Keep communication open to keep pharmacy priority
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There are many strategies and details pharmacy leaders can employ to help maintain their department's staffing and resources. But arguably one of the most important is to create and maintain a solid line of communication with hospital leaders, physicians, and staff.
"We need to make sure everyone understands that the services pharmacists deliver on a day-to-day basis have a return on investment," says Michael D. Sanborn, MS, RPh, FASHP, corporate vice president for cardiovascular service at the 3,000-bed, multisite Baylor Health Care System in Dallas. Sanborn was scheduled to speak about proving your return on investment through clinical services at the 14th Annual American Society of Health-System Pharmacists' (ASHP's) Conference for Leaders in Health-System Pharmacy, held Oct. 19-20, 2009, in Chicago.
Pharmacy directors need to keep their hospital administrations informed of how pharmacy is doing, says Billy W. Woodward, BS, RPh, executive director of Renaissance Innovative Pharmacy Services in Temple, TX. Woodward was scheduled to speak about strengthening core pharmacy services at the ASHP's conference in October.
There are seven areas of accountability for each hospital pharmacy, and pharmacy directors must keep in mind three overarching principles for each area, Woodward says.
They must make certain everyone in their department feels some level of responsibility, ensure there is a culture of leadership and top-down guidance, and maintain a proactive communication plan in dealing with hospital leadership, Woodward advises.
"The information needs to be put upfront on a regular basis," Woodward says. "And it should be hand-delivered so it doesn't end up in the inbox and never gets read."
If the pharmacy director is not regularly letting hospital leaders know what the pharmacy department is doing, there could be problems where cutbacks impact the hospital pharmacy's resources and ability to provide quality care, Woodward adds.
"Even if you're doing a first-rate job, you could have problems," he says.
"I've seen departments that were doing an A-plus job, but the bosses upstairs didn't know that, and the pharmacy department was on the verge of having positions eliminated," Woodward explains.
Even when a hospital system is not making across-the-board cuts, it is financially sensible to keep pharmacy's economic and quality successes on the leadership's radar screen, Sanborn notes.
"A hospital pharmacy might want to obtain funding for a big project one day, and the director brings the idea forward," Sanborn says. "But the project is turned down, and one reason why the department is not successful is likely because the pharmacy hasn't created an identity of fiscal value in the first place."
If the pharmacy director had been consistently providing information about the pharmacy's outcomes, including cost savings through clinical pharmacy programs or changes, top leadership will clearly understand that the pharmacy department provides significant value, Sanborn explains.
Then it would be a much shorter leap for the hospital leadership to agree that a new pharmacy project would provide value over the long run and be worth the initial investment, he adds.
Pharmacy directors need to remind hospital corporate leaders that cutting labor rarely is the best way to cut costs in the pharmacy department, Woodward says.
Labor is the biggest expense in overall hospital costs, but this isn't true in the pharmacy department, he explains.
"In the inpatient, acute care setting, 70-75% of the costs for the pharmacy is drugs," Woodward says. "Manpower might be 5%."
So when a hospital cuts pharmacy staff, they're making a big mistake because they could cut 20% of the pharmacy staff to have an impact of cutting only 4% of the pharmacy budget, Woodward says.
"Then the drug budget will start to go up 18% a year because there are no employees available to take care of reducing it," he adds. "And things suffer from a quality standpoint too."
If the bosses above the pharmacy head don't understand how this scenario will play out, then it's because the pharmacy director hasn't done a good job of communicating with them, Woodward says.
"By the time you have a consultant upstairs looking for ways to cut costs, then it's too late to convince the administration that you need enough resources to do the things you do to keep the hospital safe and control costs," Woodward adds.
It might not be possible for hospital pharmacies to avoid all job cuts during an economic downturn, Sanborn notes.
"But the more everyone realizes that every pharmacist delivers value, the less likely you will be to experience some cuts," Sanborn adds.
Here are some strategies that will help improve communication between pharmacy and the top brass:
• Speak at department head meetings: "You should make a periodic presentation to the department head meeting about what pharmacy currently is doing, such as using dashboards and metrics and other methods to demonstrate how pharmacy is creating value," Sanborn says. "Show how managing the formulary and other clinical programs impact the budget."
• Position pharmacy at the hospital leadership table: It's important for the hospital pharmacy leaders to be well-positioned in the hospital's organizational structure, Woodward says.
"ASHP has talked about having a chief pharmacy officer," he adds. "This can work, but regardless of what the position is called, it's critical for pharmacy to be positioned at the table to talk with the right people at the right time."
If pharmacy leaders aren't present at hospital corporate and leadership meetings, then it will be much more difficult for them to be heard and to maintain pharmacy as a priority.
Pharmacy heads can help encourage the hospital to include them in the leadership structure by developing relationships through communication about the size of the pharmacy department's budget, its manpower, and the safety issues and their consequences, Woodward says.
Baylor Health Care System has a corporate director of pharmacy who attends senior leadership meetings and most major meetings, Sanborn says.
The corporate director of pharmacy oversees the health care system's 13 hospital directors of pharmacy, and the position has evolved over the past few years, he adds.
"Pharmacy directors at sites have a direct line of reporting to the corporate director of pharmacy," Sanborn says. "That way, once we all agree on what the goals are for pharmacy, the corporate director drives the performance against those goals."
Baylor's pharmacy department was the first clinical department to have system-wide leadership, he notes.
"All of the clinical departments now have a corporate leader," Sanborn adds.
• Submit quarterly reports to administration: "We've been sending quarterly reports of our overall pharmacy performance to the administration for at least five years," Sanborn says.
"They're short and sweet," he adds. "We used to do a six-slide PowerPoint presentation, summarizing our performance, and now we have consolidated it down to a one-page dashboard that we can also e-mail and review with senior leadership."
• Create a dashboard to describe expenses and progress: The Baylor pharmacy dashboard includes specific labor and drug expense benchmarks that have to be hit by all of the hospitals, Sanborn explains.
"We provide an easy-to-read, one-page summary of where the department is with respect to those benchmarks, in addition to including progress initiatives that we should be working on," Sanborn says.
"For instance, there's a therapeutic interchange summary with year-to-date fiscal information about what we focus on," he explains. "There's also an Excel spreadsheet with two graphs that summarize where our labor and drug expenses are, followed by a table that shows which initiatives the department is working on and what we're doing."
The dashboard might also measure output based on pharmacists per adjusted patient day ratios and show whether the department is hitting a particular target, Sanborn says.
"We also have FTE measurements based on doses dispensed, and all of those metrics vary by facility," he adds.
• Provide anecdotes of successes: At the Baylor hospital emergency department, there's a pharmacist who works full time, and there have been documented savings since that position was created a year ago, Sanborn says.
"The savings are well above the pharmacist's salary, but more importantly, the pharmacist has had an impact on throughput in the emergency department and has helped a lot with triage," he explains. "We've been able to adjust the triage process."
For example, ED patients often need to be sent to the intensive care unit (ICU) because of their need for IV medications.
"If the pharmacist can adjust those IV drips so they're no longer necessary, then the patient can be transferred to a lower level of care, and that has a big financial impact on the hospital," Sanborn says. "The ED pharmacist also can have a big impact on antibiotic streamlining."
This is the type of anecdote a hospital director should be pointing out with hospital leadership, showing how just one clinical pharmacist program can positively impact both quality of care and the financial bottom line.
"An ED pharmacist also can standardize the ED's protocols, looking at medication use and monitoring to see if there are ways we can function more efficiently," Sanborn says. "That's a project that will last a year or two, and the physicians and nurses are very excited about it."
• Market pharmacy's successes with all staff: "You can do this in a variety of ways," Sanborn says. "Whether you're at a department head meeting or just a meeting with your supervisor or administrator, you can discuss the department's accomplishments."
If something significant has happened, then put it in an e-mail.
"Say you have numbers for a particular project and it looks like you've saved $30,000 over the past six months," Sanborn says. "Craft a short e-mail to your boss, saying, 'We just got the numbers in, and we've saved $30,000 over the past six months.'"
Even a brief walk down the hall with the hospital's chief executive could be an opportunity to reinforce pharmacy's value.
"I was recently talking in the hall with our CEO about our success with bedside barcode scanning, and he complimented the department and said, 'When you focus on patient safety, the finances take care of themselves,'" Sanborn says.
Pharmacy staff should receive the same pharmacy reports sent to hospital leaders, and hospitals should have communication boards with charts and graphics that display the pharmacy's progress on various metrics, Sanborn suggests.
These simple, persistent communications help build the understanding that pharmacy adds value, he says.
"Pharmacists understand much more now than they did 4-5 years ago that while clinical practice is very important, they also have stewardship responsibility to the organization," Sanborn says. "We recognize that the more efficient we can be from a financial standpoint, the more likely it is that our service capabilities will increase."
There are many strategies and details pharmacy leaders can employ to help maintain their department's staffing and resources.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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