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How To Boost Hospital Performance By Optimizing Your Pharmacy
July 15, 2015
&
Questions
Speakers
Michael Talerico, EnvigorateManaging Partnerwww.envigoratehealthcare.com
Joe Vargas, CompleteRxRegional Directorwww.completerx.com
Today's Objectives
1. Historical and current practices
2. Pros and cons of current options
3. Common metrics and how to choose
4. Managing a productivity target
Pharmacy Is Evolving
Historical Transition Current
• Drug procurement & distribution
• Nursing & physician satisfaction
• Charge capture
• Cost control• Clinical services• Patient safety
initiatives• Revenue cycle
• Automation• Outpatient services• Patient experience • Revenue
enhancement
Why Productivity Management?
Effective use of pharmacy resources can:
Control drug expenses Improve patient safety Improve Value Based
Purchasing (VBP) reimbursement Reduce readmission rates
80%Drug expense
percent of total pharmacy costs
No Two Pharmacies Are The Same
Physical layout limitations
Level of automation
Hospital service lines supported
Clinical services
Volume fluctuations (seasonal)
Current Skill Requirements
Traditional Skill Requirements
SUPPLY CHAIN
P&L MANAGEMENT
STAFF SUPERVISION
FORMULARY MANAGEMENT
QUALITY IMPROVEMENT
REGULATORY AND ACCREDITATION
HCAHPS
EMAR
CPOE
SMART PUMPS
340B
USP 797 - 800
BIOSIMILARS
MED THERAPY MGMT
ISMP STANDARDS
STRATEGIC PLANNING
P&L MANAGEMENT
PATIENT ASSISTANCE PROGRAM MGMT
RETAIL PHARMACY
FORMULARY MANAGEMENT
PERSONNEL DEVELOPMENT
CDM MANAGEMENT
PATIENT SAFETY
INFORMATION TECHNOLOGY
LEADERSHIP
REVENUE CYCLE
REGULATORY AND ACCREDITATION
SUPPLY CHAIN
CLINICAL
ACCOUNTABILITY AND EXECUTION
QUALITY IMPROVEMENT
Productivity Management Tools
1. Benchmarking Services
2. Self-Benchmarking
3. Productivity/Workflow Assessment
Benchmarking Services
PROS
Easy to implement
Moderate cost
Data rich
CONS
Not very specific to the individual operation
Peer Group mismatch
“Cherry-picking” of the productivity indicator
No specific guidance on how to improve workflows
No “buy-in”
Self Benchmarking
Pros “Best Period
Average” No cost Facility specific
Cons Current status quo No specific guidance
Productivity/Workflow Assessment
Gap Analysis
Workflow Analysis
Customize to Facility
Staff Engagement
What is a Volume Indicator?
Indicator for determining pharmacy’s target staffing
Used as a “surrogate” for all of the activities
The denominator in the productivity target
There is no “perfect” volume indicator!
Common Pharmacy Volume Indicators
40%
27%
15%
12%10%
Doses
APD
Orders processed
Patient days
CMI APD
Source: Am J Health-Syst Pharm—Vol 63 Sep 15, 2006
Pharmacy Variable Workload Drivers
Prescribe Dispense
AdministerMonitorOutcomes
Procure/Store
Protocol DevelopmentMed HistoriesPain Management ServicesCollaborative Practice
Nursing EducationPatient EducationDosing Protocols
Multidisciplinary RoundsKinetic Dosing Services
Controlled Substance AuditsTherapeutic Drug Monitoring
Medication Safety InitiativesISMP Self AssessmentsADE Reporting and MonitoringPost Discharge Monitoring
Inventory ManagementManagement of Shortages
Contract ComplianceDrug Supply Chain Security Act
Order Entry/VerificationSterile Product Preparation
Med Carousel/ADC ManagementProtocol Application
Chemo/TPN Preparation
Pharmacy Constant Workload Drivers
Meetings
• P&T• Infection
Control• Patient Safety• Informatics
Reg/Accred Standards
• Medication Storage Area Inspections
• Controlled Substance Audits
• IV Room Cleaning
• Nursing Orientation
• Competency Assessments
Automation Management
• ADC Optimization
• Interface Management
Education
• Pharmacy Interns
• Resident
Implement a Workflow Evaluation and Redesign
Identify rework and
work duplication
Identify staffing/ workload
mismatches
Identify workflow barriers
Implement automation optimization
Evaluate shift length/overla
p
Develop Management Action Plan
Strategic Objectives
Align strategic initiatives
Gap analysis
Define management structure based on size/service
Staff Engagement
Workflow redesign
Define roles/responsibilities
Evaluate overtime/flexible staffing
Determine appropriate skill mix
Fully leverage technician staff
Robust training and competency assessment
Key Drivers for Success
Decide on a process
Pick a volume indicator
Measure productivity
Manage staffing resources
Implement an ongoing review process
“You can only manage what you measure.”
Hospital Pharmacy Productivity
FROM TO
3436 3787 3.50 4.00 1.75 2.90 1.50 1.60 6.50 3.50 2.80 28.05
3788 4140 3.50 4.00 1.75 2.90 1.50 1.60 7.00 4.00 2.80 29.05
4141 4492 3.50 4.50 1.75 2.90 1.50 1.60 7.50 4.50 2.80 30.55
4493 4844 3.50 5.00 1.75 2.90 1.50 1.60 8.00 4.50 2.80 31.55 0.5383
4845 5196 3.50 5.00 1.75 2.90 1.50 1.60 8.50 5.00 2.80 32.55
5197 5548 3.50 5.50 1.75 2.90 1.50 1.60 9.00 5.00 2.80 33.55
5549 5900 3.50 5.50 1.75 2.90 1.50 2.00 9.50 5.50 2.80 34.95
Tech
nicia
ns
IV Te
chni
cians
Med
Rec
Tech
s*
Tota
l
Targ
et
APD
Adju
sted
Pa
tient
Day
s (A
PD)
Fixe
d*
Cent
ral
Phar
mac
istNi
ght
Phar
mac
ist *
Spec
ialis
tPh
arm
acist
* Ca
ncer
Cen
ter
Phar
mac
ists*
Ca
ncer
Cen
ter
Tech
s
Leadership Breakdown (Fixed) FTEs
Director 1.0
IT Coordinator 0.9
Inventory Clerk 0.9
Courier for Hospice Patients 0.7
EPRS Example
Patient and Provider
SatisfactionPatient Safety
Medication Cost Management
Hospital Pharmacy Productivity
Rx
