The Problem of Pay for Performance (P4P)

Linking the performance of health care professionals to their compensation is a good start but unlikely to work alone in changing behavior. Health care professionals will continue their current behavior because of some of the following reasons.

They don’t know what they are supposed to do to change.
They don’t know why they should change.
They don’t know how to change.
They think something else is more important.
There are no positive consequences for them to change.
There are no negative consequences for them not changing.
They are rewarded for not changing.
They are punished for changing.

If the health care system does not provide what professionals need to change, they will not change or they will change in undesirable ways. Compensation will not make a significant difference. Pay-for-performance schemes cannot replace the other changes necessary for improving the quality of health care -- they can only support them.

Ten Common Marketing Misconceptions of Pharmacists

1. My job is not to market. The design and promotion of pharmacist services is someone else's job -- not mine.
2. Everyone gets the same service, no matter their need or interest.
3. I know what is best -- not the patient.
4. Patients only care about low drug prices.
5. It is OK to provide exceptional service one day and mediocre service the next.
6. Loyal customers will always be loyal.
7. Satisfied customers are loyal customers.
8. Patients know what pharmacists do.

9. Talking with patients is not "market research". Market research is done by marketing departments.
10.Marketing is advertising and advertising is marketing.

How to stop worrying

In the last post, I described a book by Dale Carnegie, "How to Make Friends and Influence People." I have another one of his books to recommend. It is "How to Stop Worrying and Start Living." There are all kinds of great ideas in this book, but I want to focus on a single one. It deals with HOW TO STOP STRESSING OUT OVER YOUR PROBLEMS.

If you think about it, a lot of things can go bad in this world. If we let them get to us, we can forget to enjoy all of the good things in life. So, if you find yourself worrying about some problem like, "What if I lose my job? What if I do really bad on this exam? What if my political candidate does not get elected?", ask yourself the following questions,

1. "What is the worst that can possibly happen if what I fear happens?"

I often ask this of my students when they worry what they are going to do with their life. I am kind of sadistic in even asking that question because their faces scrunch up and they exude stress as they think about the question. After listening to their fears, I ask them, "What is the worst that can reasonably happen to you after graduation?"

They usually answer, "I won't get a job."

2. The next thing to ask is "What is the likelihood that the worst case situation will occur?"

When I ask the students, what is the likelihood that they will not get a job, they typically say, "Not very likely, but still possible." I tell them that they are correct, that they might not get a job and they need to prepare themselves mentally to accept the worst--if they think it can happen.

3. The final 2 questions to ask yourself are, "What steps can I take to reduce the possibility of the worst case occurring, and how can I increase the chances that some other better outcome occurs?"

Immediately after asking this question, students typically start thinking of actions they can use to reduce the threat. They take control and their worry starts to disappear. It also steels them to do what it takes to be successful.

One of the benefits of this process is that answering these simple questions can help identify and assess the cause of the worry. In many cases, the worry is overblown and can be put into better perspective.

The other benefit is that even if the worry is real, imminent, and scary -- taking action helps give the worrier a sense of control over the problem. And worry is reduced when we feel in control.

How to win friends and influence people

If there are any more people out there that read books, I highly recommend Dale Carnegie's "How to Win Friends and Influence People." It is easy to read and offers some basic insights that can improve the effectiveness of any health care professional.

What I still remember after reading it a couple of decades ago is that the way to to become likable and credible is to stop talking about yourself. Instead, listen to others. Ask them about their favorite subject -- themselves. That may not be the case in all people, especially in cultures that don't like to bring attention to themselves, but it is for most people.

You might say "Duh!", that is so common sense. And you would be right. But we often forget or get into the habit of making everything about us.

And in our tweeting; Facebook; me-me-me society, we often spend more time focusing on ourselves than on others.

Read the book. Dale Carnegie is still relevant to human interactions today.

Testing is the best way to learn

The New York Times discussed research about the best methods for retaining information learned by students. The study found that students who read some information, and then test their recall of that information, will retain information better (50% better) than simply studying or using a learning method called concept mapping.

Recall of material is essential for pharmacists. It is an educational building block to higher levels of problem solving. I have been increasing the use of little quizzes to test student knowledge prior to class discussion. I think I will do more testing in the future.

Physicians need help in choosing the best medicines for patients

This image presents a simplified (yes, simplified) model of what goes into choosing an antibiotic for a cellulitis infection. It comes from a paper titled "Analysis of Empiric Antimicrobial Strategies for Cellulitis in the Era of Methicillin-Resistant Staphylococcus aureus".

The model lays out the options, patient population of interest, outcomes, probabilities, and costs of a relatively simple therapeutic decision. In real life settings, it is unlikely that this information is actually used in prescribing.

How strong is your brand?

Each pharmacist has a personal brand whether they like it or not. Your name is your personal brand. You can chose to manage perceptions of your personal brand. Pharmacists who effectively manage their brand are more likely to be successful in their practice and career.

Branding is the process of developing strong, positive, and consistent images of your brand in the minds of patients and others. Your brand’s strength is determined by the extent that people (1) recognize your brand when they see it and (2) recall it when making a choice. The more familiar and memorable your name, the more likely patients will choose you when they need a pharmacist. The more positive and consistent your image, the more coherent the message patients have about your brand.

What images and adjectives come to mind when people hear your name?

Using Marketing Principles in Teaching

Marketing can be useful in many ways. Take teaching for instance.  I segment my students into the following three market segments. 


The first is "dedicated learners".  They are easy to teach.  Just guide them to what they need to know.  They do well in almost any educational environment whether it is lecture, online teaching, or group instruction.  Just give them good content and provide them with opportunities to apply the concepts in problems, discussions, and exercises.  Typically, they already know a lot because by nature, they are learners.  Sometimes, I have to even tell them to back off a bit.  


The next segment is  "skeptical learners."  These people want to learn, but they need to be convinced.  They have been asked to learn a lot hogwash over the years and are choosier in how they spend their time.  They are often older, mature students who have stronger opinions of what is important and not.   Skeptical learners require the instructor to build a persuasive argument for the value of the material and the need to learn.  Once that is done, they are often even better learners than dedicated learners because they fit the ideas into their daily lives.  


The last, and most difficult segment is "unmotivated learners."  For them, learning is not important, so coercive educational strategies are needed.  Rewards and punishments, such as assigning attendance grades, are needed.   Even then, they often do the minimum amount possible unless you can spark their interest enough to turn them into skeptical learners.  


My target market is the skeptical learners.  Good teaching can influence their learning.  My secondary market is the motivated learners who will succeed if I do a good enough job with the skeptical learners.  Unmotivated learners are NOT my target students.  Of course, I will encourage them to engage, to learn.  But time is better spent on the other two student groups.  

Which is more important -- a good process or a good outcome?

In the long run, a good process will be more likely to result in better outcomes over time.
Let's say you want to hire a new employee.  You can get lucky once or twice with a poor selection and hiring process, but over time your luck will start to fail you.

The problem with good luck and bad processes is that it can be hard to tell them apart.  Thus, an incompetent person who does not know what he is doing can be labeled a genius because of some short term good luck.  And once labeled a genius, it can be hard to recognize or admit a person's incompetence until major damage has occurred.

Therefore, it is essential to employ good processes in order to achieve good outcomes.

Discussing Pharmacoeconomics with Clinicians

This is the way a typical conversation goes when I talk about pharmacoeconomics with clinicians.

In case it is not obvious, I am represented by the character on the left and the clinician is the character on the right.

Top 10 Principles of Pharmacoeconomics

1.  Resources are limited.  You can’t have everything.

2.  All choices are tradeoffs.  When you choose one thing, you have to give up something else.  It may be time, money, attention, or something else.  

3.  The Real Cost of Something is What You Give Up to Get It.* This refers to marginal costs or the additional amount paid for each addition amount of benefit you receive.  

4.  Rational People Think at the Margin.*  A rational decision-maker takes action if and only if the marginal benefit of the action exceeds the marginal cost. 

5.  Your costs may differ from my costs. Costs depend on the perspective of the individual evaluating them.  Costs from the patient perspective differ from those of the provider and payer perspectives.

 6.  Rationing occurs whenever we make a choice.  People who are against health care rationing are naïve or disingenuous.

7.  All costs and outcomes are probabilistic.  This means that the costs and outcomes used to assess the cost benefits of medical care might be correct, but they probably are not.  Always conduct sensitivity analyses.

8.  The value of money typically varies from year to year. Always make certain that cost comparisons are standardized to the same year.

9.  All studies are biased.  You need to understand how and if it hurts your ability to use it in your practice setting.

10.  Assume that most patients and clinicians are economically illiterate.  Simplify your presentation of data to their ability to understand.

How to manage Generation X

A blog in the Harvard Business Review Website Titled "Managing and Motivating Employees in Their Twenties" gives some excellent recommendations for managing people in their 20's.

Advice includes a number of basic recommendations like "ask frequent questions", "give them personal attention", and "wear authority lightly". My question is, "Why haven't the other generations demanded the same type of treatment? It seems to me that these are basic ways of motivating and managing anyone -- not just 20-somethings. Why have we learned to accept poorly communicated management expectations, abuse of power, and demotivating managerial practices? I say, "Right On, Generation Y!"

Why pay-for-performance in health care will probably not work

Daniel Pink describes my viewpoint about the science of motivation exactly!!

You will probably not believe him, but he presents what we already know about motivating ourselves and others. The evidence is clear. We just don't use it in the practice of pharmacy and health care.

Can motivational posters motivate?

The short answer is "yes". Despite the large number of "demotivational posters" available on the Internet which make fun of motivational posters (and rightfully so), motivational posters can help motivate in the following ways.

1. When an individual uses the poster to remind herself about aspirations and goals. A classmate of mine in college had a motivational poster above his desk titled "Justification for Higher Education". This poster showed an expensive beach front house with a five car garage filled with expensive autos. He is now a successful entrepreneur who I envision has a house similar to that on the poster.

2. When the motivational poster communicates a message that is accepted by team members. Motivational posters only work when they are consistent with the beliefs of those being motivated. They cannot change cynical or pessimistic viewpoints in the workplace.

3. When the motivational poster reinforces the message of a trusted leader. Without trust in the leader, the message of motivational posters will probably be resisted and mocked. However, if the team trusts the leader, the message communicated by motivational posters is more likely to be seen as credible.

Beer and Pharmacy -- Two of My Favorite Things

From the New York Times January 13th, 2011

A Duane Reade pharmacy in Brooklyn now sells BEER. The pharmacy serves Fire Island Lighthouse Ale and eight other beers in take-home growlers — refillable 64 ounce glass containers. They also conduct tastings, but beer is not consumed on the premises.
Does this hurt the pharmacist/pharmacy brand? What message does it send to the public? On one hand, it might say that the pharmacy is part of the community and is willing to serve community needs. On the other hand, it might send a message inconsistent with health care.
I don’t know the answer. If my local pharmacy offered beer in growlers, I would probably be first in line for a fill-up. I’ll have to admit, I like beer. And I can compartmentalize the selling of beef from the provision of health care. But that’s just me. Others might not feel the same. What do you think?

The image of pharmacists need improvement?

Although pharmacists are one of the most trusted professionals, their image in the minds of the public is weak and poorly defined. Google the phrase "pharmacist are" and you will get the following output. I think that this indicates some work we need to do to project a more positive, stronger image.

How to be awesome

Common Sense

Students often complain to me that managerial problem solving is just "common sense."

In truth, common sense is not really all that common in actual work situations, because common sense is typically based upon mental models that are not tested or examined. Common sense also tends to disappear in times of stress and emotion. Common sense also does not work well for complex problems.

In real life, we don't have time to use our common sense, so we just wing it and suffer the consequences.

Bad Management Kills!

People don't typically think about true costs of poor management in health care settings. But bad managers kill people!

They do it by making it difficult for physicians, nurses, and pharmacists to serve their patients. Bad managers waste the time of people they manage. They cause distractions, waste resources, and hurt productivity. They reduce the performance of health care professionals with unnecessary paperwork, meetings, interruptions, and aggravation.

Let's get rid of bad managers in health care and save lives.

How do pharmacists succeed in helping their patients?

In an earlier post, I asked the question, "Why don't pharmacists do more to help their patients?" It provided a list of many of the reasons why pharmacists are doing much less than they are capable of doing for their patients. I now suggest reasons how so many pharmacists succeed in helping their patients.

They have a clear personal mission to help their patients.
They take ownership of their practice setting.
They accept responsibility for their patients' health.
They keep up to date with the best methods for helping their patients.
They think nothing else is more important than helping patients.
They are more motivated by the work itself, rather than the rewards that are offered by their employer.
They have balance in their life which prevents personal problems from getting in the way of helping patients.

Why don't pharmacists do more to help their patients?

Pharmacists could be doing much more to help their patients to achieve optimal health outcomes. According to a book by Fournies titled "Why employees don't do: what they're supposed to do and what to do about it," many pharmacists don't do all they can to help patients because:

They don’t know what they are supposed to do help patients.
They don’t know why they should help patients.
They don’t know how to help patients.
They think something else is more important than helping patients.
There are no positive consequences for them helping patients.
There are no negative consequences for them not helping patients.
They are rewarded for not helping patients.
They are punished for helping patients.
They are not and will never be capable to help patients.
They have personal problems which prevent them from helping patients.

That brings up a related question, "Why do so many pharmacists do such a great job helping patients when they have so many excuses not to do so?"
What motivates them to overcome the barriers present in many practice settings?

Best Video of Pharmacist value

Welcome to the first post in The Pharmaco Marketer Blog.  I really wanted to name this blog "What I should have learned in pharmacy school".   But I wondered if people could remember that name.  And abbreviating the site with the first letters results in WISHLIPS. 

So I decided to name the blog "The Pharmaco Marketer" because that pretty much describes my approach to solving problems in pharmacy.  I use a marketing mindset which consists of:

• a focus on serving the consumer/customer/patient,
• providing real value that meets the consumer's needs and wants,
• a realization that no matter what you do, you are competing with others, and
• knowing that you can't satisfy everyone so you must target those who you can best serve

I will talk more about this in future posts.