Improving the performance of pharmacy and therapeutic committees.

Rapid technological change has resulted in significant improvements in the design and availability of pharmaceuticals. Therefore, the assessment of pharmaceuticals is an important determinant of the quality of care. In hospitals, this evaluation is the responsibility of the Pharmacy and Therapeutics (P&T) Committee. This committee is a multidisciplinary group of health professionals who make decisions about the acquisition and use of pharmaceuticals. P&T Committees have high external demands placed on them as they serve the medication needs of the entire hospital. Therefore, an important way to assess their performance is to examine how they interact with their environment. This approach to study groups, labeled as the external perspective by Ancona, suggests that a group engages in activities with its environment to obtain resources and information. Committees that manage their external dependence effectively perform better than those who only focus on their internal dynamics. This study examined the relationship between the P&T Committee's external activities and performance using Ancona's model of group behavior. In the first phase, a pilot study of local hospitals was conducted to obtain a clearer understanding of committee functioning. The second phase consisted of a national survey of 308 large teaching hospitals. A 34.7% response rate was obtained. Analysis was conducted on 107 committees using causal modeling. Convergent and discriminant validity of the measures was achieved. A structural model was developed to examine relationships between external activities and group performance. Activities aimed at gathering external information and support (ambassadorial/information gathering) had the greatest effect on committee performance. Activities aimed at protecting the committee (guard) did not affect performance. Ambassadorial/information gathering and guard activities were both necessary to preserve the group's internal processes. Physician constituents' evaluations of committee performance were influenced by the committee's external activities while pharmacist constituent's evaluations were not. Findings suggest that P&T Committees should focus their efforts on creating effective channels of communication between the group and its external contacts. Committees that actively solicit input from their constituents may be more effective in implementing their medication use policies than committees who do not.Ph.D.Health and Environmental SciencesHealth care managementOccupational psychologyPharmaceutical sciencesPsychologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/132209/2/9959828.pd