It's budget development time again! This is an exciting time for directors of pharmacy, because this process represents the best opportunity for the department to request additional staff in order to launch new programs or improve existing programs. Although it really is exciting, it is frustrating at the same time, in that considerable support usually comes from pharmacy leaders, medical staff, nursing staff, and others for the recommended changes proposed by pharmacy, but that support is rarely enough to justify the addition of new positions. Thus, if the proposed staff additions are not approved, the director of pharmacy is obliged to explain why the new positions are not approved to all those who understand the need.
At the University of North Carolina Hospitals, the strongest supporters are the medical staff. Their historical experience in collaborating with pharmacists has rendered them believers. The pharmacist's drug therapy acumen optimizes care, enhances efficiency and accuracy, is invaluable in medical resident training, and promotes cost-effective care. When pharmacy staffs are readily available, they make a positive difference in the patient care process. During the past year, we have contributed to enhancing throughput and improving patient safety and have improved patient satisfaction. Overall, our pharmacists enjoy positions that encompass responsibilities that engender high satisfaction, and, thus, turnover is low.
Despite all of these successesa positive track record in terms of the overall financial performance of the departmentwe never get all of our requests approved.
Again, new programs will be evaluated on expense reductions that can be substantiated or new revenue that can be generated. The dilemma is that we contribute to improvements in financial performance, patient safety, patient and staff satisfaction, and optimal drug therapy outcomes, but differentiating our impact, compared with that of other providers, is virtually impossible. Benchmarking our effectiveness helps, and our leadership understands that we are effective in promoting cost-effective care, but our past performance in all of these advancements is now a baseline expectation, and the assumption is that, like drug distribution and basic pharmacy systems and processes, we should be able to do more with less.
Like many of my peers, we are doing all we can to pull together data that will substantiate our needs from all perspectives possible. My experience, however, is that unless financial implications have a net positive impact, our probabilities of success are marginal. It is becoming undeniable that we need to develop a strategy that enables our staff to charge for their services. This cannot be accomplished at a local level. It will require engagement with government agencies, private payers, and most importantly, patients (who can have a great impact on influencing payers).
How will this advocacy process occur? It will require a carefully constructed strategic plan, data collection from multiple environments that is reproducible, and engagement of high-level decision makers who can influence public policy. We all know the value of pharmacists. Our challenge is how to effectively educate decision makers to invest in professional evolution.
Mr. McAllister is director of pharmacy at University of North Carolina (UNC) Hospitals and Clinics and associate dean for clinical affairs at UNC School of Pharmacy, Chapel Hill.
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