The Pharmaceutical Journal
Vol 273 No 7322 p617
23 October 2004

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Clinical governance: how pharmacies in a local area can be compared

The 2004 British Pharmaceutical Conference and Exhibition “Medicines: from cell to society” took place at Manchester International Convention Centre from 27–29 September

BPC 2004 summary

Imagine “plotting” activities in the pharmacy on a grid which reveals the areas where there is room for improvement and also shows how well the pharmacy is doing compared with other pharmacies in the area. That is exactly what community pharmacists in Wales, who have become involved in a clinical governance pilot, have been doing, and they are learning from a model that was developed for general practices and their teams.

Glyn Elwyn, professor of primary care at the University of Wales, Swansea, speaking at a session entitled “Clinical governance: the Welsh model”, described how the MaturityMatrix model works for general practice.

Professor Elwyn explained that when organisations are invited to assess their successes and failures, there is a natural tendency to tell the questioner what the members of the organisation believe the questioner wants to hear. This is inevitable if, for example, a practice is invited to fill in a questionnaire. The MaturityMatrix is designed to avoid this by using a facilitator and making sure the practice team works together. Members are asked to reach a consensus of how developed they think their organisation is in certain specified areas, he explained. This way the team is given a focus of what they are doing currently and where they go next.

First step

Professor Elwyn said that the first step in the process is for an external facilitator to convene a meeting that as many members of staff as possible can attend. At the beginning of that meeting individuals are asked to think about their current processes in designated areas of activity and to say how well they are performing those activities. The group then discusses those individual assessments and this process often reveals that some team members think that certain activities are being done better than other team members believe.

An autocratic GP, for example, might believe that clinical records are kept well and efficiently and that there is little room for improvement, although the receptionists and practice managers know that there are significant problems.

The facilitator ensures that all voices are heard and that the practice jointly accepts what they are actually doing and achieving rather than what they hope. The results of the discussion are then plotted on the MaturityMatrix and this enables the team to benchmark their current performance and to decide which areas need their collective attention. The system also enables a particular practice to compare its performance with other practices in the area (an anonymous process) — another measure of how well they are doing and also an indication of what more they could be doing.

One of the benefits of using the MaturityMatrix is that the benchmarking is visually represented so it is easy for participants to understand the practice’s position and to see how well they are performing against others.

Paul Gimson, pharmacy and medicines manager, Caerphilly Local Health Board, then explained how pharmacies and local health boards could benefit from a similar system. Using eight areas of activity, as opposed to 11, defined for general practice, a pharmacy MaturityMatrix has been developed that measures current pharmacy activity, analyses those measurements and shows the areas that could be improved and what the priorities should be.

One of the main benefits, Mr Gimson explained, is that the process allows a reflective look at a pharmacist’s practice. But more than that, using the MaturityMatrix can show that “there is a good alternative health service out there and we can prove it”.

In the MaturityMatrix Pharmacy, the following eight areas are covered: clinical records; audit of performance; pharmacy information access; risk management; practice operational procedures; training and continuing professional development; sharing information with patients; and user feedback systems.

These eight columns are the “pillars” of clinical governance, Mr Gimson explained, and the top horizontal levels represent the minimum standards that pharmacies must reach. In the pillar for clinical records (see Panel) the minimum standard is the keeping of legal records for medicines. The bottom level on the matrix is the gold standard for each activity. Each pharmacy, by measuring and analysing various activities, can plot where it is in the matrix. In some pillars they will be further developed than in others, and some of the more developed areas cannot be reached by pharmacy alone but require the input of the local health board and, in some cases, the Welsh Assembly.

Andy Morris, community pharmacy facilitator, Merthyr Tydfil Local Health Board, the final speaker at the session, then went on to explain how the MaturityMatrix has been used in a pilot and how it has been received by pharmacists and their staff.

The pilot involved five pharmacies in Merthyr Tidfyl and six in Bridgend. Pharmacists volunteered to take part and they were picked as representatives of all pharmacies: large and small, independents and multiples. Two facilitators were involved (one a pharmacist, one not) and each session took between 45 and 50 minutes.

The contracted hours that each pharmacy provides and the contribution made by staff differs in pharmacy compared with general practice. This made it difficult to fit in the process during the working day and in some cases the whole team could not be involved in the process.

Useful process

In the small sample of pharmacies involved, seven out of the 11 provided feedback. Of these 86 per cent found it a useful process, 71 per cent were happy to compare their findings with those of other pharmacies, Dr Morris said. However, it was thought that the facilitated session was best undertaken when pharmacy cover was available, after hours or in protected time.

During general discussion at the end of the session, it was pointed out that the matrix will show where funding is required and will be the driver for long-term investment. It was also made clear that using the MaturityMatrix is a measure of process and not outcome. Moreover, it has given the opportunity for teams of people to work together, to feed into common objectives — in some cases for the first time.

Further details about MaturityMatrix Pharmacy are available feom CAPRICORN (tel 029 2031 6267, e-mail matrix@extra-ibs.com).