Organizations with set norms, procedures and standards function better than those without. Generally, larger organizations have such procedures documented and put in place, whereas, smaller organizations, especially family owned, or run single handedly, do not consider such possibilities. Community (retail) pharmacies are one such organization. Such organizations may serve different purposes but when the impact of activities is visible in the community or more importantly affects the quality of life of the community (like the community pharmacy), the activities need close monitoring to ensure quality assurance. Eg. in health care, any function can directly influence the patient's health and life, hence utmost care needs to be taken to ensure that these functions are standardized.
When there are guidelines laid down it can lead an organization on the path of implementation i.e. educate the concerned about what is standard. However, the implementation can be a success if a system exists that will check compliance to these standards.
In various organizations like industries, an audit system is in place that takes care of implementation and maintenance of standards, carried out by different parties that include customers, national bodies, and international bodies. The purpose of the audit is to check for compliance to standards inorder to ensure the quality of the final product. In others, a system for accreditation exists wherein guidelines are framed and simplified, organizations are asked to implement them and then by means of an assessment, the compliance to the laid down guidelines or standards is measured.
Accreditation concept
The concept of accreditation is based on the need to have a quality system in place that would help to upgrade the existing systems and the supporting processes/ activities within an organization with the aim of continuous improvement. A Quality System is a set of requirements i.e. standards which the organization/ institution have to comply with. This model is therefore 'standard-based'.
Accreditation is a voluntary process which means that an organization/ institution has to voluntarily seek to be assessed against set standards by external review.
This system works by:
● Voluntary enrolment
● Laying down standards
● Assessment by external review; checking for compliance
● Outcome denotes compliance (outcome in the form of ratings, points, grades etc.)
The guidelines for accreditation clarify the qualities required of a service to ensure the desired level of performance or results.
Accreditation system prevails in various fields. Eg., for colleges, the AICTE (All India Council for Technical Education) has set up the National Board of Accreditation (NBA) as a part of its programmes and activities, in September 1994, in order to assess the qualitative competence of educational institutions from the Diploma level to the Post-Graduate level in Engineering and Technology, Management, Pharmacy, Architecture, Town Planning and related disciplines.
Accreditation in pharmacies:
United Kingdom: In the U.K., there exists a system for Accreditation of Pharmacists. Pharmacies keep themselves upgraded because of the competition, and also because of pressures from the NHS (National Health System), which allows reimbursement to only those pharmacies which follow the laid down guidelines. Under the new reimbursement scheme, only those pharmacies which compulsorily do a certain number of medication reviews (500) per year are allowed reimbursement. This system demonstrates appropriate levels of skill and competence to fulfil the role described.
Australia: In Australia, the QCPP (Quality Care Pharmacy Programme) has been in existence since 1998, and lays down systematic guidelines for Accreditation systems for the Pharmacy. Currently, over 86% of Australian Community Pharmacies are accredited under the QCPP. All pharmacies that attain accreditation, and remain financial under the Program, are eligible to receive financial incentives which are administered by Medicare Australia. By increasing the number of accredited pharmacies in Australia, the QCPP is ensuring that Community Pharmacy provides a uniformed approach when delivering professional services and customer care.
Indian scene:
Pathological laboratories: Recently, NABL (National Accreditation Board for Testing and Calibration Laboratories), an accrediting body has been set up for accreditation of pathological laboratories. This step was taken after it was brought to notice that the tests carried out on the same individual produce different results in different laboratories. This could result in diagnosis or treatment related difficulties.
Hospitals: A system for accreditation of hospitals operates under the NABH (National Accreditation Board for Hospitals and Healthcare Providers). Over the last few years, since the Accreditation system was introduced for Hospitals, many hospitals (especially the large corporate hospitals) have got themselves accredited under the NABH. The going and logic for these Hospitals to get accredited is that the insurance companies are likely to allow reimbursement of hospitalization costs only from such hospitals. This is one of the primary reasons that such hospitals have got themselves accredited, and many more are in the pipeline. The other obvious reason is the competition from other hospitals and in the marketing and publicity campaign, an additional label "Accredited Hospitals" certainly adds value.
Pharmacies: In India, accreditation of pharmacies is still a novel concept in India.
This concept was brought into focus after initiation of an project of the IPA ( Indian Pharmaceutical Association), funded by W.H.O. India Country Office and the Drugs Controller General of India.
Under this project a pilot exercise was carried out for accreditation of pharmacies enrolling voluntarily in 2 different locations in the country in July - August 2007. The pilot exercise created a lot of positive vibes among pharmacists.
Through this project, it was realized that most pharmacies have the will to improve but lack of a supporting and backing system is one of the reasons for non compliance. The documents prepared and used during this pilot run were based on the foundation of Good Pharmacy Practice (GPP) and provided the pharmacies with the necessary guidelines in a much simplified version to aid implementation of GPP. The pharmacies that could work and sustain their enthusiasm and interest beyond the limitations of lack of time, staff shortage, lack of space in the pharmacy etc. did a wonderful job by implementing most of the criteria.
Accreditation as an educative tool:
Accreditation of pharmacies is a process whereby the routine activities, services, systems, and supporting processes within the pharmacy are critically assessed to ensure that pharmacies develop performance standards in accordance to GPP (Good Pharmacy Practice) guidelines. It is in the form of a rating system for pharmacies based on quality of systems and supporting processes within the pharmacy, which helps to self assess criteria and provides guidelines to meet or comply with GPP standards. In other words, the process of accreditation helps to achieve the best quality of activities, services, systems and supporting processes that remain constant over a long period of time, and draws tangible results.
Accreditation is a positive, educative tool to assist and support pharmacists. Accreditation also is a tangible means by which the profession can demonstrate its commitment to ensuring that health care services and products delivered to consumers are of reliable quality. It is an important part of the profession's responsibility to consumers and contributes to consumer confidence in the profession.
Why accreditation?
Presently pharmacy practice in India is facing a revolution of change that is moulding it into a more self-aware profession.
Pharmacists are beginning to realize what they are capable of and the extent to which they are under-utilized in health care compared to the status in other countries. Equally urgent is the need to address the concerns of pharmacies regarding the entry of chains in the country. This has been considered as a serious threat to the existing mom and pop pharmacies as retail chains offer discounts and lure clients. Retail pharmacies are then left with the option of utilizing strategies or means to improve services rendered to clients.
Taking into account the present status of pharmacy practice in India, and having understood that the pilot exercise has helped to upgrade pharmacies to an expected level of professionalism, we can conclude that this concept can prove to be revolutionary in pharmacy practice in India.
Professionals and professional organizations have been working towards recognition of pharmacy services and contribution of pharmacists in health care of the community. This concept can provide further impetus towards improvement of the health care provided by pharmacies, compliance to national standards, rendering of professional services to the community and in turn recognition of the role of a pharmacist.
Aims and objectives of accreditation of pharmacies:
● Raise standards of service given to the public by pharmacies/medical stores.
● Improve health outcomes.
● Improve the levels of customer satisfaction and achieve consistency
● Improve business efficiency and profitability
Advantages:
■ For the pharmacy proprietors:
● Confidence that the pharmacy is being run according to the best practice standards in all areas;
● Customer recognition of the quality of the services the pharmacy provides;
● Competitive advantage over non-accredited pharmacies;
● And a more profitable, better managed pharmacy.
■ For the pharmacy employees:
● Empowerment to set procedures for, and then continuously improve, the services provided to pharmacy customers;
● Knowledge of their role and duties, and limitations of their role;
● The capacity to continuously improve their performance against the Standards set.
■ For pharmacy customers:
● A high level of and more professional service;
● Assurance that pharmacy conforms to best practice standards;
● Confidence that mechanisms are in place to identify and eradicate problems;
● A pharmacy team more dedicated to meeting the health care needs.
Suggestions/proposals:
The concept of accreditation could be up scaled to apply to pharmacies in the country. This could serve various purposes:
● The purpose of implementation of GPP in pharmacies around the country will be served through the upscaling of the project since implementing standards means implementing GPP.
● The accredited pharmacies could display their accreditation grade on the main exterior board or practice leaflets, packing material. This will help clients to identify pharmacies that are accredited i.e. ethical and offering professionalism and better services.
● This will create awareness among the people about the concept of accreditation, concept of community pharmacy, role of a pharmacist in health care and the image of pharmacy as a health care profession.
A novel concept in India, that can stir a revolution of professional change across the country has already been initiated and thought over by professionals. It is time pharmacies accept this concept as a change bound to come, and take steps towards getting ready for the same.
A much-needed implementation of Good Pharmacy Practice is an expected outcome besides the improvement in services and health care rendered to clients. Accreditation being a quality assurance system will also check for maintenance of standards for continuity of improvement.
The pilot accreditation exercise conducted in India resulted in outcomes that could go a long way in improving the present status of pharmacy practice, if implemented on a large scale all over the country.
(The authors are with Indian Pharmaceutical Association - Community Pharmacy Division)