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Dreaming the impossible dream...
On a plane flight home, I had a chance to sit next to a fellow who is on the faculty of Stetson University near Orlando, FL who appears to specialize in innovation. As the two of us talked, he challenged me to really expand my thinking not only in regard to what I could achieve, but also in regards to the avenues open to me to achieve it.

In the following days, he sent me a book on innovation that I am still reading. It will likely be the source of yet another blog.

In the meantime, our conversation caused me to reflect on the things that have, and have not, really changed our practice. And I mean change in a good way... things that made menial jobs disappear... things that automated our weaknesses and played to our strengths. I came to a few conclusions:

1) The really big changes weren't obvious to most of us. Those of us who were blithely filling requisitions in the 1970's and 1980's really didn't understand how unit-dose would change our lives, or how fundamental it would become to what we were going to do. In 1975 I had a conversation with Warren McConnell at ASHP where he challenged me to stop thinking of pharmacy practice in the current fashion. I finally figured out what he was talking about 30 years later.

Automated dispensing cabinets completely changed how we distribute our medications. Yes, they brought some other issues, but they were counterintuitive to most of us practicing at the time. So were carousel systems.

2) The really big changes were revolutionary, not evolutionary. They changed the way we practiced in substantial ways, and caused us to rething our basic notions of where pharmacy practice needed to go. 

3) The really big changes came to us from the industry, outside of our profession. They took learning from perspectives we would ordinarily ignore, and used them to build new ways of doing the jobs we have done seemingly forever. Work flow management revolutionized the insurance industry in the late 1970's, but didn't get to our profession until the adopted in outpatient pharmacies in the 1990's and in inpatient pharmacies in the late 2000's.

4) We resisted each of them; then decided they were worth looking at, an finally came to accept them as the norm. (My friend from Stetson tells me that each major innovation goes through these phases so there is another book I need to read called the Medici Effect).

My friend and colleague Jeff Baldwin likes to quote Henry Ford as saying "If I had asked people what they wanted, they would have told me faster horses that ate less hay." It turns out he likely never said those words, but it is unquestionable that he felt that way.

I have similar experiences. The same people who told me that they wanted to see EVERYTHING and make their own judgements eventually admitted to alert fatigue. During my years in marketing with an HIS company, I had to learn about every one of my competitors because the pharmacy RFP never contained actual requirements, but eventually said "make it like the system I have, only better."

I have also seen Russ Ackoff's description of the changed in telephony that gave us modern communications. The changes were revolutionary, a complete change in direction that was intentional and painful. If it had been evolutionary, we would still be using something that looks like the old rotary dial, that many reading this blog have never used. By the way, that dial had been incrementally improved for nearly 50 years before it was abandoned in favor of touch-tone dialing.

So who will be our visionaries? Who, from our profession will transform it, lighting the way to something so totally new and wonderful that we will wonder how we ever did without it?

It might just be you, dear reader.

But to do this, you are going to have to question absolutely everything about the way we practice now. You are going to have to endure the people who fight what is so obvious to you because "it just isn't how we do things." You will try idea after idea only to have the market reject what you have done because perfect often gets in the way of pretty darned good. You will be tempted onto paths that are cul-de-sacs, like chasing a platform (e.g. the iPhone) rather than a solution. A lot of your ideas will be but steps on the journey a better system. But if you persevere, you may well invent the true change that kick-starts our profession to the next level.

Know, however, that we need you, now more desparately than ever. Look at places where other information-dense and high-reliability industries have succeeded and see what they have to tell us about where our automation should go. Think hard about what the computer does well, and what people do well, and find those places where there is synergy between man and machine. Find those of like mind and spirit (they may not be where you expect to find them) and grow from that association.

And when people tell you something is impossible, dream the impossible dream...

Dennis A. Tribble, Pharm. D., FASHP
DATdoc@aol.com
Created By: Dennis Tribble On: Mon, Sep 03, 2012 04:05 PM

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