Lifting the Mask on Global Best Practices in Health Care Industry- Fact Sheet 1 15th May, 2018 By Ola Omolasoye MSc. MBA, FPCPharm.
May 16, 2018 • 23 Likes • 3 Comments
Attention:

JOHESU
NMA
FMoH
FMoLE
Presidency
General Public

Recent developments in the Nigerian Healthcare landscape characterized by polarized views among key players in the sector spurred me to delve into this research.

As you are aware, the Joint Health Sector Union (JOHESU) embarked on the ongoing industrial action to press home its demands bordering on allowances and welfare. When the strike began on 17th April, the Nigerian Medical Association, NMA, in an apparent continuation of the rivalry among health workers, urged the government to ignore JOHESU’s threat. Furthermore, members of the NMA raised counter-motions on majority of demands of JOHESU.

Circular arising afterwards from the Federal Ministry of Health suggested unwillingness of Government to agree to the terms of the striking workers and stated punitive measures as consequence for daring health workers including invoking the infamous “No Work , No Pay” law. This wreaking strike action has since been extended to the State and Local Government-run hospital which unfortunately are the remainder source of health services hope for indigent Nigerians.

So far, all groups consistently cite ‘Global Best Practice’ as basis for their demands/counter-demands. As a researcher I wonder why global practice means varying things to either party. Of course, if we want our health system to be at the best level, we should be adopting systems that worked successfully in other climes. However, to enjoy the best benefit we need to be selfless and unbiased in our discussions.

In this article I will be discussing what is obtainable in the developed world with particular focus on the USA, Canada, UK and Australia. For the avoidance of confusion and for the benefit of policy makers in the Federal Ministry of Health, Federal Ministry of Labour and Employment, Incomes, Salary and Wages Commission and other relevant institutions, the negotiating parties (JOHESU, NMA, etc.) and the general public (who are on the receiving end of this unfortunate quagmire). According to a 2017 report of The Economist Intelligence Unit on the Global Access to Healthcare Index; UK, Canada, Australia, USA all made top 10 on the Global Access to Healthcare Index. Nigeria ranked among the bottom 6 overall performers of the 60 countries listed on same global index, hence my choice of the 4 reference countries.


1. Consultancy Status for Non-Medical Doctor Health Professionals

Specialists and Consultants in various fields of health care including medical doctors are experienced, trained, awarded memberships/fellowships and recognized for their skill sets. These health care team members earn specialist/consultant pay when appointed to serve in such specialized area. During the current loggerhead one of the parties have suggested that the name “Consultant” is sacred and reserved for use of one group (perhaps citing international best practices).

Unfortunately many professionals in this part of the world are more concerned with holding titles for their ego. I have been in conversations were even medical officers feel discriminated by fellow medical doctors who are residents or consultants, if/when consultancy status gets approved for Non-Medical Doctor colleagues they must be ready to tackle ‘inside discrimination’. No committed healthcare team member should be treated like a clog in the wheel.


*Designation- Specialist

**Designation- Consultant
PHARMACISTS

According to American Society of Consultant Pharmacists (ASCP), 2015, a consultant pharmacist is a pharmacist who is paid to provide expert advice on the use of medications by individuals or within institutions, or on the provision of pharmacy services to institutions.

The phrase "consultant pharmacist," coined by George F. Archambault who is referred to as the "founding father" of consultant pharmacy, originated in the nursing home environment when a group of innovative pharmacists focused on improving the use of medications in these facilities.

Consultant Pharmacists are now practicing in a wide variety of other settings, including subacute care and assisted living facilities, psychiatric hospitals, hospice programs, and in home and community-based care -- wherever seniors reside. Consultant Pharmacists are defined by their common commitment to enhance the quality of care for all older persons through the appropriate use of medication and promotion of healthy aging.

In the US, a consultant pharmacist focuses on reviewing and managing the medication regimens of patients, particularly those in institutional settings such as nursing homes. This specialist pharmacist group are promoted/trained and supported by bodies including; American Society of Consultant Pharmacists (ASCP), Board Certified Geriatric Pharmacists (BCGP).

In the UK's National Health Service (NHS), the term consultant pharmacist refers to a pharmacist who has advanced roles in patient care, research and education in a specific medical speciality or expert area of practice. First introduced to the NHS ten years ago, consultant pharmacists are leaders of the profession in education, research and in the delivery of expert pharmaceutical practice (Malson, 2015).

The Australian Association of Consultant Pharmacy Pty Ltd (AACP) was established to develop a national approach to the practice of ‘consultant’ pharmacy as an expansion of the professional health role of pharmacy in Australia. The AACP is jointly owned by the Pharmaceutical Society of Australia (PSA) and The Pharmacy Guild of Australia (the Guild). (ACCP, 2015).

Barbara De Angelis presenting during the Canadian Pharmacist Conference in 2015 explained various career paths for pharmacists including paths leading to becoming consultant pharmacist in specialized areas e.g. clinical consultant pharmacist.

PHYSIOTHERAPIST

In 2000, the UK Department of Health announced that a new role, that of the consultant allied health professional, was to be developed and that there would be 240 such posts available nationwide by 2004. This followed on from the introduction of the nursing, midwifery and health visitor roles, which had been successfully implemented from 1999 onwards. The posts were created in order to provide better outcomes for patients by retaining clinical excellence within the service, and encouraging the development of innovative ways of working to enhance the patient journey and improve standards of care (Vits, 2010).


In Australia, further into their career, a physiotherapist may choose to specialise in a particular area which they are passionate about, such as sports injuries or aged care. To do so they will need to apply for membership with the Australian Physiotherapy Association (APA), which has a branch in every state and territory, and participate in professional development with their relevant APA national group (eg Sports Physiotherapy Australia). Individuals who have become experts in their particular field of physiotherapy are known as specialist physiotherapists (HealthTimes, 2017).

While not mandatory, many physical therapists opt to earn a certification from the American Physical Therapy Association (APTA). These certifications allow them to highlight their expertise in a specific area of the field, and help them stand out from other candidates when they’re looking for employment.


NURSES

Job description searches using famous Job listing sites in the US and Canada including Indeed.com and Glassdoor.ca revealed specialist roles for nurses were recognized and in high demand. Examples include: Nurse Consultant, Communicable Disease, Nurse Consultant Educator, Clinical Nurse Consultant and Legal Nurse Consultant.

In 1999, the serving Prime Minister Tony Blair (then Leader of the Labour Government) announced the introduction of the Nurse Consultant (NC) role in response to a lack of clinical career pathway for senior nurses and the consequent need to keep expertise at the bedside (Department of Health, 1999b).

Guest et al. (2001; 2004) showed a Nurse Consultant operates at higher level than specialist nurses in every function. Manley, 1997, 2001, 2002 described in details the expertise of NCs.

The Clinical Nurse Consultant role in Australia is an Advanced Practice Registered Nurse Role (APRN) (Cashin et al., 2014). Clinical Nurse Consultants (CNCs) are a type of advanced practice nurse in the Registered Nurse scope in the state of New South Wales (NSW), Australia (NSW Health, 2011a). The CNC position was introduced into the NSW state award structure in 1986 (O’Baugh, Wilkes, Vaughan, & O’Donohue, 2007), and was modeled on the Clinical Nurse Specialist (CNS) role in the UK and USA (Baldwin et al., 2013).


2. Leadership of the Health Care team (Clinical/Administrative)

Perhaps one of the most controversial sentiments traded in reoccurring episodes revolves around the leadership/management of health teams at various levels of healthcare organization.

Healthcare organizations are complex and dynamic; the necessary tasks in producing services in healthcare organizations require the coordination of many highly specialized disciplines that must work together seamlessly (Thompson et al., 2016). Katz (1974) identified several key competencies of the effective manager, including conceptual skills (those skills that involve the ability to critically analyze and solve complex problems), technical skills (those skills that reflect expertise or ability to perform a specific work task for example diagnosis, treatment, procedures, etc.), and interpersonal skills (those skills that enable a manager to communicate with and work well with other individuals, regardless of whether they are peers, supervisors, or subordinates). The term competency refers to a state in which an individual has the requisite or adequate ability or qualities to perform certain functions (Ross, Wenzel, & Mitlying, 2002).

Effective health care leadership involves exercising professional judgment and skills and carrying out the managerial functions of planning, organizing, staffing, directing, controlling, and decision making at three levels: self, unit/team, and organization wide. In my observation, lack of willingness to network and work in teams in the first instance is as big as the problem of leadership in the health sector.

I reviewed and summarized the leadership of health ministries in the 4 countries (since the turn of the millennium till date) as in the tables below.

Noteworthy is the trend of selection of individual for their political and administrative (conceptual and interpersonal) prowess and to a lesser extent technical knowledge within the health sector. With the exception of UK, all countries have now trialed health experts as ministers or its equivalent who incidentally have all been medical doctors. A deep-dive into the leadership teams of these ministries reveals multidisciplinary members. These selections have arguably have contributed towards superior health system performance. However, like many other life facets, we must continue to innovate and show commitment to the welfare of the populace we serve.

It is indeed overdue for the political class, policy makers and stakeholder healthcare team players to begin to focus on managerial prowess and strong team formations that have worked well in reference countries.


The literature review of the prevailing global best practices on some other demands and counter-demands will be presented in the Lifting the Mask on Global Best Practices in Health Care Industry- Fact Sheet 2 shortly after this release.


I welcome interested researchers with published work and facts interested in supporting or constructively critiquing this article to reach out to me and let join ideas.

Helpless Nigerians are dying each minute these disagreements and strike action linger. My aim is to support government and all interested parties in focusing on actual FACTS thereby quickly resolving this situation.



Thank you.

Ola Omolasoye MBA FPCPharm.

olaomolasoye@gmail.com





REFERENCES

American Society of Consultant Pharmacists [ASCP], (2015): "What is a Consultant Pharmacist?". Retrieved:13th May 2018.

Australian Association of Consultant Pharmacy [AACP] (2015): FACT SHEET NO. 1. https://aacp.com.au/about-aacp/. Retrieved on: 13th May, 2018.

Stefanacci R.G. ( 2012). Financial oversight of medication use: an expanded role for consultant pharmacists. Consult Pharm.;27(4):290-5. doi: 10.4140/TCP.n.2012.290. PubMed PMID: 22498989.

Cashin, A., Stasa, H., Gullick, J., Conway, R., Buckley, T. (2014) Clarifying Clinical Nurse Consultant work in Australia: a phenomenological study. Collegian.;22:405–412 DOI: https://doi.org/10.1016/j.colegn.2014.09.002

Clark T.R. (2018). Gap analysis: assessing the value perception of consultant pharmacist services and the performance of consultant pharmacists. Consult Pharm.; 23 Suppl C:3-15. PubMed PMID: 19032018.
Department of Health (1999b) Making a difference: strengthening the nursing, midwifery and health visiting contribution to health and healthcare, London: DH.

Gareth Malson (2015). The role of the consultant pharmacist in the NHS. The Pharmaceutical Journal, Royal Pharmaceutical Society. https://www.pharmaceutical-journal.com/careers-and-jobs/career-feature/the-role-of-the-consultant-pharmacist-in-the-nhs/20069457.article. Retrieved: 13th May, 2018.

Guest D., Redfern S., Wilson-Barnet J., Dewe P., Peccei R., Rosenthal P., Evans A., Young C., Montgomery J. and Oakley P. (2001). A preliminary evaluation of the establishment of nurse, midwife and health visitor consultants: report to the Department of Health by a team from King’s College London and Birkbeck College. Management Centre, London: King’s College London.

Guest D, Peccei R, Rosenthal P, Redfern S, Wilson-Barnet J, Dewe P, Coster S, Evans A and Sudbury A (2004). An evaluation of the impact of nurse, midwife and health visitor consultants, London: King’s College London.

HealthTimes (2017). What Is A Physiotherapist's Typical Career Path? https://healthtimes.com.au/hub/physiotherapy/8/guidance/nc1/what-is-a-physiotherapists-typical-career-path/523/. Retrieved: 13th May, 2018

Katz, R. L. (1974, September/October). Skills of an effective administrator. Harvard Business Review, 52, 90–102.

Manley K (1997) A conceptual framework for advanced practice: an action research project operationalising an advanced practitioner/nurse consultant role, Journal of Clinical Nursing, 6(3), pp.179-190.

Manley K (2001) Nurse consultant: concept, processes, outcome, unpublished PhD thesis, London: Manchester University/RCN Institute. Manley K (2002) Refining the nurse consultant framework: commentary on critique of nurse consultant framework, Nursing in Critical Care, 7 (2), pp.84-87.

Parliament of Australia. (2010). "Ministries and Cabinets". 43rd Parliamentary Handbook: Historical information on the Australian Parliament.

Ross, A., Wenzel, F. J., & Mityling, J. W. (2002). Leadership for the future: Core com- petencies in health care. Chicago, Illinois: Health Administration Press/AUPHA Press.

Thompson, J. M. (2007a). Health services administration. In S. Chisolm (Ed.), The health professions: Trends and opportunities in U.S. health care (pp. 357–372). Sudbury, MA: Jones and Bartlett.

Thompson, J. M. (2007b). The strategic management of human resources. In S. B. Buchbinder & N. H. Shanks (Eds.), Introduction to healthcare management (pp. 265–301). Sudbury, MA: Jones and Bartlett.

Thompson, J. M, Buchbinder S. B. & Shanks N. H. (2016). Introduction to healthcare management. (pp. 3–4). Sudbury, MA: Jones and Bartlett.

Vits K.M. (2010). Consultant physiotherapist: a career goal achieved. Journal of the Association of Chartered Physiotherapists in Women’s Health, Spring: 106, 25–29.





Disclaimer: All opinions expressed in this article are solely those of the writer and acknowledged contributors.

Written by
Ola Omolasoye
Ola Omolasoye
Key Account Manager at GlaxoSmithkline Pharmaceutical Ltd, Consultant Social and Administrative Pharmacist.
3 comments
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9h
Olagoke Ewedairo MD, MPH, FMCFM
Pharmaceutical Medical Affairs Manager | Consultant…
I'm glad no part of the discuss said longevity is a requirement to head a hospital or be called consultant. Also key is that consultants offer additional services beyond what other members of the field offer, they offer specialist care and have been trained. I hope all the people who want to be called consultants gain the additional qualification from reputable accreditors… See more

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52m
Ola Omolasoye
Key Account Manager at GlaxoSmithkline…
Thank you Dr. Ewedairo, indeed we should already be building the future of our health landscape by developing interdisciplinary guidelines clearly stating and delimiting each specialist/consultant player's role rather than drain collective energy on bickering. It will be of great importance to have clear algorithms showing process flow for typical patient scenarios involvi… See more

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3d
Amah Rex
Clinical Pharmacist at Government House Clinic Jalingo
Very good research!
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3d
Abdulrahman Alabi
Business Support & Analytics at Roche
I was expecting some debate in the comments �
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