When I think about our professional roots, it seems clear to me that we have come from a long tradition of rugged individualism, where my way of doing things is my way of doing things and it is my professional right to do things my way.
After having spent the last 28 years in industry, I have come to appreciate the notion that this kind of rugged individualism is not scalable. As our practice environment requires that we continue to find new ways to do more with less, we have to be able to scale our practice methods to be able to handle larger workloads, and that requires process.
My first lesson in this came from a good friend who shared with me how using an outpatient pharmacy workflow product he had been able nearly double the output of his outpatient pharmacy, and improve the quality of his service without adding staff. This benefit came from the implementation of common process, that eliminated some of the inefficiencies caused by doing things my way.
So process can be a good thing. When work is standardized, people always know the next right thing to do.
I have observed, however, that process is a tool that is intended to produce an outcome: higher quality at a better pace. Yet, over time, I have observed processes become ends in themselves, with the actual end goal of the process getting lost. I was reminded of this recently by a colleague in the quality field, who pointed out that quality processes are a journey that requires ongoing awareness of the environment, and the ability to shift processes to address new challenges as they occur. When the process becomes an end in itself, the focus shifts from doing the right thing, to operating the process right, even in situations where the process may be inapplicable.
This becomes really obvious when the metrics being tracked for the process focus on compliance with, and operation of the process rather than on the outcome the process is supposed to achieve.
For example, a careful read of USP <797> demonstrates that the chapter is not meant as a checklist, but rather as a guide to thoughtful application of some specific concepts to the compounding of sterile preparations. Yet, over the years I spent teaching in a USP <797> course, time and again I found myself talking to people who wanted it to be a checklist; who want there to be a series of steps they can take and always be right without having to think about it. They wanted to be able to follow a process, and have their compliance to that process be a surrogate for actually implementing thoughtful quality standards. The result was that their metrics demonstrate compliance with their process, without demonstrating the actual quality of the items produced in their sterile compounding suite. My colleague spent some effort showing me how wrong that is.
Let me assert that I believe firmly that we are going to have to adopt better, and more standardized processes if we are going to achieve our PPMI goals; it will be that standardization, and that process that permits us to effectively delegate our distribution activities, much as it has permitted the pharmaceutical industry to produce high-quality pharmaceuticals without requiring a pharmacist to stand at the end of each assembly line and inspect each item coming off that line.
Having said that, our process cannot be mindless, and it will have to constantly evolve as new opportunities and threats present themselves. Our True North must be the safe and effective treatment of our patients with medications. And nothing about our processes, no matter how dear they may be, should stand between us and that goal.
What do you think?
Dennis A. Tribble, Pharm. D., FASHP
Daytona Beach, FL
DATdoc@aol.com
#PPMI #Leadership #Informatics