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‘Dragon's Den’ is a BBC television series in which budding entrepreneurs get 3 min to pitch their business ideas to five multi-millionaires, known as ‘Dragons’, who may be willing to invest their own cash.1 The contestants are usually product designers or service operators who have what they consider to be a viable and potentially profitable business idea, but who lack funding and direction.2 The format of ‘Dragon's Den’ has been emulated around the world, because of its popular entertainment value and also because the ‘Dragons’ provide real advice in an environment that is pressurised for the entrepreneur; and for the right pitch, they will provide real investment to entrepreneurs who in turn can contribute to their local economy. Viewers often see entrepreneurs learn harsh but valuable lessons for their future business aspirations. In developing countries, the ‘Dragon's Den’ format has been particularly useful. For example, in 2008, the United Bank of Africa introduced a similar TV programme, stating that ‘Dragons Den ‘ is unique and different from other business reality shows and will further the bank's aim to promote entrepreneurship and innovation in Africa.3 As an avid ‘Dragon's Den’ watcher, I have reflected that its principles resonate with the need for innovation in healthcare.
In 2010, the incoming UK coalition government's immediate priority was to begin cutting a significant budget deficit. A government ‘White Paper’ entitled ‘Equity and excellence: Liberating the National Health Service (NHS)’ set out the government's vision for the future of the NHS. It outlined the government's commitment to ensuring that a principle known as ‘quality, innovation, productivity and prevention’ would support the NHS to make efficiency savings, which could be reinvested back into the service to continually improve quality of care.4 Although, nearly 5 years on, doubts have emerged about the sustainability or long-term results of savings made through this flagship NHS efficiency programme,5 a culture of service development and innovation has arguably consolidated within pharmacy in the UK. Evidence of this includes the presence of service development and innovation competencies within the Royal Pharmaceutical Society's (RPS) two competency frameworks, one covering foundation practice (the Foundation Pharmacy Framework)6 and the other covering advanced practice (the Advanced Pharmacy Framework).7
The RPS Foundation Pharmacy Framework is aimed at, among others, junior pharmacists, many of whom in the UK undertake a work-based foundation programme associated with it. The presence of a service development competency supports the notion that to support innovation in hospital pharmacy, engaging with and educating junior pharmacists about service innovation and improvement are imperative. By doing so, we hope to practically support innovation, to secure buy-in from juniors, and develop them as future service innovators. This led to the inclusion of three supervised tasks for the second half of the London-based hospital pharmacy foundation programme8 (also known as a postgraduate diploma), at the request of local senior pharmacy managers.
First, the ‘therapeutic review/critical evaluation’ task allows practitioners to critically evaluate the literature relating to a specific therapeutic or pharmacy practice or service provision dilemma and to provide an opportunity for them to develop clinical decision making and critical reasoning skills. Next, the ‘audit/service evaluation’ task allows practitioners to be actively engaged in the audit/service evaluation process in their hospitals. Finally, the ‘service improvement and innovation’ (SII) task allows practitioners to be innovative in developing service improvement proposals and to provide an opportunity for practitioners to be actively engaged in the change management process in their hospitals. Each task also aims to provide practitioners with a range of opportunities to communicate their findings and recommendations.
So what does this have to do with ‘Dragon's Den’? A key element of the task assessments for the foundation programme is a panel review, as is found in ‘Dragon's Den.’ For audits, posters are produced and a conference-style environment provides the setting for a panel-style assessment. For therapeutic review and SII, the practitioner presents their project to a panel, and in the case of SII, this includes presenting financial proposals. Assessment panels include senior NHS hospital pharmacists who have experience of service delivery and innovation in the workplace and the aim is that projects are realistic and of practical benefit to the relevant pharmacy department.
I am struck by a number of experiences in assessing these tasks during the last 10 years. First, through the process of learning the theory behind each task (which is achieved through learning sets), developing their projects, being assessed, and in some cases seeing their work implemented, we have upskilled approximately several hundred foundation pharmacists, many of whom progress to more senior posts. Interestingly, we have also upskilled some tutors. Practitioners have learnt things (sometimes through bitter experience) like the need for generating business cases when seeking new staff, how to defend a literature review and how to justify their choice of audit standards. Second, assessment panels have helpfully exposed flaws that ultimately help the practitioner. For example, there is a common tendancy to identify a problem and implement a solution without a proper analysis, using tools such as strengths, weaknesses, opportunities and threats (SWOT – a common planning method9), or sociological, technological, economic, political (STEP/PEST – a situational analysis tool10) and options appraisal. Finally, there has been a chronic lack of publishing good quality work that we regularly encounter after the academic assessment process. Publication of work spreads innovation and it is highly motivating for foundation trainees and their supervisors alike.
Phil Wiffen, Editor of the European Journal of Hospital Pharmacy, and I share a passion for encouraging junior pharmacists to publish their work. I reflect that it took me 10 years to publish my first article and I lament the lack of encouragement to publish in my early days of practice—partly because my seniors did not publish. The EJHP editor has kindly agreed to consider for publication the best tasks produced by practitioners in the UCL School of Pharmacy foundation programme and similar programmes. Look out for these and consider whether your juniors could submit their good work too. As stated in a previous editorial, ‘get writing!’11
Competing interests None
Provenance and peer review Not commissioned; internally peer reviewed.