Transformational Change in Healthcare and Education

Transformational is the “buzz” word given to that segment of change required to eliminate medical errors and prevent iatrogenic disease from occurring. In September 2013, the Journal of Patient Safety reported that an estimated 400,000 patients die each year in the US due to preventable medical errors.
If that number of people were to die during an Ebola outbreak, that would generate panic at both government and population level. So we have a genuine and somewhat permanent epidemic within our own health systems.

Transformational translates to altering the style of payment for health services from a fee for service (current system which encourages volume patients but lower care quality) to a value based system that discourages volume and increases service quality as payments become directed towards health outcomes.

Transforming the health care system to provide safe, quality, patient-centered, accessible, and affordable care with the use of new technologies like EMR Electronic Medical Records will require a comprehensive rethinking of the roles of many health care professionals, principally pharmacists, nurses and doctors. To realize this vision, all health professional education must be fundamentally improved both before and after those professionals receive their practice licenses.

Health education generally is very expensive and with recent changes to Australian Government legislation, is set to become even more so at university level. In Pharmacy, there are wide gaps in education delivery with most of the learning centres based in capital cities. While attempts have been made to create online education it still remains expensive and not tailored to the target audience.

An effort must be made to develop courses that are physically accessible and inclusive, so that practical topics appear in courses and that content changes and evolves progressively in line with how much of a knowledge-offering converts to an outcome and thus a reimbursement by a patient or funding body.

Knowledge offerings in pharmacy must always have a duality about them. They cannot have an exclusive clinical content because the interface between pharmacist and patient requires the skills of management and marketing.
The skill of marketing, for instance, is very much required for patient education and mentoring and without that aspect a health program can collapse, because not enough consumers were communicated to at a level they could absorb and understand information provided.

Pharmacy education ought to be organized within regions. There are many regional boundaries already in existence that pharmacy educators could adopt e.g. the Division of General Practice boundaries, the hospital area health boundaries or even the boundaries originally defined as “Guild Zones”. Keeping the boundaries similar or identical to GP’s allows for collaboration in education between the two professions.

This has been one of the barriers to cheaper education for both professions in that there is doctor reluctance to attend non-doctor controlled events or even trust the quality of the delivered knowledge product, and thus not recognise it in any capacity. Health education needs to shift to a neutral form of ownership to eliminate the elitism that exists among some groups of health practitioners. Education provision has to be the lead activity to establish collaboration between health professionals.

Education collaboration will spawn health collaboration. This is a major paradigm shift but unless it happens, health education will become too expensive before and after receipt of practice licenses. Paying off a HECS debt is only one part of the equation. Maintaining a license is becoming too complex and too expensive as well.

No longer can this sort of division exist in health education. All health practitioners belong to the same broad category, simply delivering their service under a different culture depending on their specialty. It is disrespectful for the medical profession to practice discrimination that serves only to prop up a political and remunerative system. It is now too costly and unsustainable and we all end up paying for this extravagance.

Educational activities have always been adapted for the purpose of networking a free exchange of ideas and to build a range of business or social contacts It brings together pharmacists in all capacities – owners, employees, contractors, academic, student, intern, hospital and industrial. It should embrace all health professionals as well. And in that format it operates as a multicultural exchange.

Just as we are beginning to talk about “patient-centred homes” we need to think about pharmacist education with a similar connotation as an “educational-centred home” where a single designated regional precinct can nurture pharmacist education to a level of excellence, and do it affordably and economically. By developing education as a regional resource but directed on a national basis it would be possible to establish a knowledge exchange right down to the “grass-roots” of the profession.
Online courses can still flourish but they need face-to-face stimulation for direction.

Regional precincts embracing an education-centred home would logically include research projects that could be networked with universities or in collaboration with other precincts and other professions. A grass-roots stimulation is what our pharmacy profession requires to bring it to life and create a sense of direction for all governing bodies and educators (bottom up is always better than top down).

Logically, our PSA should be the leadership body coordinating transformational change for education and professional development. It’s not the first time the suggestion of regional precincts has been put forward, but has been deflected.
If transformational change is to occur for pharmacy we need our governing bodies to themselves transform into dynamic enterprises that genuinely excite its membership.
Otherwise we look forward to a collective depression and dissatisfaction.


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