Towards Enhanced Performance Assessment In Hospital Pharmacy Practice: A Comprehensive Model And Pilot Project In Quebec, Canada

• By: VAILLANT, Linda (Quebec Hospital Pharmacists Association, Canada)
• Co-author(s): Mrs Linda Vaillant (Quebec Hospital Pharmacists Association, Montreal, Canada)
  Mrs France Boucher
  Mrs Sylvie Schryve
  Mr. André Bonnici
  Mr. Carl Desparois
  Mr. François Paradis
  Mrs Julie Racicot
  Mrs Diem Vo
  Mr. Benoît Lemire
  
• Abstract:

  TITLE
  Towards Enhanced Performance Assessment in Hospital Pharmacy Practice: A Comprehensive Model and Pilot Project in Québec, Canada
  
  AUTHORS
  France Boucher, BPharm, MSc1
  Sylvie Schryve, BArch, DEA1
  André Bonnici, BPharm, MSc2,3
  Carl Desparois, BPharm, MSc4,5
  François Paradis, BPharm6
  Julie Racicot, BPharm, MSc1,5,7
  Diem Vo, BPharm, MSc, MBA8
  Benoît Lemire, BPharm, MSc2,3
  Linda Vaillant, BPharm, MSc, MBA1
  
  Affiliation
  1.Quebec Hospital Pharmacists Association, Canada
  2.Pharmacy Department, McGill University Health Centre, Canada
  3.Faculty of Pharmacy, Université de Montréal, Canada
  4.Pharmacy Department, Centre intégré de santé et de services sociaux de l’Outaouais, Canada
  5.Faculty of Pharmacy, Université Laval, Canada
  6.Pharmacy Department, Centre intégré de santé et de services sociaux du Bas-Saint-Laurent, Canada
  7.Pharmacy Department, Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval, Canada
  8.Pharmacy Department, Centre intégré de santé et de services sociaux de la Montérégie-Est, Canada
  
  ABSTRACT
  Introduction
  The Ministry of Health in Québec, Canada, recently committed to adopt a patient-focused funding approach for its 34 healthcare centres, enabling benchmarking across hospitals, including pharmacy departments. However, traditional assessments of pharmacy performance have focused solely on financial metrics, overlooking pharmacists' clinical care. This oversight risks labelling pharmacists as high cost without accounting for their impact on patient outcomes. Thus, the Quebec Hospital Pharmacists Association initiated an effort to implement a comprehensive framework for measuring pharmacists’ activities province-wide, spanning acute and long-term care facilities.
  
  Method
  A Working Group, supported by an Advisory Committee of pharmacy practice experts, led the implementation process. Phase 1 involved surveying hospital Chief Executive Officers and other stakeholders to identify information needed to understand pharmacy department operations and pharmacists' roles. Insights from these consultations shaped a patient-centred performance model, with proposed indicators selected for each framework dimension. Implementation, starting in June 2017, required collaboration across Pharmacy, Information Technology, Performance & Quality departments, and frontline pharmacists for data collection. Phase 2 consisted of implementing 11 indicators in three centres over one year. Phase 3 extended the pilot to three more centres, testing 18 indicators over 18 months. A feedback survey documented pharmacists’ experiences.
  
  Results
  Substantial data were gathered over three years, involving 358 pharmacists from six healthcare centres, approximately 20% of Quebec’s hospital pharmacists. Extracting data from centres' information systems posed challenges due to system diversity and lack of integration. Two indicators were discarded due to data collection issues, and five added to better capture frontline pharmacists' clinical practice. Despite voluntary data collection, frontline pharmacist participation was 55%. Feedback surveys favoured in-person events over online tools for project promotion. Most respondents (94%) recognised the importance of collecting pharmacists' activity data, with 82% seeing relevance to future activity-based funding systems.
  
  Conclusion
  This project demonstrated integrating meaningful performance indicators into daily pharmacy activities is feasible. This experience provides a foundation for the Ministry of Health to consider incorporating these indicators into its financial performance system, fostering a more patient-focused funding approach. Balancing financial aspects with data reflecting pharmacists' clinical impact is essential for optimal patient outcomes.