Strategic planning for clinical services: St. Joseph Hospital and Health Care Center

A pharmacy department at a 340-bed community hospital based its strategic plan for developing patient-oriented services on a sound drug distribution system, a credible work-measurement program, and fiscal responsibility. In 1982 the department of pharmacy and i.v. therapy implemented a strategic plan for improving pharmaceutical services. The plan involved developing goals and objectives for the department; marketing the department's services and fiscal management to hospital administrators, medical staff, and nursing staff; building teamwork among the pharmacy staff; and improving the drug distribution system before instituting clinical services. Hiring of additional pharmacy staff was justified on the basis of work-measurement data. By adjusting staffing levels every two weeks based on work-measurement data, the department increased the efficiency of drug distribution activities; the pharmacy also implemented cost-saving programs like selection of therapeutic alternates and formulary restrictions. The savings were then reinvested in labor-intensive patient-oriented pharmaceutical services. A staff development program using staff pharmacists as preceptors expanded the breadth and depth of pharmacists' clinical skills. The planning efforts were successful because the needs of hospital administrators, the pharmacy department, and staff members were addressed.     

Adjustments of distributive and clinical pharmacy services to financial constraints

The effects of hospital budget constraints on a pharmacy department's ability to provide distributive and clinical services are described, and the development and use of workload-monitoring systems to match resources with demand is discussed. In 1980, the pharmacy department at Grace Hospital, a 402-bed community hospital in Detroit, Michigan, began quantifying workload by using five drug distribution indicators. After the pharmacy began providing clinical services in 1981, workload elements were measured in a pilot program for ASHP's Hospital Pharmacy Management Information System. Hospitalwide staff reductions occurred in 1985, eliminating most clinical pharmacy services. From 1985 to 1986, drug costs increased more than expected; also, turnaround time for medication orders increased. In 1986, 1.4 full-time-equivalent positions were added, and the pharmacy instituted use of decentralized carts and a pharmacist on the patient-care units to provide first doses. The hospital's management engineering department had selected patient days as the single indicator for pharmacy workload, but pharmacy used the ASHP Pharma Trend monitoring system to present data that convinced management engineering that patient days was an inadequate indicator of pharmacy workload. Also, drug costs decreased after the drug distribution changes and the reinstitution of patient drug therapy monitoring. Pharmacy managers need workload monitoring systems that are responsive to changes and include departmental expense information; these systems should be able to interrelate to hospital cost-accounting systems.     

Development and implementation of a strategic-planning process at a university hospital

The development and implementation of a long-range strategic plan for the pharmacy department at a university hospital is described. Because of rapidly occurring changes in health-care delivery, financing, and education, the pharmacy department at the University of Illinois Hospitals decided to create a strategic plan that would stimulate growth, be responsive to a changing health-care environment, and emphasize the department's philosophy of striving for professional leadership in education, research, and innovation. Actual strategy development was done during a three-day administrative retreat, which was conducted according to a structured agenda that facilitated extensive brainstorming and discussion. As a result, the department developed eight major strategies that have been directing its growth and development over the last four years. Each strategy had an implementation plan that included substrategies with statements of specific results that were expected, an action plan (a list of specific tasks to be accomplished), and a general statement summarizing the benefits of each substrategy. Annual meetings were held to review the continued appropriateness of these strategies. Implementation of the strategic plan has resulted in major improvements in drug cost containment, improved ambulatory-care pharmaceutical services, a results-oriented performance-appraisal system, more support for clinical education programs, and a substantial increase in support for research. The strategic plan has allowed the department to constructively participate in two downsizing events within the hospital without major adverse effects on its own services and programs. Use of the strategic-planning process should be considered by other hospital pharmacy departments as a means of responding to the external and internal forces of change that currently affect most hospitals.     

Strategic planning for clinical services: the University of Texas M.D. Anderson Hospital and Tumor Institute

A formal, hospitalwide strategic-planning process provides structure for the pharmacy's plans for implementing clinical services. The state-supported clinical cancer and research center began a formal strategic-planning process in 1981. The institution's planning report, prepared every two years and covering three two-year periods, drives the institution's budget through the state's biennial budget process. The report focuses on each department's responsibilities, areas of service, and relationship to the mission of the institution. Through the long-range planning process, upper-level administrators learned that pharmacy was eager not only to provide high-volume drug distribution services but also to assume direct patient-care and research responsibilities. This prompted an organizational change for pharmacy from a hospital department to a clinical division. The division of pharmacy now consists of three professional departments (patient care, pharmacy research, and pharmacy academic programs) and an administrative support service area. Services offered by each of the three departments are discussed, along with specific initiatives planned for the years 1987-1993. Within the next few years, all managers will come from the ranks of clinical practitioners; nonpharmacists will oversee financial and human resource functions. The division encourages existing pharmacy staff members to enhance their clinical skills through staff development programs. Strategic planning serves the dual purposes of structuring plans for implementing clinical pharmacy services and communicating pharmacy's goals within the institution.     

Pharmacy mass casualty disaster plan implemented after the train wreck

The involvement of a hospital pharmacy department in a mass casualty disaster revealed strengths and weaknesses of the department's disaster response plan. Effective communication and notification within the pharmacy department and the need to plan to have pharmacists in the triage area to determine patients' lost medications are important areas that the department had not practiced in disaster drills.     

Issues Facing Pharmacy Leaders in 2015: Suggestions for Pharmacy Strategic Planning

Issues facing pharmacy leaders in 2015 include practice model growth and the role of pharmacy students, clinical privileging of health-system pharmacists and provider status, medication error prevention, and specialty pharmacy services. The goal of this article is to provide practical approaches to 4 issues facing pharmacy leaders in 2015 to help them focus their department’s goals. This article will address (1) advances in the pharmacy practice model initiative and the role of pharmacy students, (2) the current thinking of pharmacists being granted clinical privileges in health systems, (3) updates on preventing harmful medication errors, and (4) the growth of specialty pharmacy services. The sample template of a strategic plan may be used by a pharmacy department in 2015 in an effort to continue developing patient-centered pharmacy services.The Patient Protection and Affordable Care Act (ACA) was fully enacted in 2014, with almost 20 million people obtaining health care coverage and uninsured Americans dropping from 18% to 13%.¹ Medicaid coverage expansion is also required in patients with pre-existing conditions and requires the individual health insurance mandate.² The increase in insured Americans will logically place more cost burden on an already costly system – with a major focus of most health care providers to ensure that care is of the highest quality with a minimum of cost. As pharmacy leaders, that means to “do more with less” by optimizing pharmacy practice models to focus on efficient medication distribution and effective monitoring of medication prescribing to prevent errors and unnecessary costs. The Ohio State University’s Wexner Medical Center sponsors a cost reduction and quality improvement campaign called Create the Future Now with the following slogan: Use less, Spend less, and Waste less. Using a variety of strategic planning techniques (eg, SWOT [strengths, weakness, opportunities, and threats] analyses, environmental scans, etc) helps the pharmacy director set realistic and practical goals for the pharmacy. Strategic planning is critical for effective leadership in a department as it sets the “compass” for the direction of that department. However, to set these goals, the pharmacy director must understand the pertinent issues and prioritize these issues based on the impact they may have on the department’s progress and on how resources are allocated in a given year. Finally, key strategic goals that are directed yet simple will facilitate the buy-in and support from pharmacy staff, physicians, and the C-suite.To determine issues affecting health-system pharmacy in 2015, I reviewed topics presented at professional society meetings; sought guidance from faculty in The Ohio State’s Colleges of Pharmacy, Medicine, and Public Health; and attended an educational session on the Pharmacy Forecast 2014-2018 at the American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting in Anaheim, California, in December 2014.Pharmacy Forecast 2014-2018 is published by the ASHP Research and Education Foundation’s Center for Health-System Pharmacy Leadership.³ This publication reviews a series of environmental scans in key areas affecting the growth of the pharmacy department. Examples of environmental scans include the areas of fiscal issues, quality and safety, pharmacy practice model, pharmacy operations, and ambulatory care. By reviewing this publication, a pharmacy director can become familiar with the important trends in health care and incorporate them into their strategic planning.Based on the environmental scan, the issues for 2015 vary a bit from 2014; they focus on the areas of practice model growth and the role of pharmacy students, clinical privileging of health-system pharmacists and provider status, medication error prevention, and specialty pharmacy services. This article will address (1) advances in the pharmacy practice model initiative and the role of pharmacy students, (2) the current thinking of pharmacists being granted clinical privileges in health systems, (3) updates on preventing harmful medication errors, and (4) the growth of specialty pharmacy services. The information in this article may be used to develop a pharmacy department’s strategic plan for 2015 in an effort to continue providing patient-centered pharmacy services.     

Use of the strategic-planning process by hospital pharmacy directors

The extent to which hospital pharmacy directors use strategic planning was assessed. The strategic-planning process was divided into six steps: (1) specification of goals and objectives, (2) identification of threats and opportunities and strengths and weaknesses, (3) generation of alternatives, (4) evaluation of alternatives, (5) alternative selection and implementation, and (6) monitoring and obtaining feedback. Eight questions about these steps made up one part of a questionnaire mailed to the pharmacy directors of 1100 hospitals. In another part of the questionnaire, each director was asked to rate on a scale of 0 (low) to 100 (high) the level of the pharmacy department's performance in the areas of patient, employee, physician, and hospital administrator satisfaction; financial management; professional image; employee turnover and productivity; and clinical programs. The questionnaire was mailed on July 1, 1987, with a second mailing on August 1, 1987. A total of 343 questionnaires were returned with usable responses, for a response rate of 31.2%. Based on responses to the eight strategic-planning questions, hospital pharmacy directors were classified into seven levels of planning sophistication. Results indicated that the number of directors classified in each level increased significantly as the level of planning sophistication increased. The majority of respondents considered the scope and quality of services and the department character, quality, and reputation during the strategic-planning process, whereas less than 50% considered profitability and future needs. Pharmacy directors with a high level of planning sophistication rated their departments significantly higher in terms of hospital administrators' satisfaction, professional image among hospital administrators, number of clinical programs, and quality of clinical programs.(ABSTRACT TRUNCATED AT 250 WORDS)     

Implementation of product-line management in a hospital pharmacy department

The development and implementation of product-line management (PLM) in a pharmacy department is reviewed. The PLM system of hospital organization shifts the emphasis from function to product. The pharmacy department at a 737-bed nonprofit hospital adopted PLM in an effort to reach more directly the physician and patient markets, enhance the image of pharmacy, and help meet requirements of the Joint Commission on Accreditation of Healthcare Organizations. The department surveyed physicians and administrators to identify their product and service needs and surveyed pharmacy staff members to identify the perceived benefits and risks of a PLM system. A strategic-planning session was held to decide how best to match the pharmacy department's product lines with market needs. The team leaders were renamed clinical supervisors and were no longer responsible for defined physical areas but rather for clinical matters relating to patients in the product line assigned. Pharmacy's chosen product lines were oncology services, neuropsychiatry, maternal and child care, cardiovascular, operating room-anesthesia-pain clinic, and general medical. The transition is being accomplished one product line at a time; interested team leaders transfer into clinical supervisor positions by achieving clinical expertise within the relevant product lines. Despite some initial confusion, PLM contributed to job satisfaction and morale and allowed the pharmacy department to provide increased clinical consultation and intervention services. PLM enhanced the clinical pharmacy program and focused clinical services on the physician and ultimately the patient.     

Human resources management for a hospital pharmacy department

The concepts of human resources management (HRM) are presented, and the application of HRM concepts to a hospital pharmacy department is described. Low salaries and poor working conditions had precipitated a mass exodus of pharmacists from a 650-bed, tertiary-care medical center. The newly hired director of pharmacy sought to rebuild the department by developing a three-stage HRM model consisting of needs forecasting, performance management, and advanced management systems. In the needs-forecasting stage, the strengths and weaknesses of departmental programs were determined through analysis of existing standards of practice, situational analysis, and financial analyses; the strengths and weaknesses of departmental employees were determined through the use of talent inventories, turnover analysis, analysis of time and leave records, reevaluation of the department's job classifications, performance and productivity evaluations, and productivity evaluations, and development of a philosophy of practice and mission statement. Needs and problems were addressed by examining each existing program and developing new policies and procedures, performance standards, quality assurance mechanisms, and productivity expectations. Personnel needs and problems were addressed by designing a system of differentiated career ladders, contracting with pharmacists for career moves, developing the skills of currently employed pharmacists, and implementing a succession planning model. The model has been in place for approximately three years and is beginning to yield the desired results. Application of HRM concepts to a hospital pharmacy department appears to have been successful in improving employee morale and in helping the department to meet goals of expanded and improved services.     

Pharmacy-based distribution system for enteral nutrition products

A hospital pharmacy department's implementation of enteral nutrition product distribution and its proposal for an enteral nutrition product admixture service are described. Responsibility for the distribution of enteral nutrition formulations was transferred from the central distribution department to the pharmacy after problems with inventory control, billing procedures, and inappropriate administration of enteral nutrition products were recognized by personnel from the central-distribution area and nutrition services. After additional problems were identified using a multi-disciplinary approach, the pharmacy department implemented an enteral nutrition product distribution system and developed an enteral nutrition product formulary. A proposal was developed for a pharmacy-based enteral nutrition admixture service, but implementation of this service was deferred because data from a cost-effectiveness evaluation and random bacteriologic monitoring did not justify adding the service. Pharmacy-based distribution and formulary control of enteral nutrition products alleviated problems with inaccurate patient charges and accumulation of stock on the nursing units. Pharmacists at this hospital hope to develop an enteral nutrition product admixture program that will result in cost savings for the institution.     

Pharmacy Leader’s Role in Hospital Emergency Preparedness Planning

The Director’s Forum column is designed to guide pharmacy leaders in establishing patient-centered services in hospitals and health systems. Environmental disasters and terrorist attacks demonstrate that it is imperative for both a hospital and community to have an emergency preparedness plan. The goal of this article is to provide health-system pharmacy leaders with a practical approach in developing an emergency operations plan (EOP) that can be activated in the event of a disaster. Pharmacy leaders should (1) review government and community disaster responses and understand the movement of drug supply for each response, (2) create a pharmacy disaster plan, (3) list the essential medications and determine their inventory levels, and (4) establish a staff training program to enhance understanding and implementation of the EOP. If successfully developed and executed, a hospital pharmacy department’s EOP has a high rating of success in meeting patient-centered needs in the unforeseen event of a disasterEmergency preparedness planning or disaster planning has become a focus area for pharmacy departments given the recent environmental disasters, such as the 2008 river floods in Iowa or the 2011 tornadoes in Missouri, and the 2013 Boston Marathon bombing. These events highlighted the importance of effective emergency preparedness by hospitals and the communities they serve.¹ Communities rely on hospitals to provide essential services during a disaster, including appropriate vaccinations (eg, hepatitis B, tetanus) and prescribed medications and medication refills.²During disasters, hospital pharmacy departments are a source of medication supply and information.Disasters are unpredictable and therefore are difficult to prepare for. Pharmacy departments should be involved in hospitalwide emergency planning efforts; during a disaster, pharmacy departments are responsible for handling medication procurement and storage. The director of pharmacy makes plans for the handling and storage of medications during a disaster based on regulatory concerns; an understanding of costs and storage and stability requirements; and a unique expertise in managing the supply chain to ensure effective distribution of medications.³ As a result, it is vital that the pharmacy director understands how to prepare a pharmacy department, the hospital, and the community for a possible disaster.The American Society of Health-System Pharmacists (ASHP) and The Joint Commission (TJC) have published guidelines and accreditation standards that guide the pharmacists’ role in disaster planning.^4,5 Unfortunately, most of this information does not provide the practical steps that are needed for developing a disaster plan for the pharmacy. There is a paucity of literature to guide the pharmacy’s effort in disaster planning.The goal of this article is to provide health-system pharmacy leaders with a practical guide to developing an emergency operations plan (EOP) that can be activated in the event of a disaster. This article focuses on pharmacy planning for an event that impacts the surrounding community; a pharmacy plan to address a disaster that impacts a hospital building is not discussed. Pharmacy leaders should (1) review government and community disaster responses and understand the movement of drug supply for each response, (2) create a pharmacy disaster plan, (3) list the essential medications and determine their inventory levels, and (4) establish a staff training program to enhance understanding and implementation of the EOP. If successfully developed and executed, a hospital pharmacy department’s EOP has a high rating of success in meeting patient-centered needs during a disaster.     

Management considerations to implementing pharmaceutical care

Progressing towards the goal of PC requires a fundamental change to pharmacy practice. Strong leadership and management skills will be needed to facilitate this change. Even with enthusiastic and capable staff, implementation of the PC model will require considerable effort. Changes to the department's mission statement and organizational structure will be required. From this beginning, an action plan for the department can be developed. This plan includes the training of individuals and/or recruiting the necessary personnel. An ongoing education program, as well as determining the value of your service, is required. With successful implementation the PC model will lead to the acceptance of the pharmacist's role as the person responsible for identifying, preventing, and resolving drug-related problems.     

Strategic planning for clinical services: panel discussion

A panel of hospital pharmacy managers representing three institutions discussed issues related to planning for patient-oriented pharmacy services. The panelists discussed organizational benefits of strategic planning, ways to gain momentum for change among pharmacy staff members and from others within the institution, the need for setting realistic goals, and problems in differentiating roles for pharmacy staff. They also discussed the funding of strategic-planning programs. The panelists advocated an integrated approach to providing drug distribution and clinical services. Management must provide whatever support is necessary for integrating patient-oriented services into the daily activities of all pharmacists. That support may be in the form of additional personnel, better use of supportive personnel, staff development programs, or automation. Pharmacists, too, must recognize their combined responsibilities for drug distribution and clinical services. Only by having all pharmacists clinically trained can a department provide clinical services when needed. The experiences of these panelists may be useful to other institutions planning patient-oriented pharmacy services.     

Leadership and Effective Succession Planning in Health-System Pharmacy Departments

Leadership succession planning is crucial to the continuity of the comprehensive vision of the hospital pharmacy department. Leadership development is arguably the main component of training and preparing pharmacists to assume managerial positions. Succession planning begins with a review of the organizational chart in the context of the institution’s strategic plan. Then career ladders are developed and key positions that require succession plans are identified. Employee profiles and talent inventory should be performed for all employees to identify education, talent, and experience, as well as areas that need improvement. Employees should set objective goals that align with the department’s strategic plan, and management should work collaboratively with employees on how to achieve their goals within a certain timeframe. The succession planning process is dynamic and evolving, and periodic assessments should be conducted to determine how improvements can be made. Succession planning can serve as a marker for the success of hospital pharmacy departments.Key Words: succession planning, pharmacy department, hospital pharmacy, leadership     

Implementing a stand-alone packaged pharmacy computer system in a 580-bed hospital

The problems experienced by a hospital pharmacy department in implementing a stand-alone packaged computer system are discussed, and recommendations for avoiding and managing these problems are presented. In 1984, a stand-alone packaged computer system was implemented in a 580-bed, tertiary-care institution that provides services from a central pharmacy and five satellite pharmacies. The department developed a request for proposal and contracted with a vender for a system that would support unit dose drug distribution and i.v. admixture services. During the implementation process, the following problems were experienced: The hardware was insufficient for the department's workload, the software design was limited, and personnel were frustrated with learning to use the system. These problems were intensified by the heavy workload and the large number of users. In the 18 months since implementation, the department has purchased more hardware, improved the software applications, and resolved many of the problems associated with employee frustration. Pharmacy departments at other large institutions might avoid some of these problems by training personnel adequately before implementation and by researching and estimating hardware and software needs in advance. In this large hospital, the efficiency of a stand-alone packaged pharmacy computer system has improved 18 months after implementation.     

PDCA循环管理法在医院药事与药物使用管理工作中的应用

目的介绍PDCA循环管理法在医院药事与药物使用管理工作中的应用实践。方法运用PDCA循环管理法的＂过程管理＂,即通过质量管理计划的制订、实施、检查及处置,实现医院药事与药物使用管理的质量持续改进。结果 PDCA循环管理法能促进医院药学管理科学化、规范化、常态化,有效提高药学部门各环节管理的工作效率。结论医院药事和药物使用管理使用PDCA循环管理法能夯实学科发展,促使药学管理质量循环上升,逐步提高临床医务人员和患者对药学服务的满意度。     

Issues Facing Pharmacy Leaders in 2014: Suggestions for Pharmacy Strategic Planning

In 2013, the Director’s Forum published our assessment of issues facing pharmacy leaders to assist pharmacy directors in planning for the year ahead. The issues include health care reform and the Affordable Care Act, the American Society of Health-System Pharmacists Pharmacy Practice Model Initiative, the health care workforce, patients’ perceptions of pharmacists, and the changing landscape of pharmacy education. Based on our environmental scan, the issues addressed in 2013 are pertinent to a department’s plan for 2014. The goal of this article is to provide practical approaches to each of these issues to help pharmacy directors focus their department’s goals for 2014 to support the development of patient-centered pharmacy services. This column will address (1) strategies to reduce medication costs and generate new pharmacy revenue streams, (2) innovative approaches to improving medication safety and quality, (3) steps to advance the clinical practice model, and (4) ways to create mutually beneficial student experiences.The reduction of health care costs while improving quality will continue to be an important goal of health care reform during 2014. The Patient Protection and Affordable Care Act (ACA) legislates some important milestones that influence health care change and will continue the pressure on hospitals to control costs. Specifically, the ACA expands Medicaid coverage to patients with pre-existing conditions and requires the individual health insurance mandate.¹These required changes impact health-system pharmacy, which must assume the administrative burden to reduce costs while maintaining and even improving the quality of health care. Pharmacy leaders will need to “do more with less” by optimizing pharmacy practice models to focus on efficient medication distribution and effective monitoring of medication prescribing to prevent errors and unnecessary costs. The Pharmacy Practice Model Initiative (PPMI) developed by the American Society of Health-System Pharmacists (ASHP) serves as a guide for these practice models; the PPMI goals are focused on expanding clinical pharmacist roles, expanding pharmacy technician operational roles, developing appropriate training and credentialing for pharmacy staff, optimizing automation and technology, and taking ownership of the medication use process.²In addition to the ACA, other factors will influence pharmacy departments in 2014. A variety of strategic planning techniques (eg, SWOT analyses, environmental scans, etc) can help the pharmacy director set realistic and practical goals. By identifying major issues driving changes in the health system, pharmacy leaders can proactively guide their departments to meet the challenges that lay ahead, thereby avoiding the pressure from external forces that strive to dictate the directions and plans of a pharmacy department. Pharmacy directors must also prioritize these issues in terms of the impact they may have on the department’s progress and how they may influence resource allocations in a given year. Finally, by having a few directed yet simple strategic goals, pharmacy directors will facilitate the buy-in and understanding from pharmacy staff, physicians, and the C-suite.In 2013, the Director’s Forum published our assessment of issues facing pharmacy leaders to assist pharmacy directors in planning for the year ahead.³ The issues include health care reform and the ACA, the ASHP PPMI, the health care workforce, patients’ perceptions of pharmacists, and the changing landscape of pharmacy education. Based on our environmental scan, the issues addressed in the 2013 column are pertinent to a department’s plan for 2014. The goal of this article is to provide practical approaches to each of these issues to help pharmacy directors focus their department’s goals. This article will address (1) strategies to reduce medication costs, (2) innovative approaches to improving medication safety and quality, (3) steps to advance the clinical practice model, and (4) ways to create mutually beneficial student experiences.     

Leadership in a clinical profession

The contributions of residency training programs to pharmacy's development into a clinical profession are described. Residency programs supply institutional pharmacy with mature, highly skilled clinical and managerial practitioners, and ASHP's accreditation process ensures the programs' quality. Residents develop values, philosophy, and vision that breed innovation and advancement of the profession. As pharmacy departments strive to meet the standards set by the accreditation program, the level of services rises; subsequently, higher standards are established and practice advances accordingly. Future residency training for community practice and the movement toward the Pharm.D. as the sole entry-level degree for practitioners must be evaluated in terms of effect on patient care and on pharmacy school and hospital resources. Planning for future pharmacy education and manpower needs should involve the whole profession, but the needs of community and hospital pharmacy may differ. A goal for the future is entry-level residency training for all hospital pharmacists, with the Pharm.D. degree as a prerequisite. Such a residency program would focus on clinical practice and provide experience in all pharmaceutical services and the overall management of a pharmacy department; it would be a prerequisite for advanced specialized residency programs. Managers of departments providing clinical services will need an entry-level clinical residency followed by a specialized residency in administration. In their 25-year history, residency programs have contributed greatly to the profession. Efforts to develop quality residency training sites and promote them to pharmacy graduates should continue.