How do you measure quality and value in your pharmacy?

I must start this column out with a disclaimer. It is my intent to “explain” a mathematical formula and I have half a notion that it may not go well. As a result, there is the distinct possibility to frustrate the mathematicians in the audience. That is in no way my intent. So, let me ask for a little bit of grace and that you will “go with me” as we begin to look at the relationship between quality and value.

What does quality look like in the pharmacy? And how do we lead our team to provide quality service to the patients that we serve? These are questions that I now find quite fascinating, however 15 years ago, I just assumed that I knew what it was. Full disclosure: I had no clue back then. Today, I am much further along. I am by no means going to say that I am there, but I am so very thankful that I am no longer where I was. 

It all started with wrestling with this question: What is quality in pharmacy?

When I first started out, I would have said that quality in pharmacy is getting the right medications to the right patient at the right time with the right instructions. Or something reasonably similar to that. After all, we had a station in the pharmacy for “quality assurance” to make sure these things happen. 

What I did not realize at that time was that quality is a relative term. It is a term of comparison. The right medication for the right person at the right time definition is fine, however, it is also the baseline for being in the pharmacy business. You show me a pharmacy that cannot get the right medication to the right patient at the right time, and I will show you a pharmacy that is not long to stay in business….

Quality is a term of comparison. Consider if you will a hamburger from McDonald's. Let me ask you – is this a quality hamburger? You likely already have a response, but the nuance consideration is “compared to what other hamburger?” Quality exists because we have variations in the marketplace. You can get a burger and any of hundreds of restaurants from coast to coast. Once we have the opportunity to compare them, we can begin to describe one as being of higher quality than the other.

What helped bring this concept into focus for me was a mathematical formula that described quality in this way.

Quality = Value/Cost

This is a very simple representation, but it has been so helpful for my understanding of quality. 

Understanding how mathematics work, we can use this formula to identify levers that allow us to impact quality. For example, if we were able to lower cost in the formula, and value remained the same, quality would increase. Similarly, if cost were fixed, and we were able to add more value to the equation, quality would increase. This is where you find many pharmacies offering “value-add” services. The intent is to differentiate themselves in the marketplace as having higher quality.

Now here is the monkey wrench. I have also seen this formula offered in a slightly different way:

Value = Quality/Cost

This is what I warned of at the top of the post. For those of us who like to derive the different mathematical formulas, I cannot get the two formulas I have shared to match up. Perhaps I am missing something, and I welcome remediation from anyone who can explain it to me (please message me on LinkedIn). 

Let me simply leave the thought here: there is a relationship between quality, cost and value. While cost is often a target to improve quality, there is a place and time where we can no longer do anything to reduce costs. To me, this suggests that our focus needs to be driven to providing value! 

This is where our leadership is valuable. 

Value means that we are better off after something than before. The hairdresser delivers value because your hair looks better on the way out than it did when you walked in. Value was provided. 

In the pharmacy, that is many times much more difficult to observe. How many conditions do we describe as “silent”? 

There are golden opportunities to provide value to our patients by leading them to improved health. By becoming intentional in delivering value, we can improve the quality of care that we provide.

We will continue down this path when we meet next time.

Until next time -

Jesse McCullough, PharmD

Connect with Jesse on LinkedIn