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

  1. Contrast linear thinking with systems thinking.

  2. Identify three ways that quality problems are typically recognized in pharmacy practice and their implications for solving them.

  3. Discuss why improperly framing a quality problem will result in a poor solution.

  4. Delineate the elements of a good problem statement for a quality problem.

This chapter discusses how pharmacists identify problems with “quality” in pharmacy practice settings and how they go about approaching these problems. Specifically, it deals with recognizing and defining quality problems and addresses how pharmacists can improve the process of effective problem recognition and definition.

Quality improvement (QI) in pharmacy practice encompasses a sequence of actions taken by pharmacists to solve complex problems. The effectiveness of QI depends a great deal on the process employed. The process of QI begins with the way a problem is approached.

There are three broad approaches to dealing with quality problems: not dealing with them, tackling them using a linear approach to problem solving, and addressing them using a systems approach. These three approaches will be described in the following sections.

Not Addressing Quality Problems

The first broad approach is to not address a problem at all by avoiding the problem, denying the problem exists, judging the problem to be unimportant, rejecting responsibility for the problem, or putting the problem off through procrastination. In many cases, not dealing with a problem is the right thing to do, such as when problems are likely to resolve themselves or when they are not worth the effort of addressing. However, there are many problems that should be addressed, such as problems that have the potential to result in patient harm. This section focuses on quality problems in pharmacy practice that should be dealt with but are not for various reasons.


Pharmacists might avoid quality problems in pharmacy practice because problems appear to be so overwhelming and unsolvable that it is not clear where to start. Indeed, many quality issues are entrenched within the system, making efforts to solve them appear futile. Nevertheless, that does not make it acceptable for pharmacists to reject their professional obligation to take action. Pharmacists may also avoid quality problems because they do not have confidence in solving the problems, especially if they have not had training in QI techniques.


Some problems are not attended to because pharmacists deny that they exist (e.g., “We don't have a drug interaction problem because we have a computerized notification system in place”). In other instances, the severity of a problem is minimized (e.g., “We do miss some drug interactions but only those that are not clinically significant”). These are poor excuses unless they can be backed up by credible evidence. Indeed, if the statements can be backed up by ...

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