replicated all three major constructs of an earlier theoretical attitude model. Refinements included adjustment and addition of categorical age and military beneficiary status for individual patient variables, addition of two beliefs about the care itself, substitution of waiting time variables, and addition of reason for visit situation variables. Hypothesis test results indicated that patient satisfaction constructs were homogeneous across the uniformed services for patients from all service branches, both enrolled and not enrolled within TRICARE regions, and among branch of service medical center, hospital, and clinic facilities. The final attitude model coefficient of multiple determinations obtained was R2 = 0.701 [F(25,154,867) = 14,539.33, p < 0.0001].

Pharmacy Executives: Leadership Issues and Associated Skills, Knowledge, and Abilities in the U.S. Department of Defense

OBJECTIVESnTo identify the issues or problems that current and aspiring U.S. Department of Defense (DoD) pharmacy executives will face in the future and to define the skills, knowledge, and abilities (SKAs) required to successfully address these issues.nnnDESIGNnDelphi method for executive decision making.nnnSETTINGnDoD.nnnPARTICIPANTSnNinety-three pharmacists serving in the military grades of lieutenant colonel/commander and colonel/captain, as well as pharmacists selected for promotion to those grades.nnnINTERVENTIONSniterations of the Delphi method for executive decision making separated by an expert panel content analysis.nnnMAIN OUTCOME MEASURESnRound 1--participants identified five major issues believed to be of greatest importance to pharmacy executives and reported specific SKAs that might be needed to successfully manage those issues. An expert panel sorted these issues into meaningful domains, then provided an appropriate title for each domain. Round 2--on a 7-point scale, respondents rated the SKA items according to their assessment of how much a future DoD pharmacy executive would need each SKA.nnnRESULTSnResponse rates were 44.1% and 46.2% for Delphi rounds 1 and 2, respectively. The first round generated 62 unique issues facing pharmacy executives. The expert panel reviewed and sorted the issues into eight domains and selected an appropriate title for each domain. The domains identified by the panel were human resources, pharmacy operations/business practices, information management and technology, financial resources, formulary management, drug therapy management, pharmacy benefit management, and leadership. During round 2, 73.3% of the top 15 rated SKAs came from the drug therapy management, leadership, and formulary management domains. The three highest-rated SKAs were ability to see the big picture, ability to build strong relations with medical staffs, and skills in both writing and verbal communication.nnnCONCLUSIONnThe issues facing future DoD pharmacy executives will require them to expand their clinical abilities as well as their ability to collaborate and communicate with other professionals.

Patient Satisfaction in Military Medicine: Model Refinement and Assessment of Continuity of Care Effects

The Military Health System (MHS) identified patient-centered care and satisfied beneficiaries as main objectives in their 2006 Strategic Plan. The objective of this study was to expand upon the previous MHS model to determine predictors of patient satisfaction behaviors based upon associated attitudes and beliefs in addition to determining the predictive qualities presented by continuity of care. A sample of 90,318 patient responses from 2002 to 2004 was drawn from the Customer Satisfaction Survey database. Hierarchical multiple linear regression analyses were conducted to assess the uniquely predictive effects of the independent variables on the outcome variable. Results indicated the constructs from previous studies of satisfaction within the MHS using an attitude model were consistent when tested in a behavioral model. Hypothesis tests also indicated continuity of care demonstrated uniquely predictive qualities suggesting inclusion in the model. The final satisfaction with visit model yielded F(29, 90, 288) = 7062.37, p < 0.01 with R2 = 0.694.

Staffing Model for Dental Wellness and Readiness

Oral health is an integral part of general health. Previous research has shown that untreated oral conditions can result in increased rates of disease and nonbattle injury for deployed soldiers. The purpose of this study was to develop models for U.S. Army dental wellness and readiness using a multivariate regression analysis approach. Staffing levels and dental wellness and readiness rates were examined for the first three quarters of fiscal year 2002 at 40 Army installations. Full regression model equations were developed for percent dental wellness and readiness using location, time, dental provider types, and basic training installation as predictor variables. Both models were shown to be statistically significant, with wellness R2 = 0.37, F12,107 = 5.18, p < 0.001 and readiness R2 = 0.23, F12,107 = 2.65, p < 0.01. Further tests of specific predictor effects revealed that wellness was significantly associated with the specialties of general dentistry, hygienists, and oral surgery, and that readiness was significantly associated with region and the oral surgery specialty. Results may be useful for the U.S. Army to identify the best practices in an effort to optimize dental wellness and readiness.

The Development of a Conceptual Model for Evaluating Dental Patient Satisfaction

The purpose of this study was to identify levels and predictors of patient satisfaction and develop a conceptual model for dental patient satisfaction in military treatment facilities. Respondents completed 658,443 surveys during 17 fiscal quarters, beginning with the fourth quarter of 2000. The final data set contained 309,261 surveys, with no missing data. Principal component factor analysis was used for data reduction and hierarchical multiple linear regression to assess the predictive effects of the dependent variables on the two independent variables: (1) overall satisfaction with todays visit and (2) overall satisfaction with the clinic. On a 7-point, bipolar adjective rating scale, patients mean score was 6.53 regarding satisfaction with visit, suggesting that patients are highly satisfied. Patients beliefs about care received and environment of care were the most important satisfaction attributes. These findings are useful in educating providers about the relationship of consumer satisfaction with the interpersonal experience.

Perception of Managerial and Administrative Competencies of Professional Pharmacists in the U.S. Department of Defense

OBJECTIVEnTo determine whether executive and junior pharmacists perceive skills, knowledge, and abilities (SKA) items differently.nnnDESIGNnTwo-factor split-plot analysis of variance (ANOVA) mixed design with repeated measures.nnnSETTINGnU.S. Department of Defense (DoD).nnnPARTICIPANTSnOne hundred fifty-one active duty pharmacy officers in DoD, classified as either executive pharmacists (serving in the military grades of lieutenant colonel/commander [0-5] and colonel/captain [0-6], as well as pharmacists selected for promotion to those grades) or junior pharmacists (serving in the military grades of second lieutenant/ensign [0-1], first lieutenant/lieutenant junior grade [0-2], and captain/lieutenant [0-3], as well as pharmacists selected for promotion to those grades).nnnINTERVENTIONnSeven-point relative importance rating scales, with 1 = extremely unimportant to 7 = extremely important, were used to assess respondents judgments of SKAs.nnnMAIN OUTCOME MEASURESnMain effects of group membership (executive versus junior pharmacists), differences among items within eight specific domains, and assessment of potential interaction effects for the dependent variable of SKA item importance ratings.nnnRESULTSnNo main effects for overall rating differences between pharmacist groups were found for any of the eight domains; however, statistically significant and systematic within-main-effect differences were detected for SKA items in all domains. Additionally, statistically significant interaction effects emerged in five of the eight domains.nnnCONCLUSIONnThe importance ratings given SKAs in the domains of human resources, pharmacy operations and business practices, drug therapy management, and leadership were highly similar between the two groups. However, executive pharmacists tended to place a much greater emphasis on the importance of SKAs within the financial resources and the pharmacy benefit management domains.