A question of quality

What does quality mean to you? If asked, most of us could come up with a definition of ‘quality’.But quality can mean different things to different people and articulating the methods by which quality is achieved and maintained is not easy.

We see assuring and encouraging quality improvement in pharmacy as an essential part of our role. In our observation one of the things that the profession and the sector might find it useful to work on is developing a more consistent shared understanding of what quality in pharmacy practice means.

We wanted to start a new conversation with pharmacy about three broad elements of quality: safety, effectiveness, and patient experience. The three elements of quality have been talked about in the NHS for many years, and we wanted to understand more about what they mean to people working in pharmacy.

There are growing expectations on everyone working within health and care, including pharmacy, to deliver better-quality outcomes to patients and the public. Governments across Great Britain have made it clear that if the NHS and the wider health and care sector are to meet the challenges we face – such as an aging population, growing costs of healthcare and public health challenges – pharmacy will have to operate differently.

Operating differently is in part about the types of services that pharmacy delivers. It is also about the pharmacy workforce – particularly, as we have heard over the last year, a workforce that feels that professionalism is under pressure. But most important, we believe that it is about an increased focus on quality.

We want to build a greater, shared understanding of what enables quality in pharmacy, and what gets in the way. We have a part to play, as the regulator, in providing assurance to patients and the public about the quality of services they receive and encouraging improvement in quality in pharmacy. Pharmacy organisations and leadership bodies have a role; so too do educators and employers within and outside the NHS. And pharmacy professionals can make the biggest contribution in improving the quality of the services they provide.

In January, we launched an online workshop and asked pharmacy professionals and other stakeholders how they define quality in pharmacy practice.  

By having this conversation, we wanted to broaden our understanding of people’s views of quality, and hear examples of how quality is being delivered in practice. We also wanted to understand better the difficulties that pharmacy professionals may face in providing good quality services, and the steps that they are taking to overcome these challenges.

Over three weeks, more than 1,000 people participated in the workshop, representing the broad range of pharmacy sectors and areas of practice. They contributed more than 5,000 ideas, comments and votes – three quarters of which were positive, and solution focused.

The conversation was wide ranging, with interesting reflections on the subject of quality, and how people are addressing challenges to quality in their practice. The discussion fell into three key areas: delivering good patient experience, delivering effective services, and delivering safe services.  Here’s a bit of what we heard:

• On patient experience, discussion unsurprisingly focused on communicating effectively with people using pharmacy services, but there was also significant discussion around the idea of continuous improvement. Respondents identified a wide range of tools and approaches for gathering patient feedback, and discussed the benefits and challenges of involving people in decisions about their care.
• On effectiveness, the issue of leadership in pharmacy came to the fore, with some discussion focusing on the responsibility of leaders to ensure that pharmacies are resourced to meet the demands they face. There was also some discussion about the skills of the pharmacy team, and some practical examples shared about how these can be best used.
• On safety, there was discussion about the importance of using and following standard operating procedures, but also some honest reflection on the challenges of doing that in practice, and the need to not ‘design out’ professional judgement and decision-making. (A hugely important point closely aligned with the GPhC’s own emphasis on the public benefits of professionalism compared to, say, process.) Participants also talked about raising concerns – how best to go about doing it, and some of the barriers to dealing with problems in practice.

We also heard promising ideas and examples of what is working in practice to enable quality in pharmacy. 

The positive response and practical feedback to our first workshop has been very encouraging. We are now looking forward to our next workshop starting next month, when we’ll delve more deeply into the issues raised. We want to hear from those who have already participated and others too, to discuss their experiences of quality in pharmacy, what enables quality and, critically, what barriers there are.     

We will be reflecting back what we have heard from each workshop in more detail- watch out for updates on our website and social media platforms. Later this year, we will also be sharing our findings with members of the public, to get their take on quality in pharmacy. We will use this to continue to build a shared understanding of what the priorities should be to support quality in pharmacy, and how all of us can help to improve people’s experiences of using pharmacy services.

For as John Ruskin said:  Quality is never an accident; it is always the result of intelligent effort.