JANUARY 2023 (reprinted from CFP’s Fall 2022 Changing Face of Pharmacy report) – When describing the impact of the COVID-19 crisis on Canadian pharmacists, the famous words of Charles Dickens seem apt: “It was the best of times. It was the worst of times.”
The best of times? Yes, because during this time of mass disruption, the public finally came to realize just how essential Canada’s 42,000 pharmacists could be to their health and well-being. When doctors could only provide virtual care and emergency rooms were overloaded, pharmacists across the nation stepped up to support their communities.
“If it wasn’t for pharmacists, the entire COVID testing and vaccination effort would have collapsed,” says Dr. Zubin Austin, Professor at the University of Toronto’s Leslie Dan Faculty of Pharmacy. As panic set in, pharmacists were deluged with prescription renewals, sought out for emergency health advice around COVID-19 protocols and forced to explain drug shortages over and over again. When people didn’t know where to turn, their local community pharmacist was often the person they turned to first. “If ever there was a time t acknowledge pharmacists, this was it,” says Austin.
But it was also the worst of times. Pharmacists put in long and stressful overtime hours as their workloads increased and the burden of responsibility for patient care fell on their shoulders. The provision of remunerated clinical services often took a backseat to increased dispensing and a big uptake in nonclinical customer service activities, such as stepping up pharmacy security measures and PPE practices.
So while the provision of vaccination services certainly elevated pharmacists’ status in the public eye, the pandemic has exacted a heavy toll from members of the profession. A recent national survey from the Canadian Pharmacists Association (CPhA) reveals that pandemic stress and staffing challenges have contributed to pharmacy burnout at unprecedented levels. An astonishing 92 per cent of pharmacy staff say they are at risk of burnout and half of them blame inadequate staffing for having a negative impact on their mental health and well-being.
“The unrelenting demands, coupled with added administrative burdens and staffing challenges, have pushed us to a tipping point,” said Dr. Danielle Paes, CPhA’s Chief Pharmacist Officer, in the press release announcing the survey results.
A looming crisis
That tipping point is threatening to implode, according to Austin. “Prior to the pandemic there was a certain bandwidth that pharmacists as individuals had around personal resilience. Now that’s vanished—not only for them, but for all health professionals,” he says.
A research paper published in the summer of 2020 and co-authored by Austin, “COVID-19: How did com- munity pharmacies get through the first wave?”, posits that personal resiliency in times of a pandemic is built upon a foundation of organizational support and managerial strategies, as opposed to personal coping strategies.1
He says it’s up to pharmacy owners and managers to make “conscious employer decisions with respect to workplace organization and design.” In times of crisis or significant change, “we can’t simply leave it up to individuals in workplaces to be the shock absorber.”
The paper outlines five key strategies for increased organizational supports that will improve the working life of pharmacy teams. These include scheduling practices that support continuity of staff and workflow changes to reduce multitasking and cognitive overload (see sidebar).
Without these organizational supports, “we are setting ourselves up for a crisis,” warns Austin, noting that pharmacy— similar to other professions such as nursing—is facing the “Great Resignation,” a period of disillusionment influenced by COVID-19 also referred to as the “Big Quit” or the “Great Reshuffle.” This phenomenon involves employees voluntarily leaving their jobs in unprecedented numbers. The CPhA survey found that the impact of COVID-19 on mental health caused 72 per cent of pharmacists to consider leaving their positions or the profession altogether.
What will this crisis look like? For one thing, it will become more difficult to recruit community pharmacists, says Austin. This will result in even more overworked pharmacy staff, the consequences of which will be increased medication and dispensing errors, as well as “fractured conversations” between pharmacists, their patients and pharmacy technicians. All at a time when patients and governments will be looking to pharmacists and their teams to do more in health care.
“Employers will not be able to keep their stores open or hire replacement staff. At a certain point we are going to run out of new and fresh pharmacists. All this will limit corporate growth and expansion,” says Austin.
A more optimistic view
Dr. Nancy Waite, Professor and Associate Director of Clinical Education, School of Pharmacy at the University of Waterloo, has a different perspective. She points to the unexpected benefits of COVID-19 on the profession, not only on elevating the status of pharmacists in the public eye, but in accelerating regulation changes that, for example, allowed for pharmacists to renew prescriptions and for technicians to administer vaccinations. “The regulations changed quickly…these things are completely new for us in Canada.”
While Waite and Austin have their own takes on the crisis, they agree there is a compelling need to secure the foundation of the profession to ensure healthy working conditions and high-functioning pharmacists.
As co-authors of a research paper Pharmacy in the 21st Century, Waite and Austin outline the necessity for “transformational change” to the profession over the next five to 10 years.2 While the paper was written before the pandemic, they say its central ideas remain relevant. Such change involves, for example:
- pharmacy models that find new ways of delivering on dispensing/compounding so that the pharma- cist’s time can be focused on the clinical functions of pharmacy as dispensing and front-store products are increasingly managed by off-site storage and delivery;
- increased use of electronic software applications, analytics and artificial (machine) intelligence to help streamline and improve drug distribution and clinical services; and
- the sharing of clinical records with other healthcare providers and patients themselves through electronic information exchange, including the use of apps.
They call for a renewed focus on the “organizational building blocks” that will optimize operations, such as fully utilizing pharmacy technicians, leveraging technology to improve workflow and time management, and working more closely with other health professionals to help fulfill the profession’s emerging role as a community healthcare hub. This will allow pharmacists to focus on non-dispensing services such as health management programs, medication reviews and prescribing. In turn, all of this will boost morale, job satisfaction and help keep pharmacists in the profession.
Waite says she is encouraged by how the pandemic accelerated new technologies in the pharmacy setting, beginning with the creation of online booking systems for patients to schedule their vaccines. This proved how pharmacies can be adept at using software to improve their workflow processes.
“To be a good health hub you really need to be taking advantage of the technology,” says Waite. “This is something that’s been hard for many pharmacists, unless they are recent grads, since they haven’t been trained for it in school.” But COVID-19 forced their hand. “Suddenly we had online scheduling systems, text messaging for prescription pick-ups and pharmacies were going paperless.”
She is hopeful that a new generation of tech-savvy pharmacists will implement software systems that will create efficiencies to ease the burden of demanding pharmacy workloads and be more responsive to consumer demands. “Patients are driving the need for this—they can book an airline ticket and select a seat online for a flight and yet how much control do they have over things like ordering their refills or accessing their lab reports or booking pharmacy appointments?” She says many people want and expect these kinds of services from pharmacy.
Waite believes this next generation sees the world completely differently. “I think they are going to create a revolution in pharmacy so that it not only becomes a health hub, but also a rethought, retooled and reimagined space where we will interact differently and yet still be the same place that provides care around drugs and the diseases that they treat,” she says. “Crisis can create opportunity and we should never waste a good crisis.”
Daniel Kaldas, a 28-year-old pharmacist at Jane’s Guardian Pharmacy in Mississauga, Ont., is part of this next generation. While his mother, pharmacy owner Jane Kaldas, devotes her time to patient care, it’s up to Daniel and his brother Matthew, 31 and also a pharmacist, to “create efficiencies.”
COVID-19 made for an intense working environment in their pharmacy, he says. Home deliveries doubled, phone calls tripled and frontshop sales plummeted. “We had to do double the work to make the same amount of money as before the pandemic,” he says.
Kaldas invested in several software systems that he estimates will not only save the pharmacy approximately $30,000 a year but will also streamline workflow and staffing hours. He spent $2,000 to implement a paperless prescription management system and $6,000 on a tablet counter that can count 500 tablets in 15 seconds. He also pays four cents a text for a program that automatically messages patients the minute their prescription is ready for pick-up.
“Texting saves us a lot of time because calls can be time-consuming. If I can complete a task in one third of the time, why wouldn’t I do that,” he says. “I’m not implementing this software to take away from patient care, if anything it will free more time for it.”
Andrew Eikelenboom, Pharmacy Manager at Shubenacadie Guardian, 45 minutes outside of Halifax, says COVID-19 has also been the crucible for significant changes in his pharmacy and the banner under which he operates. “From the top down throughout the organization the owners are updating our software so we can move toward a paperless environment,” he says. “We are also hiring more regulated techs—their scope is a lot larger than they are given credit for and this is a real game-changer in the pharmacy world because the work shortage is real.”
Improved scheduling, such as booking appointments for clinical services and scheduling renewal calls, is also easing workflow. “Pharmacists tend to be their worst enemies when it comes to their workloads,” he says. “We all like to work hard and provide as many services as we can, but we have to realize not everything is urgent and scheduling these appointments can help with workflow.”
Eikelenboom agrees that COVID-19 has brought both great challenges and great opportunities to the profession. “The pandemic allowed pharmacists to show their worth and, along with vaccine rollouts, it’s been tremendous,” he says. “At the same time, we know that pharmacists are overworked, burnout is real, we are working harder than ever, and a lot of people have come and gone.”
Now that pharmacy is in a growth phase, he says pharmacists need to get creative with workflow and staffing, so they can do the expanded scopes they’re capable of. “I really think the profession is headed in the right way.”
5 Key Strategies to Improve Working Conditions1
- Reduce long shift lengths, which produce cognitive and emotional overload, to allow for more recovery time.
- Create schedules that ensure the same people work together in a consistent manner, which results in greater efficiency in communication and more interaction among team members.
- Reduce multitasking by pharmacists by having them work in a separate office space without the usual interruptions that occur within a dispensary environment.
- Enhance the use of technology, such as automated refill systems, texting, email and videoconferencing.
- Hire more non-professional support to perform non-regulated work, ranging from deliveries to inventory receiving to pharmacy-based security.
Help for Burnout
Forty-three per cent of Canadians experienced unintentional weight gain during the pandemic, putting them at risk for diabetes and cardiovascular health issues; 54 per cent say their mental health has declined over the past two years and one in 10 Canadians say they are often or always lonely, according to Cleveland Clinic Canada.
In the face of all this, “there’s an impetus for leaders in organizations to take the lead and create work cultures committed to wellness,” says Dr. Talia Varley, Physician Lead, Advisory Services for Cleveland Clinic Canada.
This can include anything from job flexibility, fitness incentives, actively engaging and seeking feedback from employees, and training programs to bolster resilience in managers.
Healthy employees create healthy companies, says Varley. “There is less room for patient errors, the quality of
the work is better and overall performance is elevated. This is bound to have a positive effect on patients and customers who come through the pharmacy.”
In addition to Cleveland Clinic’s wellness services, another resource that may be helpful to pharmacy managers and owners is the Workplace Mental Health Resource Centre at the Centre for Addiction and Mental Health. It offers information and tools to help business leaders learn more about mental health.
1. Gregory PAM, Austin Z. COVID-19: How did community pharmacies get through the first wave? CPJ. 2020 Sep;153(5):243-251.
2. Dolovich L, Austin Z, Waite N, et al. Pharmacy in the 21st century: Enhancing the impact of the profession of pharmacy on people’s lives in the context of health care trends, evidence and policies. CPJ. 2019 Jan-Feb;152(1):45-53.
Read more stories from CFP’s Fall 2022 edition of the Changing Face of Pharmacy report. Email Paul Kidston (firstname.lastname@example.org) to get your copy.