Leveraging quality improvement principles in comprehensive medication management pharmacy practice: A case example

Objective: To maximize the time pharmacists providing comprehensive medication management (CMM) services spend providing direct patient care by tracking their time spent on various activities. Setting: Fifteen primary care clinics within an integrated health care system in Minnesota. Practice description: Eleven pharmacists provide comprehensive medication management services in 15 clinic sites; 12 primary care clinics, 1 family medicine residency training clinic, and 2 specialty clinics. Practice innovation: A team of pharmacists providing CMM developed and completed a self-reported workload sheet to document how much time they spent on various activities. These sheets were completed at 4 different points over 6 years to guide efficiency efforts to increase pharmacists’ time spent in value-added activities such as direct patient care. Evaluation: Beginning in 2014, each CMM pharmacist was asked to complete the workload tally sheet to track the time they spent on all their daily activities for a 5-day period. The workload sheets were collected in 2014, 2016, 2017, and 2019 and represent a snapshot of activity at 1 point during each year. Workload sheets from each pharmacist were compiled and analyzed each year to assess time spent in direct patient care and other value-added activities. Results: From 2014 to 2019, CMM pharmacists increased their time providing value-added services from 47.1% to 72% and increased time in direct patient care from 26.7% to 52.5%. This was achieved through a number of workflow optimization strategies, including appropriation of staff to schedule and recruit CMM patients, developing expanded collaborative practice agreements, and creating documentation efficiencies. Conclusion: Collecting CMM pharmacist workload data across the years demonstrated the amount of time pharmacists were spending on various clinic-related activities and served to identify areas where workflow and processes could be improved to increase the time pharmacists spend in value-added services. As CMM practices continue to develop and expand, tracking and optimizing pharmacists’ time is essential to leverage efficiency and value of pharmacy services.