Change Management
By Dr. Terry Maguire, a Northern Irish Community Pharmacist, senior lecturer at School of Pharmacy (Queens University Belfast) and Belfast LCG member.
“Willing is not enough, we must apply
Knowing is not enough, we must do.”
Goethe
Joe Brogan, Head of Integrated Care at the Health and Social Care Board (HSCB), stares out from the cover of the June Edition of this great magazine (ViewPoint); inside his exclusive interview is well worth the time invested in its reading. In the past Joe would have had the more recognisable title of Chief Pharmacist at the Health Board but now, in an attempt to remove the silo-thinking that pervades our health service, he and his pharmacists work within the Directorate of Integrated Care along-side the Chief Doctor and the Chief Nurse. In this structural change it is hoped to forge a new culture that will bring with it a change in the way patients and their conditions are managed; through integration of those who provide care.
We are Joe’s stakeholder group; he needs us as HSCB attempts the mammoth task of changing the health service radically and totally as it implements Transforming Your Care (TYC). As change management projects go this is as big as it gets. It’s nothing short of a total re-bore of our health service and it’s likely some will not be happy.
Joe used his interview and a two-venue Road Show (hosted jointly with CPNI) to good effect. He covered the key points: there is a need for change; our model of healthcare is unsustainable; we need to “shift-left”; from more expensive venues of care – such as hospitals – to less expensive ones closer to patients’ homes. We also need to “shift-left” by investing in disease prevention services so less of our population develop long-term conditions. We need people to take more responsibility for their own health. Unless stakeholders engage with this change programme it will not happen. Unless GPs, pharmacists, OTs, social workers, hospital consultants, nurses, the Health Trusts and the public buy in then it will be an abject failure.
Joe did well selling the vision; more public health from pharmacies; pharmacies supporting self-care and pharmacies dealing with long-term conditions and reducing ADRs and an IT investment in our pharmacy network to support it.
Talk about change is one thing; making it happen something else. At the same time as Joe was speaking about TYC, the Ulster Chemists’ Association was running training workshops to help managers and contractors create the necessary change to practice. Change is not easy and unless I, and the other 532 pharmacy managers in N. Ireland, begin to do things differently; stop doing things I don’t need to do and start doing the things I do, then pharmacy will not contribute to TYC. If, as a pharmacy manager, I think that simply saying I will do in this year; 120 MURs, 100 smoking cessation interventions, 30 Managing Yours Medicines interventions, 40 Vascular Screens and 20 weight management interventions without making radical changes to the day-to-day pharmacy operation then I am living in cloud cuckoo-land.
Joe’s article and his CPNI joint Road Show and the UCA workshops are a good start. I have little doubt, judging by attendances at these meetings, that the profession is up for TYC. Momentum for change is building. I have just learned that over 300 contracts have signed up to become one of the accredited Health +Pharmacies. At the first MUR training workshop in Ballymena which I attended one hundred pharmacists turned up; they expected 50, in Belfast a few nights later over 300 turned up they expected 150. In now understand that over 1000 pharmacist have been trained.
The plan is now to translate this enthusiasm and commitment into high quality MUR interventions that make real improvements to the management of asthma and COPD. This is the challenge and if effective will contribute to a “shift left” for those suffering from respiratory disease. Our targeted MUR is a small but important part of the bigger vision set out in the “Transforming Your Care” programme; services provided closer to the patient resulting in better patient outcomes and reduced costs; less wastage and less hospitalisation. We know many patients use their inhalers incorrectly we also know that few patients are effectively managed through a personal disease management plan. The targeted MUR is designed to address this and bring about change though pharmacists working with others; that’s the real meaning of integration.
Off course it was always said the pharmacists should advise on proper inhaler technique but in practice that aspiration was never fully realised. In the absence of a formal paid service only some pharmacists sometimes did; in reality most mostly didn’t.
Now we have a targeted MUR and we must see this as only the start of pharmacists working with GPs and with patients to help ensure better outcomes in a systematic and organised way for all chronic conditions. Respiratory disease is part of the FREDS list (Frail Elderly, Respiratory, End of Life, Diabetes and Stroke) and these conditions are likely to be addressed first through Integrated Care Partnerships (ICPs) which are already up and running.
This is the change the profession has been asking for and we must not make the mistakes that were made with the introduction of MURs in England in 2005. We must ensure that all pharmacies undertake the work to the required level.
Clearly those who work at the coal face are keen to move away from prescription management (collection and delivery of medicines in fancy packs) to medicines management and public health because we know it will be more professionally satisfying; and better patient outcomes will be achieved. It will be worth the effort but it will not be easy. Most don’t understand just how difficult change is. Perhaps that’s why Joe looks so nervous in his front cover photograph.
