Quality: A Foundation of Health-System Pharmacy


Developing a quality-focused culture in a health system requires changing a range of behaviors in addition to adopting tools designed to improve quality.

Many health care organizations employ quality-improvement principles to reduce variation, improve efficiency, and enhance patient safety. In my organization, we have embraced Lean Six Sigma. One member of our department has obtained black belt status, and others are almost there. We have ongoing Kaizen events and other activities to isolate processes for improvements. We have even recognized the need to embed this in the training of our pharmacy residents, requiring them to obtain their yellow belt by the end of their residency and requiring our health-system pharmacy administration residents to lead a Kaizen.

However, my sense of accomplishment was tempered as I read an article in the April 2014 issue of Harvard Business Review titled “Creating a Culture of Quality.” Its authors, Ashwin Srinivasan and Bryan Kurey, write that 60% of employees work in an environment that does not support a culture of quality. While this conclusion was not based on data from health care delivery organizations, I wondered how different the results would be if it were. While I can speak from an administrator’s perspective on what we do in our department, would the front-line employees say the same thing? Do they understand the methods our organization has employed, and do they believe we are focusing on improving the most essential items? It is also interesting to note that the authors of the Harvard Business Review article found that there was no correlation between use of quality tools and creating the desired culture. Thus, in order to produce an organization focused on quality, more is needed than just a system.

The authors recommend 4 strategies for developing a quality-focused culture, which require changes in other behaviors and actions in addition to adopting tools. They are:

  • Getting leadership to focus on quality
  • Ensuring the trustworthiness of the message
  • Gaining peer support
  • Involving employees in change decisions

What does this mean for health-system pharmacy? Here are some strategies that one can employ to develop a culture focused on quality or assess whether such a culture already exists in an organization.

  • Conduct a confidential survey. The survey should focus on understanding whether pharmacy services are safe, on gauging the impact of departmental initiatives to improve safety, and on determining whether leadership actions are supportive of developing this culture. Keeping the survey confidential is important because it is the best way to get unvarnished opinions from participants. In addition, if constructed appropriately, such a survey can point the way to areas that need to be addressed as well as offer indications of the level of commitment of leadership to quality.

  • Hire professionals, not employees. When interviewing job candidates, it is important to assess their commitment to patient care and to the organization. Your goal should be to hire someone who understands that the well-being of the patient is the end goal of all decisions, not someone who views their job as just a means to a paycheck or just a set of responsibilities to accomplish. It is important to find someone who is committed to the aims of the organization and the mission of the department. This should apply not only to pharmacists, but also to pharmacy technicians and other support staff. They are as critical to developing a culture of quality as pharmacists are.

  • Invest in training. If employees do not understand how to improve quality, it will be hard to expect them to be involved in developing a culture of quality. In addition to the initial training, employees need to be given time to take part in ongoing quality initiatives. While a manager might worry that allowing employees a full day away from work for training is excessive and unsupportable, it may be necessary to ensure that they are committed to helping to create a culture of quality. These opportunities should be available to both pharmacists and pharmacy technicians.

  • Walk the talk. If leadership does not actively support developing a culture of quality, then it will not take hold. Not only do managers and directors need to be trained, they also need to prioritize freeing up employees so they can get trained as well and need to provide encouragement and excitement to conduct ongoing projects.

I believe that emphasizing quality has to be one of the bedrocks of how we practice pharmacy. If you are not either actively involved in projects designed to improve quality or encouraging your employees to improve quality, then patient care will suffer. Quality is the current focus of health care delivery. Let’s lead by becoming known as the department that fully embraces quality in order to have the safest and most efficient processes in place for patient care.

I would appreciate any insights you might have on this perspective. You can let me know what you think by email at seckel@unc.edu.

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