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MODULE 18: BUILDING AND LEADING HIGH-PERFORMING SPECIALTY PHARMACY TEAMS
Section 3: Strategic Planning and Goal Cascading
Learn how to translate high-level organizational objectives into actionable team and individual performance goals with measurable KPIs.
SECTION 18.3
Strategic Planning and Goal Cascading
From the 30,000-Foot Mission to the Daily, Actionable Task.
18.3.1 The “Why”: The Failure of “Being Busy”
In a traditional pharmacy, the primary goal is often simple, tangible, and immediate: accurately dispense all prescriptions by the end of the day. Success is measured in “prescriptions filled,” “wait time,” and “inventory turn.” As a manager, your job is to direct this daily workflow. Your team is busy, and their “busyness” is directly aligned with the pharmacy’s goal.
This entire model collapses in specialty pharmacy. As we’ve discussed, the “product” is not a filled prescription; it is a long-term, positive clinical outcome. The workflow is not a simple line; it’s a complex, multi-month cycle. This creates a terrifying leadership trap: it is entirely possible for your entire team to be incredibly busy, stressed, and working overtime, while simultaneously failing to achieve any of the organization’s strategic goals.
Imagine a pharmacy where the PA team is working heroically, submitting 50 PAs a day. The pharmacists are counseling 30 patients a day. The PCCs are making 100 calls a day. Everyone is exhausted. But at the end of the quarter:
- The pharmacy fails its URAC accreditation audit because patient complaints weren’t documented according to the new SOP.
- The pharmacy’s adherence rate for Humira drops from 88% to 81%, putting a payer contract at risk.
- The pharmacy loses out on a new LDD contract because it couldn’t provide the manufacturer with a report on “time-to-first-dose.”
How did this happen? The team was busy, but they were not aligned. They were working in the business, not on the business. The PA team was focused on quantity of submissions, not the quality or speed required for the LDD contract. The PCCs were focused on quantity of calls, not on the quality of the MI-based interventions needed to drive adherence. The managers were so busy fighting fires that they never trained the team on the new URAC-compliant complaint SOP.
The Tyranny of the Urgent vs. The Importance of the Strategic
As a pharmacy leader, your day is a constant battle between two forces:
- The Urgent: “A patient is on hold!” “This prescription just rejected!” “The courier is late!” These are the daily “fires” that scream for your attention.
- The Strategic: “We need to train all 20 staff members on the new URAC SOPs.” “We need to build a new data report for our LDD contract.” “We need to re-design our adherence call script.”
The “Urgent” will always win unless you have a plan. Strategic planning is the leadership discipline of making the “Strategic” more important than the “Urgent.” Goal cascading is the mechanism by which you translate that strategic plan into the daily, “urgent” work of your team. It connects the 30,000-foot objective (achieve URAC accreditation) to the 3-foot-level task (the specific words a PCC says when documenting a complaint).
This section provides you with the framework to be a true strategic leader. You will learn how to build a formal strategic plan using a model designed for complex organizations. You will then learn the “art” of cascading—breaking that plan down into meaningful, measurable, and motivational goals for every single pod, team, and individual in your pharmacy. This is how you ensure that all the “busyness” is moving the entire organization in the right direction.
18.3.2 Pharmacist Analogy: The Disease State Management Protocol
A Deep Dive into the Analogy
As a clinical pharmacist, you are an expert at strategic planning. You just call it “care planning.” When a physician refers a patient to your new pharmacist-led diabetes management service, you don’t just say, “Hi, I’m here to help.” You initiate a formal, strategic protocol.
1. The High-Level Objective (The “Mission”):
The physician’s “order” is your strategic objective: “Please help me get Mr. Jones’s diabetes under control. His A1c is 10.2%.” This is your 30,000-foot goal. It is big, vague, and lagging.
2. The Strategic Plan (The “Care Plan”):
You don’t just start throwing drugs at him. You sit down and build a comprehensive strategic plan (a care plan) with multiple “perspectives”:
- Clinical Goal: Lower A1c to < 7.0% and BP to < 130/80.
- Operational Goal: Schedule 1x monthly follow-up calls and 1x quarterly in-person visits.
- Patient-Facing Goal: Improve patient’s “health literacy” regarding diet and hypoglycemia.
- Learning Goal: Patient will demonstrate proper glucose monitoring technique.
3. The “Cascading” Goals (The “Actionable Tasks”):
This is where you, the leader, break the plan down into actionable steps for the “team” (which in this case includes you, your technician, and the patient themselves).
Masterclass Table: Cascading the “Diabetes Care Plan”
| High-Level Objective: Get A1c < 7% | Strategic Goal | Cascaded “Team” Goal | Individual Goal (KPI) |
|---|---|---|---|
| Pharmacist | Optimize medication therapy. | Initiate and titrate one new agent (e.g., a GLP-1 agonist). | – Conduct 1 CMR in Week 1.
– Complete 3 titration calls in Q1. – KPI: Titration completed. |
| Pharmacy Tech | Remove access & cost barriers. | Secure PA and financial assistance for the new GLP-1. | – Submit PA within 24h of order.
– Enroll patient in manufacturer copay card. – KPI: Patient cost = $0. |
| Patient | Improve self-management. | Monitor blood glucose and learn dietary changes. | – Log BG 2x daily.
– Meet with RPh for education. – KPI: % of days with BG log. |
The Leadership Insight: You just ran a strategic planning session. You took a big, lagging objective (A1c < 7%) and cascaded it into specific, leading, role-based tasks. The tech knows their job isn’t just “submit a PA”—it’s “get patient cost to $0” so the pharmacist can start the drug. The pharmacist knows their job isn’t just “talk to the patient”—it’s “complete 3 titration calls.”
Leading your pharmacy is exactly the same process. You just swap the “patient” for the “organization” and the “care plan” for the “strategic plan.” You already know how to do this. This section will just give you the business framework to apply your clinical planning skills to your entire operation.
18.3.3 The Framework: Using the Balanced Scorecard (BSC) in Specialty Pharmacy
The biggest mistake in strategic planning is focusing only on money. A pharmacy that only chases profit (e.g., by cutting staff, rushing calls, and ignoring training) will fail its accreditation, lose its LDD contracts, and burn out its team. It’s a short-term “win” that guarantees a long-term death.
The Balanced Scorecard (BSC) is a world-renowned strategic planning framework that forces you to plan in a “balanced” way. It was invented at Harvard Business School and is perfect for healthcare because it balances financial goals with the clinical and quality goals that actually drive long-term success. It divides your entire strategic plan into four “perspectives.” As a leader, your job is to create 1-2 high-level objectives for each of these four quadrants, every single year.
The Balanced Scorecard Framework for Specialty Pharmacy
1. The Financial Perspective
“How do we look to our stakeholders (owners, payers, manufacturers)?”
This is the “classic” business goal. It’s about revenue, profitability, and securing high-value contracts. Without this, the mission fails.
Examples:
- Secure 3 new LDD contracts.
- Increase revenue by 15%.
- Maintain a >98% payer contract retention rate.
2. The Customer Perspective
“How do our patients and prescribers see us?”
This is the quality and service goal. It’s driven by accreditation standards (URAC/ACHC) and is your key differentiator.
Examples:
- Achieve full URAC Specialty Pharmacy Accreditation.
- Improve Crohn’s disease PDC from 0.81 to 0.90.
- Achieve a >95% patient satisfaction score.
- Reduce average Time-to-Fill (TTF) to < 3 days.
3. The Internal Process Perspective
“What must we excel at to win?”
This is the “workflow” goal. It’s about making your internal operations more efficient, accurate, and scalable to support the Customer & Financial goals.
Examples:
- Reduce PA rework rate from 20% to 10%.
- Implement a new data-reporting system for LDDs.
- Decrease dispensing errors by 50%.
- Implement a new MI-based adherence call script.
4. The Learning & Growth Perspective
“How must we develop our people and culture?”
This is the “team” goal. It’s about developing the skills, talent, and culture needed to achieve all the other goals. It’s the most overlooked and most critical quadrant.
Examples:
- Train 100% of PCCs on the new MI script.
- Implement the “Tech II” career ladder.
- Certify 2 pharmacists in the Oncology specialty.
- Reduce employee turnover from 25% to 10%.
Leadership Tutorial: Connecting the Perspectives
The magic of the BSC is how the quadrants link together. As a leader, you must be able to tell this story to your team. The goals are not independent; they are a chain reaction.
The Story: “Team, our big Financial goal this year is to secure the new XYZ Oncology LDD contract (1). To do that, the manufacturer (our Customer) is demanding we prove we can achieve an average Time-to-Fill of < 48 hours (2). To do that, we must improve our Internal Process by implementing a new ‘stat’ PA workflow (3). And to do that, our Learning & Growth goal is to train and certify all PA techs on the new ‘stat’ workflow SOP by March 1st (4).”
(Learning & Growth) -> (Internal Process) -> (Customer) -> (Financial)
You have just connected a tech’s training session (4) directly to the company’s #1 financial goal (1). This is how you create an aligned, motivated, and purposeful team. You’ve given their daily work strategic meaning.
18.3.4 The Masterclass on “Goal Cascading” in Practice
This is the “how-to” guide. A “cascade” is the process of breaking a 30,000-foot objective down to the 3-foot-level individual task. As a leader, you must become an expert at this. We will now take the three strategic objectives from the prompt and run them through the cascading model, showing the *exact* goals you would set for each team member.
Cascade Example 1: Objective = Achieve URAC Accreditation
High-Level Objective: Achieve full URAC Specialty Pharmacy Accreditation (Version 4.0) within 12 months.
Strategic Importance (BSC Perspective): Customer (proves quality) & Financial (required for many payer/LDD contracts).
The Challenge: URAC is not a single goal. It’s a set of ~140 individual standards. You must break it down.
Step 1: Translate Standards into Strategic Goals.
You do a “gap analysis” and find your pharmacy is weak in two areas: Patient Complaints (PHARM-Core 33) and Patient Education (PHARM-Core 21). You create strategic goals:
- Strategic Goal A (Process): Implement a URAC-compliant Patient Complaint & Grievance process.
- Strategic Goal B (Learning): Standardize all clinical patient education to be documented and evidence-based.
Step 2: Cascade Strategic Goal A (Complaints) to the Team.
Masterclass Table: Cascading the “URAC Complaint Process” Goal
| Role | Cascaded Team/Individual Goal | Key Performance Indicator (KPI) | How to Coach It |
|---|---|---|---|
| Pharmacy Leader (You) | Implement the new complaint process by Q2. Achieve 100% team training. | – SOP written and approved by Q1.
– 100% of staff training documented by Q2. – 100% of complaints tracked in a central log. |
|
| Clinical Pharmacist (RPh) | Serve as the clinical escalation point for all “clinical” complaints (e.g., “The drug isn’t working”). | – 100% of clinical complaints reviewed and resolved within 48 hours.
– 100% of resolutions documented in the log. |
– Coach the RPh on the difference between a “complaint” (service failure) and a “grievance” (clinical failure).
– Role-play how to de-escalate an angry patient. |
| Patient Care Coord. (PCC) | Be the “front line” for identifying and documenting all complaints in the new log. | – 100% of interactions identified as a “complaint” are entered into the log before the end of the shift.
– 0 complaints missed (as found in call audits). |
|
| Data Analyst | Generate a quarterly “Complaint & Grievance Report” for the CQI committee. | – Report is 100% accurate and delivered on time.
– Report includes trend analysis (e.g., “Complaints about ‘shipping’ are up 20%”). |
– Provide the analyst with the *exact* data fields required by URAC.
– Coach them to not just “run the report” but to “analyze the trends” for the “Why”. |
Cascade Example 2: Objective = Improve Adherence Metrics
High-Level Objective: Improve the 12-month Proportion of Days Covered (PDC) for the Crohn’s disease population (Humira, Stelara, etc.) from 0.81 to 0.90.
Strategic Importance (BSC Perspective): Customer (better patient health) & Financial (required by payer “pay-for-performance” contracts).
The Challenge: PDC is a lagging indicator. You can’t “do” a PDC. You must identify the leading behaviors that *drive* PDC.
Step 1: Translate Objective into Strategic Goals.
Your data shows the #1 reason for non-adherence is “Side Effects” and the #2 is “Cost.”
- Strategic Goal A (Process): Implement a new MI-based adherence script to better identify barriers.
- Strategic Goal B (Process): Create a “Pharmacist Triage” protocol for all patients who report side effects.
- Strategic Goal C (Process): Ensure 100% of eligible patients are enrolled in financial assistance.
Step 2: Cascade Strategic Goals (A & B) to the Team.
Masterclass Table: Cascading the “Improve PDC” Goal
| Role | Cascaded Team/Individual Goal | Key Performance Indicator (KPI) | How to Coach It |
|---|---|---|---|
| Pharmacy Leader (You) | – New MI script and job-aid created by Q1.
– 100% of RPh/PCCs trained by Q2. – Bi-weekly PDC “gap report” is created. |
||
| Master and use the new MI adherence script on 100% of Crohn’s patient calls. | – 100% utilization of MI script (measured via call audits).
– >95% success in “warm transferring” all “yellow flag” (side effect) patients to the pharmacist. |
||
| Conduct a documented clinical intervention on 100% of “yellow flag” triages. | – 100% of triages result in a documented RPh intervention note.
– 90% patient retention 30 days post-intervention. |
||
| Data Analyst | Produce a bi-weekly “PDC Gap Report” for the Crohn’s pod. | – 100% on-time report delivery.
– Report identifies by-patient-name who has fallen below 0.80 PDC in the last 30 days. |
Cascade Example 3: Objective = Secure an LDD Contract
High-Level Objective: Secure the new oral oncology drug “Onco-X” from XYZ Pharma.
Strategic Importance (BSC Perspective): Financial (high-margin drug) & Learning/Growth (grows onco service line).
The Challenge: The manufacturer’s RFP (Request for Proposal) has explicit, non-negotiable service-level demands.
Step 1: Translate RFP Demands into Strategic Goals.
The RFP demands two things:
- RFP Demand A: Average “Time-to-Fill” (Referral-to-Dispense) must be < 48 hours.
- RFP Demand B: Must provide a weekly data report with 15 specific fields, including “Reason for Discontinuation.”
Step 2: Cascade these Demands to the Team. (This is a Process & Learning goal).
Masterclass Table: Cascading the “LDD Contract” Goal
| Role | Cascaded Team/Individual Goal | How to Coach It |
|---|---|---|
| Pharmacy Leader (You) | Create the “Onco-X Stat Workflow” SOP. Create the LDD data report template. | – You must lead the “workflow mapping” (swim lane) session to find and eliminate every wasted minute.
– You must work with IT to build the new data fields. |
| Intake Team | Achieve 95% “clean referral” rate for Onco-X within 4 hours of receipt. | – Leading KPI: Time-to-Clean-Referral < 4 hours.
– Leading KPI: 95% of referrals have all required data (labs, diagnosis, etc.). |
| PA Team | Submit all Onco-X PAs via “stat” verbal/phone process. | – Leading KPI: Time-to-PA-Submission < 2 hours from "clean" referral.
– Leading KPI: Time-to-PA-Approval < 24 hours. |
| Clinical Pharmacist (RPh) | Complete 100% of Onco-X onboarding calls within 4 hours of PA approval. | – Leading KPI: Time-to-Onboard-Call < 4 hours.
– Leading KPI: 100% accurate documentation of “Reason for Discontinuation” in the new data field. |
| Generate and validate the weekly Onco-X LDD report. | – 100% on-time and 100% accurate data report sent to XYZ Pharma every Monday. | – This is a “zero-error” task.
– You must “I do, We do, You do” the *validation* of the report. “Show me how you checked this data against the source system.” |
18.3.5 Defining Success: A Masterclass on Leading vs. Lagging KPIs
You now have your goals. But how do you *measure* them? This is the most common failure point of strategic planning. Leaders set big, vague goals (“Let’s improve adherence!”) and have no idea if they are winning or losing until it’s too late. The key is to understand the two types of Key Performance Indicators (KPIs).
- Lagging Indicators (The “Outcome”): This is the result. It is easy to measure, but hard to influence. It tells you what already happened.
- Examples: PDC, Revenue, Profit, Time-to-Fill, Patient Satisfaction Score.
- Leading Indicators (The “Activities”): This is the action. It measures the high-leverage behaviors that you *predict* will drive the lagging indicator. It is what you manage and coach every single day.
- Examples: # of adherence calls made, # of PA submissions with 100% data, % of staff trained.
The Leadership Pitfall: Managing the Lagging Indicator
A failing manager coaches the lagging indicator. This sounds like: “Our PDC is 81%! You all need to improve PDC!” or “Our revenue is down! Go sell more!”
This is useless. It’s like telling a diabetic patient, “Your A1c is 10! You need to lower your A1c!” This is not coaching; it’s just stating a problem. It creates stress and helplessness, because your team cannot “do” a PDC. They cannot “do” revenue.
A successful leader coaches the leading indicators. They say, “Our PDC is 81%. Our data shows this is because 30% of patients are reporting side effects. Our new goal is to increase our ‘RPh Side Effect Interventions’ from 10 per week to 50 per week. [PCC], your KPI is to ‘warm transfer’ 100% of those calls. [RPh], your KPI is to document 100% of those interventions. Let’s attack that.”
Masterclass Table: Connecting Leading KPIs to Lagging KPIs
| Strategic Objective (The Lagging KPI) | |
|---|---|
| Lagging KPI:
Improve PDC from 0.81 to 0.90. |
– Leading KPI (PCC): % of adherence calls using the MI script.
– Leading KPI (PCC): % of “yellow flag” patients warm-transferred to RPh. – Leading KPI (RPh): # of documented side-effect interventions completed. |
| Lagging KPI:
Achieve Time-to-Fill (TTF) < 48 hours. |
– Leading KPI (Intake): Time-to-Clean-Referral (e.g., < 4h).
– Leading KPI (PA): Time-to-PA-Submission (e.g., < 2h). – Leading KPI (RPh): Time-to-Onboard-Call (e.g., < 4h). – Leading KPI (Shipping): % of packages shipped “Priority Overnight.” |
| Lagging KPI:
Achieve >95% Patient Satisfaction. |
– Leading KPI (All): % of calls answered in < 30 seconds.
– Leading KPI (All): 100% documentation of all patient complaints. – Leading KPI (PCC): % of adherence calls made *before* the “due date” (proactive vs. reactive). |
| Lagging KPI:
Secure 3 New LDD Contracts. |
– Leading KPI (Data): 100% of data reports built and validated.
– Leading KPI (Ops): 100% of staff trained on all LDD-specific SOPs. – Leading KPI (Leader): # of quarterly business reviews (QBRs) conducted with target manufacturers. |
18.3.6 Creating the “Rhythm of Accountability”
Your strategic plan is not a document that sits on a shelf. It is a living system that you must manage. To prevent it from being swallowed by the “Urgent,” you must build a “rhythm of accountability”—a recurring calendar of meetings where the plan is reviewed and managed.
The “Rhythm” of Strategic Execution
The Annual Strategy Meeting (Once/Year)
Who: Leadership team.
Goal: To review the past year and set the 4-8 high-level “Balanced Scorecard” objectives for the next year.
Output: The 1-page Strategic Plan (e.g., “Improve PDC,” “Achieve URAC,” “Secure 2 LDDs”).
The Quarterly “Sprint” Planning (Once/Quarter)
Who: Leadership & Pod Leads.
Goal: To break the 1-year plan into a 90-day “sprint.”
Output: The 1-3 “Quarterly Rocks.” (e.g., “This quarter, our only strategic focus is implementing the URAC Complaint SOP and the new MI Adherence Script. Nothing else.”)
The Weekly Huddle (Once/Week or Day)
Who: Pods & Pod Leads.
Goal: To review the leading KPIs that drive the “Quarterly Rock.”
Output: An action list. (e.g., “Our ‘calls made’ KPI is down. PCCs, let’s focus on that today. Our ‘time-to-clean’ is up. Intake, let’s review the 3 dirtiest referrals and see why.”)
The Bi-Weekly 1:1 (Continuously)
Who: You and your direct report.
Goal: To coach the individual’s KPIs and skills that roll up to the team’s goal.
Output: A specific, role-played skill improvement. (e.g., “Let’s practice that MI script.”)
This “rhythm” is your management system. It connects the annual plan to the quarterly focus, which is driven by the weekly huddle, which is powered by the 1:1 coaching. Every layer is connected. This is how you ensure the “Urgent” never kills the “Strategic.”
18.3.7 Conclusion: From Task-Master to Strategic Leader
As a pharmacist, you were trained to be a master of the task: verify the script, counsel the patient, check the labs. Your value was in your personal expertise and accuracy. As a strategic leader, your value shifts entirely. Your new value is in your ability to build a system that achieves objectives.
This requires you to stop thinking about the “to-do list” and start thinking about the “Balanced Scorecard.” You must stop asking “Is everyone busy?” and start asking “Is everyone’s ‘busyness’ aligned with our URAC, Adherence, and LDD goals?”
By using the Balanced Scorecard, you force yourself to plan holistically. By mastering the “cascade,” you translate that plan into concrete, role-based goals. And by obsessively tracking leading KPIs, you create an early-warning system that allows you to coach and “titrate” your team’s performance, just as you would a patient’s therapy. This is the hardest—and most valuable—shift a pharmacy leader can make. It’s how you stop being the chief “firefighter” and start being the “architect” of a high-performing organization.
