The negotiations of a pharmacy department with a consulting firm hired to help cut the institution's staff are described. In July 1994 Duke University Medical Center announced its intention to reduce the number of full-time equivalents (FTEs) from 6500 to 5000 and hired a consulting firm. The pharmacy department was scheduled to be studied for 16 weeks. The entire pharmacy staff was educated about the initiative and about what management expected of the staff during the process. Each assistant director of pharmacy was asked to lead the ''operations improvement process,'' as the re-engineering plan was called, in his or her area of responsibility. The assistant directors were to describe key work activities and their time requirements and develop instruments for measuring work activities. Data were collected on supplemental resource requirements for paid time off and educational and meeting time. Resource requirements for clinical pharmacy specialists and other selected staff members were determined separately. The data were collected for one fiscal month, and the assistant directors then began negotiating human-resource requirements with the consultants. The director finalized the negotiations and presented the results to the hospital's leaders and the consulting firm's executives. It was proposed to reduce total pharmacy FTEs by only 5%, and the department actually gained 1 pharmacist FTE. Far greater reductions were proposed for most other departments (the entire medical center lost more than 800 FTEs). The pharmacy department at Duke dealt successfully with a re-engineering initiative. Strategies that contributed to the success included teamwork, active participation by the entire staff, empowering a core group to help lead in the process, and substantiating the value of the pharmacy's services to the medical center and its patients.
