The tool of prioritization Example of a team’s prioritization

Prioritizing pharmaceutical activities - A simulation

Renet S1, Rochais E

1, Hall K

2 Bussières JF

1,3

1Pharmacy practice research unit, Pharmacy department, CHU Sainte-Justine, Montréal, QC, Canada ,

2Faculty of pharmacy, University of Alberta, Edmonton, AB, Canada

3 Faculty of pharmacy, University of Montreal, Montreal, QC, Canada

INTRODUCTION

There is a relative paucity of literature regarding the decision-making processes that are used by pharmacy managers and practitioners to prioritize the pharmaceutical services that they provide

We developed a simulation game to examine how prioritization decisions are made by hospital pharmacy managers in a simulated environment where the available resources are constrained

Contact: jf.bussieres@ssss.gouv.qc.ca

Acknowledgements: Aurélie Guérin for the creation of this poster

The primary objective of the exercise was to examine the consistency of prioritization decisions made by pharmacy managers

The secondary objective was to identify and rank the factors that influenced individual and team prioritization decisions

OBJECTIVES

RESULTS / DISCUSSION

Cross-sectional, descriptive study

The selection of pharmaceutical activities and their relative resource requirements were established by our research team based on data from the Hospital Pharmacy in Canada Report(1) and the investigators’ knowledge of hospital pharmacy practice

METHODS

This study illustrates a simulation game to examine how prioritization decisions are made by hospital pharmacy managers

Our study indicates that most of the eight teams involved in the simulation game opted to provide a wide range of services, but at a low level of comprehensiveness

Pharmacy managers should examine their perceptions, if we aim at an evidence-based profession

This simulation game supports the observation that pharmacy leaders do not agree on a core set of pharmaceutical activities that should be prioritized

CONCLUSIONS

Secondary objective

Our pilot study identified a number of factors that influenced individual and team prioritization during the simulation game

Participants ranked “perception of the favorable impact of the service or activity” higher than “conclusive evidence” that supports the activity or service

Table 2. Individual and team ranking of factors that influenced individual and team

prioritization

Primary objective

The majority (6/8) of teams prioritized more than two-thirds of the 32 suggested pharmaceutical activities

Two (2/8) teams did appear to focus their resources on a smaller number of activities, providing a more comprehensive service

Table 1. Pharmaceutical activities prioritized

Pharmacy directors tended to prioritize clinical activities more than drug distribution activities

Pharmacy leaders gave a high priority to human resource management (all teams covered 100 % of needs) and financial management

Some other areas that were given a low prioritization by the participants included original research by members of the pharmacy department, the provision of education to external groups, and the provision of support for clinical trials

1 - Hall K, Wilgosh C, Musing E, Babich M, Mcgregor P, Bussières JF et al. Hospital pharmacy report in Canada

2009-2010. [online] http://www.lillyhospitalsurvey.ca

Primary objective

Pharmacy practice was divided into five areas, each represented by one color

Participants were divided into teams representing the management team of a fictitious pharmacy department

For each team member was designated as a department head

32 pharmaceutical activities were offered as a set of 142 color labels

Each team had 30 minutes to select 60 among the 142 labels on offer

Teams may decide to only partially implement a service or to fully implement a service

Secondary objective

Each participant had to rank in order of decreasing importance the 16 proposed factors that influenced their decision-making ranking of pharmaceutical activities:

► Individual ranking

► Team ranking after consultation with other team members

Population

During a symposium attended by 39 anglophone and 10 francophone pharmacy managers from all regions of Canada

Proportion of activities covered, per team (%)

Team 1 Team 2 Team 3 Team 4 Team 5 Team 6 Team 7 Team 8

50 56 72 75 78 81 88 88

Pharmacy practice domains

Relative weight of each domain

for all eight team (%)

Pharmaceutical activities

Pharmaceutical activity

prioritization Mean (%)

Drug distribution

24

Unit dose system-centralized 40

Parenteral Admixture Service (PAS) 55

Cytotoxic Admixture and Hazardous Drugs 73

Central packaging and robotization 25

Automated Decentralized Cabinets 39

Order entry validation by the pharmacist 54

Hours of pharmacy operation 55

Clinical 34

Decentralized pharmaceutical care-inpatient 59

Decentralized pharmaceutical care-outpatient 34

Pharmacology & Therapeutics committee 100

Infection Control Committee 25

Ethics Review Committee 25

Medication Safety Committee 88

Adverse Drug reaction Committee 38

Medication Reconciliation Process 33

Drug Information Center 25

Evaluation of clinical pharmacy services 23

Dependent/independent drug prescribing 25

Teaching 16

Inservice education to maintain technical staff competency 56

Inservice education to maintain pharmacists’ staff competency 63

Inservice education to maintain other healthcare professional’s staff competency

31

Internship training for undergraduate pharmacy students 35

Internship training for post-graduate pharmacy students 35

External education 0

Research 5

Clinical Trial support 31

Original evaluative research 10

Drug utilization reviews 31

Management 21

Human resources management 100

Material resources management 50

Financial resources management 75

Project management 44

Other management needs 19

Factors Re-ranking based on individual averages

Re-ranking based on team averages

Perception of the favorable impact of activities on the safe provision of healthcare (i.e. reduction in medication errors)

2 1

Perception of the favorable impact of activities on health outcomes (i.e. improvement or maintenance of the patient’s health status)

1 2

Conclusive evidence available to support the decisions 3 3

Required to address audits/inspections 12 4

Desire to comply with the legislative or normative framework 11 5

Leadership of the person designated as the department director 5 6

Perception of the favorable impact of activities on healthcare ex-penses (i.e. optimization of costs)

8 7

Having sufficient expertise to offer the activity 9 8

Dominant influence of a member of the team other than the de-partment director

10 9

Popularity of the activities among the members 7 10

Ease of implementing and maintaining the activity 15 11

Professional interests of the members of the team 6 12

Management support (i.e. at the financial and/or political level) or support from other stakeholders in the organization

13 13

Favorable departmental (e.g. team) dynamics 4 14

Relative quantities of one item over another (i.e.. items with more labels were prioritized more or less)

14 15

External pressure from media/public/politicians (e.g., occurrence of an adverse event covered in the media, social and media pressure, etc.)

16 16

Drug distribution Research

Clinical Management

Teaching

Fig.1 Example of a team’s prioritization

REFERENCE