Beyond the numbers: The heart of pharmacy

Alex sat in the office, the lights above him shining brightly down on the performance report stretched across his desk. The numbers were stark—all of them below company benchmarks. The subtext was clear: look out for the numbers. He remembered countless hours of counselling patients, making sure they knew what their medications were and how to take them. But now the focus had shifted to quantity, not quality.“Your med review numbers are below target.”It’s become a cliché that reverberates through the hallways of our practices, together with a subtle but nonetheless strongly implied pressure to up the number of billable services we provide. It’s a sentence that can make our hearts drop, not because we’re afraid of hard work, but because we’re likely to feel that the whole essence of our profession is being boiled down to digits on a spreadsheet.The wake-up callOne evening as Alex was preparing to close the pharmacy Mrs. Thompson, an elderly patient, came in looking very upset. “I’m confused,” she said, raising a bag of medications. “These pills are different from my normal pills.” Looking carefully, he found a dispensing error that could have caused serious harm. It was a wake-up call for Alex. The persistent and oppressive influence of quotas had almost led to harm for his patients. This pursuit of numbers had hampered not only his well-being but also the quality service being given to patients.Wider implicationsAlex’s experience is not unique. Research indicates that pharmacists who are working under strenuous quotas that cover things like medication reviews and immunizations tend to report having insufficent time to provide a proper service. In fact, this strenuous work environment raises the chances of errors. Pharmacists must operate rapidly without pause in order to be thorough; such adverse conditions only aggravate an already difficult situation.“Patients don’t care how much you know until they know how much you care.” This adapted proverb is a clear reminder that quality of connection holds more value than the quantity of services. When the scales dip too far towards volume over value, it erodes our system of care, affecting not only our profession, but our patients. The quota concept also undermines the values of trust, morale and ethical integrity. Our first responsibility is to our patients, to ensure that they get the best care, free from arbitrary targets.Reframing pharmacy success with patient-centric KPIsIf we really want to put our money where our mouth is regarding our mission, maybe it’s time to start implementing a few patient-centric key performance indicators (KPIs) that measure the quality of the care we provide.What if our performance was graded on:Rate of medication adherencePatient satisfaction ratingsHealth outcomesInterprofessional practice.Moving forward togetherIt’s easy to get lost in the numbers, but remember that every figure has a face. While we may feel pressure to hit certain performance numbers, we must not forget our mission. We should advocate for a system that prioritizes quality over quantity; one in which patient wellness is the ultimate benchmark of success.Niki Shah is a passionate and dedicated pharmacist with extensive experience as a pharmacy owner in Ontario.