Measuring time utilization of pharmacists in the Birmingham Free Clinic dispensary

Abstract

BackgroundFree and charitable clinics are a critical part of America’s healthcare safety net. Although informatics tools have the potential to mitigate many of the organizational and service-related challenges facing these clinics, little research attention has been paid to the workflows and potential impact of electronic systems in these settings. In previous work, we performed a qualitative investigation at a free clinic dispensary to identify workflow challenges that may be alleviated through introduction of informatics interventions. However, this earlier study did not quantify the magnitude of these challenges. Time-motion studies offer a precise standard in quantifying healthcare workers’ time expenditures on clinical activities, and can provide valuable insight into system specifications. These data, informed by a lean healthcare perspective, provide a quality improvement framework intended to maximize value and eliminate waste in inefficient workflow processes.MethodsWe performed a continuous observation time-motion study in the Birmingham Free Clinic dispensary. Two researchers followed pharmacists over the course of three general clinic sessions and recorded the duration of specific tasks. Pharmacists were then asked to identify tasks as value-added or non-value-added to facilitate calculation of the value quotient, a metric used to determine a workflow’s level of efficiency.ResultsFour high-level workflow categories occupied almost 95 % of pharmacist time: prescription (Rx) preparation (39.8 %), clinician interaction (21.5 %), EMR operations (14.8 %), and patient interaction (18.7 %). Pharmacists invested the largest portion of time in prescription preparation, with 21.8 % of pharmacist time spent handwriting medication labels. Based on value categorizations made by the pharmacists, the average value quotient was found to be 40.3 %, indicating that pharmacists spend more than half of their time completing tasks they consider to be non-value-added.ConclusionsOur results show that pharmacists spend a large portion of their time preparing prescriptions, primarily the handwritten labeling of medication bottles and documentation tasks, which is not an optimal utilization of pharmacist expertise. The value quotient further supports that there are many wasteful tasks that may benefit from workflow redesign and health information technology, which could result in efficiency improvements for pharmacists.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1787-6) contains supplementary material, which is available to authorized users.

Considering pharmacy workflow in the context of Australian community pharmacy: A pilot time and motion study

“…A study on community pharmacies in Portugal reports similar results, while a study in the USA reports similar results for the counselling and dispensing domains, and less time (5%) on professional management. 3 Task shifting some of these professional management activities to a pharmacy assistant for example, i.e. moving towards more of the US model may free up some pharmacist time to commit to chronic disease management activities.…”

“…1 Given the increasing time pressures on primary care physicians, 1 utilising pharmacists in a model of care is being currently proposed for chronic diseases such as asthma, cardiovascular disease, and HIV, through novel interventions implemented at the pharmacy level. [2][3][4] Such interventions can improve patient understanding, adherence to medications, and ultimately clinical outcomes with collaborative pharmacy interventions already showing improvements in lipid levels and blood pressure for cardiovascular disease.…”

“…Time and motion studies provide a method for obtaining quantitative data on workflow and work practices, and have been recently used in some healthcare settings including in Australian hospital pharmacies, 11,12 and non-Australian community pharmacies. 3,13,14 Data collected with this method uses discrete variables and can be more easily compared to standards, between studies, and with future interventions. 11 Such data can be easily collected electronically, with software loaded onto a tablet device.…”

Electronic Health Record Implementation: A Quality Assurance Assessment from a Free Clinic Perspective

“…Fisher et al discovered that process challenges and breakdowns in a low-resource medical setting could be improved with better documentation [17]. On the other hand, Makam et al showed that clinicians were not highly satisfied with EHRs meeting "meaningful use" criteria due to time efficiency issues and reducing provider optimization [18]. With the above in mind, several free clinics that implemented a provider-based EMR had improved diagnostic information, improved data quality, and higher satisfaction expressed by both providers and patients [19].…”

Utilização Da Metodologia Dmaic Em Um Hospital Da Rede Pública Federal Com Foco Em Melhoria Da Previsão De Demanda Por Consultas

“…Entre os estudos mais comuns da metodologia é possível encontrar na literatura um framework geral para implementação do Lean em instituições de saúde é implementado (Yu et al, 2015), Benchmarking de melhores práticas (Narayanamurthy & Gurumurthy 2016), estudo de tempos e movimentos (Fisher et al, 2016), e 5S (Kanamori et al, 2015).…”