By Pharm. (Barr.) Steve Okoronkwo
The healthcare landscape is constantly evolving. The dynamic nature of healthcare is said to be the major driver of change and innovation in pharmacy practice1. Innovation is at the core of pharmacy practice. It has played a key role in the significant growth and development witnessed in the field of Pharmacy.
Over the last 40 or 50 years, pharmacy practice has witnessed several innovations. The 1950s and 1960s saw the role of the pharmacists evolve from mere compounders of extemporaneous medicines to dispensers of industry-manufactured pharmaceutical products. Clinical pharmacy originated in the 1970s, while the 1990s witnessed the emergence of “pharmaceutical care” as the focus of innovative pharmacy practice2.
Whereas, some authorities canvass the concept of Medication Therapy Management, as an innovation in the pharmacy practice of the 2010 and beyond, others believe that this concept can be subsumed in the broader concept of pharmaceutical care, which is still being flaunted as the innovative key to excellence in contemporary pharmacy practice.
In Nigeria, innovation in pharmacy practice has become very imperative, in the light of changes in the drug regulation and drug distribution framework. With the promulgation of the National Agency for Food and Drug Administration and Control (NAFDAC) Decree of 1993, the rapid increase in the number of pharmacy schools, as well as the recent proposed Mega Drug Distribution system, the practice of Pharmacy has indeed changed. Accordingly, innovation, more than ever before, is now a sine qua non to achieving excellence in practice.
Innovation is the application of better solution that meets new requirements, unarticulated needs or existing market needs. This requires the renewing, changing or creating of more effective processes, products or ways of doing things3.
Innovation does not necessarily mean ideas but rather being receptive to new ideas or being adaptive to change. According to Theodore Levitt (1962), ideas are useless unless used. Innovation also differs from invention. It could, however, mean changing your business model or adapting to changes in your environment to deliver better products or services.
Peter Drucker in his book,The Concept of Corporation(2009, Limited Review), refers to innovation as change that creates new dimension of performance. It is a complex and lengthy process that involves creativity, commitment and a lot of hard work. It is usually developed through a sequence of events.
Innovation can also be seen as the price to pay to reach the next level. This price, however, must not come at the risk of patient’s safety, nor will it come as a compromise to professional ethics. Innovation must therefore be distinguished from so-called “cleverness” bordering on unethical conduct, which ultimately leads to professional damnation.
Several factors –both external and internal– drive innovation. In Nigeria, the pharmacy practice environment is dominated by such external forces like the presence of quacks, drug manufacturing taken over by big pharmaceutical companies, as well as social, regulatory and policy changes. These external factors, together with the internal factors (such as the need to improve profitability and quality, and the pressure for improved cash flow) have resulted to changes in the practice landscape4.
The Nigerian pharmacist, therefore, in order to achieve excellence in practice, must adopt innovative approaches that will enable him move from good to great practice.
Innovation in pharmacy practice
Three types of innovation have been identified as being applicable to pharmacy practice. These are: Product Innovation, Service Innovation and Business Model Innovation5.
While it may not be pertinent to go into a detailed discussion of these models, given our target audience, suffice it to say that the nature of innovation that can lead to excellence in pharmacy practice may simply mean looking beyond the traditional view of pharmacy practice or the traditional way of doing things.
The following have been identified as innovations which when adopted by pharmacists, especially those in community practice, can lead to professional excellence.
1. Innovation is properly defining your practice
Innovation in Pharmacy presents the need for pharmacists to broaden their views of the nature of their practice. The Nigerian pharmacist must come to terms with the professional-cum-commercial nature of pharmacy practice in Nigeria. He must also understand the chaotic environment in which he practises.
Undoubtedly, pharmacists are the undisputed custodians of drugs. However, it is counter-innovative for pharmacists to define their practice in terms of selling and provision of quality drugs. The activities of the National Agency for Food and Drug Administration and Control (NAFDAC) have reduced the weight attached to this assertion. Nowadays, even quacks also claim to sell only NAFDAC-registered products.
Pharmacists must therefore define their practice in terms of doing the things that will make patients and customers want, not only to visit their pharmacies, but to make repeat visits. A pharmacist in pursuit of excellence must realise that selling quality products can, at the very best, only translate into a good practice. Quality drug is not the ultimate end; rather it is an indispensible tool in attaining the ultimate goal of the health care system, namely, to improve the patient’s health-related quality of life.
In order to achieve excellence in practice, pharmacists must be perceptive enough to spot where future growth may lie. The current practice model where the pharmacist’s role is only associated with drug production and delivery must be re-engineered to include many additional responsibilities, such as patient care, primary care and public health services6.
An innovative pharmacist must understand that he is in the business of helping patients get better. Whereas pharmacists by their training are very proficient in both the biological and physical sciences, the practice environment however dictates that for pharmacists to achieve professional excellence in practice, they must also be conversant with the human sciences, which include sociology, psychology, economics and management/marketing. Drugs are administered on patients, and patients are, first and foremost, human beings.
2. Innovation is building a competitive advantage
A competitive advantage is an innovative tool that can be employed to provide superior performance in practice. In Pharmacy, competitive advantage goes beyond selling quality drug products or computerising one’s premises. Products and technologies are visible and well defined and can be copied by any person who is willing to make the investment.
According to Jean-Claude Larreche (1998), a competitive advantage, in terms of capabilities, is the ultimate advantage. Capabilities are intangible and comprise elements such as innovation, human resources and corporate culture7. A competitive advantage built on capabilities is pervasive and sustainable, and it is a veritable tool for value creation, both in the short and long terms. A pharmacist can recreate the value proposition for his/her patients by adding value to the product and service offerings, as well as appealing to the health care needs of the patients.
One way to add value is by following up on the patient through a phone call a few days after the supply of a prescription, in order to monitor the medication usage. Creating a competitive advantage that can provide superior performance and translate into excellence in practice means developing an atmosphere that will always make your customers and patients feel disappointed when they go elsewhere.
3. Innovation is marketing your services
Marketing is an innovative tool which may serve as the bridge to cross from a good practice to an excellent one. Whereas, the Code of Ethics for Pharmacists in Nigeria prohibits pharmacists from advertising their pharmacy8, it does not however preclude pharmacists from marketing their services.
The word “marketing” here is not used in its generic sense. Marketing connotes building a practice beyond mere money-making. According to Peter Drucker in his book, ThePractice of Management(1954), marketing is not a function; it is the whole practice of Pharmacy seen from the point of view of the patient.
One challenge the profession of Pharmacy faces is patients’ lack of awareness of the role a pharmacist can play within the health care team outside of dispensing medications9. Therefore, any pharmacist who desires to excel in practice must adopt marketing as an innovative approach. Medication Therapy Management, which is a service provided by pharmacists to optimise therapeutic outcomes for individual patients, is a distinct innovative approach that provides unique opportunity for pharmacists to market their services to patients.
There is the need for pharmacists to develop closer relationships with their patients by listening to and engaging them during pharmacy visits. Pharmacists should also identify unmet health care needs and present appropriate solutions/services during encounters with patients.
The practice of pharmacists handing over medications to patients like vending machines is out-dated and does not fit into contemporary pharmacy practice. Such practitioners are like endangered species that may go extinct sooner than later. A pharmacist should utilise every meeting with a patient to market his/her service. This could be achieved by using customer-friendly language, taking time to explain what the services are, giving patients realistic expectations of the service and having a plan of how to meet these expectations10. As the renowned painter Pablo Picasso has eloquently stated, “It is your work in life that is the ultimate seduction.”
4. Innovation comes from continuous learning
Achieving excellence in practice obligates the pharmacist to continuously update his/her knowledge. Pharmacy is a social profession. Society is dynamic. As the society changes, the profession inevitably evolves to meet the demands of the changing society.
Most pharmacists would invariably like to be the best. Unfortunately, only a few will develop the strict self-discipline and make the rigorous efforts required to excel. There is this general unwillingness among pharmacists to expand their horizons. Some stop learning the moment they graduate from the university. Most pharmacists, especially those in community practice, get carried away by the fact that they are making money or good sales in their pharmacies.
Excellence in pharmacy practice transcends sales or money making. You can always make money by doing what every other person is doing – selling quality drugs, locating your pharmacy in a strategic neighbourhood, using lower mark-up to attract patronage, etc.Excellence, on the other hand, is striving to be different. And one sure way to stand out is through continuous learning.
The saying that “a company surrenders tomorrow’s businesses when it gets better without getting different” is quite apt here.The knowledge base of the pharmacy graduates of the 2000s is different. This change in knowledge base has also affected the way Pharmacy is practiced now. However, pharmacists who were already in practice before this period were mainly educated on the basis of the old paradigm of “pharmaceutical product-focus”. If these pharmacists are to contribute effectively to the new paradigm of “patient-centred pharmaceutical practice”, they must make serious effort to continuously update their knowledge-base and skillset, in order to adequately empower themselves for modern day pharmacy practice.
In recognition of the importance of learning to the role of the pharmacist, as a member of the health care team, the World Health Organisation (WHO, 1997), in conjunction with the International Pharmaceutical Federation (FIP), listed one of the attributes of the “seven- star pharmacist” as a life-long learner.
Describing the “seven-star pharmacist” as a life-long learner, the WHO/FIP observe that it is no longer possible to learn all one must in school, in order to practise a career as a pharmacist. The commitment to life-long learning must begin while attending pharmacy school and must be supported throughout the pharmacist’s career. Pharmacists should learn how to learn11.
5. Innovation is practising “pharmaceutical care”
Ever since the Hepler and Strand treatise on the on the concept of pharmaceutical care in the 1990s,so much has been written on this concept which, arguably, is still being held as the most innovative approach to achieving excellence in contemporary pharmacy practice.
The FIP (1998), in an adaptation of the definition by Hepler and Strand, defined the term more realistically as the “responsible provision of drug therapy for the purpose of achieving definite outcomes that improve or maintain a patient’s quality of life”12. The concept of pharmaceutical care marks a clear departure in pharmacy practice from the age-long focus on medicine supply towards a more inclusive focus on patient care. Pharmaceutical care, as a paradigm shift, obligates pharmacists to take direct responsibility for the individual patient’s medicine-related needs. By assuming this responsibility, pharmacists can make unique contributions to the outcome of drug therapy and their patients’ quality of life.
In order to effectively carry out this new mandate of pharmaceutical care, the WHO (1997) introduced the concept of the “seven- star” pharmacist, which was adopted by the FIP (2000) in its policy statement on Good Pharmacy Education Practice. It describes the pharmacist as a care-giver, decision-maker, communicator, manager, life-long learner, teacher and leader. These attributes of the “seven-star” pharmacist are used as a benchmark to measure pharmacists who have achieved excellence in practice and are regarded as leaders of the profession.
Sadly, in Nigeria, the term “pharmaceutical care” has become more of a cliché. Whereas, every pharmacist talks about it, only very few practise it.
The belief that a pharmacy is doing well or growing and is, therefore, secure must never be allowed to overshadow the need for the pharmacist to practise pharmaceutical care. This is one sure route through which sustained excellence in practice could be achieved.
Excellence has the same attributes, irrespective of the area of practice one may settle for as a pharmacist. Achieving excellence in practice goes beyond doing well or being good. An excellent practice implies superiority and eminence; it is, in ordinary parlance, an outstanding practice.
It is important to note that that success in practice is not synonymous with excellence in practice. While it may be easy to measure how successful a person is in practice by the amount of money he/she may have made, an excellent practice transcends monetary parameters. Excellence in practice is achieved when the driving force in one’s practice goes beyond just making money. Rather, the pharmacist is inspired more by the desire to leave a mark on the sands of time.
Pharmacists achieve excellence in practice when driven by the desire to contribute in making the society disease-free. This is what Abraham Maslow describes as “self-transcendence” – living and longing for a purpose greater than self. When you transcend self, you stop competing with others; at every moment, you are intrinsically propelled by the excellent spirit to do better and improve yourself.
Finally, excellence in practice can be achieved by any person who earnestly strives to be different. It does not matter what grade you graduate with. Pharmacy training is different from pharmacy practice. Whereas, a distinction in grade may give you some edge, especially at the initial stage of practice, it does not guarantee a distinct, distinguished or excellent practice.
I leave you with these wise words by Jon Stewart in the fervent hope that you will commit it to heart: “College is something you complete. Life is something you experience. So don’t worry about your grade, or the results or success. Success is defined in myriad ways, and you will find it; and people will no longer be grading you, but it will come from your own internal sense of decency.”
(Presented at the induction/oath-taking ceremony of the new graduates of Pharmacy at the School of Pharmacy, College of Medicine, University of Lagos Teaching hospital, Idi- Araba, Lagos on 8May, 2014).
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