Only 10 health systems in the country currently hold ASHP’s Certified Center of Excellence designation, a distinction built on a rigorous document review and a multiday on-site survey of medication-use safety and pharmacy practice. Becker’s spoke with pharmacy leaders behind eight of those departments to learn about the decisions, priorities and philosophies behind their success.
Responses have been lightly edited for length and clarity.
Question: In your view, what separates a truly high-performing hospital pharmacy department from the rest?
Wafa Samara, PharmD, vice president and chief pharmacy officer, Duarte, Calif.-based City of Hope: A truly high-performing hospital pharmacy department is a strategic partner and trusted collaborator across the organization. The best departments lead change, embrace innovation, and consistently deliver results. They step forward to solve difficult problems, build new capabilities, and create value wherever the organization needs them most.
Lee Ann Cain, RPh, vice president of pharmacy services, Mobile, Ala.-based Infirmary Health, and chief operating officer, Thomas Hospital: The biggest separator between high performing and others is transparency and collaboration. The team understands that one is successful when all are successful. Without the transparency of what the department is trying to achieve we are all swimming in different directions.
Krist Azizian, PharmD, chief pharmacy officer, Los Angeles-based Keck Medicine of USC: Truly high-performing pharmacy departments do more than execute pharmacy operations well. They create a culture in which medication safety, clinical excellence, operational reliability and continuous improvement are everyone’s responsibility. High-performing departments create an environment where people understand not only what they are responsible for, but why their work matters to the patient.
Denise Scarpelli, PharmD, vice president and chief pharmacy officer, Chicago-based University of Chicago Medicine: It’s health systems that have all the facets of pharmacy, inpatient, outpatient, specialty pharmacy, retail, home infusion. Are you able to provide everything for the patient population that’s coming into our organization? High performing also means that within the department, everyone understands the different aspects of pharmacy so they’re working in unison, especially around transitions of care.
Yen Pham, chief pharmacy officer and senior vice president of pharmacy and clinical nutrition services, Portland, Ore.-based Oregon Health & Science University: What separates an average hospital pharmacy department from a high-performing one is leadership. High-performing departments are led by innovative pharmacy leaders who embrace a growth mindset and continuously seek opportunities for improvement.
Sandra Salverson, PharmD, senior vice president and chief pharmacy officer, Peoria, Ill.-based OSF HealthCare: A truly high-performing hospital pharmacy department is distinguished by its ability to consistently reduce the risks associated with medication use while improving patient safety, quality, and operational reliability. High-performing departments are also transparent about performance. They define meaningful measures, share results openly, and create accountability.
Charles Daniels, PharmD, chief pharmacy officer, San Diego-based UC San Diego Health: The department has to have some strong core values and traditions, then the staff and leaders need to make their decisions based on the principles that are defined in them. It is complicated if you can’t align decisions around a framework.
Melinda Garner, PharmD, pharmacist, corporate pharmacy services, Fort Myers, Fla.-based Lee Health: A truly high-performing hospital pharmacy department must be willing to utilize opportunities for improvement, be open to constructive feedback, and strive to implement changes that benefit the department and the safety of the patient populations served. Because this takes time and effort, it is what separates high performers from the rest.
What operational priorities have had the greatest impact on your department’s success over the past few years?
Dr. Samara: Three priorities have been foundational to our success, system-wide standardization, investing in our workforce, and advancing quality, safety and patient-centered care. We’ve worked to ensure team members are able to practice at the top of their license.
Ms. Cain: We have prioritized growth and standardization. The pharmacy built a strong strategic plan that looked at ways to grow our pharmacy footprint across the health system, and in order for this success to occur we needed standardization across the hospital pharmacy departments as well as into the outpatient pharmacy areas.
Dr. Azizian: Standardization and minimizing unnecessary variation across the medication-use continuum. We have also prioritized technology-enabled optimization and investment in our people, including automation, analytics, clinical decision support, and the thoughtful use of artificial intelligence to enhance existing workflow efficiencies.
Dr. Scarpelli: Making sure all our areas have the same technology, the same Epic system, the same automation. So it’s really that no matter where the patient gets care, they’re getting the same type of care.
Ms. Pham: Our success has depended on our ability to hire, develop and retain talented individuals with diverse skills and perspectives. As we continue to expand our pharmacy services, specialized clinical services, specialty pharmacy and infusion service, we rely on a targeted combination of data-driven business planning, multi-disciplinary collaboration and clear demonstration of return on investment.
Dr. Salverson: Building an enterprise approach to medication management across our multi-hospital health system, ensuring that consistent medication safety standards are in place 24/7 regardless of hospital size or the community served. We invested in automation and developed centralized services, including an integrated distribution center and an e-Pharmacy model.
Dr. Daniels: Keeping patient outcomes and overall wellbeing at the front of our decisions and priorities.
Dr. Garner: Our ambulatory services have seen an influx of pharmacist presence in multiple clinics, acute care sites have implemented and expanded Transitions of Care services, and specialty pharmacy and outpatient infusion services focus on quality patient outcomes.
What are two or three leadership principles that guide how you lead your pharmacy team?
Dr. Samara: First, invest in people. Second, pursue excellence relentlessly. High performing teams need a clear vision, measurable goals, and accountability for results. Third, build strong partnerships. Meaningful progress happens when pharmacy collaborates across disciplines and externally.
Ms. Cain: I try to lead by example, meaning I don’t ask my team to do anything I am not willing to do myself. I also want them to feel empowered to make decisions. Service to others would be my most valued principle. We are in these roles to serve others, our hospitals, our employees, our patients and our communities.
Dr. Azizian: Authenticity and integrity, meaningful connection and creating a culture of courage and accountability. Leadership does not require having every answer, it requires the integrity to acknowledge when you do not. Psychological safety and accountability are not opposites, we can maintain very high standards while treating people with respect and focusing on learning rather than blame.
Dr. Scarpelli: One is collaboration across the department. Another is communication. For example, we do town hall meetings and I do listening tours to make sure I’m communicating our initiatives with everybody within the pharmacy and in leadership outside of the pharmacy. And one more is influencing. I really had to work on getting the team to understand why the Center of Excellence was important to the organization.
Ms. Pham: Surrounding myself with a high-functioning team of individuals who think differently than one another and me. Diverse perspectives foster stronger decision making and innovation. I prioritize building trust, encouraging ownership, and maintaining adaptability.
Dr. Salverson: Strong systems create strong organizations. My role is to build governance, clarify decision rights, and develop operating models that allow great decisions to happen consistently, not just when I’m involved. Second, I believe my greatest responsibility is developing leaders. I set high expectations, provide candid coaching, and create opportunities for people to grow.
Dr. Daniels: Patient focused staff, outcome oriented thinking, efficient operations, reliable systems, accountable people, nimble leaders, and being better than our competition.
Dr. Garner: Pharmacy maintains a consistent mission to Optimize Patient Outcomes Through Interdisciplinary Medication Management, or OPOTIMM. Another principle we uphold is fostering continuing professional development and making annual goals, both personal and departmental.
Which pharmacy metrics tell you the most about whether your department is performing well, and why?
Dr. Samara: I look at a balanced portfolio of measures. Workforce engagement tells me whether we’re building a strong culture. Clinical quality and medication safety metrics help us understand our impact on patient care. Operational and financial indicators ensure we’re delivering value and sustaining our ability to invest in future growth.
Ms. Cain: When looking at an inpatient service line, I look at case mix index as it pertains to ICU cost of care, as well as turnaround time and productivity. When looking at outpatient, I usually focus on revenue per patient or number of patient touches. The metric needs to match the service line.
Dr. Azizian: No single metric can tell you whether a pharmacy department is performing well. We use a balanced scorecard encompassing medication safety and quality, clinical outcomes, operational effectiveness, financial stewardship and workforce health. A department can improve productivity while negatively affecting engagement, or reduce pharmaceutical expense while introducing clinical risk.
Dr. Scarpelli: On the outpatient side, volume. On the inpatient side, quality and safety metrics, and we try to tie into the organization’s metrics, like whether we’re helping with length of stay and readmission rates. We also have pharmacy stewardship metrics like cost saving initiatives at the most effective drug at the least price.
Ms. Pham: The most telling metrics about our performance are those related to clinical quality, operational efficiency and financial stewardship.
Dr. Salverson: I don’t believe any single pharmacy metric tells the full story. For me, the most important metrics fall into five areas, clinical excellence, patient experience, employer of choice, strategic growth, and ministry sustainability. What matters most is not only whether we hit a target, but whether we can perform consistently over time.
Dr. Daniels: I think every leader needs to assess what their team does that is important, and then how they know if they are doing it well. I rely on staff and leadership to assess both of those elements.
Dr. Garner: Our Pharmacy Quality and Safety Committee monitors over seventy individual metrics, from patient outcomes to employee satisfaction. The low turnover rate within pharmacy is a testament to the great work environment. When your team feels welcomed and valued, they work at their best.
What’s one operational change your team has made that produced a meaningful improvement in patient care, safety or efficiency?
Dr. Samara: Standardizing pharmacy practices across City of Hope’s national system, aligning workflows, policies, and best practices across our locations in California, Arizona, Georgia and Illinois. This helps ensure patients receive the same high standard of care regardless of where they are treated.
Ms. Cain: We have moved our inpatient pharmacists to the units. They operate in tandem with our nurses and physicians and attend interdisciplinary rounds, offering medication recommendations that can be the difference in getting discharged that day versus staying several more days.
Dr. Azizian: The establishment of a multidisciplinary alert management workgroup involving pharmacists, nurses and physicians to address alert fatigue within the electronic health record. Through this structured process, the team has reduced unnecessary drug-drug interaction alerts by 63% and duplicate-therapy alerts by 30% to date.
Dr. Scarpelli: After our first Center of Excellence survey, we knew we did not have a clinical pharmacist in our pediatric ER, and we’d been asking for years. Based on ASHP’s recommendations, we were able to get two clinical pharmacists in our ED over the last few years.
Ms. Pham: Obtaining credentialing and privileging authority for our clinical pharmacists. Pharmacists practice at the top of their licenses and exercise prescriptive authority within their scope without a physician’s approval for every intervention.
Dr. Salverson: The development of centralized pharmacy services across our integrated multi-hospital system, including our integrated distribution center and our e-Pharmacy model. We now routinely manage fewer than 5% of the shortages listed on the ASHP Drug Shortage list.
Dr. Daniels: We went all in on pharmacist driven transitions of care before it was a well-accepted pillar. That philosophical change changed how we think about care, both inpatient and ambulatory.
Dr. Garner: At Lee Health, our goal is to ensure at least 70% of Emergency Department patient medication histories are completed by a pharmacy team member. A recent review showed that 85% of patient medication histories in the ED were performed by a pharmacy team member, exceeding our goal.
What challenge do you think will define hospital pharmacy leadership over the next three to five years?
Dr. Samara: The ability to keep pace with a rapidly evolving healthcare landscape. Pharmacy leaders will need to thoughtfully leverage emerging technologies, including AI and automation, while maintaining a strong focus on workforce development, clinical excellence, and patient safety.
Ms. Cain: Succession planning. There is a lack of interest in leadership, whether pharmacy or otherwise, and we must learn how to mentor and develop the next generation. Without forward thinking leaders, pharmacy could take a step back to a necessary expense department rather than a contributing department.
Dr. Azizian: Sustaining access, quality and financial performance while the complexity and cost of medication therapy continue to accelerate. The solution cannot simply be asking our teams to work harder or reducing expense. We will have to redesign the pharmacy operating model.
Dr. Scarpelli: Making sure the next wave of pharmacists that are graduating and coming into practice really want to pursue leadership, and we’re seeing less and less of that. It’s really how do we encourage and work with pharmacy schools to make sure the next generation of pharmacists are pursuing leadership.
Ms. Pham: An intense shift toward clinical services, integration of advanced technologies such as AI, and ongoing cost containment pressures. Leaders will need to successfully incorporate AI into pharmacy operations while balancing workforce needs and resource constraints.
Dr. Salverson: The transition from hospital pharmacy leadership to true health-system pharmacy leadership. Pharmacy leaders will need to think beyond acute-care services and lead medication management across the full continuum of care, including ambulatory care and transitions of care.
Dr. Daniels: Skate to where the puck is going. If we attempt to build for today’s environment we will likely miss the eventual endpoint. I believe we are better prepared to meet our professional goal if we are nimble enough to change course faster.
Dr. Garner: We all live in a VUCA world: volatile, uncertain, complex, ambiguous. We can either let VUCA define us, or we can change what it means to us, vision, understanding, clarity, agility.
What’s one piece of advice you’d give another pharmacy leader working to build an exceptional pharmacy department?
Dr. Samara: Invest in your people and think boldly. Exceptional departments are built by leaders who develop talent, model excellence, and aren’t afraid to challenge the status quo.
Ms. Cain: Ask the questions. We need to understand the overall strategic plan for the health system, and by asking the questions we can learn how to move the pharmacy department into an integral part of that plan. I would also say think outside of your box.
Dr. Azizian: Invest in culture and engage people. You can have the best technology, sophisticated clinical programs and highly efficient operations, but without a strong culture and an engaged workforce, it is difficult to build, or sustain, an exceptional pharmacy department.
Dr. Scarpelli: If they’re looking to do a Center of Excellence, the one thing we realized was that we had to stop and really give the why to the team of why we’re doing this, because they didn’t really want to do it at first.
Ms. Pham: Stay nimble. Healthcare is evolving rapidly, and pharmacy leaders must be willing to adapt to change. Exceptional pharmacy departments are built by leaders who invest in people, embrace innovation, remain adaptable, and relentlessly focus on improving patient outcomes.
Dr. Salverson: Don’t try to boil the ocean. Start by understanding where your department is already strong, then be disciplined about choosing the next area of growth. Tools such as the High Value Pharmacy Framework can help leaders assess their current state and identify gaps.
Dr. Daniels: Hire good people, keep a 10,000 foot view of the enterprise, and don’t underestimate a strong curiosity by the leader. If you don’t have that, you will eventually fall into a trap of old thinking and lose momentum.
Dr. Garner: If a leader is considering pursuing the ASHP Center of Excellence designation, take the opportunity. While the process requires dedication and hard work, the benefits are well worth the effort.
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