1
Pa
ish Hospital Pharmacy
[This case was written in 1989 before Order Entry Systems and EMR’s were common but is still
elevant today. Analyze the case by using the PSSM and the O.B. course materials that we have
covered thus far demonstrating your mastery of these course materials.]
I had just completed a year of training as a pharmacy technician and was looking forward to my first
full-time work experience. My head was buzzing with questions, and I approached my new job in my new
profession with excited anticipation. I had been hired by Jim, the chief pharmacist. In addition to other
managerial duties, he was responsible for hiring and firing the members of the work group. Jim was
friendly toward me and this made me feel comfortable about the new job, but he did seem busy and rather
preoccupied with other matters.
The work group consisted of 14 full-time employees: Jim Jones, chief pharmacist (35 years old,
ma
ied); six full-time pharmacists, all about 25 years old, male (five ma
ied); six full-time technicians,
all female, single, and between 19 and 21 years old; one secretary, about 30 years old, ma
ied. There
were also six pharmacology students. Part-time people were hired for nights and weekend work. They
were all young people.
The pay for starting technicians was $14.50 an hour, with a $6.00-an-hour raise after one year. The one
exception to this was Sally, the intravenous medication (IV) technician. This job was for the most senior
technician and paid $25.00 an hour. Everyone had the same basic benefits:
1. Two weeks’ paid vacation after one year.
2. Paid holidays.
3. A Blue Cross/Blue Shield and Master Medical Plan.
4. Free life insurance.
5. Prescriptions at cost.
We worked 40 hours a week, 8 to 4:30, and rotated weekends. Everyone worked every third weekend.
Scheduling for vacations and days off, as well as promotions and pay raises, was done strictly according
to length of employment.
Actual training for the job lasted about two weeks, although it took most technicians nearly two months
to familiarize themselves fully with the work area. I later learned that the hospital figured that training a
new technician cost about $800, not to mention their lesser productivity during the first two months.
Marty, Susan, Sally, and I had all attended one year of school to be trained as medical assistants. Part of
our training was actually done in this particular pharmacy. Debora and Nancy, friends from high school,
had not attended school for this special training. Debora had been working there longer than anyone
except Sally, and Nancy was hired later. During high school and after graduation, Nancy had worked in
the Pa
ish Hospital kitchen. When a position opened in the pharmacy, Debora had quickly informed
Nancy. She applied for the job, was hired, and then transfe
ed to the pharmacy. None of the workers
looked down on Nancy and Debora because was they hadn’t gone to school, although, from comments
Debora made to me, I don’t think she ever quite believed that. As a person she was quiet, not very
outspoken, but likable and a willing worker before Nancy was hired and when Nancy was absent.
Nancy was a very different personality. She had definite opinions on many subjects and was quick to
speak up for what she wanted. When she joined the department, she expressed satisfaction about getting
Copyright © 1989, Whittemore School of Business and Economics, University of New Hampshire. Reproduced
with permission.
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away from the kitchen supervisor who was “a tough old guy who watched what we were doing all the
time.”
The technician seniority scale looked like the following:
Sally—two years.
Debora—eight months.
Marty—six months.
Me—four months.
Nancy—two months.
Susan—just hired.
The procedure in the pharmacy was routine. The physician wrote the medication order at the nurse’s
station, and the nurse copied it into her book for the record. A copy of the order was then sent to the
pharmacy. Our task as technicians was to write the orders we did in our own individual record books and
then fill the medication carts for the respective floors.
Each floor had its own cart, and each patient on that floor had a drawer in the cart. A book was kept in
the pharmacy for each patient, and the frequency with which his or her medication was to be delivered
was recorded in the book. The carts were sent up to the floors three times a day, at 9:30 A.M., 2 P.M., and
7 P.M., stocked with all the necessary medication for that time interval. In the event that medication was
needed immediately, a technician usually hand-ca
ied it to the floor.
Other duties included filing the medication orders after they were written in the books, typing up
drawer labels for newly admitted patients, restocking the bins with medications, and other odd jobs.
Sally’s job as the IV technician was to make up IVs for patients each day. This was done in a separate
area in conjunction with two of the pharmacists. She was not required to do any of the secretarial-type
tasks, except when she worked weekends.
The pharmacy was located in the basement of the hospital, next to the morgue. The kitchen and a large
locker room were also in the basement. The physical layout was such that whenever Mr. Jones was at his
desk he was isolated from the work area. Most of the time, he was out of the pharmacy area tending to his
many administrative duties.
The first few months were a lot of fun for me. The atmosphere in the pharmacy was one of friendliness
yet responsible interest in the work. A cooperative spirit prevailed, and socializing was accepted as long
as the tasks were completed as scheduling demanded. Employees were assumed to be trustworthy and
were thus given responsibility. There was no one timing, regulating, or watching us.
As time passed, Nancy and Debora were quick to volunteer for more and more trips to hand-ca
y
medications to the floors. Soon, these trips began to take a few minutes longer each time. Since there was
no smoking allowed in the pharmacy, Debora and Nancy were taking a “smoke
eak” every opportunity
they could. The
eaks were taken in the ladies’ locker room that was used by the custodial staff at the
hospital. None of the pharmacists smoked cigarettes, and they were opposed to the constant
eaks Nancy
and Debora took. The secretary, Frances, smoked, as did Marty, but they didn’t take
eaks very often;
although as time went on, they, too, began to take more and longer
eaks.
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Soon Debora and Nancy began to be tardy for work in the morning by at least 20 minutes. Some of the
other technicians had to travel 60 miles to work, but Nancy and Debora each lived within 1 mile of the
hospital. Their coffee
eaks began to get longer along with their lunch
eaks. Many times one of them
would call in sick, and occasionally they both did on the same day. The structure of the job was such that,
when anyone was missing, the other technicians had to take on an extra share of the workload. The most
difficult time of the day was in the early morning. At this time the cart had to be filled and checked by the
second technician before going upstairs at 9:30. If the hospital had been busy the night before, there were
many new medication orders to be written in the books even before the cart was filled. When Nancy and
Debora were late, the other technicians didn’t have enough time to finish everything. When this
happened, some of the pharmacists had to help fill up the carts. They really disliked filling the carts, both
ecause it was tedious work and they weren’t as efficient, since they didn’t do it routinely. It took them
longer, so their assistance really wasn’t very beneficial. They would occasionally remark to Nancy and
Debora, “Get going; you haven’t done anything all day.” But this was casually disregarded.
Mr. Jones became aware of the situation when he a
ived early one day and saw pharmacists filling
carts. He called a meeting with everyone present. After some discussion he suggested that there be a
otating work schedule. With this system, tasks would be assigned to specific technicians to prevent work
piling on any one person. Everyone nodded their heads in agreement with this.
Even with the schedule posted, Nancy and Debora fell behind in filling their assigned carts. The smoke
eaks and the fooling around were as prevalent as ever. The other technicians ended up helping them
with their carts because the carts had to be sent up on time. Debora worked well when Nancy was on a
day off but never produced when they were together. When they were both gone, and the tension was
educed, the rest of us actually had a good time. Naturally, Nancy and Debora were talked about. It was
evident that they were disliked, and the general attitude toward them was one of “We’d be better off
without them; they don’t seem to understand that a technician is still a professional whose work affects
the well-being of the patient.”
Along with the new task schedule, a lunch and coffee
eak schedule was devised. This, too, rotated on
a weekly basis. Whenever I went to lunch without Nancy and Debora, everyone talked about them and
was angered that they “got away with doing nothing.” Frances usually sided with whomever she was
lunching with and then managed a way to let others know what was said about them. Almost invariably
the girls from the pharmacy sat together and the pharmacists sat together at another table. On one