- Email: [email protected]
What does a pharmacist do? A time and motion study
Research in Social and Administrative Pharmacy xxx (xxxx) xxx–xxx
Contents lists available at ScienceDirect
Research in Social and Administrative Pharmacy journal homepage: www.elsevier.com/locate/rsap
What does a pharmacist do? A time and motion study Briana J. Negaarda, Kyle P. Lyonsa, Corbin L. Nichola, Linnea A. Polgreena,∗ a
Department of Pharmacy Practice and Science, University of Iowa, 115 S. Grand Ave., Iowa City, IA, 52242, USA
ABSTRACT
Background: Pharmacists work in many different settings and have various responsibilities. However, pharmacists are expensive and need to be used efficiently. Previous studies have shown that prescription preparation, clinician interaction, and medical record evaluation take a large part of a pharmacist's day. Additionally, it is also estimated that almost half of their time is considered “non-value added,” or that their tasks could be performed by a non-pharmacist. Objective: To observe pharmacists in multiple practice settings and record their activities to gauge inefficiencies. Methods: Time and motion methods were used to observe how pharmacists in retail, clinical, hospital, ambulatory, and academic settings perform daily tasks. Data was collected every 5 min for a total of 18 h from each setting, and sorted into 20 general categories of pharmacists’ tasks. Results: Pharmacists spend more time verifying prescriptions than any other activity, accounting for 31% of their time. Other common activities were patient education, charting, counseling, and chart review. Conclusion: Although most of pharmacists' daily activities add value to the healthcare team, there are ways to use their time more efficiently. Along with delegating tasks to other pharmacy personnel, new initiatives designed to help pharmacists increase time spent on value-added tasks are recommended.
Introduction A time and motion study is a business efficiency technique to establish employee productivity standards.1 This method breaks down a complex task into smaller steps and observes the time taken for each movement.2 The results are then analyzed by evaluating the sequence of movements taken by an employee to complete each task.1 This method is useful in detecting and eliminating wasted motion by establishing precise times taken for each movement.2 When employed correctly, time and motion studies prove effective in reducing/controlling costs, improving working conditions, and motivating employees while increasing productivity by establishing a “standard” job method.3 It should be noted that time and motion studies are generally only appropriate for repetitive tasks and thus methods may differ from occupation to occupation. There have been multiple time and motion studies performed in the field of pharmacy.1,4 These studies were designed to determine which pharmacy tasks could be performed by other staff or professionals. They suggest that pharmacy technicians or other pharmacy personnel should be given more responsibility so that pharmacists could spend more time with patients and adding value to the healthcare team. However, before tasks can be successfully assigned, the first step is to determine what a pharmacist's job entails. Previous studies have focused on a single setting such as a geriatric hospital4 or in a clinic.1 This present study is focused on retail, clinical, hospital, ambulatory, and academic settings.
∗
The objective of this study is to observe pharmacists in multiple practice settings and record their activities to gauge inefficiencies in order to identify new standards to increase productivity and eliminate wasted time throughout a pharmacist's day. Methods Three pharmacists were followed for 6 h in each of the 5 different pharmacy settings including retail, clinical, ambulatory care, hospital, and academic for a total of 90 h among 15 different pharmacists. During observation, data were collected every 5 min using a data collection sheet. This data was then broken down into 20 general categories of pharmacists’ tasks: verifying, chart review, counseling, prescription pick up, email, calling insurance companies, calling physicians, patient education, charting, drug information, meetings, reporting/questions, inventory, rounding, teaching, grading, professional development, planning/teaching prep, ordering drugs, and miscellaneous. The selected sites were classified using the following characteristics:
• Retail pharmacy: pharmacist working in a community/retail pharmacy setting who provides care for patients in the community • Hospital pharmacy: pharmacist working in a pharmacy within a •
hospital-based system that care for patients who have been admitted to the facility Clinical pharmacy: pharmacist specializing in a specific area of
Corresponding author. E-mail address: [email protected] (L.A. Polgreen).
https://doi.org/10.1016/j.sapharm.2019.03.007 Received 8 March 2019; Accepted 9 March 2019 1551-7411/ © 2019 Elsevier Inc. All rights reserved.
Please cite this article as: Briana J. Negaard, et al., Research in Social and Administrative Pharmacy, https://doi.org/10.1016/j.sapharm.2019.03.007
Research in Social and Administrative Pharmacy xxx (xxxx) xxx–xxx
B.J. Negaard, et al.
Fig. 1. Time spent on each task broken down by pharmacist specialty. Notice the majority of the pharmacist's time in the retail, clinical, and hospital setting was spent verifying. Ambulatory care pharmacists spent the majority of their time on a wide range of tasks.
• •
medicine who provides care for patients in various inpatient units of a hospital Ambulatory pharmacy: pharmacist working with interprofessional teams and patients in a clinic-based environment Academic pharmacy: pharmacist employed by a college of pharmacy
Results Eighteen hours of data was collected for each of the 5 categories of pharmacists that were followed, with a grand total of 90 h of data. The results, broken down into each of the 20 categories, are displayed in Fig. 1. Retail pharmacists spent 48% of their day verifying prescriptions. They spent 11% of their day counseling their patients on new medications and providing them with proper education on how to use them most effectively, while 7% of their time was spent on educating the patient on various disease states and answering any questions they may
The University of Iowa Institutional Review Board deem this study to be non-human-subjects research.
2
Research in Social and Administrative Pharmacy xxx (xxxx) xxx–xxx
B.J. Negaard, et al.
have. This amounts to 66% of their day performing essential tasks. However, they spent 15% of their day sending emails, working the prescription pick-up window, and calling insurance companies and physicians, all of which could potentially be assigned to other pharmacy staff. Hospital pharmacists dedicated 66% of their day to verifying prescriptions. Other tasks performed were specific to where they worked within the hospital system. For example if they work in a central pharmacy, they would be performing inventory, verifying batch drug supplies, and filling orders. However, if they were located on a satellite pharmacy, they would spend some time reviewing charts and speaking to other members of the healthcare team. Hospital pharmacists also spent time on non-essential tasks like email, inventory, and miscellaneous, which amount to 19% of their time. The daily operations of a clinical pharmacist consisted of verifying prescriptions (22%), charting (18%), reporting/questions (15%), rounding (10%), patient education (9%), chart review (7%), and counseling on medications (2%). These essential tasks accounted for 83% of the clinical pharmacist's day and cannot be completed by anyone other than the pharmacist. Most of an ambulatory care pharmacist's day was spent charting (20%), counseling patients (20%), providing patient education (17%) and reviewing charts (22%). The majority of their duties directly affect their patients, and these accounted for 79% of their day. Compared to other pharmacists, they only spent 11% of their day performing non value-added tasks such as email (2%), calling physicians (1%) and miscellaneous (8%). The academic pharmacist performed many functions with teaching (26%) taking the most time out of their day. Forty percent of their day was spent on teaching-related tasks which include planning/teaching preparation (10%) and grading (4%). The other tasks performed depend on where the faculty pharmacists work outside of their teaching role. For example, if they worked in retail they would spend more time counseling patients, but if they worked in ambulatory care they might spend more time charting. Pharmacists in every location spent most of their days verifying prescriptions (Figs. 1 and 2); this activity alone accounted for 31% of
their daily duties. Overall, the pharmacists also spent a considerable amount of time educating patients (9%), charting (8%), counseling (8%) and chart review (7%). Note that they spend the same amount of time reviewing charts as they do on miscellaneous activities (7%). The five tasks that pharmacist spend the least amount of time accounted for 5% of their day, and those activities include ordering drugs (1%), grading (1%), calling insurance companies (1%), working the prescription pick up window (1%), and time spent on professional development (1%). Discussion Pharmacists add value to the healthcare team as the expert in the knowledge and practice of pharmacotherapy. Their unique skillset makes them an integral part of medical care, thus, finding ways to enhance productivity is essential to improving patient outcomes. As pharmacists often work independently, efficient use of their time and energy is critical to the future of the profession. There are many similarities amongst the various settings. The main activity that dominated the largest portion of a pharmacist's time in all of the settings was verifying medications. Among all of the settings that were observed, this activity accounted for ∼30% of the total hours. This stands to reason, as a pharmacist's scope of practice is first and foremost to be the medication expert. Therefore, in any setting, pharmacists are the last line of defense against inappropriate dosing, drugdrug interactions, and drug-disease interactions. The next largest portion of a pharmacist's time was spent educating patients, representing ∼9% total. This is a good use of their knowledge and medication expertise. Patient education provides the pharmacist an opportunity to have a positive impact on patient health. A pharmacist's unique skillset makes them an integral part of the healthcare team. Thus, finding ways to increase the time pharmacists spend on patient education is essential to increasing patient outcomes. The other, and closely related, activity in which pharmacists participated was counseling patients on the correct use of their medications, representing ∼7.8% of the total hours observed. Proper education and counseling can increase the likelihood a patient is adherent to their
Fig. 2. Overall time spent on various tasks across all categories. Combining all areas of pharmacy, verifying is the most common task performed by pharmacists. 3
Research in Social and Administrative Pharmacy xxx (xxxx) xxx–xxx
B.J. Negaard, et al.
medication therapy regimen, taking it correctly, and using it as prescribed. Poor adherence or incorrect administration can result in harm to the patient, as well as poor outcomes. There is a common saying in healthcare: “if something is not recorded, it didn't happen.” Therefore, it is not surprising that the next greatest use of a pharmacist's time was spent charting information to a patient's profile or personal medical history (∼8.8%). This ensures that the interdisciplinary team is made aware of the patient's comprehensive health history. In any setting, a record of all healthcare interactions is crucial and can prevent avoidable errors that could result in detrimental health outcomes. While the previous examples in pharmacy practice are inherent to the pharmacist's scope of practice, there are also functions that could be assigned to others. Among all of the settings, functions like working at the prescription pick-up window, checking e-mail, calling physicians, calling insurance companies, going to meetings, and other miscellaneous functions accounted for ∼15.9% of a pharmacist's activity. These may be examples of inefficient use of a pharmacist's time. If more time of every pharmacist's day could be devoted to medical therapy management, instead of working the prescription pick-up window for example, patient outcomes may be improved. One way to use pharmacists more efficiently is to assign more tasks to pharmacy technicians, and a primary example is tech-check-tech. The tech-check-tech practice model is not a new concept in pharmacy: it was first reported in 1978.5 Properly trained technicians have been shown to check prescriptions as accurately as pharmacists.5,6 A 2016 study examined pharmacy technicians in 17 participating chain and independent pharmacies preforming tech-check-tech services. In order to participate in the study, the technicians were required to have 2000 h of experience, hold a national certification, be in good standing with the board of pharmacy, and the technicians were subjected to 50 monthly checks from the pharmacist. After 18 months and 5565 pharmacist checks, the investigators reported "no statistical difference between inaccuracy rates between pharmacists and technicians."5 They also noted an 18.72% net decrease in pharmacist time spent in dispensing related activities.5 If this, or a similar, type of process would be implemented, the pharmacist could spend more time on patient care.
pharmacist's work-flow and may influence their thought process or distract them from the original task. An alternative would be to include audio/video observation of the pharmacist to get a clearer picture of their work-flow. However, this method may infringe on pharmacist and patient privacy. Another limitation to this study is known as the Hawthorne effect: people alter their activities if someone is monitoring or watching them.7 In this case, however, if there were a Hawthorne effect, the recorded inefficient use of time would most likely be an underestimate. Conclusion Pharmacists have unique training to effectively and efficiently play an active role in therapy management. The next area of focus is developing and testing techniques that allow pharmacists to safely and effectively manage medication therapies and care for patients. As this data supports, correcting inefficiencies can help pharmacists add more value to patient care and the profession. Declarations of interest None. Acknowledgements This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Appendix A. Supplementary data Supplementary data to this article can be found online at https:// doi.org/10.1016/j.sapharm.2019.03.007. References 1. Fisher AM, Ding MQ, Hochheiser H, Douglas GP. Measuring time utilization of pharmacists in the Birmingham Free Clinic dispensary. BMC Health Serv Res. 2016;16(1):529. 2. Santiago AC. Career paths available in pharmacy: from retail to long-term care. https://www.verywellhealth.com/pharmacy-career-options-1736132, Accessed date: 17 January 2019. 3. Jenkins A, Eckel SF. Analyzing methods for improved management of workflow in an outpatient pharmacy setting. Am J Health Syst Pharm. 2012;69(11):966–971. 4. Wirth F, et al. Time and motion study for pharmacists' activities in a geriatric hospital. Int J Pharm Pract. 2009;17(6):373–376. 5. Frost TP, Adams AJ. Pharmacist and technician perceptions of tech-check-tech in community pharmacy practice Settings. J Pharm Pract. 2018;31(2):190–194. 6. Adams AJ, Martin SJ, Stolpe SF. Tech-check-tech: a review of the evidence on its safety and benefits. Am J Health Syst Pharm. 2011;68(19):1824–1833. 7. Mayo E, Hawthorne and the Western Electric Company. The Social Problems of an Industrial Civilisation. Routledge; 1949.
Study limitations While this study did illuminate what commonalities existed between different practice settings, there were limitations. One limitation was the difficulty of data collection. In all professional settings, pharmacists are busy and constantly multitasking. Thus, it was difficult to identify when exactly a task had changed. In addition, some processes were certainly mental exercises or judgments that the pharmacist made without verbally describing what had occurred. For more precise data collection, the pharmacist would need to be the one recording what had transpired. This note-taking, however, would add time to the
4
Contents lists available at ScienceDirect
Research in Social and Administrative Pharmacy journal homepage: www.elsevier.com/locate/rsap
What does a pharmacist do? A time and motion study Briana J. Negaarda, Kyle P. Lyonsa, Corbin L. Nichola, Linnea A. Polgreena,∗ a
Department of Pharmacy Practice and Science, University of Iowa, 115 S. Grand Ave., Iowa City, IA, 52242, USA
ABSTRACT
Background: Pharmacists work in many different settings and have various responsibilities. However, pharmacists are expensive and need to be used efficiently. Previous studies have shown that prescription preparation, clinician interaction, and medical record evaluation take a large part of a pharmacist's day. Additionally, it is also estimated that almost half of their time is considered “non-value added,” or that their tasks could be performed by a non-pharmacist. Objective: To observe pharmacists in multiple practice settings and record their activities to gauge inefficiencies. Methods: Time and motion methods were used to observe how pharmacists in retail, clinical, hospital, ambulatory, and academic settings perform daily tasks. Data was collected every 5 min for a total of 18 h from each setting, and sorted into 20 general categories of pharmacists’ tasks. Results: Pharmacists spend more time verifying prescriptions than any other activity, accounting for 31% of their time. Other common activities were patient education, charting, counseling, and chart review. Conclusion: Although most of pharmacists' daily activities add value to the healthcare team, there are ways to use their time more efficiently. Along with delegating tasks to other pharmacy personnel, new initiatives designed to help pharmacists increase time spent on value-added tasks are recommended.
Introduction A time and motion study is a business efficiency technique to establish employee productivity standards.1 This method breaks down a complex task into smaller steps and observes the time taken for each movement.2 The results are then analyzed by evaluating the sequence of movements taken by an employee to complete each task.1 This method is useful in detecting and eliminating wasted motion by establishing precise times taken for each movement.2 When employed correctly, time and motion studies prove effective in reducing/controlling costs, improving working conditions, and motivating employees while increasing productivity by establishing a “standard” job method.3 It should be noted that time and motion studies are generally only appropriate for repetitive tasks and thus methods may differ from occupation to occupation. There have been multiple time and motion studies performed in the field of pharmacy.1,4 These studies were designed to determine which pharmacy tasks could be performed by other staff or professionals. They suggest that pharmacy technicians or other pharmacy personnel should be given more responsibility so that pharmacists could spend more time with patients and adding value to the healthcare team. However, before tasks can be successfully assigned, the first step is to determine what a pharmacist's job entails. Previous studies have focused on a single setting such as a geriatric hospital4 or in a clinic.1 This present study is focused on retail, clinical, hospital, ambulatory, and academic settings.
∗
The objective of this study is to observe pharmacists in multiple practice settings and record their activities to gauge inefficiencies in order to identify new standards to increase productivity and eliminate wasted time throughout a pharmacist's day. Methods Three pharmacists were followed for 6 h in each of the 5 different pharmacy settings including retail, clinical, ambulatory care, hospital, and academic for a total of 90 h among 15 different pharmacists. During observation, data were collected every 5 min using a data collection sheet. This data was then broken down into 20 general categories of pharmacists’ tasks: verifying, chart review, counseling, prescription pick up, email, calling insurance companies, calling physicians, patient education, charting, drug information, meetings, reporting/questions, inventory, rounding, teaching, grading, professional development, planning/teaching prep, ordering drugs, and miscellaneous. The selected sites were classified using the following characteristics:
• Retail pharmacy: pharmacist working in a community/retail pharmacy setting who provides care for patients in the community • Hospital pharmacy: pharmacist working in a pharmacy within a •
hospital-based system that care for patients who have been admitted to the facility Clinical pharmacy: pharmacist specializing in a specific area of
Corresponding author. E-mail address: [email protected] (L.A. Polgreen).
https://doi.org/10.1016/j.sapharm.2019.03.007 Received 8 March 2019; Accepted 9 March 2019 1551-7411/ © 2019 Elsevier Inc. All rights reserved.
Please cite this article as: Briana J. Negaard, et al., Research in Social and Administrative Pharmacy, https://doi.org/10.1016/j.sapharm.2019.03.007
Research in Social and Administrative Pharmacy xxx (xxxx) xxx–xxx
B.J. Negaard, et al.
Fig. 1. Time spent on each task broken down by pharmacist specialty. Notice the majority of the pharmacist's time in the retail, clinical, and hospital setting was spent verifying. Ambulatory care pharmacists spent the majority of their time on a wide range of tasks.
• •
medicine who provides care for patients in various inpatient units of a hospital Ambulatory pharmacy: pharmacist working with interprofessional teams and patients in a clinic-based environment Academic pharmacy: pharmacist employed by a college of pharmacy
Results Eighteen hours of data was collected for each of the 5 categories of pharmacists that were followed, with a grand total of 90 h of data. The results, broken down into each of the 20 categories, are displayed in Fig. 1. Retail pharmacists spent 48% of their day verifying prescriptions. They spent 11% of their day counseling their patients on new medications and providing them with proper education on how to use them most effectively, while 7% of their time was spent on educating the patient on various disease states and answering any questions they may
The University of Iowa Institutional Review Board deem this study to be non-human-subjects research.
2
Research in Social and Administrative Pharmacy xxx (xxxx) xxx–xxx
B.J. Negaard, et al.
have. This amounts to 66% of their day performing essential tasks. However, they spent 15% of their day sending emails, working the prescription pick-up window, and calling insurance companies and physicians, all of which could potentially be assigned to other pharmacy staff. Hospital pharmacists dedicated 66% of their day to verifying prescriptions. Other tasks performed were specific to where they worked within the hospital system. For example if they work in a central pharmacy, they would be performing inventory, verifying batch drug supplies, and filling orders. However, if they were located on a satellite pharmacy, they would spend some time reviewing charts and speaking to other members of the healthcare team. Hospital pharmacists also spent time on non-essential tasks like email, inventory, and miscellaneous, which amount to 19% of their time. The daily operations of a clinical pharmacist consisted of verifying prescriptions (22%), charting (18%), reporting/questions (15%), rounding (10%), patient education (9%), chart review (7%), and counseling on medications (2%). These essential tasks accounted for 83% of the clinical pharmacist's day and cannot be completed by anyone other than the pharmacist. Most of an ambulatory care pharmacist's day was spent charting (20%), counseling patients (20%), providing patient education (17%) and reviewing charts (22%). The majority of their duties directly affect their patients, and these accounted for 79% of their day. Compared to other pharmacists, they only spent 11% of their day performing non value-added tasks such as email (2%), calling physicians (1%) and miscellaneous (8%). The academic pharmacist performed many functions with teaching (26%) taking the most time out of their day. Forty percent of their day was spent on teaching-related tasks which include planning/teaching preparation (10%) and grading (4%). The other tasks performed depend on where the faculty pharmacists work outside of their teaching role. For example, if they worked in retail they would spend more time counseling patients, but if they worked in ambulatory care they might spend more time charting. Pharmacists in every location spent most of their days verifying prescriptions (Figs. 1 and 2); this activity alone accounted for 31% of
their daily duties. Overall, the pharmacists also spent a considerable amount of time educating patients (9%), charting (8%), counseling (8%) and chart review (7%). Note that they spend the same amount of time reviewing charts as they do on miscellaneous activities (7%). The five tasks that pharmacist spend the least amount of time accounted for 5% of their day, and those activities include ordering drugs (1%), grading (1%), calling insurance companies (1%), working the prescription pick up window (1%), and time spent on professional development (1%). Discussion Pharmacists add value to the healthcare team as the expert in the knowledge and practice of pharmacotherapy. Their unique skillset makes them an integral part of medical care, thus, finding ways to enhance productivity is essential to improving patient outcomes. As pharmacists often work independently, efficient use of their time and energy is critical to the future of the profession. There are many similarities amongst the various settings. The main activity that dominated the largest portion of a pharmacist's time in all of the settings was verifying medications. Among all of the settings that were observed, this activity accounted for ∼30% of the total hours. This stands to reason, as a pharmacist's scope of practice is first and foremost to be the medication expert. Therefore, in any setting, pharmacists are the last line of defense against inappropriate dosing, drugdrug interactions, and drug-disease interactions. The next largest portion of a pharmacist's time was spent educating patients, representing ∼9% total. This is a good use of their knowledge and medication expertise. Patient education provides the pharmacist an opportunity to have a positive impact on patient health. A pharmacist's unique skillset makes them an integral part of the healthcare team. Thus, finding ways to increase the time pharmacists spend on patient education is essential to increasing patient outcomes. The other, and closely related, activity in which pharmacists participated was counseling patients on the correct use of their medications, representing ∼7.8% of the total hours observed. Proper education and counseling can increase the likelihood a patient is adherent to their
Fig. 2. Overall time spent on various tasks across all categories. Combining all areas of pharmacy, verifying is the most common task performed by pharmacists. 3
Research in Social and Administrative Pharmacy xxx (xxxx) xxx–xxx
B.J. Negaard, et al.
medication therapy regimen, taking it correctly, and using it as prescribed. Poor adherence or incorrect administration can result in harm to the patient, as well as poor outcomes. There is a common saying in healthcare: “if something is not recorded, it didn't happen.” Therefore, it is not surprising that the next greatest use of a pharmacist's time was spent charting information to a patient's profile or personal medical history (∼8.8%). This ensures that the interdisciplinary team is made aware of the patient's comprehensive health history. In any setting, a record of all healthcare interactions is crucial and can prevent avoidable errors that could result in detrimental health outcomes. While the previous examples in pharmacy practice are inherent to the pharmacist's scope of practice, there are also functions that could be assigned to others. Among all of the settings, functions like working at the prescription pick-up window, checking e-mail, calling physicians, calling insurance companies, going to meetings, and other miscellaneous functions accounted for ∼15.9% of a pharmacist's activity. These may be examples of inefficient use of a pharmacist's time. If more time of every pharmacist's day could be devoted to medical therapy management, instead of working the prescription pick-up window for example, patient outcomes may be improved. One way to use pharmacists more efficiently is to assign more tasks to pharmacy technicians, and a primary example is tech-check-tech. The tech-check-tech practice model is not a new concept in pharmacy: it was first reported in 1978.5 Properly trained technicians have been shown to check prescriptions as accurately as pharmacists.5,6 A 2016 study examined pharmacy technicians in 17 participating chain and independent pharmacies preforming tech-check-tech services. In order to participate in the study, the technicians were required to have 2000 h of experience, hold a national certification, be in good standing with the board of pharmacy, and the technicians were subjected to 50 monthly checks from the pharmacist. After 18 months and 5565 pharmacist checks, the investigators reported "no statistical difference between inaccuracy rates between pharmacists and technicians."5 They also noted an 18.72% net decrease in pharmacist time spent in dispensing related activities.5 If this, or a similar, type of process would be implemented, the pharmacist could spend more time on patient care.
pharmacist's work-flow and may influence their thought process or distract them from the original task. An alternative would be to include audio/video observation of the pharmacist to get a clearer picture of their work-flow. However, this method may infringe on pharmacist and patient privacy. Another limitation to this study is known as the Hawthorne effect: people alter their activities if someone is monitoring or watching them.7 In this case, however, if there were a Hawthorne effect, the recorded inefficient use of time would most likely be an underestimate. Conclusion Pharmacists have unique training to effectively and efficiently play an active role in therapy management. The next area of focus is developing and testing techniques that allow pharmacists to safely and effectively manage medication therapies and care for patients. As this data supports, correcting inefficiencies can help pharmacists add more value to patient care and the profession. Declarations of interest None. Acknowledgements This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Appendix A. Supplementary data Supplementary data to this article can be found online at https:// doi.org/10.1016/j.sapharm.2019.03.007. References 1. Fisher AM, Ding MQ, Hochheiser H, Douglas GP. Measuring time utilization of pharmacists in the Birmingham Free Clinic dispensary. BMC Health Serv Res. 2016;16(1):529. 2. Santiago AC. Career paths available in pharmacy: from retail to long-term care. https://www.verywellhealth.com/pharmacy-career-options-1736132, Accessed date: 17 January 2019. 3. Jenkins A, Eckel SF. Analyzing methods for improved management of workflow in an outpatient pharmacy setting. Am J Health Syst Pharm. 2012;69(11):966–971. 4. Wirth F, et al. Time and motion study for pharmacists' activities in a geriatric hospital. Int J Pharm Pract. 2009;17(6):373–376. 5. Frost TP, Adams AJ. Pharmacist and technician perceptions of tech-check-tech in community pharmacy practice Settings. J Pharm Pract. 2018;31(2):190–194. 6. Adams AJ, Martin SJ, Stolpe SF. Tech-check-tech: a review of the evidence on its safety and benefits. Am J Health Syst Pharm. 2011;68(19):1824–1833. 7. Mayo E, Hawthorne and the Western Electric Company. The Social Problems of an Industrial Civilisation. Routledge; 1949.
Study limitations While this study did illuminate what commonalities existed between different practice settings, there were limitations. One limitation was the difficulty of data collection. In all professional settings, pharmacists are busy and constantly multitasking. Thus, it was difficult to identify when exactly a task had changed. In addition, some processes were certainly mental exercises or judgments that the pharmacist made without verbally describing what had occurred. For more precise data collection, the pharmacist would need to be the one recording what had transpired. This note-taking, however, would add time to the
4