Even a small organization benefits from having guidelines regarding mission, hiring, training, staffing, and other employee practices. Training becomes more efficient and standardized. There is a reference for policies and questions. Employees who understand the pharmacy mission are empowered to incorporate this mission into all aspects of their work. Clear guidelines demonstrate to potential employees, communities, stakeholders, and donors that the organization has a commitment and policies for treating all persons with dignity and against discrimination.
Staffing consists of pharmacists, pharmacy technicians, student pharmacists, and volunteers. Other healthcare professionals, such as social workers, may work with patient eligibility and enrollment. Staff needs to be adaptable, empathetic, patient-focused, and willing to accept new challenges as they unfold throughout the workday. Patients in need often time have complex prescription needs that require staff to have patience and persistence in helping them to navigate a complex health care system for the poor and vulnerable. Cross-training, when possible, allows all the duties of the charitable pharmacy to be performed with flexibility. Staffing depends on the amount of prescriptions filled, counseling needs, other clinical services provided, and administrative tasks.
Adding an Executive Director to the staff allows fund development, marketing, and other roles to be provided by a trained professional. One individual concentrating on these aspects of the business, whether full or part-time, benefits the entire organization.
TIP: An Employee Handbook is an effective tool to verify the employee is informed of policies and understands what is expected with employment. Ozanam Charitable Pharmacy shares theirs. Examples in Appendices\Human Resources.
Staffing policies should consider federal and state requirements. There should always be a licensed pharmacist working, typically with at least one technician. The pharmacist/technician ratio varies from state to state and may change if the technician is certified.
Certified technicians may also be allowed additional responsibilities beyond that of non-certified technicians.
Policies should be in place regarding:
- Attire, including badge display with name and position
- Attendance, tardiness, absences, lead time for calling out, and sick day versus personal day
- Corrective action, including progressive discipline
- Licensure and certification, including terms for updating
- Position descriptions, including limitations
- Reporting suspected abuse (when patient appears to be in a harmful situation)
See Appendices\Standard Operating Procedures
More details regarding policies can be found in Standard Operating Procedures
Initial orientation includes a review of the community charitable pharmacy Standard Operating Procedures (see Appendices\Human Resources\HOPE Orientation.pptx) as well as becoming acclimated to the position. An orientation checklist and sign off ensures the employee has been introduced or trained in the various responsibilities of the position. This can also document confidentiality (HIPAA), safety, policy, and procedure training. Appendices\Human Resources\Orientation_sign-off-pharmacy_assistant_2012.docx
Startup hours of operation factor in funding, services offered, and size of the population to be served. Many stand-alone or community collaborative charitable pharmacies begin with three days per week (21 to 24 hours/week). If the charitable pharmacy is to be affiliated with a clinic or hospital with an established population, five days a week may be feasible.
Limited hours of operation provide time for marketing to community and health care referral sources, funders, and patients. Even with community support, presentations to clinics (social workers as well as providers), and health fairs, church groups, libraries, etc. are needed to introduce your pharmacy and its services to the community and establish your reputation (See: Where to start).
Hours of operation may need to be adjusted to better meet the community need. Examples: Open early or close later one day a week to accommodate patients who are working; closed on Wednesday as clinics do not have specialties open on Wednesdays; open on Friday afternoon to accommodate discharge patients. Check with local health care facilities to determine when their disease state clinics are run to best offer your services to their patients.
See Standard Operating Procedures for evaluation of competencies for annual reviews and implementation of new processes and procedures.
Students can be a valuable addition to the charitable pharmacy team. With students performing pharmacy tasks, staff is freed up for other needs. Students will encounter the uninsured population, perhaps for the first time, developing skills specific to the poor and vulnerable. Compassion, communication, social justice, and a broader global view are gifts a charitable pharmacy offers in exchange for developing pharmacy skills. Students may leave inspired to incorporate these gifts into their future positions and volunteer work.
Developing and providing an educational program is time consuming but can be a win-win for all involved. Precepting pharmacy and other students usually requires additional training or certification. Check with a local universities or schools of pharmacy to investigate requirements. Beyond pharmacy students, consider precepting other health professions, foreign language, small business, marketing, social services, and other majoring students.
TIP: Check with state board of pharmacy to verify pharmacist ratio for students and technicians, and whether volunteers are included in this ratio.
Volunteers are a valuable resource for many non-pharmacy tasks within the pharmacy. Retired or volunteer pharmacists may be able to assist with pharmacy-related tasks depending on licensure and liability. Non-pharmacy or healthcare volunteers can help with non-direct patient tasks. Students volunteering for Experiential Service Learning (ESL) may be able to interact with patients depending on the program. Pharmacist volunteers may require liability insurance if volunteering as a licensed pharmacist and not covered by a parent organization.
All volunteers should be oriented to pharmacy and pharmacy operations. Training may include HIPAA and privacy regulations, orientation to dealing with the patient population, pharmacy logistics, safety precautions, best practices, and media release if information will be used for marketing or reporting. Software products are available to manage and track volunteers.
Sources for Volunteers
RSVP is a program specially designed for seniors over the age of 55. With this program, there is a huge variety of volunteer positions available. Pharmacy chooses the hour to be put in, where volunteer will serve, and the type of work to do. Volunteer will successfully join over 500,000 senior citizens across the United States.
As a partner agency, the pharmacy can sign up with the Volunteer Program. List as looking for a development volunteer to assist with newsletter and other projects or whatever the volunteer need is.
AmeriCorps VISTA (Volunteers in Service to America) is a national service program that focuses on projects aiming to alleviate poverty in communities across the country. VISTA members make a year-long, full-time commitment, to build the capacity for programs to efficiently and effectively reach their goals of bringing individuals and communities out of poverty. AmeriCorps VISTA primarily works on projects and tasks that are considered indirect service. Their focus is working to assure projects are sustainable and can reach a larger population of people.
Local University Pre and Pro Pharmacy Students and other Students
Become a teaching organization and preceptor for both IPPE and APPE pharmacy students as well as volunteers. Use Pre-Pharmacy and Post-Pharmacy students from the local schools for daily operations and community outreach at local health fairs and workshops. Other university students to consider are nursing, other health sciences, foreign language, business, marketing, technology, depending on the needs of the pharmacy (interpretation/translation, newsletter, website, marketing materials, other).
The Senior Community Service Employment Program (SCSEP) offers training opportunities to low-income adults age 55 and older in 16 states who wish to re-enter the workforce. The program allows participants to overcome barriers to employment by gaining real world work experience at community service organizations called “host agencies” in the community. Participants are assigned to host agencies for about 20 hours per week. The objective is to provide current hands-on training that can lead to unsubsidized employment in the private sector. Assignments vary and range from six to twelve months. Participants can be assigned to more than one host agency in order to provide them with enhanced experiences and a broader range of skills.
Productivity for a pharmacy is typically measured by how many prescriptions the pharmacy fills a day and the total accumulated in a week. It is best to closely align the volume of prescriptions to the number of staff working. Be patient as building volume takes time when beginning a new pharmacy. In general, the maximum pharmacist/technician ratio is achieved before adding an additional pharmacist.
Sample measures from Saint Thomas Health:
How many prescriptions added per day?
Tip: At Saint Thomas Health in Nashville, most retail pharmacy locations average about 100 prescriptions a day; for a pharmacy that only stocks charity medications, approximately 125-175 prescriptions a day are dispensed.
- Start up
- 1 pharmacist/1 tech for new operation
- 20 – 25 patient encounters/day which = ~100 – 175 prescriptions/day
- 1 pharmacist/2 techs when increase volume
- 35 – 40 patient encounters/day = 125 – 150 prescriptions/day
- One existing retail model had the capacity to handle an additional 50 prescriptions/day prior to starting up a charity program. Within a few months, demand exceeded projection and the pharmacy was filling up to 100 prescriptions/day exceeding capacity.
- Have a plan ahead of time so if volume expands quicker than anticipated there will already be buy-in from stakeholders/funders/administrators to add additional staff.
- Consider automation (tablet counter, robot, etc.) as expansion tools.
- 1 pharmacist/1 tech for new operation
As healthcare moves away from the fee-for-service model, more focus will be on outcomes and services compared to the number of prescriptions. Services include:
- Medication Therapy Management(MTM) and targeted MTM
- Monitoring therapeutic outcomes(A1c, lipids, blood pressure, etc.)
- Device education (glucometer, insulininjectors, inhalers, etc.)
- Collaborative practiceAppendices\Collaborative Practice
- Medication and disease interventions
- Counseling in non-English languages
- Transitional Care Appendices\Transitional Care
Clinical services require more pharmacist time and perhaps specially trained staff. Example, a technician may serve both as a pharmacy technician and an interpreter, requiring time away from pharmacy tasks. Develop metrics to demonstrate how these services effect staffing as well as benefit patient outcomes. (See Measurements/ Evaluation/Outcome and Appendices\Metrics for sample studies and metrics).
Example measures from a community charitable pharmacy offering PAPs, targeted MTM, collaborative practice, and counseling in non-English:
- 1 pharmacist/2 pharmacy technicians. The technicians work three 7 hour shifts per week.
- 25-27 patients encounters/day
- 100 prescriptions/day
- 2-3 PAPs/day
- 4-6 clinical interventions/day
- 4-5 therapeutic interchanges/day
Example productivity metrics for a drug donation/reclamation program are found in Drug Reclamation/Donation Performance Metrics.