 
Managing Reduced Staffing with a Mission
Hepler and Strand introduced the “concept of pharmaceutical care” in 1989. Their definition of pharmaceutical care as “the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life” has become central to the mission of pharmacy.3 The pharmaceutical care mission statement provides a backdrop against which pharmacist shortages and hiring decision are made. Here are some steps consultant pharmacists can take to survive under potential staffing shortages.
Step 1: Portray the Value of Pharmacy“How to do more with less” is a business theme discussed repeatedly in the popular press. “Working smarter, not harder” is another hackneyed phrase used to describe increased productivity under reduced staffing. Anyone who has had to deal with staff reduction knows it is impossible to do more with less. Instead, when times are lean, most employers go back to their mission-statement roots for guidance. For pharmacists, the goal is to refocus on the mission of achieving definite outcomes that improve patients’ quality of life.The discipline of pharmacoeconomics was created in response to the emphasis of health care reform on cost containment, patient outcomes, and quality of life. Pharmacoeconomics uses guidelines and rigorous methods to demonstrate the value of pharmacy services.4 Unfortunately, a recent article in the Journal of the American Medical Association cast doubt on the economic analyses of new drugs used in oncology. According to the authors, “Recent studies have found that when investigators have financial relationships with pharmaceutical or product manufacturers, they are less likely to criticize the safety or efficacy of these agents.”5 The discipline of pharmacoeconomics has a bright future in spite of the JAMA article, and the authors themselves note that pharmacoeconomic literature could be more balanced if managed care organizations, government agencies, and nonprofit groups increased their support for high-quality, prospective pharmacoeconomic studies.5 Pharmacists, of course, are required to perform these studies, and with the predicted shortage of pharmacists, pharmacy leaders should promote the discipline of pharmacoeconomics as one of the ways pharmacists can communicate their values and patient-focused goals to health care administrators and policy makers. A positive image of pharmacoeconomics also could draw more PharmD students to the pharmacy work force. Another thing pharmacy leaders can do to promote the value of pharmacists is express the shortage of pharmacists to health care administrators in terms of return on investment (ROI). Fortunately, Michael McDaniel and Douglas DeJong have already written an article for the American Journal of Health-System Pharmacists in which pharmacists are presented as investments through ROI analysis.6 McDaniel and DeJong calculate ROI as follows:
net benefits of investment X 100% The goal is to cut expenses and maximize ROI. Through their organization’s real experience with pharmacy staff reductions and subsequent rehirings, the authors were able to show that medical costs were higher after reductions in pharmacy staff took place and that clinically active pharmacists did a much better job of controlling drug expense per patient day. 6 As far as “doing more with less,” McDaniel and DeJong were able to prove that this is impossible. In addition, they proved that when a pharmacist’s workload is reduced, he or she is more clinically effective and more active in documenting involvement.”6 Consultant pharmacists, in particular, are huge investments, not expenses. The benefits they add include:
The information points above should be presented to leadership whenever a pharmacist is not considered part of the primary care team. In addition, consultant pharmacists should check frequently with their leadership to see if materials are available for them to use to illustrate their adherence to a mission. Only a pharmacist can carry out the mission of pharmaceutical care.
Step 2: Hire Pharmacists with the Right StuffWhen they focus on the mission of pharmaceutical care, consultant pharmacists can be accountable for both expenditures and expected therapeutic outcomes.2 It is up to pharmacy leaders to hire a staff that can portray their mission. This type of personnel selection involves strategic planning and knowledge of market forces.Pharmacists who are risk takers and set ambitious goals can help raise other health care providers’ expectations for pharmacy services7 and give pharmacists greater say in multidisciplinary care teams. As pharmacists become a larger part of the primary care team, they must monitor changes in the provision of health care and determine the implications for their practice. The new pharmacy work force must be selected on its ability to adapt to this more market-driven function. According to Peter Fitzpatrick, writing in the Journal of the American Pharmaceutical Association, new work force activities must be added to ensure that pharmacists are integral to managed care.2 Fitzpatrick says disease state management and maintaining a database are crucial to evaluating the interplay of primary therapeutic protocols for disease states, health care resources used, and expected outcomes. In addition to disease state management, Fitzpatrick says pharmacists also must know how to assist physicians and educate them about formularies, as well as monitor their compliance with formulary use.2 Proper pharmacy personnel selection requires the articulation of these skills and the development of strategies to determine which applicants possess them.2 Fitzpatrick recommends a number of ways to evaluate pharmacy candidates in the managed care environment. For example, by requiring job applicants to write an essay describing their professional interests and strengths, an interviewer can tell if a candidate has good communication skills and whether the career interests of the candidate are compatible with the new requirements.2 Transcripts should be requested, according to Fitzpatrick, in order to look at the candidate’s electives and gain an appreciation of the candidate’s potential knowledge level in crucial skill areas. During the interview, the author says, role playing can be helpful to determine how a pharmacist would transfer information to physicians, other health care workers, and patients.2 Pharmacy is not exempt from the influence of managed care, and, according to Fitzpatrick, the profession will have to adjust or perish. He believes the key to adjusting is having personnel with the requisite skills.2 Hiring to support a mission is much harder than hiring to fill a position.
Step 3: Recognize the Evolution of the Hiring Process and Contribute to ItAs shown in the accompanying sidebars, the skills required of pharmacists are changing over time. In 1994, information-retrieval skills were listed among the top required skills.4 By 1997, strong communication and interpersonal skills were at the top of the list.2 With continually shrinking reimbursement systems and shortages of specially trained and experienced personnel, professional interdependence and collaboration is needed among physicians, pharmacists, nurses, and patients.1According to a recent issue of ISMP Medication Safety Alert!, staffing shortages cause practitioners to make continuous choices between productivity and patient safety.1 The new pharmacy work force must be able to work with members of the health care team to communicate to their team and to organizational leaders the fundamental incompatibility between productivity and safety. In addition to communicating the problem, they must also be able to communicate a solution. While communication is central to the pharmaceutical care mission today, what skills will be important in the next few years? The following programs may be useful to today’s pharmacists in dealing with complex pharmacy and communications skills and in focusing on the future:
According to Katherine Knapp, writing several years ago in the American Journal of Hospital Pharmacists, more residencies are needed for the following reasons:
The pharmacy staff selection process has evolved from one in which the ability to execute independent projects was especially valued in 1994 to one in which the ability to work with other health care professionals was more valued in 1997.2,4 Consultant pharmacists can contribute to the evolution of the hiring process by instilling communication-based skills in pharmacy residents. Residents who are trained to deal with staff shortages and recognize the tradeoffs involved in productivity versus safety will have the communication skills necessary to work in interdependent professional teams under the influence of managed care.
Step 4: Perpetuate Steps 1, 2, and 3In 1989, Hepler and Strand’s concept of pharmaceutical care created a mission for the profession of pharmacy. More than a decade later, pharmacists are recognized widely for their role in making pharmacotherapy successful, both in terms of overall health care outcomes and patients’ quality of life. In addition, consumers consistently put pharmacists at the top of the Gallup Poll regarding the most respected professionals and have indicated an absolute preference to have a pharmacist involved in their health care.8Over the years, pharmacists have learned to describe their value and staff selection process based on patient-focused care. The future of pharmacy in the era of managed care is bright, as long as the value of pharmacoeconomic studies and the role of pharmacists as the experts in controlling overall drug expenses are promoted. When the value and ROI of pharmacists is foremost in the minds of caregivers, policy makers, and patients, attempts to increase the pharmacist’s patient care role are more likely to be successful. Staffing shortages are proof positive that pharmacists are in great demand. It is up to today’s pharmacists to ensure future success by evolving with each new health care reform effort, while at the same time framing change in the context of the pharmaceutical care mission. The stress and error potential that accompany staff shortages are a reality under the influence of managed care. Fortunately, today’s consultant pharmacists are trained to work side by side with other health care professionals and can communicate to senior managers when they believe safe care is not possible. They know their value, they are selected based on specific hiring goals, and they take risks and help raise other health care providers’ expectations for pharmacy services.
Barbara Eilenfield
References
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American Society of Consultant Pharmacists. |
Reduced staffing is a reality in health care, and a predicted shortage of pharmacists over the next five years could increase pharmacists’ stress and error potential.1 In addition to pharmacist shortages, new pharmacy graduates and practicing pharmacists are being selected for positions based on a new set of necessary skills that make them able to compete effectively in the managed care environment.2 How can pharmacists deal with both a shortage of pharmacists and new rules of personnel selection? The answer lies in the mission statement.