FEBRUARY Edition # 20, 2001

A NOTE FROM THE EDITOR

Thank you to all those new readers who have recently enrolled themselves, or a colleague, via an e-mail subscription. Our list is certainly growing, but we have plenty of room in our database for new additions.
In this edition, Rollo Manning explores the concerns or otherwise, of identifying Australian citizens, and their health records, by a unique single numeric identifier viz. the Medicare number.
Many people have privacy concerns, but clinicians and governments see benefits that outweigh such concerns.
This article should be read in conjunction with the article on globalisation.
Because it is such a major issue, we have decided to conduct a simple poll at the foot of Rollo's article to seek reader input.
Would you please take the time to click on the appropriate button?
We will publish the result in our next edition.
I have written two articles for this edition.
One highlights the positive benefits of developing alliances within an e-commerce framework, and the range of interesting opportunities that are opening up.
The other is a more serious article trying to make some sense out of globalisation and how it will eventually impact on Australian pharmacists.
I fear that no matter what agreements have been entered into, the politicians do not have our best interests at heart, claiming that global benefits will outweigh social and other dislocations.
As the "global benefits" are not fully understood as yet, how can such claims be made?
When prime minister John Howard states that not all Australians are sharing in the benefits I fear he alludes to the vast majority of individuals and small businesses, who will not have the resources to withstand the global domination that is rapidly occurring.
John Aldous continues his series on education and discusses some intering aspects of Internet involvement. If you are not computer literate, you will still be able to follow the informative style of his article as he discusses the pros and cons of using the Internet for a total educational process.
Leigh Kibby is back with us again tackling the management issues surrounding the handling of difficult staff. Always an informative read.
Finally, our Roundup columnist highlights another rural/isolated issue, and if you have any comment or assistance for the writer of this article, please do not hesitate to e-mail some details.

Neil Johnston, 15th February, 2000

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PHARMACY POLITICS

	FROM ROLLO MANNING: TIME to improve IT approach THE MEDICARE NUMBER DILEMMA - WHAT'S IT ALL ABOUT?

MEDICARE cards will become de facto identity cards and a giant national database containing personal health information will be created under a planned Federal Government initiative.
"Privacy advocates have reacted with alarm at the proposals, under which the Medicare number will be used as a unique patient identifier for a new Pharmaceuticals Benefit Scheme entitlement checking system, and for electronic medication records to be offered through pharmacies."
" The proposal, outlined in the recent Federal Budget, would create a system similar to the Australia Card system planned in the late 1980s under Labor and twice rejected by the Senate, triggering the 1987 general election."
"The plan was later dropped in the face of heated opposition. All Australians were to be issued with an ID card for taxation, health and welfare purposes, with the Health Insurance Commission administering a central database."
The Australian, 23rd May 2000
So pharmacists don't like entering Medicare numbers to a patient file.
This is the conclusion reached after browsing the posts to the pharmacy Internet bulletin board, Auspharmlist.
Maybe the silent majority would have another view because the Auspharmlist is an exclusive club of pharmacists with the interest, the time and the system (probably at home) to bother posting or replying to the list.
To go back a step or two and see where all this came from, we find that the pharmacy community was quick to seize on information technology. But after a rapid start it has been slow on the uptake of change ever since.
It was the first of the professions to utilise computer technology, mainly through the efforts of two pharmacists, who began an information file with a data base of speciality knowledge.
When the "Yellow Book" (PBS) was added there became a means of making speedier claims to the HIC.
This set the product off and it turned into the Chemdata System, to become Amfac, and entered a competitive market with many more look alike systems.
The initial uptake and recognition of value came with a way to make money quicker. The same will apply to the next wave of development.
So where does the Medicare number fit into all this?
The answer is simple.
This is the first step in the new wave of information sharing which will make money for pharmacists.
The reason being given to pharmacists as to why this is happening is not the full story. In fact the proponents should be ashamed of such a weak excuse for the whole exercise to date. Is it really to stop drug smuggling to foreign lands, or stop the odd tourist from accessing cheap medicine, or to stop daughter sending to mum in a foreign land some inexpensive ACE inhibitors?
No of course not!
It is the first step in having immediate access on dispensing to a patient's total medication history as the starting point for the Better Medication Management System (BMMS).
Then why not tell the pharmacists?
Well here the matter becomes an intriguing trail of rumour and innuendo!
Remember the Australia Card, the ultimate in person identification, which was rolled in the 1980s?
There is a faint "smell" of that.
Maybe the HIC/DHAC are nervous it might start over again.
But let us trust the system and acknowledge this is a part of a total health information system.
Pharmacy must be a part of it.
Not all pharmacies, only those who want to.
And this gets back to an often-mentioned theme that not all pharmacies have to be the same. Those that want to participate in the Better Medication Management System (BMMS) can, publicise the fact, and leave it to the consumer to decide.
So don't all jump up and say "never".
You do not HAVE to be in it.
This will be the start of the new wave of technology to hit pharmacies.
The information revolution in pharmaceutical care.
At last it will be possible to see how medicines are contributing to "wellness" in the community.
Seize the opportunity if you want to.
Don't complain and the rewards will come through the payment for being a partner in BMMS.
ends
EDITOR'S NOTE: HAVE YOUR SAY!
You are invited to give your opinion by simply clicking on the "YES" or "NO" button in the panel below. The information is anonymous and the results will be published in the next edition.

MEDICARE NUMBER SURVEY YES             NO              Q: "Should Medicare numbers be used as a forerunner of the Better Medication Management System through pharmacy?"

The comments and views expressed in the above article are those of the author and no other. The author welcomes any comment and interaction that may result from this and future articles. The editor would be pleased to publish any responses.

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E-COMMERCE

FROM NEIL JOHNSTON The Quiet Revolution NEW E-PHARMACY ALLIANCES

It is refreshing to see that Australian pharmacists are beginning to experiment with various models of Internet alliances, and engage e-commerce in a progressive and professional manner.
One of the latest entrants is eMedical Online Pharmacy, which began life in "bricks and mortar" form as Keilor Village Pharmacy, in Victoria.

The Internet site originated as a totally medical site, developed by a group of Melbourne doctors in combination with various IT specialists.
The eMedical team includes Dr Peter Stratmann, DR Andrew Pascoe, DR Michael Hocking, DR Michael Williams, DR Natasha Livingstone, DR Chris Miller, plus Sandor Nagy (web architect), Amanada Sibbison (site coordinator), Tim De Smaele (web designer+technical support) and Douglas Chrystall (technical project manager). The recent addition of Dino Sapuppo, a partner in the Keilor Village Pharmacy, completes the balance of skills required to present a highly professional storefront to potential e-health consumers.
It does not take a lot of insight to note that this site creates some very powerful advantages for the promoters. The above group of medical practitioners are in association with 25+ other GP's, spread over two "bricks and mortar" locations. They would all obviously refer patients to the site in varying degrees, particularly for information.
The site also generates online consultations from those people who do not normally visit a doctor, or who are shy about asking personal health questions e.g. sexual health. The "arms-length" allowed by these types of consultations reaches out to a new group of medical consumers.
The pharmacy would complement the number of referrals and the mutual support and cross fertilisation between the doctor/pharmacist alliance would create a high degree of confidence for the patient. It is a little known, but well established fact, that when GP's and community pharmacists work in with each other in a supportive and professional manner, both sides thrive.
Patients remain loyal to both sides when their advisers are seen to be actively working in their best interests, and this can only result in improved patient care.
G.P's have often felt threatened by professional activities of pharmacists, and this has only occurred through lack of communication and lack of understanding of the complementary and overlapping nature of each professional role. Improved communication generates mutual respect, and each can then get on with what they do best, in a supportive manner.
As we have already noted, patients love this type of interaction and with doctors and pharmacists working together to develop an online supportive alliance, roles have to be defined and understood upfront.

The eMedical pharmacy advertises the cheapest prices for dispensed and OTC medicines, and has an efficient shopping cart with good navigation features.
Basic product information is provided in the form of CMI for most drugs, and all legal and ethical requirements appear to be in place.
Obviously the service can never fully replace a face-to-face consultation with an appropriate professional, but it goes a long way to filling information gaps. The volume of information available on the site is such that it would tend to help stimulate a patient to seek an appointment with their adviser, as they discover issues that may not have been raised on previous visits.
In this way it is quite easy to see that the eMedical site reinforces and directs potential patients back to the "bricks and mortar" establishments, while simultaneously providing a continuing and interesting flow of new and updated information online.
From the pharmacy perspective, it is an effective block to operators such as Pharmacy Direct, who have had little in the way of opposition for quite some time. No doubt, this type of competition provided some of the initial stimulus to form an alliance.
From the doctor perspective, it provides an alternative to the corporate style medical centre "supermarket" doctors, who have impacted quite severely in some areas.

In a marketing sense, the eMedical Online doctor/pharmacy alliance will increase market share for both sides, and those pharmacists and doctors who are unable to form a similar alliance, will find themselves severely disadvantaged as time progresses.
It is also very plain that only one online pharmacy is required to service a large region, and pharmacists in a given area may need to amalgamate their e-pharmacy interests, rather than openly compete at a possible loss.
The need for pharmacy incorporation is now paramount, to facilitate this type of merger.
Where is the legislation?
There is still time to look for a strategic alliance, both pharmacy with pharmacy, and pharmacy with doctor. If you are not working on this aspect now, you may find that the market will concentrate at a fairly rapid rate, and you will have missed the boat.

In our last edition we covered the success of another pharmacy online venture, Epharmacy. Based in Calamvale, Queensland, this site has been showing some remarkable progress.
We now note that this enterprising business has formed an alliance with Health Communications Network (HCN).
HCN is basically a knowledge company with licences to market some of the world's most prestigious databases, such as Micromedex, Cochrane Library, Ovid Medicine, Harrison's Online and a whole range of specialist publications. With this solid core of informational assets, HCN has built some remarkable growth and is on its way to become a global enterprise.
The fact that it is substantially Australian means that it deserves support from Australian pharmacists.
Doctors.hcn is a new site developed by this organisation set up to service all health professionals, but as the name implies, its chief focus is on doctors.
Services provided from this site include the medical library, online CME for general practitioners ( but could logically extend to pharmacists), a doctor locum service, and an online purchasing service for pharmaceuticals, office supplies and computer supplies.
All these services are provided in alliance with other respected partners, and the partner selected to provide pharmaceuticals, is of course, Brett Clark, the owner of Epharmacy at Calamvale.
One of the products marketed by HCN is the Medical Director prescription writing program, which is the system most preferred by G.P's. It doesn't take too much imagination to see that a pharmacy alliance with HCN flows on to a potential alliance with a wider group of G.P's throughout Australia, and provides mutual benefit.
A formidable access!
As Epharmacy have set out to become a credible competitor to Pharmacy Direct, we must commend Brett Clark and his marketing advisers for some fancy footwork.
And all this is quietly happening, while the bulk of community pharmacists slumber on, waiting for a directive from their Pharmacy Guild leaders!
It is great to see that the entrepreneurial spirit is alive and well, for the people we have singled out are the inheritors of the next generation of pharmacy.
Will you be joining this elite group?

To visit eMedical site, click http://www.emedical.com.au
To visit EPharmacy site, click http://www.epharmacy.com.au

The comments and views expressed in the above article are those of the author and no other. The author welcomes any comment and interaction that may result from this and future articles.

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GLOBALISATION

NEIL JOHNSTON

Food and Drug Industry Perspectives

The 25th January, 2001 marked the opening of the first Aldi supermarket store in Australia, 18 months after the first moves had been made by this secretive global enterprise.
The first opening was at Bankstown, Sydney and appeared to be very successful, with hundreds of shoppers queuing well before the 9am opening.
Other stores schedules for opening include Blair Athol(Wollongong), Nowra (south coast NSW), Marrickville (western Sydney), Quaker's Hill (Western Sydney), Arndell Park, Fairfield west and Villawood, which are all located in western Sydney.
Prices in all stores were heavily discounted, as expected, and it appears that Aldi policy will be to sell all products at the same retail price, in all stores, irrespective of location.
Customers appeared to be quite happy to travel long distances to the initial store opening, and to stand in checkout aisles for up to 45 minutes.
Each store will only stock 600-700 lines, and many industry observers have been surprised at the Australian content of these lines, which is approximately 80 percent. Most of the products sold were Aldi private label, with a smattering of national brands.
The Aldi model of a retail store is so different from existing competition, it will take some time for Australian retail management culture to adapt.
The Aldi perspective is to compete on operating costs, which in turn allows a lower retail price to emerge after a reasonable margin is applied. The components of this model include a very restricted range of products and a ruthless elimination of anything that is wasteful or nonessential. For example, Aldi transport drivers are not allowed to travel in excess of 80 Km/Hour, so as to ensure best conservation of fuel.
This does not mean that Aldi does not "invest" in an overhead, if it results in savings downstream. For example, in stark contrast to other Australian retailers, Aldi prefers permanent staff and will pay them up to 50 percent above award rates. This ensures that they attract the best motivated and trained staff who value their job and give of their best.
Customers are given the option of packing their orders in empty cartons, bringing their own shopping bags or purchasing an Aldi plastic bag for 15 cents.
In many ways, the Aldi model is reminiscent of retailing pre-1960 in Australia, when there appeared to be more stability, and more caring for employees, and yes, customers went shopping with their own bags and baskets.
What Aldi will do is disrupt the cosy arrangements that have existed between Woolworths and Coles. Aldi is practicing an ethical form of predatory pricing, in a sense that it has always been possible for Woolworths or Coles to operate a new store opening at a loss, until the local market was concentrated.
Then prices were jacked up!
As Aldi prices are not really predatory, the opposition will have trouble in keeping up. Manufacturers are now expressing concern that they may be excluded from tendering for an Aldi contract, as there will be room only for a limited number, with the potential to serve a major market share. Brand manufacturers are concerned that Aldi prices will drag down their premium brands.
The lesson for pharmacy is that there is much to admire and emulate in the Aldi model, and Aldi opens up new opportunities for those entrepreneurial pharmacists who locate near an Aldi store and supply all the niche markets.

Meanwhile, Franklins is languishing and suffering most from this form of competition.
The Australian Consumer and Competition Commission (ACCC) has blocked any potential sale of Franklin's stores to Woolworths or Coles, Aldi has stated it prefers to grow "organically" and is not interested in any of the Franklin's sites, and the Dutch based global retailer, Ahold, is rumoured to be a potential suitor.
We are only seeing the beginning of an influx of global operators in various spheres of Australian business, and it behoves those Australian operators to begin their own global development, to dissipate the pressure on their existing enterprises.
All global food retailers have the potential to become instant chain pharmacies if legislation does not hold up within Australia.

Turning to the political pharmacy arena, there are reports of alleged attempts by global drug manufacturers to interfere with governmental controls on drug pricing and distribution, including within Australia.
A logical target in Australia has been the influential Pharmaceutical Benefits Advisory Committee, which for years has been providing advice to the government regarding the cost containment and controls of drugs entering the Pharmaceutical Benefits List.
There has been a spate of resignations from the committee in response to government attempts to appoint Mr Pat Clear, a lobbyist for the pharmaceutical manufacturer's.
It is claimed that a conflict of interest exists.
Mr Clear is a director of pharmaceutical product research of the company FuCell, which is alleged to be funded in turn, by a global manufacturer.
There appears to be a growing volume of informed opinion that agrees that a conflict of interest may exist, ranging from Dr Kerryn Phelps, the Federal president of the Australian Medical Association, who sees the appointment as not being independent or objective and subject to commercial objectives; also Senator Grant Tambling (Dr Wooldridge's parliamentary secretary) who stated, while chairing a review of the Pharmaceutical Benefits Scheme, that a drug industry representative would present an "untenable conflict of interest".
At the centre of the controversy is Dr Wooldridge, the minister responsible for overseeing the responsibilities of the PBAC.
Dr Wooldridge has denied that Mr Clear would have any conflict of interest and claimed that Mr Clear had retired from active involvement in the industry.
Government opposition members allege that there is an asssociation between a group of global drug manufacturer lobbyists, located in the electorate of Bennelong (the electorate of prime minister John Howard), which is further alleged to have pushed for Mr Clear's appointment to the PBAC. They point to a recent meeting with this group, and John Howard, in his electoral office.
John Howard admits to the meeting but has stated that there was no discussion regarding Mr Clear's appointment to the PBAC.
Further pressure from government opposition spokesman Michael Crean, alleged that Dr Wooldridge has created a windfall for global drug manufacturers worth millions of dollars, and that he has a close association with one particular drug company, which is further alleged to employ three former staff of Dr Wooldridge as consultants or employees.
Dr Wooldridge is under further attack for writing an article on health care reform for a Pfizer advertorial, published in the Economist. The opposition are alleging that Pfizer has received favourable treatment.
Unfazed, Dr Wooldridge has continued to support the appointment of Mr Clear, claiming that the old PBAC was "too adversarial" and its "advice was unreliable".
The international organisation Medecins Sans Frontieres has since expressed concern at the appointment of an industry lobbyist to the PBAC and claims that it is part of a worldwide attempt by the pharmaceutical industry to undermine public interests in the health sector.
A recent editorial in the prestigious Lancet publication also criticises the appointment of Mr Clear to the PBAC, claiming that it weakens the government's ability to control prices.
There is no doubt that international aid agencies and countries with government subsidised health schemes would be viewing the Australian moves with concern.
Australia, in the past, has been instrumental in keeping a downward pressure on global drug prices, through the Pharmaceutical Benefits Scheme. Any weakening of the Australian position would inevitably increase global drug prices.

The former advisers to Dr Wooldridge have stated that PBS costs would need to be reigned in, having increased 16 percent over the last year. They recommended that generic drugs should receive further support and that patient co-payments be increased.
On the other hand, Mr Clear, when addressing a National Health Congress in 1999, stated that patients should pay more for prescription drugs to ensure long term viability of the Pharmaceutical Benefits Scheme. Mr Clear further stated that "payments to drug companies would also have to increase, otherwise Australia would miss out on access to some treatments".
British-based charity Oxfam has weighed into the pricing argument by accusing the global pharmaceutical industry of waging war on poorer countries, by using the patent laws to refuse the right to produce generic versions of their drugs.
CIPLA, an Indian pharmaceutical manufacturer has offered to fill the gap by selling a generic triple combination therapy for HIV/AIDS for $652 per patient per year. Medecins Sans Frontieres is currently considering this offer, while global manufacturers claim the offer is not legal and breaches World Health Organisation rules.
Meanwhile, Australian prime minister, John Howard, has suddenly discovered Pauline Hansen after the upset in the state elections in Western Australia. Considering that he will be facing the electorate in a few months, he has also, in a flash of political illumination, discovered that not all Australians are sharing in the "benefits" of globalisation. He has urged the "big end of town" to be a little more sensitive in their global developments and vowed that he will not sell Telstra this side of the election until rural voters are adequately serviced.
Some consolation for rural voters who fear they will never gain access to adequate and economical communication services.
Other people, such as dairy farmers have have seen farm prices decimated by deregulation (another euphemism for globalisation), causing massive financial hardship, social dislocation and in many cases, closure of a business that had been viable for generations of family members.
We reported in one of our first publications as to how American wheat farmers felt they were imprisoned on their own farms, having to accept the price that global agribusinesses were prepared to pay. Australian dairy farmers can now identify with this feeling.
In the recent American elections, George W Bush was given large donations from drug, chemical, energy and food manufacturers. They will all expect major returns for this support, and as an interim measure, drug industry executives have been appointed to top adviser positions. Recently, with consumer health concerns mounting about genetically modified food and its lack of labeling caused a Bush administration solution of appointing a Monsanto executive to fill its top regulatory position.
Monsanto is the company environmentalists love to hate.
It is a measure of the concerns that globalisation is arousing that you have to wander the globe to get some sort of big picture.

Meanwhile, back in Australia, just as we go to press, another controversial appointment has been made to PBAC in the form of Mathew Blackmore, an executive of the Consumer Health Forum (CHF).
The Australian Consumer's Association allege conflict of interest, because the CHF have received sponsorship monies from pharmaceutical companies in the past.
And where is Dr Wooldridge in this hour of crisis?
Well he has taken an unpublicised trip to Tibet as a guest of the Chinese government examining Chinese health programs.
I guess you couldn't get a more politically remote or quieter place at this moment.
Just what benefit it brings our national interests, I await with bated breath.
Perhaps we are about to get Traditional Chinese Medicines as National Health Benefits?
As Australian pharmacists are considered mere plankton in this food chain of global enterprise, with its Byzantine twists and turns, we must consider that no matter what agreements that have been negotiated between the Pharmacy Guild and the Federal Government, any benefits could quickly evaporate.
It is my belief that global interests will eventually own the major share of Australian drug manufacture and distribution, and pharmacists could find themselves like their farmer counterparts....prisoners within their own "pharms".
ends

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EDUCATION

FROM JON ALDOUS   PHARMACY EDUCATION AND THE INFORMATION AGE

Despite wild fluctuations on the stock market in recent months there is still no doubting the potential for future growth in the IT sector.
The continuing roll-out of broadband Internet access to increasing numbers of Internet consumers opens up unimaginable possibilities.

A quick note for the less Internet-savvy:

Broadband Internet access is delivered via satellite, high speed cable (the same one used for suburban pay TV operations) or your existing phone line using technology known as DSL (digital subscriber line).
Telstra promised that by the end of 2002, 90 percent of the Australian population would have access to broadband Internet
The increased speed of broadband Internet access allows users to access streaming video and audio resources from the Internet Many areas of Sydney, Melbourne and Brisbane at least, can access broadband Internet in private homes. It is at least twice the cost of normal dial-up Internet at this time, but expect prices to fall as availability becomes more widespread.
Access to streaming video and audio, on-demand, would enable a wealth of multimedia educational resources to be sent via the Internet to consumers.
This would enable pharmacists for instance, to access footage of a CPE lecture or seminar in their own home or workplace, at a time of their choosing.
But with the widespread availability of presentation software such as Microsoft's PowerPoint, interactive computer-generated, audiovisual packages can be generated with little experience.
Traditional forms of education such as the seminar may become much rarer as computer programs deliver packages of information.
The idea of education via the Internet has been bandied around for many years and is now fast becoming common place.
The University of Nottingham in the UK, offers a postgraduate course for pharmacists, completely online, with no personal attendance necessary. This enables pharmacists in even the most remote areas of the globe to complete a certificate in pharmacy practice.
However, there are limitations.
Further qualifications in this path of study require supervised project work, which can't be provided at a distance of several thousand kilometres.
The possibilities are still intriguing.
The Virtual School of Pharmacy Practice in Nottingham, uses software called WebCT to deliver its assessment (visit http://www.webct.com ). This software developed at the University of British Columbia (in Vancouver, Canada), enables online exams to be set, with students logging in via the Internet to sit the exams and answer the questions during a given time frame.
Sounds more convenient than traditional exams!
Over 6 millions students have sat courses using WebCT worldwide since its introduction, in varying fields of study.
During my time at the University of Queensland (UQ), WebCT was used as part of the assessment of Business and Commerce students. Other similar Internet based assessment is now used in the BPharm degree for first year biology students.
They do a multiple choice and short-answer style exam using UQ's own BrainZone technology.
At the time of writing, the Federal Opposition in Australia has announced plans, if elected, to start an entirely online university, which would only charge students half the fees, and offer more than 100,000 places at any time.
The politicians appear to be convinced of the promise of online education, or at least its popular appeal.
You might be thinking there is a downside to online education, in that there is a lack of personal contact between teacher and student.
I can vouch now that the easiest way to contact lecturers at university these days is via email. They also seem to be quite taken with being able to give written help and advice very quickly without needing a personal consultation, that may eat up both their time and yours.
There will always be a need for personal contact in education, but the vast majority of queries are minor and can be handled in a less urgent manner such as via email.
So to put it all together, the learning resources, as full audiovisual extravaganzas, can be delivered via broadband Internet
Then after studying the material in your own time, you can log on to be assessed using software like WebCT, again at the time of your choosing.
Suddenly the time involved in attending CPE lectures seems an even excessive burden.
For a busy pharmacist working upwards of 50 hours a week this must surely seem a more relaxing way to keep up to date. The ever-expanding amount of knowledge that pharmacists are expected to learn, remember and then re-learn, will dictate that continuing education be inexpensive in terms of both time and money.
Those that can be responsive and meet the requests of pharmacists will succeed. And they'll most likely be doing at least some of it online.

Next time: What areas will we be studying in the future?
ends
The comments and views expressed in the above article are those of the author and no other. The author welcomes any comment and interaction that may result from this and future articles.

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MANAGEMENT

FROM LEIGH KIBBY HANDLING DIFFICULT STAFF

One of the most challenging issues in the workplace today is the minefield of interpersonal relationships.
Even given the Federal Government's move to change the ground rules, there are still a host of problems that confront CEOs and managers who do not walk warily with the "problem child".
Therein rests part of the difficulty.
The identifying label that can be placed upon the recalcitrant manager or errant staff member can cause as much anxiety, for all parties, as the offending behaviours themselves. If nothing else, the perceptions associated with the "troublemaker" can prevent any real capacity to address the situation with a win-win mind set.
The attitude which precedes any "problem solving" confrontation is, of course, the absolute and only starting place for dealing with the issue. The dilemma must be approached positively with a real interest in obtaining the best outcome for all parties, even the identified nuisance. This does not mean pandering to a problem and good leaders let staff vote themselves into, or out of, a job by their behaviours, efforts and their results.
However, it is critical to be aware that the human being who may be the focus of your attention has very real concerns of their own.
Most behaviour has some logic or rationale to it and can be understood given a clear appreciation of the beliefs and experiences that produced it. Also, the deviant amongst you might also be the most perceptive or have a point of view that can provide a strong point of insight because it is not bound by the usual workplace constraints.
They key to handling the situation well is to firstly listen to the person. Hear their problem and let them know what you have heard for they too have a story and its richness might be a treasure. Then, tell them story you see in their behaviours and the consequences of these.
If possible, jointly develop a personal change management strategy (the Alignment Plus approach is a good one) with clear goals and rewards (not necessarily financial).
Additionally, although starting with positive reinforcements, it may be necessary to include clear consequences for noncompliance.

VALUES is a step by step by step process to follow for winning with difficult staff:

· Valuing - the staff member and the situation, can ensure the best attitude for creating a win. You might be receiving a gift with wrapping paper you don't like but first you have to unwrap the gift;
· Attitude - yours is the only one you can control so seek to be positive with the individual involved;
· Listening - hear the story, its meaning and the emotions it carries then communicate that you have heard these;
· Upset - can be alleviated when it is heard and understood, then change can follow;
· Expectations - release these and any judgments seeking first to learn, remaining clear and keeping your guidelines and principles intact and internal; and
· Story - having heard the speaker's story, help them sort fact from fiction and jointly create a new myth which sets out a plan that will meet the needs of all parties, if that is possible.
In the end though, the cost of nonconformance needs to be weighed against the benefits gained by keeping the person on.
A strong leader will make the best choice, either way, and not be swayed by fear of the consequences.
ends

The comments and views expressed in the above article are those of the author and no other. The author welcomes any comment and interaction that may result from this and future articles, and can be contacted directly by
e-mail at kinematic@bigpond.com , or you can visit Leigh's website at http://www.kinematic.com.au .
Alternatively, the editor would be pleased to publish any responses directed to neilj@computachem.com.au .

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RURAL AND REMOTE

FROM A GUEST COLUMNIST ROUNDUP Innovation needed

A regular column devoted to Rural and Isolated Health Issues
(N.B.The photograph is taken from the Pinnacles, an unusual rock formation, just outside of Broken Hill, NSW. Australia)

It is time the people in charge realised that looking after a community in a remote part of Australia is not the same as in the suburbs.

It is time to look at new ways of doing things like remote controlled dispensing.
That came to the surface over a year ago and we never heard any more of it. What's happened?
Is Australia not good enough for that technology?
It would be great to have one in a remote community to be operated on line from a pharmacy some hundred(s) of kilometres away?
Eighteen months ago there was a news item which can be viewed at:

http://www.auspharma.com.au/Press_Releases/press_releases.htm

Any contribution from readers as to where this has gone will be printed next edition. ends

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THE NATIONAL RURAL HEALTH ALLIANCE

Want to subscribe to another interesting newsletter?
The National Rural Health Alliance has a publication dedicated to news and reviews of all aspects of rural health. You can subscribe on the website at http://www.ruralhealth.org.au or you can contact the independent editor, Jim Groves, at grovesc@winshop.com.au

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The directory also contains a very fast search engine for Internet enquiries

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