Don Berwick, the US paediatrician and healthcare expert commissioned by the Prime Minister in 2013 to review patient safety in the NHS, has said that children are innately curious and, taking small steps at a time, naturally learn from mistakes as they grow and develop.
That is what the field of ‘quality improvement’ is all about: a step-by-step approach to learning the best way to do something. (Though, quality improvement science is a little more structured than a toddler’s approach.)
This growing discipline is becoming increasingly important in today’s healthcare environment: the NHS commissions on the basis of quality, and so pharmacy must be able to demonstrate its commitment to this field.
We all work in teams and within a ‘system’ — this being the various components that make up an organisation, such as its leadership and workplace culture. The difference between an OK and a great place to work often depends on the willingness of the individual and the workplace to learn and improve. After all, who would want to work somewhere that doesn’t learn from mistakes or try to get better?
A workplace can learn when professionals are empowered to suggest new ideas and raise concerns that are taken seriously. This is good for pharmacy teams but also means better care for patients. Where is a patient likely to receive the best care — an organisation that values quality improvement, or one that doesn’t understand what it means?
It requires the entire team to embrace these principles to really see a difference. Better yet, the entire organisation’s system should be designed in a way that allows quality improvement to flourish: this we call a ‘quality system’.
A quality system must have strong leadership at senior and team level, and a workplace culture that reassures staff that they’ll be supported to make the right decisions. It should also have policies and processes that encourage its teams to improve how they work; but also to ensure they are armed with the knowledge and the capability to do so.
These concepts are not completely alien and many are already part of pharmacy culture. For example, pharmacists and pharmacy technicians will be aware of continuing professional development cycles, and most pharmacies have adopted basic improvement cycles; phrases such as ‘Plan-Do Review’ or ‘Plan, Do, Study, Act’ might be familiar.
If these are used routinely, and the steps documented, then the pharmacy will be well placed to prove to inspectors and commissioners how they are improving the way they work. This may incorporate feedback from patients and staff, audit results, or assessments of dispensing errors and near misses.
As a first step, ask yourself these questions: does my pharmacy team know enough about quality improvement science to improve? Do we have the right leadership style to best encourage improvement? Does my pharmacy listen to the ideas and issues of staff and patients and act upon these? Do processes and procedures cause difficulties that hinder improvement?
To help the profession to develop quality systems, the Royal Pharmaceutical Society (RPS), the Association of Pharmacy Technicians UK and the Pharmacy Forum of Northern Ireland have developed an open-access web resource (www.pharmacyQS.com). This will introduce pharmacy teams to the concept of quality, quality improvement and quality systems when it is launched in January 2015, encouraging everyone in pharmacy to ‘think quality’.
In Berwick’s report, ‘A promise to learn, a commitment to act’, he wrote: “The most important single change in the NHS in response to this report would be for it to become, ever more than before, a system devoted to continual learning and improvement of patient care, top to bottom, end to end.”
This applies to pharmacy: the onus is on us to consider our ability to learn and improve, through quality improvement, and develop the quality systems that will advance patient care.