At the end of the chapter, the reader will be able to:
Contrast the business case for pharmacy quality with the economic and social cases.
Describe the needs and underlying assumptions associated with establishing a business case for pharmacy quality.
Use well-known conceptual models to advocate for how improving quality can be profitable.
Build a case for quality in pharmacy practice with financial and nonfinancial benefits.
List barriers to building a business case for quality in pharmacy practice.
Quality of care is a major issue in health care. The Institutes of Medicine stated that quality problems are everywhere resulting in large health care gaps that are better characterized as chasms.1 It has been strongly argued that for fundamental change to occur, health care providers need to make a compelling “business case” for quality.2
However, numerous obstacles have been identified to developing a business case for quality in the U.S. health care system3,4:
Payment for services within the current system is not linked to quality, while defective care is often rewarded.
Consumers are unable to perceive differences between different levels of health care quality.
The benefits of quality improvement (QI) are often seen in the distant future and do not accrue to the organizations that finance it.
Best practices in health care are often unknown, not accepted, or not feasible to clinicians in practice settings.
Changing provider behavior is difficult to do and the methods of behavior change are not well understood.
Quality measurement is still a primitive science in that many measures are not available, validated, reliable, or practical.
Health care does not have an adequate infrastructure to assess quality and act upon it.
There are legal barriers to doing what is necessary.
Fiscal concerns make investing in quality problematic.
This chapter explores the business case for quality in pharmacy practice. It will define what a business case is, and it will compare how a business case differs from nonbusiness cases. The chapter will also suggest strategies that pharmacists can use to build a business case for quality in pharmacy practice.
Before starting any discussion, it is important to define what is meant by a “business case.” A business case for a health care intervention exists whenever the intervention results in a real or estimated financial return within a reasonable time frame for an investing entity.3 A key component of this definition is the term financial return.
Financial returns are the profits or losses suffered in an expenditure of money, time, or effort. Profits result when the expenditures are less than the benefits received. Losses occur when the expenditures are greater than the benefits.
Financial returns can be real or estimated. Real financial returns are generated when an intervention generates measurable revenue or cost savings. Estimated financial returns are only anticipated. They result when an argument ...