Understanding motivations and behaviours of our influencers: What can pharmacists learn from their leaders?

Background: There has been considerable discussion regarding the "leadership crisis" in pharmacy, with concerns that insufficient numbers of pharmacists want to take on leadership roles in their own profession. This exploratory study of leaders and influencers in pharmacy was undertaken to characterize the motivations for and behaviours of titled and untitled leaders, in order to help other pharmacists learn from their experiences. Methods: Interviews with 28 individuals who self-identified or were described by others as leaders (with or without formal titles) and influencers in pharmacy were conducted using online platforms (e.g., Zoom, Teams). A semistructured interview guide was used and refined during the interviews. Data were analyzed using a constant comparative method to identify common themes. Results: While participants in this study all described different trajectories towards leadership or influencer roles, several common themes emerged, including 1) personal characteristics that enable leadership roles/activities, 2) environmental supports and drivers that propel leadership forward, 3) positive reinforcers that maintain momentum towards leadership aspirations and 4) general predictors of success as a leader/influencer in pharmacy. Discussion: To address the "leadership crisis" in pharmacy, it will be necessary to motivate and support individuals in assuming these roles. Findings from this study have highlighted the complex and individual pathways current leaders have undertaken to achieve these roles and have signposted ways in which organizations, managers and mentors can support nascent leadership aspirations in productive ways.

COVID-19 vaccination in high-risk communities: Case study of Brampton, Ontario.

Background: The Peel region in Southern Ontario is among the most ethnoculturally diverse and fastest growing areas in Canada. During the COVID-19 pandemic, the multicultural community of Brampton suffered one of the highest infection rates in Canada, in part because of the demographic and socioeconomic characteristics of the community. The role of pharmacists in supporting vaccine uptake in this linguistically, ethnically and religiously diverse community has not been adequately characterized. Methods: A qualitative case study approach was used, focusing on one of the major communities in Peel (Brampton). Interviews with community pharmacists and pharmacy staff directly involved in COVID-19 vaccine administration during the pandemic were undertaken to identify common experiences and trends related to providing care and support to this high-risk community. Constant comparative coding was used to identify common themes that can inform ongoing public health supports in future pandemics. Results: A total of 29 interviews were completed. Key themes that emerged included 1) the impact of operational, organizational and logistical issues on vaccine uptake in the community; 2) the negative influence of inconsistent messaging from public health and other experts during the pandemic; and 3) the identification of an emerging typology of "vaccine hesitancies" describing different reasons/motivations for avoiding COVID-19 vaccination and approaches taken by pharmacy staff to address these within a multicultural, multilingual practice context. Discussion: The COVID-19 vaccination campaign was unprecedented in its size, scope and speed, and community pharmacists were integral in this effort. The unique needs of ethnoculturally, linguistically and socioeconomically diverse communities like Brampton require further studies to examine ways in which the pharmacy profession can positively influence greater vaccine uptake, by increasing understanding of the diverse proliferation of vaccine hesitancies that emerged.

Understanding the psychology of trust between patients and their community pharmacists.

BACKGROUND: Pharmacists need patients to trust them in order to support best possible health outcomes. There has been little empirical work to test the widely stated claim that pharmacists are the "most trusted" health care professional. This study was undertaken to characterize the factors that shape public trust of individual pharmacists and the profession as a whole. METHODS: An exploratory qualitative study was undertaken. Semistructured interviews with 13 patients from 5 different community pharmacies were completed. Interview data were transcribed, coded and categorized to identify trust-enhancing and trust-diminishing factors influencing patients' perceptions of pharmacists. RESULTS: Four trust-diminishing factors were identified, including the business context within which community pharmacy is practised, lack of transparency regarding pharmacists' remuneration, lack of awareness of how pharmacists qualify and are regulated and inconsistent previous experiences with pharmacists. Four trust-enhancing factors were identified, including accessibility, affability, acknowledgement and respect. DISCUSSION: This study illustrates that trust-diminishing factors appear to be somewhat outside the day-to-day control of individual community pharmacists, while trust-enhancing factors are elements that pharmacists may have greater personal control over. Further research is required to better understand these factors and to develop a more generalizable understanding of how patients develop trust in their pharmacists. Can Pharm J (Ott) 2021;154:xx-xx.

Professional identity formation: The experience of regulated pharmacy technicians in Ontario.

BACKGROUND: Despite being regulated and spoken about as professionals, there is little formal research examining professional identity formation among regulated pharmacy technicians. METHODS: A semistructured interview protocol was generated, based on Holden et al.'s typology of professional identity formation (PIF). Regulated pharmacy technicians in Ontario with a minimum of 2 years' experience working a minimum of 32 hours/week were recruited to participate. Interviews were transcribed, coded and analyzed based on professional identity formation. RESULTS: A total of 15 regulated pharmacy technicians from southern Ontario participated in this study. Regardless of demographic background, most participants demonstrated identity splinting as the dominant form of professional identity formation. Issues related to social valuing of the role of the technician and environmental opportunities to develop and grow were highlighted as significant barriers. INTERPRETATION: These findings suggest regulated pharmacy technicians have incomplete professional identities due in part to reasons linked to pharmacists and the pharmacy profession. The type of professional identity expressed by participants in this study may limit opportunities for full and optimal expression of their role. CONCLUSIONS: Further work is necessary to better understand the professional identity formation of regulated pharmacy technicians, to help support the evolution of this role. Can Pharm J (Ott) 2020;153:xx-xx.

COVID-19: How did community pharmacies get through the first wave?

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic of early 2020 was one of the most impactful events in living memory. As an essential service, community pharmacies remained open to provide care and service. The unprecedented nature and scale of the pandemic triggered considerable change in daily practice. In anticipation of future pandemic waves and similar mass-scale civil disruptions, it is important to understand how community pharmacies adapted and responded in the early weeks of COVID-19. METHODS: A combination of convenience, snowball and purposive sampling methods was used to recruit staff from community pharmacies across Ontario, from a variety of different practice locations and types. A semistructured focus group interview protocol was used to elicit experiences. Data gathering was undertaken until the point of saturation. Thematic analysis was used to surface common experiences and to describe how community pharmacies adapted and responded. RESULTS: A total of 39 participants (pharmacists, registered technicians and assistants) from 11 different pharmacies participated in this study. Data were coded based on 1) what happened, 2) how community pharmacies responded, and 3) what worked and did not work to support pharmacy staff in continued provision of service and care. Key findings included the collapse of provision of nondispensing remunerated services, the central role of managerial decisions in supporting resilience (e.g., change to 8-hour shifts from 12-hour shifts) and the central role of technology in supporting continuity of quality pharmacy services. DISCUSSION: With anticipated future pandemic waves, preparedness of community pharmacy will be essential. This study provides important insights based on participants' own experiences regarding ways employers can better support staff in provision of care and service to patients during times of mass-scale civil disruption. Can Pharm J (Ott) 2020;153:xx-xx.

How do community pharmacies in Ontario manage drug shortage problems? Results of an exploratory qualitative study.

BACKGROUND: Pharmacists report spending a considerable amount of time dealing with drug shortages. There is no research in Canada identifying and describing the strategies and resources that pharmacists use to minimize disruption and continuity of care for patients. METHODS: An exploratory qualitative methodology was used. Community pharmacists and technicians in Ontario were interviewed using a semi-structured protocol. Verbatim transcripts were generated and coded by at least 2 independent reviewers using content analysis methods to identify management strategies. RESULTS AND DISCUSSION: A total of 14 pharmacists and 7 regulated pharmacy technicians participated in this study. The following 5 main strategies for managing drug shortages were identified: (1) using the supplier, (2) generic options, (3) brand options, (4) contacting other pharmacies and (5) switching to a different medication. CONCLUSION: The strategies identified through this research can provide pharmacists with some guidance in approaching the real-world problem of drug shortages. It also highlights opportunities for organizations, government and manufacturers to provide additional support for pharmacists to minimize disruptions for patients and to ensure current ad hoc practices do not further compound shortage issues. Can Pharm J (Ott) 2020;153:xx-xx.

Pharmacy Technicians Are People, Too! Let's Consider Their Personal Outcomes Along With Other Pharmacy Outcomes.

Studies have found that expanded pharmacy technician roles can help "free up" pharmacist time, leading to role optimization. However, these studies and the positions taken by many are quite pharmacist-centric. We seem to have underestimated the importance of support staff in pharmacy operations. If research demonstrates that technicians can perform a function safely and effectively, that alone should compel the function's allowance in practice. Freeing up pharmacist time for higher-order care is a positive corollary to technician advancement, but it need not be a precondition for it.

Cardiologists' and nephrologists' management of atrial fibrillation in hemodialysis patients
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BACKGROUND: Antithrombotic therapy for stroke prevention in atrial fibrillation (AF) is considered a standard of care, but for hemodialysis (HD) patients the benefits are unclear, and bleeding risks are high. Our study objective was to compare cardiologists' and nephrologists' stroke prevention practices in different patient risk scenarios. MATERIALS AND METHODS: A cross-sectional, online survey was distributed to members of three Canadian physician societies (Nephrology, Cardiovascular, Heart Rhythm), and to cardiologists affiliated with three Canadian Universities. The questionnaire included four AF scenarios in HD patients with varying stroke and bleeding risks. Physicians selected one of six antithrombotic therapy options for each scenario. RESULTS: Cardiologists were 3 times more likely than nephro-logists to choose anticoagulant therapy over both antiplatelet and no drug therapy, regardless of stroke or bleeding risk (p < 0.001). Physicians' drug therapy choices in regards to level of stroke and bleeding risk reflected the expected pattern based on current evidence. CONCLUSION: Cardiologists were more likely to prescribe anticoagulant therapy for AF in the HD population compared to nephrologists, regardless of patient stroke or bleeding risk.

Assessors' interpretations of narrative data on communication skills in a summative OSCE.

OBJECTIVES: Increasingly, narrative assessment data are used to substantiate and enhance the robustness of assessor judgements. However, the interpretation of written assessment comments is inherently complex and relies on human (expert) judgements. The purpose of this study was to explore how expert assessors process and construe or bring meaning to narrative data when interpreting narrative assessment comments written by others in the setting of standardised performance assessment. METHODS: Narrative assessment comments on student communication skills and communication scores across six objective structured clinical examination stations were obtained for 24 final-year pharmacy students. Aggregated narrative data across all stations were sampled for nine students (three good, three average and three poor performers, based on communication scores). A total of 10 expert assessors reviewed the aggregated set of narrative comments for each student. Cognitive (information) processing was captured through think-aloud procedures and verbal protocol analysis. RESULTS: Expert assessors primarily made use of two strategies to interpret the narratives, namely comparing and contrasting, and forming mental images of student performance. Assessors appeared to use three different perspectives when interpreting narrative comments, including those of: (i) the student (placing him- or herself in the shoes of the student); (ii) the examiner (adopting the role of examiner and reinterpreting comments according to his or her own standards or beliefs), and (iii) the professional (acting as the profession's gatekeeper by considering the assessment to be a representation of real-life practice). CONCLUSIONS: The present findings add to current understandings of assessors' interpretations of narrative performance data by identifying the strategies and different perspectives used by expert assessors to frame and bring meaning to written comments. Assessors' perspectives affect assessors' interpretations of assessment comments and are likely to be influenced by their beliefs, interpretations of the assessment setting and personal performance theories. These results call for the use of multiple assessors to account for variations in assessor perspectives in the interpretation of narrative assessment data.

Discriminating Features of Narrative Evaluations of Communication Skills During an OSCE.

Construct: Authors examined the use of narrative comments for evaluation of student communications skills in a standardized, summative assessment (Objective Structured Clinical Examinations [OSCE]). Background: The use of narrative evaluations in workplace settings is gaining credibility as an assessment tool, but it is unknown how assessors convey judgments using narratives in high-stakes standardized assessments. The aim of this study was to explore constructs (i.e., performance dimensions), as well as linguistic strategies that assessors use to distinguish between poor and good students when writing narrative assessment comments of communication skills during an OSCE. Approach: Eighteen assessors from Qatar University were recruited to write narrative assessment comments of communication skills for 14 students completing a summative OSCE. Assessors scored overall communication performance on a 5-point scale. Narrative evaluations for the top and bottom 2 performing students for each station (based on communication scores) were analyzed for linguistic strategies and constructs that informed assessment decisions. Results: Seventy-two narrative evaluations with 662 comments were analyzed. Most comments (77%) were written without the use of politeness strategies. A further 22% of comments were hedged. Hedging was used more commonly in poor performers, compared to good performers (30% vs. 15%, respectively). Overarching constructs of confidence, adaptability, patient safety, and professionalism were key dimensions that characterized the narrative evaluations of students' performance. Conclusions: Results contribute to our understanding regarding the utility of narrative comments for summative assessment of communication skills. Assessors' comments could be characterized by the constructs of confidence, adaptability, patient safety, and professionalism when distinguishing between levels of student performance. Findings support the notion that judgments are arrived at by clustering sets of behaviors into overarching and meaningful constructs rather than by solely focusing on discrete behaviors. These results call for the development of better-anchored evaluation tools for communication assessment during OSCEs, constructively aligned with assessors' map of the reality of professional practice.

Pharmacists' lack of profession-hood: Professional identity formation and its implications for practice.

BACKGROUND: Understanding the internalized, psychological sense of being a professional may provide important insight into understanding pharmacists' behaviours and attitudes in practice. METHODS: It is difficult to directly or quantitatively measure an internalized psychological state such as profession-hood. An indirect method was selected in which pharmacists who were themselves patients or caregivers were identified and invited to discuss their experiences, as a vehicle for better understanding how they relied upon personal and professional identities during high-stress, impactful times. RESULTS: A total of 17 community pharmacists from southern Ontario participated in this study. Regardless of demographic background, participants reported little reliance on professional identity, knowledge or role as a pharmacist when advocating for themselves or a loved one. INTERPRETATION: These findings suggest that community pharmacists have incomplete, separated or functional (rather than existential) professional identities. This lack of professional identity may influence behaviours in practice such as interactions with other health care professionals or patients or self-confidence in clinical decision-making. CONCLUSIONS: Further work is necessary to better understand the socialization and professional identity formation of pharmacists to help support them through the current evolution of pharmacy towards more interdependent and complex clinical roles and decision-making.

Community pharmacists' attitudes, opinions and beliefs about leadership in the profession: An exploratory study.

BACKGROUND: The profession of pharmacy needs effective leaders to navigate change. Indirect indicators suggest there are insufficient numbers of pharmacists who actually want to be leaders. A paucity of research limits our understanding of what motivates and demotivates pharmacists to be leaders. This exploratory study was undertaken to investigate community pharmacists' attitudes, opinions and beliefs about leadership. METHODS: Interviews with 38 pharmacists were conducted either in person or using telecommunication applications such as Skype. A semistructured interview guide was used to elicit comments about leadership in general and in pharmacy, perceived leadership roles and barriers/enablers to leadership. Data were analyzed using Chan and Drasgow's motivation-to-lead framework. RESULTS: Key barriers to assuming leadership roles included lack of education/support, inadequate compensation, concerns about work-life balance, time constraints and a generalized discontent about leadership in society and in the profession. DISCUSSION: While some of these barriers could be addressed through formal education (such as conflict management training) or through managerial influence (e.g., remuneration or scheduling to improve work-life balance), some (such as cynicism about leadership) will be more challenging to address. The need to address these barriers will grow as the need for new and emerging leaders in pharmacy continues to evolve.

What does it take to change practice? Perspectives of pharmacists in Ontario.

BACKGROUND: This is a time of rapid change in the profession of pharmacy. Anecdotally, there are concerns that the pace, extent and rate of practice evolution are lagging. There is little evidence documenting the influencers and mechanisms that drive practice changes forward in pharmacy in Canada. METHODS: An exploratory qualitative method was selected, using both one-on-one interviews with self-categorized typical pharmacists and larger focus groups to provide context and confirmation of themes generated through interviews. Data were analyzed and coded using a constant-comparative iterative method, in order to generate themes related to the factors influencing pharmacists to actually change their practice. RESULTS: A total of 46 pharmacists meeting inclusion criteria participated in this study in focus groups, interviews or both. Nine themes were identified: 1) permission, 2) process pointers, 3) practice/rehearsal, 4) positive reinforcement, 5) personalized attention, 6) peer referencing, 7) physician acceptance, 8) patients' expectations and 9) professional identity supportive of a truly clinical role. One theme that did not emerge was payment, or remuneration, as a specific or isolated motivational factor for change. INTERPRETATION: The complexity of practice change in pharmacy and the multiple factors highlighted in this study point to a more deliberate and concerted effort being needed by diverse pharmacy organizations (educators, regulators, employers, professional associations, etc.) to support pharmacists through the change management process. CONCLUSIONS: The "9 Ps of practice change" identified through this study can provide pharmacists with guidance in terms of how to better support evolution of the profession in a more time-efficient and effective manner.

Facilitating integration of regulated pharmacy technicians into community pharmacy practice in Ontario: Results of an exploratory study.

BACKGROUND: The integration of regulated pharmacy technicians (RPTs) into community pharmacy practice was intended to relieve pharmacists of certain technical duties to facilitate greater provision of direct patient care services, commensurate with expanded scope of practice. There is scant data available regarding the success, value and impact of RPT integration, either in Canada or in other jurisdictions. METHODS: Pharmacists and RPTs working in community practices were interviewed. Qualitative data were categorized using an iterative coding process to identify themes related to barriers and facilitators to integrating and optimizing the role of the RPT in community practice in Ontario. RESULTS: A total of 16 RPTs and 12 pharmacists were interviewed from community sites in Ontario. Strategies for facilitating successful integration of RPTs into daily workflow were identified, based on 4 major themes: environmental factors, interpersonal factors, professional identity formation and innovative use of delegation. INTERPRETATION: Integration of RPTs into community practice is complex and requires careful management, planning, training and follow-up to ensure attainment of objectives. Simply hiring RPTs and placing them into existing workflow patterns is generally not a successful implementation strategy. CONCLUSIONS: Implementation strategies identified through this study can provide employers, managers, pharmacists and RPTs with opportunities to enhance RPT integration and optimize the role of both pharmacists and RPTs in community practice.