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Steve Acres, pharmacy service manager at Leicester Royal Infirmary
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The question of how many people it takes to run a busy hospital dispensary
is simple enough. But who can put their hand on their heart and honestly
say they know? The answer, of course, lies in the output, but what exactly
is that? Who generates it and what do they contribute to the equation?
The concept of output-based manpower planning is not new; neither is
it rocket science. It does, however, require a reasonable management
information system from which to draw a range of accurate data. It also
requires the application of those data in a logical way to determine
task and resources or, to use Modernisation Agency speak, demand and
capacity.
Arriving seven months ago into the service manager post at Leicester
Royal Infirmary I was confronted with staff with poor morale who worked
long hours to deal with a heavy workload. The constant gripe was “we
are too busy, we don’t have enough staff”. The seemingly
obvious questions were how busy is too busy? How many more staff did
we need? Nobody knew the answers. How was the dispensary establishment
derived? Again nobody knew. How could we seek investment for new staff
if we did not know how many we needed?
It was clear that we needed to get down to some fundamentals and work
out how many people (capacity) we needed to manage the workload (demand).
Our searches through medicines information drew a blank and results were
limited to a Welsh study on average dispensing rates. In trying to understand
just how busy we were, the average dispensing rate looked to be a good
start point and was calculated across all three of the trust’s
sites. In this process we took the total number of items dispensed and
divided this by the number of dispensing hours worked by staff to give
the number of items dispensed per person per hour (p/p/h). This does
not take into account complexity but it does provide a broad indicator
of how busy the department is.
The results made interesting reading with a disparity between our three
sites: staff at Leicester Royal Infirmary were dispensing over 24 items
per person per hour against the Welsh study average of between nine and
10 items. Naturally enough, this raised the question of what is a “safe” average
dispensing rate? The jury is still out on that one but we are trying
to compare the average dispensing rate to error rates at each site. The
difficulty here is that the quality of error reporting can be adversely
influenced by heavy workload.
Now that we had a crude comparator of workload across the trust, there
was a need to get more into the detail and determine the shortfall in
capacity against demand. We started by asking the question, “in
a standard five-day working week how many working hours are available
for the core task of dispensing?”. This is the sum of the total
hours each member of staff is contracted to work in that area each week.
However, there will be times when they are not available; sickness, annual
leave, study leave, college days, meetings, etc, all reduce the available
resources. This can be adjusted by adding up all annual leave entitlement,
sick leave and all other losses for the year then dividing by 52 to give
the time lost from overall staff availability for a week. We have now
calculated capacity.
To calculate demand, the approach was simply to list all of the tasks
that form part of dispensing: dispensing, issuing Controlled Drugs, checking
and giving out prescriptions, etc. It is necessary to make the list as
comprehensive as possible and reflective of reality. It is then necessary
to allocate time to all of these tasks; for dispensing, we used an assumed “safe” dispensing
rate of 15 items per person per hour. As an example, dispensing 5,000
items per week and assuming a dispensing rate of 15 items per person
per hour would result in 333.3 hours of work. Other tasks were measured
using the actual time taken to perform the task, eg, final checking.
How the shortfall between demand and capacity was calculated
A. Hours required to complete tasks (demand) = 642.35
B. Total available resources (hours), ie, total capacity = 703
C. Time lost (hours), ie, lost capacity = 283.15
D. Resources dedicated to dispensing (B–C), ie, available
capacity = 419.85
E. Shortfall (A–D) = 222.5 (34.65 per cent) |
This
results in demand measured in the same units (hours) as capacity. All
that is now required is a simple calculation to work out the shortfall
in hours and calculate this as a percentage of the total demand. In our
case, this amounted to an astounding 34 per cent, which was calculated
as shown in the Panel.
This approach will not solve manpower shortages nor will it necessarily
increase morale. What it does do is give a clear, logical measurement
of demand and capacity. It will also provide ammunition in the search
for investment from the clinical directorates who generate the demand,
as well as reasons for discharge and outpatient prescription delays.
At least, we can now answer the question, “how many staff do we
need?”. We can also use our calculations to determine what impact
investment will have on turn-around times.
There are, of course, more worrying questions about quantifying shortfall,
particularly if it proves to be significant. When demand outstrips capacity,
it can be some of the most fundamental things that are disregarded to
push work through ever faster. In dispensing, it is the self-check which
is at the very heart of ensuring patient safety. In the quest to clear
the workload and leave for home on time there is great potential for
people to skip the self-check and rely on the final checker as a safety
net.
It would be easy to “demand” that the self-check is undertaken
but we all know that ownership of one’s own work is the real key
to success in this area. However, as employers and managers we all have
a responsibility to support our staff and ensure that sufficient resources
are available to meet demand and reduce the risks to patients.
Finally, although this model has been developed in hospital pharmacy,
the concept should be completely transferable to any environment where
output activity can be measured. |
The
Pharmaceutical Journal