Hospital Tech Workflow System--Need Advice!

[baronzb]

Hospital Pharmacy Technician Workflow Structure

​

Need junior management advice. There is much leeway in the work culture for techs here, as many have been here for years. With lower staff numbers, techs are being asked to do more with the same staffing levels. There is a severe ‘silo’ mentality of only doing the specific job they are assigned to. To rectify this issue, I have come up with some ideas to get techs to be more dynamic in helping each other if bottlenecks arise. I have tried to get techs to spontaneously help each other, to ask others for help, etc. Night shift is a bigger problem. Very little gets done there. I have talked to techs individually, some repeatedly, and they either say they will comply, then do not, or they complain about the lack of support, which has some merit. (The company has several review the boss criticism sessions, which further undermines authority.) These options can be taken as all or a la cart.



Check-off sheets:

Have a large, landscape sized paper, delineating tech responsibilities in the pharmacy. When the task is complete, have each tech check-off the task. The biggest work load is pyxis, as IV compounding is few and mostly stocked in pyxis. For instance:

• AM pyxis, PM pyxis
• IV duties, including regulatory
• Clerk, including phones, stock outs, meds not loaded, prepacking
• General duties: fill prepack bins, crash carts
• 
  
• Assign multiple roles and tier them per tech:
• 
  
• Each tech will have a primary role, e.g. IV, but then also help pull meds for pyxis, do bins, etc., as a secondary role. Each day the check-off list will be the responsibility of those two techs.
• 
  
• I obsessively monitor everyone and do multiple write-ups. This is something I do not have experience in and it seems is distracting of my other duties.

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[Sparda29]

Hospital Pharmacy Technician Workflow Structure

​

Need junior management advice. There is much leeway in the work culture for techs here, as many have been here for years. With lower staff numbers, techs are being asked to do more with the same staffing levels. There is a severe ‘silo’ mentality of only doing the specific job they are assigned to. To rectify this issue, I have come up with some ideas to get techs to be more dynamic in helping each other if bottlenecks arise. I have tried to get techs to spontaneously help each other, to ask others for help, etc. Night shift is a bigger problem. Very little gets done there. I have talked to techs individually, some repeatedly, and they either say they will comply, then do not, or they complain about the lack of support, which has some merit. (The company has several review the boss criticism sessions, which further undermines authority.) These options can be taken as all or a la cart.



Check-off sheets:

Have a large, landscape sized paper, delineating tech responsibilities in the pharmacy. When the task is complete, have each tech check-off the task. The biggest work load is pyxis, as IV compounding is few and mostly stocked in pyxis. For instance:

• AM pyxis, PM pyxis
• IV duties, including regulatory
• Clerk, including phones, stock outs, meds not loaded, prepacking
• General duties: fill prepack bins, crash carts
• 
  
• Assign multiple roles and tier them per tech:
• 
  
• Each tech will have a primary role, e.g. IV, but then also help pull meds for pyxis, do bins, etc., as a secondary role. Each day the check-off list will be the responsibility of those two techs.
• 
  
• I obsessively monitor everyone and do multiple write-ups. This is something I do not have experience in and it seems is distracting of my other duties.

Seems like you are micromanaging too much and need to hire more techs.

 

[owlegrad]

Good luck trying to get people who are used to doing X amount of work to do X+1. Isn’t going to happen. Be ready to fire everyone and start over or lower your expectations.

 

[RXDOC1986]

I can tell, from your questions, expectations, and charts, that you are new to this management thing.
I didn't read through all your post, damn this ADHD, but again good luck implementing what you may think is a logical plan.
In my region, SE, technicians are MUCH more valuable than pharmacists. We try to handle them with kid gloves, help them at all times, and try not to lose them to another hospital.

 

[baronzb]

Seems like you are micromanaging too much and need to hire more techs.

I hate to micromanage. I don't have time for it. The budget is extremely tight and is based on weakly correlated adj. pt. days, giving no rationale.

Techs are getting upset at the work. They are used to silo mentality and will not ask other techs for help out of fear of ruffling feathers.

I am looking for structure.

 

[baronzb]

Anyone have any solutions? This is an opportunity to solve a problem, not grind axes as a proxy to other workflow problems you are experieiencing

 

[Rockinacoustic]

Anyone have any solutions? This is an opportunity to solve a problem, not grind axes as a proxy to other workflow problems you are experieiencing

Corrective action

 

[owlegrad]

Anyone have any solutions? This is an opportunity to solve a problem, not grind axes as a proxy to other workflow problems you are experieiencing

I understand you are looking for serious answers and I respect that. But without knowing your workflow and the people involved it is hard to give anything but vague answers.

I wasn’t really joking in my original answer though. The odds of you being able to change the culture of your workplace without massive turnover is basically nil. People aren’t going to change how they do things willingly or frictionless. Be prepared to write people up endlessly and terminate them. Otherwise be prepared to put up with people doing my whatever they want.

 

[baronzb]

I understand you are looking for serious answers and I respect that. But without knowing your workflow and the people involved it is hard to give anything but vague answers.

I wasn’t really joking in my original answer though. The odds of you being able to change the culture of your workplace without massive turnover is basically nil. People aren’t going to change how they do things willingly or frictionless. Be prepared to write people up endlessly and terminate them. Otherwise be prepared to put up with people doing my whatever they want.

The worflow is pretty standard and is delineated below. We use a lot of pyxis here, so we fill few IVs, but can vary, mostly venofers and K riders, daptos, etc. I feel there could be more cross tasking here. Because of the above, the pyxis tech has the biggest job, with 14 pages to pull and fill in a day. For night coverage, we are going with two techs, even though only one is needed, to cover their vacations and call-ins. To utilize the second tech, we are putting another pyxis run on it. The clerk is busy from all of the phone calls and stock outs. We also have much prepacking here, with bagged ABX kit popons having to be made, as well as prepacking and narc following. We cannot hire anyone else, apparently, even replacements.

The workflow:

Check-off sheets:

Have a large, landscape sized paper, delineating tech responsibilities in the pharmacy. When the task is complete, have each tech check-off the task. The biggest work load is pyxis, as IV compounding is few and mostly stocked in pyxis. For instance:

• AM pyxis, PM pyxis
• IV duties, including regulatory
• Clerk, including phones, stock outs, meds not loaded, prepacking
• General duties: fill prepack bins, crash carts
• 
  
• Assign multiple roles and tier them per tech:
• 
  
• Each tech will have a primary role, e.g. IV, but then also help pull meds for pyxis, do bins, etc., as a secondary role. Each day the check-off list will be the responsibility of those two techs.
• 
  
• I obsessively monitor everyone and do multiple write-ups. This is something I do not have experience in and it seems is distracting of my other duties.

The whole thing is turning into a complaining fest, with techs claiiming they do more work than others and vice-versa. They also wont ask each other for help. Given we don't even have enough help to cover vacations or call-ins, I am not sure how to enforce more discipline. We are in a hard to staff area, even for pharmacists.

I was thinking of having a check-off list, to make sure it gets done per tech/assignment for the day. I was toying with the idea of putting more tasks per tech per shift, put tier them, e.g., primary and secondary duties.

 

[Rockinacoustic]

What do you mean by "we can't hire replacements"?

 

[sunnyandseventytwo]

I understand you are looking for serious answers and I respect that. But without knowing your workflow and the people involved it is hard to give anything but vague answers.

I wasn’t really joking in my original answer though. The odds of you being able to change the culture of your workplace without massive turnover is basically nil. People aren’t going to change how they do things willingly or frictionless. Be prepared to write people up endlessly and terminate them. Otherwise be prepared to put up with people doing my whatever they want.

I'll second this. You're asking people who haven't done much for the last several years to start doing more. And you appear to be only using sticks.

"I obsessively monitor everyone and do multiple write-ups. This is something I do not have experience in and it seems is distracting of my other duties."

That's fine if your eventual goal is to get your staff to quit, and they likely will...eventually. But be warned: Your best performers are likely to go first.

Just a little advice: Do not have team meetings where you say things like you've outlined above. The techs who aren't "helping out" aren't going to think you're talking about them and the techs who are helping already are just going to get ticked off.

If you haven't already, spend a few days doing a technician's job. Get a feel for how long it takes to refill the hospital's pyxis machines. I've found overall, techs work better if they have a technician supervising their tech duties. Put someone in this role, even if it's symbolic only.

If you could pay the techs who work twice as hard twice as much, your problems would be solved pretty quickly. Unfortunately, that's not possible in corporate hospital America. Look for some carrots that are possible. See what you can do about schedules. Shuffle them a couple of times a year with your best performers getting the preferred shifts. Note: you seem to be good at keeping lists. Make sure the KPI you keep on your staff are objective and that you're not even appearing to be playing favourites.

 

[Script1992]

Hospital Pharmacy Technician Workflow Structure

​

Need junior management advice. There is much leeway in the work culture for techs here, as many have been here for years. With lower staff numbers, techs are being asked to do more with the same staffing levels. There is a severe ‘silo’ mentality of only doing the specific job they are assigned to. To rectify this issue, I have come up with some ideas to get techs to be more dynamic in helping each other if bottlenecks arise. I have tried to get techs to spontaneously help each other, to ask others for help, etc. Night shift is a bigger problem. Very little gets done there. I have talked to techs individually, some repeatedly, and they either say they will comply, then do not, or they complain about the lack of support, which has some merit. (The company has several review the boss criticism sessions, which further undermines authority.) These options can be taken as all or a la cart.



Check-off sheets:

Have a large, landscape sized paper, delineating tech responsibilities in the pharmacy. When the task is complete, have each tech check-off the task. The biggest work load is pyxis, as IV compounding is few and mostly stocked in pyxis. For instance:

• AM pyxis, PM pyxis
• IV duties, including regulatory
• Clerk, including phones, stock outs, meds not loaded, prepacking
• General duties: fill prepack bins, crash carts
• 
  
• Assign multiple roles and tier them per tech:
• 
  
• Each tech will have a primary role, e.g. IV, but then also help pull meds for pyxis, do bins, etc., as a secondary role. Each day the check-off list will be the responsibility of those two techs.
• 
  
• I obsessively monitor everyone and do multiple write-ups. This is something I do not have experience in and it seems is distracting of my other duties.

My advice would be to motivate my techs. Give them compliments when they sterile compound medications as quickly as possible. That is how I got one Tech to work very quickly. too much micromanaging will lead to alienation. Also some techs will hate to sterile compound medications, while prioritize loading medications in the omnicell or Pyxis.

 

[baronzb]

What do you mean by "we can't hire replacements"?

current FTE or PRNs were hired at a time when there were more FTEs allotted, several years ago.

Tell me more about the tech supervisor--given shifts, there would have to be two of them?

What's the best way to demonstrate to corporate that we need more FTEs? The rph and techs come from the same bucket.
Pharmacy doesn't have direct metrics, e.g., orders filled, just patient days.

 

[Rockinacoustic]

current FTE or PRNs were hired at a time when there were more FTEs allotted, several years ago.

Tell me more about the tech supervisor--given shifts, there would have to be two of them?

What's the best way to demonstrate to corporate that we need more FTEs? The rph and techs come from the same bucket.
Pharmacy doesn't have direct metrics, e.g., orders filled, just patient days.

Respectfully, you sound in over your head and are asking questions that are more appropriate for your senior leadership and HR than this board.

The best way to get more FTEs? Spend less $...

 

[RXDOC1986]

I obsessively monitor everyone and do multiple write-ups. This is something I do not have experience in and it seems is distracting of my other duties.

This definitely has to stop, immediately. Very detrimental to, and serving no purpose with the overall goals.
Please feel free to contact me, any time this week, to discuss.

 

[baronzb]

This definitely has to stop, immediately. Very detrimental to, and serving no purpose with the overall goals.
Please feel free to contact me, any time this week, to discuss.

If read the sentence above the bullet points, you would have inferred that this was a possible way things were going, but not desired.

 

[mustang sally]

These are not solutions, but just some of my thoughts:

-Everyone has a very distinctive personality that is unlikely to change. Perhaps it is best to find a way to work with an individual's unique personality/strengths/weaknesses.
-As noted above, obsessive monitoring and write ups are probably not going to help the situation.
-Do pharmacists and management lead by example (ie. Do you guys jump in to help each other? Do you jump in to help out the technicians?)
-Finally, I think it's easy for technicians to feel unappreciated. I'm not sure what the pay is like where you work, but it's easy enough these days to lose a good technician when they get tired of the working situation (and a pain to have to hire and train someone new).

 

[baronzb]

No one has ever been written up, someone misread what I ambiguously wrote. My meaning was that this was a possible step.