The hospital pharmacy of tomorrow
What is the core activity of a hospital pharmacy? To provide the right drugs and other pharmaceutical products to the right patient at the right time, in the right dose and in the right condition. Currently, there is a trend towards expanding the contribution of the hospital pharmacy to include services such as information provision, advice and follow-up. ‘However, the question is whether the present organisation of the hospital pharmacy can support this trend,’ says Brecht Cardoen, Assistant Professor in Service Operations Management and head of Vlerick research centre MINOZ. ‘Hence the publication of the Hospital Pharmacy White Paper (Dutch only).’
The white paper describes the role the hospital pharmacy wants to fulfil in the near future and the preconditions for doing so.
In addition to expanding the role of the hospital pharmacy, there are also several challenges which will need to be faced.
Avoiding medication errors remains a top priority.
- Quality and effectiveness
The key is to provide the most effective pharmaceutical care which provides the greatest health gain possible (decreased morbidity and mortality) and/or quality of life.
- Integration and communication
The research showed that both the integration of the pharmacy in the care chain – process integration – and the internal and external communication can be improved. The different stakeholders lack insight into the operation of the hospital pharmacy and what it offers.
- Process control
The rational utilisation of resources and staff requires a critical study of the processes. Because there are so many different parties involved, these processes are not only complex but also variable. This variability leads to a loss in efficiency and an increased chance of errors, which threatens the quality and effectiveness of care.
Computerisation and automation can lead to operational efficiency but require considerable investment. Moreover, the integration with existing systems is complex, and the fragmentation of the market makes it more difficult to gear the different applications to each other. And finally, sufficient attention must be paid to the expert use of technology, data security and patient privacy.
It is important that legislation supports the current and future operation of the hospital pharmacy and links it to delivery commitments. As legislative changes invariably result in adjustments to procedures and processes, it is crucial that they are well thought-out and timed.
Due to the financial and economic crises, the government has systematically made more cuts to the health care budget in recent years. Moreover, current hospital funding is complex and lacks transparency. A number of factors have resulted in shrinking margins and financial resources being drained away from the hospital pharmacy to other hospital departments. Consequently, it is becoming increasingly difficult to meet the ever more stringent quality requirements.
- Changing health care needs
With an ageing population comes a rise in chronic diseases and multiple disorders, which results in a greater need for pharmaceutical products and services on admission. New technology enables better diagnosis and tailor-made treatments. Hospitalisations are becoming shorter and there is a shift from hospitalisation to admissions to day hospitals. Furthermore, people in need of care are encouraged to stay at home as long as possible, making the support for home medication, and ensuring that the hospital pharmacy and other care providers are geared to each other, even more important. And finally, patients now have more of a say and want to play a more active role in their care. Naturally, all of this has a major impact on the operation of the hospital pharmacy.
Five questions, five answers
‘The white paper was drawn up around five key questions,’ says Brecht. ‘Who is the focus? What do we want to offer the patient? How do we want to achieve this? With whom? And what do we need to do so?’ The answers to these questions should define the hospital pharmacy of tomorrow and can be summarised as follows:
1/ The patient is the focus
In the hospital pharmacy of tomorrow, the entire care process should ‘follow’ the patient so that he or she has to invest as little effort as possible into receiving quality treatment. Because patients want to play a more active role in their care, the hospital pharmacy will have to involve them as co-producing and co-creating customers.
2/ Products and services
The hospital pharmacy of tomorrow wants to be able to continue to carry out its core activities, as well as advise on the choice of medication therapy, provide information and, in consultation with the doctor in attendance, monitor the pharmaceutical care of individual patients. By offering guidance in the transition from primary to secondary, to tertiary care, it will also support continuity of care.
3/ More than clinical excellence
Multidisciplinary collaboration is a way to achieve clinical excellence, but is not enough in itself. The hospital pharmacy of the future will also need to invest in continuous knowledge development, look for the causes of problems as a ‘learning organisation’, and will need to integrate the acquired insights into its service provision. Moreover, clinical excellence will have to go hand in hand with operational excellence and service excellence. This means that in the daily operation, enough attention must be paid to process control, as well as interpersonal and social skills.
4/ Care chain with partners
The hospital pharmacy of tomorrow operates within a network of partners, with the patient as the end customer. To avoid discontinuity of care, it is of crucial importance that the hospital pharmacy also collaborates optimally, not only with the patient, but also with all internal and external partners. Mutual commitment, understanding and communication are essential to this.
5/ Action plan
To arrive at the hospital pharmacy of tomorrow, targeted changes will need to be made to the context, organisation and operation of the pharmacy. The white paper sets out concrete actions in terms of (1) collaboration between the hospital pharmacy and its partners and ensuring they are geared to each other, (2) funding and legislation, (3) medication therapy, (4) computerisation and automation, (5) training and retraining, (6) process management and (7) creating awareness and accountability.
‘With this white paper, we want to help the various stakeholders in health care to better understand the role and operation of the hospital pharmacy. And it should also initiate change. Consequently, we also hope that it provides the basis for constructive and fruitful discussions,’ says Brecht.
MINOZ (‘Management, Integratie, Navorsing en Onderzoek in Ziekenhuizen’, [Management, Integration, Investigation and Research in Hospitals]) is one of Vlerick Business School’s research centres. The centre focuses on operational management in and for hospitals. The research programme is centred on an annual theme, which is explored in depth in three workshops, together with Vlerick researchers, the members of the centre and the Prime Foundation Partner.