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Corresponding to Jon Beard, Pharmacy Department, Musgrove Park Hospital, Taunton & Somerset NHS Foundation Trust, Musgrove Park Hospital, Taunton TA1 5DA, UK; [email protected]
Introduction
This article describes key changes made within one hospital pharmacy department in the UK during ongoing work aimed at improving the quality and efficiency of its pharmaceutical services. The changes were implemented in response to various factors and over several years have significantly increased the value of the service; waste has been reduced, efficiency increased and clinical services improved, without employing more staff. The target audience for this article is anyone wanting to improve service efficiency and increase output without the need to invest significantly in additional resources. This paper is not a review of improvement methodologies1–3; rather it outlines how the application of these techniques has transformed a service.
Musgrove Park Hospital is an acute district hospital with 621 beds, admitting around 85 000 patients annually and generating around 99 000 Finished Consultant Episodes (FCE) (2012). In 2013, the pharmacy employed 49.4 wholetime-equivalent staff. When staffing levels were standardised against hospital workload (ie, staff/1000 FCEs or 1000 admissions) it ranks as relatively small (see figure 1).
Historically, the department had operated a range of hospital pharmacy systems not dissimilar to those found in other UK hospitals. Systems and processes were reviewed and changed infrequently, and such reviews would often coincide with the arrival of a new staff member from another hospital. The department had no formalised method for reviewing and changing practices, and this, coupled with relatively low staffing levels resulted in frequent criticism of service quality. Complaints focussed on long waiting times for dispensed medicines, ward stock and chemotherapy. Staff spent much time and effort attempting to resolve the same range of acute, operational problems each day, often describing this as ‘fire fighting’. However, little effort was spent exploring permanent remedial actions, and so these operational problems continued to occur. This had negative consequences for service quality in other areas, one example being the provision of ward-based clinical pharmacy which was fragmented, and its sustainability sensitive to staffing levels and daily dispensary workloads.
The situation was further complicated by numerous, long-standing service-level agreements that required the department to provide services to external organisations. These commitments were often...