ASHP REPORT Organizational structure
ASHP REPORT
Report of the ASHP Task Force on Organizational Structure Developed by the ASHP Task Force on Organizational Structure Am J Health-Syst Pharm. 2014; 71:1049-54
I
n January 2012, the ASHP Board of Directors commissioned a Task Force on Organizational Structure to provide recommendations to improve the effectiveness of ASHP through the use of organizational structure. Organizational structure is the framework for expressing and actualizing the will of ASHP members and includes the processes for governance and policy development. The profession of pharmacy is rapidly evolving, and the needs of ASHP members are transforming. The diversity of practice has increased. Drug therapy and health care have become more complex. The utilization of technology has expanded, necessitating more robust and rapid communication. Members need timely responses to critical policy issues from ASHP. As the profession of pharmacy advances, it is important that ASHP remains relevant and responsive to the needs of its members and continues to be a leader in preparing members for the future. The charges of the Task Force as approved by the ASHP Board of Directors in January 2012 were to review ASHP’s organizational structure and governance and recommend changes to the Board of Directors to improve the organizational effectiveness of ASHP. The Task Force was asked to assess the following areas:
• The membership structure of ASHP and membership classifications as defined in the governing documents, • The role and structure of ASHP state affiliates, Sections, and Forums in terms of governance and policy, and • The ASHP policy development process.
The Task Force met in person at ASHP headquarters in Bethesda, Maryland, on July 25 and 26, 2012, November 9, 2012, March 29, 2013, and July 19, 2013. The members of the Task Force are listed in Appendix A. Throughout its history, ASHP has periodically made several significant organizational adjustments in response to changes or anticipated changes in its environment. The Task Force on Organizational Structure is another step in this tradition of selfassessment and self-renewal. The Task Force developed 14 recommendations for ASHP—2 on policy development and 12 on governance and membership structure. On September 20, 2013, the ASHP Board of Directors voted to approve the recommendations of the Task Force. The recommendations are listed in Appendix B and discussed individually below. Task Force recommendations for ASHP policy development Principles supporting the recommendations related to policy development included the following:
• The creation of official professional policy is an important function of ASHP and is an important area of member participation. • Efforts to create a more ongoing, nimble, and dynamic process (as opposed to a periodic or annual process) are desirable. • Efforts should be made to identify ways to effectively engage more ASHP members and component groups (i.e., ASHP Sections, ASHP Forums, and state affiliates) in the policymaking process not only to enhance the quality of ASHP policy but also to provide additional ways for members to participate in the Society and cultivate future leaders. • There are opportunities to better leverage the use of technology throughout the policymaking process. • ASHP guidelines are highly valued documents to ASHP members and other interested parties, and focused attention should be given to identifying new and innovative ways to ensure that guidelines can be created in a timely fashion and maintained over time. • Striking the right balance between face-to-face and virtual or electronic interactions among individuals involved in the policymaking process is important. Copyright © 2014, American Society of Health-System Pharmacists, Inc. All rights reserved. 1079-2082/14/0602-1049$06.00. DOI 10.2146/ajhp140109
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ASHP REPORT Organizational structure
• Volunteer time is valuable and limited and needs to be strongly considered as new processes are conceptualized. • ASHP financial and human resources are valuable and limited and need to be strongly considered as new processes are conceptualized.
Recommendation 1: Create a yearround policy development and approval process. The proposed process for policy development is designed to be timelier, effective, efficient, responsive to member needs, and forwardlooking. Further, it is intended to engage the expertise of a variety of ASHP members and groups. The Task Force believes that having members engaged in a policy process that includes face-to-face participation promotes networking, collegiality, and other social dynamics that provide value to and benefit members. Therefore, the following characteristics of policy development would remain the same: • ASHP would continue to coordinate and host ASHP Policy Week during which policy councils convene in person and generate policy proposals. • There would continue to be an annual House of Delegates session at the ASHP Summer Meeting. • Live regional delegates conferences would be held before the annual House of Delegates session.
The Task Force envisions a new model for policy development that would have the following characteristics: • Policy committees would meet electronically to revise current policies and develop new professional policies. There is a desire to continue to have the House of Delegates meet face-to-face on an annual basis, but the House should be more engaged throughout the year through the enhanced use of technology. • Proposed policies would be routinely sent to the Board of Directors from
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•
•
•
policy committees such as ASHP Councils, Sections, and Forums. Before approval by the Board, proposed policies would be distributed to delegates for feedback. The House of Delegates could take action on proposed policies through a technology portal on a routine basis. Live regional delegates conferences would continue to occur before the face-to-face House of Delegates meeting at the ASHP Summer Meeting. Recommendations would serve as the primary mechanism to identify emerging policies; resolutions and new business processes would be addressed during the face-to-face House of Delegates meeting.
The Task Force did not recommend any fundamental change in the composition of the House of Delegates, for which the majority of delegates are elected at the state level and coordinated by state affiliates to represent ASHP active members in the state. ASHP should provide information and guidance to assist state affiliate organizations with the nomination and election of state delegates. Recommendation 2: Create a technologically enhanced guidelines development process. The rates of change in technology, evolution of pharmacy practice, and health care in general can make elements of a guideline obsolete by the time it is published. The ASHP sunset review process for guidelines is five years, which is too long in the current environment. Volunteer time is limited, and identifying volunteers with sufficient expertise and experience for guideline development can be difficult. Therefore, the Task Force recommends that ASHP • Develop guidelines in a more efficient and rapid fashion through drafting teams, • Consider new ways to use technology to create other credible guidance resources that can be developed in realtime and in an ongoing fashion (This
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may involve using crowd-sourcing principles that maximize the engagement of experts through new software platforms.), and • During the creation and revision of guidelines, develop and communicate guidelines in real time, engage larger groups of members and other outside experts, review and approve content (by an expert) before it gets published or posted, view all revisions in an uncluttered fashion, and have the flexibility to repackage content in different ways (print or online).
Additional discussion. The intent of these recommendations is to maintain high-quality policies through continuous and timely development and revision while maximizing member engagement and input. The Task Force discussed possible metrics for evaluating the short-term and longterm success of the processes for the development of year-round policy and revised guidelines. Task Force recommendations for ASHP membership structure and governance Principles supporting the preliminary recommendations related to membership structure and governance include the following: • Engendering a high level of member involvement and commitment across the full range of diversity among members is of strategic importance to ASHP. • Resources should be allocated strategically to cultivate and engage smaller member groups. There should be an enhanced focus on smaller important member segments without creating an inflexible or resource-intensive membership structure. • Senses of identity and engagement among members, such as through ASHP Sections and Forums, are important, and actions to expand the number of volunteer opportunities should be prioritized.
ASHP REPORT Organizational structure
• ASHP’s value and influence are extended through the development of mutually supportive relationships with organizations that mirror ASHP’s purpose at the state level. ASHP should strive to create a closer alignment among ASHP and its state affiliates. • An assessment of the current ASHP charter and bylaws may identify areas in which there are opportunities to modify governance practices to reflect contemporary organizational models. • The experience and expertise of former leaders of ASHP should be continually nurtured.
Recommendation 3: Implement a mechanism by which online communities may convene and collaborate within ASHP. Previous ASHP task forces on organizational structure focused on how to engage important member segments and their potential evolution to Sections or Forums. Key elements for consideration continue to be assessments of membership size, level of engagement, unique membership service needs, and overall contribution to ASHP. An important goal that the Task Force identified was to develop an evolutionary pathway from which member segments could demonstrate success for the ASHP Board of Directors to consider investing in additional resources or structure. The Task Force recommends that ASHP create a more fluid framework for smaller strategic membership groups that would have the following characteristics: • Member communities would be informal groups that convene virtually around specific interests or issues of national interest. The communities could serve as networking groups to foster a sense of member identity, unite practice interests and issues, and facilitate the exchange of information among involved individuals. • To form a community around a specific topic or issue, several factors would need to be taken into consid-
eration, including the (1) relevance of the topic to ASHP’s mission and vision, (2) overlap with other ASHP networking opportunities and existing networking forums sponsored by other organizations, (3) number of potential members with an interest in the topic, (4) availability of resources, and (5) estimated longevity of the topic or issue. • Growing and maintaining communities would be a leadership growth opportunity for members and may also serve to engage former leaders of ASHP. • If a community exhibits ongoing success, it may merit a more formal relationship to the ASHP governance structure such as the evolution to a Section Advisory Group or a freestanding Section. The criteria for this decision-making process are yet to be determined. • ASHP should implement a process to establish the best model for developing member communities. Areas to explore include determining topics of the communities and deciding how to initiate, grow, maintain, and retire communities.
Recommendation 4: Increase technician membership and engagement within ASHP and its state affiliates. Continuously study and evaluate the evolution of governance structures that will successfully incorporate technicians. The Task Force discussed the criticality of ASHP’s role in advancing the level of pharmacy technician practice and competence to support pharmacist involvement in patient care roles. Task Force members believe that ASHP has a responsibility to develop a strategy to incorporate technicians into the Society and to advance the technician work force through standardized education and training and effective state advocacy. The Task Force discussed ASHP’s long-term vision for technician membership and roles within governance. There exists a dichotomy between a profes-
sional imperative to support pharmacy technicians and the imperative to create a membership component group for technicians. Based on technician membership size and current engagement, the Task Force believes that pharmacy technicians are an important strategic group to ASHP, but the formation of a specific component group may not be warranted at this time. It is believed that ASHP may better benefit from investing in the development of resources to advance technicians’ roles to support successful practice models. ASHP should work in partnership with state affiliates and health systems on technician-related activities including advocacy initiatives. ASHP might explore collaborative opportunities with national and state technician organizations. ASHP should continue to monitor the growth of technician membership and consider if a more formal component structure is appropriate in the future. Recommendation 5: Create a closer collaboration between ASHP and its state affiliates through advocacy and partnership opportunities. The Task Force recommends that ASHP explore, through a consensus process with state affiliates, ways to create a closer alignment among ASHP and its state affiliates. This may be facilitated through the ASHP Commission on Affiliate Relations, whose purview is to advise the Board of Directors on standards for affiliation, implementation of the standards, methods of strengthening affiliates, and methods of building affiliate relationships that help advance ASHP’s objectives. Through modification of ASHP’s affiliation guidelines, ASHP should clarify what it desires from its relationship with state affiliates and determine the best mechanism for ASHP to support its affiliated state organizations. Efforts should be made to identify partnership opportunities and models between ASHP and its state affiliates.
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ASHP REPORT Organizational structure
Recommendation 6: Amend the ASHP governing documents to clarify that practice within the United States is a requirement for active membership (active members are eligible to vote and hold office). Further, clarify that ASHP welcomes international members as associate members (receive all benefits but not eligible to vote or to hold office). It is the opinion of Task Force members that international members join ASHP because they value ASHP services and resources to advance practice in their respective countries; Task Force members do not believe that a significant number of international members join to receive voting and governance rights within the Society. ASHP encourages and supports international membership and offers an international associate membership category in which international members receive all benefits but are not eligible to vote or hold office within the Society. The ASHP bylaws define the international associate membership category as members who are pharmacists who practice outside of the United States and are not citizens of the United States or nonpharmacists who are not citizens of the United States. Differences between the ways in which the active and international membership categories are defined have led to confusion regarding the eligibility for active membership. The bylaws should be revised so that the membership eligibility for active and international membership is clearly defined. Recommendation 7: Amend the ASHP governing documents to extend the term of office for Chair of the House of Delegates to three years. The term of the Chair of the House of Delegates should be limited to one three-year term of office. Current bylaws require an election of the Chair of the House of Delegates annually up to a limit of three years. The Task Force recommends that the Chair of the House of Delegates 1052
be considered for a three-year term of office, which is consistent with the terms for other elected Board members. In the current process, the newly elected Chair of the House of Delegates immediately becomes a voting member of the Board of Directors. Changing to a three-year term may allow for a greater period of Board orientation for the Chair of the House of Delegates. In addition, it would minimize the resources, both human and financial, currently required to conduct an annual election. This proposed term of office would not preclude the Chair of the House of Delegates from seeking a different ASHP officer position once the term of office has concluded. Recommendation 8: Amend the ASHP governing documents to modify the term of the Board of Directors Member-at-Large position to one three-year term of office. Current bylaws allow for the Board of Directors Member-at-Large position to serve two consecutive three-year terms. The Task Force recommends modifying the term of the Board of Directors Member-at-Large position to one three-year term. This revised term of office would open an additional engagement opportunity for members to serve on the ASHP Board. It would also provide consistency with the terms of office for the proposed Chair of the House of Delegates position and other officer positions. In addition, it is not a common practice for Board of Directors Members-atLarge to seek two consecutive terms. This proposed term of office would not preclude a Board of Directors Member-at-Large from seeking a different ASHP officer position once the term of office has concluded. Recommendation 9: Amend the ASHP governing documents to elect the Treasurer by the general membership. Current bylaws require an election of the Treasurer by the delegates who comprise the House of Delegates. The recommendation of the Task Force is that the general prac-
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titioner membership of ASHP elect the Treasurer. The primary purpose of the House of Delegates is to review and oversee the professional policies of ASHP. The Treasurer has the fiduciary responsibility of overseeing the management and reporting of the Society’s finances. Therefore, the Treasurer should be elected by the general membership, consistent with other elected officer positions of the Society. The Task Force believes that the Board of Directors should continue to nominate the Treasurer, because the Treasurer position is complex in its scope and purpose. The Task Force believes that the Treasurer position is one that should be reserved for individuals who have significant ASHP leadership experience and are familiar with ASHP’s strategic purposes and operations. The Task Force believes that the term limit for the Treasurer should remain the same (two three-year terms of office). This proposed term of office would not preclude the Treasurer from seeking a different ASHP officer position once the term of office has concluded. Recommendation 10: Amend the ASHP governing documents to appoint the Committee on Nominations from among the general membership by the Chair of the House of Delegates. Current bylaws call for the appointment of the Committee on Nominations by the Chair of the House of Delegates from among ASHP delegates. The Committee on Nominations is responsible for nominating candidates for the offices of President-Elect; Chair, House of Delegates; and Member, Board of Directors. The intent of the recommendation is to broaden the scope of the potential members who may serve on the Committee on Nominations. Doing so provides an additional member engagement opportunity beyond the House of Delegates. The Task Force believes that the appointment to the Committee on Nominations should continue to
ASHP REPORT Organizational structure
come from the Chair of the ASHP House of Delegates. Members of the Task Force encourage ASHP to promote all appointment opportunities within the Society. Members may not intuitively know the many ways they may become appointed and therefore more involved in the Society. Providing these opportunities in a more transparent way will encourage member engagement and satisfaction. Recommendation 11: Engage former leaders of ASHP from all levels of the Society. The Task Force believes that ASHP should proactively engage former leaders of ASHP, including but not limited to former delegates, Council and Commission members, Section and Forum leaders, past presidents, Board of Directors members, Fellows, and other members that have unique and valuable ASHP experience to serve in an ad hoc advisory capacity for ASHP. These individuals would be called upon on an ad hoc basis when needed for consultation or specific service to ASHP. Former leaders often desire to contribute to their professional Society; creating a mechanism to do so would be beneficial to ASHP and its members. Recommendation 12: Enhance the conversion of student members to new practitioner members, expand the opportunities for student introduction and transition to ASHP Section structure, and increase student engagement throughout ASHP, including active participation in the policy process. Throughout the Task Force deliberations, the importance of student participation in the Society was reinforced. Many options within the Society exist for students to pursue their professional aspirations while learning and contributing to the organization’s success. It should be a top priority of ASHP to recruit and retain students as they transition to health-system practitioners. Early awareness and participation in the Society’s policy and membership activities will reinforce the understand-
ing and value of ASHP. ASHP’s future success is predicated on its ability to continually recruit, retain, and advance its membership, starting with student members. Recommendation 13: Develop new strategies to increase retention of residents and new practitioners following graduation from pharmacy school or residencies such as through enhanced engagement. The Task Force believes that a specific recommendation should be created that addresses new practitioners. Whereas recruiting and retaining student members are important to building awareness and value to the Society, new practitioner members have distinctive needs that merit special attention by ASHP. ASHP is in a unique position to recruit new practitioners into the Society through career-focused opportunities such as participation in the services ASHP provides around residency training. New practitioners have a strong desire to build their professional identity quickly through participation in member committees and virtual networking. ASHP experiences competition in this area from other organizations. The Task Force encourages ASHP to develop assertive strategies to retain new practitioners in the Society as lifelong members through new services and engagement opportunities. Recommendation 14: Expand and promote member engagement and leadership cultivation. The Task Force recommends that ASHP’s membership be empowered to pursue activities within ASHP that are specific to members’ interests and that the Society make it a priority to expand volunteer opportunities and cultivate new leaders into the Society. The Task Force believes that membership engagement is an important indicator of member satisfaction with the Society. Member feedback has indicated that the Society could more clearly promote its current volunteer opportunities and should seek
to expand new opportunities. Creating and executing a more-effective strategy regarding member involvement and cultivating new leaders will improve ASHP’s value. Additional discussion. The Task Force explored areas for future exploration by ASHP. Topics included ASHP’s expansion into ambulatory care including transitions of care, Section structure and cross functionality, pharmacy technicians, pharmacy educators and preceptors, review of focus areas of ASHP and alignment with organizational structure, strengthening the grassroots advocacy structure of ASHP, and refining the face-to-face operations of the House of Delegates. Conclusion ASHP remains a strong organization with a growing membership and solid reputation for quality and integrity in its policymaking and advocacy efforts. The ASHP Board of Directors wants to ensure that ASHP’s structure and governance prepare the organization for the future so that it remains responsive to the needs of its members and continues to lead the transformation of pharmacy practice. Appendix A—Members of the ASHP Task Force on Organizational Structure Paul W. Abramowitz, Pharm.D., Sc.D.(Hon), FASHP Chief Executive Officer American Society of Health-System Pharmacists Bethesda, MD Burnis D. Breland, M.S., Pharm.D., FASHP Director of Pharmacy Columbus Regional Healthcare System Columbus, GA Cynthia A. Clegg, B.S.Pharm., M.H.A. Assistant Director, Ambulatory Pharmacy Services Harborview Medical Center Seattle, WA Debra B. Feinberg, B.S.Pharm., J.D., FASHP Executive Director New York State Council of Health-System Pharmacists Albany, NY
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ASHP REPORT Organizational structure Christopher R. Fortier, Pharm.D. Manager, Pharmacy Support and Operating Room Services Medical University of South Carolina Charleston, SC Thomas J. Johnson, Pharm.D., M.B.A., BCPS, FASHP, FCCM Director of Hospital Pharmacy Avera McKennan Hospital and University Health Center Sioux Falls, SD Gerald E. Meyer, M.B.A., Pharm.D., FASHP Director, Experiential Education Thomas Jefferson University Philadelphia, PA Kathleen S. Pawlicki, M.S., B.S.Pharm., FASHP Administrative Director, Professional Services, and Director, Pharmaceutical Services Beaumont Hospital Royal Oak, MI
Douglas Slain, Pharm.D., BCPS, FASHP Associate Professor and Infectious Diseases Clinical Specialist School of Pharmacy West Virginia University Morgantown, WV Kelly M. Smith, Pharm.D., BCPS, FASHP, FCCP Associate Dean, Academic and Student Affairs, and Associate Professor, Department of Pharmacy Practice and Science College of Pharmacy University of Kentucky Lexington, KY Hannah K. Vanderpool, Pharm.D., M.A. Vice President, Member Relations American Society of Health-System Pharmacists Bethesda, MD Sara J. White, M.S., FASHP (Chair) Leadership Coach Mountain View, CA
Rafael Saenz, Pharm.D., M.S. Administrator, Pharmacy Services Department of Pharmacy University of Virginia Health System Charlottesville, VA
David R. Witmer, Pharm.D. Senior Vice President and Chief Operating Officer American Society of Health-System Pharmacists Bethesda, MD
Kathryn R. Schultz, B.S., Pharm.D., FASHP Director of Pharmacy HealthEast Bethesda Hospital St. Paul, MN
Appendix B—Executive summary of Task Force recommendations
Lanita S. Shaverd, Pharm.D. Director, Community Health Center University of Arkansas Medical Center Little Rock, AR Janet A. Silvester, B.S.Pharm., M.B.A., FASHP Director of Pharmacy and Emergency Services Martha Jefferson Hospital Charlottesville, VA
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1. Create a year-round policy development and approval process. 2. Create a technologically enhanced guidelines development process. 3. Implement a mechanism by which online communities may convene and collaborate within ASHP. 4. Increase technician membership and engagement within ASHP and its state affiliates. Continuously study and evaluate the evolution of governance structures that will successfully incorporate technicians
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5. Create a closer collaboration between ASHP and its state affiliates through advocacy and partnership opportunities. 6. Amend the ASHP governing documents to clarify that practice within the United States is a requirement for active membership (active members are eligible to vote and hold office). Further, clarify that ASHP welcomes international members as associate members (receive all benefits but not eligible to vote or to hold office). 7. Amend the ASHP governing documents to extend the term of office for Chair of the House of Delegates to three years. The term of the Chair of the House of Delegates should be limited to one three-year term of office. 8. Amend the ASHP governing documents to modify the term of the Board of Directors Member-at-Large position to one three-year term of office. 9. Amend the ASHP governing documents to elect the Treasurer by the general membership. 10. Amend the ASHP governing documents to appoint the Committee on Nominations from among the general membership by the Chair of the House of Delegates. 11. Engage former leaders of ASHP from all levels of the Society. 12. Enhance the conversion of student members to new practitioner members, expand the opportunities for student introduction and transition to ASHP Section structure, and increase student engagement throughout ASHP, including active participation in the policy process. 13. Develop new strategies to increase retention of residents and new practitioners following graduation from pharmacy school or residencies such as through enhanced engagement. 14. Expand and promote member engagement and leadership cultivation.
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ASHP REPORT
Report of the ASHP Task Force on Organizational Structure Developed by the ASHP Task Force on Organizational Structure Am J Health-Syst Pharm. 2014; 71:1049-54
I
n January 2012, the ASHP Board of Directors commissioned a Task Force on Organizational Structure to provide recommendations to improve the effectiveness of ASHP through the use of organizational structure. Organizational structure is the framework for expressing and actualizing the will of ASHP members and includes the processes for governance and policy development. The profession of pharmacy is rapidly evolving, and the needs of ASHP members are transforming. The diversity of practice has increased. Drug therapy and health care have become more complex. The utilization of technology has expanded, necessitating more robust and rapid communication. Members need timely responses to critical policy issues from ASHP. As the profession of pharmacy advances, it is important that ASHP remains relevant and responsive to the needs of its members and continues to be a leader in preparing members for the future. The charges of the Task Force as approved by the ASHP Board of Directors in January 2012 were to review ASHP’s organizational structure and governance and recommend changes to the Board of Directors to improve the organizational effectiveness of ASHP. The Task Force was asked to assess the following areas:
• The membership structure of ASHP and membership classifications as defined in the governing documents, • The role and structure of ASHP state affiliates, Sections, and Forums in terms of governance and policy, and • The ASHP policy development process.
The Task Force met in person at ASHP headquarters in Bethesda, Maryland, on July 25 and 26, 2012, November 9, 2012, March 29, 2013, and July 19, 2013. The members of the Task Force are listed in Appendix A. Throughout its history, ASHP has periodically made several significant organizational adjustments in response to changes or anticipated changes in its environment. The Task Force on Organizational Structure is another step in this tradition of selfassessment and self-renewal. The Task Force developed 14 recommendations for ASHP—2 on policy development and 12 on governance and membership structure. On September 20, 2013, the ASHP Board of Directors voted to approve the recommendations of the Task Force. The recommendations are listed in Appendix B and discussed individually below. Task Force recommendations for ASHP policy development Principles supporting the recommendations related to policy development included the following:
• The creation of official professional policy is an important function of ASHP and is an important area of member participation. • Efforts to create a more ongoing, nimble, and dynamic process (as opposed to a periodic or annual process) are desirable. • Efforts should be made to identify ways to effectively engage more ASHP members and component groups (i.e., ASHP Sections, ASHP Forums, and state affiliates) in the policymaking process not only to enhance the quality of ASHP policy but also to provide additional ways for members to participate in the Society and cultivate future leaders. • There are opportunities to better leverage the use of technology throughout the policymaking process. • ASHP guidelines are highly valued documents to ASHP members and other interested parties, and focused attention should be given to identifying new and innovative ways to ensure that guidelines can be created in a timely fashion and maintained over time. • Striking the right balance between face-to-face and virtual or electronic interactions among individuals involved in the policymaking process is important. Copyright © 2014, American Society of Health-System Pharmacists, Inc. All rights reserved. 1079-2082/14/0602-1049$06.00. DOI 10.2146/ajhp140109
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ASHP REPORT Organizational structure
• Volunteer time is valuable and limited and needs to be strongly considered as new processes are conceptualized. • ASHP financial and human resources are valuable and limited and need to be strongly considered as new processes are conceptualized.
Recommendation 1: Create a yearround policy development and approval process. The proposed process for policy development is designed to be timelier, effective, efficient, responsive to member needs, and forwardlooking. Further, it is intended to engage the expertise of a variety of ASHP members and groups. The Task Force believes that having members engaged in a policy process that includes face-to-face participation promotes networking, collegiality, and other social dynamics that provide value to and benefit members. Therefore, the following characteristics of policy development would remain the same: • ASHP would continue to coordinate and host ASHP Policy Week during which policy councils convene in person and generate policy proposals. • There would continue to be an annual House of Delegates session at the ASHP Summer Meeting. • Live regional delegates conferences would be held before the annual House of Delegates session.
The Task Force envisions a new model for policy development that would have the following characteristics: • Policy committees would meet electronically to revise current policies and develop new professional policies. There is a desire to continue to have the House of Delegates meet face-to-face on an annual basis, but the House should be more engaged throughout the year through the enhanced use of technology. • Proposed policies would be routinely sent to the Board of Directors from
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•
•
•
•
policy committees such as ASHP Councils, Sections, and Forums. Before approval by the Board, proposed policies would be distributed to delegates for feedback. The House of Delegates could take action on proposed policies through a technology portal on a routine basis. Live regional delegates conferences would continue to occur before the face-to-face House of Delegates meeting at the ASHP Summer Meeting. Recommendations would serve as the primary mechanism to identify emerging policies; resolutions and new business processes would be addressed during the face-to-face House of Delegates meeting.
The Task Force did not recommend any fundamental change in the composition of the House of Delegates, for which the majority of delegates are elected at the state level and coordinated by state affiliates to represent ASHP active members in the state. ASHP should provide information and guidance to assist state affiliate organizations with the nomination and election of state delegates. Recommendation 2: Create a technologically enhanced guidelines development process. The rates of change in technology, evolution of pharmacy practice, and health care in general can make elements of a guideline obsolete by the time it is published. The ASHP sunset review process for guidelines is five years, which is too long in the current environment. Volunteer time is limited, and identifying volunteers with sufficient expertise and experience for guideline development can be difficult. Therefore, the Task Force recommends that ASHP • Develop guidelines in a more efficient and rapid fashion through drafting teams, • Consider new ways to use technology to create other credible guidance resources that can be developed in realtime and in an ongoing fashion (This
Am J Health-Syst Pharm—Vol 71 Jun 15, 2014
may involve using crowd-sourcing principles that maximize the engagement of experts through new software platforms.), and • During the creation and revision of guidelines, develop and communicate guidelines in real time, engage larger groups of members and other outside experts, review and approve content (by an expert) before it gets published or posted, view all revisions in an uncluttered fashion, and have the flexibility to repackage content in different ways (print or online).
Additional discussion. The intent of these recommendations is to maintain high-quality policies through continuous and timely development and revision while maximizing member engagement and input. The Task Force discussed possible metrics for evaluating the short-term and longterm success of the processes for the development of year-round policy and revised guidelines. Task Force recommendations for ASHP membership structure and governance Principles supporting the preliminary recommendations related to membership structure and governance include the following: • Engendering a high level of member involvement and commitment across the full range of diversity among members is of strategic importance to ASHP. • Resources should be allocated strategically to cultivate and engage smaller member groups. There should be an enhanced focus on smaller important member segments without creating an inflexible or resource-intensive membership structure. • Senses of identity and engagement among members, such as through ASHP Sections and Forums, are important, and actions to expand the number of volunteer opportunities should be prioritized.
ASHP REPORT Organizational structure
• ASHP’s value and influence are extended through the development of mutually supportive relationships with organizations that mirror ASHP’s purpose at the state level. ASHP should strive to create a closer alignment among ASHP and its state affiliates. • An assessment of the current ASHP charter and bylaws may identify areas in which there are opportunities to modify governance practices to reflect contemporary organizational models. • The experience and expertise of former leaders of ASHP should be continually nurtured.
Recommendation 3: Implement a mechanism by which online communities may convene and collaborate within ASHP. Previous ASHP task forces on organizational structure focused on how to engage important member segments and their potential evolution to Sections or Forums. Key elements for consideration continue to be assessments of membership size, level of engagement, unique membership service needs, and overall contribution to ASHP. An important goal that the Task Force identified was to develop an evolutionary pathway from which member segments could demonstrate success for the ASHP Board of Directors to consider investing in additional resources or structure. The Task Force recommends that ASHP create a more fluid framework for smaller strategic membership groups that would have the following characteristics: • Member communities would be informal groups that convene virtually around specific interests or issues of national interest. The communities could serve as networking groups to foster a sense of member identity, unite practice interests and issues, and facilitate the exchange of information among involved individuals. • To form a community around a specific topic or issue, several factors would need to be taken into consid-
eration, including the (1) relevance of the topic to ASHP’s mission and vision, (2) overlap with other ASHP networking opportunities and existing networking forums sponsored by other organizations, (3) number of potential members with an interest in the topic, (4) availability of resources, and (5) estimated longevity of the topic or issue. • Growing and maintaining communities would be a leadership growth opportunity for members and may also serve to engage former leaders of ASHP. • If a community exhibits ongoing success, it may merit a more formal relationship to the ASHP governance structure such as the evolution to a Section Advisory Group or a freestanding Section. The criteria for this decision-making process are yet to be determined. • ASHP should implement a process to establish the best model for developing member communities. Areas to explore include determining topics of the communities and deciding how to initiate, grow, maintain, and retire communities.
Recommendation 4: Increase technician membership and engagement within ASHP and its state affiliates. Continuously study and evaluate the evolution of governance structures that will successfully incorporate technicians. The Task Force discussed the criticality of ASHP’s role in advancing the level of pharmacy technician practice and competence to support pharmacist involvement in patient care roles. Task Force members believe that ASHP has a responsibility to develop a strategy to incorporate technicians into the Society and to advance the technician work force through standardized education and training and effective state advocacy. The Task Force discussed ASHP’s long-term vision for technician membership and roles within governance. There exists a dichotomy between a profes-
sional imperative to support pharmacy technicians and the imperative to create a membership component group for technicians. Based on technician membership size and current engagement, the Task Force believes that pharmacy technicians are an important strategic group to ASHP, but the formation of a specific component group may not be warranted at this time. It is believed that ASHP may better benefit from investing in the development of resources to advance technicians’ roles to support successful practice models. ASHP should work in partnership with state affiliates and health systems on technician-related activities including advocacy initiatives. ASHP might explore collaborative opportunities with national and state technician organizations. ASHP should continue to monitor the growth of technician membership and consider if a more formal component structure is appropriate in the future. Recommendation 5: Create a closer collaboration between ASHP and its state affiliates through advocacy and partnership opportunities. The Task Force recommends that ASHP explore, through a consensus process with state affiliates, ways to create a closer alignment among ASHP and its state affiliates. This may be facilitated through the ASHP Commission on Affiliate Relations, whose purview is to advise the Board of Directors on standards for affiliation, implementation of the standards, methods of strengthening affiliates, and methods of building affiliate relationships that help advance ASHP’s objectives. Through modification of ASHP’s affiliation guidelines, ASHP should clarify what it desires from its relationship with state affiliates and determine the best mechanism for ASHP to support its affiliated state organizations. Efforts should be made to identify partnership opportunities and models between ASHP and its state affiliates.
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Recommendation 6: Amend the ASHP governing documents to clarify that practice within the United States is a requirement for active membership (active members are eligible to vote and hold office). Further, clarify that ASHP welcomes international members as associate members (receive all benefits but not eligible to vote or to hold office). It is the opinion of Task Force members that international members join ASHP because they value ASHP services and resources to advance practice in their respective countries; Task Force members do not believe that a significant number of international members join to receive voting and governance rights within the Society. ASHP encourages and supports international membership and offers an international associate membership category in which international members receive all benefits but are not eligible to vote or hold office within the Society. The ASHP bylaws define the international associate membership category as members who are pharmacists who practice outside of the United States and are not citizens of the United States or nonpharmacists who are not citizens of the United States. Differences between the ways in which the active and international membership categories are defined have led to confusion regarding the eligibility for active membership. The bylaws should be revised so that the membership eligibility for active and international membership is clearly defined. Recommendation 7: Amend the ASHP governing documents to extend the term of office for Chair of the House of Delegates to three years. The term of the Chair of the House of Delegates should be limited to one three-year term of office. Current bylaws require an election of the Chair of the House of Delegates annually up to a limit of three years. The Task Force recommends that the Chair of the House of Delegates 1052
be considered for a three-year term of office, which is consistent with the terms for other elected Board members. In the current process, the newly elected Chair of the House of Delegates immediately becomes a voting member of the Board of Directors. Changing to a three-year term may allow for a greater period of Board orientation for the Chair of the House of Delegates. In addition, it would minimize the resources, both human and financial, currently required to conduct an annual election. This proposed term of office would not preclude the Chair of the House of Delegates from seeking a different ASHP officer position once the term of office has concluded. Recommendation 8: Amend the ASHP governing documents to modify the term of the Board of Directors Member-at-Large position to one three-year term of office. Current bylaws allow for the Board of Directors Member-at-Large position to serve two consecutive three-year terms. The Task Force recommends modifying the term of the Board of Directors Member-at-Large position to one three-year term. This revised term of office would open an additional engagement opportunity for members to serve on the ASHP Board. It would also provide consistency with the terms of office for the proposed Chair of the House of Delegates position and other officer positions. In addition, it is not a common practice for Board of Directors Members-atLarge to seek two consecutive terms. This proposed term of office would not preclude a Board of Directors Member-at-Large from seeking a different ASHP officer position once the term of office has concluded. Recommendation 9: Amend the ASHP governing documents to elect the Treasurer by the general membership. Current bylaws require an election of the Treasurer by the delegates who comprise the House of Delegates. The recommendation of the Task Force is that the general prac-
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titioner membership of ASHP elect the Treasurer. The primary purpose of the House of Delegates is to review and oversee the professional policies of ASHP. The Treasurer has the fiduciary responsibility of overseeing the management and reporting of the Society’s finances. Therefore, the Treasurer should be elected by the general membership, consistent with other elected officer positions of the Society. The Task Force believes that the Board of Directors should continue to nominate the Treasurer, because the Treasurer position is complex in its scope and purpose. The Task Force believes that the Treasurer position is one that should be reserved for individuals who have significant ASHP leadership experience and are familiar with ASHP’s strategic purposes and operations. The Task Force believes that the term limit for the Treasurer should remain the same (two three-year terms of office). This proposed term of office would not preclude the Treasurer from seeking a different ASHP officer position once the term of office has concluded. Recommendation 10: Amend the ASHP governing documents to appoint the Committee on Nominations from among the general membership by the Chair of the House of Delegates. Current bylaws call for the appointment of the Committee on Nominations by the Chair of the House of Delegates from among ASHP delegates. The Committee on Nominations is responsible for nominating candidates for the offices of President-Elect; Chair, House of Delegates; and Member, Board of Directors. The intent of the recommendation is to broaden the scope of the potential members who may serve on the Committee on Nominations. Doing so provides an additional member engagement opportunity beyond the House of Delegates. The Task Force believes that the appointment to the Committee on Nominations should continue to
ASHP REPORT Organizational structure
come from the Chair of the ASHP House of Delegates. Members of the Task Force encourage ASHP to promote all appointment opportunities within the Society. Members may not intuitively know the many ways they may become appointed and therefore more involved in the Society. Providing these opportunities in a more transparent way will encourage member engagement and satisfaction. Recommendation 11: Engage former leaders of ASHP from all levels of the Society. The Task Force believes that ASHP should proactively engage former leaders of ASHP, including but not limited to former delegates, Council and Commission members, Section and Forum leaders, past presidents, Board of Directors members, Fellows, and other members that have unique and valuable ASHP experience to serve in an ad hoc advisory capacity for ASHP. These individuals would be called upon on an ad hoc basis when needed for consultation or specific service to ASHP. Former leaders often desire to contribute to their professional Society; creating a mechanism to do so would be beneficial to ASHP and its members. Recommendation 12: Enhance the conversion of student members to new practitioner members, expand the opportunities for student introduction and transition to ASHP Section structure, and increase student engagement throughout ASHP, including active participation in the policy process. Throughout the Task Force deliberations, the importance of student participation in the Society was reinforced. Many options within the Society exist for students to pursue their professional aspirations while learning and contributing to the organization’s success. It should be a top priority of ASHP to recruit and retain students as they transition to health-system practitioners. Early awareness and participation in the Society’s policy and membership activities will reinforce the understand-
ing and value of ASHP. ASHP’s future success is predicated on its ability to continually recruit, retain, and advance its membership, starting with student members. Recommendation 13: Develop new strategies to increase retention of residents and new practitioners following graduation from pharmacy school or residencies such as through enhanced engagement. The Task Force believes that a specific recommendation should be created that addresses new practitioners. Whereas recruiting and retaining student members are important to building awareness and value to the Society, new practitioner members have distinctive needs that merit special attention by ASHP. ASHP is in a unique position to recruit new practitioners into the Society through career-focused opportunities such as participation in the services ASHP provides around residency training. New practitioners have a strong desire to build their professional identity quickly through participation in member committees and virtual networking. ASHP experiences competition in this area from other organizations. The Task Force encourages ASHP to develop assertive strategies to retain new practitioners in the Society as lifelong members through new services and engagement opportunities. Recommendation 14: Expand and promote member engagement and leadership cultivation. The Task Force recommends that ASHP’s membership be empowered to pursue activities within ASHP that are specific to members’ interests and that the Society make it a priority to expand volunteer opportunities and cultivate new leaders into the Society. The Task Force believes that membership engagement is an important indicator of member satisfaction with the Society. Member feedback has indicated that the Society could more clearly promote its current volunteer opportunities and should seek
to expand new opportunities. Creating and executing a more-effective strategy regarding member involvement and cultivating new leaders will improve ASHP’s value. Additional discussion. The Task Force explored areas for future exploration by ASHP. Topics included ASHP’s expansion into ambulatory care including transitions of care, Section structure and cross functionality, pharmacy technicians, pharmacy educators and preceptors, review of focus areas of ASHP and alignment with organizational structure, strengthening the grassroots advocacy structure of ASHP, and refining the face-to-face operations of the House of Delegates. Conclusion ASHP remains a strong organization with a growing membership and solid reputation for quality and integrity in its policymaking and advocacy efforts. The ASHP Board of Directors wants to ensure that ASHP’s structure and governance prepare the organization for the future so that it remains responsive to the needs of its members and continues to lead the transformation of pharmacy practice. Appendix A—Members of the ASHP Task Force on Organizational Structure Paul W. Abramowitz, Pharm.D., Sc.D.(Hon), FASHP Chief Executive Officer American Society of Health-System Pharmacists Bethesda, MD Burnis D. Breland, M.S., Pharm.D., FASHP Director of Pharmacy Columbus Regional Healthcare System Columbus, GA Cynthia A. Clegg, B.S.Pharm., M.H.A. Assistant Director, Ambulatory Pharmacy Services Harborview Medical Center Seattle, WA Debra B. Feinberg, B.S.Pharm., J.D., FASHP Executive Director New York State Council of Health-System Pharmacists Albany, NY
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ASHP REPORT Organizational structure Christopher R. Fortier, Pharm.D. Manager, Pharmacy Support and Operating Room Services Medical University of South Carolina Charleston, SC Thomas J. Johnson, Pharm.D., M.B.A., BCPS, FASHP, FCCM Director of Hospital Pharmacy Avera McKennan Hospital and University Health Center Sioux Falls, SD Gerald E. Meyer, M.B.A., Pharm.D., FASHP Director, Experiential Education Thomas Jefferson University Philadelphia, PA Kathleen S. Pawlicki, M.S., B.S.Pharm., FASHP Administrative Director, Professional Services, and Director, Pharmaceutical Services Beaumont Hospital Royal Oak, MI
Douglas Slain, Pharm.D., BCPS, FASHP Associate Professor and Infectious Diseases Clinical Specialist School of Pharmacy West Virginia University Morgantown, WV Kelly M. Smith, Pharm.D., BCPS, FASHP, FCCP Associate Dean, Academic and Student Affairs, and Associate Professor, Department of Pharmacy Practice and Science College of Pharmacy University of Kentucky Lexington, KY Hannah K. Vanderpool, Pharm.D., M.A. Vice President, Member Relations American Society of Health-System Pharmacists Bethesda, MD Sara J. White, M.S., FASHP (Chair) Leadership Coach Mountain View, CA
Rafael Saenz, Pharm.D., M.S. Administrator, Pharmacy Services Department of Pharmacy University of Virginia Health System Charlottesville, VA
David R. Witmer, Pharm.D. Senior Vice President and Chief Operating Officer American Society of Health-System Pharmacists Bethesda, MD
Kathryn R. Schultz, B.S., Pharm.D., FASHP Director of Pharmacy HealthEast Bethesda Hospital St. Paul, MN
Appendix B—Executive summary of Task Force recommendations
Lanita S. Shaverd, Pharm.D. Director, Community Health Center University of Arkansas Medical Center Little Rock, AR Janet A. Silvester, B.S.Pharm., M.B.A., FASHP Director of Pharmacy and Emergency Services Martha Jefferson Hospital Charlottesville, VA
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1. Create a year-round policy development and approval process. 2. Create a technologically enhanced guidelines development process. 3. Implement a mechanism by which online communities may convene and collaborate within ASHP. 4. Increase technician membership and engagement within ASHP and its state affiliates. Continuously study and evaluate the evolution of governance structures that will successfully incorporate technicians
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5. Create a closer collaboration between ASHP and its state affiliates through advocacy and partnership opportunities. 6. Amend the ASHP governing documents to clarify that practice within the United States is a requirement for active membership (active members are eligible to vote and hold office). Further, clarify that ASHP welcomes international members as associate members (receive all benefits but not eligible to vote or to hold office). 7. Amend the ASHP governing documents to extend the term of office for Chair of the House of Delegates to three years. The term of the Chair of the House of Delegates should be limited to one three-year term of office. 8. Amend the ASHP governing documents to modify the term of the Board of Directors Member-at-Large position to one three-year term of office. 9. Amend the ASHP governing documents to elect the Treasurer by the general membership. 10. Amend the ASHP governing documents to appoint the Committee on Nominations from among the general membership by the Chair of the House of Delegates. 11. Engage former leaders of ASHP from all levels of the Society. 12. Enhance the conversion of student members to new practitioner members, expand the opportunities for student introduction and transition to ASHP Section structure, and increase student engagement throughout ASHP, including active participation in the policy process. 13. Develop new strategies to increase retention of residents and new practitioners following graduation from pharmacy school or residencies such as through enhanced engagement. 14. Expand and promote member engagement and leadership cultivation.
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