The Pharmacy Forecast report: Planning or preparedness?

In developing long-term strategic plans for their departments, pharmacy leaders typically pursue approaches that are integrated with their organizations’ priorities and are based on an understanding of emerging healthcare issues that can be characterized by their likelihood of occurrence. Such likelihood is often contemplated in categorizing future events as certainties (ie, things that are clearly established or assured) or contingencies (ie, possibilities that require preparation). Traditional pharmacy enterprise–based approaches to strategic planning routinely incorporate these factors to ensure that the resulting plan is grounded in the health system’s current and future patient care and medication-use priorities. Since its inception in 2013, the annual ASHP/ASHP Foundation Pharmacy Forecast report, the latest edition of which is published in this issue of AJHP,¹ has served as an essential resource for these health-system pharmacy strategic planning efforts.

Along with certainties and contingencies, visionary leaders must also contemplate the possibility of unpredictable or unforeseen events that may have extreme consequences. A 2020 Pharmacy Forecast report² discussion of unforeseen events—so-called black swan events—described the severe shortage of intravenous fluids that ensued when Hurricane Maria devastated Puerto Rico in 2017. While the hurricane itself was not unforeseen, as hurricanes in the Caribbean can be categorized as certainties, the destruction of a manufacturing facility and the resulting severe intravenous fluid shortage were unforeseen and defied traditional approaches to planning.

Was the COVID-19 pandemic unpredictable and unforeseen? Could we have planned for it? Prior to the COVID-19 pandemic, 4 global pandemics had occurred since 1900, and pandemic preparedness has been a priority in emergency planning for decades. We knew that a global pandemic was possible. Nonetheless, despite our understanding of the risk, the profound societal effects of COVID-19 were certainly unforeseen. These include a number of factors that directly affected medication use and pharmacy practice: a societal lockdown, supply chain disruptions, unfounded claims about the effectiveness of some treatments, and rapidly emerging science, including the discovery of COVID-19 vaccines and therapeutic agents.

Through traditional approaches to strategic planning, organizations cannot specifically plan for unpredictable or unforeseen events. However, as author and business leader Margaret Heffernan discussed in her 2019 TED Talk (TED Conferences, LLC),³ organizations can prepare. Heffernan went on to emphasize the importance of robustness and relationships to preparation for the unforeseen.

Investments by health-system pharmacy departments in the development of leaders, clinical services, cutting-edge operations, and stakeholder relationships have effectively positioned these departments to plan for certainties and contingencies while preparing for unforeseen events. It has been obvious throughout the COVID-19 pandemic that health-system pharmacy’s long-term commitment to the development of robust services (eg, critical care pharmacy) and cultivation of trust-based relationships with key stakeholders have been essential.

Topics in previous Pharmacy Forecast reports—including pharmacy practice models, drug development and therapeutics, workforce issues, advancing pharmacy technician roles, and disruptive forces in healthcare—have been foundational in supporting the preparedness that ultimately enabled health-system pharmacy teams to respond nimbly to the pandemic. As a result, pharmacy departments were positioned to: participate in the care of critically ill people with COVID-19, including understanding the evidence for and against emerging treatments; manage shortages of life-saving drugs in the critical care setting; transition key services to telehealth; and lead rapid establishment of new services, including mass COVID-19 vaccination programs and administration of monoclonal antibodies. In addition, it is fair to credit health-system pharmacy’s robust preparedness efforts as key drivers of the federally sanctioned expansions of pharmacy practice that have occurred since March of 2020.

The Pharmacy Forecast 2022 report addresses issues that moved further into the forefront as a result of COVID-19, including healthcare value, access, disparities, and equity; workforce capabilities, agility, and resilience; and preparedness for change. These topics reflect some of the greatest challenges that are affecting health systems and their pharmacy enterprises as they plan to emerge from the COVID-19 pandemic.

In the “Preparedness for Change” chapter, new to the Pharmacy Forecast this year, Shane and Cunningham synthesize forecast survey respondents’ views on the likelihood of and preparedness for a select set of influencers. Stark differences between assessments of likelihood and preparedness were revealed in several cases. Seventy-three percent of respondents, for example, indicated it is likely or very likely that health systems will use advanced data analytics to address health disparities in their patient populations. Yet, only 48% of respondents indicated that their pharmacy department or staff was prepared for this transformation. The inclusion of these comparisons of likelihood and preparedness adds great value to the report by providing additional perspective as pharmacy leaders contemplate their departments’ readiness for future events and prioritize those areas where gaps may exist.

Since its inaugural publication in 2013, the ASHP/ASHP Foundation Pharmacy Forecast report has served as an essential strategic planning resource for health-system pharmacy leaders. The 2022 edition, informed by the early lessons of COVID-19, provides insights into some of the most complex issues in healthcare—both certainties and contingencies—that pharmacy leaders must consider as they prepare their departments for a future that will certainly include more unforeseen events.

Disclosures: Dr. Cobaugh is editor in chief of AJHP. He has declared no potential conflicts of interest.

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