Section 9.5: Leveraging Support Staff and Delegation

9.5.1 The “Why”: You Cannot Scale Your Brain

Let us begin with a fundamental truth: as a collaborative practice pharmacist, your single most valuable asset is your clinical brain. Your ability to synthesize complex patient data, apply deep pharmacotherapeutic knowledge, and make sound clinical judgments is the entire reason your role exists. It is a finite, non-scalable resource. There are only so many hours in a day and only so much high-level cognitive work you can perform before your performance degrades. This reality leads to an unavoidable conclusion: for your practice to grow in impact and scale, you must ruthlessly protect your cognitive time for tasks that only you, the pharmacist, can perform.

Every moment you spend on a task that does not require a pharmacy license—chasing down medical records, making scheduling calls, faxing forms, troubleshooting a printer—is a moment you are not using your most valuable asset. It is a moment you are not managing a complex polypharmacy case, educating a high-risk patient, or collaborating with a physician on a care plan. This is not just inefficient; it is a profound strategic failure. It is the equivalent of a surgeon stocking their own supply closets or a pilot collecting tickets at the gate. To truly function as a high-level clinician, you must learn to systematically offload operational, procedural, and administrative work to skilled support staff. This is not “dumping work”; it is strategic delegation, and it is the only way to scale your impact beyond the absolute limit of your own time.

This section is arguably the most critical in this entire module on operations. Building a workflow, schedule, and SOPs for a team of one is a valuable academic exercise. But building those same systems with the explicit purpose of empowering a technician or medical assistant to execute large portions of them is how you build a real, sustainable, and scalable clinical service. We will provide a masterclass in shifting your mindset from a solitary “doer” to a clinical “director.” You will learn how to identify what to delegate, how to train and empower staff to perform those tasks with excellence, and how to build a system of trust and accountability that frees you to finally—and consistently—work at the absolute top of your license. This is the key that unlocks the true potential of your practice.

9.5.2 The Crucial Mindset Shift: From “Doer” to “Director”

For many pharmacists, delegation is one of the most difficult skills to master. Our training and professional identity are often built on a foundation of individual responsibility and meticulous self-reliance. We are taught that “the buck stops here” and that we are ultimately responsible for every detail. While this is true from a legal and professional standpoint, it can lead to a dysfunctional operational mindset that becomes the primary bottleneck to our own success.

The most common barrier to effective delegation is the pervasive belief: “It’s just faster and safer if I do it myself.” In the short term, for a single task, this might even be true. It probably is faster for you to quickly place a scheduling call than it is to stop, write an SOP for it, train a technician, and then review their work. However, this is a classic example of sacrificing long-term strategic gain for short-term tactical convenience. The five minutes you “save” by doing it yourself today is a five-minute task you are doomed to repeat every single day, forever. The one hour you invest in training a technician to do it correctly is an investment that pays you back five minutes every single day for the rest of your career. To become a clinical leader, you must escape this “doer” trap and embrace the mindset of a “director.”

Masterclass Table: Contrasting the “Doer” vs. “Director” Mindset

Situation	The “Doer” (Pharmacist-Only) Mindset	The “Director” (Team-Based) Mindset
A new referral arrives.	“I need to process this. Let me open the chart, find the numbers, make the calls, and schedule the patient.”	“My technician will execute the Intake SOP (ADM-001). They will log the referral, gather the records, and queue it up for my clinical triage. My only task at this stage is the 2-minute clinical decision.”
A patient needs follow-up.	“I need to remember to call Mrs. Smith in two weeks to see how she is doing on the new medication.”	“I will place a follow-up task in the EMR assigned to my technician for two weeks from now with the instruction: ‘Per Follow-Up Call SOP (CLN-003), please call Mrs. Smith and administer the ‘Statin Side Effect Questionnaire’. Route results to me.'”
A process seems inefficient.	“Ugh, this is so frustrating. I’m just going to have to work faster or stay later to get this done.” (Accepts the broken process)	“This process is broken. I will schedule 30 minutes with my technician to map out the current workflow, identify the bottleneck, and co-design an improved process that we can codify in a revised SOP.” (Improves the process)
A mistake happens.	“I can’t trust anyone else to do this right. From now on, I have to do it all myself to ensure it’s perfect.” (Reacts with micromanagement)	“A mistake occurred. Let’s do a blameless root cause analysis. Was our SOP unclear? Was the training insufficient? Let’s fix the system so this error is less likely to happen again, for anyone.” (Reacts with system improvement)

9.5.3 The Delegation Matrix: Identifying “Top of License” Work

The core of strategic delegation is the ability to systematically analyze your entire workflow and categorize every task based on the level of licensure and clinical judgment required to perform it. Not all tasks are created equal. Some require the full depth of your doctoral training, while others are procedural and can be safely and effectively performed by a well-trained technician following a clear SOP. This analysis allows you to intentionally design a practice where you spend the vast majority of your time on the irreplaceable work that only you can do.

We can categorize all tasks in your practice into one of three buckets:

• Pharmacist-Only Tasks: These tasks require clinical judgment, assessment, synthesis of data, or therapeutic planning. They are non-delegable and represent the core of your professional function.
• Delegable Tasks: These are procedural, administrative, or data-gathering tasks that do not require clinical judgment. They can be clearly defined in an SOP and performed by a trained support staff member.
• Shared Tasks: These are collaborative tasks that may involve both the pharmacist and support staff working together, each performing distinct roles within the larger process.

Masterclass Table: The CMM Practice Delegation Matrix

This table breaks down a typical CMM workflow, assigning each task to the appropriate role. This is your blueprint for building job descriptions and training plans.

Workflow Stage	Specific Task	Delegation Level	Rationale & Key Considerations
Pre-Visit Activities	Receiving and logging a new referral	Delegable	A purely administrative task. Can be governed by SOP-ADM-001. Requires attention to detail but no clinical judgment.
	Clinical Triage of Referral	Pharmacist-Only	Requires clinical judgment to determine if the patient’s complexity and disease state are appropriate for the service. This is a critical safety and scope-of-practice checkpoint.
	Gathering external medical records	Delegable	A procedural task of making calls, sending faxes, and checking portals. Can be guided by a checklist (FORM-ADM-001B).
	Initial patient outreach and scheduling	Delegable	Following a script (SCRIPT-ADM-001C) to explain the service and schedule the appointment based on pre-defined templates.
	Pre-visit chart prep & data synthesis	Shared Task	Technician: Can collate the data (e.g., pull labs into a flowsheet, update the medication list from fill history). Pharmacist: Must review and synthesize all collated data, identify DTPs, and formulate the preliminary plan.
Patient Visit Activities	Rooming the patient, taking vital signs	Delegable	Standard procedure for any clinical encounter, well within the scope of an MA or trained technician.
	Performing medication reconciliation interview	Pharmacist-Only	This is not just data entry. It is a clinical interview requiring probing questions, assessment of adherence, and identification of subtle discrepancies that requires a pharmacist’s full skill set.
	Conducting the clinical assessment and forming the plan	Pharmacist-Only	The absolute core of CMM. This is the synthesis of subjective and objective data into a therapeutic plan. It is the definition of “top of license” work.
	Providing patient education	Shared Task	Pharmacist: Provides the core, complex education on disease states and medication changes. Technician: Can provide reinforcement, review printed materials, and demonstrate device usage (e.g., glucometer) once trained.
Post-Visit Activities	Writing the clinical note (Assessment & Plan)	Pharmacist-Only	The A&P section is the pharmacist’s legal and clinical record of their judgment. It cannot be delegated.
	Updating the EMR medication list	Shared Task	Pharmacist: Determines what changes need to be made. Technician: Can often perform the clerical task of discontinuing old meds and entering new ones based on the pharmacist’s clear instructions in the note. This requires careful oversight.
	Communicating recommendations to provider	Pharmacist-Only	Communicating a clinical recommendation is a professional act that must be done by the pharmacist.
	Handling prior authorizations	Delegable	An administrative process of filling out forms and submitting clinical data. A well-trained technician can manage the vast majority of this workflow.
	Scheduling the follow-up appointment	Delegable	A simple administrative task based on the pharmacist’s plan (e.g., “RTC 4 weeks”).

9.5.4 The Delegation Playbook: A Step-by-Step Guide to Empowering Your Team

Effective delegation is a skill, and like any skill, it can be learned and mastered through a structured process. It involves more than just handing off a task; it requires a thoughtful approach to hiring, training, communication, and feedback. This playbook will guide you through the essential steps to build a support staff member from a new hire into a trusted and indispensable partner in your practice.

Step 1: Hire for Traits, Train for Skills

When hiring a technician or MA for your advanced practice role, their existing technical skills are less important than their innate personal traits. You can teach someone how to use the EMR or how to process a referral. It is much harder to teach curiosity, critical thinking, and a passion for patient care. Prioritize these traits in your hiring process.

• Key Traits to Look For:
  • Attention to Detail: Do they take pride in accuracy?
  • Curiosity: Do they ask “why?” Are they eager to learn?
  • Initiative: Are they a self-starter who looks for what needs to be done next?
  • Communication Skills: Are they clear, professional, and empathetic on the phone and in writing?
  • Resilience: Can they handle feedback and adapt when a process changes?

Step 2: Build a Structured Onboarding and Training Program

Do not leave training to chance. Use your SOPs as your curriculum. Create a formal onboarding plan that systematically builds your new hire’s competency and confidence.

Step 3: Master the Art of the Clear Handoff

When you delegate a specific task, how you communicate the instruction matters immensely. A vague handoff leads to errors and rework. A clear handoff ensures the task is done right the first time.

Poor Handoff (Vague & Ineffective)	Excellent Handoff (Clear & Actionable)
“Can you help me with this prior auth for Mrs. Johnson?”	“Please initiate a prior authorization for Mrs. Johnson’s Ozempic. The diagnosis is Type 2 Diabetes, and the last A1c was 8.7%. Please use the ‘PA Initiation Checklist’ in our SOP manual and let me know when it’s submitted, or if the insurance company requires a peer-to-peer review.”
“Follow up with Mr. Davis about his blood pressure.”	“Please schedule a ‘BP Check Telephone Call’ with Mr. Davis for next Tuesday. During the call, use the ‘BP Follow-Up Script’ to collect 3 days of home BP readings and ask about dizziness or side effects. Please route the completed script to my inbox for review.”

Step 4: Establish a Robust Feedback Loop

Delegation is built on trust, and trust is built on open, consistent, and psychologically safe communication.

• Schedule Regular Check-ins: A brief 10-15 minute huddle at the start or end of each day to review the workload, prioritize tasks, and identify any barriers is invaluable.
• Encourage Questions: Create an environment where your technician feels safe saying, “I’m not sure how to do this” or “I think I made a mistake.” The worst errors happen when staff are too intimidated to ask for help. Acknowledge and praise them for asking clarifying questions.
• Provide Balanced Feedback: When reviewing work, provide a mixture of positive reinforcement and constructive criticism. Frame corrective feedback in the context of the process, not the person. Instead of “You did this wrong,” try “In our SOP, this step is designed to be done this way. Let’s walk through why that’s important for patient safety.”