Transcript Managers

Pharmacy Management
PHCL-420
Teachers
T. Alnajjar- Female
Staff (N.A, L.A)
Coordinator
T. Alnajjar
Course Objectives
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To introduce pharmacy students to the followings:
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Management activities
Strategic planning
Operation management
Resources management
Quality control
Financial statements
Inventory management
Selected management topics
Introduction To Pharmacy
Management
Tawfeeg Alnajjar
420-PHCL
• Learning Objectives
– Definitions
– Management process
• Manager functions
• Management resources
• Management levels
• Management?
– Is the process which brings together
resources and unites them in such a way
that, collectively, they achieve goals or
objectives in the most efficient manner
possible."
– Is the art and science of planning,
organizing, directing, and controlling
human effort and resources for the general
good within the organizational framework
and economic environment of the firm.
• Managers:
– Simply people who perform management
activities
– Anyone who has a task to accomplish or a goal
to achieve is also a manager
– Thus all pharmacists, regardless of their job
responsibilities or position, should view
themselves as managers!
?.. Study
Management
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Good business practice and good patient
care are not mutually exclusive. In fact,
they are almost entirely mutually
dependent.
• H.C mission: high quality, affordable,
and accessible
Superior patient care and the
implementation of clinical services are
made possible by pharmacists who are
skilled in management.
Universal skills (each is a manger)
M. Process
• Follow 3 dimensions:
Activities that managers
perform
Resources that
managers need
Levels at which
managers make
decisions.
Management Process
M.
Activities
1. Planning
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Predetermining a course of action based on
one's goals and objectives.
The process of attaining objectives
Influenced by the internal and external
environments (PEST)
What should be done?
Services that should be provided to improve
patient care?
formal vs. informal plans (student reading)
• Organizing
– The arrangement and relationship of
activities and resources necessary for the
effective accomplishment of a goal or
objective.
– How it should be done (create structure)
• What resources you needs
• How you will go about obtaining these
resources.
• When you will need to obtain them
• Leading
– Bringing about purposeful action toward
some desired outcome.
– It can take the form of actually doing
something yourself or working with others to
lead them to where you want your
organization to be.
– Directing
– Orienting, training, ordering.
• Controlling
– Reviewing the progress that has been made
toward the objectives that were set out in the
plan.
– Process of comparing results with standards
and take corrective actions only when deviation
occurs.
– This step involves not only determining what
actually happened but also why it happened.
– Performing quality-control checks
Plan
Control
Organize
Lead
Need
“Resources”
Money
information
Material
People
Time
Apply
“Levels of Management”
Self-management
“Pharmacist ensuring that every
prescription is dispensed”?
Interpersonal management
“Pharmacist counseling a patient about a
medication”?
Organizational management
“Pharmacist planning to add a new service to
his chain community pharmacy chains”?
Modern
Views
Energize
Empower
Support
Communicate
…..Not working for money only
“motivate: ……
• Have a vision and ideas about what would like to see their
organizations become in the future….. Objec.
• Provide the employees with training, resources, and advise and
then let them get the job done …. educate
• Letting their employees know when they have done a good job, as
well as helping them to learn when things are not going well…
incentive, autonomy
• The corner stone of communications is trust … participation
Strategic Planning in Pharmacy
Operations
Tawfeeg Alnajjar
420 PHCL
Learning Objectives
1. Describe the general process common
to all types of planning.
2. Describe the purpose of strategic
planning, and illustrate the specific
steps to develop a strategic plan.
3. Situational analysis
4. Barriers and limitations to planning.
Planning
In General
Planning is purposeful efforts taken by an
organization to maximize its future success.
Manager functions
Simply objectives, data, course of action.
Planning Process
Define the vision
and mission
Assess the current
situation
Establish goals
Define
responsibilities
and timelines for
each objective
Establish
objectives that
support progress
toward those
goals
Identify strategies
to reach those
goals
Write and
communicate the
plan
Monitor progress
toward meeting
goals and
objectives
• Strategic Planning
– It is the process of selecting an organization's
goals, determining the policies and programs
(strategies) necessary to achieve specific
objectives en route to those goals, and
establishing methods necessary to ensure that the
policies and strategic programs are implemented.
– Purpose is to ensure that the organization is doing
the right things now and in the future.
– Addresses what business the organization is in or
ought to be in, and helps to determine long-term
goals for the organization.
 S.P
A. Timeline
 The time horizon of strategic planning helps to distinguish it from
other types of planning.
 A key component of strategic planning is to identify time periods
within which goals are to be reached.
 It may be as long as 10 to 20 years or as short as 2 years.
B. Terms
a. Vision
b. Mission
c. Goal
d. Objective
e. Task
Vision Statement
Vision is what the pharmacy organization wants
to be at some future time point.
 It should make people think and motivate them to
create a better future for the organization.
 It is used in the planning process as both the beginning
point and the end point (begin with the end in your
mind)
 Once the vision is set, then strategic planning is about
how to reach that end point.
 For example…... (next)
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Examples
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Hospital pharmacy
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2.
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Patient Care: to be an integral member of the
healthcare team responsible for the outcomes
associated with the medication use process.
Education: fostering an environment designed
to advance knowledge of the rational use of
medications.
Research: making sound decisions supported
by evidence based medicine through research
on medication use and patient safety.
 Mission Statement
 Mission is the purpose of the company.
 Mission statement defines what the company does
or is.
 It focuses on the common purpose of the organization and
may draw from the values or beliefs held by the
organization.
 It should help to differentiate the company from others that
provide the same products or services.
 Some organizations include in the mission statement not
only what the company does but also how it does it.
 The following elements suggested in developing a mission
statement for a community pharmacy:
1. Intended customers
2. Key services and products provided by the pharmacy
3. Core values of the pharmacy (such as compassion,
respect, and confidentiality),
4. Benefits incurred by customers (such as improved
health and improved safety),
5. Desired public image of the pharmacy
Vision and Mission
A.Company slogan vs. mission statement.
 Vision, mission, and other statements that
form the company story are critical elements
in strategic planning.
 If these elements already exist in the organization,
then the process of strategic planning starts with
these as its foundation or modifies them as
necessary.
 If these elements do not already exist, then the
process of strategic planning must include their
conception.
Planning
Phase
Preplanning
Phase
Postplanning
Phase
 Preplanning Phase
 Planning for the planning
 Preplanning will define:
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4.
The objectives of the planning
Who should be involved
Where the planning process will occur
How much time will be allotted to the effort.
 Planning Phase
 Start with the destination in mind:
 The "destination" is the vision of the
organization in the future.
 Perform situation analysis
 To identify where, what, and how the
organization is in the present.
 It should consider both the past performance
and the current situation.
 Planning Phase:
 Situation Analysis
 SWOT analysis
 A common method for conducting the situation analysis, identify
using Brainstorming process
 Internal Factors
1. Strengths – what do we do well? …employee
2. Weaknesses – where would we like to improve? … correct
or compensate
 External Factors
1. Opportunities – what is occurring in our “external”
environment that may create opportunity…utilize or did
not miss
2. Threats – what is occurring in our “external” environment
that we should be prepared for? …. avoid
Planning Phase: Situation Analysis
Strength
Weakness
Opportunities
Threats
Strategic Planning: SWOT analysis
Positive
Negative
Internal
S
W
External
O
T
Examples?
 Examples
 Internal S & W
 Profitability
 Quality of pharmacy service
 Customer service
 Competence and ability of pharmacy staff.
 External O & T
 Competition from other pharmacy organizations
 Availability of technology
 Regulations that may help or hinder the
business,
 Changes in the market
 Types of customers served by the organization.
Planning Phase
Bridge that gap
 By comparing the results of the situation analysis
with the desired future state (vision), the extent
and nature of the gap between the two begins to
become clear.
 Planning Phase
 Developing the Plan (continued)
 Goals
 Identify long-term outcomes to provide focus for
the planning process
 Strategies
 Outline how you will achieve your goals
 Objectives
 Identify specific, measurable results produced while
implementing strategies
 SMART criteria
 Planning Phase
 Goals and Objectives Should Be SMART
 Specific  the objective should state exactly what is to be
achieved
 Measurable an objective should be capable of measurement –
so that it is possible to determine whether it has been achieved
 Achievable  the objective should be realistic given the
circumstances in which it is set and the resources available to the
business
 Relevant (Reachable) objectives should be relevant to the
people responsible for achieving them
 Timeframe  objectives should be set with a time frame in mind.
These deadlines also need to be realistic
 Planning Phase
 Operate the strategy
 Goals and vision are a desired future state that
may be unachievable in the short term
 Intermediate objectives are needed to help
advance toward that target.
 Objectives pertinent to each goal should be
identified
 a budget, schedule, and responsibility should be
assigned to each objective.
The relationship between vision, goals,
strategy, and objectives
Vision
Goal 1
Goal 2
Objective 1C
Objective 1B
Present
Objective 1A:
Tasks
Tasks
Time
Goal 3
 Planning Phase
 Write the Plan
 The document must contain the following
key elements:
1. The organization's vision
2. Strategies
3. Goals for each strategy
4. Objectives required to meet those goals
5. Tasks or action plans to compete the objectives.
 Post-planning Phase
 This phase includes three vitally
important steps:
1.Communicating the plan: the strategic plan
document
2.Implementing the plan: operational planning
(tactics)
3.Monitoring progress and assessing results once
the plan is implemented.
• Barriers to Planning
1. Failure to commit sufficient time to planning
2. Interpersonal issues such as struggles for
power or politics and individual or group
resistance to change
3. Lack of planning skills
4. Failure to plan far enough into the future
5. Constantly changing environment
6. Lack of support by top corporate executives
and the board of directors
7. Failure to implement owing to: lack of time or
resources, or failure to monitor progress
 Management by crisis?
 Limitations to Planning
1. Planning is to some degree guesswork, risk
is still involved.
2. Plans and predictions are only as good as
the data and information that go into them.
Poor data will result in poor strategy.
3. How an organization implements the plan:
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Planning is not a substitute for action
The plan should not be considered as static or
unyielding
Conclusion
General Operations
Management
• General Operations Management
– Operations:
• All activities (output)performed by
the org. to transform resources into
valued, profit-generating goods &
services
– Operations management:
• The management of such activities
or the critical decisions that need to
be made by operations managers.
• Pharmacy Outputs
• In tangible ……..services
• Tangible …..goods
• Tangible inputs: can be seen or touched & their
quality may be evaluated (goods are tangibles)
• In the creation of goods, there are many
intangible , non- product inputs as well as the
tangibles such as:
• Speed
• Proficiency
• interaction with patients (assistance?)
• All of which will influence retaining the pt. for the
future
• In community pharmacy:
– Common example of services:
• Packaging
• Adding information
• Billing insurance co.
All of which add value to the product.
– Resources →Services is NOT easily understood
• Providing info. must:
– Recall info. or Look it up &
– Apply info. to pt. or communicate info.
clearly
• Community Pharmacy Practice:
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Prescription meds. Filling based on Dr.s’ orders
Compounding
OTC meds
Nutritional supplements
Offering & fitting durable medical equipment
Info. about Rx , OTC meds. & nutritional supp.
Health & beauty aids
Disease-state mgt.
DUR
Counseling on drug use
Adjudication of claims with insurance co.
Screening for Dis
• Institutional Pharmacy Services:
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Prescription meds. Filling based on Dr.s’ orders
Compounding
IV meds. & solution preparation
Meds delivery to floors
Oversight & inventory of controlled substances
Order collection from floors
Drug event monitoring
Formulary mgt.
Therapeutic interchange
Rx med counseling
MUE
Rx med carts filling
DI to h/c providers
TPN & PN
Emergency crash carts stocking
PK dosing
Clinical drug trials
• The outputs of a business
– Justify its existence.
– Categorize it → pharmacy business provide safe,
effective and economic medicine
– Driven by decisions made by owners or managers
taking into consideration:
• Consumer opinion (need, want)
• Mission
– Mission defines the reason for the business’s
existence & communicates the advantages it has in
the G & S it offers
– Owners or managers can: add, enhance, eliminate,
or change the G & S offered which need strategic
planning
– Strategic planning can assist in identifying the
internal & external factors faced by the business:
strengths, weaknesses, opportunities, and threats
• Typical Pharmacy Inputs (Resources):
– Examples of Resources Used to Fill a Prescription:
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Rx meds
Pharmacist who ordered Rx meds
Delivery service provided by wholesaler
Technician who stores meds
Shelf where med. sat until used
Vial used
Computers used
Service offered by insurance co.
Label printed by comp.
Software used by computer
Phone line used
Clerk who rung the Rx
Register used
Counter
The pharmacy facility
Electricity & other utilities used by pharmacy
• Resources
– Each of the resources plays a critical role in
transforming the med. received by wholesaler
to med. dispensed to pt.
– Many of such resources are transparent
(taken for granted) i.e. electricity
– The resource influences the efficiency &
ability to perform activities in Rx filling
– Some resources are not critical but ↑
efficiency & ultimately profitability of
process i.e. shelving units
• Operations Management:
1. Designing G & S
2. Strategies processing
3. Managing quality
4. Location strategies
5. Layout strategies
6. Human resources
7. Scheduling
8. Supply chain-management (inputs)
9. Inventory management
10. Maintenance
1) Designing product (Goods
& Services)
• Planning plays critical role in development of G & S.
– Based on analyses of internal & external environments
determine 1) the needs in the market, 2) capabilities of
the pharmacy.
• To be in line and consistent with consumers needs &
wants:→↑chances of profitability
• Products
• Goods: tangible (held & touched)
• Except for compounding, designing goods → up to
manufactures (seperable: not influenced by C)
• ↑ Opportunities to design innovative & creative
services to accomplish the goals
• G &S
– Services: intangible
• Experienced by consumer
• The offering of services will affect multiple aspects of
pharmacy’s operations , i.e. marketing, production,
delivery, internal communications (influence the day to
day processes used to offer G & S to customers).
– Services can be designed in 3 different approaches:
1. Customer Service (way C handled & treated)
2. Product Services (S that add values to the product:
way Rx introduced to patient)
3. Service Product (MTM)
– Each always provide intangible
2) Process Strategies
– The operations process involves many steps.
– The order in which steps are performed →influence
efficiency of operations → influence profitability (e.g.
filling Rx drug not put on the shelf yet)
– Differentiate between
• Process used to create goods → customer is not
likely to be involved
• Services → customer may be integrally involved
(waiting for Rx to be filled)
– The process have specific capacity, determined by the
resource that imposes the greatest limitation on the
process (BOTTLENECK)
– To increase capacity → Identify & eliminate bottleneck
& other externals to avoid →↓quantity of goods created
& services provided
• Example:
– A pt. is waiting for a refill in a limited space
of a crowded pharmacy.
» Solution: Line up each pt med. Refills so that
pt can get all his meds once a month &
contact every pt before Rx is due to be filled.
– This will allow for:
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Pt to discuss his med problems with
pharmacist
↓the need to maintain a large inventory
More control over the pace of filling Rxs
↑pharmacist contact with pt
Significantly ↓ pt traffic in pharmacy
• A flowchart
– Diagram of the steps involved in creating & offering G & S)
→ helpful in:
1. Analyzing the resources used
2.
Designing the process
3. Identifying & evaluating the capacities of
each element of the process
4. Identifying the areas that can be improved
→improve efficiency
5. manage the quality
– The more detailed the diagram is → the easier it is to
evaluate the time & resources necessary @ each step of
the process (flowchart for filling Rx)
3) Managing Quality
• Measuring quality is very important &
depends: Depend on kind of G & S
provided.
– Quality of goods can be based on
objective standards (i.e., quantity of
active ingredient)
– Quality of services can be based on
subjective standards (quality of DI
provided)
– Services , although intangible → need to
be evaluated
• Two Types of costs associated with quality:
1. The cost of maintaining quality:
1. Prevention Cost:
Result from the use of resources ( time &
personnel) to prevent errors from
occurring e.g. training employees & use
of technology
2. Appraisal Cost:
Result from the use of resources to
inspect, test & audit to identify a
drop in quality of service or product.
2) Cost associated with poor service quality:
a. Internal Failures:
Errors or defects that are identified &
rectified before consumers receive the
product or service (e.g., a mistake in
labeling)
b. External Failures:
Errors or defects in G or S that are
actually delivered to the consumers &
frequently identified by consumers
(wrong med). Take much more time &
money to correct
4) Location
 Can affect:
 How easily & efficiently the inputs for
operations can be acquired
 How easily the outputs of operations
can be transferred to consumers of
these outputs
 Which outputs are chosen to be offered
by a given business ( designing of G & S
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• Examples:
– Conductive to attracting qualified
pharmacists to work there
– Proximity to consumers (busy metrplex &
requires public transportation →
pharmacy has no stock → pt
inconvenience → ? Return
– Large population that need drive-thru
window (mothers with sick infants)
– If located near people who need its
products → ↑chance of attracting them
to the pharmacy ( dermatologic clinics )
5) Pharmacy Layout
– Location of various G & S within the
pharmacy
– Designed to maximize efficiency of
processes conducted to create G & S
– Counseling area
– Patients’ movements through the
pharmacy
6. Human Resources
– Examples of evaluating tools to determine HRs needed to
accomplish the operations:
• job design
• job analysis
to make good decisions about the HRs needs for
specific operations
– Supply & demand → may prevent finding enough efficient
pharmacists
– Environmental factors may cause higher pay, better working
hrs, or better benefits
– Motivated, productive & competent pharmacists → greater
profitability
– Training on their responsibilities is important (phone ring)
– HRs play a big role in transformation of inputs → outputs
7) Scheduling
– Regulations → licensed pharmacists
present during pharmacy working hours
– Individual work preference
– Scheduling support staff ( chart demand)
using computer system → most help
needed with greatest Rx filling (careful
planning, evaluation of sales, volume
trends)
• Chase strategy: Personnel available when
predicted demand is greatest (after a
weekend)
• Level Scheduling: to provide a level amount
of production so that a constant workforce
can be employed to handle the demand
day after day & week after week (preparing
IV solution)
• Forecasting Strategy: Forecasting demands
for G&S requires use of info, mathematical
functions & statistical analyses
• Scheduling the delivery of orders is
important (@ night or when closed or not
busy) requires relationships with
→suppliers
8) Supply-Chain Management
• Supply chain is the chain of business that
supply the pharmacy with necessary
inputs.
• Wholesalers: The primary vendors; they
distribute the majority of prescription
drugs in the USA.
– Should have relationships with reputable
companies that provide reliable services.
– Some chain pharmacies receive goods from
distributors they own + wholesalers
• Services may include:
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Electronic order submission
Next-day delivery service
Private-label programs
Advertising programs
Special-handling services
Pharmacy computer systems
Pricing
Store planning
• Key elements in choosing suppliers:
– Timely delivery of needed & properly stored
meds by licensed & reputable wholesalers @
best price
– Wholesalers: (difference in services &
authorization)
– Large full-service
– Regional
– Smaller
– Secondary
– Different types may be used to meet
different needs
9) Inventory management
– Too much inventory: money sitting on the
shelves
– Too little inventory: insufficiency in the
system
10) Maintenance:
Human Resources Management
Functions
Tawfeeg Alnajjar
2015
• Outline
– Human Resources management (HRM)
definition
– HRM tasks:
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Recruitment and placement
Training and development
Performance feedback
Termination of employee
• Human resources management
(HRM) is the process of achieving
organizational objectives through
the management of people
• Tasks associated with HRM include
recruiting, hiring, training,
developing, and firing employees
• Why HRM is critical to the pharmacy
profession?
– It can make the difference between a smoothly
running pharmacy and a dysfunctional,
unsuccessful one
– When HRM tasks are done well, pharmacy
employees know their responsibilities and receive
sufficient feedback to meet them successfully
– Many pharmacists are capable of much higher
performance levels than they are providing
currently
– Many problems in the pharmacy
profession result from the fact the
pharmacists are often poorly managed e.g.:
• Job stress and burnout
• Dispensing error
• Pharmacist shortage
• Recruiting and Placement
– Each employee represents the org. & the
profession
– Pharmacy clerks, technicians, and pharmacists are
more likely to determine a pharmacy’s image than
any advertising or promotional events
– A good pharmacist can generate significant
revenue for a firm by maintaining a loyal patients
base and drawing others from competitors.
• Recruiting and Placement
– Choosing the wrong employee for a
position can be quite expensive!
– If that employee leaves after a short
time, the employer must bear the cost
of recruiting, selecting, and training a
replacement.
• Recruiting
– The purpose of recruiting is to attract the
most qualified candidate to interview for
vacant job positions
– Recruiting is easer when employers are
proactive.
– Proactive recruiting :
• Continually recruit and network
• Maintain pleasant work environment
• Establish positive image in the minds of
potential recruits
• Recruiting Methods
– Develop contacts in professional meeting,
and social gatherings.
• Pharmacy students
– Advertisements
• Ads media (newspapers, professional journals,
internet)
• Targeting an appropriate demographic
• Keep the written ads simple, no false promises
and it should only capture the eye of qualified
candidates
Placement
Hiring
Selecting
candidates
Interviewing
Screening
Application
• Placement: Application
– To help screen unqualified candidates
– Provide background about the
candidates for the interview
• Placement: Screening
– To weed out unqualified applicants from
the pool of potential candidates
– Common screening criteria
• lack of job qualifications (license, degree, experience)
• poorly completed applications (misspelling, missing
information)
• negative history (felony conviction, frequent changes in
employment)
Placement: Interviewing Preparation
Send info about the
position to the
candidate
Identify interview
objectives
Review the position
description and
performance
standards
Schedule a quite,
uninterrupted
interview
Study the
applications and
resumes
Develop a list of
interview questions
Placement: Interviewing Types
Traditional
interviews
• To engage candidates in general
discussion about themselves
Situation (role- • Assess candidates’ problem-solving
play) interviews capability and communication
Stress
interviews
• Discern candidate preparation and
ability to handle stress
Behavioral
interviews
• To predicts future behavior from
past behavior
• Example of interview questions
– Tell us about your self?
– What are your strengths & weaknesses?
– Why would a women like you want to
work here?
– You are the pharmacy manager, and one
your employees has just told you that
another worker is stealing merchandise.
What would you do?
Interview checklist
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____Good first impression (introduce self)
____Relaxed, composed, in control
____Good posture (positive body language)
____Good eye contact (looks at interviewer in eyes)
____Show confidence
____Exhibit enthusiasm
____State selling points well
____Freely volunteer information
____Speak clearly and loudly enough
____Get information on salary in right way
____Good answer to "Why should we hire you?"
____Ask questions
____Ask about "call back"--time and date
____Close interview nicely (thank you, etc.)
• Placement: interview common mistakes
– Lack of preparation from the manager
– The interviewer does most of the talking
and does not give the candidate an
opportunity to speech
– Interviewers treat the interview as an
inquisition designs to squeeze the candidate
into revealing his/her flaws
• Selecting candidates
– Keep a good notes about each candidate immediately
after the interview & develop an interview checklist
– Interview mistakes that may immediately exclude a job
candidate from consideration:
Arriving late
Dressing inappropriate
Poor body language
Arrogance
Self-serving questions
Irritating speech patterns
Failing to answer questions
• Selecting candidates
– The final choice of the interviewer often
comes down to how well a candidate can
address the following questions:
• Can this person do the basic job ?
• How well do the candidates skills and capabilities
mesh with the org’s needs?
• Will the candidate make my job easier?
• Would I want to work with this person?
• Hiring
– Hiring is just the first step in the HRM
process
– Employees must be given the training
and feedback necessary to do their job
• Training & Development
– Excellent pharmacy services organizations
invest in the training & development of their
employees
– Training benefits both:
– The organization: improve the quality &
quantity
of work
– The employee: more interesting & meaningful
job and lead to greater morale & sense of
accomplishment
• Training & Development
– Training  to improve employee
performance with current tasks and jobs
(essential for meeting current need )
– Development  prepares employees for
new responsibilities and position
(investment in future needs)
Training
Types
Orientation
training
Job training
Job
rotation
Training
Type
Objective
Example
Orientatio Welcome new employees, present
n training a positive 1st impression, provide
inf. that will permit them to settle
into their new responsibilities
Coworker introductions, a tour
of the facilities, review of
departmental policies &
procedure, demo of the
computer system
Job
training
Helps current employees learn
new inf. and skills to do their jobs
and refresh capabilities that may
have diminished over time
CEP, develop new habits (time
management), skills (BP
monitoring), procedures
(handling drug insurance claims)
Job
rotation
Give an individual broad
experience through exposure to
different areas of the org.
Outpatient dispensing, IV
admixture , satellite pharmacy
units, inventory management
Development
What skills, knowledge, and training do I
need to get where I want to be?
What is
my
present
situation?
College courses, multiday seminars, residences,
fellowships
Where
do I want
to be?
Performance feedback
Types of feedback
Day-to-day
Annual
performance
reviews
ad hoc
performance
reviews
Performance feedback
Day-to-day feedback
– Practice management-by-walkingaround (MBWA)
– When practicing MBWA:
•
•
•
•
listen more than talk
Focus on the positive
Take notes
Make individuals see your presence as
helpful
The purpose of MBWA is to assist and support
Employees, not to criticize and inspect their
work!
• Performance feedback
– Annual (or semiannual) performance
reviews
• Act as long term planning sessions
• Managers help employees to review their
previous progress, identify successes and
areas that need improvement, and establish
goals and objectives for the next year
• Performance feedback
Ad hoc performance reviews
– Reviews scheduled ad hoc in response to
certain particularly good or bad performances
– Good ad hoc reviews  provide recognition for
outstanding performance and may be
accompanied by some award or gift
– Bad ad hoc reviews  address unacceptable
employee behavior or performance
immediately
• Progressive Discipline
– A series of acts taken by management in
response to performance be employees
– Responses by management to undesirable
behavior become progressively sever until
the employee either improves, resigns, or is
terminated from the position
– The aim to make explicit to an employee
the consequences of unsatisfactory
behavior in order to encourage improved
behavior
Progressive Discipline
• Formal oral reprimand
about the
consequences of
failing to perform as
expected
Verbal
Warning
Written
Warning
• Should describe the unacceptable
behavior clearly, previous warnings,
specific expectations of future
behavior to be achieve by a precise
deadline and consequences of not
meeting expectations
• Punitive action meant to
demonstrate the
seriousness of a situation
and act as a final warning
that current behavior is
unacceptable.
Suspension
• Termination of Employees
– Situations for terminating employees
1.
2.
3.
New employee can be terminated at any time during
the probationary period if it is clear that he will not
succeed in the job
Employees who commit acts that can be lead to
immediate termination (fighting, stealing, alc. use)
Employees who do not fall into 1&2, termination
should not come as a surprise and every step leading
up to the termination must be appropriate and
documented
• Conclusion
– Good HRM is an important requirement for
providing excellent pharmacy services
– Pharmacy personnel who are well
managed are more likely to be
satisfied in their jobs, effective, and
productive
Organizational
Structure and
Behavior
Tawfeeg Alnajjar
2015
Learning Objectives
• Discuss the field of organizational behavior and its
development over time.
• Describe the basic components of traditional and newer
organization forms.
• Compare and contrast different elements of formal
organizational structure.
• Discuss the basic incompatibilities between organizational
and professional models of structure.
• Identify influences on pharmacists' job satisfaction,
organizational commitment, job stress, and job turnover
intention and organizational identification and how they
affect organizational behavior and performance.
• Describe the role of emotions in organizational behavior.
What Is Organizational Behavior?
• An organization is a group of individuals
working to reach some common goal.
• Organizations can be very small in numbers of
personnel (fewer than three) or very large
(more than 5,000).
Organizational Structure and Behavior
• It is the systematic and scientific analysis of
individuals, groups, and organizations
– to understand, predict, and affect human behavior to
improve the performance of individuals
– ultimately affects the functioning and success of the
organizations in which they work
Organizational Structure and Behavior
• To be effective, managers must be able to:
– understand why people in their organizations
behave in certain ways.
– to take corrective action if problems arise.
– predict how employees will react to new
technologies and changes in the marketplace
Organizational Principles
Organizational Principles
• To understand an organization requires knowledge of its
purpose or reason for being.
• Organizations do not function in isolation. They are created
to meet some need in the external environment.
– The center of any organization is a set of values that form the
reason for existence, the philosophy, and the purpose of the
organization
– Articulations of these values often are represented as the goals
of the organization.
– To make the goals of the organization a reality, a structure must
be put in place to make the organization operational.
• Typically, the structure includes such concepts as reporting
relationships, communication patterns, decision-making procedures,
responsibility/accountability, norms, and reward structures.
Organizational Principles
• Structure produces the climate, or the
psychological atmosphere of the organization
– The climate of an organization consists of such
factors as the amount of trust, the levels of
morale, and the support employees experience
– Organizational climate is often confused with
organizational culture
Organizational culture
– The system of shared meaning held by members
that distinguishes one organization from another
– It refers to beliefs regarding how "things are done
around here“
– Managers are essential in creating the culture,
which influences interactions among coworkers
and relationships with patients
Organizational culture
– A strong culture will have a greater effect on the
climate because the high degree of sharedness
and intensity creates an internal climate of high
behavioral control
• Assessing an organization's culture will assist
in determining how the organization is
responding to both its internal and external
environments.
Assessing Organizational Culture
• Wide range of tools exist to assess
organizational culture, including techniques
ranging from observation, informal interviews,
and attending meetings to the administration
of carefully developed survey instruments.
– An example of such an instrument is the
Competing Values Framework.
ORGANIZATIONAL STRUCTURE
Organizational Structure Aspects
Differentiation
Centralization
Formalization
Others
Organizational Structure Aspects :
Differentiation (Complexity)
• Refers to the degree to which units are dissimilar.
• Types:
– Horizontal
– Vertical
– Spatial
Organizational Structure Aspects :
Differentiation (Complexity)
• Horizontal Differentiation
– It describes the degree of differentiation based on
how many different types of either people or
units are included in the organization.
– It can also take the form of multi ownership of a
variety of related industries.
Organizational Structure Aspects :
Differentiation (Complexity)
• Vertical Differentiation
– It refers to the depth of the organizational
hierarchy.
– One key feature of an organization is the chain of
command, or the number of levels between the
owner or president of the organization and the
staff.
• Vertical differentiation is represented by an
organizational chart.
Organizational Structure Aspects :
Differentiation (Complexity)
Organizational Structure Aspects :
Differentiation (Complexity)
• Spatial Differentiation
– It is the degree to which the location of an
organization's units is in one place or spread
across several locations.
– A large health system or chain pharmacy
operation can have multiple units spread across a
city, or entire regions of the country.
– It also can occur when different departments are
located in different areas e.g. pharmaceutical
manufacturer
Organizational Structure Aspects :
Formalization
• The degree to which jobs in the organization
are standardized
• It include the presence of rules, procedural
specifications, technical competence, and
impersonality.
– Standardize procedures to reduce errors and
increase efficiency.
Organizational Structure Aspects :
Formalization
• The degree of formalization can vary considerably
within and between organizations:
– Positions that make up the organization can have very
detailed job descriptions, whereas other organizations are
less formal and do not have written job descriptions or
vague descriptions.
– Individuals who are higher in the organization will have
less formal job descriptions than those lower in the
company.
– Some jobs also lend themselves to more or less
formalization. E.g. drug procurement and dispensing are
highly formalized, but the individualized services that
pharmaceutical care requires leave much discretion to the
individual pharmacist.
Organizational Structure Aspects :
Centralization
• The extent to which decision-making is
concentrated at a single point in the
organization:
– Usually the very top levels of management make most
of the policy decisions in a centralized organization.
– More recently, the trend has been to decentralize
decision-making and move it down to lower levels of
management or to staff-level employees.
– Problems arise when employees are responsible for
achieving goals without the authority to make policies
or gather the needed resources.
Organizational Structure Aspects:
Centralization
• Centralization sometimes is confused with
spatial differentiation.
– E.g. hospital pharmacy that has satellite
pharmacies located throughout the hospital?!
Organizational Structure Aspects:
Division of Labor
• Divides work tasks into specific parts.
– E.g. pharmacists responsible for dispensing functions or clinical
functions.
– clinical pharmacists, can specialize in a particular field.
• An advantage is more efficient use of the specialized skills of the
individual.
• The professional may become very narrow in his or her abilities,
and the job could become routine.
• Enlarging rather than narrowing the scope of some jobs leads to
greater productivity by using employees with interchangeable skills
– This can be seen in the hospital setting, where pharmacists provide
both traditional staffing functions on certain shifts and patient care
(clinical) functions on others.
Organizational Structure Aspects :
Unity of Command
• An individual reports to only one supervisor, to whom he or
she is responsible.
• As pharmacy organizations have tried to decentralize,
employees may have more than one person to whom they
are reporting.
• A structure that makes the most of this concept is called a
matrix organization.
– A matrix organization integrates the activities of different
specialists while maintaining specialized organizational
departments
– This type of structure works well in environments that are
continually changing and in need of innovation.
– It also works well when people are required to get together in
interdisciplinary terms
Organizational Structure Aspects :
Unity of Command
Organizational Structure Aspects :
Unity of Command
• Pharmaceutical manufacturers and crossdisciplinary teams in hospitals (e.g., nurses,
physicians, pharmacists, and social workers) are
particularly well suited for this endeavor.
• This allows for diversity of ideas and for the best
possible solution to emerge.
• The negative side:
– employees don’t prefer reporting to more than one
supervisor
– confusion as to who is responsible for what can
develop
Organizational Structure Aspects :
Span of Control
• How many people a manager effectively controls.
• In pharmacies, we can see a wide variation in the number
of individuals a pharmacist supervises.
– One pharmacist can supervise only one or two technicians in
the pharmacy
– or the pharmacist can manage the entire store, including nonpharmacy personnel.
– Recently, there has been a push to increase the span of control
of managers
– Drawbacks to small spans of control:
• They are expensive because they add layers of management,
• complicate vertical communication by slowing down decision-making,
and discourage employee autonomy because of the close supervision
by management. It is also felt that highly trained employees do not
need as much direct supervision
Organizational Structure Aspects :
Departmentalization
• Grouping individuals according to specific
tasks.
• The advantages of having departments is that
the individuals share a common vocabulary
and training and expertise.
– This should increase efficiency and effectiveness
of the unit.
– For example, persons responsible for purchasing,
distributing, and managing drug products could
constitute a department.
Organizational Structure
Simple
structure
Machine
bureaucracy
Divisional
structure
Professional
bureaucracy
Adhocracy
Organizational Structure
1. Simple structure is one in which a single
person runs the entire organization.
– Example: independent community pharmacy.
• This type of organization is quite flexible and
can respond to the environment quite quickly
• It is also quite risky because the success or
failure of the business depends on one or two
individuals.
Organizational Design
2. Machine bureaucracy is a highly complex
formal environment with clear lines of
authority.
– Example: mail-order pharmacy
• This type of organization is highly efficient in
performing standardized tasks
• It may be dehumanizing and boring for
employees.
Organizational Design
3. Professional bureaucracy is one in which much of the
day-to-day decision-making is vested in the
professionals who carry out most of the work.
• In this type of structure, there are many rules and
regulations that may inhibit creativity.
–
•
•
Example health system pharmacy.
The positive side of this structure is that it allows
professionals to practice those skills for which they
are best qualified.
On the negative side, these professionals may
become overly narrow, which may lead to errors and
potential conflicts between employees
Organizational Design
4. Divisional structure is one that consists of a set of
autonomous units coordinated by a central
headquarters.
• In this design, divisional managers have a lot of
control that allows upper-level management to focus
on the "big picture.“
• A negative side of this structure is duplication of
effort.
–
Example: college of pharmacy that is structured around
the various disciplines of the pharmaceutical sciences
Organizational Design
5. Adhocracy which is very informal in nature.
There is very little formalization and
centralization.
• Most of the work is done in teams.
–
Example the research and development
department of a pharmaceutical company.
• This type of design fosters innovation but can
be highly inefficient and has the greatest
potential for disruptive conflict.
Pharmacists' Organizational Behaviors
• Examining pharmacists' work-related attitudes and behaviors is important
to improve the positive and decrease or minimize the negative actions of
employees.
– Increased absenteeism, tardiness, and counterproductive behaviors will
decrease organizational productivity and performance significantly. This has
the economic consequence of decreasing the profitability of the organization.
– An unhappy coworker also can make the work environment unpleasant for
other workers, the entire day seems longer and more stressful.
– Negative organizational attitudes also can compromise patient care.
– An unhappy or dissatisfied pharmacist may be less motivated to keep skills
and knowledge levels current.
– Job dissatisfaction also has been found to be associated with an increased risk
of medication errors.
– The physical and mental health of the pharmacist also can suffer, owing to the
stress of working in an unappealing pharmacy environment with a heavy
workload.
Pharmacists' Organizational Behaviors
job
satisfaction
organizational
commitment
job stress
job turnover.
Job Satisfaction
• An emotional response or a comparison between
expectations and the perceived reality of the job as a
whole.
• Predictors of job satisfaction:
–
–
–
–
–
–
performing more clinical or non distributive work activities
higher levels of autonomy
recognition
good environmental conditions
professional commitment
working in an independent pharmacy environment
• Enhanced job satisfaction leads to more positive
feelings toward the employing organization
Organizational Commitment
• An emotional attachment and accepting the
organization's goals and values, putting forth effort,
and wanting to maintain membership.
• Organizational commitment is important because it is
related to reduced job turnover.
• Organizational commitment is enhanced when:
– Clinician receive appropriate compensation and benefits
– have access to important organizational information,
resources to perform the job
– opportunities for advancement within the organization
– organizational support
Job Stress
• Role stress in the form of role conflict, role ambiguity,
role overload, and work–home conflict increases job
stress.
• Stress that continues to be ignored can lead to a
phenomenon known as burnout.
• Support, recognition and collaboration help people
focus their energy more effectively, justify their
involvement and extend their achievements.
Consequently this leads to a more robust organization
and lessens burnout
Job Turnover
• The decreased productivity from voluntary turnover is very costly to
an organization because :
– less experienced workers must be used to replace the more
experienced workers who leave.
– Advertising, recruiting, and training a replacement employee for
someone who has left
– In a time of shortage of available employees, it is important to retain
existing employees.
• Reasons pharmacists gave for leaving were related to
– working conditions: inflexible and long working hours and inadequate
support personnel. Other reasons for leaving an organization relate to
job dissatisfaction, role stress, and culture and climate factors
– Personal variables
– Market conditions
Emotions
• Emotions are intense feelings that are directed at someone
or something
• Health care organizations put more emotional demands on
employees and patients than many other organizations
• Emotional regulation in the workplace has been termed
emotional labor.
• Emotional labor is defined as expressing organizationally
desired emotions during service transactions
• Individuals who have the ability to take another's
perspective or to know what another is feeling (empathic
concern) or who generally express or feel positive emotions
(positive affect) will have less of a need to expend
emotional labor
Nahla A Alageel
1st semester
Nov 2014
Learning Objectives
• Discuss the importance of quality in pharmacy practice.
• Describe how quality is measured in pharmacy practice.
• Explain the differences between quality assurance, quality
control, and continuous quality improvement.
• List three methods for ensuring quality in pharmacy practice.
• Outline the steps necessary for a successful continuous
quality improvement plan.
• Prioritize areas/functions most suitable for conducting a
quality analysis.
What Is Quality?
• Webster's Dictionary defines quality as a
"degree of excellence"
What Is Quality?
• The Institute of Medicine (IOM) Definition
– Quality of care is the degree to which health
services increase the likelihood of desired health
outcomes and are consistent with current
professional knowledge
Quality in Pharmacy Practice
•
•
•
•
•
•
Represents degree of excellence
Increases probability of +ve outcomes
Decreases probability of -ve outcomes
Corresponds with current medical knowledge
Offers patient what he wants
Provides patient what he needs
How is Quality Measured?
• By assessing:
1. Structure: raw materials needed for
production (e.g. RPh, meds in stock)
2. Process: the methods or procedures used
(prescribing, dispensing, monitoring)
3. Outcomes: the end result or end product
How is Quality Measured?
• ECHO Model purports three basic types of
outcomes:
1. Economic (includes directed and indirect costs and
consequences)
2. Clinical (morbidity, mortality, event rates, symptom
resolution)
3. Humanistic (quality of life, patient satisfaction)
What Can Pharmacy Learn from Other
Industries?
• Health care traditionally has lagged behind
other industries in quality improvement.
• Health care system can improve the quality of
care by borrowing techniques used in other
industries to standardize processes.
• Various organizations have turned to a
systems view of quality improvement termed
human factors principles
Human Factors Principles
1.
2.
3.
4.
5.
6.
7.
8.
Reduce reliance on memory
Simplify and standardize
Use protocols and checklists
Use constraints and forcing functions to
physically prevent errors
Improve access to information
Decrease reliance on vigilance
Differentiating
Implementing automation
Human Factors Principles
• Standardization
– simplest, most broadly applicable and most
effective method in pharmacy
*Quality improves as variation is reduced
Methods for Ensuring Quality in
Pharmacy Practice
Quality
Assurance
Quality
Control
Continuous
Quality
Improvement
Quality Assurance (QA)
• Systematic monitoring and evaluation of
various aspects of a system to determine if
they conform to standards
• Basically, a check is performed to ensure that
a good or service meets a certain quality
standard.
• Problems are addressed after they occur
Quality Control (QC)
• An aggregate of activities designed to ensure
adequate quality
• Quality control improves product or service
design to improve the level of quality
• It can be thought of as defect prevention.
Continuous Quality Improvement (CQI)
• Continual improvement of all processes in a
system to meet or exceed customer
expectations
– AKA Total Quality Management (TQM), Quality Improvement Process,
and Total Quality Control
• CQI two important aspects:
1. Total systems perspective concerning quality.
2. The quality improvement process is continuous.
Examples of CQI in Pharmacy
• Develop, implement, revise, and improve
compliance with clinical guidelines
• Monitor medication errors
• Improve prescription writing
• Implement new technology
• Decrease ADEs
• Implement and improve pharmacy services
• Improve pharmacist interventions
A CQI Improvement Model
• Many CQI models exist.
• Examples of specific models include:
• Plan, Do, Check, and Act (PDCA) model
• Find, Organize, Clarify, Understand, Select, Plan, Do,
Check, and Act (FOCUS-PDCA) model
• Most models include elements that reflect
the following core concepts:
– (1) plan, (2) design, (3) measure, (4) assess, and
(5) improve
The CQI measurement cycle.
Background
Conclusions &
Recommendations
Results
Methods
CQI Cycle Background
Select a focus
Describe the focus
Sate focus importance
Relate focus to literature
Select global and specific goals
CQI Cycle Background
Select a focus
Describe the focus:
 description of the area, the setting, the portion of
the medication use process affected, and baseline
data.
Sate focus importance:
It should be considered high priority, high volume,
high cost, or high risk
Relate focus to literature:
discover techniques, interventions, and other
The CQI measurement cycle.
Background
Conclusions &
Recommendations
Results
Methods
CQI Cycle Methods
Select intervention
Select process & outcome measures
Describe data collection procedure
Describe analysis
CQI Cycle Results
• Analyze Data
– Most descriptive statistics (e.g., mean, median,
and percentages) often suffice for data analysis.
CQI Cycle Conclusions, Implications,
and Recommendations
• This is the "bottom line" of the process, it is
important that this section be understandable
to those outside the CQI team.
• This section should concisely explain the
conclusions and detail the actions that need
to take place.
• The CQI process is iterative; thus, the team's
recommendations for this CQI cycle and for
the next CQI cycle must be included
Quality Standards Organization
• Often quality improvement activities are
necessary for accreditation.
• Earning accreditation indicates that an
organization has met predefined standards.
• The accreditation process provides a
framework to help organizations focus on
providing safe, high-quality service and
requires that the organization demonstrate to
outside reviewers its commitment to
continuous improvement
Quality Standards Organization
• The Joint Commission (TJC):
– Established to "continuously improve the safety
and quality of health care provided to the public
through the provision of health care accreditation
and related services that support performance
improvement in health care organizations
• National Committee for Quality Assurance
(NCQA)
Ensuring Healthcare Quality
Build a system-focused, non-punitive culture
Promote a team oriented, systems view of
quality
Focus on high risk populations, high risk
medications, high risk processes
Implement changes that have worked
elsewhere
Implement small changes in quick cycles
Remember quality improvement is a
Conclusion
• Quality is an essential component of
competent, professional pharmacy practice.
• Increasing quality can have many beneficial
effects on any practice, such as minimizing
rework and increasing productivity.
• Many quality improvement changes are
simple and can be implemented quickly but
may have a large impact on the quality of
patient care.