Amanda Chuk gives us a hospital pharmacist leader’s perspective on healthcare on today’s episode of the Perspectives on Healthcare Podcast with Rob Oliver. A younger member of the Generation X age group, she joined us from the state of New Hampshire.
Here are 3 things that stood out from a hospital pharmacist leader’s perspective on healthcare with Amanda Chuk:
· The goal of the healthcare interaction is to make the patient better than when you met them (i.e. address the issues that brought them to you in the first place.)
· One way to make pharmacy safe is to develop definitive standard operating procedures so things get done to the same high standard of quality every single time
· Pharmacists can help educate patients about the purpose of their medications and the side effects and other interactions
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Here is the transcript of Amanda Chuk: A Hospital Pharmacist Leader’s Perspective on Healthcare
Rob Oliver: Thank you. And I appreciate you being with me. Today’s perspective comes from Amanda Chuk. She is right on the edge between being a Generation X and being a millennial. So we’ll give her credit for being Generation X. She is from up in New Hampshire where she is a pharmacist leader. Amanda, welcome to the show.
Amanda Chuk: Thank you, Rob. Thank you so much for having me.
Rob Oliver: Thrilled to have you here. So tell me a little bit about yourself and about your role in health care, please.
Amanda Chuk: Sure. So I trained as a pharmacist, and when I went to school that’s six years for a professional doctorate, came out as a pharmacist, and I knew I wanted to work in the hospital setting. So as a pharmacist, I continued my training as a pharmacy resident in the hospital setting, and I completed a two year residency. The first year was focused on general pharmacy practice, and then I specialized in adult critical care. So working my first job, then out of that training was within an adult intensive care unit supporting the therapy for adult critical care patients. And I did that for several years until I really found myself involved in quality multidisciplinary effort between not only pharmacy but providers and nurses within the hospital setting. I pivoted a bit to leadership position within pharmacy to support that quality and medication safety. So that’s my realm. Now, as you introduced me, thank you so much as a leader, but still a pharmacist at heart.
Rob Oliver: Yeah. No problem. So the pharmacist leader is basically in a management position within pharmacy. Is that what I’m understanding?
Amanda Chuk: Yes. I’m still within the health system arena, but my first leadership position was a manager, so oversaw direct reports of pharmacist and pharmacy technicians. Now, my role is not only in the queue care setting of a health system, but also our community pharmacy space, but really serving as that support to not only staff, which are pharmacists and pharmacy technicians, but other pharmacy operational levers as well, helping support the medication safety, patient safety work that is occurring across all realms of pharmacy in health system.
Rob Oliver: Okay. This next question I know is a passion of yours because we actually met through the New England Association for Health Care quality. What does quality health care mean to you?
Amanda Chuk: Yes. Thank you. Absolutely. And I think one way to consider quality is through that lens of safety and improvement. And I think at its core, a patient is coming to us with an acute problem, so health care workers can aim to make the patient better than when we met him or her. That’s a cute problem. I have the opportunity to really engage with the patient and the patient’s family to improve other aspects of their wellbeing as well. So that’s improvement from the patient side. I also think that healthcare workers can really leverage the quality of health care provided by aiming for improvement. And what I mean by that is really continuing to have that drive of learning when things don’t quite go as anticipated or as we wanted to. That happens. But we need to look at those as occurrences to learn from. And I also really champion learning from successes. Let’s make sure that those are repeatable and not just a happy accident. So absolutely, as you kindly said, I’m proud to be a certified professional in healthcare quality. So I think quality goes hand in hand with improvement. But improvement needs to mean what it means for the patient. That definition of what does improvement look like. And also again, within the very complex realm of health care, we can continually drive to improve the way we deliver it.
Rob Oliver: Okay. And I’m just curious, as your role in health care as a pharmacist and as a pharmacist leader, how does that relate to you think to that concept of health care quality that you’ve mentioned?
Amanda Chuk: Sure. Yeah. Absolutely. I think I’ve been fortunate enough to be involved in quality improvement efforts that have some aspect of pharmacy, some aspect of medication use. There’s so much that is done now with medications, and it’s a blessing. And it’s also an opportunity to understand the complexity and to really be mindful of safe medication use. So I’ve led quality improvement projects involved with medication use. And I’ve also interacted with other disciplines to really champion that if there’s any project or any patient care process that has medications, the perspective of pharmacy can be taken into account. We hope to bring our expertise about medications and also partner with patients and families so that they’re understanding the medications when they leave our walls into the homes that those medications make sense. The patient is empowered about knowing what they’re for, knowing what to look out for. So it’s really more than just the names of medications on a medication list. With this charge paperwork from the hospital, it’s really having that good understanding. So I think there’s a lot of opportunity for pharmacy to be at the core of health care. Quality improvement.
Rob Oliver: Yeah. You mentioned the concept of empowering patients. What a novel concept. And yet what a powerful concept can you give me an example of quality health care?
Amanda Chuk: Sure. Absolutely. And I think an approach that gets me excited, especially within pharmacy, because when we think about preparing medications and providing those medications to the patient, we can actually perform our work the same way each and every time. We don’t quite have the bedside X factor as some of the other disciplines do. What I mean by that is we can really generate standard operating procedures, so we can literally do the same thing every time follow, checklist, follow procedures. So we know that we have all of the steps covered, but that also allows some room for customizing as needed for the patient case for that extraordinary case where we need to defer to the experts in the room, and that could be the patient, that could be another care team member. So I think healthcare quality and approach would be that standardization as much as possible, but have that flexibility as well. But a more specific example of that, and I already touched on this a bit is taking a process, again, having a standard approach, but making it as impactful as possible for the patient. And one concept within healthcare quality, and a very important issue that has medications at the core is called medication reconciliation, and it is what it sounds like. It reconciles medication information across what we call transitions of care. So a patient coming to the hospital has a home medication list. It’s really important for the care team to know what’s on that medication list, to make the decisions about what to continue in the hospital. What brought the patient to the hospital may add a medication to the list so that on discharge, that same reconciliation happens at the surface. The approach to medication reconciliation could be an accurate medication list, and that’s certainly important. But I think taking it one step further and keeping that healthcare quality and that partnership with patients in mind is also using the opportunity when you’re talking to Mr. Jones about the medications is also, as I said, making sure that the patient understands what the medications are for, especially with chronic conditions or may not be a symptom to drive that medication use. But the pharmacist can help educate about the importance of taking the medications so that if when Mr. Jones goes home, not only do we have an accurate medication list, but we have, again, that empowerment of making sure that the medications are going to be taken safely. So I think that’s an example of I hope, both things a standard approach, keeping the patient in mind to bring it to have as much impact as possible.
Rob Oliver: There’s so many things in what you just said that I would love to keep on. You said talking about the people that are the expert in the room, and the first person that you mentioned was the patient as being the expert, which a phenomenal concept. But then so many times, I feel like a pharmacist. People are separated from their pharmacist, like the pharmacist is behind the counter, and you don’t have kind of medication counseling. Does that make sense to you? And it sounds like you’re pushing to make sure that there’s a relationship with the pharmacist in which people understand the medications that they’re taking, understand why they are taking them and have a better grasp on what’s going on with their medications. So it’s not just these are the medications I take, and I take them because that’s what my doctor told me to do.
Amanda Chuk: Sure. Absolutely. I’d like to think that pharmacists continue to be untapped resources. So let’s today be the message that we are ready and eager to share the information that we know about medications to patients. And there’s national effort to have pharmacist recognized as providers, even when it comes to reimbursement. So I think our profession is still developing and still really signifying what our place on the health care team is. But even despite all of that, if you have a corner pharmacist, a corner drugstore pharmacist, don’t be afraid of patients and families to bring the questions forward because it’s win win. The pressures on the physicians are such that there’s less and less time, probably during those office visits to maybe spend taking a full medication history, answering the questions that patients and families have so far. I’m assist with our training. We would love to have that opportunity to know that patients and families identify us as resources for them.
Rob Oliver: Fantastic. And that really leads right into the next question is, what do you wish people understood about your role in health care?
Amanda Chuk: Sure. Absolutely. I think for a long time, even when I first went into hospital pharmacy, some people weren’t even sure about pharmacists in hospital. So I’d love to say that behind every medication across so many realms is a pharmacist and a pharmacy technician. And that’s hospital that’s the corner drug store. That’s the chain drug store. It’s the grocery store. It’s long term care facilities. It’s College infirmaries mail service, mail, mail order prescriptions. There’s a pharmacist looking at the patient profile, looking at other medications that are prescribed at the same time to make sure there’s no interactions and that the dosing is appropriate. And there’s pharmacy technicians. And it is what it sounds like. It’s a technical role that helps again, the complexity of preparing those medications, stalking them in the hospital, stocking them on the shelves. Our technicians are involved in a variety of roles. So as pharmacists are trying to practice at the top of our license, we are releasing development in our pharmacy technicians as well. So that’s why I hope people understand that again, more and more medications are used, and there’s a pharmacy team behind them.
Rob Oliver: Right. And it is more than just counting out to make sure that someone gets 100 pills in their bottle. Do you remember that there was a commercial a number of years ago about a kid who was sick and the parent was a pharmacist. And so they got, like, a box of runts candy. And the pharmacist sorted them all out individually because the child only liked one particular kind. But what you’re talking about is really the power that there is in a pharmacist to make sure that people are getting the proper medication, that there aren’t any interactions or so on. That goes with that. What excites you about the future of health care?
Amanda Chuk: Absolutely. I think it’s hard not to think about health care and forget the pandemic that we’re still living through. So I think that the COVID 19 pandemic highlighted the consideration of health equity, and I heard that described one time as everyone having a fair and just opportunity to be as healthy as possible. And isn’t that a great goal? So I think that to me, the momentum behind that aspect of public health is exciting, and I can’t help but see the role of pharmacists and pharmacy technicians to help that we can be sure that the best medication is the most available one to anyone who needs it.
Rob Oliver: Okay. Do you think that there’s a difference in the way that pharmacies operate when you’re talking about a hospital pharmacy, a suburban pharmacy, and an urban pharmacy? Ideally, they all operate the same. But do you see a difference between the practical aspects of each one?
Amanda Chuk: Oh, sure, absolutely. I think that there are different skill sets because it’s hard to separate the pure professional pharmacy from pharmacy, if that makes sense. So I really give kudos to our community pharmacists who are also navigating the insurance and the billing aspects because the best medication is only as good as having the patient and family be able to afford it and be able to have the insurance coverage in the hospital. We’re a little bit insulated from that because medication use is less encumbered by those really important considerations. So I think every realm of pharmacy has its own. Like I said, skill set at the core is medication knowledge and patient safety and medication safety. But there’s pharmacists involved in drug development. So we don’t think about that often. But there’s the research and development aspect of pharmacy as well. So we all have the pharmacy degree. But I think what drew me to the profession is that I knew with that degree I could go in so many different areas and even my own career. I started off in the acute care bedside critical care, and now I’ve pivoted into safety and quality, and I love that realm as well.
Rob Oliver: Yeah. It’s interesting to hear you talk about this because I think the concept of the pharmacist relates back to the Apothecary, which relates there’s a huge long history. And yet what you’re talking about is that the true extent of what is available as a resource from your local pharmacist is still not being properly not being fully utilized. Let’s put it that way. What is one thing medical professionals can start doing today to improve the quality of healthcare?
Amanda Chuk: Sure. I think any healthcare professional can start tomorrow in their next shift, bringing that lens of safety and improvement to their work. And I think that’s as simple as coming to work and adopting a questioning attitude, really understanding if something went wrong, why? Let’s understand why or being open to others asking questions. So really developing that learning culture, aiming for zero harm, zero preventable harm for patients and just continuing that drive. So that really starts with the people doing the work and partnering, of course, with patients, as I said, but I think improving the quality starts with that being considered a part of everyone’s job. I happen to be a quality leader in pharmacy, but everyone in health care quality improvements part of their job as well.
Rob Oliver: Got it. It’s so interesting. I was part of an organization, and I think when we got together for sessions, they were blame storming sessions, not brainstorming sessions where we weren’t trying to figure out how to solve the problem. We were figuring out who to pin it on. I think what you’re talking about sometimes is what happens where something goes wrong. And there’s an effort to kind of pinpoint who is at fault. And who do we blame for this as opposed to saying, what have we learned? What can we learn from this? How do we make sure it doesn’t happen again? And the point you made earlier is also very powerful, which is when things go well, how do we repeat that and put it into a process that goes forward from there? Amanda Chuk, thank you so much for being with me today. I really appreciate you sharing and thank you for sharing your perspective on healthcare.
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