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At the end of the chapter, the reader will be able to:


  1. Compare and contrast reengineering and incremental approaches to quality improvement implementation.

  2. Briefly describe several factors that help determine the selection of the best quality improvement strategy.

  3. Discuss potential barriers to change.

  4. Apply change concepts to the dispensing process to enhance quality.

  5. Briefly describe examples of models used to facilitate and maintain change and how they can be applied to pharmacy practice.


The overall objective of this book is to make the case for the use of quality improvement strategies in pharmacy settings and processes. At the core of any quality improvement implementation lies change. Thus, this chapter explores the challenges and opportunities of implementing organizational change to enhance quality. This chapter will discuss major types of change implementation (reengineering versus incremental techniques), resistance to change, and strategies for facilitating and maintaining change. Finally, the chapter will address how change can enhance the quality of pharmacy services.


Some of these concepts are examined in other chapters, so, to minimize redundancy, we provide truncated explanations of them.


Reengineering versus Incremental Changes


Changes aimed at improving the quality of any organizational process could be classified as belonging to two major groups: reengineering and incremental models. In general, reengineering suggests the complete overhaul of a process while incremental models are characterized by gradual change. Reengineering and incremental techniques [such as total quality management (TQM) and Six Sigma] have been explored widely in the business world and applied to health care relatively recently. Both concepts represent innovative business management models characterized by an “orientation toward change and creativity.”1 These models differ from more traditional business management techniques in that they allow organizations to better respond to health care's dynamic environment, characterized simultaneously by the pursuit of quality and the containment of costs. They “are more complex and more difficult to implement . . but have the potential for producing major improvements in quality, service and cost.”1


The concept of reengineering, one of the American business buzzwords of the 1990s, has been defined as “the fundamental rethinking and radical redesign of process to achieve dramatic improvements in critical, contemporary measure of performance, such as cost, quality, service, and speed.”2 Also known as business process reengineering (BPR), this model is cross-functional in nature and recommends the reorganization of staff by processes (e.g., reorganizing health care teams by disease state rather than functional departments). These process-based teams would be in charge of redesigning the structure of their process “from start to finish” rather than improving upon existing methods.1,3 BPR is a radical change process that requires upper management commitment and leadership.4


Though popular when first originated, reengineering has acquired a negative image because its implementation often focused on downsizing, at least in certain industries.3 The data on reengineering's use in the hospital setting ...

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