REVIEW
Pharmacy workforce : matching staffing resource to service demand
This paper reflects on the results of a study validating a clinical pharmacy workforce calculator , the questions that the use of such a tool raises for the profession more widely and how it might support the challenges of delivering pharmacy services in a changing healthcare arena environment
Ruth Bednall DPharm MRPharmS University of North Midlands NHS Trust , UK Simon White PhD FRPharmS School of Pharmacy & Bioengineering , Keele University , UK Elizabeth Mills PhD MRPharmS School of Pharmacy , UCL , UK
GETTY
Clinical pharmacy was first described in the seminal paper by Hepler and Strand , 1 where it was defined as the provision of ‘ pharmaceutical care ’, that is , ‘ the responsible provision of drug therapy for the purpose of achieving definite outcomes which improve the patient ’ s quality of life ’. Since the publication of this paper , the provision of pharmaceutical care has advanced in countries such as the UK , USA and Australia . However , whilst clinical pharmacy ward-based services are well established in modern healthcare environments and the benefits of this approach to providing safe , effective and cost-effective use of medicines are known , 2 – 4 the workforce required to deliver these services has not been well described or standardised . In the UK , this has resulted in what has been described as ‘ unwarranted variation ’ in staffing levels . 5 Subsequently , annual data collection by the NHS Benchmarking Network further identified apparent variation in service delivery , 6 but does not identify the the associated variation in patient outcomes .
The pharmacy profession does not have a mandated approach to staffing levels such as that seen in other professions , for example , nursing . 7 A team in Stoke-on-Trent , England , developed a Clinical Pharmacy Workforce Calculator ( CPWC ) to standardise the way in which they requested workforce resource when clinical pharmacy services were requested for new or changed ward environments .
The methodology used in the development of this tool was that provided by the World Health Organization ’ s Workload Indicators of Staffing Need ( WISN ). 8 This is an established approach to identifying health care staffing resources and has been applied to a variety of settings and professions globally . 9 – 11 The WISN approach calculates staffing requirements from the equation shown in Figure 1 .
Furthermore , WISN suggests that the ‘ activity standard ’ is to be identified by consensus from ‘ experts in the field ’. In the initial development of the CPWC , the activity standard was developed by the local clinical pharmacy leaders who confirmed the required task list according to local policy and timings from time and motion observation of staff activity . This reflected the traditional ‘ peripatetic ’ lone practitioner delivery of pharmaceutical care common in UK hospitals . The generalisability of this approach to clinical pharmacy in
FIGURE 1
WISN equation
Staff resource required = Time to perform role for patient population Available staff time
Where : Time to perform role for patient population = ‘ activity standard ’ x number of patients ‘ Activity standard ’ = the full list of task required to deliver care for one patient , how long they take and how often they should be completed by what staff group and Available time = That portion of employed time available for patient care , i . e . what remains after annual leave , sickness , training or travelling is excluded
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