Are You Sure I Have to Change?

Self-reflection opens the door to improving one's skills and changing the pharmacy profession

“In fact, hospitals, physicians, and nurses—all of health care—must change,” according to the authors of On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry (Toussaint J and Gerard RA, Lean Enterprise Institute, Cambridge, MA, 2010). My students and I are going through this book as part of a class I am teaching this semester. It describes one health care system’s experience in implementing lean management throughout the organization.

One of the reasons we chose this book is that pharmacy plays a prominent role in many of the examples used. “Lean health care” was adopted by the authors from the improvement model popularized by the Toyota Production System. As I have been reading this book, this notion that I have believed in my gut for some time now—that everyone in health care must change—became even stronger in my mind. We will not make real progress in improving our health care system outcomes until we all realize that change even includes me, not just the other players on the team.

The idea that real progress in delivering high quality health care at an affordable price with superior patient satisfaction will only occur if EVERYONE changes is hard for most of us to swallow. After all, we are well-trained, hard working, committed professionals doing what we have been trained to do and doing it well. “What do you mean I have to change?” is our thought. “If only … (put anyone here) changed, my job could get done better,” we think.

A recent experience has made the need for all of us to change even more certain in my mind. I have been engaged in a project to bring pharmacists into the patient-centered medical home and evaluate the benefit of this new arrangement. We have pharmacists working with physician practices, in new arrangements in community pharmacies, and in a unique community-based medication resource for seniors. I have realized for some time now that we often provide health care within our own silo. I thought that if we brought new players into that silo, we could improve overall outcomes.

What I am observing as I visit these sites is that in large measure we are improving the way drugs are used, but we may not be improving overall outcomes. This is because the current players have not changed how they practice, nor did the presence of a pharmacist create new relationships between community providers that would improve quality of care across the continuum and over time. Incremental improvement, which is what we have been prone to do in health care today, has little value beyond the initial patient intervention was my observation after these site visits. Unless there is a change in what everyone embraces and new relationships are initiated to ensure continuity of care across the continuum and over time, these incremental improvements are not going to solve the health care crises we are facing today.

Here’s the other problem with incremental change. Unless people really change how they see their role, we offer incrementally better results for a while until everyone slides back to old habits. Of course, there is much more to this issue of changing our health care system than having each player willing and open to change. What changes will make things better? How do we know when we have it right, or what new skills do I need to do my job better? These are not easy questions to answer, but I believe they are easier to begin answering when we realize that we have to change.

So, how do we get pharmacists to address that their role needs to change? I’ve been struggling to answer this question throughout my career. Many of my commentaries over the years have addressed this idea. Even our new columns in Pharmacy Times, for example, “Medication Therapy Management Today,” are based on helping pharmacists change what they do.

Perhaps this is a way too simplistic idea, but I think the first step is to ask oneself at the end of the day, “What did I do differently today in my activities as a pharmacist to develop new relationships or make an intervention that helps a patient make the best use of their medications?” I invite you to share with our readers what you have done differently recently in your practice.

Mr. Eckel is a professor emeritus at the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill. He is past executive director of the North Carolina Association of Pharmacists.