Q: Our pharmacy team is large and diversified, both in location and specialization. While a large professional team has many advantages, it also poses leadership challenges related to departmental cohesiveness, team unification, and goal achievement. How have other large pharmacy departments structured themselves to optimize team unity, productivity, and job satisfaction? A: Our Veterans Affairs medical center is a large four-campus health care delivery system. Collectively, the system has over 580,000 outpatient visits annually and processes more than 1,200,000 prescriptions each year. The hospital supports approximately 8,300 inpatient admissions each year, with over 44,000 bed-days of care. The pharmacy team consists of 111 full-time equivalents. These members serve the ambulatory care, inpatient care, geriatrics, extended care, clinical, and mental health service lines and include the department’s management team, clinical pharmacy specialists, clinical pharmacists, staff pharmacists, clinical technicians, pharmacy technicians, and pharmacy residents. Since each team member has been assigned to a service line, management oversight for the clinical pharmacy team is matrix based.