s Crisis Times Upon Us - Look at the Aldi Business Model | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists

Editorial

From the desk of the editor

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine.
At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration.
We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.
Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.
If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.
Who would you blame when that happens?
But I have to admit there is some effort, even though the results are but meagre.
In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

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News Flash

Newsflash Updates for July 2014

Newsflash Updates

Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
Access and click on the title links that are illustrated

Comments: 1

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Feature Contribution

Woolworths Pharmacy - Getting One Stage Closer

Neil Johnston

It started with “tablet” computers deployed on shelves inside the retailer Coles, specifically to provide information to consumers relating to pain management and the sale of strong analgesics.
This development was reported in i2P under the title Coles Pharmacy Expansion and the Arid PGA Landscape”
In that article we reported that qualified information was a missing link that had come out of Coles market research as the reason to why it had not succeeded in dominating the pain market.
Of course, Woolworths was working on the same problem at the same time and had come up with a better solution - real people with good information.

Comments: 5

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Intensive Exposition without crossing over with a supermarket

Fiona Sartoretto Verna AIAPP

Editor's Note: The understanding of a pharmacy's presentation through the research that goes into the design of fixtures and fittings that highlight displays, is a never-ending component of pharmacy marketing.
Over the past decade, Australian pharmacy shop presentations have fallen behind in standards of excellence.
It does not take rocket science - you just have to open your eyes.
Recently, our two major supermarkets, Woolworths and Coles, have entered into the field of drug and condition information provision - right into the heartland of Australian Pharmacy.

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The sure way to drive business away

Gerald Quigley

I attended the Pregnancy, Baby and Children’s Expo in Brisbane recently.
What an eye and ear opening event that was!
Young Mums, mature Mums, partners of all ages, grandparents and friends……...many asking about health issues and seeking reassurances that they were doing the right thing.

Comments: 1

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‘Marketing Based Medicine’ – how bad is it?

Baz Bardoe

It should be the scandal of the century.
It potentially affects the health of almost everyone.
Healthcare providers and consumers alike should be up in arms. But apart from coverage in a few credible news sources the problem of ‘Marketing Based Medicine,’ as psychiatrist Dr Peter Parry terms it, hasn’t as yet generated the kind of universal outrage one might expect.

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Community Pharmacy Research - Are You Involved?

Mark Coleman

Government funding is always scarce and restricted.
If you are ever going to be a recipient of government funds you will need to fortify any application with evidence.
From a government perspective, this minimises risk.
I must admit that while I see evidence of research projects being managed by the PGA, I rarely see community pharmacists individually and actively engaged in the type of research that would further their own aims and objectives (and survival).

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Organisational Amnesia and the Lack of a Curator Inhibits Cultural Progress

Neil Johnston

Most of us leave a tremendous impact on pharmacies we work for (as proprietors, managers, contractors or employees)—in ways we’re not even aware of.
But organisational memories are often all too short, and without a central way to record that impact and capture the knowledge and individual contributions, they become lost to time.
It is ironic that technology has provided us with phenomenal tools for communication and connection, but much of it has also sped up our work lives and made knowledge and memory at work much more ephemeral.

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Academics on the payroll: the advertising you don't see

Staff Writer

This article was first published in The Conversation and was written by Wendy Lipworth, University of Sydney and Ian Kerridge, University of Sydney
In the endless drive to get people’s attention, advertising is going ‘native’, creeping in to places formerly reserved for editorial content. In this Native Advertising series we find out what it looks like, if readers can tell the difference, and more importantly, whether they care.
i2P has republished the article as it supports our own independent and ongoing investigations on how drug companies are involved in marketing-based medicine rather than evidence-based medicine.

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I’ve been thinking about admitting wrong.

Mark Neuenschwander

Editor's Note: This is an early article by Mark Neuenschwander we have republished after the soul-searching surrounding a recent Australian dispensing error involving methotrexate.
Hmm. There’s more than one way you could take that, huh? Like Someday when I get around to it (I’m not sure) I may admit that I was wrong about something. Actually, I’ve been thinking about the concept of admitting wrong. So don’t get your hopes up. No juicy confessions this month except that I wish it were easier for me to admit when I have been wrong or made a mistake.
Brian Goldman, an ER physician from Toronto, is host of the award-winning White Coat, Black Art on CBC Radio and slated to deliver the keynote at The unSUMMIT for Bedside Barcoding in Anaheim this May. His TED lecture, entitled, “Doctors make mistakes. Can we talk about it?” had already been viewed by 386,072 others before I watched it last week.

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Dispensing errors – a ripple effect of damage

Kay Dunkley - BPharm, Grad Dip Hosp Pharm, Grad Dip Health Admin, MPS, MSHPA

Most readers will be aware of recent publicity relating to dispensing errors and in particular to deaths caused by methotrexate being incorrectly packed in dose administration aids.
The Pharmacy Board of Australia (PBA), in its Communique of 13 June 2014, described a methotrexate packing error leading to the death of a patient and noted “extra vigilance is required to be exercised by pharmacists with these drugs”.
This same case was reported by A Current Affair (ACA) in its program on Friday 20 June
http://aca.ninemsn.com.au/article/8863098/prescription-drug-warning

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Take a vacation from your vocation

Harvey Mackay

Have you ever had one of those days when all you could think was, “Gosh, do I need a vacation.”
Of course you have – because all work and no play aren’t good for anyone.
A vacation doesn’t have to be two weeks on a tropical island, or even a long weekend at the beach. 
A vacation just means taking a break from your everyday activities. 
A change of pace. 
It doesn’t matter where.
Everyone needs a vacation to rejuvenate mentally and physically. 
But did you also know that you can help boost our economy by taking some days off? 
Call it your personal stimulus package.

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Explainer: what is peer review?

Staff Writer

This article was first published in the Conversation. It caught our eye because "peer review" it is one of the standards for evidence-based medicines that has also been corrupted by global pharma.
The article is republished by i2P as part of its ongoing investigation into scientific fraud and was writtenby Andre Spicer, City University London and Thomas Roulet, University of Oxford
We’ve all heard the phrase “peer review” as giving credence to research and scholarly papers, but what does it actually mean?
How does it work?
Peer review is one of the gold standards of science. It’s a process where scientists (“peers”) evaluate the quality of other scientists' work. By doing this, they aim to ensure the work is rigorous, coherent, uses past research and adds to what we already knew.
Most scientific journals, conferences and grant applications have some sort of peer review system. In most cases it is “double blind” peer review. This means evaluators do not know the author(s), and the author(s) do not know the identity of the evaluators.
The intention behind this system is to ensure evaluation is not biased.
The more prestigious the journal, conference, or grant, the more demanding will be the review process, and the more likely the rejection. This prestige is why these papers tend to be more read and more cited.

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Dentists from the dark side?

Loretta Marron OAM BSc

While dining out with an elderly friend, I noticed that he kept his false tooth plate in his shirt pocket. He had recently had seven amalgam-filled teeth removed, because he believed that their toxins were making him sick; but his new plate was uncomfortable. He had been treated by an 'holistic dentist'. Claiming to offer a "safe and healthier alternative" to conventional dentistry, are they committed to our overall health and wellbeing or are they promoting unjustified fear, unnecessarily extracting teeth and wasting our money?

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Planning for Profit in 2015 – Your key to Business Success

Chris Foster

We are now entering a new financial year and it’s a great time to reflect on last year and highlight those things that went well and those that may have impacted negatively in the pursuit of your goals.
It's also a great to spend some time re-evaluating your personal and business short, medium and long term goals in the light of events over the last year.
The achievement of your goals will in many cases be dependent on setting and aspiring to specific financial targets. It's important that recognise that many of your personal goals will require you to generate sufficient business profits to fund those aspirations

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Attracting and Retaining Great People

Barry Urquhart

Welcome to the new financial year in Australia.
For many in business the past year has been described as a challenging period.
Adjectives are a key feature of the English language.  In the business lexicon their use can be, and often is evocative and stimulate creative images.  But they can also contribute to inexact, emotional perceptions.
Throughout the financial pages of newspapers and business magazines adjectives abound.
References to “hot” money draw attention and comment.  The recent wave of funds from Chinese investors, keen to remove their wealth from the jurisdiction and control of government regulations is creating a potential property bubble in Australia.

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Updating Your Values - Extending Your Culture

Neil Johnston

Pharmacy culture is dormant.
Being comprised of values, unless each value is continually addressed, updated or deleted, entire organisations can stagnate (or entire professions such as the pharmacy profession).
Good values offer a strong sense of security, knowing that if you operate within the boundaries of your values, you will succeed in your endeavours.

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Evidence-based medicine is broken. Why we need data and technology to fix it

Staff Writer

The following article is reprinted from The Conversation and forms up part of our library collection on evidence-based medicines.
At i2P we also believe that the current model of evidence is so fractured it will never be able to be repaired.
All that can happen is that health professionals should independently test and verify through their own investigations what evidence exists to prescribe a medicine of any potency.
Health professionals that have patients (such as pharmacists) are ideally placed to observe and record the efficacy for medicines.
All else should confine their criticisms to their evidence of the actual evidence published.
If there are holes in it then share that evidence with the rest of the world.
Otherwise, do not be in such a hurry to criticise professions that have good experience and judgement to make a good choice on behalf of their patients, simply because good evidence has not caught up with reality.

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Laropiprant is the Bad One; Niacin is/was/will always be the Good One

Staff Writer

Orthomolecular Medicine News Service, July 25, 2014
Laropiprant is the Bad One; Niacin is/was/will always be the Good One
by W. Todd Penberthy, PhD

(OMNS July 25, 2014) Niacin has been used for over 60 years in tens of thousands of patients with tremendously favorable therapeutic benefit (Carlson 2005).
In the first-person NY Times best seller, "8 Weeks to a Cure for Cholesterol," the author describes his journey from being a walking heart attack time bomb to a becoming a healthy individual.
He hails high-dose niacin as the one treatment that did more to correct his poor lipid profile than any other (Kowalski 2001).

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Culture Drive & Pharmacy Renewal

Neil Johnston

Deep within all of us we have a core set of values and beliefs that create the standards of behaviour that we align with when we set a particular direction in life.
Directions may change many times over a lifetime, but with life experiences and maturity values may increase in number or gain greater depth.
All of this is embraced under one word – “culture”.
When a business is born it will only develop if it has a sound culture, and the values that comprise that culture are initially inherent in the business founder.
A sound business culture equates to a successful business and that success is often expressed in the term “goodwill” which can be eventually translated to a dollar value.

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Pharmacy 2014 - Pharmacy Management Conference

Neil Johnston

The brave new world of health and wellness is not the enemy of Pharmacy, it is its champion.
Australian futurist, Morris Miselowski, one of the world's leading business visionaries, will present the Opening Keynote address on Pharmacy's Future in the new Health and Wellness Landscape at 2.00pm on Wednesday July 30.
Morris believes the key to better health care could already be in your pocket, with doctors soon set to prescribe iPhone apps, instead of pills.
Technology will revolutionise the health industry - a paradigm shift from healthcare to personal wellness.
Health and wellness applications on smartphones are already big news, and are dramatically changing the way we manage our personal health and everyday wellness.

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Generation and Application of Community Pharmacy Research

Neil Johnston

Editor’s Note: We have had a number of articles in this issue relating to pharmacy research.
The PGA has conducted a number of research initiatives over the years, including one recently reported in Pharmacy News that resulted from an analysis of the QCPP Patient Questionnaire.
Pharmacy Guild president, George Tambassis, appears to have authored the article following, and there also appears to be a disconnect between the survey report and its target audience illustrated by one of the respondent comments published.
I have asked Mark Coleman to follow through, elaborate and comment:

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Crisis Times Upon Us - Look at the Aldi Business Model

Neil Johnston

articles by this author...

Neil Johnston is a pharmacist who trained as a management consultant. He was the first consultant to service the pharmacy profession and commenced practice as a full time consultant in 1972, specialising in community pharmacy management, pharmacy systems, preventive medicine and the marketing of professional services. He has owned, or part-owned a total of six pharmacies during his career, and for a decade spent time both as a clinical pharmacist and Chief Pharmacist in the public hospital system. He has been editor of i2P since 2000.

Ever since i2P began publishing it has been warning about the problems of pharmacy.
In particular, the PGA misinterpretation of its role and its damage to the entire fabric of pharmacy.
Also, the encroachment of government in the practice of pharmacy and the negative impacts of managed care through a centralised PBS.
Pharmacy is now very close to the end of a long survival dance, never once looking at an alternative strategy to break down the dominance of the PBS.

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I2P has warned on many occasions that as the PBS ended its life cycle it would become commoditised and then scattered to the supermarket wolves.

We have now reached that stage with the Abbott Commission of Audit recommending one of its cost saving recommendations – allow supermarket ownership of pharmacy.
The Commission of Audit is a device where recommendations reflecting Tony Abbott's thinking can be owned or disregarded with minimum political fallout.
But it is a true reflection of his thinking - there is no independence of thought. To think otherwise is a fiction!

Without doubt we are seeing a very incompetent politician trying to make a mark in any way possible.
Tony Abbott has tried to make substantive savings by chipping at the edges of every program in existence. He has no real long-term substantive savings plan – just cut for cutting's sake.
All he is succeeding in doing is destabilising significant economic groups (starting with the automotive industry) and now he has been pointed to the health economy – both medicine and pharmacy.
Another significant recommendation by the Commission of Audit is a $15 co-payment for GP fees- a charge that will hurt the majority of seniors with low incomes and worsening health issue as they near their end of life.
It will also hurt pharmacy with reduced script volumes.

But looking closer to home at pharmacy problems, we see our poor leadership problems really coming home to roost – a divided profession that has lost control of its prime markets and with no real plan to unite pharmacists to weather the political hazards we are about to face.

The issues that have brought pharmacy to its knees include:
* The PGA total support of a supply chain driven pharmacy enterprise excluding any major professional initiatives.
* The dividing of pharmacists along professional lines and not developing a clinical services market to absorb, nurture and develop revenue streams independent of the PBS, plus a revenue stream to absorb new pharmacists.
* The immoral arrangement between the PGA and government whereby the PGA became the sole manager for pharmacy grants. This has meant a skewing of pharmacy projects, in many cases incurring a conflict of interest, so we have seen little real innovation coming out of pharmacy.
It also created a large pool of funds that incurred a political obligation to the government that has coloured negotiations at all levels (you scratch my back and I'll scratch yours).
By accepting grant commissions, the PGA could never properly negotiate on behalf of its members, because they did not wish to lose this lucrative source of funds as it bought them so much privilege compared to other pharmacy leadership groups.
If you wonder why pharmacy is well and truly boxed into a corner today, go no further than the PGA/governemnt decisions negotiated since that date.

Obviously, we are facing the total disintegration and rebuilding of community pharmacy as we know it. The rate of disintegration depends on the strength of our leaders, and given their performance to this date, there is no cause for optimism there.
In the face of these problems i2P recommends that all pharmacists come together on a regional basis to establish separate lines of communication for political negotiation and more importantly, to design a model of pharmacy that can hold up against supermarket pharmacies, which will include warehouse pharmacies.
If a representative organisation is not inclusive of all pharmacists and readily accessible at a local level, then the fight is lost before it has begun. Of course, regional bodies can have delegates to a national body but a national body needs to be kept on a short leash, completely responsible to the grass roots.
The business model is another story and i2P recommends that it be modeled on the Aldi supermarket model.
In 2000 Aldi announced it was setting up in Australia.
This immediately rang alarm bells for Woolworths and Coles and they both set about reconstructing their own business models to compete with Aldi.
In 2000 i2P started publishing and we ran a story analysing the Aldi business model.
Remember that at that date they had no stores, just a plan for an entry to the Australian market.
Aldi is a very private organisation and rarely releases information on its operations.
So what sets them apart?
Well, they are constantly reviewing their overheads and devising more efficient ways of doing more with less. One example is the fact they have “governors” on all their vehicles. Fuel consumption is economised because drivers cannot exceed a mandated speed.
It is this attention to detail that gives them a good return on investment.

Aldi has patiently built a portfolio of 340 stores over 14 years – a new store on average every 3 weeks. They set out to capture 10 percent of the Australian market and they achieved that target approximately two years ago.
What sets Aldi apart from its competitors is its stock management:
Aldi keeps a limited product range of less that 1500 SKUs – or products – per store, while Woolworths and Coles often have more than 10,000. This limited range has many benefits - it enhances Aldi’s buying power, facilitates smaller stores, increases product turnover and simplifies inventory management.

In store, Aldi uses simple and effective palletised logistics for its fast turnover products and keeps its staffing levels low. Around 95% of its products are own-brand, and the quality of these products is often excellent. These are sourced both locally (for most fresh foods) and from its global supply chain (for many longer shelf life products).

Thus with high stock turns and minimal stock handling, Aldi generates a strong cash flow and rarely needs to engage in borrowing for trading activity.
It is a lesson that Australian pharmacists have been slow to learn even though there are some successful practitioners of this management form within the ranks of pharmacy.

Aldi's other success point is to build retail scale – but to do it slowly so as not to strain existing resources.
They now have a flexible, light on its feet administrative structure that delivers real competition to Woolworths and Coles who have become sluggish and monolithic in comparison.

Few pharmacists would realise that the Aldi model was practiced by the majority of pharmacists pre-1960 where “patent medicines” were frowned upon in favour of private label or individual compounding.
Similar decisions will have to be made for future survival.
If you continue to sell nationally advertised “branded” products you will never catch up to Woolworths, Coles or warehouse pharmacies.
The additional time available to look after customers and patients is created because all the noise associated with highly competitive marketing and high volume stock handling is avoided.
Also, this form of retailing, as Aldi has found, is much more profitable than head-to-head competition.

Personalised dispensing pre-1960 was managed using personal pharmacopoeias- a situation that can be reinvented using low cost generic drugs coupled with personal detailing of local GP's.

It's all been done before and it is sad that that the “enemies” of pharmacy (including government) have been allowed to usurp so much market power.
There is no alternative.
You have to rebuild your market brick by brick, patiently, and according to your plan – not the dictates of others.
Rebuilding a private market allows you to value add with clinical services and valuable private label products that will be more profitable and more controllable.

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