Strategic approach for improving the medication-use process in health systems: The high-performance pharmacy practice framework

Abstract

A strategic approach to improving the medication-use process in health systems by using a framework for setting priorities on the basis of feasibility, the potential for financial return, and the effect on quality and safety is described. A panel consisting of leaders in health-system pharmacy identified seven dimensions of high-performance pharmacy (HPP) framework: medication preparation and delivery, patient care services, medication safety, medication-use policy, financial performance, human resources, and education. Performance elements, which are specific policies, procedures, activities, and practices that indicate high performance and result in a financial or clinical return on investment of resources, within each dimension were identified. References, practice standards, and policies related to each performance element were also identified. By consensus, the panel assigned qualitative metric scores for each of the 69 performance elements that represent the panel's assessment of the resources necessary to achieve full implementation of the element and the potential financial and quality and safety returns if the element has not yet been implemented. It is noted that a pharmacy department's actual outlay of resources and expected financial return will differ depending on the size of the health system, the size of pharmacy staff, and the extent of previous implementation efforts. The framework can also be used to rejustify existing services and programs and identify opportunities for improvement. The HPP framework characterizes pharmacy performance elements on the basis of feasibility, financial return, and effect on quality and safety. The framework provides pharmacists with a means to establish priorities in improving the medication-use system.