This health-system pharmacy department found success through a combination of approaches.
In these cost-conscious times, health-system pharmacies are often asked to cut staff while keeping up with increasing workloads. It can be done, through good planning and an eye for opportunities to redeploy centralized pharmacists, expand pharmacy services in ways that do not require an additional pharmacist, and make best use of technology to improve efficiency in the pharmacy.
When Cleveland Clinic in Cleveland, Ohio, faced this challenge in 2013, staff cuts were managed through changes in the organization of pharmacy services. Garrett Eggers, PharmD, pharmacy manager for the Clinic’s Heart and Vascular Center, reported on the process at ASHP’s Midyear Conference in a presentation titled, “Management Case Study: Expansion of Pharmacy Services in the Era of Cost Containment at an Academic Medical Center.”
Garrett Eggers“The climate in 2013 was the height of when the Affordable Care Act started to go into place, and we realized that reimbursement was going to be decreasing and hospitals were looking for opportunities to cut costs," Eggers said.
At Cleveland Clinic, the pharmacy department was asked to cut 1.75 full-time equivalent (FTE) positions from a staff of 130 FTE pharmacists delivering direct patient care, part of a total staff of 402 FTEs, Eggers said.
"That may not seem like a lot, being about 1%, but we were very close to our capacity in many of our services. We really had to rethink the way we were doing things in order to make this possible."
One of the first steps is to determine what functions cannot be cut, the “must-haves,” as Eggers put it. "If we are going to be cutting FTEs, what are the things that we absolutely need to keep?" At Cleveland Clinic, these included maintaining all decentralized services and a safe rate of order verification.
The next task is to look for inefficiencies, he said. The pharmacy system looked for opportunities to redistribute order volume in a decentralized manner and for ways to automate processes.
"The primary driver of the central workload was order verification, so we came to the conclusion that we needed to find a way to redistribute this work into other areas where order verification currently was not being performed to its optimum," Eggers said.
For example, the clinic implemented a clinical decision-support system to review all enoxaparin orders, he reported. This reduced the number of orders that needed to be reviewed from 100 per day to 3 or 4 per day. This constituted a significant savings in time while a safe rate of order verification was maintained.
The changes to pharmacy system operations resulted in an elimination of 1.5 FTEs who had been used to verify orders in the central pharmacy and one FTE redeployed to nursing units. The pharmacy at the Heart and Vascular Institute was able to eliminate 0.25 FTE used to verify orders and redeployed one FTE to nursing units. In both areas, queue orders per hour per registered pharmacist remained under 40, he said.
In reviewing the changes, Eggers noted what worked well and what didn’t work as well.
"We were able to either redeploy, eliminate, or shorten the shifts in order to save FTEs," he said. The pharmacy system was able to avoid layoffs because all cuts were made to positions that had already been vacated. All goals were met and decentralization was extended, he added.
But the timing of the changes was something that could have worked better, said Eggers. Had it been possible, it would have been better to reduce the number of FTEs first and get used to that level, before expanding services. And communication with clinical specialists could have been improved to increase their support of the changes.
If the changes had to be made all over again, he said, the pharmacy would exert greater pressure to maintain control over the timing of what needed to be done.
Valerie DeBenedetteis a medical news writer in Putnam County, N.Y.