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The Pharmaceutical Journal Vol 265 No 7114 September 16, 2000
Pharmacy Practice Research
Papers presented at the British Pharmaceutical Conference, Birmingham, September 10 to 13, 2000 pR54

A survey of manager attitudes to benchmarking in hospital clinical pharmacy services

By D. Campbell and A. Fowler*

Introduction This paper reflects current interest in the spread of good practice, including the development and delivery of standards. It explores the potential of benchmarking, within this context, as a particular improvement methodology that focuses upon recognising excellence and encouraging its transfer between organisations.1 The literature suggests that although the theory of performance management is not alien to hospital pharmacists,2 benchmarking's usefulness and applicability remains relatively unexplored.3,4 The aims of this study were, therefore, to investigate awareness of performance and practice benchmarking, as an improvement methodology for hospital clinical pharmacy services, and to explore the key issues perceived.

Method The research is based on the results of a questionnaire aimed at senior hospital pharmacists within the Northern region of the United Kingdom National Health Service (heads and deputy heads of service and senior clinical and operational pharmacists). The questionnaire was developed within the context of generic benchmarking theoretical frameworks drawn from the literature of operations management and pharmacy, respectively. A pilot study with 12 senior pharmacists, involving a draft questionnaire and semi-structured interviews, preceded the collection of both quantitative and qualitative data in the main study. The results from the quantitative analysis could thereby be interpreted in the light of qualitative statements received in the questionnaire responses and interview notes.

Focal points

  • Senior pharmacists believe that benchmarking can be usefully applied to clinical pharmacy services but most feel that considerable problems are associated with its deployment
  • Perceived problems include a lack of precise, agreed definitions of services performed and outcomes to be achieved, measurement difficulties due to the qualitative nature of outcomes and a lack of available standardised measuring tools
  • Difficulties are also experienced in ensuring like with like comparisons and acquiring resources with which to effectively implement benchmarking
  • It appears that many who claim to have undertaken benchmarking studies may not, in practice, have understood its full implications and that the process is rarely carried through to fruition and consequently, its full potential may not have been recognised

Results Seventy-three completed forms were returned (67 per cent of those issued). A partial summary is reproduced in Table 1. Data were interpreted using a bipolar scale with weightings ranging from "strongly agree" = +2, to "strongly disagree" = -2. This implies that a score of 100 per cent would be taken to correspond to all correspondents having ticked "Agree". Negative scores can also arise, denoting disagreement with a particular proposal. A zero score corresponds to neutral.

Table 1

Discussion From the results it was clear that managers believed that benchmarking was generally applicable to clinical pharmacy services although most felt that there were problems associated with its implementation. The main problems described were a lack of clarity in definition of services performed and target outcomes to be achieved. Also noted were difficulty in measurement due to the qualitative nature of outcomes, a lack of readily available standardised measuring tools, difficulty in ensuring that like with like comparisons are made and finally, a lack of resources. The results indicate a consensus that, despite these perceived problems, most senior pharmacists felt that benchmarking could provide a useful management tool with considerable potential to assist with the continuous improvement of hospital pharmacy services, thereby mirroring its wider deployment in other management sectors. Conversely, there appears to be considerable disagreement over which performance indicators should be prioritised. The results also suggest that additional hurdles exist in adapting the technique. Consequently, it appears, to these researchers, that many who claim to have undertaken benchmarking studies have not, in practice, understood its full implication or seen the process carried through to fruition. If this is indeed the case, then they may not have been in a position to realise its full potential.

North Durham Health Care NHS trust; *Newcastle University school of management

References

1. Camp RC. Benchmarking. The search for industry best practice that leads to superior performance. Milwaukee, United States: ASQ Quality Press; 1989.
2. Anderson SC. Application of theory to hospital pharmacy practice, Pharm J 1987;238:372-5.
3. Anderson S. Developing clinical pharmacy performance indicators: the North American experience. Proc Guild Hosp Pharmacists 1986;22:3-31.
4. Barber N, Batty R, Ridout DA. Predicting the rate of physician-accepted interventions by hospital pharmacists in the United Kingdom, Am J Health-Systems Pharmacists 1997;54:397-405.