After some honest and necessary conversations with my staff, I began to see real improvement in their work ethic and commitment. This resulted in them taking active steps to improve the customer service in the pharmacy. One of the fundamental changes I wanted and demonstrated was courtesy and customer satisfaction.
Dr Alf Collins’ ‘thought paper’ resonated well with me. The paper outlined the principles of person-centred care and the steps that such a system could be used in different situations. The paper also describes the core elements of person-centredness system. (Collins. A 2014).
We are working with patients, professionals, and health care providers so that people have a better health care experience and better health. Armed and encouraged by Dr Alf’s paper, I analysed how patients viewed their health care regime and their chronic illnesses. I encouraged my staff to initiate conversations regarding patient’s medication, and lifestyle issues. for example, when patients picked up their medication, we reinforced that certain medications which were supposed to be taken in the evening, were being taken then. this conversation would bring forth many other issues and often, the conversation would lead to the patient requiring reassurance. as mentioned in Alf’s paper, this was all part of being patient centred.
In dealing with patient queries and requests for medication we regularly encountered bottlenecks and carelessness in primary health care settings such as GP practices and hospitals. Like Margaret Heffernan, who saw patterns in this respect, and gathered data to bring attention to her cause, I too desperately wanted to change this. For example, patient discharged from hospital with new medications for inflammation and pain relief would expect their medication waiting for them at the pharmacy because the discharge notes and instructions are faxed over. The surgery however would not oblige and refer to GP for a prescription for these. The reason cited is no discharge information received. In the meantime, patient is suffering. I would fax our discharge copy to surgery to convince the GP to issue a prescription. This is a daily reality and the impasse had to be broken.
I researched and familiarised myself with micro systems by referring to Mohr (Mohr et al 2004) and his research and approach to understanding our micro systems and how we were connected, in terms of providing patient-centred services. To combat the bottleneck and carelessness, I took the initiative to communicate with the various surgeries to ascertain their approach in dealing with patient queries. It transpired that, to the surgeries, the patients were mere names and numbers. That was the prevailing culture and climate. Furthermore, I persisted on communicating these queries myself with a conducive and friendly tone every time. Over time, my diplomacy and influence building bore fruit. The most positive response was being given a direct phone line to the surgeries.
Killman and Thomas ‘the assertive-cooperative gauge’ was also a useful guide and tool to demonstrate to my team on how we should tackle issues of impasse and conflict.
We set about building our relationships with a focus on strengthening our influence with the various parties. For example, GP surgeries, hospital, district nurses, community psychiatric nurses etc. I reinforced to my team that, if you create good relationships with the people you work with, you’re more likely to collaborate to achieve your goals. we approached these groups with an open mind, courtesy and with a tone to reassure them we were on the same side. We devoted time and nurtured good relationships and no matter how difficult a situation we were dealing, with the use of the principles of push and pull cycle, we achieved a patient-centred result.
We looked at the efficiency and seamlessness of communications channels between our micro-systems and where and how to improve them for mutual benefit. We realised that though we were related microsystems, yet we did not have insight as to how our partners operated and the systems they employed. I arranged surgery visits to learn and understand how they dealt with patient’s queries, referrals and our medication requests. As well as, how they liaised with other micro systems both clinical and non-clinical. We reciprocated by inviting them to witness our daily work routines. This resulted in a cordial and friendly working relationship and a more willingness to solve pertinent issue as they arose and developing simple procedures for recurrences.
The foundation of health care is to support patients in making informed decisions about taking control and understanding their own health and care, as well as delivering care, based on people’s individual abilities, preferences, lifestyles and goals. Whilst carrying out Medicines Use Reviews (MUR) and dealing with patient queries, I noticed that patients with chronic illness who were prescribed multiple medications were not very familiar with the names or what the medications were for. This leads to indiscriminate ordering of repeat medication and the shear wastage was disheartening and very wrong. (Fischer M 2012) We welcomed when the pharmacy ordering system was stopped, and patients requested to order their medications either on line or in person. I began to personally give out medication and enquiring if the patient knew about the supply and reassuring how to take it for optimal results. While conducting MURs I also drove the point home that patients were expected to know what they were taking and for what condition I also ensured that patients were encouraged in sharing in decision making and supported in self-management skill sets (Collins. A 2014)
I also noticed that in the haste of getting the job done, my staff did not notice a medication regime change, for example a dose change or medication change. This resulted in items being ordered unnecessarily, from the surgery, and subsequently, from suppliers. this lack of attention to detail and knowledge or patient regime leads to high amounts of wastage, costing the NHS millions. To resolve this, I reinforced a necessary vigilant attitude when processing prescriptions or when ordering prescriptions of high value for patients.