The Pharmaceutical Journal
Vol 268 No 7200 p778
1 June 2002

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Happy continuous New Year!

By Prashant Sanghani

It is traditional to make resolutions at the beginning of the year, but all too often these New Year's resolutions are broken quickly. This may be because many resolutions, although well meant, are simply unrealistic, for example, "I will take up regular exercise" or "I will stop eating chocolate". In this article I present some resolutions that have been created long after the effects of New Year excess have worn off. My June resolutions merely require adoption of a few substitute words — this should make them easier to keep.

Resolution 1: I will stop using the word change and adopt the word develop An immediate advantage of this change, sorry, development, is that we can archive all the text of change management theory. So, out goes the idea of unfreeze-change-refreeze, moving from one old, but stable platform to another. This is a good move because, let's face it, when was the last time your life or work was stable enough for long enough to plan change? Certainly the National Health Service has moved on continually and one idea, be it at the patient or policy level, has typically been followed by another and in such rapid succession that change, as the old saying goes, is constant.

Given that change is indeed ongoing and in many cases inevitable, for example, increasing patient autonomy, involvement and empowerment and NHS reform [sic], I would argue it makes more sense to plan continual development rather than change management. This approach is fairer to you, your staff, colleagues, patients and customers, all of whom, in the old change management process needed to be convinced, each time, of the need to change, the next agreed step and that the benefits of the upheaval will outweigh the costs of intervention.

Additionally, this old change concept can be cruel because it implies that what came before was not good enough, whereas often the most effective developments are just that: developments of the previous status. It is better perhaps to acknowledge what was and is still good in the previous system. Also, in fairness, we often make one change after another and on each occasion argue that the new state will be better and that everything will settle down after the move. However, the new state rarely solves all problems and so I believe that continual development is a fairer, perhaps more honest description of the way we all work.

One component that should be retained from the pile of change management books is the need to share a vision. With continual development, it is perhaps easier to accept that the vision is something that we continually strive for (via a cyclical process) rather than inaccurately implying that one or two (linear and isolated) changes will get us there.

Resolution 2: The "P" in my CPD will not only stand for "professional" but will also signify "personal" As I looked back at my portfolio, leafed through it and thought about all the courses I had been on, reading I had done, and conferences and symposia I had attended, I saw a problem. I could not really explain why I had been on some of them. I certainly could not explain why I had read half the articles. So I took another look at the continuing professional development cycle and identified and concentrated on my weakest segment: evaluation. This, I have decided, is perhaps the most important and commonly ignored aspect of my CPD; analysing the impact of these activities and reflecting on what has happened.

In trying to think about what areas I had already identified for my further development, I found that my personal documentation in this area was pretty sparse. Surely, I had not performed brilliantly all year long? There must have been at least one patient who I could have done more for — in fact, there were several. There must have been at least one colleague with whom I could have cultivated a better relationship — in fact, there were several. There must have been at least one management decision that could have been improved — in fact, there were several.

Then I came across a significant event record that I had completed over a year ago. Great, I had embraced reflection. As I re-read the event, I smiled at my superficial response to it. I admit that I could not even relate any of my subsequent CPD activities to this significant event. So much for reflection. Then again, on the brighter side, I clearly had developed — I was criticising myself, criticising my thoughts and my actions from last year. This it seems to me is the value of reflection: a self-analysis made after enough time has passed to allow a fresher view of past performance. Now, I just need to link this to my future development . . .

Resolution 3: I will adopt the philosophy that patients are no longer discharged, but are transferred When it comes to the long standing matter of cross-interface working, why is it that when patients are moved from secondary to primary care they are said to be discharged, however, when patients are moved between hospitals, they are said to be transferred? This latter phrase suggests a greater sense of retained responsibility on the part of the transferring hospital, whereas the word discharged suggests a greater degree of shedding of responsibility. There is also the implication that hospitals work better with other hospitals than they do with the primary care sector.

Perhaps we ought to consider replacing the term "discharge planning" with "transfer planning". Would this make hospital pharmacists more inclined to engage in dialogue at the critical point when patients and their care are, rightly, transferred from hospital to primary care? Certainly, for the large number of patients suffering acute exacerbations of chronic conditions and, as a result, visiting hospital on a regular and frequent basis, the idea of being discharged is fanciful.

If patients' main concern is the quality of care they receive, not where they receive it, then we should follow suit. To assist this, perhaps we could arrange for named contacts between pharmacies in primary, secondary and tertiary care to be available as a routine part of the transfer process. This would indicate a clearer framework for implementing pharmaceutical care and be seen by other health care professionals as the pharmacy profession playing its valuable part in helping to co-ordinate services across the various interfaces. Thus, within the health care system we acknowledge that patient care itself is part of a continuous cycle and not just a series of discrete changes.

Happy continuous New Year!

Acknowledgement
Thanks to Andreas Bjørneby for talking circles with me.