Certification BY COLLABORATION.

How four associations got together to create one national certification program for their industry.

Today's pharmacists must devote more time than ever to direct patient care, counseling, and service. As a result, their job has expanded beyond dispensing medications to encompass performing patient assessment, developing health education programming, and formulating treatment plans. This shift in responsibility means that the profession is relying more on the pharmacy technician to fulfill the functions that don't require a licensed pharmacist. For example, pharmacy technicians obtain appropriate information from the patient, enter patient/doctor data into the computer, prepare prescriptions, and resolve third-party payer issues.

The number of pharmacy technicians has grown rapidly during the past few decades. Today some 200,000 work everywhere from community pharmacies to long-term care facilities to home-care organizations. To ensure that these workers have the demonstrated expertise to serve the public well, back in the 1980s and 1990s several associations began to address the need for a pharmacy technician certification examination.

The first voluntary examinations were administered in 1981 and 1988 by, respectively, the Michigan Pharmacists Association (MPA), Lansing, and the Illinois Council of Health-System Pharmacists (ICHP), Rockford. By the early 1990s, 24 additional states had adopted one or both of the exams for their own use. Gradually, these and other industry associations realized that a unified effort to set certification standards that would apply across the country would be even better for the profession.

To create a single, consolidated, voluntary national certification program, in 1994 four founding organizations established the Pharmacy Technician Certification Board (PTCB), a 501(c)(6) corporation located in Washington, D.C. The founders were the American Pharmaceutical Association (APhA), Washington, D.C.; the American Society of Health-System Pharmacists (ASHP), Bethesda, Maryland; ICHP; and MPA.

Getting started was a challenge-- one that required plenty of consensus and compromise as these four separate entities collaborated to achieve one common goal. But the effort was a success. Thanks to a strong, multifaceted plan and a commitment to partnership, in January 1995 PTCB was established as the national credentialing organization for pharmacy technicians.

Putting the pieces in place

Since July 1995, PTCB has certified more than 54,000 pharmacy technicians through the Pharmacy Technician Certification Examination and certification transfer process. The degree of cooperation among PTCB's founders is notable. With the early guidance of Knapp and Associates International, Inc., a Princeton, New Jersey, consulting firm that specializes in establishing certification programs, the four groups set aside their own interests and differences to develop the plan for the comprehensive program. Here is an overview of the steps the associations took to achieve their goal.

Getting started. In December 1993, during the ASHP Midyear Clinical Meeting, the four pharmacy organizations announced that they were cooperating in the initial steps toward establishing the national voluntary certification program. The organizations believed that a consistent approach was needed to develop pharmacy technicians as a well-recognized component of pharmacy--and that a national certification program, rather than individual state programs, was the most desirable solution.

Following the December 1993 announcement, both ICHP and MPA agreed to stop actively marketing their state certification programs. Within a year of PTCB's formation, the state certification programs ceased to exist.

Creating a plan of work. In 1994 the four founding organizations established a PTCB development committee. The committee met quarterly that year to identify the tasks that were key to forming PTCB and to create and administer the national voluntary certification examination. To keep everything on track, each step of the process included both a summary of assignments for the planning committee and a list of next steps. Once the development committee hired me as PTCB's executive director, I then led the plan of work and provided the committee with frequent updates and time lines.

The plan of work included

* Obtaining approval from the founders' respective governing boards to form PTCB.

* Developing a pro forma business plan with projected budgets for three years.

* Creating an organizational plan, including a governance structure.

* Drafting bylaws, articles of incorporation, and a founder's agreement.

* Incorporating the organization as a 501(c)(6) corporation.

* Obtaining insurance.

* Disseminating a request for proposals and selecting a testing-service provider.

* Hiring the executive director.

* Developing a program to recognize technicians previously certified by Michigan or Illinois.

* Merging examination questions from the state certification programs to the national examination.

* Assembling a pool of subject-matter experts for the Certification Council and item writing.

* Conducting meetings with PTCB stakeholders to build consensus.

* Establishing a communication plan, including what needed to be done, who was going to do it, when it needed to be completed, and why the tasks were important.

* Developing and disseminating materials on the state marketing partner program.

* Developing and disseminating marketing materials, including the candidate handbook for those seeking certification and news releases.

* Administering the first national Pharmacy Technician Certification Examination in July 1995.

Creating consensus. Involving past stakeholders was important to getting agreement. For example, the state organizations that used the Michigan or Illinois certification programs played a key role by advancing the concept of the national pharmacy technician examination. To recognize their contributions, PTCB created the State Marketing Partners program. (More on this later.)

To bring about consensus among the many stakeholder groups, market research was conducted throughout 1994 and 1995. Specifically, PTCB surveyed national and state pharmacy organizations, credentialing organizations, and individuals interested in the certification process using mail surveys and phone interviews. The research helped us understand a variety of important issues, including

* what stakeholders thought about PTCB certification (because not all parties supported it);

* what they would support as a common vision of the program; and

* ways to ensure program quality, govern the program, and value the collaboration of multiple partners.

Seeking compromise, sharing credit. Everyone knew that PTCB's four founders regularly competed for members, program participants, and buyers of their services. Even so, they set aside their organizational differences to stay on track with the plan of work. It was important for the members of the board of governors to compromise as needed while the program was being developed.

Some of the most delicate compromises inevitably involved how each party would receive credit for its contributions. This is one of the most important issues for multi-organizational programs, if not the most important. The group needed to agree at the beginning on how to acknowledge the participation of the various entities; for example, PTCB decided to always list all four founding organizations together in alphabetical order. The problems that have cropped up tended to concern times when founding organizations neglected to mention their equal partners in articles and presentations.

Reaping the unplanned benefits. The collaborative process resulted in several unexpected rewards: greater buy-in from stakeholders, an increased pool of resources, and access to subject matter experts with diverse experience. Perhaps most important, this united front sent a powerful message within the pharmacy profession that by working together, everyone could accomplish bigger things. At a time when many organizations are challenged to do more with less, multi-organizational programs allow for effective use of limited human and financial resources.

Today PTCB stands as an effective organizational model. At the top is its board of governors, made up of the chief executive officers of the four founding organizations and myself as the executive director. Because this board's primary job is to establish policy and set fees, it delegated the execution of several important tasks to other groups it formed.

For example, to develop the Pharmacy Technician Certification Examination, the governing board created the PTCB Certification Council. The council is a group of subject-matter experts (pharmacists, certified pharmacy technicians, and technician educators) drawn from various practice settings, geographical areas, and backgrounds. To provide further advice on stakeholder issues, the board formed such groups as the State Advisory Panel, representing state pharmacy organizations; and the Employer Panel, representing employers of pharmacy technicians in diverse practice settings.

As executive director of PTCB, I found that several special leadership skills were essential to helping the governing board oversee this complicated process. Among them were business development skills, to help us determine just what needed to be done; relationship management skills for working with stakeholders; and the ability to assess, control, and monitor business risks. Equally important were creative thinking, excellent communication, and perseverance as everyone worked together to solve problems.

The process of getting launched took an entire year. In the end, one of the factors that kept the four organizations on track was the tight focus on the certification program's primary objective: to enable certified pharmacy technicians to work more effectively with pharmacists for better patient care and service.

Making the vision real

The details for the plan of work grew out of PTCB's overall vision and expectations for the certification program itself. This vision was carried out through the following steps:

1. Develop a comprehensive, psychometrically sound, and legally defensible examination process. This process included completing a practice analysis, developing test specifications, writing test questions, preparing the examination, setting the passing point, and scoring the examination.

2. Establish the value of the certification process for the pharmacy technicians, employers, pharmacists, and patients.

3. Recruit new pharmacy technicians to sit for the examination.

4. Identify sources other than hospitals of large numbers of pharmacy technicians--such as major employers in chain, home health care, and long-term care practices--to promote the certification program to employers. (See Figure 1.)

5. Retain current Certified Pharmacy Technicians (CPhTs) through the recertification process.

One of my first responsibilities as executive director was to prioritize these tasks and create detailed plans of work. The work plans were a key part of PTCB's strategic planning process, and similar plans continue to serve that purpose.

Paying for the new program

Deciding how to finance program development was important, as planning and corporation start-up activities would eventually cost approximately $100,000. PTCB recognized that several factors drive the cost of certification, including the complexity of the program, the number of candidates to be certified, the practice analysis, travel costs for subject-matter experts, the marketing budget, legal fees, insurance, consultants such as psychometricians (experts in testing), and staff.

Several fortunate circumstances helped PTCB keep the costs from growing even higher. For example, the pharmacy profession had recently completed a practice analysis, the data from which became the foundation for the PTCB examination. This was a big savings; the budget for the practice analysis, paid for by four pharmacy organizations including APhA and ASHP, had been approximately $400,000. In addition, the state founding organizations helped with the initial test development by allowing PTCB to incorporate appropriate examination questions from the state certification programs to the national program.

Funding for the start-up itself came from the four founding organizations. They did the start-up calculations during the planning phase, based on the business pro forma.

Admittedly, the groups took a considerable risk by putting so much money into this endeavor. But because of the thorough planning, the projected return, and the widespread support the project had won, the founders were confident they'd get a strong return on their investment.

Getting the word out

As the plan of work unfolded, marketing and communication became critical, particularly after PTCB held a media briefing in February 1995 to announce that the first examination was scheduled for July 1995. The result of that briefing and several other communications: 5,000 technicians eagerly awaited the opportunity to take the first examination.

One of my first leadership responsibilities as executive director was to develop a communication strategy. PTCB used a multi-level process to inform key stakeholder groups about the start of the certification program. The process included

* issuing candidate handbooks designed to give program information and facilitate the application process;

* providing fact sheets to answer candidate questions;

* placing advertisements for the certification examination in national and state pharmaceutical publications;

* hosting media briefings and issuing frequent news releases to a mailing list of more than 450 stakeholders;

* exhibiting program information at national and state pharmacy association meetings; and

* publishing articles in the pharmaceutical press detailing the mission of the certification program and its implications for employers, pharmacists, technicians, and patients.

To enhance its overall communications and marketing, PTCB launched an interactive Web site (www.ptcb.org) in December 1997. The site offered a practice examination, late-breaking news, exam and recertification information, and a bulletin board for technicians and pharmacists to post questions and comments. New developments since then include online application processing and a career services center. PTCB has positioned the Web site as the virtual community on pharmacy technician issues. Since its launch, the site has received one million hits. PTCB worked with HealthTech Solutions, St. Louis, Missouri, to not only design the interactive Web site but also create a new and improved database for Certified Pharmacy Technicians.

Strategic partnerships

In keeping with its dedication to collaboration, PTCB continually looks for ways to develop new products and services for its stakeholders. This has led to the following initiatives:

State partnerships and alliances. In its key outreach effort, PTCB recognized that it could leverage its activities by taking advantage of APhA and ASHP's network of state affiliates. The result was the State Marketing Partner Program, a catalyst for many state organizations to work together more closely. Today all 50 states are represented as PTCB marketing partners; 34 took part via joint agreements with APhA and ASHP state affiliates, and several have unilateral agreements independently promoting the PTCB certification process.

The role of these partners is to promote the examination and offer review courses, technician training programs, and continuing education programs. PTCB helps the partners by suggesting marketing strategies, providing fact sheets and camera-ready advertisements, and offering discounts on recognition items. As compensation for their efforts, State Marketing Partners receive reimbursement for every candidate who takes the examination after submitting an application obtained via the state organization.

PTCB plans further changes to this program in 2001 to support more pharmacy technician activities at the state level.

Corporate collaboration. One of PTCB's original goals was to improve the pharmacy practice by finding new ways to benefit technicians, major employers, pharmacists, and their patients. To accomplish this goal, PTCB is building relationships with large chain pharmacy groups, other major employers of hospital technicians, and the military.

Major employers, such as CVS, Eckerd, Walgreens, Kmart, Owen Healthcare, King Soopers, and Schnucks, are embracing the PTCB certification program. Their contributions include developing training programs and materials to help pharmacy technicians prepare for the PTCB certification examination. "The position of pharmacy technician no longer may be a pass-through," says Philip P. Burgess, national director of pharmacy affairs for the Walgreen Company, Deerfield, Illinois.

"[ldots] the PTCB certification program has moved forward the world of pharmacy by defining the position of pharmacy technician and by providing a work-related, objective benchmark for measuring a core of relevant knowledge."

PTCB is finding that initiatives like this not only encourage technicians to take the examination but also spur employers to offer salary and reimbursement incentives to successful candidates. Such industry support has helped PTCB reach another goal: higher pay for certified pharmacy technicians. (See Figure 2.) Employers reap benefits with increased employee satisfaction, reduced staff turnover, and improved performance.

Using a different partnership model, in 1998 PTCB launched the Innovations in Pharmaceutical Care Awards program. Funded by a grant from Baxter Healthcare Corporation, Deerfield, Illinois, five $1,000 awards are given to the pharmacist/certified pharmacy technician teams that demonstrate leadership and innovation in improving patient care in their practice setting. PTCB plans to collaborate with still others in the pharmaceutical industry on programs of mutual interest.

Managing exponential growth 

The response to the new certification program has been significant. Since its founding in 1995, PTCB has

* Certified more than 54,000 pharmacy technicians through the national Pharmacy Technician Certification Examination and certification transfer process. The overall passing rate is 82 percent.

* Administered the national exam at 120 sites nationwide three times per year.

* Developed a valid and reliable national exam that applies to all practice settings, including independent community hospitals, community chain hospitals, home health care, long-term care, mail-service facilities, managed health care practices, the pharmaceutical industry, and the military.

* Provided tests overseas to reach United States pharmacy technicians serving in the military.

* Created a recertification program to help certified pharmacy technicians (CPhTs) maintain a high level of knowledge and skills.

* Promoted the value of PTCB certification to PTCB stakeholders, including pharmacy technicians, pharmacists, major employers of pharmacy technicians, regulatory bodies, national and state pharmacy organizations, and the public.

* Hosted an employer forum for 25 senior executives from major employers of pharmacists and pharmacy technicians. Procter and Gamble Health Care, Cincinnati, Ohio, provided an unrestricted educational grant in support of the forum.

* Received several educational grants and sponsorship to promote PTCB activities, including the Web site, awards program, employer forum, and database development.

As they've done from the start, PTCB's leaders work together to ensure ongoing development and expansion of the certification program. For example, the leadership

* devotes segments of each board of governors meeting to environmental scans and ongoing strategic planning;

* focuses one meeting a year entirely on strategic initiatives;

* performs operational and fiscal performance self-evaluation through regular trend analysis that benchmarks PTCB against a variety of standards;

* increases its use of technology to manage volume demands. Responding to thousands of inquiries, processing a high volume of applications, maintaining records, and forecasting budgets has led PTCB to initiate online application processing and voice mail boxes for frequently asked questions.

Building for the future

Since its inception in 1995, PTCB has adhered to its main mission: recognizing pharmacy technicians in all sectors of practice who have demonstrated their mastery of the knowledge required to assist pharmacists. This mission will benefit all aspects of the pharmacy profession as the health care industry continues to evolve.

It has only been through the collaborative efforts of many individuals and organizations that PTCB accomplished so much in its formative years. Because PTCB also continues to seek solutions for its stakeholders, collaboration will continue to be the core of its future activities. Key priorities include identifying innovative roles for certified pharmacy technicians; gathering data to quantify the benefits of certification, including reduced employee turnover; and using technology for application processing and communications.

As before, the wise use of strategic partnerships will do much to realize these goals.

Melissa M. Murer is executive director of the Pharmacy Technician Certification Board, Washington, D.C.

Data Collection Defines Next Steps

What lies ahead for pharmacy technicians--and the certification process that serves them? To answer that question, the Pharmacy Technician Certification Board (PTCB), Washington, D.C., has established a specialized data-collection process.

The goal is both to gather demographic information for a national Certified Pharmacy Technician Databank and to document the value of certification for pharmacy technicians. PTCB collects the data in three main ways: through surveys that candidates complete before each examination session, questionnaires for individuals completing the recertification process, and surveys of PTCB committee members.

The collected data relates to the areas and settings in which pharmacy technicians work, their education and training, their reasons for seeking certification, and its benefits or outcomes. PTCB uses the data of refine its policies and procedures well as to enrich PTCB presentations, articles, and the Web site.

To ensure that it can continue to stay on top of factors that influence certification, PTCB has recently made major investment in a new certification database. Implemented in July 1999, the data base will substantially increase PTCB's ability to manage the growing number of certified pharmacy technicians in the future.

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