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Table 2. Gaps Identified Between the Initial and Target States in
Meeting ASHP Standards for Management and Leadership.
Lack of standard topics
Private sector information lacking
Too much downtime during training/discussions
Resident interest in topics
Patient care demands competing with time to devote to other
activities
Unawareness of all committees available for resident participation
Limited opportunities for all residents
Chief resident too accessible
Understanding research project ideas created by pharmacy
preceptors
Size/scope of project may be too large for a 1-year project
IRB barriers can delay project implementation
Resident assigned a staff development topic versus selecting one
on their own
Staff disengagement during large group talks
Staff development attendance not valued
Supervisor buy-in needed for staff development talks
Yellow and green belt training occurs too late in the year
Note. ASHP = American Society of Health-System Pharmacists; IRB =
Investigational Review Board.

To complete Box 4, the Gap Analysis, the facilitator asked
participants to reflect on their experiences and create a list of
the associated challenges or barriers that were occurring. The
gaps identified in Box 4 between the initial and target states
are listed in Table 2. Overall, these gaps created occasional
disengagement by both residents and staff. An example of
this disengagement was identified upon review of the pharmacy practice management and leadership (PPM&L) seminar activity. This seminar is a required monthly meeting the
department implemented in which an invited speaker would
come and talk to the residents about various administrative
topics not being addressed during the course of their usual
rotations. Speakers could be from inside or outside the organization. Topics included, but were not limited to, writing
business plans, patient assistance programs, comparing the
VA with private sector institutions, work-life balance, and
stress management. One of the barriers identified for the
PPM&L activity included residents being unable to attend
due to competing patient care demands. In addition, a voice
of the customer analysis indicated that there was a lack of
interest in some of the selected topics.
After all gaps and barriers were identified, it was time for
the solution approach, Box 5. The residents hypothesized
that the establishment of a core list of topic discussions
would increase knowledge and provide more uniform exposure to various management and leadership topics, regardless
of when the resident had the health-system pharmacy administration rotation throughout the year. In addition, they
believed the implementation of collaborative precepting
would maximize their learning experience with accessibility
to a variety of leadership styles and levels of practice experience. Finally, the residents felt committee involvement and

Hospital Pharmacy 53(4)
taking ownership of departmental projects would allow them
to improve their individual leadership skills.
The next step was Boxes 6 and 7, Rapid Experiments and
the Completion Plan. Table 3 shows the "just do its" (JDIs)
and PDSA cycles that the residents brainstormed to address
the identified problems and achieve the ideal future state.
The residents could take action on the JDIs immediately
while the PDSAs required additional planning and evaluation before implementation. Each task listed was assigned an
owner and a target completion date, the "who, what, and by
when" of the desired plan. Residents were reminded that the
overall plan should be something that is manageable in the
amount of time targeted. The ownership of these tasks was
determined and delegated by all members of this yellow belt
team. For example, the chief resident, who represents the
residents on the RAC, agreed to present the desired changes
for the longitudinal research project experience. The 3
PGY1s who had upcoming administration rotations agreed
to own the PDSA cycle related to collaborative precepting
among all pharmacy administrative staff. Their task was to
pilot the administration learning experience with the inclusion of multiple preceptors from the department as compared
with a single preceptor, the chief of pharmacy. Members of
the yellow belt team worked on their action plans, and the
lean facilitator continued to monitor their progress through
monthly meetings for the next 4 months.

Results
Of the 10 action items listed on the completion plan, the residents did an excellent job of successfully accomplishing
80% of them in 2015 (Table 3). The first of these included
educating residents and preceptors on the importance of
leadership activities. It was reiterated by the RAC that
PPM&L attendance was required. This was then clearly
communicated to all residents, preceptors, and pharmacy
supervisors by the residency program directors (RPDs).
Second, a core list of topics was created by the residents for
the administration learning experience. Topics from this list
were then assigned among the pharmacy administration preceptors to pilot collaborative precepting to expose residents
to several educators and to decrease preceptor burnout. Next,
the residents made a schedule for PPM&L topics and confirmed speakers for the remainder of the year. Another action
item was utilization of a resident huddle board for communicating and tracking process improvement ideas concerning
the residency program. Next, a tip sheet was developed by
the residents to assist future residents with navigating the
Investigational Review Board (IRB) process. To establish a
standard process for identifying and assigning resident
research projects, project proposal and closeout documents
were created. Finally, annual yellow belt training for the residents was moved from December to August.
There were 2 action items within the completion plan that
were started by the residents, but not completed during the
year (Table 3). The first was revising the staff development

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