Embracing change leads to positive outcomes

“To get ahead, sometimes you have to take a calculated risk. When you believe a change will lead to positive outcomes, that it’s best for your patients and best for your organization, you have to push through the resistance to the change.”

Dennis Killian
PharmD, PhD; VP Clinical Operations, TidalHealth, Salisbury, MD

It’s a good thing Dennis Killian is hardwired for change. Just months into his promotion overseeing laboratory and radiology in addition to pharmacy, the health system merged multiple hospitals together. The COVID-19 pandemic followed soon after. About the only thing not changing is his unwavering appetite for applying new technologies to accomplish strategic outcomes.


  • Q: What are some similarities and differences in leading laboratory and imaging as compared to pharmacy?

    A: Some key commonalities are around operational stability, which include process, flow, and safety measures. We routinely leverage Lean Six Sigma for our performance improvement methodology, so we have a common approach to developing and applying safeguards and operational efficiency. We also focus on standardization of workflow for each area. 

    As I shadow staff and learn more about radiology and laboratory, I’m learning a lot about the various technologies in each area. For example, if we want to purchase a new MRI, the capital purchase selection process and criteria are completely different from my past experiences in pharmacy. 

    The laboratory is probably one of the most complex areas when you look at the amount of instrumentation and the level of integration you need with the electronic health record (EHR). For instance, we have five different testing platforms for COVID-19. Each platform has distinct differentiating factors with differences in specificity, accuracy, test time, and so forth.  

  • Q: How does a pharmacy leader from a small, independent health system become a technology early adopter?

    A: I’ve always had an aptitude for technology. I’m a self-taught techie and in my early teens was writing HTML and Visual Basic code from scratch. Early in my pharmacy career, I was very hands-on and had a penchant for evaluating new technology—sometimes we refer to being on the bleeding edge. We beta tested many different pharmacy technology offerings. Now, I’d like to think that we are more strategic with our technology decisions. We’ll evaluate emerging technologies only when they align with our strategic goals. 

    For example, one of our strategic goals is decreasing reliance on 503B vendors in order to reduce risks associated with compounded sterile products. We became an early adopter of IV workflow and robotics systems, and it’s worked to our advantage from a safety, efficiency, and cost standpoint.

  • Q: Why have you become such an outspoken advocate for IV compounding technology?

    A: Before we were an early adopter of IV technology, I’ll admit that I was a skeptic. I thought the process looked cumbersome and would slow us down. 

    After a week of trying out an IV workflow system, I was a believer. Why? Sterile compounding is the highest risk process in the pharmacy. It’s the one area that will keep you up at night. One error can cause disaster. 

    The syringe pullback method that we’re all taught is based entirely on trusting in humans. Well, what if the syringe wasn’t drawn back correctly? Or the mark is in the wrong place? 

    That’s why we’ve focused on sterile compounding technology—to eliminate human error. 

    Another reason is visibility. When a clinician comes to you, says the patient didn’t respond right and questions what is in the IV bag, you want to be able to know. The feeling that you may be hurting patients can hit you right in the gut. With IV technology, we’ve got proof; there are images of the vial and the bag. As a pharmacy leader, that gives me an incredible level of comfort.

  • Q: Where do you see IV technology progressing into the future?

    A: I want the robot to prepare just about every sterile compounded product. 

    It’s such a complex process with multiple steps and many potential failure points. I don’t doubt the human initiative and ability, but studies have shown time and again the non-reliability of humans in the IV preparation process. 

    Automation helps to eliminate accuracy errors, remove potential for contamination, and introduce more consistency and reliability. It’s just a fact that technology can perform a complex repetitive process better than humans. 

    While I think today’s IV robotics are great, they need to continue to advance and get faster. We’re starting to see that now, with more advanced, more affordable, and smaller footprint robots that easily fit into a cleanroom.

  • Q: How do you manage change?

    A: For many people, fear of change is real and can be difficult to overcome. Doctors can react negatively to even small, incremental change. For instance, when you introduce technology in the sterile compounding process, you’re kind of turning everyone’s world upside down. So there’s a resistance. 

    Often, I think we change only when mandated by regulation or when the government steps in, like for EHR adoption that came with incentives and penalties. Or, the Joint Commission comes in and says you have to do something. 

    But to get ahead, sometimes you have to take a calculated risk. When you believe a change will lead to positive outcomes, that it’s best for your patients and best for your organization, you have to push through the resistance to the change.

  • Q: What are some of your proudest professional moments?

    A: Two big things come to mind. 

    We opened several ambulatory retail pharmacy locations—both on campus and in the community—that are extremely successful. Initially, this proposal was met with some resistance, not because of the validity of the business model, but over concern how local pharmacies would react. We live in a small community, and we wanted to maintain friendly relations with area pharmacies and avoid conflicts. However, that’s not been an issue. Now, our employee prescription capture exceeds 95%, we’re filling the vast majority of specialty medicines, and it’s proving to be financially successful. More importantly, we’re providing medications for patients before they leave the hospital and positively impacting readmissions. 

    Another area that I’m really proud of is our decentralization of pharmacy services, for which we earned a local quality award. We completely shifted workflow, provided clinical skills training, and moved pharmacists out of the basement to the bedside as part of the patient care team. Pharmacists are able to work at the top of their license because the automation technology behind the scenes manages verification and distributive processes.

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