How to Maximize the Effectiveness of Pharmacy Personnel- The Deming Approach

In the average independently owned community pharmacy employee wages
represents the largest expense. Averaging approximately $90,000 or 8.7% of sales, this expense tends to increase with sales volume and prescription volume reflecting the increased number of hours a high volume store must be open and the increased need for pharmacist personnel in pharmacies with high prescription volume. These data and the increased competitive community pharmacy marketplace indicate the need to effectively control this resource. Ironically, human resource management may be even more important for the small business manager than employers of thousands of workers. Ten ineffective employees in 1,000 represents only 1%, where as a pharmacy with 5-10 employees can ill afford even one ineffective employee. It is through the employees that the goals and objectives of the business are achieved. Moreover, as the pressures from third parties, mail order and competition increase, it is imperative that the effectiveness of this largest expense by maximized. In this issue of the Pharmacy Management Advisor, Dr. D. Garner, PH.D., Professor and Chairman of the Department of Pharmacy Administration at the University of Mississippi School of Pharmacy describes the application of the Deming Model to the personnel management of community pharmacy. Dr. Garner details those aspects of the successful Deming Model that directly apply to increasing your effectiveness as a manager of human resources.

Introduction

Maximizing the effectiveness of pharmacy personnel is critical to the success of a community pharmacy. The objectives of the pharmacy are accomplished through the efforts of its employees. The pharmacy's image is an extension of the employee's attitude and behavior. Personnel cost constitutes the major expense of the pharmacy. How do we maximize the effectiveness of pharmacy personnel, the most valuable resource of the pharmacy?

Prior to discussing the Deming Model as it applies to personnel management let me briefly discuss the Man, Edwards Deming, and his mission. Not many people in the United States were aware of the Deming Management Philosophy until NBC aired a documentary entitled, "If Japan Can…Why Can't We?" on June 24,1980.

Edwards Deming grew up on a Wyoming homestead. As a boy and throughout college he worked at many odd jobs including that of a "soda jerk." He received a B.S. Degree in mathematics at the University of Wyoming, a Masters Degree in mathematics and physics from Yale University.

In 1947, Dr. Deming was recruited by the Supreme Command for the Applied Powers to aid in Japan's economic recovery by teaching by teaching the Japanese statistical quality control and principals of management. The rest is history. In 30 years Japan rose from the ashes of World War II to economic gianthood.

Back in the United States none of this success made much of an impression until the NBC documentary. Thirty years after he first taught the Japanese his methods. Dr. Deming was "discovered" in his homeland. At a time in their lives when most men would have long retired, Dr. Deming was catapulted into national prominence. More than any other single event, that NBC program set America on a new course toward quality, with Deming at the helm.

Dr. Deming attributed the decline in American industry to its obsession with quantity rather than quality. The cause of the decline was that management walked off the hob of management. Following World War II the rest of the world was devastated. North America was the only source of manufactured products that the rest of the world needed. Almost any system of management will do well in a seller's market.

Obviously there are many parallels to this scenario for pharmacy. Third years ago competition was minimal. There was little third party influence or managed care activity. There was little third party influence or managed care activity. Mail order was not an issue. Pharmacy could survive, and often did, without much attention to quality care.

Let us examine the points in the Deming Management Philosophy placing emphasis on those that directly apply to maximizing the efficiency of pharmacy personnel.

POINT ONE: Creative Constancy of Purpose for the Improvement of Product and Service

Establishing constancy of purpose means: 1. innovation; 2. research and education; 3. continuous improvement of product and service; 4. maintenance of equipment, furniture and fixture, and new aids to production in the pharmacy.

Innovation means that the product or service must have a market and be able to help people to live better materially in some way. Innovation requires faith in the future and it cannot possibly succeed unless the pharmacy management has a declared unshakable commitment to quality and productivity. Management must plan for the future and continuously innovate services that benefit the pharmacy's patients. An example is the patient information printouts to provide detailed information on new prescriptions.

There can be no innovation without research and no research without properly educated employees. Management must discover the needed innovations and train employees to provide these innovations. Parents' needs and wants can be determined through a simple questionnaire or by taking six patients to lunch and asking them to tell what they don't like about your pharmacy and by asking what additional services is most desired.
The pharmacy must continually strive to improve its products and service. The pharmacy cannot do things today as it did yesterday and be successful. This obligation to the patient never ceases. It is possible and in fact fairly easy for the pharmacy to go out of business offering the wrong type of service even though every employee performs devotion, applying statistical methods and every other aid to boost efficiency. The pharmacy must respond to the changing needs and wants of its patients.

Clearly a pharmacy cannot improve its delivery system with equipment that malfunctions or is outdated. For example, the computer software must be updated to accommodate the additional patient history information and documentation required under OBRA '90.

To create a constancy of purpose for the improvement of product and service management must recognize that the patient is at the top of the organizational pyramid, that the employees are in the middle, and management is on the bottom. Management must be proactive and put out fires early. Management should obtain positive and negative input from both patients and employees.

POINT TWO: Adopt the New Philosophy

Management must totally replace the existing traditional top down style of management with the Deming Method. Quality must become the new religion. The pharmacy manager can no longer afford to live with mistakes, poor workmanship, fearful and uninformed workers, poor training or not at all, an inattentive and sullen service. Reliable service reduces costs. Pharmacy managers seldom learn of their patients' disappointment. Patients do not complain. They merely switch pharmacies. How much better it would be to have patients who would boast about services and bring new patients into the pharmacy. The pharmacy manager must believe in quality today as in progress in the 1950's.

Quality is not an act. It is a habit. It is a conviction. Sometimes it can cost money. Toss out that compounded prescription because it does not meet your standard of quality. Quality is a way to attract and retain patients. The new motto for the pharmacy might well become: "When quality service counts."

POINT THREE: Cease Dependence on Mass Inspection

Inspection with the aim of finding the bad ones and throwing them out is too late, ineffective, costly, says Dr. Deming. In the first place you can't find the bad ones, not all of them. Second, it costs too much. Quality comes not from inspection but from improvement of the process. The old way: Inspect bad quality out. The new way: build good quality in. The most common error in the dispensing process is giving the wrong drug to the patient. This may result in injury to the patient and a lawsuit for the pharmacy. Quality must be built into each step of the drug delivery process in the design phase.

POINT FOUR: End the Practice of Awarding Business on Price Tag Alone

Price has no meaning without a measure of the quality being purchased. Striking deals with the cheapest supplier is the accepted American way of doing business. Certainly thrift is an admirable quality, and costs are important. But if low cost guarantees low quality anywhere in the supply chain, then the final product, though it may cheap, will also be of low quality. Good quality is cheap; it's poor quality that is expensive.

A price tag, notes Dr. Deming, is unambiguous and therefore appealing. Determining quality is another matter entirely, and it requires some degree of knowledge and skill. Applying this point to a community pharmacy the manager should select only a couple of generic drug suppliers to deal with, ideally those that follow the fourteen points in their business, and establish long-term partnerships with these suppliers.

POINT FIVE: Improve Constantly and Forever the System of Production and Service

Every employee in the pharmacy must subscribe to constant improvement. Management must lead the way. Only management can initiate improvement in quality and productivity. Employees on their own can achieve very little.

Removal of an irritant, or solving a particular problem, is not an improvement of a process or the system. It is simply putting out a fire. By the same token, meeting specifications does not result in constant improvement. It ensures the status quo. Zero defects is the same misguided notion. As a goal, it makes no sense. There must be a method. Likewise, with "meeting the competition." Do you think the other pharmacy managers are going to stand still while the competing pharmacies catch up?

It is more appropriate, Dr. Deming suggests, to consider such questions as whether your pharmacy is doing better than a year ago; whether marketing is more effective; whether patient satisfaction has increased; and whether pride and performance of employees has improved. A pharmacy manager that subscribes to Point Five can answer yes to these questions.

POINT SIX: Institute Training and Retraining

All too frequent are stories of employees who learn their jobs from other employees or who are focused to depend on unintelligible printed instructions. Often there is little training or none at all. Just as often, employees don't know when they have done their jobs correctly. It is very difficult to erase improper training. Dr. Deming notes, it can be done only if the new method is totally different or if the person is being trained in a different set of skills for a different job.

Dr. Deming says, "A woman said she couldn't find out what the job was." I said, Well how did you find that out? Her fellow workers helped her. They taught her what was right and what was wrong. How could they teach her anything else but they way they were doing it, some ways of which were right and some wrong. They didn't know; she couldn't know. It's just like taking lessons on the piano from someone who never had a lesson on the piano. He learned by himself how to play. If you take lessons from him, you will learn a lot that is wrong; you might learn some that is right. Neither pupil or teacher will know what is right and what is wrong.

Did you know that when this happens, and it is going on all around us, the training gets worse and worse. It resembles a game everyone knows about. A number of people sit in a circle. Someone whispers words to the next person, who whispers it onward. By the time the words make the words make first circle, they may be distorted beyond recognition. The meaning takes a random walk as it does around. That's what you get when worker trains worker.

End the practice of having other employees informally train new employees. Train employees for the job until no further training is beneficial. Retrain employees as needed or when new services or technologies are implemented.

JOB ANALYSIS

Before a pharmacy manager can properly recruit, select, orient, and train new employees on the job, a guide must be developed to indicate the types of skills, experience, education, and training that are required and necessary to perform the job. This may best be accomplished by completing a job analysis. Conducting a job analysis consists of observing and studying a job to determine its content, conditions, and relationship to other jobs in order to specify the skills, training, attitudes, attitudes, and abilities necessary to perform the job.

JOB DESCRIPTION
After all the pertinent job facts have been identified by job analysis, a job type description should be developed for each employee position and type. Providing a detailed and precise description of the actives of a particular job is important for both employees and managers. A job description lets employees know what is expected of them in order to perform the job and clarified responsibilities. Because job related tasks are clearly delineated and the percentage of time while should be devoted to each set of responsibilities is provided, worker autonomy is increased and the need for constant supervision is diminished. A job description provides an opportunity for job enhancement by increasing worker independence, and it should be used as a management tool throughout employment to review performance and evaluate future activities.

Although content and format of job description documents vary, there are components which are common to all. These include: the job title, location, job summary, job relationships, and responsibilities and duties. When developing job description it is important to remember that specificity is preferred over generalities. Avoid the use of vague terms which provide little meaning to the actual responsibilities of the job. Finally, if a job description is prepared, it should be used. Developing a good job description takes time and effort, and unless it is a familiar document to both employees and management, the job description is a useless tool.

JOB SPECIFICATION

Related to job descriptions are job specifications, which also serve as guides when selecting applicants for a particular position. The job specification differs from the job description in that it contains a statement of the human qualifications necessary to do the job. Components of a job specification include the following: education, training, and experience, and personal characteristics such as judgment, initiative, emotion, communication and physical skills. An example of a job description and a job specification is presented in Table 1.

ORIENTATION

The process of maximizing employees' productivity begins on the first day of the job. Orientation and training of employees is important not only for supportive personnel who may have limited work experience in a pharmacy, but also for professional staff who should be introduced to the pharmacists and other employees and gain an understanding of the philosophy of the practice.

The manager should be directly involved in an employee's orientation program. While some of the orientation activities may be carried out by other employees, the manager should provide the initial indoctrination in order to foster positive feelings toward the pharmacy and to welcome the employee as a vital part of the team.

The orientation period is the time to provide an objective view of how the employee's job fits into the organization. Every employee needs to recognize their importance. It is the time to go through the policy and procedure manual with the new employee. Remember, it is not sufficient to hand the manual over to the new employee with the directive to read and follow it.

TRAINING AND DEVELOPMENT

Training and development consists of expanding the knowledge and skills of employees through an organized process by which they learn skills, abilities, and attitudes needed to perform their work. While on-the-job training is a commonly used form of employee training, it should be formalized and supplemented with a more structured program to limit employee obsolescence due to technological, cultural, or social changes.

The pharmacy manager should develop a policy and procedures manual to utilize in the training process and employees should be included in its development. The job descriptions and job specifications are a part of the document. The job descriptions and job specifications are a part of the document. Good policies will enable the pharmacy organization to act promptly on frequently reoccurring problems based upon care considerations. This avoids "snap judgments" when the employee's mind is clouded by other pressing matters or under the pressure of the occasion. Good policies allow the employee to act with confidence without the feeling s of embarrassment. This makes the employee feel more secure and more useful. Good policies assure near uniformity of actions of all employees. Management is relieved of trivial decisions and can devote its time to more important matters.

In the training process it is important to encourage employees to give their undivided attention to patients rather than visiting with other employees. Non-selling activities should not (?) take priority over attending to patient needs. From the patient's prospective the employee is the overhead and the patient is the profit. The patient expects and demands top priority. Remember the pyramid. Patients are at the top of the pyramid; employees in the middle.

In training employees explain why something will not work if you have already tried it. Don't just say it won't work. Rotate employees through jobs to prevent burnout and to make sure all areas can be covered in case of sickness or during vacation time.

POINT SEVEN: Institute Leadership

Leadership is the job of management. It is the responsibility of management to discover the barriers that prevent employees from taking pride in what they do. The employees know exactly what these barriers are: an emphasis on numbers, not quality (turning out 200 prescriptions a day); turning out the product quickly rather than properly; a deaf ear to suggestions; too much delegation of menial duties rather than expanding the employees role in the important activities of the pharmacy.

The job of the manager is to lead, to help employees do their jobs better. In hiring people, management takes responsibility for their success or failure. Dr. Deming contends that most people who do not do well on the job are not maligerers, but have simply been misplaced. There is no excuse to offer, Dr. Deming says, for putting people on a job that they do not know how to do. Most so called "goofing off" - somebody seems to be lazy, doesn't seem to car - that person is almost always in the wrong job, or has very poor leadership.

It is the managers responsibility to lead, to find ways to enable employees to perform their duties better and better. Management is responsible for the success or failure of the employees it hires.

Characteristics and responsibilities of an effective employees include the following:

It is doubtful that anyone will argue with the merits of the previous list of effective leadership traits and actions. In fact, it seems a bit ridiculous to have to state the obvious. However, supervise employees, review the list frequently and evaluate yourself as to how many of the characteristics you possess.

It is the manager's responsibility to create a more positive organizational climate for the employees. Some suggestions include the following:

Some further suggestions from attendees of the National Association of Retail Druggist's Pharmacy Ownership Training program include:

The successful manager does not perform every technical operation of work. Instead, he or she must induce others to perform that work in a manner that is consistent with the goals of the pharmacy. The effective manager gains an understanding of why employees are willing to contribute their efforts and develops skill in obtaining cooperation from employees.

WORK PERSONALITIES

A number of theories exist concerning employee productivity. Basically, people act as they do because of needs and attempts to satisfy needs. These needs are related to the individual's work personality. For example, employees may be classified into one of the following work personalities:

1.	Ascendent employees
2.	Indifferent employees
3.	Ambivalent employees

 

The ascendent employee desires to be promoted to a managerial position, is loyal and easy to manage, gets along well with management and often does not get along with fellow workers.

The indifferent employee desires to be socially accepted by fellow workers, has a low achievement need, views the job simply as a means for income, often does not get along well with management, and often exhibits tardiness or absence from work.

The ambivalent employee desires to be promoted but often is not willing to put forth the effort required, has an inflated ego and overestimates worth, and is hypercritical of other workers.

Each of these employees can be motivated by different techniques and rewards. The techniques are influenced by the style of management and the types of rewards offered.

Characteristics of the Theory X Management Style

1.	The average human being has and inherent dislike of work and will avoid it if possible.
2.	Because of this human characteristic of dislike of work most people must be coerced, controlled, directed and threatened with punishment to get them to put forth adequate effort toward the achievement of organizational objectives.
3.	The average human being prefers to be closely directed, wished to avoid responsibility has relatively little ambition, wants security above all.

Characteristics of the Theory Y Management Style

1.	The expenditure of physical and mental effort in work is as natural as play or rest. The average human being does not inherently dislike work
2.	People will exercise self-direction and self-control in the service of objectives is a function of the rewards associated with their achievement
3.	Commitment to objectives is a function of the rewards associated with their achievement
4.	The average human being learns under proper conditions not only to accept by to seek responsibility

A Theory X manager primarily will utilize salary and the threat of punishment to motivate employees. A Theory Y manager will more readily recognize the importance of titles, promotion, and other types of intrinsic rewards. The Ascent employee is much more responsive to the Theory Y management style since esteem rewards (titles and promotion) are paramount. The Ambivalent employee responds to a combination of the two styles since both esteem and security rewards are important.

POINT EIGHT: Drive out Fear in Organizations

Most people on a job, says Dr. Deming, especially people in management positions, do not understand what the job is, nor what is right or wrong. Moreover, it is not clear to them how to find out. Many of them are afraid to ask questions or to take a position. The economic loss from fear is appalling.

People are afraid to point out problems for fear they will start an argument, or worse, be blamed for the problem. In the perception of most employees, preserving the status quo is the only safe course.

It is necessary, Dr. Deming says, for better quality and productivity, that people feel secure. He notes that "se" comes from Latin, meaning "without fear"; "cure" means "fear" or "care." Secure means without fear - not afraid to express ideas, not afraid to ask questions. Employees should not be afraid to ask for additional instructions, or to call attention to conditions that interfere with quality. Fear, says Dr. Deming, will disappear as management improves, and as employees develop confidence in management.

Drive out fear by letting employees know you can take criticism. Admit it if you are wrong. Keep lines of communication open. Let your employees know that you want them to ask if they do not understand. Encourage them to constantly suggest ways to improve on current procedures and processes. Instead of following the principle of, "If it ain't broke don't fix it," follow the principle of, "If it ain't perfect, make it better."

POINT NINE: Break down Between Staff Areas

Probably every organization and company in America can tell stories to illustrate what happens when departments have different goals and do not work as a team to solve problems, set policies, or map out new directions. Historically in the pharmaceutical industry the Research and Development Department would develop a product and then run it over to the Sales and Marketing Department and say, "Sell it." Often times, to management's dismay, there was wither no market for the product or the sales people were not overly enamored with the new entity.

People forces to administer policies that they had no hand in drafting and with which they may disagree do so half-heartedly and without uniformity, angering patients. People can work superbly in their respective departments, Dr. Deming says, but if their goals conflict, they can ruin the company. It is better to have teamwork, working for the company.

Dr. Deming says, Is it management's job to help employees work together. To promote teamwork?" Sounds great, but according to Dr. Deming, it can't be dome under the present systems. In spite of the system, you will find teamwork. But when it comes to a showdown under the present system and someone has to make a decision; his or her own rating or the company's - he or she will decide for himself/herself. Can you blame them? People work in the system. Management creates the system and management is responsible for the working environment

POINT TEN: Eliminate Slogans, Exhortations, and Targets for the Workforce

Slogans, Dr. Deming says repeatedly, never helped anybody do a good job. They "generate frustration and resentment. "l The slogan of Zero defects"- Do it right the first time - has a lofty ring but management fails to provide the means to the ends it proclaims. Implicit in such sloganeering is the supposition that employees cold, with they tried to do better. They are offended, not inspired by this suggestion. Forced to work with improper or malfunctioning equipment in inadequate surroundings under impatient supervision, they percent slogans and exhortations as signals that management not only doesn't understand their problems it doesn't care enough to find out.

Dr. Deming places numerical goals in the same category. A goal without a method for reaching it is useless, he says repeatedly. But setting goals without describing how they are going to be accomplished is a common practice among American managers.
Moreover, Dr. Deming adds, it is totally impossible for anybody or for any group to perform outside a stable system, below or above it. If a system is unstable, anything can happen. Management's job as we have seen is to try and stabilize systems. An unstable system is a bad work against management.

Dr. Deming says "You can beat horses; they run faster for a while. Goals are like hay somebody ties inform of the horse's snout. The horse is smart enough to discover no matter whether he canters or gallops, trots or walks, or stands still. He can't catch up with the hay. Might as well stand still. Why argue about it? It will not happen except by change of the system. That's management's job not the employees.

POINT ELEVEN: Eliminate Numerical Quotas

Quotas or other work standards such as "measured day or "rates," Dr. Deming maintains, impede quality performance than any other single working condition. I have yet to get a work standard that includes any trace of a system which would hold anyone do a better job, he says. Indeed work standards are generally used; they guarantee inefficiency and high cost.

Consider a quota that is set to the average output of a group of workers. Half will be above it and half below. Peer pressure, noticed Dr. Deming, holds the upper half to the average create, while those below cannot make the average rate. The result is loss, chaos dissatisfaction, and turnover. Sometimes, Dr. Deming notes, management will propose set a work standard on the high side to weed out people who can't make it. When rates are set for the achievement the demoralization is even more intense. Moreover, he contends once workers have completed their quotas for the day they quit working and linger around till the end of the day.

The same is true for numerical goals assigned to management. All too often, a company will announce such goals out of the blue with no plan. Increase sales by ten percent or the increase productivity by three percent are examples of non-sensible goals. If they can do it next year with no plan, why didn't they do it last year?

A system that fosters an atmosphere of receptivity and recognition is far preferable to one that measures people by the number thy turn out. Moreover, Dr. Deming adds, the quality will snowball fro that stage onward. Rather than assigning quotas to a hob Dr. Deming suggests studying the work and defining the limits of the job.

POINT TWELVE: Remove Barriers to Pride in Workmanship
Employees understand very well that as quality improves, so too does productivity. They understand very well that their jobs more than those of management, depend on the acceptance to their product or service on the market place. Yet they are powerless to change things. Often managers are shocked when they hear what is wrong.

Under Dr. Deming's questioning, employees reveal that they never really learn to their job. They were trained, perhaps by another employee, or told to read the instructions. Employees complain about managers whose only interest is in getting the work out, not the quality of the work.
Dr. Deming has observed that managers work long hours and willing cope with many vexing situations by shy away from the problems of the people who work for them. Managers need to give as much respect to their people as they do to their other resources.

Talk about motivation. People are motivated. All people are motivated. Everyone? No, there are exceptions. Some are beaten down so often, sometimes, that they have lost, temperately at least interest in the job.

Focus on quality work; Let employees know what is expected of them; and provide constructive feedback whenever it is available. Incorporate the quality standards into job performance organization programs. This is difficult to do when relying on soft or subjective data. How do I measure an employee's performance in satisfying a patent? The old way was less subjective. We utilized sales data to measure productivity. Management may evaluate pharmacists on their clarity and completeness in providing patient counseling. It may evaluate the effectiveness, efficiency, and appropriateness of the information provided as well as how courteous the employee was in delivering the information.

The integration of quality criteria into the pharmacy's organizational culture involves the establishment of the process performance benchmarks. These benchmarks are based on the mutual agreement of the employees and manager. Thus, expectations of performance are understood and disappointment are minimizes. The result of this is the development of long-term partnerships with a pharmacy and its employees because job satisfaction is increased

POINT THIRTEEN: Institute a Vigorous Program of Education and Retraining

This concept is essential for the survival of the pharmacy. It is not enough to have good people in your organization. They must be continually acquiring the new knowledge and the new skills that are required to deal with the rapidly changing health care market place. Education and retraining - an investment in people- are required for long-term planning. The education must fit people into new jobs and responsibilities.

Training and development consists of explaining the knowledge and skills of employees through an organized process by which they learn the skills, abilities, and attitudes needed to perform their work. While on-the-job training is commonly used from of employee training, it should be supplemented with more structured programs to limit employee obsolescence due to technological, cultural or social changes.

Some formal development programs - such as continuing education - are becoming mandatory for pharmacists and other health professionals. Certification programs, such as those developed for prosthesis fitters, are well recognized and available, and technician training programs are becoming more widespread. It is important, however, not to overlook non-technical personnel such as salespeople and clerks when evaluating your pharmacy's training and development needs. Courses and seminar exist which can make these employees more effective and efficient communicators and salespersons.

Pharmacy and business-related associations provide a number of training and development opportunities for pharmacy employees. In addition to the large number of live programs and external seminars, associations, have an extensive list of written materials and audio or video tapes which can provide educational experiences.

Participation in association work at the local, state, and national level is another growth experience for pharmacists. Committee work, attendance meetings, and communication with other pharmacists provide valuable experience and information to professional personnel and should be encouraged.

Conduct formal and informal training with changing goals. The collecting of patient histories, patient counseling provisions and documentation under the OBRA '90 regulations necessitates the institution of a vigorous program of education for pharmacists as well as other employees.

POINT FOURTEEN: Take Action to Accomplish the Transformation

Management will have to organize itself as a team to advance the thirteen other points. Every employee of the pharmacy, including the managers, should acquire a precise idea of how to improve quality continually. The initiative must come from management.

Given the fourteen point how do you move the pharmacy organization to Deming's objective of total quality management, and in so doing maximize personnel efficiency? Continue the self education process. Read a few books on the subject to gain a broader prospective and allow your ideas and opinions to gel. The magnitude of understanding the concepts, principles, and tool s of total quality management is not yet understood or appreciated by the American business community at large.

Coordinate with your training people. Regardless of the size of the pharmacy organization training constitutes a large component of the total quality management process. Recognize that quality systems are not necessarily transportable from one pharmacy to another. While we can benefit from hearing and learning what has worked for other pharmacy managers we must evaluate and test those ideas in our pharmacy. Something that works for someone else may not work for us.

Realize that total quality management improves the job you are presently doing and finally, communicate. If you proceed you must communicate with your people so they know what to expect and when. Communicate an emphasis on quality by paying attention to details.

Total quality management programs focus management's efforts on learning what the patient needs and constantly improving organizational processes to deliver it. These programs often require significant changes in the culture of organizations. Total quality management methods emphasize the role of leadership within organizations, the assessment of both internal and external patient relationships, and the inclusion of all staff in quality improvement activities. These methods focus on overall processes of caregiving rather than on individual employee performance. While individual competency of pharmacists remains an integral part of total quality management, the primary focus is placed on the improvement of outcomes via improvement of the delivery system itself. Total quality management methods may be applied to pharmacy operations to facilitate the improvement of both pharmacist performance and over all patient outcomes.

The Deming Model provides a means to maximize the effectiveness of the pharmacy's most valuable resource, its personnel. The Deming Model assumes that if you keep the employee satisfied, they will be more productive. It assumes that total quality management is measurable. It assumes that total quality management produces staff loyalty, thus developing a long-term partnership