Organizational behavior in a complex system. A pilot study: The impact of a change model on health care practice improvement

The relationship of selected organizational behavior theories to a recently developed practice change model was described. A retrospective pilot study consisting of a convenience sample of three hospital pharmacies in Ohio was utilized to: (1) ascertain the objective(s) of a work redesign initiative, (2) quantify the resultant changes in specific measures of accuracy and costs, and (3) determine whether the implementation of components of the practice change model was associated with practice improvement. Each of the three sites had implemented a work redesign initiative involving similar robotic technology. A pharmacy manager from each site was interviewed during March–April, 2003 to: (1) ascertain the objective(s) of the work redesign initiative, (2) determine preparatory interventions, and (3) determine work redesign outcomes. Data collected were from six-month intervals previous to and after work redesign implementation. Financial statements and medication error reports were analyzed. The primary objective of the work redesign in each location was to reduce the amount of time pharmacists were involved with medication cart-fill checking activities. The mean reduction in pharmacist time spent involved with medication cart-fill checking was 3.3 hours per day. There was a positive relationship between the utilization of components of the Holland-Nimmo practice change model and practice improvement. The results demonstrated that through the implementation of robotic technology, personnel cost-avoidance was achieved. The utilization of this technology may better enable practitioners to provide improved patient safety monitoring in the health care setting. The results of this pilot-study also indicated the need for future study in the area of medication error reporting with respect to work redesign implementation. Due to non-precise and inconsistent methods of reporting medication errors at these sites, caution must be utilized in analysis of the data.