How a Connecticut hospital upended its traditional pharmacy staffing model

Posted on: Friday, July 19, 2019 By: KorchekStaff

As the shift to value-based care continues, health systems are launching quality, cost-saving and patient satisfaction initiatives to minimize the effects of reimbursement changes. Many of these programs fall on the shoulders of already-strained pharmacy staff, according to Kelly Morrison, director of remote and retail pharmacy services for Cardinal Health.

During a July 11 webinar sponsored by Cardinal Health and hosted by Becker's Hospital Review, Ms. Morrison outlined the challenges presented by traditional pharmacy staffing models in the era of value-based care. She was joined by Mike Culligan, director of pharmacy at Saint Francis Hospital and Medical Center in Hartford, Conn., who explained how his pharmacy team addressed those challenges.

Mounting demands on pharmacy staff

Clinical pharmacists are now expected to develop, execute and maintain many new initiatives in response to reimbursement changes from the shift to value-based care, according to Ms. Morrison. As a result, many organizations are focused on antibiotic and pain stewardship programs, medication utilization initiatives focused on drug cost savings, discharge counseling and medication reconciliation. In addition, many hospitals are also evaluating retail strategies to expand pharmacy's reach beyond the hospital.

The problem? Pharmacy leaders are already spending more time on regulatory compliance, supply chain management, cost savings initiatives and consolidation change management. As a result, they're "struggling to find time to design and execute additional new programs,” according to Ms. Morrison.

"They have minimal time to focus on collaborating with the medical staff and counsel patients because they spend much of their time on administrative tasks that need to be done," she said. "All these demands result in less time [for] pharmacy leaders [to be] able to develop a proactive, workload-balanced pharmacy staffing model that focuses on improved quality, patient safety and clinical outcomes."

The obvious solution would be to hire additional support. Unfortunately, in many cases, personnel budgets are flat, Ms. Morrison said. So, pharmacy leaders like Saint Francis Hospital and Medical Center's Mr. Culligan must turn to alternate staffing models.

A Connecticut hospital's creative solution

A couple of years ago, Mr. Culligan tasked their pharmacy residents with developing a business plan to address the problem. That led to an eye-opening realization.

"As we were executing the early stages of our strategic plan, it became extremely apparent … that our third-shift capacity was really holding us back from being able to execute many of these clinical strategies," Mr. Culligan said.

The hospital's goal was to provide excellent around-the-clock care for all patients, but it had only one pharmacist and two technicians working the 11:30 p.m. to 6:30 a.m. shift — a small number for a 617-bed acute care teaching hospital. They were also handling the various operational tasks Ms. Morrison outlined, so adding more to their workload wasn't an option.

The initial solution was to hire another third-shift pharmacist, for a total of two pharmacists each working seven days on and seven days off. However, it can be hard to fill these positions for multiple reasons: Third-shift pharmacists are expensive and hard to find and the onboarding process for a large academic medical center can be extensive, Mr. Culligan said.

Mr. Culligan's team went to Plan B: use remote models temporarily, budget for two full-time equivalents and then make the transition to internal staffing next fiscal year. But even that plan changed — because of pharmacist input.

"Our third-shift pharmacists strongly felt that they didn't need the additional FTE and that the current model that we implemented — the hybrid model with the onsite [and] remote — was adequate for our current volume and clinical status," Mr. Culligan said.

When they were beginning to build a business case for the staffing solution, his team homed in on three justifications for a new staffing model: improved patient safety, cost savings and existing productivity benchmarks.

Productivity benchmarking was the key to success, according to Mr. Culligan. When compared to like-sized facilities across the country, the hospital's third-shift pharmacists were processing close to twice the average order volume. Mr. Culligan's team emphasized this metric in their business case.

Adding headcount, they said, would benefit patient safety — because existing verification delays were driving an increased percentage of nursing overrides. The business case also revealed that changing to a hybrid onsite and remote pharmacy staffing model could deliver a stronger return on investment.

Evaluating results one year later

With a strong business case that addressed executives' individual priorities, the new labor model was approved. Under the new model, Saint Francis Hospital and Medical Center achieved a 40 percent reduction in order verification turnaround times, as well as a "dramatic" decrease in nursing overrides and "tremendous improvement" in how nurses were vetting higher-acuity orders, Mr. Culligan said.

Additionally, the model was linked to unexpected but welcome improvements in engagement among employees, who were involved in the entire process. Before implementing the new staffing model, the emergency department occasionally reported delays in verification and patient care. There haven't really been any since, according to Mr. Culligan.

"[Even though] traditional staffing models may have been effective in the past," Ms. Morrison said, "there's a lot of hospitals out there that are implementing creative staffing models just like [Mr. Culligan's] that they found can be both cost-effective and really help them align with and achieve hospital-wide safety, quality and cost efficiency goals."

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