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Record learning outcomes

By Alexander Humphries*

I have been hunkered down in my office armed with folders, subject dividers and the most evil invention known to man (after cling film) €“ the poly-pocket...

All this activity was not due to a new year resolution to be tidier or even a case of OCD €“ this was panic stations because a pre-notification letter had arrived from the GPhC. Yes, we were due to have an inspection. Having heard so much about the new inspection regime, I was both nervous and excited. The masochist in me was looking forward to pitting my professional performance and ethos against the 'Evil Empire'.

We have a new inspector in our area, so part of me was expecting Darth Vader to walk through the door and put me to the sword for not rigorously following the standard operating procedure for standard operating procedures... Joking aside, I do agree with the GPhC's ethos: the emphasis should not be on ticking boxes but on me proving how I am meeting their standards.

What I was concerned about, however, was how closely the theory matched the reality of an inspection. With my prep time severely curtailed (the pre-notification letter went to a dead email address and it was only by chance that we found it), I tried to be smart about how I used my time. No point in duplicating things that already exist. I scouted around the available resources and found that everything and everyone was obsessed with SOPs! 

It seems that the only way most organisations can perceive meeting half of the standards was to have SOPs for every minor operation within the pharmacy. Personally, I think SOPs rob pharmacists of the ability to use their professional judgement but, even so, I have plenty of them. I have the handful of mandatory ones.

I have the raft of pseudo-mandatory ones (which are required by the contract or various enhanced services). I've also got a load of 'nice to-dos' and, lastly, a pile of completely pointless procedures that add nothing to man nor beast. The trouble is that the more SOPs you have, and the more pedantic you make them, the less likely people are to follow them.

Locum pharmacists are supposed to read, sign and abide by the contents of the SOP folder before they start work. However, if my newly edited CD SOPs are anything to go by (now down to a mere 6,000 words), that task would challenge even Jonas von Essen, the world memory champion.

I was both nervous and excited 

A just culture

We have worked very hard to build a just culture in the pharmacy and I am grateful that the inspector recognised the open and honest ethos that we ingrain in our team. We talked the inspector through our approach to risk management, which is about trying to keep workflows safe through simplicity. We try to keep discussion of errors lighthearted, not because we have a lax attitude, but because I do not believe there is anything to gain from beating up people who have come to work and made an honest mistake.

We have a long-term view of quality and have spent a long time quality assuring various elements of our service. Some people think that having a swanky refit makes you a quality outfit €“ it doesn't. Take dispensing as an example. We spent a week logging every item dispensed, and took a strict view of any variance that could have affected the patient.

This was enormously time-consuming but gave us an idea of our true error rates and where the risks lay €“ both for the process and the team as a whole. We were able to improve both process and people as a result.

Red, amber or green?

My wife has been laughing at me because I have a Word document that breaks down each performance standard and looks at the evidence required to show compliance. I score this on a red-amber-green scale and called it my 'performance dashboard' because I could see at a glance exactly where I needed to focus my efforts. This tool was enormously helpful through the inspection, and made both my and the inspector's life easier.

We were absolutely honest throughout this benchmarking exercise €“ if there was work to do, we didn't shy away from saying so. As a result we were able to make a clear improvement plan to ensure that our professional standards improve over time, no matter how the GPhC chooses to grade us. Before the inspection, a colleague asked me what grade I expected.

I said I would be happy with 'satisfactory' and anything else would be a bonus. After the inspection, which I thought went very well, I might be edging towards 'good', (probably doomed after writing these words). We'll find out when we see the draft report.

* Pen name of a practising community pharmacist. Alexander Humphries' views are not necessarily those of Pharmacy Magazine. Have you been inspected? What tips would you pass on? Email pm@1530.com