TRENDS | Beating Burnout

BEATING BURNOUT

Two national organizations help pharmacies tackle a major threat to the profession

With a patient waiting at the pharmacy counter, another on hold, and a backlog of administrative work on the desk, a retail pharmacy can be an overwhelming workplace on the best of days. When pharmacists and other staff members face demanding workloads day in and day out, feeling overwhelmed can start to transform into feeling burned out. "People get fatigued and they report out or don't show up for work at all. You've got people who leave the job and, in some cases, leave the profession entirely,” said Mitch Rothholz, chief of governance and state of affiliates and executive director at the American Pharmacists Association (APhA), which has co-authored a new report on pharmacist well-being in the United States. Many pharmacies are having to reduce their hours of operation or even close entirely on days they don't have enough staff available. “It’s not sustainable for practices and is having long-term effects on the profession,” said Rothholz. Besides depleting the workforce, burnout creates a negative work environment and a worse patient experience. It can manifest in employees being rude with patients, or worse, making medication errors because they aren't alert or are distracted in their pharmacy duties.

COMMON CAUSES OF BURNOUT

The Covid-19 pandemic has certainly amplified feelings of burnout, but Rothholz emphasized it isn't a new phenomenon for pharmacy staff. It has been brewing under the surface for many years across the entire healthcare system. "Some of the issues surrounding well-being distress are not having enough staff, not having the resources or the technology to do your job, and the never-ending phone-ringing that disrupts members of the pharmacy from providing care and focusing their time on patients' needs," he explained. Pharmacy employees are often given a full plate of tasks with no one to assist when things get chaotic. On top of the typical prescription dispensing process, patient care services add another layer of stress on the day-to-day commotion of keeping the pharmacy running. Covid-19 vaccinations, testing, and treatment, along with the regular vaccinations and lab tests, have to be performed within the daily workflow. "They all can contribute to feeling overwhelmed," Rothholz said. Another exacerbating factor is the lack of down time. Lunch breaks are good, but Rothholz explained that many pharmacy employees need stretches of time during the workday to catch up on administrative tasks without being interrupted by patients or other pharmacy staff.

HOW TO REDUCE BURNOUT IN YOUR PHARMACY

Even though well-being distress, which can lead to burnout, is a concern, there are changes you can make to lessen the impact in your community pharmacy. Rothholz gives four workflow remedies.

Divert phone calls to a call center or use an interactive voice recording system that has clear messaging for patients. Or let your front-end staff handle and direct incoming calls.

MINIMIZE PHONE CALLS APPOINTMENT-BASED MODEL

"The appointmentbased model creates a mechanism for predictability for the team," Rothholz said. Under this model, pharmacy managers can better align staff with demand.

GUARANTEE FOCUSED TIME

"You can set it up so the first hour of the day or the last hour of the day has no phone calls and no patients," he said. Make sure it’s every day, and that teams are compensated for this time.

EDUCATE THE COMMUNITY

Manage patients' expectations about what pharmacy staff can reasonably do for them. “Harassment of pharmacy personnel by the patients and consumers is real,” Rothholz said.

MANAGERIAL SUPPORT

If you or one of your staff members is experiencing burnout, there are resources available. Rothholz recommended the Pharmacist Well-Being Index, a tool created through a collaboration between APhA and the Mayo Clinic’s Well-Being Index. "It's a set of nine validated questions that a team member can take to tell them about their well-being," he explained. "It looks at their level of distress based on their score and benchmarks them against other like practitioners. It also connects them to resources to help them manage their stress level. It is not a one-time survey, but instead is a tool that pharmacy team members can utilize to monitor the state of their well-being." Pharmacy staff members can answer the questions once a month, which can help them manage their stress levels and track their well-being over time. Although data is collected to learn more about workplace stress, Rothholz emphasized that individual scores are confidential. Data from the Well-Being Index shows that 32 percent of people who use the tool indicate a high distress level, and those people have a three-fold higher risk of a low quality of life and an eight-fold higher risk of burnout. A high distress level also correlates to higher risk of fatigue, medication errors, and a desire to leave their current job. Those are problems managers need to reckon with—both for the health of staff members and the health of patients. "Pharmacy managers have a responsibility to open up lines of communication with their team members and let them know that what they say to a manager is not going to be used against them," Rothholz said. "One of the biggest fears we have seen in our surveys is fear of retribution for bringing up a concern." Rothholz also discouraged the inappropriate use of metrics—surveys and feedback indicate that it can cause employees to worry about being penalized for not meeting a numerical goal and prevent them from focusing on the needs of individual patients. "Instead of focusing on metrics, it's really about having discussions with your team to see what is really happening in the practice and learning what the pressure points are so you can come to a solution together," he said, though he noted that not all metrics are bad if they are appropriately designed and utilized, with input from team members. Refer to the Pharmacist's Fundamental Responsibilities and Rights document as a starting point for these discussions. "It's a template for things that can be done to address workplace and well-being issues without ignoring the responsibility pharmacists have to their patients and community." To discover more about how stress and burnout are affecting pharmacy practices across the United States, the American Pharmacists Association (APhA) and the National Alliance of State Pharmacy Associations (NASPA) have recently launched Pharmacy Workplace and Well-Being Reporting (PWWR).

Pharmacy Workplace and Well-Being Reporting is a mechanism for pharmacy team members to anonymously report the positive and negative experiences they have in the workplace.

"On the positive side, it's a team member saying that their supervisor commended them for how they approached a patient care situation, or that a supervisor made them feel heard and respected," Mitch Rothholz explained. "Negative reports are often about concerns for patient safety in the practice or some sort of error occurring."

It's an anonymous way for pharmacy employees to voice their concerns, and the APhA and NASPA use these aggregate reports to identify trends in the field. The report of PWWR data was released in February, and it identified some alarming trends:

of reporters said their workplace recommendations were not considered or applied

of problems reported were recurring

of reporters noted that staffing was at less than normal levels at the time of a negative experience

reported experiences were negative, while only 4 were positive

The PWWR tool, and those created by state boards of pharmacy, provide data points for discussions by pharmacy teams, management and decision makers, but will only be optimized if team members submit data.