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Why a pharmacist feedback system is better than using simulated patients

The Which? report and the Daily Mail mystery shopping experience incommunity pharmacies has been widely discussed and the views that havebeen expressed towards the mystery shopper or “simulated patient”concept by some of the profession have been starkly hostile

by Joanna Aling

The Which? report and the Daily Mail mystery shopping experience in community pharmacies has been widely discussed and the views that have been expressed towards the mystery shopper or “simulated patient” concept by some of the profession have been starkly hostile (PJ, 8 November 2008, p535).

The Royal Pharmaceutical Society and the National Pharmacy Association perhaps misjudged the situation by rushing to publish details of their own simulated patient initiative. Having first appeared to be jumping on the mystery shopper bandwagon, they then needed to clarify their positions after an exchange of letters (PJ, 8 November 2008, p535, and 22 November 2008, p594).

Perhaps we have been unkind: they say their programme is older than of either Which? or the Daily Mail and is designed to support the profession rather than act against.

The Which? and Daily Mail reports had many flaws, perhaps the most glaringly obvious of these being the statistically insignificant results due to the tiny sample sizes and the slightly more subtle flaw that the main motivation behind both publications is to sell them to the public and this is often achieved through sensational headlines.

However, we must ask ourselves whether, if the sample sizes in the Which? or Daily Mail reports were increased to statistically significant levels, the results would be any different. To that the answer is a reluctant “no”.

It is unfortunately not an urban myth that checkout staff and the perfume counter assistants with no pharmacy experience or knowledge are drafted in to cover the pharmacy counter when there is no staff available, and I know of not one pharmacist who has closed a pharmacy because of poor quality staff. Perhaps the perception that they would find obtaining further employment problematic is too much of a risk.

So, are there benefits to a voluntary simulated patient scheme? Clearly Barry Shooter thinks there are (PJ, 15 November 2008, p561). Although I do see some benefits of a simulated patient scheme, such as for monitoring politeness and general customer service, I would not be as enthusiastic as Mr Shooter if this were to go beyond monitoring staff attitude and extend into the clinical arena.

This is because I believe that there is an alternative concept that is vastly superior and involves a framework that is already in place. Furthermore, it will require little or no funding to implement and uses the skills of real pharmacists.

It is routine for regular pharmacy staff to feedback to locum co-ordinators or employers about the quality of a locum and it is undeniable that this feedback is on the whole is beneficial when conducted objectively and professionally.

How about using a similar feedback mechanism for auditing the standards, working conditions and staff competency in a pharmacy — except that the person doing the auditing would be the pharmacist-in-charge? To ensure objectivity this pharmacist needs to be someone who does not have too frequent a working relationship with a particular pharmacy.

Therefore a relief pharmacist, or an area manager willing to dip a toe back into day-to-day dispensing, or even a locum pharmacist might be ideal.

The advantages of a pharmacist-in-charge feedback system over simulated patients are numerous (see Panel).

Benefits of pharmacist-in-charge feedback

  • A day, rather than minutes, spent in the pharmacy
  • Recognised professional with a code of ethics
  • Intimate knowledge of the pharmacy environment
  • Unparalleled training, education and work experience
  • Framework already largely in existence

A simulated patient captures less than five minutes of what happens in a pharmacy and samples only the response of usually one or two members of staff at the most.

However, a pharmacist-in-charge will spend a minimum of a few hours and more likely at least a full day working in the pharmacy, giving him or her an unparalleled opportunity to appreciate the whole pharmacy team and to understand the depth and general level of competence.

Simulated patients are usually lay people who have no background knowledge of how pharmacies operate and who have to be expensively trained briefly in the topic they will ask questions about. The inevitably brief training will mean that these simulated patients are unlikely to understand the science behind the questions they ask, let alone the answers, and therefore make judgements that they are unqualified to make.

Few mystery shopper systems progress beyond mere box ticking. A pharmacist-in-charge feedback system would involve pharmacists who have undergone a minimum of four years’ theoretical education at university and a preregistration training year in a pharmacy environment. Some will also have years of subsequent working experience. There is just no comparison.

Furthermore a pharmacist is a professional — a professional with a regulatory body and a code of ethics which maintain professional standards, a professional with an intimate knowledge of the inner workings of a pharmacy. Anybody can “act” professionally but not every vocation is a profession.

Finally — and this is certainly not a minor point — the structure for pharmacist-in-charge feedback is largely in place and does not require expensive implementation. It is relatively easy to devise a short, closed question survey form for the pharmacist-in-charge to fill in. This could even be structured into the locum payment system and would cost little to implement.

For a small pharmacy chain or independent business, the data could be used almost immediately by the owner, although in a larger organisation an administrator might be required to process the data into meaningful reports for the superintendent. Arguably, many pharmacists would be happy to fill in these brief reports for no additional charge if they know that by doing so they are likely to improve the quality and training of the staff they work with, which also means they are supported by competent staff if they return to work in the same pharmacy.

If the reports need to be more detailed and require more time to complete then half an hour’s worth of extra pay for the locum or relief pharmacist would, in my view, be cost-effective.

In terms of assessing how well the pharmacy team is responding to patients, simulated patient schemes are no comparison to objective pharmacist-in-charge feedback. Far better, if monitoring of the pharmacy environment is required, that this is done by people who know how a pharmacy should operate in the first place.

If pharmacist feedback is coupled with a non-blame culture and is accepted by superintendent pharmacists who are willing to listen then this should be by far the best mechanism for improving standards in our pharmacies.


Joanna Aling is a community pharmacist working in London

Citation: The Pharmaceutical Journal URI: 10041282

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