“A large, freshly-paved parking lot has no boundaries. You can drive in any direction, free to speed to your destination.
But once there’s more than a few cars driving, traffic stops. It’s too risky, there are too many uncertainties. A car could come at you from any direction, and so we crawl.
Flow is far more efficient, and flow comes from well-placed guardrails and intelligently painted lines. Flow only happens when the guardrails are universally accepted, when we can find the confidence to drive just a bit faster than our eyes can see.
One opportunity to make progress presents itself when it’s possible to move a guardrail, to show the others a better route.
The other leap occurs when we realize that we’ve been imagining a guardrail, one that’s been causing us to detour when in fact it’s not actually there. We’re obeying invisible guardrails when it doesn’t benefit the others. Ignoring these self-erected guardrails permits us to contribute more than we thought possible.”
The above profound thoughts belong to Seth Godin, the well-known marketing guru.
The process of establishing “Guardrails” has potential for business planning, the design process for a pharmacy (the first step to creating a new pharmacy is the floor plan – which is full of guardrails controlling customer traffic flow).
There is also potential for external forces to impose guardrails through directing information flows and knowledge transfers – a process of manipulation that our mainstream media seems to have developed to a high degree in the form of manufactured (fake) news.
However, there are many positive applications where existing guardrails can be removed or placed in a different area of activity.
For example, pharmacy is always dealing with the medical profession and its front organisations as they seek to impose guardrails on pharmacist activity in an attempt to restrict any new initiative, or activity expansion, that pharmacists may wish to engage in.
By disrupting or causing pharmacists to detour through the imposition of a distorted guardrail or by propagandising a guardrail to make pharmacists believe it actually exists when it is really an illusion and doesn’t exist at all – will contribute to a lack of progress or a waste of effort in directing a flow, (which includes financial expenditure and human resource energy), simply to divert or suppress a pharmacy opportunity that might be thought to be competitive to another health profession.
Another example of guardrailing includes government policies that can cause business and professional disruption (Read Location Rules, Ownership Rules, PBS Price Transparency as example types).
But a more sinister and manipulative guardrail has been developed by the Internet Technology giant “Google”.
It is a system which channels all news and other “fact-type” articles through a fact-check filter which gives a tick of approval if the facts are correct as judged by the electronic arbiters of the system.
But who checks the checkers and what safeguards exist to eliminate bias within that system?
And it is certainly a system with potential for abuse by government and other controllers of media and corporate influence.
Mainstream media and government are already designated as prime fact references, so this cleverly designed system will suppress independent news media by having a “pop-up” box appear with a warning notice as to why people who access the site should not believe the information published within that site.
It is a system designed to limit freedom of speech through a form of censorship and thought influencing that has immediate attraction for the power elite around the world.
But back to pharmacy and some of its invisible (and therefore removable) guardrails, and identify the inertia within community pharmacy obviously suffering from this guard-railing.
* Guardrail #1 Clinical services:
There is no formal guardrail here, just a random but frequent “turf attack” by the medical profession that has created an invisible guardrail that has had the effect of slowing down the flow volume to a very slow-moving version.
More analysis by pharmacy managers and leaders and creating a new and efficient guardrail that generates an increasing flow in the right direction.
Once recognised by power groups, it provides a channel for them to be involved with for their own benefit.
Pharmacy leaders need to be more active in this type of activity.
* Guardrail #2 PBS dispensing:
There are some very obvious (but invisible) guardrails here as well.
i2P has been warning pharmacists for a long time now that this product had reached the end of its lifecycle.
No alternative appears to have been formulated by either side, hence the Stephen King review into pharmacy remuneration and other random issues such as location and ownership rules.
Why has there not be a push for pharmacy to be involved in other public/private partnerships that could integrate with the now commoditised discount product that few people respect? It has become devalued.
Public health and public/private partnerships create a need for evenly distributed geographic access points – a slightly modified version of the Location Rules that currently exist.
So pharmacy could lose a real opportunity if the rules disappeared.
This changes any PBS debate completely in a positive fashion and pharmacy management can strip pharmacists out of the dispensary to be involved in clinical primary health activity in a forward and accessible location within a pharmacy, as new streams of revenue open up.
On the other hand, community pharmacy ought to be able to provide administration of a public health activity cheaper than government can.
A potential “win-win” for both sides.
* Guardrail #3 Inhibiting Employees and Contractors.
Pharmacists themselves have put a guardrail around certain practice activities e.g. Community Pharmacy.
We have a number of other practice formats:
– Professional service pharmacists who can operate within non-pharmacy locations.
– Hospital pharmacist practice
– Academic/Research pharmacist practice
– Industry Representative practice pharmacists who may provide medical detailing services or educational services on a drug manufacturer’s behalf.
The problem with practice pharmacists is that they do not necessarily respect one another. Often, they are competitive for no reason.
Properly constructed guardrails could have guided the various practices to a more integrative and collaborative approach and extending this process to other variants of health practice e.g. GP’s, radiologists, naturopaths, osteopaths, occupational therapists as a few random variants.
While practice pharmacists are generally highly skilled, this has not been reflected in pay packets.
Solutions will involve altered pharmacist culture to reflect collaboration at multi-levels of practice such as Community Pharmacists seeking to expand public/private partnerships.
Clinical services pharmacists can also pursue public/private partnerships that fits their cultural practice but they first need to organise themselves into an identifiable group.
Not united means that they cannot effectively negotiate appropriate reimbursement for their services.
If they could also incorporate themselves into a branded form of infrastructure their visibility would become more distinct.
There is definitely a blocked guardrail between clinical service practice pharmacists and community pharmacy practice pharmacists.
If the appropriate guardrails are put in place you would see immediate collaboration creating patient engagement with new forms of energy manifesting itself in new and expanded professional services.
I cannot even begin to understand why these blocked guardrails ever existed – but they do.
Unblocking them is the responsibility of pharmacy managers and their industry representatives through altering culture and unblocking those guardrails, to facilitate growth in all of its manifestations.
As Seth Godin puts it so eloquently:
“Ignoring these self-erected guardrails permits us to contribute more than we thought possible.”