On Change and Progress

R. David Cobb, PharmD Chairman, Board of Trustees

On Change and Progress Cobb highlighted APhPis accomplishments.

have never claimed to be a great philosopher. Although my present credentials are academic, I like to think that I am known more for my pragmatism and my ability to get things done than I am for my philosophical insight. I consider that one of my strengths, and I am proud of it. Nevertheless, it would not be proper to speak from this podium with the title of chairman of the APhA Board of Trustees without being at least a little philosophical; that is expected of leaders. Therefore, as I reflected on the message I want to bring to you today, I scanned the writings of famous philosophers and writers who had written about the same subject -Thlstoy, Thoreau, WIlliam Cullen Bryant, John Milton, and other equally notable thinkers. All of these famous men from the past had written about change - the subject I want to talk to you about. But the words I finally settled on are not from the past. They are those of a contemporary writer - columnist and commentator Carl T. Rowan. On the subject of change, Rowan once wrote the following:

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We emphasize that we believe in change because we were born of it, we have lived by it, we prospered and grew great by it. So the status quo has never been our .god, and we ask no one else to bow down before it.

Few would deny that those words apply to the American Pharmaceutical Association. APhA has never been satisfied with the status quo. APhA always has believed in change,

and indeed, we always have prospered and grown great by change. No era in the Association's history has brought more change than has the past 5 years. During that time we have seen APhA pass from the end of the 25-year stewardship of a legendary leader, through an orderly transition, and then into a new era of dramatic revitalization led by an energetic, dynamic, and forward-looking young leader. That young leader, Jack Schlegel, has now decided that his primary mission here has been completed and that it is time for him to seek other mountains to climb. We of course will miss Jack. His contributions have been significant, and he has left a mark on the progress of this Association that will endure. We wish him every success in the next challenge that he takes on. Jack's resignation and the realization that a new chief executive officer will soon be coming aboard means that we now are about to enter another historic time in the Association's evolution - yet another new era. However, as we look ahead, we can take comfort by looking back. By looking back we can see that our Association now is revitalized and strong, and because of that, the inevitable changes that lie ahead do not seem frightening. We know that as in the past, APhA will continue to prosper and grow.

What We've Accomplished We can all be proud of what has been accomplished during this era of revitalization. And we can be proud that APhA has been able to provide in large part what you, the members, told us you wanted ~m your Association. You said that you wanted a stra-

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tegic-planning exercise to assure the future growth of the Association and to direct our activities in the future. And you got it. We now have an action plan that has reordered APhA's priorities and charted a course to membership growth. You said you wanted more opportunities for members to be directly involved in the Association. And you got it. Our new structure in itself ensures widespread member input through the academies and their sections and committees. Member involvement has never been higher in special activities-

'We can be proud that APhA has been able to provide in large part what you, the members, told us you wanted from your Association. ' like the Cognitive Services Working Group, the Committee on Women's Affairs, and the National Forum on the Employed Pharmacist Planning Committee. A roster of members involved directly in Association activities during 1988 appeared in the February issue of American Pharmacy. That list included almost 550 persons in some kind of official APhA or APhA-related position. Add the names of those of you who serve the Association by being delegates in our House of Delegates, and add those people who are members of APhA's Congressional Contact Network and recovering-pharmacists network, and the number of involved members reaches well over 1,500! I will stack that record of member involvement against

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that of nearly any association, of any size, found anywhere! You said that you wanted APhA to cooperate with other organizations. And you got it. We have implemented a strong outreach program to state pharmaceutical associations, and the number of state associations affiliated with APhA has now reached 48. To work better with other national pharmacy organizations, we have rejoined the National Drug Trade Conference; we have become a member of the Joint Commission of Pharmacy Practitioners; and we have helped forge several coalitions of organizations around specific issues, such as discriminatory pricing, the Prescription Drug Marketing Act, the Medicare Catastrophic Coverage Act, physician dispensing for profit, and the cost-effectiveness of pharmaceuticals and pharmacy services. Our interaction with other health-care organizations, such as the American Medical Association and the Joint Commission on the Accreditation of Healthcare Organizations, has increased dramatically. You said you wanted APhA to be a major player on the Washington scene. And you got it. You wanted us to become a major lobbying organization, so we did it. APhA has become well-known and respected · on Capitol Hill and in the federal agencies, and the successes we recently have achieved there are evidence of that fact. The governmentaffairs issues we have tackled have been tough ones - like physician dispensing, mail-order pharmacy, discriminatory pricing, Medicaid reimbursement, third-party-payment programs, pharmacy crime, prescription-drug coverage under Medicare, polygraph testing, drug sampling, and others. And, as you asked, we formed the APhA Political Action Committee, and it has become one of the top 15% of national PACs in the country in tenns of money contributed to it. You said that we should be more active in the national health-policy arena. And you got it. Besides substantially .increasing the emphasis on policy in APhXs day-to-day activities, we formed the American Pharmaceutical Institute which now is gearing up to become a strong 44

influence on national health policy. You told us that you wanted to reach out to special groups of our colleagues in the profession. And you got it. We have implemented a series of new programs targeted to special colleague groups - such as pharmacy students, young pharmacists, employee pharmacists, and women pharmacists. You said that you wanted quality educational programming. And you got it. The quality of educational programming at this Annual Meeting is unsurpassed. An ongoing, high-quality continuing-education series in American Pharmacy has made it much easier for you to meet your CE requirements. We have also created special educational opportunities, like the Community Pharmacy Residency Program, the Apple Pharmacy Management Program,

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has become well-known and respected on Capitol Hill and in the federal agencies. The government-affairs issues we have tackled have been . tough ones.' the Executive Residency in Association Management, and a summer course on chemical dependency. You told us you wanted a stronger public-relations effort. And you got it. We added a full-time public-relations professional to our staff, and we're getting results. The documentation is there - the number ofpharmacy mentions in the electronic and print media have increased dramatically over the past year. On television, APhA has become a frequent contributor to Cable News Network, ''USA Today - The TV Show," and CBS News. In news publications, we have been quoted frequently in the New York Times, the Wall Street Joumal, the Los Angeles Times, the Washington Post, and U.S. News & World Report, and we have found our way into newspapers nationwide through the Associated Press, United Press International, and Reuters News Service wire services. In consumer magazines, articles

quoting APhA spokespersons have appeared in major publications like Good Housekeeping, McCall's, Thgue, Parade, and Reader's Digest. And in the wings, we have a major publicrelations program that will knock your socks off when we are able to announce it later this year. You said that you wanteQ.APMs scientist members to have a greater role in the Association, and you got it. Through our Academy of Pharmaceutical Research and Sciences' committee structure, scientists now have direct input into APhA's policy-making mechanism, as well as into our awards program, educational programming, and publications. Scientist members are now working much more closely with practitioner members, and last year's End-of-Summer Science Symposium was an unqualified success. In the national scientific-policy arena, APhA has had substantial input into important national science issues like orphan drugs, biological diversity, treatment INDs, andAmS. Many of ·you said you wanted APhA's prestige on the international pharmacy scene to be strengthened. And you got it. Over the past several years, APhA has again become a force in international pharmacy. You said you wanted APhA to have a strong physical capacity. And you got it. We renovated our headquarters building in Washington, D.C., and we furnished it with stateof-the-art equipment to maximize staffproductivity. And we have built a staff you can be proud of. It is dedicated, highly competent, and extremely well-respected in the Washington association community.

Progress Has Its Cost Change has been a way of life for APhA over the past 5 years. But while change is necessary - and in the long run beneficial- it can also breed discomfort and restlessness. Those satisfied with the ~tus quo are suspicious of change; thoSe afraid of the future are threatened by it. So as would be expected, some change has had its detractors as well as its champions. As a result, our progress over the past 5 years hasn't always come easily.

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And it has not come without financial cost. The APhA Board of Trustees has had to make the hard choice of allocating funds from reserves as a financial investment in the Association's future. Achieving membership growth is a classic chicken-and-egg situation. To attract new members - and therefore to increase our dues income - we knew we had to put into place dynamic new programs. However, we couldn't build such programs without the dues dollars coming in to do it. Therefore, just as in business you must have investment capital to operate until a certain sales level is reached, so it was with APhA. We needed to subsidize the establishment and growth of our many new programs until new membership dues and other income would reach a level where the programs would pay for themselves. Increasing membership dues income has not been easy either. APhA's membership figures had been on a steady decline - the momentum was downward. So first we had to stop that momentum we had to get the decline stopped. That done, we would be in a position to get the membership momentum headed in the other direction - up. I am pleased to report that we are now there. The decline has been stopped, and for the first time in a decade we have an increase in the number of members. We definitely have a new trend - membership is growing. The direction of the momentum is up. My predecessor, Charlie Green, made an appeal to you last year. He asked that every member become involved in our membership-recruitment efforts. I want to repeat that challenge today.

Ask Colleagues to Join My predecessor, Charlie Green, made an appeal to you last year. He asked that every member become involved in our memhership-recruitment efforts. I want to repeat that challenge today. It would be ideal if each of you would go out and knock on doors asking your colleagues to join. Pharmacy students are doing it now. They actively recruit their fellow

students to be members, and it works. APhA's student membership is the highest this year that it has been for years. That in itself is a positive omen for things to come for APhA, but students are going even further than that. Our student leaders have adopted as a priority the job of influencing a greater percentage of their fellow students to become and remain APhA active members after graduation. The effect that can have on future membership growth could be phenomenal. I hope many of you will become as active in your new-member-recruitment efforts as our student members. But to be realistic, I know that directly soliciting colleagues for membership is not everyone's cup of tea. Even if it isn't yours, there are other ways you can help.

'Spread the word among your colleagues about APhA's good health and new directions.' First, remember to keep people's varying reactions to change in perspective. The American inventor Charles Kettering once said, "The world hates change, yet it is the only thing that has brought progress." Change will always breed its detractors, and indeed we have some out there. I'm not sure what their motives are. Maybe they just haven't paid attention to what's been going on lately. But whatever the reason, to be perfectly honest I'm losing my patience with those who have nothing but negative things to say about APhA. I have a very positive feeling about where we are now and where we are going, and I'm not about to let anyone change that. I hope that you all feel the same! Second, to help boost our membership recruitment efforts, you can help us destroy the myth that APhA is in competition with any other organization for members - we are not. In fact, all of us must do all that we can to convince our colleagues that association membership is not a pick-and-choose proposition. All pharmacists should be

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members of their local and state pharmacy association and of APhA. If they practice in a specialized area, they should also be members of their national specialty organization - and the state specialty organization as well if there is one. Period. No exceptions. In this day and age, we can no longer accept the old excuse, "I can't afford it." The truth is, we can't afford not to. If this profession is to survive and continue to advance, all of its organizations - at all levels - must become even stronger and more effective. It's just that simple. Third, if you want to help our membership growth, spread the word among your colleagues about APMs good health and new directions. APhA is not the organization it was 5 years ago. Unfortunately - although we've certainly tried we've yet to get that word to everyone in the profession. Or maybe some just don't believe it. Whichever is the case, there is no better way of getting that message across than by word-of-mouth. If you like what you see about APhA and its activities, talk about it. Let our nonmember colleagues know about our progress, and remind them that we can do even better with their support. And when you run across the naysayers and the critics, challenge them - loudly and publicly. Don't let them turn our many positives into negative perceptions. We will continue to do our part to spread the word from Washington, but nothing is more convincing and more believable than when a prospective member hears from a colleague about the good things APhA is doing. Our agenda for the future is not finished yet, and we hope it never will be. The environment in which we exist is not static, and we dare not be either. There will be more changes - that is inevitable. But we need not fear those changes. Just as change has brought progress to APhA in the past, it will likewise bring progress in the future - especially with the help, support, and dedication of each of you. To me, the future of this association and of our profession looks very, very bright.

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Lucinda L. Maine, PhD Speaker, House of Delegates

An A-Plus House of Delegates Maine cited the need for change in the House's new business procedures.

everal Sundays ago my minister began his sermon with the folS lowing observation: "Every writer knows that to be successful in writing you need drama, and drama requires conflict." Ironically that was the day that I planned to sit down at the computer and spend the afternoon preparing this address. How tempting it was to let the potential drama of our current transition of leadership overtake all the other thoughts I have been collecting in this year I served as your Speaker. Realistically I knew that the selection of a new CEO would be discussed in many other forums. I will say that I hope that members will use the Annual Meeting as an opportunity to share thoughts with the Board ofTrustees relative to the qualities you think they should seek in identifying a new chief executive officer for APhA. Your timely input to individual board members is vitally important. I will focus instead on the reason why we are gathered here so early in the morning - to act in a most important capacity for the Association as the policy-making body within APhA. The importance of policy to this association cannot be overstated, for it literally drives much of the day-to-day operation of APhA. This is a most interesting time to be reporting on the process because it marks the end of the first year that certain new elements of the process were implemented. Today is a good day to stop and reflect on the policy-making mechanism, to highlight that which seems to be working well, and to identify certain areas that warrant further analysis. 46

When I speak of the new, I specifically refer to the structure of academy-level policy committees and the Policy Advisory Committee which went fully into operation this year. The three academy policy committees were charged with the task of recommending policy issues, conferring with the Association when advice was sought on issues pertinent to academy members, and recommending actions on policies that affect the Association's immediate and long-term interests.

'The importance of policy to this association cannot be overstated, for it literally drives much of the day-to-day operation of APhA.' The most direct result of these academy committees' efforts this year was the fruitful identification of topics suitable for discussion by this House of Delegates. In preparing for this presentation, I looked back over several recent Speakers' messages and noted with interest that in 1984 Speaker Lowell Anderson expressed concern about the difficulty in identifying an adequate number of topics for policy consideration. With all of the problems noted by pharmacists, he found it rather incredible that there would be insufficient fuel for policy-committee discussion. In contrast, this year there were more topics identified than could reasonably he taken up by policy

committees in the time frame allotted for their work. This meant that the Policy Advisory Committee faced the difficult task of prioritizing issues, so not all policy recommendations could be pursued. However, the task of the Board of Trustees in making the final assignment of topics to committees was considerably easier because of the increased member input provided by the new structure. This year, by a quirk of appointment prior to my election as Speaker, I served on the new APRS Policy Committee. I therefore had the opportunity to view the process from multiple vantage points - as a committee member, as Speaker, and as a trustee. I feel quite satisfied that we have enhanced the policy process with these two new steps. Because the new committee structure was the only enhancement made in our policy process this year, I am afforded an opportunity to step back and reflect on the entire, system which has served the Association so faithfully for years. There are four specific issues I would like to focus on briefly, sharing my overall positive observations, as well as a few areas where I believe we might stop to see if further enhancements would be productive.

The Goal in Policy-Making If you did not know it before, you learned in my introduction that I am a teacher by vocation. Some teachers tend to evaluate their lives according to the traditional A-B-C grading standard. However, evaluation is only valuable to the extent that it involves measuring how well

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