CASP Module 18, Section 2: Coaching, Feedback, and Professional Development
MODULE 18: BUILDING AND LEADING HIGH-PERFORMING SPECIALTY PHARMACY TEAMS

Section 2: Coaching, Feedback, and Professional Development

From Preceptor to Performance Coach: Developing Your Team’s Elite Competencies.

SECTION 18.2

Coaching, Feedback, and Professional Development

Develop skills in coaching team members on specialty-specific competencies and providing feedback that drives performance and supports career growth.

18.2.1 The “Why”: The Shift from Manager to Performance Coach

As a pharmacist, you have likely held the title of “Manager.” In a traditional retail or hospital setting, this role is often 90% operational. You are the “chief problem-solver” and “task-director.” Your day is consumed by managing inventory, building schedules, verifying prescriptions, and putting out fires. Your primary focus is managing the work. If a technician is slow, you might put them on a different task or simply do it yourself. This is a directing model.

Specialty pharmacy leadership demands a fundamental identity shift. You are no longer just a Manager of Work; you must become a Developer of People. The complexity of the specialty lifecycle, which we explored in Section 18.1, is far too great for one person to “direct.” You cannot personally navigate every payer portal. You cannot personally make every adherence call. You cannot personally research every foundation’s funding status. Your pharmacy’s success is 100% dependent on the competency of your team.

A single untrained technician can cost your pharmacy $150,000 in lost revenue from mishandled PAs. A pharmacist who hasn’t been coached on empathetic communication can drive a patient to abandon a $20,000-per-month therapy. The “sink or swim” model of management, where you throw a new hire into a role and hope they figure it out, is an act of operational negligence in this environment.

The Fallacy of the “Managing Manager”

Many pharmacy leaders fall into the “super-tech” or “super-pharmacist” trap. They believe their job is to be the best person on the team at every single task. When a complex PA is denied, they say, “Give it to me, I’ll do it.” When a provider calls, they take the call. When a patient is upset, they handle it.

The result?

  • The manager is completely burned out, working 60 hours a week.
  • The manager’s team is completely underdeveloped, bored, and disengaged.
  • The pharmacy has a “key-person dependency” and cannot scale. If the manager goes on vacation, the entire operation grinds to a halt.

Your new job is not to be the best player on the team. Your job is to be the coach who builds a team of 10 players who are all better than you at their specific, specialized roles. This requires a profound shift in mindset: from doing to delegating, and from directing to developing.

This section is your masterclass in making that shift. We will translate a core clinical skill you already possess—therapeutic drug monitoring and titration—into a new leadership framework. You will learn how to observe performance, how to diagnose a skill gap, how to deliver feedback that doesn’t create conflict, and how to build a development plan that grows your people and your pharmacy. This is the most leveraged, and most rewarding, skill a leader can possess.

18.2.2 Pharmacist Analogy: Coaching as a Titration Protocol

A Deep Dive into the Analogy

As a pharmacist, you are a master of therapeutic titration. When a patient starts on warfarin, do you just hand them a 5mg tablet and say, “Good luck, see you in six months”? Of course not. That would be malpractice. Instead, you initiate a meticulous protocol:

  • 1. Baseline Assessment: You get a baseline INR. You assess their diet, their risk factors, and their other medications.
  • 2. Initial Dosing: You start with a conservative dose, (e.g., 5mg daily).
  • 3. Frequent Monitoring: You check their INR again in 3-5 days. You don’t wait a month.
  • 4. Diagnosis & Intervention:
    • If the INR is 1.4 (sub-therapeutic), you diagnose the problem (dose is too low) and intervene by increasing the dose.
    • If the INR is 4.5 (supra-therapeutic), you diagnose the problem (dose is too high) and intervene by holding a dose and decreasing the maintenance dose.
  • 5. Maintenance & Follow-up: You continue this loop of “Monitor, Diagnose, Intervene” until the patient is stable. Then, you transition to less frequent monitoring, but you never stop monitoring entirely.

Coaching is this protocol. Your employee’s skill level is their “INR.” A manager who just “gives orders” is the pharmacist who writes “5mg daily” and never checks an INR. A coach, by contrast, applies the titration protocol to their people.

Masterclass Table: The Titration Protocol vs. The Coaching Protocol
Clinical Titration (Warfarin) Leadership Coaching (A PA Specialist)
1. Baseline Assessment 1. Baseline Assessment
Get a baseline INR. Assess diet and drug interactions. Assess the new hire’s baseline skills. “What computer systems do you know? Tell me about your experience with insurance.”
2. Initial Dosing 2. Initial “Dosing” (Training)
Start 5mg daily x 3 days. “For your first week, you are only going to handle portal-based submissions for our top 5 drugs. Let’s not worry about phone calls or appeals yet.”
3. Frequent Monitoring 3. Frequent Monitoring (Observation)
“Let’s check your INR on Friday.” “I’m going to audit 5 of your submissions at the end of the day and we’ll review them together.” (This is your “skill-check”).
4. Diagnosis & Intervention 4. Diagnosis & Intervention (Coaching/Feedback)
“Your INR is 1.5. This is sub-therapeutic because the dose isn’t high enough. Let’s increase your dose to 7.5mg.” “Your submissions are accurate, but they are getting denied for ‘missing clinicals.’ This is sub-therapeutic because you’re not attaching the chart notes. Let’s increase your dose of training on how to find and attach labs.”
5. Maintenance & Follow-up 5. Maintenance & Follow-up
“Your INR is stable at 2.7. Great! Let’s re-check in 4 weeks.” “Your first-pass approval rate is now 90%. Great! You’re stable. Let’s start training you on your next skill: verbal appeals.” (This is Professional Development).

This analogy proves you already have the required skill. You are a clinical expert at “Monitor, Diagnose, Intervene.” This section will simply teach you how to apply that clinical framework to your team’s performance.

18.2.3 A 4-Step Framework for Coaching and Feedback

To “titrate” performance, you need a systematic process. You can’t just randomly tell people they’re doing a good or bad job. Coaching must be structured, regular, and evidence-based. This 4-step framework is your new protocol. You will run this “loop” for every employee, on every key competency, indefinitely.

The Coaching & Feedback Loop
STEP 1: OBSERVE

Gather objective, specific performance data. (The “INR Check”)

STEP 2: DIAGNOSE

Identify the specific skill gap or success. (The “Diagnosis”)

STEP 3: INTERVENE

Conduct the feedback/coaching session. (The “Intervention”)

STEP 4: FOLLOW UP

Set a new goal and schedule the next check-in. (The “Refill”)

Step 1: The Masterclass on Observing

You cannot coach what you do not see. Feedback based on “feelings” or “rumors” is useless and destructive. (“I feel like you’re not making enough calls.” “I heard you were rude to a patient.”) You must gather objective, specific, and non-judgmental data. This is your “INR check.”

Masterclass Table: How to “Observe” Each Role
Example
Role to Coach “Bad” (Vague) Observation “Good” (Specific/Objective) Observation
PA Specialist “You’re too slow at PAs.” “I audited 10 of your PA submissions from yesterday. 8 of them were missing the required lab values, which led to a denial and 2 days of rework. The submission itself was fast, but the quality check was missed.”
Care Coordinator (PCC) “You sound robotic on the phone.” “I listened to 3 of your adherence calls. On all 3, you asked ‘Have you missed any doses?’ and the patient said ‘no.’ You didn’t ask any open-ended questions to explore how they were feeling, so you missed a chance to build rapport.”
Clinical Pharmacist “You’re not being a team player.” “I noticed during the huddle this morning, when the PA team flagged a denial, you said ‘That’s a PA problem, not a clinical one.’ This stopped the problem-solving, and the case is still stuck.”
Intake Specialist “Your work is sloppy.” “I reviewed your intake queue from yesterday. You had 15 referrals, and 6 of them had the wrong payer BIN/PCN. This created 30 minutes of rework for the billing team for each of those 6 patients.”

Your Leadership Action: You must schedule time for observation. This means 1 hour a week of “silent call monitoring” for your PCCs. It means 30 minutes a day of “submission auditing” for your PA team. It means listening intently in the daily huddle. This is your data-gathering time.

Step 2: The Masterclass on Diagnosing

Once you have your objective data, you must make a diagnosis. The “symptom” is the failed metric (e.g., the PA denial). The “diagnosis” is the root cause, which is almost always one of three things:

  1. Skill Gap: The employee doesn’t know how to do the task. (e.g., “They don’t know where to find the lab values in the EMR.”)
  2. Will Gap: The employee knows how, but is choosing not to. (e.g., “They are taking a shortcut because they are disengaged or feel rushed.”)
  3. Process/Resource Gap: The employee knows how, wants to, but the system is broken. (e.g., “The EMR access is down,” or “The new payer policy wasn’t communicated.”)

Your intervention is completely different for each diagnosis. You don’t “coach” a process gap—you fix the process. You don’t “train” a will gap—you motivate or discipline. You train and coach a skill gap. A good leader spends 90% of their time on Skill and Process gaps.

Example:
Symptom: PCC is not making adherence calls.
Bad Diagnosis: “They are lazy.” (A “Will Gap” assumption).
Good Diagnostic Question: “Hey, I noticed your adherence call queue is backed up. Tell me about your workflow.”
Patient’s Answer: “I can’t make any adherence calls because the new intake referrals keep auto-assigning to me, and I’m spending all day just answering the intake line!”
Correct Diagnosis: This is a Process Gap. The software routing is broken. No amount of “coaching” will fix this. You, the leader, must fix the technology. This builds massive trust.

Step 3: The Masterclass on Intervening (Delivering Feedback)

This is the step most leaders fear, because it can lead to conflict. The key is to have a non-confrontational script. The best model for this is the SBI Feedback Model: Situation-Behavior-Impact. This model removes all judgment and focuses only on objective data. It is the single most powerful tool you will learn.

Leadership Tutorial: The SBI Feedback Model

This script is your new best friend. It has three parts, delivered in this order.

  • SITUATION: Set the context. Anchor the feedback to a specific time and place. This prevents the “you always…” trap.
    • Example: “Hey John, did you have a minute? I wanted to check in about the daily huddle this morning…“
  • BEHAVIOR: Describe their action using objective, non-judgmental language. This is what you observed (Step 1).
    • Example: “…When the PA team brought up the Aetna denial, I observed that you said ‘That’s a PA problem, not a clinical one’ and then looked at your computer.”
  • IMPACT: Explain the consequence of their behavior. This is the “why” it matters.
    • Example: “The impact of that was that the team’s problem-solving stopped, the PA specialist looked deflated, and the case is still stuck, which means that new oncology patient is going to have their start delayed.”

The Final Step (The Pivot to Coaching): After you deliver the SBI, you must pause and ask a question.
Script: “…That’s what I observed. What’s your perspective on what happened?”

This 4-part script—Situation, Behavior, Impact, and “What’s your perspective?”—is the secret to feedback. It is non-arguable (you’re stating facts), it’s not personal (you’re not saying “you’re a bad team player”), and it invites them into a dialogue. Now you can coach the “Skill Gap” (e.g., “My role as the pod pharmacist is to help solve those PA problems, not just do clinical checks. Let’s talk about how we can collaborate on that next time.”).

Step 4: The Masterclass on Following Up

This is the step everyone skips. This is the “titration” part of the analogy. After you coach, you must “schedule the next INR check.”The Goal: To close the loop, set a new, small, achievable goal, and schedule a time to review it. This proves you are invested in their success, not just in “scolding” them.

Example (Continuing the SBI):
Manager: “Okay, so we agree that when a PA gets stuck, the whole pod owns it. Here’s the new goal: For the rest of this week, I want you to proactively offer one piece of clinical data in the huddle that could help the PA team. It could be as simple as, ‘I see that patient has failed X, make sure that’s in your submission.’ Can you do that?”
Pharmacist: “Yes, I can do that.”
Manager: “Great. I’m going to put 10 minutes on our calendars for Friday afternoon, just to see how it went. Thanks for being open to this.”

You have now completed one full “loop.” You Observed the behavior, Diagnosed the skill gap (teamwork vs. silo thinking), Intervened with SBI, and set a Follow-Up. You have just titrated their performance. You are now a coach.

18.2.4 Deep Dive: Coaching Specific Competencies (Part 1: The “Soft Skills”)

This 4-step loop is your framework. Now, let’s apply it to the specific, high-stakes competencies you must build in your specialty team.

Coaching Masterclass: Motivational Interviewing (MI)

Why it Matters: This is the single most important “soft skill.” Payers and manufacturers are no longer just paying for “a drug in a box.” They are paying for outcomes. Your adherence calls are your #1 tool to drive those outcomes. A robotic, “yes/no” call is useless. A call using MI can uncover the real reason for non-adherence (e.g., depression, cost, side effects, lack of belief in the drug) and allow your pharmacist to intervene.

Core Concept (OARS): MI is built on four skills. You must know them and coach to them.

  • Open-Ended Questions: (What, How, Tell me about…)
  • Affirmations: (Acknowledging their effort: “That’s great that you remembered all your doses this week even while you were traveling.”)
  • Reflections: (Reflecting their feeling/meaning back to them: “It sounds like you’re frustrated with the injection-site redness.”)
  • Summaries: (Summarizing the conversation: “So, we’ve agreed that you’re happy with the drug’s effect, but you’re struggling with the nausea, so we’re going to try the new pre-medication.”)
Masterclass Table: Diagnosing Gaps in MI (Robotic vs. MI)
Assessment Area “Bad” Coaching (Robotic Script) “Good” Coaching (MI-Based Script)
Opening “Hi, I’m calling for your refill. Do you need it?” “Hi Mrs. Jones, this is [Name] from your pharmacy care team. I was just calling to check in and see how things have been going with your Humira this past month?”
Assessing Adherence “Did you miss any doses?” (A “yes/no” question that invites lying) “Life can get busy. In the last 30 days, how many days would you say you remembered to take your injection exactly as prescribed?” (Normalizes missing a dose).
Assessing Side Effects “Any side effects? No? Okay.” “What side effects or symptoms have you noticed since you started? … You mentioned some nausea. Tell me more about that.” (Open-ended).
Responding to a Barrier Patient: “I’ve been feeling sick.”
PCC: “Okay, but do you want the refill?”		 Patient: “I’ve been feeling sick.”
PCC: “It sounds like you’re really uncomfortable (Reflection). That must be frustrating. What’s your biggest concern about that?” (Open-ended).
Closing “Okay, we’ll ship it. Bye.” “So, to summarize, you’re going to try taking it with food, and I’m going to have our pharmacist call you in 2 days to check on that nausea. You’re doing a great job by letting us know about this. We’ll get it shipped out for Friday delivery.” (Summary + Affirmation).
Leadership Tutorial: How to Role-Play MI with Your Team

You cannot teach MI in a memo. You must practice it. Use your weekly 1:1s for 10-minute role-play sessions. This is your “titration.”

The Setup: “Hey [PCC], for our skill focus today, I want to practice MI. I’m going to be a patient, and I want you to be the PCC. My ‘secret’ is that I’m not taking my drug because it makes me nauseous, but I’m embarrassed to say so. Your goal is to find that out using OARS. Go.”

The Role-Play:
PCC: “Hi Mr. Smith, calling for your refill. Did you miss any doses?”
Manager (as Patient): “Nope, I’m fine.”
PCC: “Any side effects?”
Manager (as Patient): “Not really.”
PCC: “Okay, so you want the refill?”
Manager (as Patient): “Sure.”
Manager (pausing role-play): “Okay, PAUSE. Great. You asked the questions, but what did you learn? Nothing. You diagnosed me as ‘adherent’ but I’m not. Let’s try again. This time, don’t ask me a single ‘yes/no’ question. Start with ‘Tell me about…'”

PCC: “Hi Mr. Smith… Tell me about how it’s been going with your new medication this month.”
Manager (as Patient): “Oh, it’s… fine, I guess.”
PCC: “You sound a little hesitant. What’s on your mind?” (Open-ended).
Manager (as Patient): “Well, I just… I’m not sure it’s working. I’ve been feeling kind of sick.”
PCC: “It sounds like you’re feeling sick, and that’s making you doubt the medicine. (Reflection). Tell me more about ‘feeling sick.'” (Open-ended).
Manager (as Patient): “Well, every time I take it, I feel really nauseous for about a day after.”
Manager (pausing role-play): “STOP. Do you see what just happened? With two open-ended questions and one reflection, you got the real answer. That is a perfect MI skill. Now you can triage me to the pharmacist. That was a 10/10.”

18.2.5 Deep Dive: Coaching Specific Competencies (Part 2: The “Hard Skills”)

Coaching isn’t just for “soft skills.” It’s even more critical for the complex, technical “hard skills” that define specialty operations. Here, we’ll use a different coaching model.

Coaching Masterclass: Payer Portal Navigation & PA Submissions

Why it Matters: A PA tech who can’t navigate a portal is just an expensive data-entry clerk. A tech who *can* is a revenue-generating machine. The “skill gap” is the difference between a 7-day denial and a 24-hour approval.
The Coaching Model: “I do. We do. You do.” This is the classic, unbeatable model for training any technical task.

Leadership Tutorial: The “I do. We do. You do.” Coaching Model

This is a 3-step process, done live with screen sharing (e.g., on Teams or Zoom). You are “titrating” their responsibility.

Step 1: “I DO” (You drive, they watch.)
Script: “Okay [PA Tech], I’m going to show you how to do a full PA submission for Aetna. I’m sharing my screen. Your only job is to watch and ask questions. First, I log into CoverMyMeds. I see the case, but I *never* trust the data. I open a *second* window and log into the Aetna provider portal. I use the patient’s ID to find their *specific* clinical criteria for Humira. Ah, see? It says here they require ‘failure of methotrexate AND one other biologic.’ Now, I go back to CMM. I attach the chart notes, and in the ‘comments’ section I write, ‘Per Aetna criteria: Patient has failed 6-month trial of MTX (see notes pg 2) and 3-month trial of Enbrel (see notes pg 4). Please approve.’ Now I hit submit. … What questions do you have?”

Step 2: “WE DO” (They drive, you navigate.)
Script: “Great. Now let’s do the next one together. I want *you* to share *your* screen and log in. I’ll be your ‘navigator.’ Go ahead and open the case… Okay, now stop. Where are you going to go first to find the criteria? … Exactly. Open the payer portal in a new tab… Good. Now, what labs are you looking for? … Perfect. Now let’s go back to CMM and write that clinical note together…”

Step 3: “YOU DO” (They drive, you observe.)
Script: “Okay, you’re ready. I want you to take the next one from start to finish. Share your screen. I’m going to be completely silent. I’m just here if you get stuck. Go.”
(You watch them navigate the portals, find the criteria, and build the case. They submit it.)
Script: “That was 100% perfect. You saw the criteria, you found the labs, and your clinical note was excellent. You are now cleared to handle all Aetna PAs. I’m going to assign the rest of the queue to you. Let’s check in at the end of the day to see how it went.”

Coaching Masterclass: Side Effect Triage Protocols

Why it Matters: This is a critical safety and accreditation requirement. Your non-clinical staff (PCCs) must know when to triage to a pharmacist. A PCC who tries to give clinical advice (“Oh, just take half a pill”) is a lawsuit waiting to happen. A PCC who triages every call (“Patient sneezed, here’s the RPh”) will crush your pharmacists. You must coach them on the “gray” area in the middle.

The Coaching Model: The “If-Then” Triage Logic Tree. You must create this as a job-aid and then coach to it.

Masterclass Table: Sample Triage Logic Tree (PCC Job Aid)
Patient Reports… “If-Then” Logic & Triage Action
“RED” SYMPTOMS (CRITICAL)
(e.g., Chest pain, shortness of breath, sudden vision loss, suicidal thoughts, swelling of lips/tongue)		 This is NOT a triage. This is an EMERGENCY.
IF patient reports any of these:
THEN: “This sounds serious. I need you to hang up with me and call 911 immediately or go to your nearest emergency room. I will also contact your doctor.”
THEN: Immediately escalate to Pharmacist & notify prescriber.
“YELLOW” SYMPTOMS (CLINICAL)
(e.g., “I’m so nauseous I can’t eat,” “I have a new rash,” “I’m having a lot of pain,” “I stopped the drug last week”)		 This is a WARM TRANSFER.
IF patient reports a significant, non-emergent symptom OR has stopped therapy:
THEN: “That sounds really uncomfortable, and I want our pharmacist to talk to you about that. (Empathy). Do you have a moment for me to transfer you to our clinical pharmacist, [RPh Name], right now?”
THEN: Transfer directly to the RPh. Do NOT schedule the refill.
“GREEN” SYMPTOMS (EXPECTED/MILD)
(e.g., “A little redness at the injection site,” “A mild headache,” “I feel a little tired the day after”)		 This is a “COUNSEL & DOCUMENT.”
IF patient reports a known, mild, and expected side effect:
THEN: Use the RPh-approved script: “That is a very common and expected side effect. As we discussed in your first counseling, you can try… [RPh-approved tip, e.g., ‘a cool compress or 1% hydrocortisone cream’].”
THEN: “I will document this for the pharmacist to review. Does it feel manageable for you?”
THEN: If yes, proceed with refill. All notes are reviewed by RPh.
“BLUE” ISSUES (FINANCIAL/LOGISTICAL)
(e.g., “I lost my copay card,” “My package didn’t arrive,” “I need to change my address”)		 This is “OWN & SOLVE.”
IF patient reports a non-clinical issue:
THEN: This is the PCC’s area of expertise. “I can absolutely help you with that. Let me get that sorted out for you right now…”
THEN: Solve the problem. No pharmacist transfer needed.

Coaching this skill involves role-playing. You give the PCC a symptom (“I have a rash”) and they must walk you through the logic tree. (“Okay, can you describe the rash? Is it just where you injected, or all over? Is your breathing okay?”). You coach them on the questions they ask to determine if it’s a “Red,” “Yellow,” or “Green” symptom.

18.2.6 The Feedback Spectrum: From “On-the-Spot” to the Formal Review

“Coaching” is not just one thing. A good leader must be ableto give the right *kind* of feedback in the right *context*. You wouldn’t pull a tech into your office for a 30-minute SBI session because they forgot to attach one lab. You also wouldn’t save up 6 months of their mistakes for their annual review. You must “titrate” your feedback itself.

1. “On-the-Spot” Coaching (The 2-Minute Intervention)

What It Is: Quick, informal, immediate feedback to correct or praise a single behavior.
When to Use It: Immediately after you observe a small win or a minor mistake.
The Goal: To reinforce good habits and course-correct bad ones in real-time.
The Script (Praise): “Hey [PCC], I just overheard you on that adherence call. The way you used that ‘reflection’ skill—’It sounds like you’re frustrated’—was perfect. The patient’s whole tone changed. That’s exactly what we’re looking for. Great job.”
The Script (Correction): “Hey [PA Tech], I just saw that Cigna PA you submitted. You got it out fast, which is great. I noticed you didn’t include the ‘failed MTX’ note in the comments. Let’s add that right now—it’ll save us from a denial. Thanks.”

2. The Weekly/Bi-Weekly 1:1 (The “Coaching Session”)

What It Is: The most important meeting you will have. This is a scheduled, recurring, 30-minute, 1-on-1 meeting with each of your direct reports.
When to Use It: Every single week (for new hires) or every other week (for tenured staff). This is their meeting, not yours.
The Goal: To build trust, identify roadblocks, discuss skill development, and review goals. This is your primary “titration” checkpoint.

Leadership Tutorial: The 4-Part 1:1 Agenda

This 30-minute meeting should be sacred. Do not cancel it. It proves you are invested. It has four parts.

  1. The Check-In (5 min): “How are you doing? How’s your week going? Any big wins?” (Start with the personal, build rapport).
  2. The Roadblocks (10 min): “What’s in your way? What’s driving you crazy? Are you waiting on me for anything? Is there a broken process?” (This is your “Process Gap” diagnosis. Your job is to listen and take notes to go fix the problems they identify).
  3. The Skill Focus (10 min): “Last time, we talked about using more ‘Open-Ended Questions.’ How did that go? Let’s do a quick 5-minute role-play…” (This is your “Skill Gap” coaching. It’s where you practice one specific thing).
  4. The Set-Up (5 min): “Okay, great. Your goal for next week is to keep focusing on that. I also want you to start shadowing the FA team. I’ve set it up for Wednesday at 2 PM. Let’s plan to talk about how that went in our next 1:1.” (This is your “Follow-Up” and “Professional Development”).

3. The Annual Performance Review (The “Summary”)

What It Is: A formal, documented, annual summary of performance, tied to compensation and promotion.
When to Use It: Once per year.
The Goal: To formally document the year’s performance and set high-level goals for the *next* year.

The Golden Rule of Performance Reviews

There should be zero surprises in an annual review.

If your employee is shocked by what they hear in their formal review, you have failed as a coach for the last 12 months. The annual review should be the easiest, most boring meeting of the year. It is simply a written summary of the 26 bi-weekly 1:1s you’ve already had. It’s a look-back at all the “titrations” you did together. If you’ve been coaching well, the employee should be able to write their own review, and it should match yours perfectly.

18.2.7 Professional Development: Building Career Ladders

You cannot keep high-performing “A-Players” if you don’t give them a path to grow. Specialty pharmacy is a new and dynamic field, but many technicians and even pharmacists feel “stuck” in a role. Your final job as a coach is to be a career architect. You must show your team a path forward. This is the #1 retention tool you have, and it costs you nothing but time and creativity.

The “flat” model of a pharmacy (1 Pharmacist, 5 Techs) must be replaced with a “ladder” model. You must create defined levels of competency that allow your team to earn promotions, gain new skills, and increase their pay based on the value they add.

This act of “career pathing” is the ultimate expression of coaching. It tells your employee, “I am not just invested in your performance in this *job*; I am invested in your success in your *career*.”

Masterclass Table: The Specialty Technician Career Ladder

– You “coach the coach.”
– Have them lead the role-play sessions.
– Goal: Become a leader and force-multiplier.
Level Role Title Key Competencies How to Coach Them to This Level
Tech I Intake Specialist – 100% accuracy in data entry.
– Manages intake queue.
– Understands “clean” vs. “dirty” referral.		 – Focus on speed, accuracy, and basic system navigation.
– This is 90% “I do, We do, You do.”
– Goal: Master Stage 1.
Tech II PA Specialist – All Tech I skills.
– Mastery of ePA portals.
– Can build a basic “first-pass” PA submission.
– Can do a benefits investigation (BI).		 – This is your PA/portal coaching.
– Shadowing the “I do, We do, You do” model.
– Goal: Master Stage 2.
Tech III Reimbursement Specialist or Disease-State Specialist – All Tech II skills.
– Mastery of financial assistance (foundations, copay cards).
– OR: Deep knowledge of one disease (e.g., Onco PA criteria).
– Can handle complex appeals.		 – Give them the “hardest” cases.
– Have them build the appeal letters for the RPh to sign.
– Goal: Master Stage 3.
Tech IV Senior Tech / Team Lead / Trainer – All Tech III skills.
– Can train new hires (the “I do, We do, You do” model).
– Can perform QA audits on other techs.
– Can help manage the daily huddle.
Masterclass Table: The Specialty Pharmacist Career Ladder
Key Competencies
– This is the baseline.
– Focus on safety, accuracy, and efficiency.
– Goal: Master Stage 5.

– Delegate leadership tasks.
– Have them run the 1:1s with the techs.
– Involve them in accreditation/CQI projects.
– Goal: Master Stages 7 & 1.
Manager / Director

– This is your replacement.
– Involve them in budget and strategy meetings.
– Goal: Master the entire business.
Level Role Title How to Coach Them to This Level
Pharmacist I Staff / Dispensing Pharmacist – 100% dispensing accuracy.
– Basic clinical review and counseling.
– Manages the verification queue.
Pharmacist II Clinical Pharmacist / Pod Pharmacist – All P-I skills.
– Mastery of MI.
– Deep knowledge of 1-2 disease states.
– Confident in provider peer-to-peer calls.
– Manages a patient panel (Stages 4 & 6).		 – This is your MI role-playing.
– Send them to disease-state CEs.
– Have them lead the “yellow” triage interventions.
– Goal: Master the clinical loop.
Pharmacist III Clinical Coordinator / Lead Pharmacist – All P-II skills.
– Can coach other pharmacists and techs.
– Can run the Daily Huddle.
– Can analyze data and help fix process gaps.
– Can handle LDD/Payer audits.
Pharmacist IV – All P-III skills.
– Manages the P&L.
– Leads strategic planning.
– Manages payer/manufacturer relationships.
– Hires, fires, and builds the team.

18.2.8 Conclusion: The Coach’s Legacy

The shift from pharmacist-manager to pharmacist-coach is the single most challenging—and most rewarding—transition of your career. It requires you to consciously decide not to be the hero who solves every problem. It forces you to find your satisfaction not in your personal expertise, but in the growth of your team’s expertise.

Your clinical skill of titration is the perfect analogy. You would never “dump” 30mg of warfarin on a patient and walk away. You should never “dump” a job on an employee and do the same. By applying the “Observe, Diagnose, Intervene, Follow-Up” loop, you are performing a clinical intervention on the health of your team. You are titrating their skills, one “INR check” at a time.

The ultimate goal of a great coach is to make themselves obsolete. You will know you have succeeded when your team can run the daily huddle, solve complex PA denials, and handle clinical triages without you. Your legacy will not be the number of prescriptions you verified, but the number of “Tech IIIs” and “Clinical Coordinators” you built from scratch.