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Pharmacists represent a scarce human resource in Canadian hospitals, with about 2900 full-time pharmacists providing care for 95 000 acute care bed-days in 2010. It is vital to ensure that clinical pharmacists are performing the highest-value activities for the highest-priority patients. Clinical pharmacy leadership and front-line pharmacists require tools to facilitate objective assessment of employee performance, to define benchmarks for performance, and to facilitate the improvement of employee performance. If we cannot measure something, then we cannot control it. In turn, if we lack the ability to control something, then we cannot improve it. In brief, then, improvement efforts rely on measurement. This concept applies to the performance of both organizations and employees. Clinical pharmacists need objective feedback on their performance to understand what is expected of them and what is required to improve. A process known as performance management can assist with the provision of feedback and the promotion of performance improvement that is aligned with overall organizational performance. Examples of activities within a performance management system include setting performance targets at the individual level that are linked to organizational objectives, reviewing employees’ progress toward those targets, and identifying areas for further development. The clinical pharmacy key performance indicator (cpKPI) is a tool that facilitates the setting of expectations and the measurement of progress by clinical pharmacists toward identified clinical performance goals. It can be used to quantitatively describe how often an evidence-based process or outcome of care occurs and ultimately to help identify focus areas for future strategies to improve employee performance. A Canadian collaborative of hospital pharmacists recently developed evidence-informed cpKPIs that aim to advance pharmacy practice and improve patient care. These cpKPIs will measure a wide variety of activities performed by pharmacists, including performance or review of medication reconciliation on admission; participation in interprofessional patient care rounds; completion of a pharmaceutical care plan; resolution of drug-therapy problems (DTPs); delivery of in-person disease and medication education to inpatients; delivery of in-person discharge education and counselling to inpatients; medication reconciliation on discharge; and bundled, proactive direct patient care activities. These cpKPIs include both outputs that a pharmacist should achieve, such as DTP resolution, and inputs that should help in achieving the outputs, such as completion of a pharmaceutical care plan. It is advantageous to have a suite of evidence-based cpKPIs, consisting of both input and output activities, to guide performance management because it allows for creation of employee-specific strategies for performance improvement through a focus on both the “how-to” (input) and the final result (output). Using a tool such as the cpKPI may help to standardize performance improvement by defining benchmarks for clinical performance. The relative value of a clinical pharmacist’s outputs, such as DTP resolution, should be determined by the prevalence of the problem, multiplied by the quality of the action, divided by the effort required to manage it. The quality of the action should be determined from the strength of the supporting evidence for effectiveness, safety, and modifiability of the intervention, and the reliance on pharmacists to perform it. According to this model, low-value DTP-related examples might include adjusting the dose of folic acid for a critically ill patient who does not have anemia or adding docusate to the medication regimen of a patient who has constipation secondary to opioids. Examples of high-value actions would be initiating an angiotensin-converting enzyme inhibitor for a patient with heart failure or discontinuing an antibiotic for pneumonia at the earliest appropriate time. Developing a list of high-value DTP-related actions tailored to a particular service area or patient group and then explaining to the clinical pharmacist why they are important ensures broad applicability to individual pharmacists in different practices and helps in setting performance expectations (in terms of clinical service quality). Such high-value actions should be incorporated into the performance management process for employees. Furthermore, focusing on high-value actions will promote the provision of standard evidence-based activities, while allowing for individualization in application of these services (depending on the patient population served) and also allowing flexibility in the overall performance management process. Employee-level indicators used for performance management must be linked to broader organizational objectives. An example of an organizational indicator that every Canadian hospital must report is readmission rate. It is impossible to ascertain the direct impact of an individual pharmacist’s activities on the readmission rate. However, by measuring the quantity and quality of clinical pharmacists’ activities (or process

Should Key Performance Indicators Be a Component of Performance Assessment for Individual Clinical Pharmacists?