February 23, 2023
After the Adrenaline is Gone:
How to reinvigorate vax programs
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There wasn’t a parade for America’s vaccinators, but there should have been. Thanks to heroic efforts, a massively expanded immunization infrastructure was fabricated almost overnight and millions of lives were saved. And now, after the parade that should-have-been, after the huge success, after the adrenaline… what?
We put that question to Jason Briscoe, the man whose vax wisdom we’ve been seeking out since long before the pandemic. It was in 2017 that we asked, referring to his work for regional chain Discount Drug Mart, “Is this the best flu shot program in the country?” No one challenged that notion. Later, we applauded the success of the Covid programs he oversaw. And now we sought him out to ask that big “What now?”
When asked about the current state of morale among vaccinators, Jason sighed and said, “The adrenaline is gone. And we’re seeing some burn-out, even some migration of pharmacists out of community pharmacies.” He added, “Let me start at the end to explain where we’re at. We’ve had great news! We just got the report that the number of flu vaccines in pharmacies is increasing sharply, and that the trend line is moving up on other vaccines, as well. The same increase is true when looking at the proportion of vaccines in pharmacies to the total across all provider types – an indicator of where we can continue to go with vaccines and clinical services. But, at the same time, we just got reports from major pharmacy chains that they are reducing the pharmacy hours. Why? Well, that’s a multi-faceted conversation with many, many layers and contributing factors, but ultimately, they don’t have the pharmacists or techs they need. So we need to face up to that contradiction. We need to reinvigorate the pharmacy.”
At one level, this isn’t a new conundrum. Jason faced it a decade ago with flu shots, when he led the effort to turn his drugstore chain (now at 77 locations) into what they came to call (and trademark) as “Your Immunization Destination®.” It worked: while in a time when community pharmacy flu vaccines were flat or down, Discount Drug Mart boasted a 25% increase. We recall another passage from what we wrote back then, starting with a quote from Jason:
“We don’t like to talk about the number of shots given – we like to talk about the number of patients protected.” No wonder one of his pharmacists told us, “I love flu shot season.”
Thus, we wanted to know what he had learned about getting buy-in from pharmacy staff for a future of playing the leading role in adult vaccinations. He explained:
“What we didn’t want was for anyone to conclude, ‘This is just corporate being greedy.’ So we started having conversations, agreeing that if we are going to stay relevant as a profession we had to find new ways to provide value. We found an appetite to expand our scope. Vaccinations were a logical extension.”
Makes sense. Still, it’s rare to find people in any corporate role who hear from their team, “Yeah, we’ve got free time. We could do a lot more in a day.” As Jason put it:
“There is the blocking and tackling of a community pharmacy, and it couldn’t be, ‘Jason says we need to do vaccinations, end of conversation.’ Instead, right from the start, it was all about how we in leadership could help. We would never provide goals without the ability to look at our pharmacists and technicians with a straight face in knowing we’ve provided resources necessary for attainable and sustainable success. We set out to eliminate 30 to 40 percent of the routine work in order to free up time for vaccinations. We had three major initiatives: a new pharmacy management system, a contact center that took care of many calls, and a central fill facility.
“The management system was intended to streamline routine work improving workflow and in conjunction with a tremendous I.T. team – made processes such as scheduling intuitive and user-friendly for our patients and our staff. The contact center meant that if Mrs. Jones called to ask about a prescription, that call was routed to pharmacy techs at the contact center and that it was, in most cases, handled to completion as well, if not better, than in the pharmacy. As for central fill, we leaned on our program called ‘sync your meds’; an appointment-based model that allows of teams to work with our patients and their prescribers in synchronizing their maintenance meds to be filled at the same time every month or every three months. A patient’s game plan is set several days in advance of when they stop by the pharmacy to pick up their meds, thus creating better service and patient care for them and operational efficiencies for us.”
Looking back at Jason’s plan, we can see that, he essentially offered this proposition to pharmacy staff: We will eliminate a large portion of your current workload, including the most boring, redundant parts, and instead you’ll spend more time in direct involvement with patients, including vaccinations. Deal? I suspect that there were those who preferred doing routine behind-the-scenes tasks, but I also suspect that the best pharmacist and techs welcomed the change.
Even so, when Covid vaccines came along, it pushed every limit. “I’m not opposed to the prospect of being uncomfortable,” Jason said of that time of high-pressure and long hours. “Progress often occurs when we push beyond comfortable. However, there is a point when being uncomfortable for too long is counter to progress. That’s why I can understand the burnout. But now that the number of Covid vaccinations is slowing, it’s time to reinvigorate. We need willing vaccinators, ready to take on more types of vaccines. We want people to say, Bring it on – it feels good to protect our community.”
How do you do that? we wondered. “We must be more efficient in our day-to-day activities, we must continue to create time and space for our pharmacists and techs to be in front of and engaged with our patients,” he responded. “When patients are in front of us, that’s where we must continue to be effective – in providing education and in providing care.”
Indeed, Jason helped create The Navigators, a group dedicated to removing barriers to pharmacy efficiency and effectiveness. Further, CEO Mike Popovich has recruited Jason to work with STChealth, charged with finding new ways to use technology to increase efficiencies. We look forward to reporting on progress to maximize the ability to administer vaccines – let’s see what Jason can inspire next.
STATS OF THE MONTH
Any “Poverty Vaccine” in Sight?
By Bill Davenhall, Geomedicine Analyst
This month I choose to look at where poverty is in decline, and perhaps even hard to find — I like to think of these above-average income areas as “Poverty Deserts.” These are counties where families, as defined by the US Census Bureau, live with more resources (i.e., money) than the other half of the population. The map below illustrates areas where incomes are above average, and the white spaces are those places where poverty is more likely and might be in the early stages of becoming a “poverty incubator.”
Median Family Income is one of the less frequently used measures of wealth, but it’s a good way to assess how well families in a defined geography are faring in meeting today’s “average” family needs. The US Census Bureau defines “family households” as households consisting of two or more individuals who are related by birth, marriage, or adoption, although they also may include other unrelated people. Median means the middle point – the 50/50 – a statistic that helps reduce the skewing of the data introduced by a few very high-income earners. Some statisticians will certainly argue over this measure, but family household income is what most people can understand in determining their own overall economic “health.” The map below shows where the other half lives – those who have family household incomes above the median and thus reside in my defined “Poverty Deserts.”
As you ponder all the complex determinates of health, remember that many of the disparities we observe in the data (where you see no green) are directly related to the lack of many critical resources, mainly money, education, transportation, healthcare, jobs, and a whole collection of other things that the green geography, or the “other half” are likely have more of. It’s a simple picture of complex local disparities, hopefully to get your attention.
Consider making the data you use “do something” for people. Let the data inspire you to look deeper, think differently about the problems and issues, then act more aggressively about those things that can help an area’s households move into the “other half” of Americans’ income bracket (above the median). And yes, an anti-poverty “vaccine” would be nice, but short of having such an innovation, let the data you create, see, touch, or pass onto others really do something that “moves the needle”, as they say. Start thinking that data is an action “verb”!
As always, I appreciate 2nd opinions.