Pharmacy Management PHCL-420

TeachersT. Alnajjar- Female Staff (N.A, L.A)

CoordinatorT. Alnajjar

Course Objectives

• To introduce pharmacy students to the followings:• Management activities• Strategic planning• Operation management• Resources management• Quality control• Financial statements• Inventory management• Selected management topics

Introduction To Pharmacy Management

Tawfeeg Alnajjar420-PHCL

• Learning Objectives – Definitions – Management process

• Manager functions • Management resources • Management levels

• Management?– Is the process which brings together resources

and unites them in such a way that, collectively, they achieve goals or objectives in the most efficient manner possible."

– Is the art and science of planning, organizing, directing, and controlling human effort and resources for the general good within the organizational framework and economic environment of the firm.

• Managers:– Simply people who perform management

activities– Anyone who has a task to accomplish or a goal to

achieve is also a manager– Thus all pharmacists, regardless of their job

responsibilities or position, should view themselves as managers!

?.. StudyManagement

• Good business practice and good patient care are not mutually exclusive. In fact, they are almost entirely mutually dependent. • H.C mission: high quality, affordable,

and accessible• Superior patient care and the

implementation of clinical services are made possible by pharmacists who are skilled in management.

• Universal skills (each is a manger)

M. ProcessActivities that managers perform

Resources that managers need

Levels at which managers make decisions.

• Follow 3 dimensions:

Management Process

1. Planning• Predetermining a course of action based on one's

goals and objectives.• The process of attaining objectives• Influenced by the internal and external

environments (PEST)• What should be done?• Services that should be provided to improve patient

care?• formal vs. informal plans (student reading)

M. Activities

• Organizing– The arrangement and relationship of

activities and resources necessary for the effective accomplishment of a goal or objective.

– How it should be done (create structure)• What resources you needs• How you will go about obtaining these resources.• When you will need to obtain them

• Leading– Bringing about purposeful action toward some

desired outcome.– It can take the form of actually doing something

yourself or working with others to lead them to where you want your organization to be.

– Directing– Orienting, training, ordering.

• Controlling– Reviewing the progress that has been made toward

the objectives that were set out in the plan.– Process of comparing results with standards and take

corrective actions only when deviation occurs.– This step involves not only determining what actually

happened but also why it happened.– Performing quality-control checks

Plan

Organize

Lead

Control

Need“Resources”

Money

People

TimeMaterial

information

Apply “Levels of Management”

Self-management“Pharmacist ensuring that every prescription is dispensed”?

Interpersonal management “Pharmacist counseling a patient about a medication”?

Organizational management“Pharmacist planning to add a new service to his chain community pharmacy chains”?

Modern Views

• Have a vision and ideas about what would like to see their organizations become in the future….. Objec.Energize

• Provide the employees with training, resources, and advise and then let them get the job done …. educateEmpower

• Letting their employees know when they have done a good job, as well as helping them to learn when things are not going well… incentive, autonomySupport

• The corner stone of communications is trust … participationCommunicate

…..Not working for money only“motivate: ……

Tawfeeg Alnajjar420 PHCL

Strategic Planning in Pharmacy Operations

Learning Objectives

1. Describe the general process common to all types of planning.

2. Describe the purpose of strategic planning, and illustrate the specific steps to develop a strategic plan.

3. Situational analysis 4. Barriers and limitations to planning.

Planning

In General Planning is purposeful efforts taken by an

organization to maximize its future success.Manager functionsSimply objectives, data, course of action.

Planning ProcessDefine the vision

and missionAssess the current

situation Establish goals

Identify strategies to reach those

goals

Establish objectives that

support progress toward those

goals

Define responsibilities

and timelines for each objective

Write and communicate the

plan

Monitor progress toward meeting

goals and objectives

• Strategic Planning– It is the process of selecting an organization's

goals, determining the policies and programs (strategies) necessary to achieve specific objectives en route to those goals, and establishing methods necessary to ensure that the policies and strategic programs are implemented.

– Purpose is to ensure that the organization is doing the right things now and in the future.

– Addresses what business the organization is in or ought to be in, and helps to determine long-term goals for the organization.

S.PA. Timeline

The time horizon of strategic planning helps to distinguish it from other types of planning.

A key component of strategic planning is to identify time periods within which goals are to be reached.

It may be as long as 10 to 20 years or as short as 2 years. B. Terms

a. Visionb. Missionc. Goald. Objectivee. Task

Vision Statement Vision is what the pharmacy organization wants to

be at some future time point. It should make people think and motivate them to create

a better future for the organization. It is used in the planning process as both the beginning

point and the end point (begin with the end in your mind)

Once the vision is set, then strategic planning is about how to reach that end point.

For example…... (next)

• Examples• Hospital pharmacy

1. Patient Care: to be an integral member of the healthcare team responsible for the outcomes associated with the medication use process.

2. Education: fostering an environment designed to advance knowledge of the rational use of medications.

3. Research: making sound decisions supported by evidence based medicine through research on medication use and patient safety.

Mission Statement Mission is the purpose of the company. Mission statement defines what the company

does or is. It focuses on the common purpose of the organization

and may draw from the values or beliefs held by the organization.

It should help to differentiate the company from others that provide the same products or services.

Some organizations include in the mission statement not only what the company does but also how it does it.

The following elements suggested in developing a mission statement for a community pharmacy:

1. Intended customers2. Key services and products provided by the pharmacy3. Core values of the pharmacy (such as compassion,

respect, and confidentiality), 4. Benefits incurred by customers (such as improved

health and improved safety), 5. Desired public image of the pharmacy

Vision and Mission

A.Company slogan vs. mission statement.

Vision, mission, and other statements that form the company story are critical elements in strategic planning. If these elements already exist in the organization,

then the process of strategic planning starts with these as its foundation or modifies them as necessary.

If these elements do not already exist, then the process of strategic planning must include their conception.

Pre-planning Phase

Planning Phase

Post-planning Phase

Preplanning Phase Planning for the planning Preplanning will define:

1. The objectives of the planning2. Who should be involved3. Where the planning process will occur4. How much time will be allotted to the effort.

Planning Phase Start with the destination in mind:

The "destination" is the vision of the organization in the future.

Perform situation analysis To identify where, what, and how the

organization is in the present. It should consider both the past performance

and the current situation.

Planning Phase: Situation Analysis

SWOT analysis A common method for conducting the situation analysis, identify

using Brainstorming process Internal Factors

1. Strengths – what do we do well? …employee2. Weaknesses – where would we like to improve? … correct or

compensate External Factors

1. Opportunities – what is occurring in our “external” environment that may create opportunity…utilize or did not miss

2. Threats – what is occurring in our “external” environment that we should be prepared for? …. avoid

Planning Phase: Situation Analysis

Strength Weakness

Opportunities Threats

Strategic Planning: SWOT analysis

Positive Negative

Internal S W

External O T

Examples?

Examples Internal S & W

Profitability Quality of pharmacy service Customer service Competence and ability of pharmacy staff.

External O & T Competition from other pharmacy organizations Availability of technology Regulations that may help or hinder the

business, Changes in the market Types of customers served by the organization.

Planning Phase

Bridge that gap By comparing the results of the situation analysis

with the desired future state (vision), the extent and nature of the gap between the two begins to become clear.

Planning Phase Developing the Plan (continued)

Goals Identify long-term outcomes to provide focus for

the planning process Strategies

Outline how you will achieve your goals Objectives

Identify specific, measurable results produced while implementing strategies

SMART criteria

Planning Phase Goals and Objectives Should Be SMART

Specific the objective should state exactly what is to be achievedMeasurable an objective should be capable of measurement – so

that it is possible to determine whether it has been achievedAchievable the objective should be realistic given the

circumstances in which it is set and the resources available to the business

Relevant (Reachable) objectives should be relevant to the people responsible for achieving them

Timeframe objectives should be set with a time frame in mind. These deadlines also need to be realistic

Planning Phase Operate the strategy

Goals and vision are a desired future state that may be unachievable in the short term

Intermediate objectives are needed to help advance toward that target.

Objectives pertinent to each goal should be identified

a budget, schedule, and responsibility should be assigned to each objective.

The relationship between vision, goals,strategy, and objectives

Present

Vision

Goal 1 Goal 2 Goal 3St

rate

gy #

1

Objective 1C

Objective 1B

Objective 1A:TasksTasks Time

Planning Phase Write the Plan

The document must contain the following key elements:

1. The organization's vision2. Strategies3. Goals for each strategy4. Objectives required to meet those goals5. Tasks or action plans to compete the objectives.

Post-planning Phase This phase includes three vitally important

steps:1.Communicating the plan: the strategic plan

document2.Implementing the plan: operational planning

(tactics)3.Monitoring progress and assessing results once the

plan is implemented.

• Barriers to Planning1. Failure to commit sufficient time to planning 2. Interpersonal issues such as struggles for power or

politics and individual or group resistance to change3. Lack of planning skills4. Failure to plan far enough into the future5. Constantly changing environment6. Lack of support by top corporate executives and the

board of directors 7. Failure to implement owing to: lack of time or

resources, or failure to monitor progress Management by crisis?

Limitations to Planning1. Planning is to some degree guesswork,

risk is still involved. 2. Plans and predictions are only as good as

the data and information that go into them. Poor data will result in poor strategy.

3. How an organization implements the plan: Planning is not a substitute for action The plan should not be considered as static or

unyielding

Conclusion

General Operations Management

• General Operations Management– Operations:

• All activities (output)performed by the org. to transform resources into valued, profit-generating goods & services

– Operations management: • The management of such activities

or the critical decisions that need to be made by operations managers.

• Pharmacy Outputs• In tangible ……..services • Tangible …..goods

• Tangible inputs: can be seen or touched & their quality may be evaluated (goods are tangibles)

• In the creation of goods, there are many intangible , non- product inputs as well as the tangibles such as:

• Speed• Proficiency• interaction with patients (assistance?)

• All of which will influence retaining the pt. for the future

• In community pharmacy:– Common example of services:

• Packaging • Adding information• Billing insurance co. All of which add value to the product.

– Resources →Services is NOT easily understood• Providing info. must:

– Recall info. or Look it up & – Apply info. to pt. or communicate info.

clearly

• Community Pharmacy Practice:– Prescription meds. Filling based on Dr.s’ orders– Compounding– OTC meds– Nutritional supplements– Offering & fitting durable medical equipment– Info. about Rx , OTC meds. & nutritional supp.– Health & beauty aids– Disease-state mgt.– DUR– Counseling on drug use– Adjudication of claims with insurance co.– Screening for Dis

• Institutional Pharmacy Services:– Prescription meds. Filling based on Dr.s’ orders– Compounding– IV meds. & solution preparation– Meds delivery to floors– Oversight & inventory of controlled substances– Order collection from floors– Drug event monitoring– Formulary mgt.– Therapeutic interchange– Rx med counseling– MUE– Rx med carts filling– DI to h/c providers– TPN & PN– Emergency crash carts stocking– PK dosing– Clinical drug trials

• The outputs of a business – Justify its existence.– Categorize it → pharmacy business provide safe,

effective and economic medicine – Driven by decisions made by owners or managers taking

into consideration:• Consumer opinion (need, want)• Mission

– Mission defines the reason for the business’s existence & communicates the advantages it has in the G & S it offers

– Owners or managers can: add, enhance, eliminate, or change the G & S offered which need strategic planning

– Strategic planning can assist in identifying the internal & external factors faced by the business: strengths, weaknesses, opportunities, and threats

• Typical Pharmacy Inputs (Resources):– Examples of Resources Used to Fill a Prescription:

• Rx meds• Pharmacist who ordered Rx meds• Delivery service provided by wholesaler• Technician who stores meds• Shelf where med. sat until used • Vial used• Computers used• Service offered by insurance co.• Label printed by comp.• Software used by computer• Phone line used• Clerk who rung the Rx• Register used• Counter• The pharmacy facility• Electricity & other utilities used by pharmacy

• Resources– Each of the resources plays a critical role in

transforming the med. received by wholesaler to med. dispensed to pt.

– Many of such resources are transparent (taken for granted) i.e. electricity

– The resource influences the efficiency & ability to perform activities in Rx filling

– Some resources are not critical but ↑ efficiency & ultimately profitability of process i.e. shelving units

• Operations Management:1. Designing G & S 2. Strategies processing 3. Managing quality 4. Location strategies 5. Layout strategies 6. Human resources 7. Scheduling8. Supply chain-management (inputs)9. Inventory management 10. Maintenance

• Planning plays critical role in development of G & S.– Based on analyses of internal & external environments

determine 1) the needs in the market, 2) capabilities of the pharmacy.

• To be in line and consistent with consumers needs & wants:→↑chances of profitability

• Products• Goods: tangible (held & touched)

• Except for compounding, designing goods → up to manufactures (seperable: not influenced by C)

• ↑ Opportunities to design innovative & creative services to accomplish the goals

1) Designing product (Goods & Services)

• G &S– Services: intangible

• Experienced by consumer• The offering of services will affect multiple aspects of

pharmacy’s operations , i.e. marketing, production, delivery, internal communications (influence the day to day processes used to offer G & S to customers).

– Services can be designed in 3 different approaches:1. Customer Service (way C handled & treated)2. Product Services (S that add values to the product:

way Rx introduced to patient)3. Service Product (MTM)

– Each always provide intangible

– The operations process involves many steps.– The order in which steps are performed →influence

efficiency of operations → influence profitability (e.g. filling Rx drug not put on the shelf yet)

– Differentiate between• Process used to create goods → customer is not

likely to be involved• Services → customer may be integrally involved

(waiting for Rx to be filled)– The process have specific capacity, determined by the

resource that imposes the greatest limitation on the process (BOTTLENECK)

– To increase capacity → Identify & eliminate bottleneck & other externals to avoid →↓quantity of goods created & services provided

2) Process Strategies

• Example: – A pt. is waiting for a refill in a limited space

of a crowded pharmacy.» Solution: Line up each pt med. Refills so that pt

can get all his meds once a month & contact every pt before Rx is due to be filled.

– This will allow for:1. Pt to discuss his med problems with

pharmacist2. ↓the need to maintain a large inventory3. More control over the pace of filling Rxs4. ↑pharmacist contact with pt5. Significantly ↓ pt traffic in pharmacy

• A flowchart – Diagram of the steps involved in creating & offering G & S)

→ helpful in:1. Analyzing the resources used

2. Designing the process3. Identifying & evaluating the capacities of

each element of the process4. Identifying the areas that can be improved

→improve efficiency5. manage the quality

– The more detailed the diagram is → the easier it is to evaluate the time & resources necessary @ each step of the process (flowchart for filling Rx)

• Measuring quality is very important & depends: Depend on kind of G & S provided. – Quality of goods can be based on objective

standards (i.e., quantity of active ingredient)

– Quality of services can be based on subjective standards (quality of DI provided)

– Services , although intangible → need to be evaluated

3) Managing Quality

• Two Types of costs associated with quality:1. The cost of maintaining quality:

1. Prevention Cost: Result from the use of resources

( time & personnel) to prevent errors from occurring e.g. training employees & use of technology2. Appraisal Cost:

Result from the use of resources to inspect, test & audit to identify a drop in quality of service or product.

2) Cost associated with poor service quality: a. Internal Failures: Errors or defects that are identified & rectified before consumers receive the product or service (e.g., a mistake in labeling) b. External Failures: Errors or defects in G or S that are actually delivered to the consumers & frequently identified by consumers (wrong med). Take much more time & money to correct

Can affect: How easily & efficiently the inputs for

operations can be acquired How easily the outputs of operations

can be transferred to consumers of these outputs

Which outputs are chosen to be offered by a given business ( designing of G & S )

4) Location

• Examples:– Conductive to attracting qualified

pharmacists to work there– Proximity to consumers (busy metrplex &

requires public transportation → pharmacy has no stock → pt inconvenience → ? Return

– Large population that need drive-thru window (mothers with sick infants)

– If located near people who need its products → ↑chance of attracting them to the pharmacy ( dermatologic clinics )

– Location of various G & S within the pharmacy

– Designed to maximize efficiency of processes conducted to create G & S

– Counseling area– Patients’ movements through the

pharmacy

5) Pharmacy Layout

– Examples of evaluating tools to determine HRs needed to accomplish the operations:

• job design• job analysis

to make good decisions about the HRs needs for specific operations

– Supply & demand → may prevent finding enough efficient pharmacists

– Environmental factors may cause higher pay, better working hrs, or better benefits

– Motivated, productive & competent pharmacists → greater profitability

– Training on their responsibilities is important (phone ring)– HRs play a big role in transformation of inputs → outputs

6. Human Resources

– Regulations → licensed pharmacists present during pharmacy working hours

– Individual work preference– Scheduling support staff ( chart demand)

using computer system → most help needed with greatest Rx filling (careful planning, evaluation of sales, volume trends)

7) Scheduling

• Chase strategy: Personnel available when predicted demand is greatest (after a weekend)

• Level Scheduling: to provide a level amount of production so that a constant workforce can be employed to handle the demand day after day & week after week (preparing IV solution)

• Forecasting Strategy: Forecasting demands for G&S requires use of info, mathematical functions & statistical analyses

• Scheduling the delivery of orders is important (@ night or when closed or not busy) requires relationships with →suppliers

• Supply chain is the chain of business that supply the pharmacy with necessary inputs.

• Wholesalers: The primary vendors; they distribute the majority of prescription drugs in the USA.– Should have relationships with reputable

companies that provide reliable services.– Some chain pharmacies receive goods from

distributors they own + wholesalers

8) Supply-Chain Management

• Services may include:– Electronic order submission– Next-day delivery service– Private-label programs– Advertising programs– Special-handling services– Pharmacy computer systems– Pricing– Store planning

• Key elements in choosing suppliers:– Timely delivery of needed & properly stored meds

by licensed & reputable wholesalers @ best price– Wholesalers: (difference in services &

authorization)– Large full-service– Regional– Smaller– Secondary– Different types may be used to meet different

needs

– Too much inventory: money sitting on the shelves

– Too little inventory: insufficiency in the system

9) Inventory management

10) Maintenance:

Human Resources Management Functions

Tawfeeg Alnajjar2015

• Outline – Human Resources management (HRM)

definition– HRM tasks:

• Recruitment and placement• Training and development • Performance feedback• Termination of employee

• Human resources management (HRM) is the process of achieving organizational objectives through the management of people

• Tasks associated with HRM include recruiting, hiring, training, developing, and firing employees

• Why HRM is critical to the pharmacy profession?– It can make the difference between a smoothly

running pharmacy and a dysfunctional, unsuccessful one

– When HRM tasks are done well, pharmacy employees know their responsibilities and receive sufficient feedback to meet them successfully

– Many pharmacists are capable of much higher performance levels than they are providing currently

– Many problems in the pharmacy profession result from the fact the pharmacists are often poorly managed e.g.:

• Job stress and burnout• Dispensing error• Pharmacist shortage

• Recruiting and Placement – Each employee represents the org. & the

profession– Pharmacy clerks, technicians, and pharmacists are

more likely to determine a pharmacy’s image than any advertising or promotional events

– A good pharmacist can generate significant revenue for a firm by maintaining a loyal patients base and drawing others from competitors.

• Recruiting and Placement– Choosing the wrong employee for a

position can be quite expensive!– If that employee leaves after a short

time, the employer must bear the cost of recruiting, selecting, and training a replacement.

• Recruiting – The purpose of recruiting is to attract the

most qualified candidate to interview for vacant job positions

– Recruiting is easer when employers are proactive.

– Proactive recruiting :• Continually recruit and network• Maintain pleasant work environment • Establish positive image in the minds of

potential recruits

• Recruiting Methods– Develop contacts in professional meeting,

and social gatherings. • Pharmacy students

– Advertisements• Ads media (newspapers, professional journals,

internet)• Targeting an appropriate demographic• Keep the written ads simple, no false promises

and it should only capture the eye of qualified candidates

Placement

Application

Screening

Interviewing

Selecting candidates

Hiring

• Placement: Application– To help screen unqualified candidates– Provide background about the

candidates for the interview

• Placement: Screening– To weed out unqualified applicants from

the pool of potential candidates– Common screening criteria

• lack of job qualifications (license, degree, experience)• poorly completed applications (misspelling, missing

information)• negative history (felony conviction, frequent changes in

employment)

Placement: Interviewing Preparation

Send info about the position to the candidate

Identify interview objectives

Review the position description and

performance standards

Develop a list of interview questions

Study the applications and

resumes

Schedule a quite, uninterrupted

interview

Placement: Interviewing Types

•To engage candidates in general discussion about themselves

Traditional interviews

•Assess candidates’ problem-solving capability and communication

Situation (role-play) interviews

•Discern candidate preparation and ability to handle stress

Stress interviews

•To predicts future behavior from past behavior

Behavioral interviews

• Example of interview questions– Tell us about your self?– What are your strengths & weaknesses?– Why would a women like you want to work

here? – You are the pharmacy manager, and one

your employees has just told you that another worker is stealing merchandise. What would you do?

Interview checklist • ____Good first impression (introduce self) • ____Relaxed, composed, in control • ____Good posture (positive body language) • ____Good eye contact (looks at interviewer in eyes) • ____Show confidence • ____Exhibit enthusiasm • ____State selling points well • ____Freely volunteer information • ____Speak clearly and loudly enough • ____Get information on salary in right way • ____Good answer to "Why should we hire you?" • ____Ask questions • ____Ask about "call back"--time and date • ____Close interview nicely (thank you, etc.)

• Placement: interview common mistakes– Lack of preparation from the manager– The interviewer does most of the talking and

does not give the candidate an opportunity to speech

– Interviewers treat the interview as an inquisition designs to squeeze the candidate into revealing his/her flaws

• Selecting candidates– Keep a good notes about each candidate immediately

after the interview & develop an interview checklist– Interview mistakes that may immediately exclude a job

candidate from consideration:

Arriving late Dressing inappropriate

Poor body language Arrogance

Self-serving questions Irritating speech patterns

Failing to answer questions

• Selecting candidates– The final choice of the interviewer often

comes down to how well a candidate can address the following questions:

• Can this person do the basic job ?• How well do the candidates skills and capabilities

mesh with the org’s needs?• Will the candidate make my job easier?• Would I want to work with this person?

• Hiring – Hiring is just the first step in the HRM

process– Employees must be given the training

and feedback necessary to do their job

• Training & Development– Excellent pharmacy services organizations invest

in the training & development of their employees– Training benefits both:– The organization: improve the quality &

quantity of work– The employee: more interesting & meaningful

job and lead to greater morale & sense of accomplishment

• Training & Development– Training to improve employee

performance with current tasks and jobs (essential for meeting current need )

– Development prepares employees for new responsibilities and position (investment in future needs)

Training

Types

Orientation training

Job training

Job rotation

Training

Type Objective Example

Orientation training

Welcome new employees, present a positive 1st impression, provide inf. that will permit them to settle into their new responsibilities

Coworker introductions, a tour of the facilities, review of departmental policies & procedure, demo of the computer system

Job training

Helps current employees learn new inf. and skills to do their jobs and refresh capabilities that may have diminished over time

CEP, develop new habits (time management), skills (BP monitoring), procedures (handling drug insurance claims)

Job rotation

Give an individual broad experience through exposure to different areas of the org.

Outpatient dispensing, IV admixture , satellite pharmacy units, inventory management

Development

College courses, multiday seminars, residences, fellowships

What is my

present situation?

Where do I want

to be?

What skills, knowledge, and training do I need to get where I want to be?

Performance feedback

Types of feedback

Day-to-day

Annual performance

reviews

ad hoc performance

reviews

Performance feedbackDay-to-day feedback– Practice management-by-walking-

around (MBWA)– When practicing MBWA:

• listen more than talk• Focus on the positive • Take notes • Make individuals see your presence as

helpful

The purpose of MBWA is to assist and support Employees, not to criticize and inspect their work!

• Performance feedback– Annual (or semiannual) performance

reviews• Act as long term planning sessions• Managers help employees to review their

previous progress, identify successes and areas that need improvement, and establish goals and objectives for the next year

• Performance feedback Ad hoc performance reviews– Reviews scheduled ad hoc in response to certain

particularly good or bad performances– Good ad hoc reviews provide recognition for

outstanding performance and may be accompanied by some award or gift

– Bad ad hoc reviews address unacceptable employee behavior or performance immediately

• Progressive Discipline– A series of acts taken by management in

response to performance be employees– Responses by management to undesirable

behavior become progressively sever until the employee either improves, resigns, or is terminated from the position

– The aim to make explicit to an employee the consequences of unsatisfactory behavior in order to encourage improved behavior

Progressive Discipline

• Formal oral reprimand about the consequences of failing to perform as expected

Verbal Warning

• Termination of Employees – Situations for terminating employees

1. New employee can be terminated at any time during the probationary period if it is clear that he will not succeed in the job

2. Employees who commit acts that can be lead to immediate termination (fighting, stealing, alc. use)

3. Employees who do not fall into 1&2, termination should not come as a surprise and every step leading up to the termination must be appropriate and documented

• Conclusion– Good HRM is an important requirement for

providing excellent pharmacy services– Pharmacy personnel who are well

managed are more likely to be satisfied in their jobs, effective, and productive

Organizational Structure and Behavior

Tawfeeg Alnajjar2015

Learning Objectives • Discuss the field of organizational behavior and its development over

time.• Describe the basic components of traditional and newer organization

forms.• Compare and contrast different elements of formal organizational

structure.• Discuss the basic incompatibilities between organizational and

professional models of structure.• Identify influences on pharmacists' job satisfaction, organizational

commitment, job stress, and job turnover intention and organizational identification and how they affect organizational behavior and performance.

• Describe the role of emotions in organizational behavior.

What Is Organizational Behavior?

• An organization is a group of individuals working to reach some common goal.

• Organizations can be very small in numbers of personnel (fewer than three) or very large (more than 5,000).

Organizational Structure and Behavior

• It is the systematic and scientific analysis of individuals, groups, and organizations– to understand, predict, and affect human behavior to

improve the performance of individuals– ultimately affects the functioning and success of the

organizations in which they work

Organizational Structure and Behavior

• To be effective, managers must be able to: – understand why people in their organizations

behave in certain ways.– to take corrective action if problems arise. – predict how employees will react to new

technologies and changes in the marketplace

Organizational Principles

Organizational Principles

• To understand an organization requires knowledge of its purpose or reason for being.

• Organizations do not function in isolation. They are created to meet some need in the external environment. – The center of any organization is a set of values that form the reason

for existence, the philosophy, and the purpose of the organization – Articulations of these values often are represented as the goals of

the organization. – To make the goals of the organization a reality, a structure must be

put in place to make the organization operational. • Typically, the structure includes such concepts as reporting relationships,

communication patterns, decision-making procedures, responsibility/accountability, norms, and reward structures.

Organizational Principles

• Structure produces the climate, or the psychological atmosphere of the organization – The climate of an organization consists of such

factors as the amount of trust, the levels of morale, and the support employees experience

– Organizational climate is often confused with organizational culture

Organizational culture

– The system of shared meaning held by members that distinguishes one organization from another

– It refers to beliefs regarding how "things are done around here“

– Managers are essential in creating the culture, which influences interactions among coworkers and relationships with patients

Organizational culture

– A strong culture will have a greater effect on the climate because the high degree of sharedness and intensity creates an internal climate of high behavioral control

• Assessing an organization's culture will assist in determining how the organization is responding to both its internal and external environments.

Assessing Organizational Culture

• Wide range of tools exist to assess organizational culture, including techniques ranging from observation, informal interviews, and attending meetings to the administration of carefully developed survey instruments.

– An example of such an instrument is the Competing Values Framework.

ORGANIZATIONAL STRUCTURE

Organizational Structure Aspects

Differentiation

Formalization

Others

Centralization

Organizational Structure Aspects : Differentiation (Complexity)

• Refers to the degree to which units are dissimilar.

• Types:– Horizontal– Vertical– Spatial

Organizational Structure Aspects : Differentiation (Complexity)

• Horizontal Differentiation– It describes the degree of differentiation based on

how many different types of either people or units are included in the organization.

– It can also take the form of multi ownership of a variety of related industries.

Organizational Structure Aspects : Differentiation (Complexity)

• Vertical Differentiation– It refers to the depth of the organizational hierarchy. – One key feature of an organization is the chain of

command, or the number of levels between the owner or president of the organization and the staff.

• Vertical differentiation is represented by an organizational chart.

Organizational Structure Aspects : Differentiation (Complexity)

Organizational Structure Aspects : Differentiation (Complexity)

• Spatial Differentiation– It is the degree to which the location of an

organization's units is in one place or spread across several locations.

– A large health system or chain pharmacy operation can have multiple units spread across a city, or entire regions of the country.

– It also can occur when different departments are located in different areas e.g. pharmaceutical manufacturer

Organizational Structure Aspects : Formalization

• The degree to which jobs in the organization are standardized

• It include the presence of rules, procedural specifications, technical competence, and impersonality. – Standardize procedures to reduce errors and

increase efficiency.

Organizational Structure Aspects : Formalization

• The degree of formalization can vary considerably within and between organizations:– Positions that make up the organization can have very detailed

job descriptions, whereas other organizations are less formal and do not have written job descriptions or vague descriptions.

– Individuals who are higher in the organization will have less formal job descriptions than those lower in the company.

– Some jobs also lend themselves to more or less formalization. E.g. drug procurement and dispensing are highly formalized, but the individualized services that pharmaceutical care requires leave much discretion to the individual pharmacist.

Organizational Structure Aspects :Centralization

• The extent to which decision-making is concentrated at a single point in the organization: – Usually the very top levels of management make most

of the policy decisions in a centralized organization. – More recently, the trend has been to decentralize

decision-making and move it down to lower levels of management or to staff-level employees.

– Problems arise when employees are responsible for achieving goals without the authority to make policies or gather the needed resources.

Organizational Structure Aspects:Centralization

• Centralization sometimes is confused with spatial differentiation.– E.g. hospital pharmacy that has satellite

pharmacies located throughout the hospital?!

Organizational Structure Aspects:Division of Labor

• Divides work tasks into specific parts. – E.g. pharmacists responsible for dispensing functions or clinical functions. – clinical pharmacists, can specialize in a particular field.

• An advantage is more efficient use of the specialized skills of the individual.

• The professional may become very narrow in his or her abilities, and the job could become routine.

• Enlarging rather than narrowing the scope of some jobs leads to greater productivity by using employees with interchangeable skills – This can be seen in the hospital setting, where pharmacists provide both

traditional staffing functions on certain shifts and patient care (clinical) functions on others.

Organizational Structure Aspects : Unity of Command

• An individual reports to only one supervisor, to whom he or she is responsible.

• As pharmacy organizations have tried to decentralize, employees may have more than one person to whom they are reporting.

• A structure that makes the most of this concept is called a matrix organization. – A matrix organization integrates the activities of different specialists

while maintaining specialized organizational departments – This type of structure works well in environments that are continually

changing and in need of innovation. – It also works well when people are required to get together in

interdisciplinary terms

Organizational Structure Aspects : Unity of Command

Organizational Structure Aspects : Unity of Command

• Pharmaceutical manufacturers and cross-disciplinary teams in hospitals (e.g., nurses, physicians, pharmacists, and social workers) are particularly well suited for this endeavor.

• This allows for diversity of ideas and for the best possible solution to emerge.

• The negative side:– employees don’t prefer reporting to more than one

supervisor– confusion as to who is responsible for what can develop

Organizational Structure Aspects : Span of Control

• How many people a manager effectively controls.• In pharmacies, we can see a wide variation in the number of

individuals a pharmacist supervises. – One pharmacist can supervise only one or two technicians in the pharmacy– or the pharmacist can manage the entire store, including non-pharmacy

personnel. – Recently, there has been a push to increase the span of control of managers – Drawbacks to small spans of control:

• They are expensive because they add layers of management,• complicate vertical communication by slowing down decision-making, and

discourage employee autonomy because of the close supervision by management. It is also felt that highly trained employees do not need as much direct supervision

Organizational Structure Aspects : Departmentalization

• Grouping individuals according to specific tasks.• The advantages of having departments is that

the individuals share a common vocabulary and training and expertise. – This should increase efficiency and effectiveness of

the unit. – For example, persons responsible for purchasing,

distributing, and managing drug products could constitute a department.

Organizational Structure

Simple structure

Machine bureaucracy

Professional bureaucracy

Divisional structure

Adhocracy

Organizational Structure

1. Simple structure is one in which a single person runs the entire organization.– Example: independent community pharmacy.

• This type of organization is quite flexible and can respond to the environment quite quickly

• It is also quite risky because the success or failure of the business depends on one or two individuals.

Organizational Design

2. Machine bureaucracy is a highly complex formal environment with clear lines of authority.

– Example: mail-order pharmacy

• This type of organization is highly efficient in performing standardized tasks

• It may be dehumanizing and boring for employees.

Organizational Design

3. Professional bureaucracy is one in which much of the day-to-day decision-making is vested in the professionals who carry out most of the work.

• In this type of structure, there are many rules and regulations that may inhibit creativity.

– Example health system pharmacy. • The positive side of this structure is that it allows

professionals to practice those skills for which they are best qualified.

• On the negative side, these professionals may become overly narrow, which may lead to errors and potential conflicts between employees

Organizational Design

4. Divisional structure is one that consists of a set of autonomous units coordinated by a central headquarters.

• In this design, divisional managers have a lot of control that allows upper-level management to focus on the "big picture.“

• A negative side of this structure is duplication of effort.

– Example: college of pharmacy that is structured around the various disciplines of the pharmaceutical sciences

Organizational Design

5. Adhocracy which is very informal in nature. There is very little formalization and centralization.

• Most of the work is done in teams.– Example the research and development

department of a pharmaceutical company. • This type of design fosters innovation but can

be highly inefficient and has the greatest potential for disruptive conflict.

Pharmacists' Organizational Behaviors

• Examining pharmacists' work-related attitudes and behaviors is important to improve the positive and decrease or minimize the negative actions of employees.– Increased absenteeism, tardiness, and counterproductive behaviors will

decrease organizational productivity and performance significantly. This has the economic consequence of decreasing the profitability of the organization.

– An unhappy coworker also can make the work environment unpleasant for other workers, the entire day seems longer and more stressful.

– Negative organizational attitudes also can compromise patient care. – An unhappy or dissatisfied pharmacist may be less motivated to keep skills and

knowledge levels current. – Job dissatisfaction also has been found to be associated with an increased risk of

medication errors.– The physical and mental health of the pharmacist also can suffer, owing to the

stress of working in an unappealing pharmacy environment with a heavy workload.

Pharmacists' Organizational Behaviors

job satisfaction

organizational

commitmentjob stressjob turnover.

Job Satisfaction

• An emotional response or a comparison between expectations and the perceived reality of the job as a whole.

• Predictors of job satisfaction:– performing more clinical or non distributive work activities– higher levels of autonomy– recognition– good environmental conditions – professional commitment– working in an independent pharmacy environment

• Enhanced job satisfaction leads to more positive feelings toward the employing organization

Organizational Commitment

• An emotional attachment and accepting the organization's goals and values, putting forth effort, and wanting to maintain membership.

• Organizational commitment is important because it is related to reduced job turnover.

• Organizational commitment is enhanced when:– Clinician receive appropriate compensation and benefits – have access to important organizational information, resources

to perform the job– opportunities for advancement within the organization– organizational support

Job Stress

• Role stress in the form of role conflict, role ambiguity, role overload, and work–home conflict increases job stress.

• Stress that continues to be ignored can lead to a phenomenon known as burnout.

• Support, recognition and collaboration help people focus their energy more effectively, justify their involvement and extend their achievements. Consequently this leads to a more robust organization and lessens burnout

Job Turnover• The decreased productivity from voluntary turnover is very costly

to an organization because :– less experienced workers must be used to replace the more experienced

workers who leave.– Advertising, recruiting, and training a replacement employee for

someone who has left – In a time of shortage of available employees, it is important to retain

existing employees. • Reasons pharmacists gave for leaving were related to

– working conditions: inflexible and long working hours and inadequate support personnel. Other reasons for leaving an organization relate to job dissatisfaction, role stress, and culture and climate factors

– Personal variables– Market conditions

Emotions

• Emotions are intense feelings that are directed at someone or something

• Health care organizations put more emotional demands on employees and patients than many other organizations

• Emotional regulation in the workplace has been termed emotional labor.

• Emotional labor is defined as expressing organizationally desired emotions during service transactions

• Individuals who have the ability to take another's perspective or to know what another is feeling (empathic concern) or who generally express or feel positive emotions (positive affect) will have less of a need to expend emotional labor

Quality In Pharmacy Operation

Nahla A Alageel1st semesterNov 2014

Learning Objectives• Discuss the importance of quality in pharmacy practice.• Describe how quality is measured in pharmacy practice.• Explain the differences between quality assurance, quality

control, and continuous quality improvement.• List three methods for ensuring quality in pharmacy practice.• Outline the steps necessary for a successful continuous

quality improvement plan.• Prioritize areas/functions most suitable for conducting a

quality analysis.

What Is Quality?

• Webster's Dictionary defines quality as a "degree of excellence"

What Is Quality?

• The Institute of Medicine (IOM) Definition– Quality of care is the degree to which health

services increase the likelihood of desired health outcomes and are consistent with current professional knowledge

Quality in Pharmacy Practice

• Represents degree of excellence• Increases probability of +ve outcomes• Decreases probability of -ve outcomes• Corresponds with current medical knowledge• Offers patient what he wants• Provides patient what he needs

How is Quality Measured?

• By assessing: 1. Structure: raw materials needed for

production (e.g. RPh, meds in stock)

2. Process: the methods or procedures used (prescribing, dispensing, monitoring)

3. Outcomes: the end result or end product

How is Quality Measured?

• ECHO Model purports three basic types of outcomes:1. Economic (includes directed and indirect costs and

consequences)2. Clinical (morbidity, mortality, event rates, symptom

resolution)3. Humanistic (quality of life, patient satisfaction)

What Can Pharmacy Learn from Other Industries?

• Health care traditionally has lagged behind other industries in quality improvement.

• Health care system can improve the quality of care by borrowing techniques used in other industries to standardize processes.

• Various organizations have turned to a systems view of quality improvement termed human factors principles

Human Factors Principles

1. Reduce reliance on memory2. Simplify and standardize3. Use protocols and checklists4. Use constraints and forcing functions to physically

prevent errors5. Improve access to information6. Decrease reliance on vigilance7. Differentiating 8. Implementing automation

Human Factors Principles

• Standardization– simplest, most broadly applicable and most

effective method in pharmacy*Quality improves as variation is reduced

Methods for Ensuring Quality in Pharmacy Practice

Quality AssuranceQuality Control

Continuous Quality

Improvement

Quality Assurance (QA)

• Systematic monitoring and evaluation of various aspects of a system to determine if they conform to standards

• Basically, a check is performed to ensure that a good or service meets a certain quality standard.

• Problems are addressed after they occur

Quality Control (QC)

• An aggregate of activities designed to ensure adequate quality

• Quality control improves product or service design to improve the level of quality

• It can be thought of as defect prevention.

Continuous Quality Improvement (CQI)

• Continual improvement of all processes in a system to meet or exceed customer expectations – AKA Total Quality Management (TQM), Quality Improvement Process,

and Total Quality Control

• CQI two important aspects:1. Total systems perspective concerning quality.2. The quality improvement process is continuous.

Examples of CQI in Pharmacy

• Develop, implement, revise, and improve compliance with clinical guidelines

• Monitor medication errors• Improve prescription writing• Implement new technology• Decrease ADEs• Implement and improve pharmacy services • Improve pharmacist interventions

A CQI Improvement Model

• Many CQI models exist.• Examples of specific models include:

• Plan, Do, Check, and Act (PDCA) model • Find, Organize, Clarify, Understand, Select, Plan, Do,

Check, and Act (FOCUS-PDCA) model

• Most models include elements that reflect the following core concepts:– (1) plan, (2) design, (3) measure, (4) assess, and (5)

improve

The CQI measurement cycle.

Background

Methods

Results

Conclusions & Recommendation

s

CQI Cycle Background

CQI Cycle BackgroundSelect a focusDescribe the focus:

description of the area, the setting, the portion of the medication use process affected, and baseline data.

Sate focus importance: It should be considered high priority, high volume, high cost, or high

riskRelate focus to literature:

discover techniques, interventions, and other tools that have been successful in improving quality in similar situations

Select overall and specific goals: (1) discovery(2) frequency estimation, and (3) measuring a change

The CQI measurement cycle.

Background

Methods

Results

Conclusions & Recommendation

s

CQI Cycle Methods

CQI Cycle Results

• Analyze Data– Most descriptive statistics (e.g., mean, median,

and percentages) often suffice for data analysis.

CQI Cycle Conclusions, Implications, and Recommendations

• This is the "bottom line" of the process, it is important that this section be understandable to those outside the CQI team.

• This section should concisely explain the conclusions and detail the actions that need to take place.

• The CQI process is iterative; thus, the team's recommendations for this CQI cycle and for the next CQI cycle must be included

Quality Standards Organization

• Often quality improvement activities are necessary for accreditation.

• Earning accreditation indicates that an organization has met predefined standards.

• The accreditation process provides a framework to help organizations focus on providing safe, high-quality service and requires that the organization demonstrate to outside reviewers its commitment to continuous improvement

Quality Standards Organization

• The Joint Commission (TJC): – Established to "continuously improve the safety

and quality of health care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations

• National Committee for Quality Assurance (NCQA)

Ensuring Healthcare Quality

Build a system-focused, non-punitive culturePromote a team oriented, systems view of qualityFocus on high risk populations, high risk

medications, high risk processes Implement changes that have worked elsewhereImplement small changes in quick cyclesRemember quality improvement is a continuous

process

Conclusion

• Quality is an essential component of competent, professional pharmacy practice.

• Increasing quality can have many beneficial effects on any practice, such as minimizing rework and increasing productivity.

• Many quality improvement changes are simple and can be implemented quickly but may have a large impact on the quality of patient care.