ISSN 2052-6415 (Online) ISSN 1354 ... - Pharmacy Management

17

IN THIS ISSUE:● Impact Of An Integrated Medicines

Management Service (IMMS) OnPreventable Medicines-relatedReadmission To Hospital: A Pilot ParallelCohort Study

● Competency-Based Learning NeedsAnalysis Of Pharmacists At WesternHealth And Social Care Trust

● A Retired Industrial Pharmacist’s Tale:What I Wish I Had Known Before

● Home Oxygen Service Review (HOS-R)Pharmacist

● Will The Elastic Break?

● How To Be A Success At Failure

17JulyVolume Thirtythree

Number Three

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ISSN 2052-6415 (Online)ISSN 1354-0912 (Print)

Journal of Pharmacy Management

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Journal of Pharmacy Management Volume 33 Issue 3 July 2017

Impact Of An Integrated Medicines Management Service (IMMS)

On Preventable Medicines-related Readmission To Hospital:

A Pilot Parallel Cohort Study

Professor Nina Barnett, Krupa Dave, Devinder Athwal, Paresh Parmar,

Sunaina Kahe and Christine Ward

Competency-Based Learning Needs Analysis Of Pharmacists

At Western Health And Social Care Trust

Kathryn S. King and Dr. Alison J. Gifford

CLARION CALLA Retired Industrial Pharmacist’s Tale: What I Wish I Had Known Before

Dr Malcolm E Brown

FACE2FACEHome Oxygen Service Review (HOS-R) Pharmacist

Ameet Vaghela

MANAGEMENT CONUNDRUMWill The Elastic Break?

LEADERSHIP How To Be A Success At Failure

77

90

101

108

111

114

CONTENTS

BEST PRACTICE IN PHARMACY MANAGEMENT

73



Medicines are known to contribute to

approximately 10% of hospital admissions

and up to half of these may be

preventable. A paper in this edition

compares the rate of preventable

medicines-related readmissions in a

hospital where an Integrated Medicines

Management Service (IMMS) had been

developed in comparison to a traditional

service at another hospital within the same

organisation. The IMMS was found to

reduce the rate of preventable medicines-

related readmissions with a saving of £3

for every £1 spent on an IMMS

pharmacist. Hospital pharmacy managers

will find this to be a useful resource when

making a case to develop pharmacy

services to improve patient care.

A review of learning needs for

pharmacists has shown that they need to

improve their personal effectiveness and

develop their emotional intelligence. It is

suggested that proactive communication

and networking must be encouraged

using formal methods. Ttraining on

preparing workshops and educational

materials should be provided and

mentoring should be more widely

established. Methods discussed to

promote management and leadership

skills include learning from role models,

delegation and managing projects. It is

clearly important to identify staff learning

needs and make appropriate provision in

training if services are to be developed to

the highest possible standard. The work

reported here will provide a most useful

template for those who wish to conduct

a local needs analysis.

Clarion CallThere comes a time in every pharmacist’s

life when they need to consider

retirement. Leaving it until it is upon you

is too late. Consideration needs to be

given ahead of time to a raft of issues.

Finance is important but, as the article in

this section shows, there are many other

aspects that need some thought.

Will you wish to continue registration

with the General Pharmaceutical Council

or member/fellowship of the Royal

Pharmaceutical Society? Do you need to

attend a course relevant your outside

interests or hone some interpersonal

skills? How will you keep fit and healthy?

Will you want to do occasional work?

Will you need to build new networks?

These aspects, and more, are answered in

an article that will be of much interest not

only to those within striking distance of

retirement but to those who have some

years to go but need to start planning for

it now.

Management ConundrumThe issue of 7 day working is a topical

one that will be presenting challenges for

many, particularly when there is an

expectation that longer working hours

should be provided without additional

investment. The Management Conundrum,

which explores some thoughts about

how to handle such a situation, will prove

helpful to those in similar situations.

Face2FaceThis describes the role and duties of a

Home Oxygen Service Review Pharmacist.

Is that a role that would be helpful in your

organisation?

Leadership sectionSomeone once said to me “Show me

someone who has never failed and I’ll

show you someone who has never

achieved anything”. It’s a fact of life that

failure will happen at some point –

particularly for those who are developing

and ‘pushing the boat out’. How, then,

should you deal with failure or prevent a

fear of failure from becoming

overwhelming in the first place? The

article in this section will tell you!

EDITORIAL


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ADVANCE NOTICE

Autumn series of Pharmacy Management Academy Meetings

Make sure you save the date in your diary for your nearest meeting!

Further details and the topic will follow on the Pharmacy Management website atwww.pharman.co.uk .

Thursday 5th October North London

Thursday 12th October Cardiff

Thursday 19th October Manchester

Wednesday 1st November Stirling

Tuesday 7th November Gateshead

Thursday 16th November Birmingham

Tuesday 28th November Gatwick

Wednesday 29th November Leicester

Tuesday 5th December Bristol

Thursday 7th December South London

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Journal of Pharmacy Management

Journal of Medicines Optimisation

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77

BEST PRACTICE IN PHARMACY MANAGEMENT

Impact Of An Integrated Medicines Management Service(IMMS) On Preventable Medicines-related Readmission To Hospital: A Pilot Parallel Cohort Study Professor Nina Barnett,1 Krupa Dave,2 Devinder Athwal,2 Paresh Parmar,2 Sunaina Kaher,2 Christine Ward.2

1 Consultant Pharmacist, Care of Older People, Northwick Park Hospital, London North West Healthcare NHS

Trust & NHS Specialist Pharmacy Service; Honorary Reader, School of Pharmacy, University College London;

Visiting Professor, Institute of Pharmaceutical Science, Kings College, London.

2 London North West Healthcare NHS Trust

Correspondence to: [email protected].

Introduction

About £12.5 billion was spent in England

between 2012-2013 due to emergency

admissions.1 This is an important quality

outcome measure2 for hospitals in

England who may compare their

emergency admission with the national

figure, which is 5.3% for emergency

admissions (2012/2013). In addition,

hospitals are liable for penalty payments

when patients are readmitted as an

emergency within 30 days of being

discharged so local readmission rates are

also important. Data from the local Trust

indicates a readmission rate of 6.4%.3

Approximately 10% of all hospital

admissions and readmissions can be linked

to medication with up to half being

considered preventable.4,5 While there are

many reasons for preventable medicines-

related admissions and readmissions,

common causes include non-adherence,

taking specific high risk medicines, poor

communication between care settings at

care transitions and lack of monitoring.6-9

Abstract

Title Impact Of An integrated Medicines Management Service (IMMS)On Preventable Medicines-related Readmission To Hospital:A Pilot Parallel Cohort Study.

Author ListBarnett NL, Dave K, Athwal D, Parmar P, Kaher S, Ward C.

BackgroundMedicines are known to contribute to approximately 10% ofhospital admissions and up to half of these may bepreventable. A service, known as the Integrated MedicinesManagement Service (IMMS), was developed at a largegeneral hospital (A) to identify and manage patients at risk ofpreventable medicines-related readmission (PMRR) in order toreduce the risk of PMRR.

Objectives This study investigates the effect of the pharmacy IMMS atHospital A on the rate of PMRR in comparison to a traditionalUK hospital pharmacy service at Hospital B within in thesame organisation.

Method Hospital A: Between October 2008 - October 2014, 744patients were identified using the PREVENT© tool. IMMSpharmacists managed patients at risk of PMRR throughmedication reconciliation, review, consultation and, whereappropriate, undertook post-discharge follow-up.

Hospital B: From February until October 2014, 92 patientswere identified as at risk of PMRR who were then managed

Abstractwith a traditional pharmacy service.

Results Hospital A: 119/744 patients were readmitted within 30 daysof discharge. 2/119 patients (0.3%) were assessed as havinga PMMR.

Hospital B: Of 92 patients identified 17 (18%) were readmittedwithin 30 days of discharge of whom 4/17 had a PMMR(4.4%). The difference was statistically significant.

Discussion The IMMS pharmacists provided interventions to improvesafety and efficacy of medicines use, identifying and resolvingkey concerns which can lead to medicines-related problemspost discharge. This is supported by published literature.Consultations included using a coaching approach to supportmedicines adherence. Cross-sector, multidisciplinarycommunication with patients, carers and health/social careprofessionals supported safe transfer of care.

Conclusion IMMS statistically reduces the rate of PMRR, representing asaving of £3 for every £1 spent on an IMMS pharmacist. Widerprovision of this service has the potential to improve safetyand reduce cost for the organisation.

Keywords: medicine support, medicine safety, medicinesoptimisation, pharmacy interventions, medicines-relatedreadmissions.

Nina Barnett




Figure 1: PREVENT© - current version at the time of publication

PREVENT© CHECKLISTRefer patients with unmanaged complex medicines issues, modifiable through pharmaceutical care.

Patient Name: Name of Referrer:

NHS Number: Designation:

DOB: Contact no:

Address/Ward, Bed no Date of Referral: Site: NPH/ CMH /Ealing /E-CCG

Managed by:

If appropriate For Pharmacy Integrated Care Service (PICS) use only:

Date of Admission: Referral Accepted: Yes

Date of Discharge: No Reason ____________________________________________

Please circle relevant risk factors

Physical impairment

FRailty

adhErence issues/compliance support

cognitiVe impairment

nEwdiagnosis/exacerbation ofdisease

MediciNes relatedadmission/risk from specific medicines

culTural/social

Patient has difficulties with swallowing, impaired dexterity, poor vision, hard of hearing orpoor mobility which will impact on them taking medication.

Patient is identified as frail using validated methods e.g. Clinical Frailty Index (1 = very fit, 2 = well, 3 = managing well, 4 = vulnerable, 5 = mildly frail, 6 = moderately frail, 7 = severely frail, 8 = very severely frail, 9 = terminally ill).

Patient has not been taking their medicines e.g. various dispensing dates on medicines, norecent dispensing of medication, newly started on all medicines or cannot give names ofmedicines they are taking.

Patient has decided to stop taking all or some of their medicines which has led, or will lead,to worsening of their clinical condition.

Refer all new requests for compliance support.

Patient has a temporary or long-term condition which affects their mental capacity to safelytake medicines (including memory loss) e.g. confusion, delirium, dementia.

Admission is related to poor management of medication for a long-term clinical conditionor deterioration of organ system function e.g. renal, cardiac, epilepsy, diabetes.

Previous admission or A&E attendance within 30 days.

Depression, high level of stress, other mental health, alcohol or drug abuse.

Falls - include disease and medication related (exclude mechanical/alcohol related falls).

Patient is taking a high risk medicine: anticoagulants/antiplatelets, insulin/oralhypoglycaemics, NSAIDs, benzodiazepines, antihypertensives, diuretics, beta blockers,opioids, methotrexate, injectable medicines or drugs requiring therapeutic drug monitoringespecially with no monitoring which the patient is unable to manage.

Patient has a complex of medicine regimen, recent stop, start or change in medicines.

Polypharmacy or patient is unable to manage.

Patient cannot manage daily activities independently or has carers to help with dailyactivities but not medicines.

Patient has cultural beliefs around illness and treatment impacting on medication adherence.

Patient has social issues such as no fixed abode, unkempt, etc which impacts on themtaking medication.

Smoker.


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79

A local referral tool was created from the

literature and informed by pharmacy

practice, known as the PREVENT© tool (see

Figure 1, current version at the time of

publication. For the version used in the

study, please contact the author). This tool

has been designed and was developed over

time to identify risk factors for preventable

medicine related readmissions (PMRR)4-9

and, while the literature offers a number of

methods to target patients at high risk of

readmission, there is no nationally accepted

or validated method.10,11,12

The literature describes integrated

medicines management (IMM) services in

the USA, Northern Ireland and Sweden

which reduce preventable medicines-

related readmissions.13-16 In 2008, an IMM

service was introduced to Hospital A, a

658 bedded district general hospital with

one whole time equivalent (WTE)

experienced pharmacist (provided by two

half time pharmacists) during weekday

and working hours. The service was

managed and supervised by a Consultant

Pharmacist for Older People and key

components of the service, which has

been described in the literature,17 are

described in Box 1.

Objective

To pilot a comparison of the effect of a

traditional United Kingdom (UK) Clinical

Pharmacy Service with IMMS on reduction

in preventable medicines-related hospital

readmissions within 30 days of the first

discharge across two hospital sites.

Method

In Hospital A (active site, Northwick Park

Hospital), patients meeting the referral

criteria for a PMRR from any ward were

referred to and managed by the IMMS

team using the method outlined in Box 1.

This constituted the active group. Patients

who had risks not modifiable by pharmacy

were referred to the appropriate service.

In Hospital B (control site, Central

Middlesex Hospital), an approximately

200 bedded hospital within the same

Trust without IMMS, patients who met

the PREVENT© criteria for referral were

identified during a specified time period

and managed as per the standard clinical

pharmacy service. This constituted the

control group.

Pharmacy staff involved in the pilot

were trained to use the PREVENT© tool

(both sites).

Data collection

In order to achieve statistical significance

for the comparison, retrospective data

was collected on the 744 patients

referred to IMMS in Hospital A between

October 2008 and October 2014. Full

year data was available from October

2008 - March 2010 but information

technology challenges meant that only

samples of data were available thereafter.

Data was compared with Hospital B

where a statistician was consulted and it

was calculated that 92 patients from

Hospital B were required to compare to

the 744 in Hospital A. The data from

Hospital B was collected between

February and October 2014.

Box 1: Key components of the IMMS

• Medicines reconciliation on admission.

• Medicine optimisation e.g. stopping or starting medicines, titrating medicines to clinically effective doses.

• Patient-centred medicines consultations, including discussion of newly prescribed, stopped and changed medicines.

All members of the team received formal training in health coaching during 2014.

• Full documentation of medicines changes and monitoring required on the discharge notification sent to GPs and/or

pharmacies.

• Medicines-related discharge planning with patients, carers, health and social care teams in primary and secondary

care, including medicines compliance aid assessment where appropriate and medication counselling.

• Pre-discharge referral to primary care health and social care professionals as well as carers where necessary,

including referrals to community pharmacists for the New Medicines Service (NMS) or discharge Medicines Use

Review (MUR) where appropriate.

• Post discharge telephone follow-up with patient and/or carers to support medicines-related care.

“Approximately 10% of all hospital admissions and readmissionscan be linked to medication with up to

half being considered preventable.”



Readmission review

Using the Trust Hospital Admissions data,

information on readmissions at 30 days

was obtained for both Hospital A and B

for the periods studied. Data were

reviewed from the electronic discharge

summary for patients readmitted as an

emergency (excluding A&E visits only) by

two IMMS senior member pharmacists

and the reason for readmission was

classified according to clinical, social and

medicines-related. The readmission was

also classified as preventable or non-

preventable. Note that some patients had

more than one classification (see Box 2).

A Consultant Geriatrician, blinded to

the cause of readmission and hospital site,

peer reviewed all readmissions including

cause of readmission as preventable or

non-preventable and clinical, social or

medicine-related classification.

In addition, the Consultant Geriatrician

reviewed a random sample (1 in 10), of all

patients readmitted from both hospitals

and classified according to the same criteria.

A flow chart to illustrate Hospital A

and Hospital B data collection is

presented in Figures 2 and 3.

Statistics

A statistician was engaged to review the

data. Fisher’s exact test was used to

compare the data from Hospital B and

Hospital A as this data was binary and

readmissions were uncommon. In

addition, 95% confidence intervals and

risk ratio were calculated for both sites.

Box 2: Readmission classification examples and details for preventable medicines-related readmissions

Readmission classification

Readmissions can either be preventable (e.g. patient not taking their regular medicines as they are unable to obtain them) or

non-preventable (e.g. patient had a new diagnosis of depression).

The preventable readmission can be modifiable (e.g. arrange repeat dispensing and delivery of medicines through pharmacy

intervention) or unmodifiable (e.g. patient is homeless). While the IMMS team can contribute to reducing a preventable

medicines-related readmission through pharmacy interventions, other readmissions can only be influenced where there is a

medicines-related aspect to that readmission.

Readmissions can be classified according to clinical, medicines-related or social reasons. Clinical reasons may include patients who

are readmitted due to an exacerbation of a long term medical condition such as Parkinson’s disease, diabetes, heart failure, asthma

and chronic obstructive pulmonary disease, as well as chronic alcohol use and recurrent falls. Social readmission relates to, for

example, patients who have no fixed abode or GP, show signs of self-neglect, social isolation, housebound and patients unable to

manage tasks of daily living independently. These patients may require support with daily tasks through carers (informal or formal.

Medicines-related reasons include patients who have poor adherence and those prescribed a high risk medication but due to a

physical or cognitive impairment may not be able to take their medication safely. There are many medicines that can increase the

risk of a readmission if not taken as prescribed; examples include insulin, warfarin, antiplatelets, diuretics, oral hypoglycaemics,

antihypertensives and opiates. Poor communication on medicine changes between care settings may also lead to a readmission.9

Preventable medicines-related readmission data from Hospital A and Hospital B

• Patient was readmitted one day following discharge with diarrhoea secondary to laxatives use that were not reviewed on the

previous admission (Hospital B).

• Patient was readmitted with unresolved vomiting secondary to use of anti-tuberculosis medication (Hospital B).

• Patient with dementia readmitted with seizures secondary to non-compliance with anti-epileptic medication as patient had

carers but they would not support with medication unless in a compliance aid (Hospital B).

• Patient on warfarin for deep vein thrombosis (DVT), insulin and oral anti-diabetic medicines for diabetes was readmitted with

reduced mobility and treatment of DVT. On his readmission it was noted that he was non-compliant with medication due to

longstanding cognitive impairment, therefore his warfarin was stopped and arrangements were made to start LMWH for

treatment and for support with his other medicines, including district nurses to administer insulin ( Hospital B).

• Patient medication changes were not actioned by GP on discharge and patient readmitted as ran out of medication following

discharge (Hospital A).

• Patient was started on dexamethasone prior to admission for a tumour. However, the patient was intentionally non-complaint

due to fear of adverse effects from steroid therapy. Readmitted due to exacerbation of clinical condition that could have been

prevented with dexamethasone. Potential for prevention of readmission if the patient’s health beliefs had been explored more

during admission (Hospital A).


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81

92 patients identified at risk ofpreventable medicines-related

readmission at Hospital B(One in ten patients were

peer reviewed)

17 patients readmitted within30 days of discharge

NB: patients may have hadmore than one reason

for readmission

5 Medicines-relatedAdmissions

12 Non-PreventableClinical Admissions

3 Non-Preventable Social Admissions

4 preventablemedicines-related admissions

1 non-preventablemedicines-related admission

Note: Some patients have more than one reason for readmission so total readmission reasons exceed total Figure 3: Flow chart for patient numbers at Hospital B

119 patients readmitted within30 days of discharge

NB: patients may have hadmore than one reason

for readmission

744 patients identified atrisk of preventable medicines-related

readmission at Hospital A

13 Social Admissions

1preventable

12 non-preventable

116 Clinical Admissions

1preventable

115 non-preventable

10 Medicines-related Admissions

2preventable

8 non-preventable

Note: Some patients have more than one reason for readmission so total readmission reasons exceed total readmission. The majority of all cause readmissions identified were non-preventable.

Figure 2: Flow chart for patient numbers at Hospital A



Governance

The study was assessed by the Trust

Governance Committee and was deemed

to be a service improvement and did not

need ethical approval.

Results

ReadmissionsThe IMM team saw 744 patients for which

data was available in the pilot study period

of whom 119 (16%) were re-admitted to

Hospital A within 30 days of discharge,

with two (0.3%) of the readmissions being

identified as a PMRR (Chart 1).

92 patients were identified at Hospital

B of which 17 (18%) were re-admitted

within 30 days of discharge, 4 (4.4%) of

these patients were re-admitted for a

PMRR (Chart 2).

The difference between PMRR rates at

the two sites was statistically significant

(P<0.002, Fisher’s exact test) with a risk

ratio of 16.2 and 95% confidence

intervals of 3.0, 87.1.

ReferralsAt Hospital A, the most common reason

for referral to the service was to assess the

need for commencing a compliance aid.

At Hospital B, however, the main reason

for referral was cognitive impairment, non-

adherence to medication and risk from

specific medicines followed by compliance

aid support (Chart 3).

Interventions

Most interventions identified ongoing

medication problems for patients,

interventions made during the inpatient

stay and follow-up recommendations

post discharge (including community

pharmacist). Specifically, more than three

quarters of interventions (84%) involved

patient consultations. Half (50%)

included discussion with the patient’s

community pharmacist and one third

(32%) with their GP surgery (Chart 4).

CostAn IMMS patient episode was estimated at

4 hours per patient during the pilot. This

equates to 1 WTE (given 46 weeks/year

with 6 weeks leave) reviewing 460 patients

each year. Data from this pilot suggests

Preventable

Non-Preventable

140

120

100

80

60

40

20

01 1 2

115

128

Clinical Social Medical

Reason for Readmission

Nu

mb

er o

f Pa

tien

ts

Note: There may have been more than one reason for readmission. The majority of all cause readmissions identified were non-preventable.

Chart 1: Bar Chart showing the reasons for readmission within 30 days of dischargefor 119 patients at the Hospital A site.


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83

that, if 460 patients are seen, only one

patient would be re-admitted with a PMRR

compared to 20 when the service was not

provided. This suggests that 19 PMMRs

per year per pharmacist per site could be

avoided if the service had been provided

in Hospital B. Provision of the service at

Hospital A cost £49,974 per annum.

With over 95% of patients seen by

IMM pharmacists being older people, the

length of stay was estimated from Care

of Older People wards. This is nineteen

days at a cost of £444 per day (non-

elective emergency admission) and the

estimate of cost for one PMRR is £444 x

19 days = £8436 which, for 19 patients,

is £160,284. With a pharmacist cost of

£49,794, there is an opportunity cost of

£110,490. Our pilot suggests this equates

to a saving of over £3 for every £1 spent

on pharmacist or an return on investment

(ROI) of >2.

Discussion

With approximately 10% of hospital

admissions being medicines-related and

half being considered to be preventable,

our study showed that at Hospital A had

less readmissions than expected. From

local readmission data we would expect

6.3% of patients to be readmitted within

30 days. For the number of patients seen

in the study, this means 47 patients would

be readmitted with a PMRR at Hospital A.

By providing IMMS, this number was

reduced to 2. In comparison to Hospital B,

where 4 of 92 (4.4%) patients were

readmitted, there were only 2 of 744

(0.3%) readmissions, the difference being

statistically significant (p<0.002).

Scullin et al demonstrated that one

readmission was prevented for every 12

patients receiving an IMMS.14 Similar

services in other countries have

demonstrated benefits.15,16 The pilot study

data from Hospital A alone have been

published17 and the full data given here

concurs with findings from other centres.

While it is recognised that the data

presented here are pilot results, these

data suggest that provision of the service

could benefit the health care economy

with a return of over £3 per £1 invested.

Preventable

Non-Preventable

14

12

10

8

6

4

2

00 0

4

12

3

1

Clinical Social Medical

Reason for Readmission

Nu

mb

er o

f Pa

tien

ts

Note: There may have been more than one reason for readmission. The majority of all cause readmissions identified were non-preventable.

Chart 2: Bar Chart showing the reasons for readmission within 30 days of discharge for 17 patients at the Hospital B site.


Journal of Pharmacy Management Volume 33 Issue 3 July 201784 Chart 4: Interventions by IMMS pharmacy staff at Hospital A.

90

80

70

60

50

40

30

20

10

0

Perc

enta

ge

of

pat

ien

ts

84

Patie

nt consu

ltatio

n

22

32

50

2319

45

5

53

36 36

24

10 71

53

Med

icins O

ptimisa

tion

Discussi

on: GP

Discussi

on: Com

m Ph

arm

Discussi

on: Socia

l Car

e

Discussi

on: Dist

rict n

urse

Discussi

on: Hosp

ital c

linici

an

Arrange N

MS/M

UR

Info

rmal

care

support

Form

al ca

re su

pport

Med

icaca

tion co

mplia

nce ai

d

Med

icines

rem

inder

char

t

Post

disch d

iscussi

on care

r

Post

disch ca

ll to p

t.

Sign Po

sting

Dischar

ge note

annota

ted

Chart 4: Interventions by IMMS pharmacy staff at Hospital A.

30

25

20

15

10

5

0

Nu

mb

er o

f Pa

tien

ts

Hospital A

Hospital B

1210.4

5

10.8

17

19.7

26

13

21

17.8 17.815

3

10

Socia

l

Phys

ical

Cognitive

Impair

men

t

Med

icines

Com

pliance

aid

Adheran

ce is

sues

Spec

ific m

edici

nes ri

sk

New co

ndition/Ex

erbat

ion

Reasons for referral

Note: some patients had more than one reason for referral.

Chart 3: A bar chart to compare the reason for referrals via the PREVENT© checklist to the IMMS team between Hospital A and Hospital B site.


www.pharman.co.uk

85

This finding is in line, but with a lower

ROI, with data reported from other IMMS

sites where savings calculated including

opportunity costs suggested a return of

between £5 and £8 per every £1 spent on

service provision.18 Reasons may be that

other studies included costs associated

with admission and outside hospital costs

rather than cost of staff alone and

assessing readmissions over a longer time

frame.

Other benefits suggested by this

pilot include support for medicines

optimisation, including reducing

inappropriate polypharmacy and

improving transfer of care, which have

been highlighted nationally.19 The IMMS

team at Hospital A provided patient-

centred consultations using a coaching

approach and following NICE

recommendations7 prior to discharge, and

at discharge, documented medication

changes to improve safety at transfer of

care as part of medicines optimisation.20

This included discussion of perceptual and

practical issues around medicine taking as

well as education of patient and/or carer

regarding indications, adverse effects,

follow-up and ongoing monitoring.

Many of the interventions included

facilitating information transfer between

the patient, community pharmacist and

GP. Studies have shown that risk around

medicines can be minimised with good

communication8,9,21 and referral to

community pharmacists can reduce

length of stay by 50%.22 The IMM service

commonly liaised with social care as

patients needing help with activities of

daily living may also require assistance

with medicines.9,23,24,25

It is interesting to note that 36% of

patients had medication compliance aids

(MCAs) initiated at Hospital A whereas

Hospital B does not provide a hospital-

based compliance aid filling service for new

patients. This is likely to account for the

difference in interventions in this category.

However, interventions including MCAs at

Hospital A often resulted in alternative

medicines support being put into place.

This has been described recently in a study

of a hospital and primary care service

published by Lai et al24 who identify that

patients referred for compliance aids often

need individualised medicines support.

In terms of cross-sector working, there

are a number of published studies which

describe post discharge follow-up and its

contribution to improving care through

patient satisfaction24,26 as well as

reducing hospital utilisation and

admission.27-30 In a review of drug-related

problems in older people after hospital

discharge, the most effective

interventions in reducing drug-related

problems were considered as including

both discharge planning and home

“In a review of drug-related problems in older people after hospitaldischarge, the most effective interventions in reducingdrug-related problems were considered as including

both discharge planning and home follow-up.”

iStock.com/jorgeantonio

Inappropriate polypharmacy needs to be reduced



follow-up. The IMM team worked across

the interface, undertaking agreed post

discharge telephone calls to patients/

carers to support post discharge

medicines management integrated with

the multidisciplinary health and social

care team. Studies have shown that

post discharge follow-up helps promote

patient satisfaction24,26 and reduce

admission and hospital utilisation.27-30 In

this study the community pharmacist was

contacted to support adherence and

provide community pharmacy medication

services as appropriate.

As stated, studies suggest that causes

of readmission are multi-factorial and

that multidisciplinary team working

supports reducing overall readmissions to

hospital. A number of IMM services

similar to this pilot have also

demonstrated benefits of this type of

support,14,15,16,24,25 which begs the question

regarding rollout of IMM services. In

order to do this, a collection of

prospective data will be needed,

preferably including a number of sites

in primary and secondary care. An

exploration of other measurable outcomes,

which could include patient satisfaction,

will also be needed.

Bias and limitations

This study is a pilot to explore what is

possible in terms of data collection within

a hospital Trust. Several limitations to this

study are acknowledged including:

● lack of published data to guide the

study around methods of reducing

PMMRs

● discontinuous data collection from

Hospital A

● convenience sampling over a

different time period in Hospital B

● lack of detailed demographic data

● unmatched cohorts

● lack of standardisation of service

across the time period due to

evolving practice. Standard procedure

and forms minimised variation but

individualised care possibly limits

standardisation.

● readmissions collected over 30 days (a

longer period may have revealed more)

● PREVENT© checklist not formally

validated (although developed from a

literature review, has been peer

reviewed and aligns with other UK

tools).

While some pharmacists at Hospital B

knew about IMMS, Hospital B did not

provide the opportunity to undertake IMMS.

When Hospital B pharmacists identified

‘at risk’ patients and then managed them

as per usual ward management, they also

had an ethical duty to ensure that any

medication issues that they identified

were highlighted or addressed during the

admission if possible or on the electronic

discharge note so it could be actioned in

the next care setting or by the primary

physician. This may have led to GPs/social

care, etc acting upon issues highlighted

by the pharmacists that would not

previously have been identified and thus

prevented a medicines-related admission.

A different culture and availability of

pharmacy services at Hospital B

compared to Hospital A may have led to

different actions for the same problem.

Ongoing developments

The team has been renamed ‘Pharmacy

Integrated Care Service’ (PICS) to reflect

that services from the other sites will be

merged and that work will be across

disciplines and sectors of care.

The following is in progress:

● The service on all three sites is in the

process of being merged, with staff

in place on each site to undertake

identification and management of

patients in the risk group in

secondary care and, on one site,

primary care too.

● The data collection tool is being

updated to improve robustness of

data gathering and to add exclusion

criteria for the service to PREVENT© to

ensure that services are being

appropriately prioritised.

● PICS was launched on 6th June 2017.

Conclusion

Some medicines-related admissions and

readmissions to hospital are avoidable.

Reducing readmissions is better for

patients and for the health system. This

pilot study focussed on the provision of an

IMMS to deliver holistic pharmaceutical

care, identifying and managing high-risk

patients to reduce preventable medicines-

related readmissions. Results of this work

suggest that an IMMS team is a cost-

effective method to reduce PMMR.

Further work, such as a case control

prospective study, is required to confirm

or refute these findings.

Declaration of interests

The authors have nothing to disclose.

Acknowledgements

We would like thank Dr Joseph Devine for

peer reviewing the cases, Mr Paul Bassett

for statistical analysis and Professor

Michael Scott for his comments on the

paper.

“. . . an IMMS team is a cost-effective method to reducepreventable medicines-related readmissions.”


www.pharman.co.uk

87

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11. El Hajji FW, Scullin C, Scott MG, McElnay JC. Enhanced clinical pharmacyservice targeting tools: risk-predictive algorithms. J Eval Clin Pract.2015;Apr;21(2):187-97. doi: 10.1111/jep.12276. Epub 2014 Dec 15.Available from: https://www.ncbi.nlm.nih.gov/pubmed/25496483[Accessed 14 November 2016]

12. Barnett N, Athwal D and Rosenbloom K. Medicines-related admissions: Youcan identify patients to stop that happening. The Pharmaceutical Journal. 1April 2011. Available at: http://www.pharmaceutical-journal.com/learning/learning-article/medicines-related-admissions-you-can-identify-patients-to-stop-that-happening/11073473.article?adfesuccess=1[Accessed 14 November 2016]

13. Schnipper JL1, Kirwin JL, Cotugno MC, Wahlstrom SA, Brown BA, Tarvin E,Kachalia A, Horng M, Roy CL, McKean SC, Bates DW. Role of pharmacistcounseling in preventing adverse drug events after hospitalization. ArchIntern Med. 2006 Mar 13;166(5):565-71. Available from:https://www.ncbi.nlm.nih.gov/pubmed/16534045 [Accessed 14 November2016]

14. Scullin C, Scott MG, Hogg A, McElnay JC. An innovative approach tointegrated medicines management. J Eval Clin Pract 2007 Oct;13(5):781-8.Available from: https://www.ncbi.nlm.nih.gov/pubmed/17824872[Accessed 14 November 2016]

15. Gillespie U, Alassaad A, Henrohn D, Garmo H, Hammarlund-Udenaes M, TossH, Kettis-Lindblad A, Melhus H, Mörlin C. A comprehensive pharmacistintervention to reduce morbidity in patients 80 years or older: a randomizedcontrolled trial. Arch Intern Med. 2009 May 11;169(9):894-900. doi:10.1001/archinternmed.2009.71. Available from:https://www.ncbi.nlm.nih.gov/pubmed/19433702 [Accessed 14 November2016]

16. Hellström LM1, Bondesson A, Höglund P, Midlöv P, Holmdahl L, Rickhag E,Eriksson T Impact of the Lund Integrated Medicines Management (LIMM)model on medication appropriateness and drug-related hospital revisits. .Eur JClin Pharmacol. 2011 Jul;67(7):741-52. doi: 10.1007/s00228-010-0982-3.Epub 2011 Feb 12. Available from:https://www.ncbi.nlm.nih.gov/pubmed/21318595 [Accessed 14 November2016]

17. Barnett NL, Dave K. Athwal D, Parmar P, Kaher S, and Ward C. Impact of anintegrated medicines management (IMM) service on preventable medicines-related readmission (PMRR) to hospital: A descriptive study. European Journalof Hospital Pharmacy. Available from:http://ejhp.bmj.com/content/early/2016/11/01/ejhpharm-2016-000984[Accessed 14 November 2016]

18. Scott MG, Scullin C, Hogg A, Fleming GF, McElnay JC. Integrated medicinesmanagement to medicines optimisation in Northern Ireland (2000–2014): areview. Eur J Hosp Pharm 2015;22:222-228. Available from:http://ejhp.bmj.com/content/early/2015/04/13/ejhpharm-2014-000512[Accessed 14 November 2016]

19. Royal Pharmaceutical Society. Medicines Optimisation: Helping patients tomake the most of medicines. 2013.

20. Garcia-Caballos M, Ramos-Diaz F, Jimenez-Moleon F, Bueno-Cavanillas A.Drug-related problems in older people after hospital discharge andinterventions to reduce them. Age and Ageing 2010; 39:430–438. Availableat: http://ageing.oxfordjournals.org/content/39/4/430.1.abstract[Accessed 14 November 2016]

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22. Personal communication, Rachel Howard. Isle of Wight Medicinesoptimisation in vulnerable patients project, Jan 2015.

23. Moving patients,Moving Medicines, Moving Safely. Guidance on Dischargeand Transfer Planning. 2005. Available at: http://psnc.org.uk/wp-content/uploads/2013/07/Moving20Medicines20new1.pdf [Accessed 14November 2016]

24. Lai K, Howes K, Butterworth C, Salter M. Lewisham Integrated MedicinesOptimisation Service: delivering a system-wide coordinated care model tosupport patients in the management of medicines to retain independence intheir own home. Eur J Hosp Pharm 2015;22:98-101. Available from:http://ejhp.bmj.com/content/early/2014/11/03/ejhpharm-2014-000565[Accessed 14 November 2016]

25. Blagburn J, Kelly-Fatemi B, Akhter N, Husband A. Person-centredpharmaceutical care reduces emergency readmissions. European Journal ofHospital Pharmacy August 2015. Available at:http://ejhp.bmj.com/content/early/2015/10/01/ejhpharm-2015-000736

[Accessed 14 November 2016]

26. Dudas V, Bookwalter T, Kerr KM, Pantilat SZ. The impact of follow uptelephone calls to patients after hospitalization. The American journal ofmedicines 2001;111(9B)26s-30s. Available from:https://www.ncbi.nlm.nih.gov/pubmed/11790365 [Accessed 14 November2016]

27. Wright PN, Tan G, Iliffe S, Lee D. The impact of a new emergency admissionavoidance system for older people on length of stay and same-daydischarges. Age Ageing. 2014 Jan;43(1):116-21. Available from:https://www.ncbi.nlm.nih.gov/pubmed/23907007 [Accessed 14 November2016]

28. Talsma J. Post-discharge pharmacist follow-up as important as pre-dischargemed review. April 28, 2014. Available at:http://formularyjournal.modernmedicine.com/formulary-journal/content/tags/american-pharmacists-association/post-discharge-pharmacist-follow-imp?page=full [Accessed 14 November 2016]

29. Jack BW, Chetty VK, Anthony D, Greenwald JL et al. A ReengineeredHospital Discharge Program to Decrease Rehospitalization. A RandomizedTrial. Ann Intern Med. 2009 Feb 3;150(3):178–187. Available from:https://www.ncbi.nlm.nih.gov/pubmed/19189907 [Accessed 14 November2016]

30. Novak CJ, Hastanan S, Moradi M, Terry DF. Reducing unnecessary hospitalreadmissions: the pharmacist's role in care transitions. Consult Pharm. 2012Mar;27(3):174-9. Available from:https://www.ncbi.nlm.nih.gov/pubmed/22421517 [Accessed 14 November2016]


http://www.bmj.com/content/329/7456/15

https://www.ncbi.nlm.nih.gov/pubmed/20158287

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2000562/

http://guidance.nice.org.uk/CG76/Guidance/pdf/English


http://link.springer.com/article/10.2165/00044011-200323020-00005






http://ejhp.bmj.com/content/early/2016/11/01/ejhpharm-2016-000984


http://www.nao.org.uk/wp-content/uploads/2013/10/10288-001-Emergency-admissions.pdf

http://archive.hospital-pharmacy.com/doi/abs/10.1310/hpj4611-876

https://www.rpharms.com/resources/reports/getting-the-medicines-right

http://www.pharmaceutical-journal.com/learning/learning-article/medicines-related-admissions-you-can-identify-patients-to-stop-that-happening/11073473.article?adfesuccess=1

http://ageing.oxfordjournals.org/content/39/4/430.1.abstract

http://pathways.nice.org.uk/pathways/medicines-optimisation

http://psnc.org.uk/wp-content/uploads/2013/07/Moving20Medicines20new1.pdf





http://formularyjournal.modernmedicine.com/formulary-journal/content/tags/american-pharmacists-association/post-discharge-pharmacist-follow-imp?page=full




Pharmacy in Practice

Pharmacy in Practice is an online publication for pharmacists. The ultimate aim is to provide

information, advice and insights that will improve the practice of pharmacy.

Unusually in today’s pharmacy press, Pharmacy in Practice is edited by practising pharmacists

Johnathan Laird and Ross Ferguson, who are based in Scotland and between them have decades

of experience in pharmacy and publishing.

Moreover, while site content is useful for pharmacists throughout the UK and beyond, Pharmacy

in Practice only focusses on pharmacy news in Scotland, as despite the significant changes in

pharmacy compared to the rest of the UK, it is largely ignored by the pharmacy press. As an

online publication, we are responsive, relevant and reliable.

Pharmacy in Practice provides a collaborative platform for pharmacists to share their knowledge,

voice an opinion and inform their colleagues. Uniquely, we encourage our audience to be part of

the site through an open invitation to submit articles, and we engage daily with them on social

media and in person at events and conferences.

Our weekly CPD quizzes are very popular, as is our weekly dilemma which encourages reflection

on practice when faced with a difficult situation. Our weekly e-mail digest keeps people up to

date with the latest content.

We are delighted to form a professional partnership with Pharmacy Management as our ethos is

the same: to create confident clinical pharmacy professionals that can positively contribute to

improving the health of the nation.

We are incredibly excited about the future and have some great joint plans to support

pharmacists in their work and careers and to celebrate and promote their successes. We want you

to be part of that journey.


www.pharman.co.uk

89

We are delighted to announce that Pharmacy in Practice has teamed up with Pharmacy Management in a

professional partnership, with the aim of creating, supporting and delivering a number of pharmacy

projects that will benefit pharmacists and their teams.

As the official media partner for Pharmacy Management in Scotland, we are proud to be supporting PM

events this year, including the:

• Pharmacy Management Academy on April 26.

• Clinical Leadership in Pharmacy – Certificates Award Ceremony in Edinburgh on June 8 (Certificates

to be presented by Scotland’s Chief Pharmaceutical Officer, Professor Rose Marie Parr).

• Pharmacy Management National forum for Scotland on August 30, in Dunblane.

• Pharmacy Management Academy – Autumn Series.

Pharmacy in Practice’s Ross Ferguson said: “We have the same ethos: to help create confident clinical

pharmacy professionals that can positively contribute to improving the health of the nation.

Ted and his team have a range of skills and experience that fit nicely with ours and we look forward to

working with them on a number of projects.

We are incredibly excited about the future for the site and this collaboration, and have some great joint

plans to support pharmacists in their work and careers as well as to celebrate and promote their successes.”

Johnathan Laird said: "This professional partnership is something we are extremely proud of at Pharmacy in

Practice. We have many shared values so it feels like a perfect fit.

Like Pharmacy Management we aim to use the partnership to help pharmacists increase their competence,

but possibly as important to us is to help pharmacists increase their confidence too.

We have exciting plans and very much look forward to the journey together."

Ted Butler, Chairman of Pharmacy Management, said: “Scotland has long been a key focus for Pharmacy

Management and we introduced our ground breaking programme Clinical Leadership in Pharmacy there

before going to other countries in the UK.

We have some exciting plans for the future to support the profession and believe that Pharmacy in Practice

is the ideal partner



Competency-Based Learning Needs Analysis Of PharmacistsAt Western Health And Social Care TrustKathryn S. King, Teacher Practitioner Pharmacist, Altnagelvin Hospital, Londonderry and School of

Pharmacy, Queen’s University, Belfast; Dr. Alison J. Gifford, Postgraduate Programme Manager,

School of Pharmacy, Keele University.


Abstract

Title Competency-Based Learning Needs Analysis Of PharmacistsAt Western Health And Social Care Trust.

Author ListKing KS, Gifford AJ.

SummaryThis project aimed to identify the learning needs ofpharmacists employed within the Western Health and SocialCare Trust through learning needs analysis (LNA) to informtraining decisions. An evidence-based, contemporary,competency model approach to LNA was selected for use.Mixed methods were used with an online survey as theprimary, quantitative method and face-to-face, semi-structured interviews as the secondary, supporting method.Quantitative data was processed using descriptive statistical

Abstractanalysis and the interview data using thematic analysis. Theresponse rate to the questionnaire was 62 percent and all fiveinvited senior pharmacy managers (SPMs) agreed toparticipate in the interviews. The results showed thatpharmacists need to improve their personal effectiveness anddevelop their emotional intelligence. Proactive communicationand networking must be encouraged using formal methods.Training on preparing workshops and educational materialsshould be provided and mentoring should be more widelyestablished. Methods discussed to promote managementand leadership skills include learning from role models,through delegation and by managing projects.

Keywords: learning needs, LNA, competency, survey,interview.

Kathryn S. King

Introduction

An important method of establishing the

learning and development needs of

healthcare staff is through learning needs

analysis (LNA). Generally, a learning need

exists when there is a gap between what

is required of a member of staff to

perform their duties competently and

what they know and do.1 LNA will

identify the new knowledge, skills and

behaviours required to close this gap.

In 2015, senior managers within the

Western Health and Social Care Trust

(WHSCT) pharmacy department approved

a strategy for pharmacy staffs’ learning,

education and development (LED),

informed by a regional review of

development needs,2 observations,

workshops, and benchmarking. LNA was

proposed at this time to help identify

prevalent and appropriate learning and

development needs. Identification of the

same learning needs by a number of

individual pharmacists would facilitate a

departmental LNA3 and could inform a

LED action plan. The goal was to have a

workforce that has the right skills,

behaviours and training to support the

delivery of excellent healthcare and

health improvement.4

Literature review

A published search of the nursing and

healthcare literature between 1985 and

2003 identified 266 papers concerned

with LNA.5 The authors note that most of

these consist of ‘recipe book’ accounts of

how to undertake LNA. We searched the

electronic databases ProQuest and

EBSCO, and individual journals (pharmacy,

medical, nursing and health education)

for peer-reviewed publications in the

English language from 2005-2015 using

keywords ‘learning needs’, ‘learning

needs analysis’ and ‘training needs

analysis’. These searches produced 228

papers and, of these, 23 papers reported

identified learning needs.

Six papers explored learning and

development needs using competency

frameworks as the method, or the basis

to design the method, of data collection.

Researchers employed varying approaches

and methods to LNA in healthcare: seven

papers6-12 used qualitative methodology

to identify learning needs including

interviews, focus groups and participant

observation. Eleven papers13-23 used

quantitative methodology issuing either

postal or internet survey questionnaires

and five studies24-28 used mixed qualitative

and quantitative methods. Where

competency models were not employed,

authors designed questionnaires and

interview schedules using various methods

(for example, focus group findings,

literature reviews, reviews of existing

courses, theories and surveys), or used a

validated instrument appropriate to the

topic. These published studies tended to

focus on learning needs within a specific

subject, often seeking to gauge needs

across different professions or different


job roles in the same profession.

Overlapping learning needs within topics

and professions in these studies include

research activity, legal issues, clinical

practice and skills, communication/

interpersonal skills, health promotion,

evidence-based medicine, teaching and

learning from others.

Justification of approach

We opted for an evidence-based,

competency model approach for our LNA.

Competency models allow for a highly

targeted LNA as their design reflects the

knowledge, skills, behaviour and attributes

required by staff working at different levels

of practice. An NHS wide competency

framework, the NHS Knowledge and Skills

Framework (KSF) was introduced in

2004.29 It applies to all staff who are

employed under Agenda for Change (AfC)

terms and conditions, including hospital

pharmacists. Evidence indicates that the

KSF has recently been used, or considered

for use, by healthcare professionals to

conduct learning needs analyses.30-32 The

KSF is also capable of linking with other

nationally developed competencies that

have been externally quality assured and/

or approved.29 Two such pharmacy practice

competency frameworks are available, the

Foundation Pharmacy Framework (FPF)33

and the Advanced Practice Framework

(APF),34 endorsed by the Royal

Pharmaceutical Society (RPS) in Great

Britain through its Faculty.

Within this LNA, where the intention

was to inform training decisions, it was

important to identify other factors,

such as learning methods and learner

characteristics, which may have an impact

on individuals’ commitment to learning

and development.35 We therefore

introduced a career concept model,36,37

Schein’s Career Anchors (Box 1),38 into our

LNA. Schein’s model describes a broad

view of what is important to an individual

by combining talents, motives and values.

Where Schein’s theory has been tested in

pharmacists, career aspirations have been

reported to be influenced by life and age.39

Objectives

• To gather the views of the WHSCT

pharmacists regarding their learning

needs within key dimensions of the

simplified NHS KSF, which have been

mapped to professional competency

frameworks.

“. . . a learning need exists when there is a gap between what is

required of a member of staff to perform their dutiescompetently and what they know and do.”


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91

A learning needs analysis will identify what needs to be done to ensure staff perform their duties competently

iStock.com/vaeenma



• To determine how these pharmacists

would prefer to address their

identified learning needs.

• To ascertain career aspirations and

motivators for these pharmacists.

Method

The primary, quantitative method was

survey research, which facilitated inclusive

and anonymous coverage. Qualitative,

semi-structured interviews with senior

pharmacy managers to whom these

individuals report were used to provide

further insight into their learning needs

from a manager’s perspective and help

formulate a holistic, departmental view of

learning and development needs. The

face-to-face interviews were completed

during August 2015, and the online

questionnaire was launched in September

2015. The survey remained available for

completion for five weeks.

Questionnaire design

Competencies required in key KSF

dimensions (Communication, Personal

and People Development, Health, Safety

and Security (HSS), Service Improvement,

Quality, and Management and Leadership)

were mapped to recognised professional

frameworks (FPF and APF) at the

standards expected for AfC bands 6, 7,

8a/b and 8c/d, and to example job

descriptions to enhance the relevance

and depth of questioning appropriate to

pharmacists. Such mapping is not a new

occurrence having been performed by

other groups for pre-registration

pharmacists,40 for band 6 pharmacists41

and by other professions such as

physiotherapy and psychology.42,43

Survey questions were then

constructed using the mapped

competency model documents. We

designed an online questionnaire using

software powered by SoGoSurvey®

(www.sogosurvey.com). A range of

question types were used in the design

including open-ended questions, lists

from which participants selected

preferred responses, five-point Likert

scales, visual analogue scales and ranking

scales. Questions were also included to

ascertain which methods of learning are

Box 1: Definitions of the eight generally acknowledged Career Anchors

Schein’s Career Anchor

Technical/ Functional

General Managerial

Autonomy/ Independence

Security/ Stability

Entrepreneurial Creativity

Service/ Dedication to a Cause

Pure Challenge

Lifestyle

Definition

Primarily excited by the content of the work itself; prefers advancement only in his/her

technical or functional area of competence; generally disdains and fears general

management as too political.

Primarily excited by the opportunity to analyse and solve problems under conditions

of incomplete information and uncertainty; likes harnessing people together to

achieve common goals; stimulated (rather than exhausted) by crisis situations.

Primarily motivated to seek work situations which are maximally free of organisational

constraints; wants to set own schedule and pace of work; is willing to trade off

opportunities for promotion to have more freedom.

Primarily motivated by job security and long-term attachment to an organisation;

willing to conform and to be fully socialised into an organisation’s values and norms;

tends to dislike travel and relocation.

Primarily motivated by the need to build or create something that is entirely their own

project; easily bored and likes to move from project to project; more interested in

initiating new enterprises than in managing established ones.

Primarily motivated to improve the world in some fashion; wants to align work

activities with personal values about helping society; more concerned with finding

jobs which meet their values than their skills.

Primarily motivated to overcome major obstacles, solve almost unsolvable problems,

or win out over extremely tough opponents; define their careers in terms of daily

combat or competition in which winning is everything; very single minded and

intolerant of those without comparable success.

Primarily motivated to balance career with lifestyle; highly concerned with such issues

as paternity/maternity leave, child care options, etc. Looks for organisations that have

strong pro family values and programmes.

http://www.sogosurvey.com


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93

preferred by pharmacists and to identify

their Career Anchor.38

We piloted the questionnaire with ten

pharmacists from other Health and Social

Care Trusts in Northern Ireland and one

NHS Trust in England to assess response

burden and identify any components of

the questionnaire that were difficult to

complete. Feedback indicated that the

survey was lengthy and subsequently a

number of questions were removed.

Semi-structured interviewdesign

A semi-structured interview schedule was

developed to facilitate the face-to-face

interviews with individual senior pharmacy

managers (SPMs). Topics were identified a

priori, allowing the mapped competency

model approach to continue in this part of

the LNA. The interviews were held in the

individual SPMs’ office at their convenience.

Each interview was voice-recorded using

the Voice Memos app on iOS.

Ethical approval

The Director for Research and

Development at the WHSCT designated

this project a service evaluation therefore

research governance approval was not

required. The project proposal was

approved by the Keele University School

of Pharmacy Research Ethics and

Governance Committee. All participants

provided overt, informed consent.

Data analysis

Quantitative data from the questionnaire

was entered into SPSS® for descriptive

statistical analysis. Reliability analyses

were performed and Cronbach’s α values

exceeded 0.7 for all subscales within the

questionnaire indicating good internal

consistency. The non-parametric Kruskal-

Wallis test was used to identify the effect

of AfC band on response to some Likert-

scale questions. Thematic analysis was

used to process the qualitative data,

following a six-step process described by

Braun et al (2006).44

Results

Questionnaire results

The survey was issued to 55 pharmacists

and the response rate was 62 percent

(34/55). Respondents were mostly

female (n=29, 85%), accurately reflecting

the female: male ratio of pharmacists in

the department. Other respondents’

demographics are given in Table 1.

Communication

Communication skills most commonly

identified by pharmacists for development

were persuading or influencing, and

negotiating (n=26, 76.5% of cases). Two

further skills, motivating (n=20, 58.8% of

cases) and writing professional

documents (n=19, 55.9% of cases), were

also frequently selected.

Graph 1 is a boxplot showing the

distribution of perceived competence in

building working relationships amongst

respondents.The median (midpoint of the

ratings) for accepting feedback, knowing

when to ask for help, supporting

colleagues, being a role model and

having the respect of others was ‘usually’

with a positive dispersion i.e. the overall

pattern of response was between usually

and consistently. The median for giving

feedback was also ‘usually’ but with a

negative dispersion. There was a high

level of consistency for the statement

around accountability where the median

was ‘consistently’ competent. The range

of views was wide for some statements

as indicated by the long whispers.

Respondents largely felt able to share

and engage their thinking with others but

were less able to manage conflict (n=9,

26.4%), present work or research

externally to the Trust (n=9, 26.4%) or be

assertive (n=16, 47.1%) and were less

aware of others’ team roles (n=27,

79.4%). Band 8 pharmacists (n=22) were

asked additional advanced practice

questions around effective working

relationships. Participants predominantly

disagreed that they network and

influence the service at a national level, or

are a champion for a service or patient

group. They did, however, ‘agree’ that

they approach Trust colleagues from

other professions and people working at

other Trusts to offer support and ideas.

Personal and people development (PPD)

Respondents generally felt able to

consider their own development and

Characteristic n Percentage

Age (years) - -

18 to 24 0 0

25 to 34 13 38.2

35 to 44 15 44.1

45 to 54 6 17.6

55 to 64 0 0

65 or older 0 0

Agenda for Change (AfC) band - -

Band 6 2 5.9

Band 7 10 29.4

Band 8a/b 18 52.9

Band 8c/d 4 11.8

Table 1: Demographics of respondents (N=34)



contribute to the development of others.

They reported feeling less able to make

presentations externally to the Trust,

prepare educational materials and

solve problems. Band 8 respondents

indicated that they had learning needs

around managing performance, research

supervision and creating learning

opportunities for others. This group felt

they were consulted externally for advice

within their area of practice although a

wide variety of views was demonstrated.

Professional practice

Figure 1 shows the level of practice at which

respondents felt they were currently

working and the number of pharmacists

selecting this level of practice at each AfC

band. Most participants categorised their

level of practice as commensurate with

their grade. Participants were also asked

to list one way in which they could be

supported at work to develop. Three

themes were uncovered:

• Formal education including managing

budgets, attending courses and

conferences.

• Resources such as protected time for

LED, more staff and improved skill mix.

• Learning from others; for example,

consultant ward rounds, work

shadowing and discussions.

Participants appeared confident in

identifying problems in their area of

practice (Graph 2) but felt less able to

take action based on their own

interpretation of information. The widest

spread was seen with ability to solve

problems, which was affected by AfC

band (H (3) = 13.243, p = .004).

Quality

Pharmacists indicated a high level of

agreement in ‘consistently’ working in a

way that complies with legislation and

Trust policies. The median rating of

competence for managing resources,

supporting colleagues around medicines

governance, implementing guidelines or

policies and contributing to risk

management discussions was also

‘consistently’ but the range of responses

3 4

11

16

Foundation (band 6: n=2,band 7: n=2)

Advanced Stage I (band 7: n=5, band 8a/b: n=8)

Advanced Stage II (band 7: n=3, band 8a/b: n=11, band8c/d n=2)

Fig 1: Level of practice in area of work (N=34)

4

3

2

1I give

feedback tocolleagues

I acceptfeedback from

colleagues

I know whento ask

for help

I am a rolemodel for

others

I identifywhen a

colleagueneeds supportand provide it

I acceptresponsibility

for myown actions

I have therespect of

teams accrossthe department

Vertical axiskey:

1 = rarely

2 = sometimes

3 = usually

4 = consistently

Graph 1: Distribution of perceived competance in building effective relationships


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95

was greater. Recording their contributions

and influencing the governance agenda

showed a lower median of ‘usually’.

Service development, management

and leadership

Participants generally felt that they did

contribute to service development. Graph

3 indicates that managing a process of

change and managing performance

were prioritised for development by

participants whereas research methodology

was regarded as the least necessary by

many.

Preferred methods of learning

Graph 4 shows that participants prefer to

learn by attending workshops or seminars,

by doing and in discussion with peers.

Peer review, teaching, research and

mentoring are less favoured methods.

Career values and motivators

As displayed in Graph 5, respondents

selected the Technical/ Functional Career

Anchor most often, indicating that they

are primarily motivated by the content of

the work itself in their careers.

Pharmacists were also asked how they

envisaged their careers would have

progressed five years from now. Five

themes were evidenced:

Graph 3: Dot plot showing how respondents rank skills they need to develop to improve the service (band 7 and 8 pharmacists only)

Graph 2: Dot plot showing how respondents rate their ability for skills required in professional practice


• In the same job but continuing to

develop in that role.

• Achieve enhanced professional

recognition.

• Become an expert practitioner.

• Exert a strategic influence.

• Achieve a degree-credit qualification.

Semi-structured interview findings

All five senior pharmacy managers (SPMs)

agreed to be interviewed. Four major

themes were identified and confirmed

through data analysis.

1) The influence of behaviour on LED

Desirable behaviours included being

passionate, enthusiastic, assertive,

accountable, confident, resilient and

honest. Taking initiative and seizing

opportunities, adopting a questioning

approach, influencing others and

making decisions were also identified.

Commonly discussed was the need for

pharmacists to understand behaviour

better, reflecting on their own

behaviour, and identifying and

supporting the behaviour of others.

SPMs talked about the need for staff to

know others’ strengths and weaknesses

and have patience and tolerance.

Factors that they considered influence

behaviour towards LED include career

commitment and culture.

2) Ability as a primary requisite for LED

SPMs identified key abilities as having

vision, insight, the respect of others

and self-belief. They want pharmacists

to be reflective practitioners, self-

starters, able to hold their own in a

discussion, aware of their own

limitations and able to articulate


Graph 5: Histogram showing respondents’ Career Anchors by age

Graph 4: Histogram showing how respondents prefer to learn and develop


www.pharman.co.uk

97

concerns, and work effectively in a

team. SPMs described the relative

ease of recruiting into posts without

managerial responsibilities but the

difficulty into posts that have.

Methods for providing management

and development opportunities such

as identifying projects and delegating

tasks with managers’ support were

considered.

3) Formal mechanisms as a major

enabler of LED

A significant theme across all KSF

dimensions related to the effectiveness

of formal mechanisms and methods in

achieving objectives. SPMs described

degree-credit qualifications, appraisal and

continuing professional development

(CPD) as drivers for LED. Mentoring

and coaching were frequently alluded

to and peer review, as a development

rather than managerial tool, was

specifically mentioned by some.

Quality improvement methodology

was commonly discussed with the

observation that this has taken root

and projects are helping to develop

staff. The need to create opportunities

for pharmacists to learn from role

models and colleagues in a supportive

way resonated from SPMs. Being

research active, attending conferences

and skill mix review were discussed as

other ways to facilitate LED. Key to

the success of formal mechanisms

around LED was ‘timetabling these in’.

4) Barriers to developing advanced

practitioners

SPMs talked about perceived

communication silos, both within the

pharmacy department and the region

generally. They commented that

pharmacists can lack understanding of

their position and its importance, and

how they portray themselves and

are viewed by others. Certain SPMs

expressed a view that advancing

practice pharmacists were often

developed by other senior healthcare

professionals (such as designated

medical practitioners) rather than by

mastery level pharmacists in certain

practice areas. Time, money,

opportunities and priorities were also

discussed.

Discussion

Identified learning needs

This project has identified key learning

needs of pharmacists employed within the

WHSCT through LNA. Communication

weaknesses relate to individuals’ personal

effectiveness i.e. their ability to persuade,

negotiate, motivate and influence and

their emotional intelligence, which

encompasses handling emotions, self-

management, empathy and social skills.45

Pharmacists need to develop these soft

skills as evidenced by feeling less able to

manage conflict, make presentations or

be assertive and in situations where SPMs

have observed difficulties in human

relations e.g. understanding personalities

and personal styles. Similar learning needs

around interpersonal skills and recognising

the value of team members have

previously been highlighted by Rutter et al

(2012)7 and Hicks et al (2005)18 in their

needs assessment studies of healthcare

practitioners.

The finding that survey participants

considered they usually approach

colleagues offering advice and support or

are themselves approached for their

expertise contrasts with the perception of

SPMs around communication silos, and a

lack of networking and links with the

wider pharmacy community. Austin et al

(2005)9 and Power et al (2011)16 both

describe the important role of peers and

learning from others in their studies of

pharmacists’ attitudes to CPD.

Around personal and people

development, participants favoured

discussions and workshops as methods of

learning but have little experience of

preparing and delivering workshops, or

educational material (lower AfC grades)

that commonly facilitate discussion.

Respondents in a study of pharmacist

preceptors’ learning needs by Troung et

al (2012)25 indicated that being familiar

with small group teaching strategies

would be beneficial in developing others.

The SPMs’ view that mentoring and

coaching could be more widely established

is reflected in the questionnaire results.

Pharmacists are not consistently research

active and interestingly research was

rarely mentioned in the SPM interviews.

A majority of pharmacists felt they

were working at the Advanced Stage II

level of professional practice (defined as

an expert in an area of practice,

experienced; routinely manages complex

situations and a recognised leader locally/

regionally). SPMs would generally

support the view that pharmacists’

adroitness in their pharmacy practice

areas is good but not that abilities are

advanced in all other non-practice areas.

Observed difficulty in transitioning from

band 7 to 8a posts has previously been

reported in the pharmaceutical press.46

The existing momentum surrounding

quality improvement methodology and

its observed impact on developing

pharmacists may explain why quality and

risk management was not identified by

participants as a priority learning need.

SPMs identified managing and leading

“. . . participants favoured discussions and workshopsas methods of learning but have little experienceof preparing and delivering workshops . . .”



as a development need and responses to

the questionnaire statements addressing

man management, such as holding others

to account or managing performance,

confirm this development need.

Learning preferences, and career

motivators and values

This study provides evidence of

pharmacists’ preferred methods of

learning to managers commissioning or

selecting, and trainers providing or

facilitating, internal and external education.

Schein’s Technical/Functional Career

Anchor was most frequently selected as

describing what primarily motivates and

inspires pharmacists in their career and

this fits the ‘role culture’ seen within

hospital pharmacy departments.47 The

ability to work accurately has been

described by Ortiz et al (1992)48 as an

important characteristic for pharmacists’

job satisfaction.

Limitations of the study

Limitations to the study relate to its design

and objectivity. The use of competency

frameworks to design a broad LNA for

hospital pharmacists means that it will not

be all things to all people. It was not

possible to drill down to precise learning

needs for specific service areas or subjects.

Survey respondents were asked to self-

select their primary Career Anchor after

reading a brief description of Schein’s

eight Career Anchors. A more robust

measure may have been the career

orientations inventory, a 48-item

questionnaire. One of the researchers

practices alongside all participants in the

study and although steps were taken to

promote reflexivity, a researcher’s

background and prior knowledge will

have had an unavoidable influence.

Conclusion

Pharmacists need to improve their

personal effectiveness and develop their

emotional intelligence to enhance

communication, promote personal and

people development and enable effective

leadership. Proactive communication and

networking must be encouraged using

formal methods and learning shared with

the wider group. Establishing links with

the wider pharmacy community will also

reap benefits to individuals’ personal

development and their management and

leadership skills. Training on preparing

workshops and educational materials

should be provided to all pharmacists to

help facilitate communication and

discussion. Mentoring should be more

widely established to support personal

growth but also to help develop leaders

and ultimately with succession planning.

Methods discussed to promote

management and leadership skills include

learning from role models, through

delegation and by managing projects.

The design of this LNA is transferable to

other pharmacy staff groups using

recognised, practice-based competencies

and/or job descriptions, which can be

mapped to the KSF. The online survey has

already been adapted to gather the views

of the WHSCT pharmacy technicians,

support workers and administrative staff.

Acknowledgements

We would like to acknowledge Ms Anne

Friel, Head of Pharmacy and Medicines

Management at WHSCT for her

encouragement and support.


This project was submitted by Mrs King in

partial fulfilment of the requirements for

the degree of Professional MSc at the

School of Pharmacy, Keele University.

iStock/com/Halfpoint iStock.com/vaeenma

Pharmacists need to develop their emotional intelligence


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99

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“Pharmacists need to improve their personal effectiveness and develop

their emotional intelligence to enhance communication, promote

personal and people development and enable effective leadership.”


http://www.lpet.nhs.uk


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http://archive.ajpe.org/aj6901/aj690104/aj690104.pdf

http://onlinelibrary.wiley.com/doi/10.1211/ijpp.17.02.0003/epdf


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3887592/pdf/hpj4901-32.pdf




https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5110320/pdf/nihms6240.pdf




https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3379827/pdf/cjhp-65-202.pdf



https://www.health-ni.gov.uk/sites/default/files/publications/health/review-development-needs-report.pdf

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216421/dh_132087.pdf

http://archive.ajpe.org/aj6901/aj690104/aj690104.pdf

http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4090861.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3017526/pdf/1472-6920-10-92.pdf

http://www.pharmaceutical-journal.com/career/career-feature/implementing-and-updating-a-learning-needs-analysis-toolkit/10007278.article

http://www.nurseeducationtoday.com/article/S0260-6917(06)00030-X/pdf


33. Royal Pharmaceutical Society. RPS Foundation Pharmacy Framework. 2014.Available at: http://www.rpharms.com/development-files/foundation-pharmacy-framework---final.pdf [Accessed 301115]

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35. Hanson AL, Bruskiewitz RH and DeMuth JE. Pharmacists’ Perceptions ofFacilitators and Barriers to Lifelong Learning. Am J Pharm Educ 2007;71(4):1-9. Available at:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1959207/pdf/ajpe67.pdf[Accessed: 150317]

36. Derven M. Lessons Learned: Using Competency Models to Target TrainingNeeds. T+D 2008:68-73.

37. London Pharmacy Education and Training (LPET). Inspiration and Motivationand the links with Goal Setting and Personal Development Plans. 2008.Available from: http://www.lpet.nhs.uk [Accessed 301115]

38. Schein EH. Career dynamics: matching individual and organizational needs.London: Addison Wesley; 1978.

39. Rodrigues R and Guest D. Career anchors of professional pharmacists: testingSchein’s theory. Paper presented at 16th Congress of the EuropeanAssociation of Work and Organizational Psychology (EAWOP): Imagine thefuture world: How do we want to work tomorrow?; Germany; 2013 May 22-25.

40. London Pharmacy Education and Training (LPET). Guidance on Producing KSFOutlines for Pre-registration Trainee Pharmacists. 2010. Available from:http://www.lpet.nhs.uk [Accessed 301115]

41. Competency Development & Guideline Group and Cambridge UniversityHospitals NHS Foundation Trust. NHS Trust Band 6 Pharmacists KSF Outline:Operational Guidance on using General Level Framework (editions 1 & 2).2007. Available at:http://www.codeg.org/fileadmin/codeg/pdf/glf/KSF_full_Outline_Band_6_PharmacistswithGLFguidance.pdf [Accessed 301115]

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44. Braun V and Clarke V. Using thematic analysis in psychology. Qual ResPsychol 2006;3(2):77-101. Available from:http://eprints.uwe.ac.uk/21155/3/Teaching%20thematic%20analysis%20Research%20Repository%20version.pdf [Accessed 150317]

45. Goleman D. Working with Emotional Intelligence (Kindle edition). New York:Bloomsbury; 1999.

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http://www.csp.org.uk

https://www.rpharms.com/resources/frameworks/foundation-pharmacy-framework-fpf

https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Frameworks/RPS%20Advanced%20Pharmacy%20Framework.pdf

http://www.codeg.org/fileadmin/codeg/pdf/glf/KSF_full_Outline_Band_6_PharmacistswithGLFguidance.pdf

http://www.bps.org.uk/system/files/documents/pact_knowledge_and_skills_framework.pdf

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www.pharman.co.uk

101

CLARION CALLA section for passionate calls for action to further develop the contribution that

pharmacy can make to healthcare

A Retired Industrial Pharmacist’s Tale: What I Wish I Had Known Before Dr Malcolm E Brown, Sociologist and retired pharmacy manager, Beccles, Suffolk, UK.


Abstract

Title A Retired Industrial Pharmacist’sTale: What I Wish I HadKnown Before.

Author ListBrown ME.

SummaryPharmacy managers who plan and act could enhance theiremotional fulfillment and financial security on retirement. Thispaper offers opinion on the next stage of a career i.e.retirement. Sociologists Bourdieu and Weber inform it.Retirement is a rite of passage. You should plan and act for itmeticulously. Consider whether you wish to continueregistration with the General Pharmaceutical Council ormember/fellowship of the Royal Pharmaceutical Society. Evenif you leave both you will retain the mindset of a pharmaceutical

Abstract

scientist. You will no longer have patients whose interests youare bound to serve. However, people will still ask your opinionabout medicines. Practical advice includes attending coursespertinent to your outside interests and honing interpersonalskills. They will remain important. Refine the tale that you tellabout yourself to maximise your self-esteem. Maximise yourNHS pension; public service, compared with private, pensionschemes are a better investment for you. Start to spend onlarge or long term purchases such as a car, house or holidaybefore retirement. Remember the possibility of continuingoccasional practice. Stress should reduce. Work at keepingfit. Develop new social contacts.

Keywords: retirement, sociology, pension, interpersonal skills,keeping fit, Bourdieu, Weber.

Introduction

The common reaction of a Briton to a

colleague who has announced that he

or she is to retire is, “What are you

going to do?”

However, the reaction of the typical

Italian is, “Bravo! Is your hammock

comfortable? Is your cellar sufficient?”

“The relief! It felt as if a great weight

had fallen from my shoulders!” said one

retired pharmacist.

Some pharmacists retire with glee;

others, such as I, did not. I retired with

mixed feelings. Relaxation beckoned.

However, my career had rewarded me

with fulfilment and variety in community,

hospital and industrial pharmacy

including senior management roles.

I am now able to reflect upon what I

lost on retirement and what, with

hindsight, I should have done differently.

Human beings can plan; other animals

cannot. Famously, failure to plan is

planning to fail. It would be presumptuous

to suggest that my take on practice might

influence those still practising. One reason

is that what is ‘right’ for one generation

may be ‘wrong’ for the next. However, my

experience and, maybe, the odd

recommendation might be worth bearing

in mind especially for younger pharmacy

managers. For example, some time after

‘retirement’, I undertook two weeks

consultancy after which I returned to

retirement. “What’s the problem?” gushed

the recruiter levering me from retirement.

“Lots of people pop out of retirement and

pop back. Look at the judges!”

So I experienced the double shock of

again entering and leaving practice. The

Dr Malcolm E Brown

“. . .failure to plan is planning to fail.”




shock of the ‘strange’ is the stock in trade

of those, such as I, who write about

people - so I noted behaviours and fitted

into an explanatory framework.

Bordieu’s habitus formula

Learn from luminaries. I have borrowed

the qualitative ‘formula’ of the often-

cited, well-respected sociologist Bourdieu

(1930 – 2002).1 I show it in Figure 1.

Practice

You know what pharmaceutical

‘practice’ is.

Habitas

The ‘habitus’ is your disposition: your

lasting, acquired schemes of perception,

thought and action. It is how you are

socialised to perceive things as a

pharmacy manager. It is looking after

people (your patients) who have to trust

you and cannot look after themselves,

your drive to follow NHS guidelines and

so on.

Capital

‘Capital’ is your material (e.g. pension,

property, salary) and intellectual wealth.

The latter includes scientific knowledge,

your up-to-the-minute savvy about the

‘lie of the land’ in connection with top

management, attitude of clinical

consultants, inspections from all sorts of

authorities and so on. It could also

include the contents of a course on

planning for retirement; many are

available. If your NHS management will

not pay, it is well worth funding one

yourself. It is an investment in your

future. It seems unbalanced to be

saturated with training for working life

(say forty years) but benefit from none

whatsoever for retirement (say twenty-

five years). Ensure that your course does

not only cover financial aspects;

obviously, any financial opinion within it

should be independent.

Field

‘Field’ is structured social space with its

own rules, schemes of domination,

legitimate opinions and so on. One field

is pharmacy management. There, you

are responsible for overseeing

professional pharmaceutical aspects,

management, including personnel,

finance and staff pastoral care and

generally trying to juggle all the

crockery simultaneously.

Practice changes on retirement: a rite

of passage. The practice of pharmacy

metamorphoses into the practice of

retirement. Your practice might become,

for example, minding grandchildren. You

become the happily exhausted locum

responsible person. Your habitus loses

only its pharmaceutical professional and

practitioner dimensions. Your financial

capital may reduce. Your intellectual

capital may reduce or appear to do so in

the eyes of others.

Consider retaining registration as a

pharmacist. You would retain a

pharmacist’s title and prestige. You have

lived with that privilege for decades and

may not realise how much you would

miss it. However, remaining registered is

expensive and demands continuing

continual professional development

(CPD) and, if practising, insurance. You

might after a year or two perceive CPD as

a time-consuming chore that you simply

no longer want. CPD had just become

more paper or electronic labour that you

thought you had escaped. Things that are

more important crowd it out. Be aware

that, if you remain registered, community

pharmacist managers may ask you to do

community locums. Doing them may be a

shock. At the very least some supervised

training, probably unpaid, would be

prudent. I will delve into why people do

things later.

You might want to stay with the Royal

Pharmaceutical Society (RPS). You would

keep your post-nominal MRPharmS or

FRPharmS if you can bear to pay the £71

a year, if paid by bank debit. I still would

not feel ‘whole’ without them.

One retired chemist volunteered, “I

couldn’t bear not to be a member of the

Royal Society of Chemistry. It’s what I am.

It was so hard to get it. I’d be nothing

without it.”

Moreover, the RPS continue on

request to provide you with high quality

up-to-date focused information on

clinical or other queries. That is valuable

as friends may well ask you about taking

medicines, efficacy and so on.

Intellectual capital may increase;

retirement offers time to do what you

really want to do. Examples include

annihilating monsters within ‘EverQuest’,

cross-stitch, drawing, flicking through

YouTube, gardening, reading ‘free’ on-

line newspapers, relaxing with coffee and

newspaper, stargazing, travelling, and

tweaking your collection of digital

photographs using image-processing

software - or even reading Bourdieu.

His formula suggests that you can

remove the pharmacist from the retired

pharmacist by removal from the General

Pharmaceutical Council’s register but

you cannot remove the pharmaceutical

scientist. More specifically, the pharmacist

is socialised to be a practitioner,

professional, scientist and scholar. The

pharmacist stops being a practitioner

on ceasing to practise. The retired

pharmacist stops being a professional

when ceasing to be paid. Professionals

are, by definition, paid for their work,

otherwise it is ‘merely’ a hobby. However,

you do not lose all your pharmaceutical

knowledge. You retain, for example,

some understanding of the scientific

method absorbed during degree studies:

you remain a natural scientist. You also

remain a scholar. You remain learned onFigure 1: Bourdieu’s habitus formula

Practice = (habitus X capital) + field

topics

such as

pharmaceut i ca l

history, the aspirations of

behavioural science and CPD.

All manner of people will still ask you

about their, mainly clinical, concerns.

Topics such as mortgages, job insecurity,

Scouts/Guides, holidays, who is with

whom and university fees have waned.

The hot topic becomes ‘pills’– and you

remain comparatively expert. If you feel

that you still know enough, it is fine to

venture an opinion so long as you say

that you are retired.

What you lose is the privilege of trust,

when many people presented their

problems to you and you could help.

Practising pharmacists may become so

used to that situation that they are no

longer conscious of their prestige. You

should perhaps reflect upon that trust

and just how privileged you are.

Weber

The luminary sociologist Weber (1864 –

1920) is useful here.2 He said that there

were just four reasons for human

behaviour.

EgotismThe main one is egotism (self-interest).

You act because it is in your interest.

TraditionThe second is tradition, the great flywheel

of society. You act that way because of

habit.

AltruismThe third, far less common, is altruism. All

your professional life as a pharmacist you

are socialised, and bound by your code of

ethics, to put your patients first, before

yourself. Some sociologists argue,

perhaps over-cynically, that is merely a

generic marketing ploy by professions to

gain market share. Note that altruism only

counts if it is anonymous. If others know,

for example, that you have given to

charity that does not count: it is egotism

because

you increase

your prestige.

Such pontifications

may not make you feel

any better while you are

called into the hospital to dispense

an urgent medicine on a Christmas

morning when your children are opening

their presents.

AffectivityThe final reason, Weber only added for

completeness. It is affectively. You act

because you just like it such as putting a

sweetener in your coffee because you

have a sweet tooth.

Figure 2’s word cloud illustrates the

above points.

What changes in retirement is that you

no longer have patients so you can be

unashamedly egotistical. You can maximise

your income. At last, you should be able to

do what you want to do. So, perhaps,


www.pharman.co.uk

103

Figure 2: Weber’s reasons for behaviour

egotismtradition

altruismaffectivity

iStock.com/monkeybusinessimages



savour that fine malt with the newspaper

moaning about the winter NHS bed crisis

while sporting your favorite purple pullover.

Three practical tips

Three more practical suggestions for

practising pharmacists emerged from my

interpretation of Bourdieu’s formula.

Transferable skillsFirst, accumulate transferable skills. Seize

any courses at work connected, even

tenuously, with your hobbies or any

activity that you would like to develop.

For example, I love writing and speaking,

so report writing and public speaking

courses suited me. An MBA or similar

would be excellent. I know of no one

possessing an MBA who is poor during

retirement. I lack one. However, I knew

sufficient, having been a pharmacy

manager and starting my own business,

to help younger people develop theirs as

a volunteer with a retiree organisation

organised by the business school of the

University of East Anglia and as a mentor

for undergraduates. You can learn from

them and they help to keep you ‘young’.

I was asked to talk to science PhD

students about the real world of work

outside academia; it was a privilege.

Assisting individual pupils in a local

primary school with English or

mathematics is another possibility.

Your interpersonal skills are presently

high. Seize any mentoring or similar

opportunity to polish further. They are

perhaps the most valuable skills that you

can transfer to retirement. People will ask

you to take assorted roles. Be careful. Do

not take on so much to satisfy other

peoples’ needs that you lack time to fulfil

your own dreams. Interpersonal skills will

help you make new friends to replace

some work colleagues. Despite close

collegiate relationships, after a few years,

contact with them tends to diminish. So

join, now, clubs and local societies

unconnected with work.

MemoriesSecondly, you will possess many

memories. The most vivid are when you

were emotionally involved. For example,

one trauma was in 1994 when the NHS

made me redundant. I was furious. How

dare lay individuals make a pharmacist

manager redundant? My naivety was

extreme. Actually, they did me a favour

by opening a plethora of opportunities,

especially in pharmaceutical consultancy.

However, my redefinition of that tale

from tragedy to heroic saga demanded

continuing exertion: work. My heart goes

out to those pharmacists and others

presently being made redundant for the

pain that they will suffer. However, the

sooner they perceive those threats as

opportunities the better. During your

work, you will have had some really good

times. For example, you may have

travelled. You may have met some top

people. You will have seen how some

organisational wheels rotate within

wheels and how people work, or jostle

together, in groups. Your practice has

become slicker. You have been trusted to

write countless references. Occasionally,

you may have been thanked.

After retirement, you may feel

perceived as a seldom-visible subordinate,

iStock/com/Halfpoint iStock/com/Halfpoint

Keeping fit and healthy is important


www.pharman.co.uk

105

a grey-haired bed-blocker, no longer

contributing anything to the economy

and only taking. However, you have been

privileged to have held a high visibility

post wielding position and expert power.

You should gather those joys together

and shamelessly refine the tale that you

tell to yourself about yourself: your

memories.

LifestyleThirdly, plan and act to maintain your

favoured lifestyle on retirement. Ensure

that your NHS pension is the maximum

possible. My hunch is that if any ‘new’

government scheme attempts, hard, to

sell you any modified pension or similar

scheme, they do so to save government

money and that means taking it from

you. Your long-established scheme is

probably better. Private pension and

similar schemes are, in my lay experience,

inferior to government-backed schemes.

These are complex matters. At least take

advice from your trade union and

consider hiring an independent financial

advisor. Money is that important.

Dickens, in ‘David Copperfield’

(1850), shared Mr Micawber's recipe for

happiness, "Annual income twenty

pounds, annual expenditure nineteen

[pounds] nineteen [shillings] and six

[pence], result happiness. Annual income

twenty pounds, annual expenditure

twenty pounds ought and six, result

misery.”

That still applies. Presently, your

prospects seem sound. However, they

merit continued scrutiny to ensure they

are not raided.

Decide who your reference (peer)

group are with whom you compare

yourself. If they seem at your level yet

after retirement seem to be doing better

than you are, your reaction may well be a

violent sense of misfortune. The

philosopher de Botton (1969- ) informs

that perspective.3 Medical practitioners

will comfortably trump your pension.

Make big-ticket purchases now,

before retirement. They will require more

agonising afterwards, when your income

is smaller and fixed. So buy that newer

car and reflect that, for example, a S̆koda

may be more affordable, longer term,

than a BMW. Travelling and telephone

expenses will no longer contribute to

your domestic budget. Winter fuel

allowance, subsidised travel and film

screenings (with ‘free’ tea and biscuits in

a grey ghetto) may not compensate. You

may have promised yourself that once-in-

a-lifetime six-week trip to Australia and

New Zealand or around-the-world cruise.

Book it now, before you retire. Generally,

you get a better deal the further ahead

you book. Relish those long-haul holidays

sooner rather than later. You will be fitter

to savour them. Famously, world-cruise

ships reserve extra refrigeration space for

customers who do not survive to get their

full money’s worth. Consider photovoltaic

solar panels and that big monitor. Ask IT

contacts what home computer they

recommend for you (not them!).

If moving posts (with funded costs) for

house purchase, bear retirement needs in

mind when choosing. A bungalow or

ground floor flat is better for long-term

motility. Ensure it is on a public transport

route. Check that the bus signs have not

been sawn off at ground level. Ensure

that a well-regarded GP surgery and the

accident and emergency department of

your local hospital is near enough — and

remaining open.

To reduce the chance of that cardio-

vascular or other accident, keep fit. That

matters. Sweat at the gym, or similar

exercise, now. Eat healthily, stop

smoking, be vaccinated against influenza,

and reduce stress. You know the public

health messages. You have trumpeted

them all your professional life. Pharmacy

manager, follow them yourself .

I was fortunate in being a fit retiree

until, in 2015, influenza turned to

pleurisy, double pneumonia, 13 lung

abscesses that required two emergency

operations, ITU and six weeks in hospital.

I remember little, except a physiotherapist

saying, “Cough! Spit! Cough or you will

die!” I was not expected to live. Being

here to tell you my tale, I put down to the

strength of being, initially, fit.

Gender has a substantial impact on

your life expectancy. Are you female? If

so, congratulations. In 2013 - 2015 a

man in the UK aged 65 had an average

further 18.5 years of life remaining and a

woman 20.9 years. The most common

age at death in the UK for men was

85 and for women it was 89. As a

pharmacy student in the 1960s, I knew

well four male and four female students.

Even before I had retired, 50% (two) of

the males were dead but 0% of the

females. I am not suggesting a sex

change operation if you are male. I am

suggesting both genders should take full

account of demography in pre-retirement

planning.

Overview

Plan now. Do not assume that you will

have plenty of time after you retire. You

will have less.

Reflect on Bourdieu’s formula and

Weber’s reasons to help you understand

“Make big-ticket purchases now, before retirement. They will requiremore agonising afterwards, when your income is smaller and fixed.”



your life during and after pharmacy

management. Nurture your habitus and

capital so that when retired you can relish

a variety of pursuits without having to

strive to excel. Maximise retirement

income. Refine your biography so that it

offers more meaning to your career and

income potential afterwards.

Do your bit: fight for pharmacy and

the NHS according to your circumstances,

as generations have before you. Look

forward to observing the jostling of the

pharmaceutical service from the sidelines

as it is no longer your direct concern – but

root for it nevertheless.


I am a paid columnist in Industrial

Pharmacy and European Industrial

Pharmacy journals.

REFERENCES

1. Sayer A. Habitus, work and contributive justice. Sociology 2011;45(1):7-8.Available from:http://journals.sagepub.com/doi/abs/10.1177/0038038510387188 .

2. Weber. M. 1956 (translated from original German 1922) Wirtschaft undGesellschaft 4th ed. Tubingen 1,1-14.

3. de Botton A. Status Anxiety. 2014. London:Penguin

4. Office for National Statistics. National life tables, UK: 2013 - 2015. 29thSeptember 2016. Main points. Available at:https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/lifeexpectancies/bulletins/nationallifetablesunitedkingdom/20132015 .

“Look forward to observing the jostling of the

pharmaceutical service from the sidelines as it

is no longer your direct concern . . .”

iStock/com/Halfpoint iStock.com.shutteratakan

http://journals.sagepub.com/doi/abs/10.1177/0038038510387188

https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/lifeexpectancies/bulletins/nationallifetablesunitedkingdom/20132015

COMING TO A TOWN NEAR YOU IN 2017 - APHARMACY MANAGEMENT EVENT FOR MEDICINES

PM National Forum for Scotland 30 August 2017, Dunblane

JoMO-UKCPA National Cardiovascular Workshop 19 September 2017, Leicester

National Homecare Conference 28 September 2017, London

National Forum for Northern Ireland October 2017 (day and venue to be confirmed)

JoMO-UKCPA National Diabetes Workshop 10 October 2017, London

Pharmacy Management National Forum Workshop 10 November 2017, London

Pharmacy Management Academy See details for the next programme elsewhere in the Journal.

Details from [email protected] or [email protected]

75c High Street, Great Dunmow, Essex CM6 1AE

Tel: 01371 874478

Homepage: www.pharman.co.uk

Email: [email protected]

Further information relating to these events will be added onto the PharmacyManagement website events page which

can be found using the QR code.





Question:

What is your job title?

Answer:

Lead Respiratory and Home Oxygen

Service Review (HOS-R) Pharmacist

What are your main

responsibilities/duties?

● Providing a clinical pharmacy service for

respiratory inpatients at Whittington

Hospital.

● Identifying adults in Islington who

have oxygen at home and reviewing

their oxygen prescriptions so that they

are appropriate and safe.

● Identifying high risk patients (smokers,

misusers of oxygen) and reducing

harm to them from smoking, fire and

oxygen toxicity.

● Managing oxygen use (wastage,

misuse) and improving the patient

experience of having oxygen at home

and thereby increase the value of

oxygen as a treatment in a safe,

clinically effective, patient-centric

manner.

● Keeping patients safe by setting up

Patient Specific Protocols together

with London Ambulance Services for

those patients who are at risk of

developing hypercapnic respiratory

failure from oxygen toxicity.

● Being a key component of the

Multidisciplinary Community Respiratory

Team providing pharmacy input on

individual patients.

● As part of the Responsible Respiratory

Prescribing Group, working towards

improving respiratory care for patients

within the Camden, Haringey and

Islington boroughs of London.

● Delivering education and training for

the pharmacy and respiratory teams

as well as patients in the Islington

community.

To whom do you report and where

does the post fit in the management

structure?

I work within a Pharmacy Medicine Team

as well as within the wider Respiratory

Multidisciplinary Team. So, in the pharmacy,

I have a Medicine Lead and I also have a

Respiratory Consultant I work under for

the HOS-R service.

How is the post funded? Is the post

funded on a non-recurring or

recurring basis?

Islington Clinical Commissioning Group

commissioned the HOS-R service. The

HOS-R Team is made up of 1 day a week

of a Specialist Respiratory Pharmacist’s time,

2.5 days a week of a Specialist Respiratory

Physiotherapist and 2 hours a week of a

Respiratory Consultant.

The remaining 4 days of my week are

funded by Pharmacy.

When was the post first established?

The post was initially a fixed-term 2-year

pilot and was subsequently made into a

permanent post in 2015.

Are you the first post holder? If not,

how long have you been in post?

I was not successful at interview during

the initial stage of the pilot. My

predecessor left the post in early 2015.

The job went out for advert and I was

successful the second time round. I

started at the Whittington in September

2015.

What were the main drivers for the

establishment of the post and how

did it come about?

A Respiratory Consultant was the

visionary and main driver for setting up

the Islington HOS-R.

Oxygen is a drug and should always

be planned, prescribed and reviewed by

staff trained in oxygen prescription and


FACE2FACEHome Oxygen Service Review (HOS-R) Pharmacist Ameet Vaghela, Lead Respiratory Pharmacist, Whittington Health, London

Correspondence to: [email protected]

Ameet Vaghela

“Oxygen is a drug and should always be planned, prescribed and

reviewed by staff trained in oxygen prescription and use.”



www.pharman.co.uk

109

use. It only made sense that, as

pharmacists are experts of medicines, one

was recruited into a HOS-R team.

What have been the main difficulties

in establishing/developing the post

to its current level?

Securing funding for the service meant

proving to the commissioners that there

is worth in having a pharmacist within

the team.

So that I can understand the

intricacies of oxygen prescribing, I needed

to upskill my respiratory and oxygen

knowledge.

What has been really important is

working as part of a close-knit team. This

is essential so that patients are provided

with the right treatment at the right time

by the right people.

What have been the main

achievements/successes of the post?

The first task I had was to manage a

person who was costing the CCG in

excess of £1,500 per month on oxygen.

His neurologist prescribed his oxygen for

treating cluster headaches. He was a

high-risk smoker with excessive oxygen

orders and deliveries. Through working

closely with several clinicians involved in

his care, we were able to review his

oxygen prescription, address his tobacco

dependence, provide a safe environment

for him and his family and reduce costs

down to £450 per month.

What are the main challenges/

priorities for future development

within the post, which you currently

face?

Identifying and managing smokers on

home oxygen is an ongoing challenge.

Treating tobacco dependence is really

difficult. This is where my motivational

interviewing training and knowledge of

‘stop smoking’ medicines comes into

play. It isn’t easy.

Lots of these patients haven’t had an

oxygen review in years and tracking

down the original oxygen prescriber has

proven difficult.

Most patients have multi-comorbidities

and have complex needs due to the

nature of their illnesses. Therefore, they

require very much an individualised

approach in their care. This can only be

achieved in a way that is co-ordinated

and integrated.

What are the key competencies

required to do the post and what

options are available for training?

For me, it has been a steep learning

curve. I have always enjoyed the

respiratory aspects of medicine and it has

helped to have strong support from my

peers.

I think I have benefited from learning

from specialists. All members of the

teams are smart, forward-thinking and

like-minded individuals. That makes for

solid teams.

How does the post fit with general

career development opportunities

within the profession?

I think it is a good fit. I have met several

Respiratory Pharmacists and they are

involved in various aspects within the

field e.g. stop smoking services and

respiratory pharmacist-led clinics in

severe asthma. I don’t know any other

pharmacists currently involved in oxygen

prescribing.

How do you think the post might be

developed in the future?

I would like there to be a core group of

pharmacists interested in respiratory

medicine and in oxygen prescribing.

Celebrating and sharing success stories

only makes us work harder towards

better patient outcomes.

What messages would you give to

others who might be establishing/

developing a similar post?

Be patient. Setting up a Home Oxygen

Service requires time, tact, effort and

energy. Work closely with your

commissioners and your consultants.

Even once a service is commissioned,

know that patients can have very fixed

health beliefs and this makes it tricky in

engaging with them. It’s hard work but it

is also rewarding, particularly when

patients turn round and thank you for

your efforts.

Do you have any Declarations ofInterest to make and, if so, whatare they?

A payment for writing the article will be

made by Pharmacy Management.

“I would like there to be a core group of pharmacists interestedin respiratory medicine and in oxygen prescribing.”


www.pharman.co.uk


www.pharman.co.uk

111

MANAGEMENT CONUNDRUM

Will The Elastic Break?

Janet Donit, Chief Pharmacist at Metropolis NHS Trust

stared pensively out of her office window and drummed

gently with her fingers on her desk.

Clive Black, Chief Executive had just been in to say that

the demands of patient flow for unscheduled care were

increasing and had got to the level where it was

necessary to extend the hours of the pharmacy service

at weekends and weekday evenings.

Janet had said she could certainly look at that but there

would be a need for additional resources since the

pharmacy service was already struggling with

demands and extending the hours of service will add

further strains.

Clive Black had, though, taken the view that since the

service was to improve patient flow then it should be

provided as a cost-neutral project and be achieved

through the appropriate re–engineering of core services.

Janet had started to protest but Clive Black had simply

said that financial restraints were making it hard for

everyone in the NHS and he wanted to have a paper put

before the management team to show how pharmacy

would respond.

Janet was concerned that what she had been asked

could not be done without stretching staff too much

and, possibly, impairing the safety of services. Her

inclination was that she should frame a case for

investment in the service to support additional hours

but that would not meet the ‘cost-neutral’ requirement.

If you were Janet, what would you now do?

Ewan Maule, Deputy

Chief Pharmacist -

Operational Services,

Northumberland Tyne

and Wear NHS

Foundation Trust.

Email: ewan.maule @ntw.nhs.uk

Janet may be right about the risk of

overstretching the service; however, she

should view this as an opportunity to

showcase, at a high level, the services

pharmacy do and could provide. Whilst

further investment may not immediately

appear to be on offer, presenting a

compelling case backed up by data may

unlock some of this. It is also important

that Janet understands the motivation of

Clive by asking herself some questions e.g:

• does he understand and value the role

pharmacy plays?

• does he want services to be

consistent across the week?

• is it an alignment with other services

increasing their service offering or is it

simply that he is asking all department

heads to outline their offering?

Janet will undoubtedly be aware of

the impact on her staff of the

introduction of weekend working, but

the expectation of the Board will

probably be that this is an issue for her to

manage locally. Her paper should,

therefore, focus on what a pharmacy

Commentaries

“. . . point out where the skills and activity of the pharmacy team

can reduce reliance on other staff groups . . .”


mailto:@ntw.nhs.uk


service can do to support the aims of the

organisation, and how investment in

pharmacy services can save money

elsewhere in the system.

I would advise that she obtain accurate

figures relating to admissions, length of

stay and discharges across the week, the

availability of other services (radiology,

pathology, etc) and, from this, anticipate

how pharmacy activity would change if

pharmacy services were available at

weekends. In doing so, it will be necessary

to make clear the range of services

pharmacy offer and the impact this has on

patient flow and outcomes. This would

need to differentiate the medicines supply

service from the clinical pharmacy service.

Present a range of options which include

a varying range of investment (including

at least one low impact cost neutral

approach ). For example:

• Cost neutral option – 8 hours of

medicines supply service across the

weekend (4 hours a day).

• Minor investment – 8 hours of

medicines supply service and clinical

pharmacy service (focussed on urgent

care and high turnover areas) across

the weekend (4 hours a day).

Investment required - £x/pa

• Comprehensive service – weekend

service exactly mirroring weekday

service. Investment required - £x/pa.

In framing these cases, Janet would

be well advised to point out where the

skills and activity of the pharmacy team

can reduce reliance on other staff groups

in their existing service models, and also

take the opportunity to present ideas on

new roles they could undertake (with

adequate investment of course) to

enhance skill mix, which would support

the aims of the organisation.

Present a range of options

Christine Gilmour,

Chief Pharmacist,

NHS Lanarkshire

Correspondence to:

christine.gilmour@

lanarkshire.scot.nhs.uk

Janet needs to be very clear what it is she

has been asked to provide and what the

organisation wants/needs from the

extended service. She must also

determine if this will be a short term or an

ongoing service commitment. Whilst her

instinct is to prepare a case for additional

funding she must think through all the

implications of that not being supported.

The impact of this and the

sustainability of the pharmacy service

needs to be considered as a whole. Janet

needs to review and document how the

current service is structured and funded,

and highlight if any current services that

the organisation is reliant on are provided

via staff working overtime. Overtime

working is voluntary and staff cannot be

obliged to undertake overtime duties.

Janet must not try and meet the needs of

the organisation by designing a solution

reliant on staff goodwill. It may be,

however, that there are already services in

place that work this way - for example

existing Saturday and Sunday services, or

iStock.com/BrianAJackson


www.pharman.co.uk

113

evening working over the winter period

to assist with bed pressures.

Janet should work with her senior

team to try and identify changes that

could make the pharmacy service more

efficient, for example earlier presentation

of discharge prescriptions from wards,

etc. The organisation is looking for

solutions and will support her, however

when all that is said and done she needs

to be prepared to consider restructuring

and even cutting existing services to

accommodate this request. Doing this

should be difficult and uncomfortable for

her, because if it’s not then that is a

whole different matter to reflect on.

Through this process she must identify

where her ‘red lines’ are and why.

Restructuring can mean changing duties

and skill mix so she needs to engage with

HR and staff side colleagues.


● Ewan Maule: Personal fee from

Pharmacy Management for writing

the commentary.

● Christine Gilmore: Member of the

Editorial Board, Journal of Pharmacy

Management (JoPM). Personal fee

from Pharmacy Management for

writing the commentary.

Janet needs to be clear about her red lines

iStock.com/sukmaraga

“Janet should work with her senior team to try and identifychanges that could make the pharmacy service more efficient . . .”



We live in a society where the pressure to

be successful has reached almost

pandemic levels. Whether it is our personal

or professional lives or both, we feel like

we have to ‘succeed’ at everything we do.

Ironically, this pressure is often the very

thing that hold us back from being

successful. Fear of failure is not just an

expression, for some people it is an actual

clinical condition called atychiphobia. For

many of us a fear of failure is not this

severe, but it does hold us back.

So how should we deal with failure or

prevent a fear of failure from becoming

overwhelming in the first place?

1. Know what you want to achieve

and have a plan to achieve it

There is a well-worn old adage that

says: ‘A failure to plan is a plan to fail’.

That is very true here. Nobody plans to

fail but, in not having a plan to get to

where we want to with our lives, we are

more likely to end up in a place we

don’t want to be. Having a clear

destination and a plan to get there

gives us a much greater chance of

arriving successfully. Consider this

analogy, how many times have you

gone on holiday and just turned up

at the airport, jumped on the first

available flight to wherever and then

checked-in to the nearest available

hotel when you reach your destination?

Not many of us have done this or would

do this. Ironically, most of us spend

more time every year planning our

holidays than we do planning our lives.

The other great thing about having a

plan is that we quickly realise when the

plan is not working and we can change

it. The destination remains the same,

but the journey to get there can and

does change.

2. Adopt a ‘black box’ mentality

In his best-selling book, ‘Black Box

Thinking: The Surprising Truth About

Success’,1 author Mathew Syed talks

at length about the global aviation

industry and how it learnt very quickly

from mistakes, some of which have

had catastrophic consequences.

Within days of an incident occurring

(no matter how major or minor)

aviation companies will pull together

teams of investigators and anyone

involved in the incident is fully

encouraged to disclose everything

relating to it that they can. In this way

lessons are learned and mistakes of a

repetitive nature are avoided. Key

learnings from the incident are very

quickly disseminated and acted upon.

Interestingly, Syed draws lots of

comparisons with global healthcare

where the reverse is often true.

When you make a mistake, look at

what you can learn from it and take

steps to avoid repeating the same

mistake again .

How To Be A Success At FailureBy Tom Phillips, lead trainer at Pharmacy Management, who has enjoyed 20 years of working with both theprivate and public sector, during which time he has gained extensive experience and demonstratedconsiderable success in management, sales, marketing and training. Tom is an excellent communicator andmotivator and has designed/ delivered training at all levels from trainees to directors at both a national andinternational level. Such is Tom’s love of training and development that, in his personal life, he is also aqualified fitness and diving instructor. Tom Phillips

LEADERSHIP

‘There is freedom waiting for you on the breezes of the sky, and you ask “What if I fall?” Oh but my darling, what if you fly?’

Erin Hanson, Poet

“Having a clear destination and a plan to get there gives us

a much greater chance of arriving successfully.”


www.pharman.co.uk

115

3. To err is human

Accept that we can and do make

mistakes and when we do, rather

than beat ourselves up, we need to

accept that we are human and fallible.

Look at the situation objectively and,

with reference to point 2 above, look

at what you can learn from the

situation. Something can be learned

even from the worst mistakes. Do not

put unrealistic pressure on yourself to

be perfect. Accept from the outset

that mistakes are an everyday part of

life. In designing the lightbulb,

Thomas Edison famously ‘failed’ 999

times. He saw each failure as an

integral part of his human nature and

also saw each failure as another

learning opportunity and another step

closer to his ultimate goal.

4. Don't make it personal

Failure is human. To have failed in a

task or a pursuit does not make you, as

a person, a failure. We need to

separate the incident from who we are.

In fact, if we dust ourselves off, learn

from the experience and have another

go, by definition we are not a failure.

5. The past is a place of reference,

not a place of residence

Do not dwell on past failures. The past is

in the past and whilst we should always

be ready to learn from past experiences,

it is not healthy to keep dwelling on

them and allowing them to interfere

with our present and our future.

6. Get someone else to hold themirror for you

If you are really struggling to analyse a

failure in an objective manner, then it

is a good idea to get someone else to

help you review the situation

objectively. A professional business or

life coach can help you to do this.

They should help you to review the

event objectively and to learn from it.

7. Fail fast

As we embark upon a journey to

wherever, it is a good idea to get the

failure out of the way early on so that

we can arrive at our destination that

much faster. Procrastination (possibly

because of a fear of failure) will only

delay us from reaching our objectives

and learning along the way. You are

going to make mistakes, that is

inevitable. Surely it would be best to

get the mistakes out of the way

sooner, rather than later?

Good luck with all your failure in the

future!


Tom Phillips discloses payment for

writing the article and professional fees

from Pharmacy Management outside the

submitted work.

REFERENCES

1 . Black Box Thinking: The Surprising Truth AboutSuccess. Mathew Syed. 2015.

Learning from your mistakes will help you to avoid repeating them

iStock.com/GOSPHOTODESIGN

“. . . whilst we should always be ready to learn from pastexperiences, it is not healthy to keep dwelling on them . . .”



www.pharman.co.uk

EDITORIAL BOARD FOR THE JOURNAL OF PHARMACY MANAGEMENT (JoPM)

Dr Tim HanlonChief Pharmacist & Clinical Director ofPharmacy and Medicines Optimisation,Guy's and St Thomas' NHS Foundation Trust;Visiting Professor of Pharmacy, School ofPharmacy, University of [email protected]

Katy JacksonHead of Prescribing and MedicinesCommissioning/ Controlled DrugsLead, Brighton and Hove ClinicalCommissioning [email protected]

Jas KhambhPharmacy and Medicines OptimisationLead, Primary Care, NHS LondonProcurement Partnership (seconded toNHS England) [email protected]

Robbie TurnerDirector for England,Royal Pharmaceutical [email protected]

Anthony YoungLead Clinical Pharmacist,Northumberland Tyne and Wear NHS Foundation [email protected]

SCOTLANDChristine Gilmour Chief Pharmacist, NHS Lanarkshirechristinegilmour746@ btinternet.com

Sharon PflegerNHS Highland, Consultant inPharmaceutical Public Health/NationalClinical Lead, Area Drugs andTherapeutics Committee Collaborative,Healthcare Improvement [email protected]

Campbell ShimminsCommunity Pharmacist, Owner,[email protected]

David Thomson Lead Pharmacist, CommunityPharmacy Development &Governance, NHS Greater Glasgowand [email protected]

EditorAlex BowerDirector of Publishing,Pharmacy Management [email protected]

ENGLANDRena AminClinical Associate, Hartland WaySurgery, [email protected]

Graham BrackDeputy Accountable Officer forControlled Drugs, NHS South Region(South West) [email protected]

NORTHERN IRELANDLindsay GraceyCommunity [email protected]

Dr Ruth MillerProject Manager, Medicines Optimisationin Older People & Lead ResearchPharmacist, Western Health and SocialCare Trust, Altnagelvin Area [email protected] [email protected]

Professor Michael ScottHead of Pharmacy and Medicines Management.Northern Health and Social Care [email protected]

WALESJohn Terry Head of Pharmacy,Neath Port Talbot [email protected]

Roger WilliamsHead of Pharmacy Acute Services,Abertawe Bro Morgannwg UniversityHealth [email protected]



















Published by Pharman Limited

75c High Street, Great Dunmow, Essex CM6 1AE

Tel: 01371 874478 Homepage: www.pharman.co.uk Email: [email protected]

July17



ISSN 2052-6415 (Online) ISSN 1354 ... - Pharmacy Management

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