What's the most important variable you need to know about as pharmacy leaders?

In March of 2010 I attended a meeting where I was introduced to the concept of the Appointment-Based Model of pharmacy. A key component of this concept was using synchronized refills to be able to drive the appointments with patients. My imagination was captured! It took some time, but we were able to develop and deploy the synchronization engine to many pharmacies.

The thing is not every pharmacy ran with the opportunity. To my dismay, I even had a pharmacist tell me that it should not be our responsibility to make sure patients are taking their medications. While I could not disagree more with this pharmacist’s philosophy, there is an important principle for us to consider as leaders.

I first learned this principle, quite accidentally, from an offhand comment one of my colleagues made as we were discussing synchronization. The comment was quite matter of fact. “Refill sync works because it uses Deming’s Principles,” my colleague Sam told me.

Between you and me, I had never heard of “Deming’s Principles” before. But I am so glad that I did. We could probably do a whole series on Deming’s Principles at some time, but for today, I want to focus on just one principle that has come up in my conversations repeatedly these past few days. 

The variable is always the input, never the output.

This principle is so simple, yet so true. And I have seen far too many people be confused because they do not know, understand, or honour this principle.

Let me illustrate this principle. If you were in the kitchen and you mixed up flour, yeast, water, and salt, then put it in a pan and placed it in the oven, we would not be surprised if a loaf of bread came out of the oven in a little while. But what if we were in the kitchen and took that same pan but instead put some toothpaste, a shoelace, and a baseball in it? We could put that pan in the oven for a long time and a loaf of bread would NEVER come out. Why? Because we didn’t use the right ingredients. The input always determines the output. When we put the right things in, we get the right things out.

I have heard a tale of a pharmacy that was using automated cells to dispense popular drugs many years ago. One cell was to dispense HCTZ 25MG tablets. However, when the cell was last refilled, it was filled with loratadine 10MG tablets. And you know what? Every time the dispensing system called for HCTZ 25MG, the system produced the wrong product – loratadine 10MG! Because we had the incorrect inputs, the pharmacy received the incorrect outputs. 

The variable is always the input!

I encourage you to take some time to consider this principle as I believe you will find it not only to be true, but also very helpful when we consider some of the leadership challenges we all face.

When we face results that we did not want or don't like, it can be very easy to become angry and frustrated. As we seek to lead our teams well, we would be well served to take a good look at the inputs of whatever caused the error. When we do this, we can make practical, impactful corrections that will benefit the entire team. It will help us lead well. After all, everyone deserves to be led well.

Until next time –

Jesse McCullough, PharmD

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