Dr. Michael Kosal takes a data-driven and analytical approach to managing pharmacy operations. Work days are never the same, allowing for continuous learning and keeping it fun!
Name: Michael Kosal
Position: Pharmacy Operations Manager, Ascension Genesys Hospital
Email: michaelkosal@gmail.com
Interview Summary
Lynn: [00:00:01] Lynn Paterini here with The Nontraditional Pharmacist, part of the Pharmacy Podcast Network. Today we are focusing on pharmacy administration. Now this is a great career for pharmacists to go into mainly because of how diverse of a field it is. There’s many positions available for pharmacists and you might be wondering what is pharmacy administration? I actually came across a great article that was featured in APhA, written by Melissa Skelton, and she described pharmacy administration from a basic level that it provides leadership and support to practicing pharmacists in any setting. And as you can see, there’s a lot of opportunities available. We’ve already explored one of those roles here on The Nontraditional Pharmacist with a great interview with Anthony Boyd, who was the pharmacy inpatient manager at the Cleveland Clinic. Today we’re going to dig deeper into pharmacy administration with Dr. Michael Kosal, who is Pharmacy Operations Manager at Ascension Genesys Hospital in Grand Blanc, Michigan. So Mike, thank you so much for being on the show with us today.
Michael: [00:01:05] Thanks for having me.
Lynn: [00:01:06] So let’s get started. Why don’t you tell us a little bit about your background through pharmacy and how you got to your role in pharmacy administration?
Michael: [00:01:14] So yeah, great place to start. My path through pharmacy actually started just with volunteering at a hospital pharmacy as a school student. I spent time kind of looking at their operations and what they were doing. I found it really was something that I felt quite passionate about and felt I could really make a difference with. So I began progressing through undergrad and then grad school at the University of Michigan to get my doctor of pharmacy (PharmD). I then spent that time interning at the same hospital I initially volunteered at. As an intern I was able to see that there were opportunities to blend not only operational excellence, but also clinical excellence. I thought that [operations] was where I could make the most significant impact, in helping everything run smoothly, so that the care for patients was as top notch as possible. Looking at what I could do with that after graduation, administration was a natural draw, looked at interfacing not only between our clinicians but our patients and then also the operational side of things to draw all of that together and connect those two parties. That’s really what drove me in that direction and I landed here.
Lynn: [00:02:20] That’s great. So you knew from high school you were interested in pharmacy administration, or would you say you were locked into it as you got through pharmacy school?
Michael: [00:02:30] I would say it was definitely an interest, it was always there. I felt it would have been a disservice to myself to just kind of go down one path. So all through pharmacy school I was exploring the various avenues and options, several of which you guys have talked about even on this program. Things looking at the very clinical aspect of things, whether that was ICU specialty, cardiology focus, and even some experience in the ambulatory care setting. It was really kind of my desire to get to a broad spectrum and at the end of it, I still felt that administration was where I could really make a difference and where my passion truly lies.
Lynn: [00:03:02] Now pharmacy administration is a pretty broad term. What would you say, you know being immersed in the field, how would you define pharmacy administration?
Michael: [00:03:12] Now there is a fun question. So pharmacy administration, like you said even at the start of the broadcast here, really is a broad sweeping title that covers anything from a supervisor role all the way up to chief pharmacy officer for several-hospital health systems. Each one of those roles has a slightly different scope, but they all kind of focus on the same thing and it is similar to what we were describing. The closer you are to the clinical side of things, you have more experience in those day to day activities. That might be, “okay, how do we handle this, or what’s our vancomycin dosing nomogram look like and things along those lines, and how do you operationalize that? As you move further up that chain, progressing from say supervisors to manager to director and so on, you start to interface more with folks outside of the pharmacy department and looking at how does pharmacy interface with other specialties and groups in order to unify all of healthcare. Looking at budgeting, operations, department interface, and a little bit of that aspect of things, all the way up to chief pharmacy officer, where you may be dictating an entire scope of pharmacy for up to 10 to 15 hospitals.
Lynn: [00:04:27] Wow, it sounds like there’s a lot of opportunity available. You mentioned there is the clinical side of it with you were saying vancomycin dosing and you know again the clinical role, how about in terms of supervising and the financial aspect of it, is there are a lot of business involved? How did you get your business experience to do your job?
Michael: [00:04:46] So I will say that’s probably one of the biggest differences between a strictly clinical role and an administrative role. You have to marry those two subjects to an extent. Whereas a clinician is focused primarily on face-to-face care of the patient or day-to-day operations associated to the patient, the operations side and the administration side looks at okay, our patients are still our primary focus, but how do we also make sure that we have the funds necessary to do what we’re trying to do? How do we make sure we have the equipment that we need to do our job? What do we need to do from a staffing standpoint or what protocols need to be put in place so that our staff are able to effectively and efficiently tackle patient care? And that’s really where you see administration shine. I always used to describe it to people as the triangle that sits right in between patients, business, and providers. Because if you don’t take care of patients, you shouldn’t be in the healthcare field. If you’re not taking care of your providers, they’re not going to be there to take care of patients. And if you’re not keeping an eye on the financial side of things, well you’re not going to be able to keep your facility’s doors open and then you’re not taking care of anybody. So I always looked at it as administration sits right in the center of that triangle and it’s their job to kind of keep all three of those things in balance.
Lynn: [00:05:57] So patient, business, and providers, that’s great. Can you give us a description of your role, your day-to-day responsibilities of what you do, and we can kind of work into how that fits into your personal life and your work-life balance. But let’s just start with your day-to-day responsibilities on the job.
Michael: [00:06:17] So that is one of the other things that I’ll say is absolutely exciting about pharmacy administration, your day-to-day is almost always guaranteed to change. There are certain things that you have to tackle every day. Do I have enough staff here today? Are operations working the way they’re supposed to? Are any of my machines malfunctioning or not performing their job appropriately? What’s going on in the hospital that I might need to address?”Those are the things that you kind of ask yourself as a survey every day, what things do I need to triage and tackle or are we working the way we’re supposed to? But then in addition to that, you tackle various projects, maybe you’re trying to operationalize a new approach to a clinical problem, or perhaps you’re looking at a cost-saving measure, or perhaps most people can ally with this, in the past year we’ve been managing drug shortages at an unprecedented rate. So looking at how is your facility going to adapt and adjust when the drugs that you are normally expecting to have aren’t available. How do you make sure that you’re still doing what you can for patients and that your staff are armed and equipped with what they need in order to do their job? And so one of the greatest advantages is the field of administration is that the day to day looks a little different every day. So you’re never bored. What you’re working on Monday may be totally different than what your working on, on Friday. And it really is again looking at all those interfaces to see where am I most needed today, what work needs to happen?
Lynn: [00:07:38] Is there any particular part that you prefer or you like doing more than another?
Michael: [00:07:44] I’ll say I’m a little biased, I’m a numbers guy. I love looking at metrics and seeing hey you know last month we were here, and we tried this tweak about improving our turnover rate on a particular drug agent and then seeing how that work has impacted our performance the next month. We see that also in things like are we hitting our budget goals? How many patients are we caring for? One of the current initiatives we’re working on is CHF [congestive heart failure]readmissions and trying to make sure that our patients are being counseled and educated so that they can avoid coming back to the hospital. And so we monitor and look at that kind of information and what really, I guess, gets me psyched about my job is when I get to go in and say hey we tried making this change last month and here’s what we saw go well or maybe not well, and how do we adjust that? You’ll hear a lot of people talk about the plan, do, check, adjust cycle. And that is I would say is the bread and butter for pharmacy administration. It’s “okay, what can we plan to do,” “what are we going to do,” “how do we check it,” and then “what adjustments do we need to make?” So I would say that’s really what gets me excited is looking at how the little things that you do make a measurable difference.
Lynn: [00:08:51] It sounds like you’re really passionate about what you do and it really fits your personality really well. In terms of you know you have your work life all set, how does that fit into your work-life balance? Do you work a lot of nights? With pharmacy, a common complaint is working on weekends. How does that look like for you in pharmacy administration?
Michael: [00:09:13] Great question. I know it’s extremely important to most folks. And I would say there’s a variance across the spectrum. As you’re closer to a clinical role, maybe in a supervisor position or something along those lines, you tend to see more of that off-hour requirement where you may be supervising a second or third-shift type setup. However, as you move up that chain, you tend to see less of that and more of a shift towards the 9 to 5, Monday through Friday type positioning. The one aspect of pharmacy administration that often is kind of forgotten about with that, is that you kind of need to be available to your staff. Things don’t always happen between 9 and 5. So you may occasionally get the phone call at 9:00p.m. hey something’s really gone wrong and we need a little guidance here. Now you can build protocols and procedures in with those things, but it’s a good idea and it really helps your staff feel connected to you if you’re available to those folks. I would say that’s a rarity, but it is something that kind of comes with the job. It really comes down to what people are looking for. Personally, I enjoy the schedule. It’s nice to have the weekends off, but again I’m always available to my staff, they all have my cell phone number, it’s posted in our department and there have been times that I received a call at 3:00a.m. asking what do we do? I would say that’s rare, but can happen.
Lynn: [00:10:31] Yeah because ultimately if you’re a manager, you’re responsible for the outcomes that are in the pharmacy and on your unit. But you said that’s very rare. That’s not a common occurrence, but you do have to be prepared for that for that to happen.
Michael: [00:10:49] Absolutely. And like I said, one of the other really nice things about it is you can help and empower your staff to address a lot of concerns and that gets back to what we were talking about before, creating operational protocols and procedures and helping your staff understand, what is it I can do to take care of an issue or a problem? Empowering your people in that manner not only makes them better practitioners and better clinicians, but can help your department run a little bit more smoothly, increasing their satisfaction and then also reducing the likelihood that you get that 3:00a.m. phone call.
Lynn: [00:11:18] How would you say this role in pharmacy fulfills your personal and your professional goals? What is your ultimate goal with pharmacy administration?
Michael: [00:11:26] Great question, Lynn. Thank you for asking how it fits into my personal goals and professional growth. Realistically, I’ve always had that feeling that pharmacy needed someone to connect the components. As we discussed before, I see it [pharmacy administration] as the patients we’re caring for, the people who are providing the care, and the business and operational side of pharmacy. So professionally, being able to sit in that position and help unify those things makes a world of difference. For the past 10, 15, 20 years, we’ve heard “patients first”. I think a lot of that causes people to focus just on the patients. And I’ve always felt that a key component of caring for patients, is caring for the people who care for patients. So our providers, our staff, etc. and it’s just as important to keep a focus on those folks and make sure that they’re empowered and they have the tools they need so that they can provide that top quality care. Oftentimes, I find that that is [empowering staff] my job, it is to take care of our people and help them do that [provide patient care]. So from that standpoint it’s very satisfying to me personally, to see the difference I can make in the lives of my associates, whether that’s helping them with scheduling, or arranging some coverage when they have an emergency arise, or even allowing them to learn new things and to put that extra knowledge into practice. To me that’s extremely satisfying. Personally, I enjoy what I do and I think it’s for someone who is looking to kind of pull all the pieces together, it’s a great opportunity.
Lynn: [00:12:56] That’s a great point that you just made with the behind the scenes is just as important as the face to face interaction with the patients. That’s something that we don’t really think about, what goes on behind the scenes to pharmacists to do what they’re are able to do and help patients. You mentioned a little bit about other roles in pharmacy administration, could you going to get a little bit more, in terms of you know we have your role as operations manager. What are some of the other positions that are involved in administration?
Michael: [00:13:35] So as you highlighted earlier in this discussion, they are widely varied. You have everything from a supervisor and that can be either just a generic supervisor, or it can be a very specialized supervisor. It may be a technician supervisor or a sterile compounding supervisor. Supervisor tends to be your first, introductory level into pharmacy administration, usually above that you’ll have assistant managers, and again those can be very generic or very specialized. It’s usually associated with the size of the health system, larger health systems tend to require more specialization in their pharmacy administration team versus a smaller 200-300 bed hospital may only have an assistant manager and a manager, you may not have the supervisor role. Moving up from assistant managers, you tend to hit the managers standpoint and managers are also varied. You can have folks who fall into my position, which would be operations management, you can have clinical managers, and with that you can also just have a generic manager who’s responsible for it all. It usually depends on the size of the health system and how specialized they want to get with their folks. Above that, you tend to have either assistant directors or directors. Depends again on the size of the health system and those folks are where you start kind of see more the budgetary interfacing. How are we going to fit into the whole hospital picture? And then above that oftentimes, you’ll have either directors over an entire health system or chief pharmacy officers or vice presidents of pharmacy. The titles tend to vary, but it’s usually about a 4-step or a 5-step process from supervisor to assistant manager to manager to director to top of the ladder. Again it varies with the health system, but overall that tends to be the overarching structure. As you go, kind of what we said throughout this presentation, starting from the supervisor role, you’re much closer to clinical activities. It’s where your focus tends to be is more on that day-to-day clinical, plus a sprinkling of administration. As you move up slightly into assistant manager and manager role, you tend to be more concerned with the entire operation of the department or the clinical initiatives of the entire department. That director role tends to be how does the department fit inside the hospital, and then as you move up to a vice president or a chief pharmacy officer role tends to be how does the pharmacy or all of the pharmacies fit into the whole health system? And that tends to be how you see the scope.
Lynn: [00:15:58] What does the pharmacy administration landscape look like today and how do you think it will change in the future? I know you just mentioned it can depend on the size of the health system, but can you just give us a little bit of insight into how it is now versus the future?
Michael: [00:16:14] So I would say now, there is certainly opportunity in pharmacy administration, and I would expect that to continue into the future. We’ve noticed that pharmacy schools tend to put a very high focus on clinical attentions and training pharmacists to be great clinicians, which I think is excellent, but oftentimes we miss that at some point there needs to be leaders of those clinicians. I don’t know that a lot of pharmacy schools do an excellent job of that. There are some that are certainly starting to, but as I see the landscape right now, we see a lot of open leadership positions and I expect that that will continue especially with changes in the healthcare landscape. We are starting to see more health system type structuring, we’re seeing fewer and fewer single entity hospitals. As we start to conglomerate hospitals together, there will be need for that pharmacy structure to kind of unify the work those folks are doing. And that’s where I think we’ll see opportunities for pharmacy administration folks and people interested in pursuing those leadership roles outside of just frontline or clinical work.
Lynn: [00:17:19] Leadership experience is definitely a key component to being a manager. What advice would you give to pharmacy students and pharmacists that are looking to pursue a career in pharmacy administration?
Michael: [00:17:29] I think the biggest part is to cultivate a passion for learning. We already know we have to do that as clinicians. You’re learning about any new agents that are hitting the market, new protocols, new procedures, new guidelines, but it’s essentially important to do that even as you transition into administration, If you are responsible for leading your staff, you need, to an extent, to know what they know or know how to get the information that they have. That helps you liaison and interface with those folks. So it’s truly, to cultivate a passion for learning. Read. Read incessantly. Because what you will pick up from reading are either new ways to help your staff, new ideas about how to operate your department. And don’t be afraid to read outside of pharmacy. My book shelf is littered with things ranging from how to lead people to how to persuade to how to negotiate. I can’t stress enough the importance of reading a newspaper. Personally, I read a newspaper every day. I look at specifically the business section because that’s an important part of our world. As healthcare becomes more and more business driven, we look at changes in CMS, and educating yourself and being aware of what’s happening in the landscape will be vital. So for folks interested in pursuing a career in leadership, there is no such thing as a leadership role that’s too small. And sure, you don’t necessarily have to have a title to be a leader. Grow and focus on how you interact with people because ultimately being a leader is just that: it’s convincing people to get on board with you in the direction that you’re headed. That is what being a leader is, so interfacing with folks, expanding a network of friends, those are all key things that provide great practice for becoming a leader. So if I had to sum it up into three things its:
- Cultivate a passion for learning.
- Don’t be afraid to get out there and try something (there’s nothing that’s considered too small a leadership position).
- Read, read, read.
Lynn: [00:19:32] That’s great. It’s definitely important to be aware of what’s going on in the world. I know with pharmacy we tend to get very focused and specialized on the most up-to-date treatments that are available, but you have to remember what’s going on in the world and stay up-to-date with the news so you can help shape healthcare of the future. Where would people go to learn more?
Michael: [00:19:55] They always say pharmacy is a very small community. For folks interested in pharmacy administration, I would try to reach out either through a school of pharmacy or through a local hospital or a place that you may be already employed and working, try to shadow. Get some opportunities to see what that looks like, find out if that’s really where your passion is. And if that is something that you’re interested in, ask to do a little more, ask to take on a project to help out. I will say that’s where I got my start. I was an intern and I noticed an opportunity to improve some operational components of what we did and said hey, can I give this a try? And my manager at the time said sure, go ahead. Let’s see what you come up with. That definitely got me excited and that was an opportunity to put that to use. So I would say don’t be afraid to ask someone who is in a position if you can kind of see what they’re doing. Outside of that, there are limited resources in pharmacy administration. We’re starting to see more pharmacy residencies pop up that are geared towards administration, so you can certainly reach out to those folks. But overall, the best experience is almost seeing someone who is doing the job because it is different than really anything most places are teaching.
Lynn: [00:21:06] Networking. It’s a key component in pharmacy, right?
Michael: [00:21:09] Absolutely.
Lynn: [00:21:11] This is the question we love asking all of our guests here. Where do you think the future of the pharmacy profession in general is going?
Michael: [00:21:20] Well there’s a very interesting question. Given the way we’re seeing healthcare change and the fact that so much from CMS guidelines and things on those lines are changing so much, we’re starting to see our population get significantly older and we’re starting to see our population get much sicker. If you compare even the difference between 1970 and now, the average cost to take care of a patient over the age of 70 I think is almost double. And then you pair the fact that the number of people who are getting to the age of 70 has is also increasing. With that we know it’s going to cost more to provide healthcare as we currently do it, and to figure out where those dollars are going to come from is challenging. I think a big change for healthcare is going to be we’ll see less hospital focus and more health system focus, where it will become how has a patient moved from community health services to perhaps a clinic to perhaps a secondary care facility. Only then making it to a tertiary care facility like a hospital. Right now, I think we kind of skip that process a bit and we see a lot of patients go from a I don’t feel well to being in a hospital emergency department. I think there’s a real opportunity to expand our services, not only through pharmacy but healthcare in general across that spectrum, how do we keep people from getting sick? Rather than seeing them when they’re at their sickest. And I think that will be a huge component in healthcare as it changes in the next 10 to 20 years. I think it will be hospital administration or even health system administration’s role to say how can we move our people in the directions that we want so that we have those folks interfacing with patients at every step of that process, not only at their sickest.
Lynn: [00:23:06] Absolutely I agree with that in that pharmacy needs to look into preventative care, rather than just treating them once they get to that disease state. So definitely agree with that.
Well there you have it, a great look into another role in pharmacy administration. Mike, thanks so much for being on the show with us today and sharing your story.
Michael: [00:23:28] I appreciate it, thank you for having me.
Lynn: [00:23:29] This is Lynn Paterini with The Nontraditional Pharmacist and we will see you next time.