Shane Desselle, RPh, PhD, FAPhA

Pharmacists have many things competing for their time, including vaccinating patients, ensuring patient safety during the prescription dispensing process, and performing consultations, just to name a few. Pharmacists’ performance and ultimately their own well-being on the job can be largely determined by their effectiveness in time management.

Much of pharmacists’ work would appear to be at the behest of supervisors and dependent on workload. However, pharmacists are able to exercise at least some degree of autonomy, even in a more corporatized environment. It is critical to differentiate what tasks must be performed perfectly, versus those that might not have to be perfect yet are still potentially time-consuming, versus those that require neither perfection nor great cognitive load. If someone has seemingly too many tasks to complete, they must consistently vary their schedule so that it maintains a healthy balance between productivity and remaining busy, while also aligning it with your professional goals and the needs of your patients and other clients. The need for perfectionism when it is not necessary, as well as ineffective multitasking, are common time management pitfalls that exacerbate stress and lower performance.

Inefficient time management leads to chaos among pharmacy personnel, unfinished tasks, and the inability to reach personal goals. It not only affects our own physical and mental capacities, but also compromises patients’ wellbeing and safety. An overwhelming amount of work leads to poor customer service and a high occurrence of errors. This erodes trust not only in individual pharmacists, but eventually, the entire profession, in general.

Rhodes et al. assessed the economic impact of a targeted medication intervention program provided by pharmacists in a community setting. They reported that the average time to complete 1 medication intervention was 22.63 minutes, resulting in a return of investment of negative 3%.

 To break even, the time to complete a review would have had to be 21.85 minutes or less.

Many factors could help decrease the time for each intervention. For example, other pharmacy colleagues such as technicians and clerks can be utilized to focus on technical tasks,

 granting time for pharmacists to choose to prioritize and organize their time in providing patient and provider education.

 Furthermore, pharmacists who already have MTM expertise or those in the process of gaining more experience can be employed.

 With decreased time for each intervention, overall work productivity and revenue will increase.

Overall, time management is not just about managing time; rather, it is about managing yourself and others. An achievement-oriented pharmacist practices and improves their time management so as to increase time available to deliver quality services, while also setting the attitude and empowering others to develop this essential skill.

 can be found in Pharmacy Management: Essentials for All Practice Settings, 5e.

 is a PharmD candidate at the Touro University California College of Pharmacy.

 is a professor of social and behavioral pharmacy at the Touro University California College of Pharmacy.

1. Rhodes SA, Reynolds AE, Marciniak MW, Ferreri SP. Evaluating the economic impact of a targeted medication intervention program. J Pharm Pract. 2013;26:562-573.

Desselle SP, Hoh R, Holmes ER, Gill A, Zamora L. Pharmacy technician self-efficacies: Insight to aid future education, staff development, and workforce planning. Res Social Adm Pharm. 2018;14(6):581-588.

Articles

Pharmacists’ performance and ultimately their own well-being on the job can be largely determined by their effectiveness in time management. 

Tip of the Week: Time Management is About Managing Yourself and Others

Pharmacy education typically deals with subjects such as pharmacology, medication management, and patient safety. Although knowledge of these topics is vital to the success of students, a more diverse skill set is necessary for them to excel on rotations and in their future careers.

This focus on clinical knowledge may be thought of as a “uni-professional” approach.

 Although necessary, it can be an impediment to optimal practice when pharmacists are members of a collaborative in which they are expected to work closely with other health care professionals. Beneficial in these settings is the “multiprofessional” approach, with its emphasis on abilities beyond clinical knowledge, that creates effective teams.

 By strengthening their organizational citizenship behaviors (OCB), students can develop useful skills like leadership, good communication, and self-efficacy.

OCB can be defined as voluntary actions that are not part of a formally defined role and are performed without the expectation of recognition or compensation.

 In many ways, OCB mirrors the core values of the Oath of a Pharmacist, in which practitioners pledge to devote themselves to a lifetime of service through their profession.

 Advocating for continual improvement of care, the welfare of humanity, and the advancement of health equity may not be in the formal job description of most pharmacists, but they are behaviors that the best pharmacists exhibit. These OCB virtues can greatly benefit pharmacy students and new graduates.

OCBs can be further broken down into these components: altruism, sportsmanship, consciousnesses, courtesy, and civic virtue, all of which are essential to promoting collegiality while enhancing a group’s or department’s productivity.

 Civic virtue encompasses the behaviors of an individual who is a reliable participant in an organization. Altruism takes civic virtue a step further. Rather than merely completing the minimum of work, individuals exhibiting altruism take the initiative to help others without expecting anything in return. This behavior likely comes from employees who are highly engaged.

Collegiality is the cooperation among colleagues, and sportsmanship describes those behaviors that allow people to avoid conflict.

 Individuals who demonstrate sportsmanship maintain a positive attitude even when they don’t get their way and are not upset when their recommendations are not followed. It is essential for budding pharmacists to develop these behaviors in order to engage in effective conflict resolution, which is an important part of working in a team.

Those who exhibit OCBs are also likely to demonstrate higher levels of self-efficacy and personal initiative. In turn, people who have greater self-efficacy feel confident in their ability to perform tasks and contribute to organizational citizenship through their personal initiative.

 These individuals are more likely to attend voluntary meetings and assist colleagues with work-related problems because they are typically more organized and thus able to accommodate extra tasks. Students and newly graduated pharmacists who demonstrate OCBs will impress preceptors and pharmacy managers with their initiative and positivity.

In addition to greater productivity and better morale, ethical leadership—the modeling of ethical behavior, fair treatment of others, and the putting of ethics into practice

—has also been linked to OCBs. A recent study of nurses found
that ethical leadership was shown to enhance their trust in management and promote psychological well-being, thereby positively influencing organizational citizenship behaviors.

 This finding establishes an important link between OCBs and how contagious positivity translates into the health professionals’ work.

The principles of ethical leadership are not unlike the core values taught in pharmacy school, including beneficence, nonmaleficence, autonomy, and justice. Pharmacy students can go beyond classroom learning and incorporate these principles in their lives and in their leadership style when managing support personnel. Practicing these behaviors makes it clear to others that you are a reliable and valued member of the team who can be looked upon as a role model. In addition, other team members are likely to follow suit and model your behavior.

Pharmacy students can demonstrate ethical leadership by being open to change and by adapting practices to best fit a given situation. They can also adopt a collegial stance during conflict resolution by considering the opinions of everyone involved and being compassionate and fair as they seek a solution.

Applying altruism, sportsmanship, consciousnesses, courtesy, and civic virtue in the workplace can foster interprofessional communication and help students and newly graduated pharmacists further their careers. OCBs create a win-win for students and graduates, their colleagues, supervisors, organization, profession, and the patients they serve.

 at the Touro University California College of Pharmacy in Vallejo, California.

, is a professor of social and behavioral pharmacy at the Touro University California College of Pharmacy in Vallejo, California.

1. Ascione FJ. Preparing pharmacists for collaborative/integrated health settings. 

. 2019;7(2):47. doi:10.3390/pharmacy7020047

2. Yaakobi E, Weisberg J. Organizational citizenship behavior predicts quality, creativity, and efficiency performance: the roles of occupational and collective efficacies. 

. 2020;11:1-18. doi:10.3389/fpsyg.2020.00758

3. Oath of a pharmacist. American Pharmacists Association. Accessed March 11, 2022. https://pharmacist.com/About/Oath-of-a-Pharmacist

Organizational Citizenship Behavior: The Good Soldier Syndrome

5. Podsakoff NP, Whiting SW, Podsakoff PM, et al. Individual- and organizational-level consequences of organizational citizenship behaviors: a meta-analysis. 

6. Huang N, Qiu S, Yang S, et al. Ethical leadership and organizational citizenship behavior: mediation of trust and psychological well-being. 

. 2021;14:655-664. doi:10.2147/PRBM.S311856

Students and new graduates can excel in their career through leadership,
communication skills, and self-efficacy.

Leveraging Organizational Citizenship Behaviors to Impress Preceptors and Pharmacy Managers

Job satisfaction reflects the contentment employees feel towards their job. Many extrinsic factors play a role in determining satisfaction, including salary, promotion opportunities, collegiality with coworkers, and relationship with management.

The level of satisfaction an employee feels can directly affect an organization through engagement levels, organizational commitment, and motivation. Improving employees’ job satisfaction has the potential to benefit the organization as well as the quality of patient care. Satisfied pharmacists are likely to be engaged at work and be more committed to providing optimal pharmacy services.

 While employees’ satisfaction will vary within an organization, organizations will have cumulative levels of satisfaction based on the workplace culture they cultivate.

A recent study measured the principal drivers of pharmacist job satisfaction in the hospital setting.

 The study authors measured 4 main factors through use of a survey, including promotion opportunities, management‑interpersonal relationships, organizational communication, and overall job satisfaction.

 Overall, most pharmacists in the study were satisfied at their job and not intending to leave the organization,

 but pharmacists reported low levels of satisfaction in regard to promotion and advancement opportunities. Relationships with management and organization communication were reportedly sufficient.

However, a different study investigated satisfaction levels among both pharmacists and technicians and revealed that 47% were not satisfied with their job.

 The factors most strongly associated with dissatisfaction were high workload, lack of autonomy, and insufficient recognition and promotion opportunities.

 Like the previous study, there was lack of contentment regarding advancement and promotion opportunities. Most concerning, only 26% of study participants felt their talents were being fully utilized in their current position.

 At the end of the day, the things that many employees value are simply that they be recognized for their contributions and have opportunities for further development.

A recent Gallup poll revealed that 48% of workers in the United States are actively searching or watching for new job opportunities.

 Considering the previously mentioned job satisfaction results, this may not be surprising. However, 52% of employees who voluntarily exit report that their manager could have done something to prevent them from leaving the organization.

Taking preventative action to ensure employees feel satisfied and content in their current position is essential to mitigating turnover. Organizations should consider utilizing “stay conversations” to encourage employee retention and let them know what a future might look like for them upon staying with the organization. By speaking with employees to uncover their career goals, motivations, and what they need to be more successful in their role, managers can form stronger partnerships with staff.

These conversations should be conducted routinely with each individual to offer support and guidance regarding their personal job expectations and goals. By getting to the heart of the employee’s motivations and needs, stay conversations allow the employer to tailor each position to the individual employee, getting them more engaged in the organization and providing the opportunity to learn new skills. It is important to note that these are not single conversations; instead, these coaching sessions should be conducted regularly to build a positive professional relationship with management.

In the second study discussed above, pharmacists and technicians reported that their talents were not being fully utilized by their organization.

 Routine coaching conversations could have revealed this, and management would have the opportunity to work with employees to tailor their responsibilities to utilize their individual strengths, in turn better serving the organization.

By utilizing stay conversations, managers can forge a more personal relationship with their staff, identifying factors that motivate them and offering opportunities that align with their career goals.

 By committing to work with staff to improve their employee experience, loyalty and commitment to the organization is developed. Stay conversations cost only a little bit of time, and managers and organizations should reap a tremendous return on this relatively small but highly salient investment.

can be found in Pharmacy Management: Essentials for All Practice Settings, 5e.

 is a professor of social and behavioral pharmacy at Touro University California.

1. Iorga M, Dondaș C, Soponaru C, Antofie I. Determinants of hospital pharmacists' job satisfaction in Romanian hospitals. Pharmacy (Basel). 2017;5(4):66.

2. Al-Muallem N, Al-Surimi KM. Job satisfaction, work commitment and intention to leave among pharmacists: a cross-sectional study. BMJ Open. 2019;9(9):e024448.

3. Overwhelmed by employee turnover? Have stay conversations. Gallup.com. https://www.gallup.com/workplace/355238/overwhelmed-employee-turnover-stay-conversations.aspx.

4. Hohmeier KC, Desselle SP. Exploring the implementation of a novel care model in the community pharmacy setting. J Am Pharm Assoc. 2019;59(3):310-318.

Proactive retention strategies can improve employee satisfaction and reduce turnover rates.



Tip of the Week: “Stay Conversations” May be a Remedy for Unsatisfied Employees

As stress rises for workers and as more individuals quit their jobs or retire, the concept of burnout has gained attention. As described by the World Health Organization (WHO) in its International Classification of Diseases, “burnout is a syndrome conceptualized as resulting from workplace stress that has not been successfully managed” and is categorized by exhaustion, a low sense of accomplishment and personal impact, and negative feelings toward a job.

In addition to WHO’s definition, there is a common conceptualization of burnout as per the Maslach inventory. 

It consists of depersonalization, emotional exhaustion, and lack of personal accomplishment.

 The culmination of these feelings can cause individuals to lose motivation and decrease quality of their work, which can become dangerous in industries as critical as health care.

Although burnout can happen to anyone in any profession, health care workers are especially vulnerable because of the potential consequences of their actions and the high performance standards and high-stress environments in which they work.

 Health care workers are more likely to experience higher levels of burnout and stress if they are female, unmarried, younger than 30 years, or have low self-esteem, among other risk factors.

 They are also frequently subject to chronic understaffing and an immense workload, especially in the pharmacy profession.

Although there are numerous studies exploring burnout among nurses and physicians, few have focused on pharmacy staff members and even fewer have examined pharmacy technicians.

 This is unfortunate, because technicians may have some of the highest burnout rates in health care. Compared with nurses and physicians—who reported 43% and 50% of professionals experiencing burnout, respectively—the results of 1 survey of health system pharmacy departments reported a burnout rate of 70% among participants.

Results of another study of technicians in Singapore showed that 52% of respondents were clinically categorized with moderate or greater levels of burnout via evaluation of their survey responses, although 81.7% reported feelings of burnout on a subjective level.

 Pharmacy teams receive little attention to their mental health, despite being among groups most vulnerable to burnout.

Results of a study of health care professionals showed that those with postgraduate degrees are less likely to experience burnout, possibly because there is a greater sense of achievement associated with earning such a degree.

 Technicians might not be rewarded properly or shown acknowledgement for their important work, contributing to depersonalization and feelings of a lack of accomplishment, even while laboring in high-pressure environments under intense scrutiny.

Technicians participate in myriad tasks, all of which are vital to effective pharmacy practice. In a survey of certified technicians, those in community settings reported that their most important roles are collecting and communicating patient information and filling and verifying prescriptions.

In the hospital, technicians reported being most involved in packaging and repackaging activities, quality assurance and unit inspections, and restocking automated dispensing cabinets.

 This is not an exhaustive list of responsibilities for technicians, but it does highlight their essential contribution to effective pharmacy services delivery.

Recognizing the efforts of technicians and conveying proper appreciation for their work are important steps in mitigating their burnout, which helps them want to stay with the organization and in the profession. Although technicians report amicable relationships with pharmacists and fellow technicians, many report dissatisfaction with their employers, citing being treated as replaceable, poor pay, and understaffing as major sources of their work stress.

 Technicians who experienced burnout reported decreased sleep quality, higher rates of mental health conditions, lower job satisfaction rates, and more frequent thoughts about changing jobs or careers compared with those not experiencing burnout.

 With such high burnout rates and the potential consequences for personal well-being and work effectiveness, it is important that employers, pharmacists, and other leaders in the profession act to improve the situation.

Work-related burnout and stress were exacerbated by the COVID-19 pandemic. 

It resulted in many health care workers getting sick or becoming anxious about the possibility. This created more staffing shortages even as demand rose at pharmacies because of the roles they play in vaccinations, testing, and treatment. Technicians have, at least temporarily and in some cases permanently, seen an expansion in job responsibilities and scope, due to the pandemic. Under guidance from the US Department of Health & Human Services, certified or state-licensed technicians who received vaccine training have been temporarily authorized to administer COVID-19 vaccines in all states, under the supervision of pharmacists.

 Implementation has been effective and safe, allowing pharmacists to delegate tasks to improve workflow and expanding the role of technicians in serving communities.

 This is a silver lining for the advancement of pharmacy services, yet it remains problematic in regard to technicians’ workloads given their still relatively low pay.

As such, there has been an increase in burnout among technicians, especially in community pharmacies.

 Challenges have included extra work related to COVID-19 involving patients’ questions, access to testing, and new vaccination mandates.

COVID-19 has also exacerbated staff shortages, leading to sick leave, placing more pressure on pharmacists and technicians.

 As a result, there is a larger workload causing more burnout, increased mental and physical fatigue, and weakened immune responses, which can lead to susceptibility to other diseases.

Burnout within community and retail pharmacies has become a phenomenon. 

Some states’ required ratios of pharmacists to technicians do not help matters. Although 22 states do not have a required pharmacist-technician ratio, as of 2020 7 required a ratio of 1:2, and 18 required a ratio of 1:3 or 1:4.10 In view of the pandemic, several states have opted to either relax or suspend these requirements to accommodate the increased workload on pharmacy personnel, which has increased productivity without compromising patient safety.

 As the pharmacy industry continues to expand its role in providing health services, permanently implementing such relaxations may be a crucial step forward in maintaining wellness for pharmacists and technicians.

Evidence-based mitigation strategies include the incorporation of exercise programs, regularly scheduled breaks, and wellness teams to focus on preventing burnout. One example of a wellness team at Rush University in Chicago, Illinois, was created and integrated as part of daily routine. The institution decided to implement organizational strategies to address mental health concerns, but initially there was resistance because of factors such as reluctance to engage with services and stigma regarding mental health concerns.

Health system work environments are not immune to burnout and stressful environments, either. Rush University System for Health created wellness response teams, each of which consists of a licensed social worker, nurse, psychologist, and physician. The leaders of each team conduct quality analyses to ensure that mental health resources, tool kits, and triage are viable. All team members were volunteers from different departments within the institution. Rush University System for Health also appointed a chief wellness officer to coordinate teams and keep track of all services.

 The 4 teams established were engaged in mental health emergency response, mental health intervention programs, wellness consulting services, and wellness rounds.

 After implementing this program, the health system saw an increase in the number of staff members who registered for these services, indicative of the program’s success. Addressing burnout and any associated symptoms such as emotional exhaustion, feelings of depersonalization, and stress can minimize lack of initiative and lost productivity while promoting a positive, safe environment for technicians to grow within their scopes of practice.

There are many evidence-based recommendations and strategies presented in literature that address burnout among health care workers, as well as potential solutions that can be incorporated. However, very few specifically address burnout among technicians. In general, pharmacy managers and owners must recognize burnout as a phenomenon that has short-term and long-term effects. The first step in addressing burnout among technicians is acknowledging that it exists.

Managers should see this as a human condition but also must recognize it from an economic perspective: Employee burnout costs money. Compromised patient safety, customer service mistakes, diminished productivity, errors in dispensing, employee replacement, and heightened legal vulnerability are substantial economic burdens. To avoid these outcomes, managers can balance workload while allowing greater employee buy-in, engagement, and trust in a way that leverages environmental, personal, and situational factors.

 Fostering camaraderie, collegiality, and interpersonal relationships is important in creating a positive workplace culture where burnout is less prevalent. Additionally, managers can help employees further their development in terms of effective coping strategies and emotional intelligence. A public health framework is crucial for implementing burnout prevention strategies.

 Many evidence-based principles have suggested incorporating a prophylactic method of preventing burnout.

Finding and incorporating ways to diminish burnout in pharmacies is challenging but necessary to preserve vitality in the profession. It is incumbent upon managers to create positive, safe environments for technicians, but it is also the responsibility of technicians to maintain their own wellness and seek development opportunities to help them cope in increasingly challenging, complex work environments.

 at Touro University California College of Pharmacy in Vallejo.

, is a professor of social, behavioral pharmacy, and administrative sciences at Touro University California College of Pharmacy in Vallejo.

1. QD85 burnout. ICD-11 for Mortality and Morbidity Statistics. February 2022. Accessed February 24, 2022. https://icd.who.int/browse11/l-m/en#/http:// id.who.int/icd/entity/129180281

2. Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory: third edition. In: Zalaquett CP, Wood RJ. 

3. Johnson AR, Jayappa R, James M, Kulnu A, Kovayil R, Joseph B. Do low self-esteem and high stress lead to burnout among health-care workers? Evidence from a tertiary hospital in Bangalore, India. 

. 2020;11(3):347-352. doi:10.1016/j.shaw.2020.05.009

4. Desselle SP, Holmes ER. Results of the 2015 National Certified Pharmacy Technician Workforce Survey.

. 2017;74(13):981-991. doi:10.2146/ajhp160666

5. Kraus S, Gardner N, Jarosi N, McMath T, Gupta A, Mehta B. Assessment of burnout within a health-system pharmacy department. 

. 2020;77(10):781-789. doi:10.1093/ajhp/zxaa042

6. Chong JJ, Tan YZ, Chew LST, Tan KH, Wang A. Burnout and resilience among pharmacy technicians: a Singapore study. 

. 2022;62(1):86-94.e4. doi:10.1016/j.japh.2021.09.013

7. Guidance for PREP act coverage for qualified pharmacy technicians and state-authorized pharmacy interns for childhood vaccines, COVID-19 vaccines, and COVID-19 testing. US Department of Health & Human Services. October 20, 2020. Accessed February 25, 2022. https://www.hhs.gov/sites/ default/files/prep-act-guidance.pdf

8. Adams AJ, Bright D, Adams J. Pharmacy technician-administered immunizations: a five-year review. 

. 2022;62(2):419-423. doi:10.1016/j.japh.2021.11.011

9. Hayden JC, Parkin R. The challenges of COVID-19 for community pharmacists and opportunities for the future.

. 2020;37(3):198-203. doi:10.1017/ipm.2020.52

10. Broughel J, Yatsyshina Y. Pharmacy technician ratio requirements. SSSN. March 22, 2021. Accessed March 29, 2022. https://ssrn.com/abstract=3809876

11. Adibe B, Hebert C, Perticone K, Dowd SM. Creating wellness in a pandemic: a practical framework for health systems responding to Covid-19. 

. March 24, 2021. March 29, 2022. https://catalyst.nejm.org/doi/ full/10.1056/CAT.20.0218

12. Maslach C. Finding solutions to the problem of burnout. 

. 2017;69(2):143-152. doi:10.1037/cpb0000090

Lack of acknowledgement or rewards in high-pressure pharmacy environments can lead to mental health issues.

Learn to Mitigate Feelings of Burnout and Stress

Pharmacy has a long history of entrepreneurism and many pharmacists are entrepreneurs, yet do not even fully realize it. Some people think of entrepreneurs as eccentric inventors who come up with an ingenious idea or get lucky when an out-of-the-box idea simply “sticks” in our increasingly viral and social-media driven environment. But entrepreneurism is actually more a function of hard work, networking, and certainly a dash of creative thinking than it is eccentricity, luck, or superior genius.

Despite an increasingly competitive health care market, anecdotal evidence suggests a renaissance in pharmacy students hoping to take an ownership position. However, entrepreneurism is not confined to ownership or to the young and recently graduated pharmacists. It can also take the form of veteran practitioners filling a market niche with solutions that solve problems or make lives better for others.

Jones and Hill provide practice tips for aspiring entrepreneurs that are applicable at any stage of a pharmacist’s career.1 They described that what was thought to be a really novel idea ultimately fell flat due to ill-conceived commercialization plans and because their team was not fully prepared to handle all the challenges that lay ahead.

The authors also provide a set of recommendations for aspiring entrepreneurs in scientific and professional fields. These include:

Building credibility, which in pharmacy can include volunteering in associations, being active in the community, and projecting your expertise in a humble fashion

Evaluating the landscape for potential competition and allies

Gaining recognition for your business skills, even if you are working in a corporate environment

Building your network, preferably under the auspices of a mentor

Determining key advantages for your potential idea, including lower cost, market disruption, and/or greater efficacy

Building a product or service that is realistic to develop and commercialize by taking steps to reduce its complexity to potential stakeholders and limiting the design to one that will make it digestible in scope to buyers

Achieving “flight” by taking part in business plan competitions and identifying various forms of small-scale funding, including angel investors and community grants

Balancing the work and entrepreneur lifestyle and expecting to work many hours while communicating with a wide variety of people.

These recommendations underscore the fact that entrepreneurism is actually broadly applicable. Students can learn from this as they position themselves with the right initial job to fulfill their future entrepreneurial endeavors. Current pharmacy owners have already done much of what is described but can continue to work and “stay fresh” so that their business can continue to develop niche services that keep them ahead of the game. And those working in more corporate environments can plant seeds that will position themselves with entrepreneurial endeavors outside the company in the future or can even contribute novel ideas within the company that help address problems while advancing their career within the organization.

can be found in Pharmacy Management: Essentials for All Practice Settings, 5e.

is a professor of social and behavioral pharmacy at Touro University California College of Pharmacy.

Jones CH, Hill A. So you want to be a student entrepreneur? Bioentrepreneur. 2017;35(2):113-116.

Entrepreneurism is actually more a function of hard work, networking, and certainly a dash of creative thinking than it is eccentricity, luck, or superior genius. 

Tip of the Week: Entrepreneurism Requires More Determination Than Luck

Budgeting is among the management topics you will not often find in the pharmacy, because many budgeting processes are proprietary in nature and assumed to be undertaken only by corporate executives. However, budgeting is critically important.

All of us perform some level of budgeting daily regarding our own cash flows and expected expenditures. After all, a budget is essentially a detailed plan expressed in quantitative terms (dollars) that specifies how resources will be acquired and used during a specified period. This is especially salient for pharmacy owners, but understanding the principles of planning and budgeting are useful for any pharmacist, particularly one who is in or aspires to be in a managerial role.

The process of budgeting involves facilitating communication and coordination, allocating resources, controlling profit and operations, evaluating performance, and providing incentives to perform. There are different types of budgets, including revolving budgets, sales revenue budgets, cash budgets, operational budgets, and capital budgets.

A capital budget is a plan for the acquisition of capital assets, such as buildings and equipment. It would typically accompany a strategic plan in helping to differentiate between potential locations of a new pharmacy or the relocation of an existing one. It also corresponds with plans to expand a business and thus make decisions about major renovations and automated dispensing technologies.

Again, there are relatively few studies of budgeting in pharmacy, but there are a few worth noting in medicine and health care, more generally. Wenz and Zhang examined capital investment decision-making by US hospitals. Their case study examined 4 hospitals: a small, private for-profit community hospital; a large, private, nonprofit trauma center; a publicly owned, medium-sized, non-profit, university-affiliated hospital; and a very large, private, nonprofit acute care hospital. The researchers conducted interviews of key hospital administrators and found that capital budget decisions differed among the 4 but still focused on return-on-investment and ad hoc mechanisms not related to long-term visionary processes.

Criteria of need were based primarily on stated physician needs, more immediate needs, and those that might provide a competitive edge in local market share. The researchers also found that overall, hospital organizations should develop and implement systematic processes by building upon decision analysis principles and approaches, such as the Simple Multi-Attribute Rating Technique (SMART).

A complete SMART analysis includes 10 steps and calculates the overall value of a given alternative as the sum of the performance score (value) of each attribute (criterion) multiplied with the weight of the attribute. Its advantage is its explicit accounts of multiple, often conflicting, objectives. This is not unlike what is faced by an individual dealing with conflicting objectives to maximize leisure, spend more time with family, work overtime to get promoted, and save money to send a child to a top-tier university. Nor is it unlike the pharmacy owner or manager faced with conflicting objectives to earn a greater profit on each prescription dispensed, provide better customer service, initiate new direct patient care services, and remodel a stylistically and logistically problematic pharmacy structure.

Capital budgeting accompanies planning and is at the heart of very important decisions made from what can appear to be conflicting goals. Reconciling those goals and priorities might help a decision-maker realize that the goals might not be so disparate, after all. A greater understanding of capital budgeting will help pharmacy managers but can also help staff pharmacists understand why executives make the decisions that they do.

Capital Budgeting and Strategic Planning 

Wenz C, Zhang H. Medical technology investment decision-making at U.S. hospitals: A comparative case study of four organizations. Proceedings from the 51st Hawaii International Conference on System Sciences. Accessed on November 18, 2020.

Capital budgeting accompanies planning and is at the heart of very important decisions made from what can appear to be conflicting goals. 