The Point-Rating Plan - An Opportunity
In America during the past 10 years, as you are all aware, there has been a phenomenal growth in the number of hospital patients. This increase in hospital patients has necessitated an increase in available hospital beds, which were provided either by remodeling or by new hospital facilities.
During the same period, cost per patient day has more than tripled; a new factor has to be dealt with in the payment of patient bills – hospital insurance companies; diagnostic aids have multiplied; and the therapeutic measures have become complex. Pharmacy plays some part in most of the therapeutic facilities of the modern hospital. In today’s overall complex hospital picture, pharmacy finds itself involved with an increasing budget, finding adequate storage for many more heat- or cold-sensitive drugs or chemicals, helping hospital personnel through the maze of confusing drug names, helping with the selection of basic drugs so that adequate care may be given a patient without unduly adding to the cost per patient day, providing sufficient supervision for the pharmacy technical staff, and many other involved problems that any of you could add to the list.
Hospital pharmacists have looked forward to the time when the administration of hospitals and pharmaceutical educational faculties would be aware of the part pharmacy should contribute to the nation’s hospitals. The time has arrived, and why aren’t we as satisfied as we had expected to be? For the reason that there are many more places to be filled with competent hospital pharmacists than there are pharmacists available.
An adequate basic college degree in pharmacy should provide sufficient groundwork upon which to build the specialized training needed to cope with today’s hospital pharmacy. For the recent graduate of pharmacy, the hospital pharmacy internships provide this specialized training. But there are not enough such plans nor enough graduates enrolled in them to supply our hospitals’ needs. Then how can the situation be aided until the above condition changes? Self-education of the present hospital pharmacists will aid us now. And how can we do this? One of the aids that has helped in the past 10 years has been the specialized professional publications – both periodicals and books. Probably the one of most general help has been our Society’s Bulletin. The Bulletin as we have it today is the result of the devoted care and time given it by Mr. Don Francke and Miss Gloria Niemeyer.
Another aid has been the institutes and refresher courses for hospital pharmacy held all over the United States. Part of the success of the institutes and refresher courses has been due to the great amount of time and thought given to them by a great number of people interested in hospital pharmacy. Conventions and local meetings of pharmacy groups have been aided not only by their programs but because of the opportunity afforded for pharmacists to become acquainted with others of their profession and so more easily exchange ideas and enthusiasms.
In going back to the hospital as a whole, when we look for one single thing that probably has contributed more than any other one factor in providing the American people with the best hospital care to be found in the world today, we find standardization programs such as that started by the American College of Surgeons years ago. Now we in pharmacy have been very fortunate in having some foresighted pharmacists who were aware of what hospitals should be getting from their hospital pharmaceutical service. Two such people were Mr. Edward Spease, one of the recipients of the Harvey Whitney Award, and Harvey Whitney for whom the Award was so appropriately named. Mr. Spease was instrumental in formulating the original Minimum Standard which was adopted by the American College of Surgeons. The concepts found in this standard are the same as those in our present Minimum Standard. There is one difference; the concepts have been expanded. I imagine at the time of the original writing Mr. Spease hoped there would not be too many, when they read them, that would think he lived in an ivory tower instead of the practical world of teaching hospital and active pharmacy college.
Your own Mr. Whitney established the hospital pharmacy internship at the University of Michigan. I believe that the examples they set and their teaching programs inspired and influenced so many other pharmacists that it was possible to develop the groundwork necessary, over the past years, to have made possible the development of the present Minimum Standard for Pharmacies in Hospitals. We are fortunate and should be ever grateful that precepts of what constitutes modern hospital pharmacy were developed long enough before this great upsurge in modern hospital care so that hospital pharmacy is ready to present a united front based on sound concepts when carrying out the objectives of the pharmacy in a hospital.
As has been mentioned, we cannot wait for sufficient special formal training such as internships of hospital pharmacists but must turn to self-education. Three aids have been mentioned – first, The Bulletin; second, the institutes; third, conventions and meetings. And now a fourth is added, the Point-Rating Plan to implement the Minimum Standard. This plan was worked out by Mr. Ray Kneifl, Executive Secretary of The Catholic Hospital Association, with the help of a committee made of Catholic sisters who are hospital pharmacists. The plan was for the aid and education of the Catholic group of hospitals. The universality of the plan was recognized when the American Society of Hospital Pharmacists accepted this plan at the Philadelphia Convention in August 1952.
To me, the Point-Rating Plan represents more than a tool to implement the Minimum Standard—rather it represents an opportunity for every hospital and hospital pharmacist to become aware of where he and his hospital pharmacy stand as regards the standards for hospital pharmacy in the United States. This affords the opportunity for one to locate the strong points as well as the weak, where more emphasis must be placed, where we are to look for help, and where we shall be able to help others. And why is this such an opportunity? It is an opportunity to help yourself. We can foresee in the not-too-distant future the need of a standardization body evaluating the pharmacy department of the hospital. Until then, we have the opportunity of correcting and improving our own weak points. But regardless of this, most of us like keeping up to a mark; but sometimes we get a little confused as to what is the mark. I suppose that it works something like competition. We sometimes need to get a stimulant from an outside source to keep up our spirits. So we need a measuring tool, and now we have one for hospital pharmacy – the Point-Rating Plan.
There comes a time during feverish activity, shortage of time, ever increasing responsibility, piling up of unread literature, and endless conferences when we must find time to stop and survey our results to see if we are still on the road towards our goal. This appraisal is absolutely necessary if we are to keep forging ahead with our other partners in the hospital team. Even if one feels he cannot spare the time to attend conventions and institutes at distant places, one need have no doubt as to how well he or his department measures up in the field of good hospital pharmacy. Here is a rating plan one can study, alone if necessary and at his own convenience. The results would be more objective if he could do it with someone else who has some understanding of hospital procedures. Using the plan alone, the pharmacist might be too modest in his scoring – then he does his hospital and himself an injustice. On the other hand, he does an injustice to both if the scoring is too high, because then a false sense of security or performance prevents expending the necessary thought and energy to correcting the weak spots. Should the rating be too low at first, here is the opportunity to become aware of which areas need reinforcement. A low score does not necessarily place the blame on the pharmacist, because this score might be the result of conditions that only the administration can remedy. The pharmacist should feel that he has the backing of the whole American Society of Hospital Pharmacists as he presents these points to the administrator.
We are all too busy; we need the stimuli of something such as the Point-Rating Plan to make us stop and think about our overall plan. Working hard does not excuse us from obtaining the expected and necessary results. Pharmacy is no longer working alone, no longer can it be hidden off in a far corner because the past few years have taken pharmacy off of its island of isolation. Partnership in the public health team carries the responsibility of constantly keeping abreast of pharmaceutical progress. So we need to review our past and present performance if we are to decide what we need to do today and tomorrow to keep our part of the partnership in good order.
There are some things about the Point-Rating Plan which look a little formidable at first glance. For instance, there are a lot of pages with a lot of print. There is the temptation to put it aside and do something about it another time. You know, the time that never comes. One needs to remember that this rating was designed to fit all hospitals – large, small, specialized, or general – and to be applied by skilled pharmacists with varied experiences or the neophyte, and to be understood by many types of administrators. To fit such a great array of things and people, an explanation that is extensive is needed. By the time anyone has gone through such explanation and definition of terms and checked the rating sheets, a much clearer picture of what comprises hospital pharmacy is provided, even if a rather complex one. Is there anyone who still thinks that hospital pharmacy is a place to retire or an easy berth? Then here is an outline to disillusion quickly that innocent.
This plan is not meant to be static. There is no reason it should not be worked over to try to simplify or clarify it. In fact, the plan in its present form is simpler than the form first presented in the July–August (1952) issue of The Bulletin.
The categories of the Point-Rating Plan are specifically numbered to show which minimum standard they are implementing. The total possible basic points is now 2000 so that each 20 points equals 1%. This makes the figuring simple. There probably could be some way to summarize the plan so that we would have a long and short form – something like the government has with its short and long tax blanks.
In conclusion, the Point-Rating Plan affords the opportunity for every hospital pharmacist to see the maximum possibilities of hospital pharmacy in all its ramifications and the inter-relationship between the various categories; with this understanding, all hospital pharmacists should be able to have a feeling of kinship to every other hospital pharmacist. This united strength should be the guarantee of the future progress of pharmacy in its special field of hospital pharmacy.
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Any references cited in this lecture are available in the PDF version.
Originally published in Bull Am Soc Hosp Pharm. 1954; 11:186-8.
© 1954, American Society of Health-System Pharmacists, Inc. All rights reserved.
Posted with permission.
