Jump To:MEETING 1 SUMMARY
Date: July 15, 2020
The first Community Practice Environment Advisory group meeting focused on orienting members to the College’s Community Practice Environment Initiative. This multi-stakeholder Advisory Group will develop principles to be used as a foundation for a system of behaviour that enables safe, quality practice and supports patient safety in community pharmacy.
Members discussed the definition of “principles” and commented that examples would be helpful for distinguishing this work from the development of policies, standards or guidelines. Similarly helpful would be information on the experiences of other jurisdictions and insight into any research on the connection between the practice environment and the pharmacy professional’s experience of providing pharmacy care.
Stakeholder engagement is a key component of the principles development process. An overview of the plan to engage pharmacy professionals and patients through online focus groups and consultations was provided. Members provided insight into other stakeholders that might provide helpful insight, including pharmacy assistants, pharmacy professionals who are earlier in their careers, and relief pharmacists.
Shared accountability amongst all pharmacy stakeholders was discussed. Members of the group commented on the Terms of Reference, and made suggestions to enhance the clarity of the purpose and scope sections. The Terms of Reference were carried forward for further discussion at the next meeting.
MEETING 2 SUMMARY
Date: July 23, 2020
The second Community Practice Environment Advisory Group meeting focused on reviewing the definition of a ‘principle’ and examples from other organizations, and reflecting on the information presented through an environmental scan that was circulated after the first meeting.
Principle (Oxford Dictionary): A fundamental truth or proposition that serves as the foundation for a system of belief or behaviour or for a chain of reasoning.
Examples:
Association of Health Care Journalists
American College of Physicians
Institute for Healthcare Improvement
The members noted that the principles that will be developed should provide clarity to support behaviour without being so high-level that they become difficult to implement.
The group commented that concerns raised by registrants about time constraints, low staffing levels, and managing increasing expectations from patients and employers are not isolated issues and are being felt across community pharmacy alongside other areas of the health system. There was recognition that there is an opportunity to respond to the issues being raised about the community pharmacy practice environment by starting with the development of principles of shared accountability that will support culture change.
After reviewing the jurisdictional information from the UK, US, Saskatchewan and Nova Scotia and the research related to stress, burnout, and the concept of psychological safety and team effectiveness, members shared that additional information on best practices from community pharmacies is available and could support the goal of culture change. Advisory Group members offered to share best practices from their organizations with the rest of the group.
Discussions from this meeting noted the following early themes:
- Public expectations and public education
- Culture change and continuous quality improvement
- Evaluating practices and learning from each other
- Connection between operational performance and patient outcomes
- Leadership and training for pharmacy managers
An interim update was provided on the stakeholder engagement process. To date, four focus groups (conducted by a 3rd party firm) with community pharmacy patients exploring their expectations and opinions about their pharmacy care have been completed. Preparations are underway to recruit pharmacy professionals for upcoming focus groups. The Advisory Group will receive an analysis of the patient focus groups at the next meeting in August, and the analysis of the registrant focus groups at the fourth meeting in September.
Finally, an updated Terms of Reference was circulated prior to the meeting. Edits had been made for clarity, with the addition of a section that outlines the group’s scope and when the work of the group will conclude. The updated Terms of Reference were accepted by the Advisory Group and are available on the Community Practice Environment Initiative webpage.
MEETING 3 SUMMARY
Date: August 11, 2020
The third Community Practice Environment Advisory Group meeting focused on discussing the themes that have been identified thus far in the process, and reviewing a preliminary analysis of the focus groups conducted with patients and caregivers.
The themes identified thus far include themes from the environmental scan, as well as early themes from discussions at the second meeting.
Themes that emerged from the environmental scan can be summarized as:
- Community pharmacy professionals are experiencing increasing levels of stress, and are at risk of burnout
- Health professionals experiencing burnout can be a risk to patient safety; can negatively affect patient outcomes
- Lack of psychological safety can negatively affect team effectiveness
Themes that emerged from the discussions at the second meeting were:
- Public expectations and public education
- Culture change and continuous quality improvement
- Evaluating practices and learning from each other
- Connection between operational performance and patient outcomes
- Leadership and training for pharmacy managers
The Advisory Group reflected on these themes and shared experiences and insights from their own perspectives that supported and expanded on points raised during the discussion at the previous meeting. Members shared that the experience of pharmacy professionals will vary across practice environments, that there is value in identifying the barriers that exist within the practice environment that influence how pharmacy professionals practice their profession, and that beyond the need for guiding principles are practical and structural barriers that should be addressed.
College staff shared a preliminary analysis of the information collected through four focus groups held with pharmacy patients. The feedback related to 5 domains:
- Patient Safety – Participants overwhelmingly felt that their pharmacy and pharmacist(s) were providing safe patient care, and had their safety as a top priority.
- Trust – Participants overwhelmingly indicated that they trust their pharmacist, and this trust supports their feeling that their safety was a top priority.
- Privacy – Participants noted that a lack of privacy can be an issue, and indicated a preference for the use of a private room or a phone call to discuss sensitive matters.
- Patient Identity – Some participants identified as a patient of the pharmacist, while others identified with being a customer of the pharmacy. The identity aligned with expectations, where customers expect quick transactions and patients expect dedicated time with the pharmacist.
- Pharmacy Environment – A busy pharmacy environment affected the likelihood that some participants would ask questions or wait to consult the pharmacist, though there were no concerns expressed by participants about the overall effect busyness may have on their safety.
The full report on the focus groups with patients can be found on the College’s website.
It was acknowledged that focus groups provide the opportunity to hear from participants through rich discussion about their personal experiences. Though participant numbers are smaller and are accepted to be non-representative samples of the broader patient population, they provide valuable qualitative information through a validated approach involving an independent third-party facilitated and moderated discussion. The insights gleaned from the focus groups are part of several sources of information, both qualitative and quantitative, that the College and the Advisory Group will review and consider in the development of accountability principles.
MEETING 4 SUMMARY
Date: Sept 15, 2020
The fourth Community Practice Environment Advisory Group meeting focused on reviewing a preliminary analysis of the focus groups held with pharmacy professionals practising in community pharmacy.
The College regularly seeks registrant input on initiatives, policies and practice-related issues through engagement activities such as consultations, surveys and regional meetings. For the Community Practice Environment Initiative, it was important to build off of what registrants have shared with the College through past consultations. Using this information as a starting point, the first engagement was planned to be with a smaller group of registrants to identify common concerns. This would be followed by a survey that engages with all registrants practising in community pharmacy to confirm whether the concerns raised resonate and to assess the perceived level of impact these concerns have on their ability to provide safe, quality patient care at all times.
One focus group was held with registrants occupying specific roles within community pharmacy: (1) Staff Pharmacists, (2) Staff Pharmacy Technicians, (3) Designated Managers, and (4) Pharmacy Owners.
College staff shared a preliminary analysis of the information collected through four focus groups held with registrants. The feedback related to five domains:
- Time Constraints – Across all roles, participants overwhelmingly expressed that time constraints affect their experience providing pharmacy services.
- Public expectations around prompt service, managing challenging organizational metrics and/or targets, and the time it takes to communicate with other health professionals were identified by participants as specific contributors to experiencing time constraints.
- Participants shared that they feel rushed, are multi-tasking and feel like there is limited time to review the patient’s profile or to conduct a double-check prior to providing a patient with their medication. A majority of participants expressed concern that rushing contributes to the risk of medication errors, and that time constraints contribute to the prioritization of dispensing services over consultation services and clinical pharmacy care.
- Performance & Human Needs – Participants who were staff pharmacists and pharmacy technicians, as well as designated managers reflected on organizational performance expectations, and noted that human needs (such as rest, nourishment and hydration) are not consistently factored into day-to-day operations.
- Expecting speedy pharmacy-patient interactions, combined with a revenue model that is heavily dependent on the number of prescriptions dispensed, and feeling an obligation to the patient first while also managing the workload were identified as specific contributors.
- Participants shared that to manage the workload within resource allocation parameters, they may work longer shifts or may go long periods of time without food, water or a break to use the facilities and that this can lead to difficulty concentrating.
- Privacy – Participants noted that the ability to maintain privacy varies by pharmacy size and layout, and that the ability to maintain privacy was made more difficult by public health measures in place during the pandemic (e.g. Plexiglas, masks, distancing requirements).
- Providing patient assessments at the counter is common in community pharmacy, and was noted as a specific barrier to privacy when considering that many pharmacies are small, may not have a private counselling room, or that patients don’t know they can request access to a private space when speaking with their pharmacy professional.
- Participants shared that some patients may self-censor by not asking questions when receiving an assessment at the counter, and that the counter contributes to pharmacies feeling more like dispensaries rather than a place to receive clinical pharmacy services.
- Not Part of Health Care Team – Participants overwhelmingly identified that pharmacy professionals are not considered part of the health care team by the public or by other healthcare providers.
- Unclear privacy rules, being unable to access the reason for a prescription, and patients seeing themselves as customers were identified by participants as contributors to the experience of not being part of their patient’s health care team.
- Participants agreed that they experience resistance from other health care professionals when asking for patient information, and that pharmacy services may be provided without access to patient information. All participants expressed concern for the risk of harm this presents to patients.
- Not Practising to Scope – Participants reflected on their ability to practice to their full scope and noted that the full scope of pharmacy technicians is not consistently used.
- Some participants who were not pharmacy technicians shared that they were unclear on the scope of technicians, while others indicated that in their areas there were not enough technicians available for hire. Other contributors identified by participants included having limited resources to hire technicians, and being unable to compete with hospital salaries and working conditions when hiring for technicians.
- Pharmacist participants expressed that without technicians they are unable to dedicate the time needed to provide clinical services.
- Others noted that management may not be clear on the benefits of the technician role when compared to pharmacy assistant roles and this limits pay and scope for technicians who are hired as assistants.
The full report on the focus groups with registrants can be found on the College’s website.
The Advisory Group was asked to review a list of statements that would be presented to registrants practicing in community pharmacy through an online survey. Registrants will be asked to indicate the level of impact each statements has on their ability to provide safe, quality care at all times. Feedback was received and the survey to registrants was scheduled to launch September 18th – October 1st. Results of this survey will be presented to the Advisory Group at the next meeting in October.
MEETING 5 SUMMARY
Date: Oct 13, 2020
The fifth Community Practice Environment Advisory Group meeting focused on reviewing the results of a survey conducted with registrants who practice in community pharmacy.
The purpose of the survey was for community pharmacy professionals to provide their assessment of the impact practice environment-related concerns that have been raised through previous engagements have on their ability to practice to standard. The survey was sent to all registrants in a letter emailed from CEO and Registrar Nancy Lum-Wilson on September 18th. The survey closed on Oct 1st, and received 2135 total responses. After removing duplicates and non-responses, 1830 responses were valid for analysis.
The vast majority (90%) of respondents were Part A pharmacists. Of the 1640 Part A pharmacists, 34% were Designated Managers and 21% owned a pharmacy. Pharmacy Technicians accounted for 102 responses. A good range of community pharmacy types were represented, with responses indicating practice locations in chain-owned (41%), independently-owned (31%), franchise-owned, (20%), and other practice locations (8%) such as hospital-owned community pharmacies and family health teams.
Respondents were asked to indicate their level of agreement with observations previously made through focus groups and consultations, as well as to review 26 practice environment-related concerns and indicate the level of impact each has on their ability to provide safe, quality care to patients at all times.
A majority of respondents agreed that:
- The day-to-day experience of providing care in their pharmacy could lead to stress and burnout (84%).
- They are concerned about their ability to adapt to clinical practice changes (71%).
- Their ability to meet the standards of practice is affected by workload and operational demands (73%).
- They have less time than they need to provide patient-centred care (78%).
- They are concerned about the risk of medication errors (78%), and about their ability to provide safe, quality patient care at all times (74%) in an increasingly challenging practice environment.
Twenty-six statements capturing the spectrum of practice environment related concerns that the College has been made aware of were presented to registrants grouped into categories: Professional Requirements; Practising to Scope; Use of Technology; Physical Environment & Privacy; Part of the Patient’s Circle of Care; and, Public Expectations.
The top five statements that respondents indicated had the most impact on their ability to provide safe, quality patient care related to public expectations of pharmacy professionals and feeling an obligation to put the patient and workload obligations ahead of their personal biological needs.
A report summarizing the findings of the Community Practice Environment Registrant Survey will be posted to the College’s website once finalized..
The Advisory Group discussed how there is a connection between public expectations for immediate service and response from pharmacy professionals, and their ability to take the time needed to process prescriptions or provide a professional pharmacy service according to standard. Advisory Group members shared experiences of managing patient expectations for immediate service, and reflected on the range of expectations from patients based on what they know about pharmacy and what they have been encouraged to expect.
Some members of the Advisory Group shared information on practice supports available to pharmacy teams, and insights into the patient experience and the opinions of pharmacy staff collected through internal surveying.
The Advisory Group discussed how to transform the information and insights gained into principles that will provide a foundation for improving the practice environment and the experience of providing pharmacy services in community pharmacy settings. It was confirmed that the principles will need to be at a level that can be translated to pharmacy-level action based on the context of the pharmacy and the pharmacy team’s approach to implementation. There was consensus that the principles should relate to:
- Improving the public’s understanding of what pharmacy professionals do, and public expectations of pharmacy services
- Supporting the pharmacy team’s access to ongoing training and mental health supports
- A commitment to continuous quality improvement
- Technology, resources and tools to support practice
- Learning from others in pharmacy and interdisciplinary collaboration
- Targets that are reasonable and patient-centred
- Leadership and training for pharmacy managers
College staff will work to turn the information and insights received so far from the public, registrants and the Advisory Group into a draft principles document. This document will be circulated to Advisory Group members in advance of the next meeting on November 10th.
MEETING 6 SUMMARY
Date: November 10, 2020
The sixth Community Practice Environment Advisory Group meeting focused on reviewing draft principles and discussing the language and purpose of each.
Seven draft principles were presented to the Advisory Group for consideration and feedback. The principles relate to:
- Improving the public’s understanding of what pharmacy professionals do, and public expectations of pharmacy services
- Supporting the pharmacy team’s access to ongoing training and mental health supports
- A continued commitment to continuous quality improvement
- Technology, resources and tools to support practice
- Learning from others in pharmacy and interdisciplinary collaboration
- Measures that are patient-centred
- Leadership and training for pharmacy managers
Feedback was provided on the content and format of the principles, with a primary focus on ensuring that the language of each principle addressed the original concerns raised by registrants and patients. The Advisory Group discussed how the role of each stakeholder will inform how they apply the principle within their area of influence, noting that each stakeholder will have a role in identifying the issues within their environments and ways to respond in line with the principles.
Advisory Group members were asked to submit any additional feedback through email. College staff reviewed all feedback and updated the language of the principles to reflect the comments and suggestions received. An updated version will be circulated to the Advisory Group prior to the next meeting on December 1st.
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