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Letters to the Editor
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Standard operating procedures
Even the best of the best can have a bad day
From Mr J. M. Evans, FIQA
I read Peter Armstrong’s Broad
spectrum article on standard operating
procedures (PJ, 4 March, p262) with wry amusement. Naturally enough,
people do not much like having their wings clipped and it certainly ruffles
their feathers. The trouble is that I have been on the receiving end
of the 50mg that should have been 100mg. I know of people who have been
given other people’s medicines and concurrent doses of products
both containing paracetamol, and so on. Of course we have all had shed
loads of correct medicines over the years and so what am I complaining
about? Surely less than 1 per cent defective is OK, is it not? Or is
it?
In the years before cheap jet travel, the captain was king. His (and
it usually was his) word was law. They each enjoyed the professional
freedom to operate the aeroplane as they thought fit. Unfortunately when
a little lapse of concentration smears a couple of hundred people across
a mountainside, confidence in the process sags a little, in spite of
the millions of passenger-miles flown with barely a hiccup. Those unworldly
souls at NASA and Farnborough soon realised (from cockpit voice recorder
transcripts of the newly deceased) that a lack of standardisation of
process played a major part in accidents. In the present-day world of
professional aviation, everyone sings from the same hymn sheet, wherever
they were trained and there are far fewer accidents. Flying has, though,
lost that frisson of spontaneity.
How about the pharmaceutical industry? It packs pills in bottles on quite
a big scale and most of the time gets it right. Has the industry got
anything to teach the NHS?
Perhaps I am no judge of it, but if the practices in common and increasing
use in pharmaceutical manufacturing were to be applied to hospital or
community pharmacy, they would be in with some chance of making their
contribution to the Department of Health’s (quietly buried) year
2000 target of reducing medication errors by 40 per cent by 2005. Far
from cowering behind their machinery, slavishly plodding through the
SOPs (that brutal bosses and “bright young thing” assistants
have dreamt up in their ivory towers), workers in the pharmaceutical
industry write their own SOPs with a glad heart. They know that even
the “best of the best” can have a bad day, get interrupted
or be preoccupied. They can separate out the times when they need to
use judgement and times when following the process is the only safe path.
I have a lot of sympathy for Mr Armstrong, with his intellect impugned
by the faceless, mindless bureaucrats that impose daft ideas from management
gurus and academia. He is obviously a free spirit: the kind of man who,
with a head of steam, would go and tell my friends working in industry
in the UK and the US that they have a “staggering poverty of intellect”.
I would like to hold his coat while they explain their point of view.
John Evans
Principal, HEB Ltd
We can think for ourselves, and we will
From Mr C. Morris, MRPharmS
I would like to express my surprise on reading Peter Armstrong’s
Broad spectrum article on standard operating procedures (PJ, 4 March,
p262) — surprise, because I thought that I was the only one to
think that they were idiotic and useless.
I have worked in many shops where the staff are taught “always
ask for the address”. But have they been told why? I have seen
people interrogate their next-door neighbours as to their address.
I agree with rules and frameworks for doing things but what is wrong
with telling people: “You check the address to make sure you have
the right person. If you went to school with that person and you know
them well you might not need to get address verification.”
SOPs belong to the same mindless rule set: do this this way. Do not deviate,
do not think. Above all do not demonstrate initiative or professional
judgement. One company I work for has an SOP stating that pharmacists
now are considered responsible for all prescriptions that go out on their
shift, regardless of whether they dispensed or checked it. All pharmacists
must check all prescriptions from scratch as they are handed out. Now
if that company wanted an extra check then put it that way but what they
have said is “you are risking your certificate and job; do it this
way”.
It is my certificate. I am a professional. Should I not have a say in
how I do or do not risk it (within reason)?
But, of course, “within reason” is the problem. There is
no reason when it comes to illogical management decisions. As Mr Armstrong
puts it they are the “brainchildren of management gurus cloistered
on the other side of the Atlantic” and they have been lapped up
by the management in the head offices of the companies over here.
Yet again common sense loses out to SOPs, corporate identity, and retail
mission statements; the list goes on and on. Can we do anything about
it? Probably not, until we are prepared to unite and say “we are
professionals, we can think for ourselves and we will”.
Remember, all it takes for stupidity to flourish is for intelligent people
to say nothing.
Chris Morris
Newquay, Cornwall
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The
Pharmaceutical Journal