By Kelly M. Lee

Specialty pharmacy teams often describe the weeks leading up to an accreditation survey as a never-ending fire drill. Whether the accreditor is URAC, the Accreditation Commission for Health Care (ACHC), The Joint Commission, or the National Association of Boards of Pharmacy (NABP), the pattern is remarkably consistent. The survey window opens, and a team that has been running a pharmacy all year suddenly has to prove it.

Meanwhile, the work does not stop. Pharmacists are still counseling patients and monitoring therapy. Technicians are still chasing prior authorizations, coordinating refills, and resolving payer issues. Shipments still have to go out on time. Survey preparation gets layered on top of all of it.

That is firefighting. For many organizations, it has quietly become the default way of getting ready.

What firefighting looks like

The signs are easy to spot. A policy nobody has opened since the last survey jumps to the top of everyone’s list. Someone discovers that a workflow changed when the pharmacy moved to a new system, but the procedure still describes the old process. Training and competency records are spread across a shared drive, a learning management system, and one supervisor’s inbox. Staff members get pulled into mock interviews, chart audits, and late meetings, and every gap that turns up becomes a new assignment with a short deadline.

Some of that work is necessary. Real gaps have to be closed. But when readiness only happens in a sprint, the survey ends up measuring how well an organization can cram rather than how it actually operates.

The part that doesn’t show up on a checklist

Survey preparation is usually managed as an operational project. It is also a people challenge, and that side gets far less attention.

As pressure builds, a few things tend to happen. Experienced staff start second-guessing processes they perform confidently every day. Leaders working against a deadline shift from conversations to directives. Team members hold back a new concern because raising it means one more task for a group that is already stretched. Departments retreat into their own preparation rather than working together, even though the handoffs between intake, clinical, dispensing, and shipping are precisely where accreditation reviewers tend to find problems.

One of the most familiar moments in a mock survey is a technician who handles a process flawlessly every day, only to freeze when asked to walk through it. The process was never the issue. The stress was.

Broader research on pharmacy well-being lines up with what teams feel. A 2024 commentary in the American Journal of Health-System Pharmacy cited international data showing that roughly half of pharmacists experience burnout and urged pharmacy leaders, both formal and informal, to address its causes directly. What’s more, a study of 665 health-system pharmacists found that those working in settings with stronger workplace wellness support were less likely to report burnout, depression, or anxiety. 

A survey sprint stacked on top of an already demanding job is not a neutral event for the people carrying it out.

What flourishing looks like

Starting the sprint earlier doesn’t solve the problem. What works is building accreditation expectations into how the pharmacy already runs, so there is far less to sprint toward. In practice, that usually comes down to a handful of habits:

• Give every standard an owner and a backup. When only one person knows where the competency files are stored, that person’s vacation becomes a survey risk.
• Put the standards on a rolling calendar. Reviewing a few sections each month is manageable. Reviewing all of them in 6 weeks is not.
• Audit on a schedule, not a deadline. Routine chart and documentation audits catch gaps while there is still time to ask why they are happening, rather than just patching them.
• Keep quality data on the standing agenda. When patient management, complaint, and error data are reviewed at every quality committee meeting, trends surface long before a surveyor points them out.
• Update the policy when the workflow changes. A system conversion, a new payer requirement, or a staffing change should prompt a quick review of the procedures and training that describe the work.
• Practice in low-stakes ways. Short mock tracers during a normal week build more confidence than one high-pressure rehearsal right before the survey.

Leaders set the tone for all of this. Readiness holds up when it is treated as a shared responsibility across the organization, not the job of a single accreditation coordinator or quality leader. It also holds up when leaders look after the team during the push by protecting time for preparation work, rotating who carries the heaviest load, recognizing the effort, and making it safe to raise a gap without being blamed for finding it.

Readiness should reflect the work already being done

A survey is meant to confirm how a pharmacy operates every day, not reward a temporary version of it. No organization will take all the stress out of the process. Surveyors will ask unexpected questions, and something will always come up the week before.

Still, a team that has been living its processes all year walks into a survey very differently from one that has been rehearsing them for a month. It is more confident, less exhausted, and better able to keep its attention where it belongs: on the patients it serves.

That is the shift from firefighting to flourishing.

Kelly Lee is Managing Partner at RBS Solutions, a specialty pharmacy accreditation consulting firm. Over seven years with RBS, she has supported more than 300 engagements with specialty pharmacies, health systems, infusion providers, and pharmacy service organizations preparing for URAC, ACHC, NABP, and Joint Commission accreditation. Before consulting, she served as a Quality Director, preparing multiple pharmacies for accreditation. She co-presented “From Firefighting to Flourishing” at the Accreditation Workshop at NASP inSPire 2026.¹

References

Hardeman, S. M., et al. (2024). A call to action: How pharmacy leadership can manage burnout and resilience. American Journal of Health-System Pharmacy.

Lee, K., et al. (2026). From firefighting to flourishing: Survey ready & self-care steady! National Association of Specialty Pharmacy inSPire 2026.

Melnyk, B. M., et al. (2022). The state of health, burnout, healthy behaviors, workplace wellness support, and concerns of medication errors in pharmacists during the COVID-19 pandemic. Journal of Occupational and Environmental Medicine.