Hospital productivity monitoring misses clinical workload data
A survey of U.S. community hospitals that were part of a national group purchasing organization charged with identifying and characterizing pharmacy productivity monitoring systems found the systems often failed to capture all relevant clinical workload data. The study was published in the American Journal of Health-System Pharmacy.
Researchers from the University of Illinois at Chicago led by Glen Schumock, PharmD, MBA, FCCP, said an inability to effectively and efficiently measure workload and productivity in hospital pharmacies has been a longstanding issue for the profession. "Efforts to identify systems to measure hospital pharmacy productivity date back to the early 1960s," they said. "Hospital pharmacy productivity monitoring is fraught with difficulty. First, pharmacists and pharmacy departments provide services that can range from the manufacturing and distribution of pharmaceutical products to the provision of direct patient care. The sheer number of different services provided by a given department makes measurement difficult. Further, many of the functions of hospital pharmacy departments are not routinely recorded or are not captured in information management systems, and manual collection of such data often is inefficient or impractical.
"Second, the intensity of services provided often varies on a case-by-case basis, which makes standardized relative work unit assignment difficult. This is especially true of clinical functions. Third, the activities of hospital pharmacy departments vary considerably among institutions, making universal measurement systems inept. These barriers have contributed to the lack of a widely adopted productivity measurement system for the profession."
According to the report, consulting organizations that specialize in hospital operational benchmarking or reengineering often attempt to assess pharmacy productivity by comparing staffing or workload ratios. But such ratios are often based on measures of product distribution such as doses dispensed and thus fail to measure workload in terms of clinical and patient care activities.
Cutting staff can hurt care
"Recommendations of consulting organizations to reduce pharmacy staff based on measures of product distribution may in fact result in higher pharmaceutical expenditures, higher overall hospital costs, and reduced quality of patient care because of the elimination of clinical pharmacy services," the researchers wrote. "Hospital pharmacy directors are often in the uncomfortable position of having to defend against the claims of consulting organizations while at the same time not having systems in place to measure the workload or outcomes of the nondistributive functions of the department. Given the lack of a national system for productivity monitoring, most hospital pharmacies collect some form of internal data for longitudinal benchmarking. Which data to collect and how to present those data in an effective and efficient manner remain perplexing questions for many hospital pharmacy managers."
The researchers received responses to an Internet questionnaire from 110 members of Consorta in 34 different states. On average, respondents maintained 228.5 staffed beds and had an average daily census of 145.3 patients.
Of primary interest to the researchers were indicators community hospitals used to routinely measure and track productivity and departmental effectiveness. Among a variety of productivity workload ratios, those most commonly reported were fulltime equivalents (FTE) per adjusted patient day, FTEs per dose dispensed, and FTEs per dose billed. Respondents were specifically asked if clinical pharmacy activities were included in the productivity monitoring systems used by the hospital and, in nearly 80% of the cases, clinical activities were not included. However, among those who reported measurement of clinical workload, the most common types of clinical functions were drug therapy consultations, clinical interventions, pharmacokinetic dosing and monitoring, nutrition support consultations, adverse drug event and medication error reporting, renal dosing, drug information, and clinical rounds. Of the respondents whose systems did not incorporate clinical activities, 86.2% felt there was a need for the system to do so, while 12.6% felt there was no need. The most common reporting interval for productivity information was monthly.
Computer barriers to recording data
Respondents were asked about the limitations and barriers to monitoring hospital pharmacy productivity data. Nearly 80% indicated that the inability of their productivity measuring system to account for the clinical services provided by the pharmacy staff was the single biggest limitation. Those participants whose systems account for clinical activities listed a variety of limitations involving logging clinical activities and discrepancies in dispensing activity documentation. For instance, a consistent trend was that most systems neither differentiated the type of clinical activity performed nor the time involved in performing the activity. Other computerized system shortcomings included time consumption and forgetfulness in manually entering each clinical intervention or activity, lack of appropriate workload weight for individual activities, failure to capture nonbilled activities, and lack of consideration of patient acuity in workload measures.
Community hospitals that responded to the survey appeared relatively efficient with respect to staffing, the researchers reported. For example, while the average number of FTE pharmacists in respondent hospitals was 10.5 and the national average is 10.1, respondent hospitals had fewer pharmacists per 100 occupied beds (8.6 vs. 13.1). For pharmacy technicians, respondent hospitals averaged 10.6 FTEs or 7.7 per 100 occupied beds, whereas the national average was 9.7 FTEs or 12.3 per 100 occupied beds.
Schumock tells Drug Formulary Review that other professions provide more standardized services and thus have an easier time measuring productivity. He notes that respiratory care, for instance, has more standardized treatments and activities and thus better lends itself to measuring individual and department-wide productivity.
Requirements differ
Schumock says there are differing time requirements on pharmacists who are involved in dispensing and compounding drugs. "The clinical activities pharmacists provide vary in the amount of time they require," he says, "and there's no good system to record them because often they aren't billed. The things that are easy to measure, such as doses dispensed, don't capture many of the things that pharmacists do."
A better system is needed, Schumock says, to be able to justify to those looking to reduce pharmacy staff the clinical and consulting roles pharmacists play. He says he and his colleagues are working with a University of Illinois business professor to develop a statistical method for combining activities. It would be similar to the systems used in banking and other industries but have not yet been applied to pharmacy.
The next step for the researchers is a March 2007 study looking at differences in productivity monitoring systems based on hospital size. "We want to determine the degree to which pharmacists provide clinical services in hospitals of various sizes," he tells us.
[Editor's note: Contact Dr. Schumock at [email protected].]
A survey of U.S. community hospitals that were part of a national group purchasing organization charged with identifying and characterizing pharmacy productivity monitoring systems found the systems often failed to capture all relevant clinical workload data.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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