Background I was a manager at the Hospital Pharmacy at the University Hospital in Uppsala. The hospital has about 1100 beds. The hospital pharmacy employs a staff of about 75. Production consisted of both chemotherapy unit preparations and other sterile preparations. This Friday afternoon in November, I was summoned to the hospital’s Chief Medical Officer. Once there, I receive complaints on the service from our production unit for Chemotherapy Preparations. Orders were often delivered too late – No notice of delays – Lack of communication between the hospital staff and the staff at the production unit.

Purpose To show how we improved the service from the Centralised Chemotherapy IV Preparation Unit.

Materials and Methods It was important to use my leadership to see something positive in what happened. It was not our skills that were complained about, but our service, which made it all easier. My point was, we are competent and skilled, now we have to improve our service. Together with the staff we decided:

• The complaint in terms of communication was true. Action: Hospital staff were invited.

• Tuesdays and Thursdays we had information for the staff, and we were always late. Action: We changed to providing more written information and just assembled the staff one Tuesday and Thursday every month.

• We did not answer the phone, or call and notify the delay. Action: We extended the staff in the morning by a technician who could answer the phone. Then we agreed to measure the delays. We completed a document in which we recorded when orders come in, if they were complete or if it needed a phone contact before they would be prepared. Then we documented when the preparations were ready. We decided to measure for 4 weeks in December. This measurement has since then been performed every year. We could pretty quickly see that we often received orders late and they were not complete.

Delivery of chemotherapy from Centralised Chemotherapy IV Preparation Unit at Uppsala University Hospital. Data for each year show the fraction of preparations delivered on time, fraction delivered after the requested time and the average time delay.

These results were discussed later with the hospital staff and together we were able to improve the ordering schedule and we improved service with the deliveries. More preparations could be delivered on time.

Conclusions Inform your manager and staff. Take your time and plan how to handle the situation. Try to find out what you and your staff can learn. Try to understand the cause of the complaint and motivate staff for change. Try to measure in order to have a base for discussion and change. Good management is extra important for to support your staff when you and your staff are questioned.

No conflict of interest.