On The Docket
David B. Brushwood, BSPharm, JD
It is challenging to objectively evaluate the efficiency of health professionals. A designated task related to the provision of health care products or services may require a lengthy period of time to complete, or it may be accomplished very quickly, depending on the patient’s condition, the nature of the product or service, and the environment in which the activity is being performed. Nevertheless, establishing productivity metrics for the performance of professional responsibilities in health care has become standard. A pharmacist recently challenged the manner in which quantitative measures were being used in the evaluation of his productivity.
Background
The pharmacist was working in a clinical role when the health care system issued a mandate to increase efficiency in pharmacy operations. Some clinic pharmacies were closed, and the pharmacist was reassigned to a role that primarily involved the review and resolution of pending prescriptions. Within that new role, the pharmacist criticized inefficiencies related to delays in patients receiving medications, the destruction of thousands of dollars’ worth of prescription medications, and the extensive resources used to handle returned medications. An investigation was conducted, and the pharmacist’s concerns were substantiated. Changes were made to reflect the findings of the investigation.
The pharmacist repeatedly failed to meet the performance standard for pending prescription processing. In 2018, successful performance required processing 125 pending prescriptions per day, but the pharmacist processed an average of only 76 pending prescriptions per day. In 2019 and 2020, successful performance required processing 120 pending prescriptions per day, but the pharmacist only processed 100 and 104, respectively.
The pharmacist was placed on a Performance Improvement Plan (PIP), with which he refused to cooperate. The pharmacist filed an internal complaint alleging whistleblower reprisal, based on “numerous adverse personnel actions.” An administrative judge (AJ) held a 5-day hearing to review the complaint. The judge denied the pharmacist’s request for corrective action, and from this denial the pharmacist appealed to a United States Court of Appeals.
Rationale
The appellate court reviewed the pharmacist’s allegation that the AJ had “failed to consider scheduling inequalities, relied on unreliable metrics, and failed to find a hostile workplace.”
The court first noted that there was “substantial evidence to conclude that there were no scheduling disparities between [the pharmacist] and other outpatient pharmacists.” The court said that the AJ had “carefully compared [the pharmacist’s] shifts to those of other pharmacists and found that those who worked the same or fewer number of pending shifts nonetheless filled more prescriptions than him.”
The court also noted “clear and convincing evidence that similarly situated individuals who were not whistleblowers were also placed on a PIP, when they failed to meet the performance standard for processing pending prescriptions.”
The appeals court affirmed the denial of corrective action.
Takeaways
Negative performance evaluations can be annoying and insulting, particularly when they seem to be unfairly based on invalid criteria. On the other hand, it is important to appreciate how the commercial side of health care must be conducted efficiently. Cost constraints are genuine. Performance expectations are equally authentic. Health care is both a public service and a business.
Quantitative measures of productivity are intended to avoid what has at times been referred to as “the tyranny of subjectivity.” A person who is evaluated as being “too slow” may wonder what criteria for production are being applied. If a specific number can be used as a criterion for productivity, then at least there is a possibility to understand the expectation and to appreciate how an evaluation is being made.
The foundational problem illustrated by this case is that sometimes clinical pharmacy services are viewed as being gratuitous luxuries that can be discontinued to promote efficiency. The necessity of clinical pharmacy care can be difficult to economically substantiate. A pharmacist who is transferred from a clinical role to a distributive role might have difficulty understanding the efficiency of such a move. ■