People acquainted with Dianne Tobias may find it hard to believe that anything could scare her. She's so self-possessed, organized, and upbeat—the sort of person who makes hard work look easy. But when Tobias decided to leave the security of a full-time corporate job a few years ago to become an independent consultant, "I was frightened," she says.

In January 1997, she launched Tobias Consulting Services, which provides data management, educational programming, continuous quality improvement (CQI), and other services to health care clients. "I felt very uncomfortable—I'm not a risk taker—but many people were encouraging me to go off on my own, and it seemed like the right time." Now, Tobias says, she has grown in ways she hadn't envisioned. "It was a good move, and I'll never regret it. I realized I can do things that I thought I couldn't, like marketing. I thought the lack of security would be a major worry, but it isn't. I guess," she says, laughing, "that now I am somewhat of a risk taker."

Her new-found confidence at pushing the envelope is sure to be valued in an era of unprecedented change for pharmacy in general and consultant pharmacy in particular. "Expanding to senior care pharmacy, with its emphasis on population rather than setting, makes this a challenging but interesting time," Tobias says. "Meeting the needs of an aging population—only a small percentage of which is in nursing homes—is so important."

Always the Teacher

Tobias grew up east of Berkeley, California, in the town of Orinda. In 1971 she graduated from the University of California, San Francisco, earning a Pharm.D. in one of the country's first clinical pharmacy programs. For three years after graduation she was an assistant professor of clinical pharmacy at the State University of New York at Buffalo and a practitioner in a SUNY-affiliated hospital satellite pharmacy, serving adult patients in intensive care. Then she joined the faculty at the University of Maryland School of Pharmacy, where she stayed for four years before returning to California and discovering the world of long-term care pharmacy.

As an independent contractor, Tobias visited nursing homes, reviewed charts, and provided input to improve patients' therapy. "I thought I'd do this for a short time," Tobias says, "and then I'd get back into hospital pharmacy and teaching. I didn't know then that long-term care pharmacy would be the majority of my career."

The Path to Quality Improvement

Tobias soon discovered that her work was rewarding and served all her needs. "It offered a lot of clinical involvement, and it gave me the opportunity to provide education to the nurses and staff." In addition, she taught and precepted students doing pharmacy clerkships at the University of California, Irvine.

Tobias was drawn to quality improvement because it allowed her to solve problems using the data she collected routinely as a long-term care pharmacist. "I could analyze the data and put those findings in perspective to improve the system. It was a way out of the trap of being negative," Tobias explains. "Rather than being the one to find errors at the end of the road, I wanted to look at what might be redesigned at the beginning. Data, especially aggregate data, are extremely interesting to me. Examining statistics, looking at why one facility differs from another, measurement—these are all important aspects of my work."

Making Things Better

What motivates her most, Tobias says, is the challenge of making things better, creating innovative solutions, and meeting goals. "I always want to raise the bar, and in health care that translates to improving someone's quality of life." Tobias describes herself as "extremely people-oriented," one who thrives on contact with others. In fact, she says, the most difficult aspect of being an independent consultant has turned out to be the isolation factor. On days when she is not meeting with clients, she stays in touch with colleagues through e-mail and phone calls.

On a typical workday, Tobias will get a couple of calls for speaking engagements or potential assignments, check the Internet several times, and work on a project or proposal. A few times a month she meets with clients, such as a nursing home chain in Los Angeles for which she consults on quality assurance issues. A future project will involve pinpointing and examining the reasons for variations in medication usage in Alzheimer's units. She has particularly enjoyed coordinating medication use studies involving American Society of Consultant Pharmacists (ASCP) members, aggregating the data they provide her to determine benchmarks for general and psychotherapeutic medication use.   

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