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Ultan Molloy Ponders The Conundrum Of Keeping A Workforce Happy And Inspired While Still Running A Viable Pharmacy Business.

The present workforce situation continues to weigh on my mind, and how we might adapt and develop things in order to better the situation for everyone involved. There are several problems with ‘throwing money at’ it creates, and if we are thinking that buying-off some of our employees solves the problem, we’re grossly underestimating its complexity. 

An evolution of our present standard as employers will be of course looking at additional workplace benefits for all of our staff. We’re at a time, however, when prescription item volumes are increasing and all members of our team need to be considered. Pensions supplementation, maternity benefit, sick pay and employee health insurance are some things that we can consider. The costs to the business would be significant, and having facilitated significant wage increases across the board in recent times, how to manage these and to plan into the future while ensuring that the business continues to be viable has me somewhat in a state of anxiety and paralysis. I have after many months got some pharmacist support — from outside the country, I might add — for a couple of months, which will help me get myself out of the ‘day-to-day’ enough to try and learn about benefits, and how we might manage them in the business. 

As an aside, I hadn’t considered some other things, like training fees paid, subscription fee payments, clothing allowances, additional annual leave entitlement, One4All vouchers (up to €500), team nights out, accommodation and parties paid for, staff discounts, and travel allowances/free parking, as ‘benefits’, but they’re really all in the mix for us to consider. 

Dan Pink’s book Drive, which explores motivation and offers a model for its understanding, is something I will endeavour to explore, relate to community pharmacy and synopsise as best I can at this time in the next few paragraphs. 

Motivation 1.0 is survival. Those of us reading this are all in pretty good shape there, and thankfully so. Gratitude is good for us to embrace here, given that about 9.2 per cent of the world, or 689 million people, live in extreme poverty on less than $1.90 a 

day, according to the World Bank. 

Motivation 2.0 is the carrot-and-stick idea, much like the money and benefits discussion that seems to regularly permeate our thinking. Frustration, discontent, entitlement both by employees and employers, societal change and expectations around work-life balance, alternate reference points for workplace pay and conditions to private retail healthcare (ie, Tech sector, other healthcare workers, public sector, etc), marketplace changes, increasing workloads, downward pressure on margins, inflation, etc. All have emotions running high with some of us pharmacists, and create an underlying appetite for something different to our present status quo. We must do better for all our employees at this point if we’re to have an engaged, productive and happy workforce in our community pharmacies. 

Motivation 1.0 is survival. Those of us reading this are all in pretty good shape there 

Motivation 3.0 is also worth considering though. It has three elements, as referenced by Dan Pink. These are autonomy, mastery and purpose. Autonomy is the need to direct your own life and work, like the “sun in the self-determination universe”. To be fully motivated, you must be able to control what you do, when you do it, and whom you do it with. According to Pink, autonomy motivates us to think creatively without needing to conform to strict workplace rules. Autonomy has the elements of time, task, technique, team and technology. 

The opportunities as a community pharmacist here include being left to work through your own day, and self-determine autonomously. The challenge can come in terms of time pressure (customer-facing, or lack of capacity), the nature of the task (perhaps more technical than clinical, where one may have a preference for the latter), team pressure (not enough people, capacity or capability, or relationship pressures), and technology (FMD, and other clunky elements of the present dispensary systems, based of course on regulatory requirements, and present technological limitations come to mind). 

Some of the above may be in our control as employers and employees. What can we delegate? What time can we ring-fence as ‘checking time’ for pharmacists? Can we get ahead and anticipate patients coming in for regular scripts and items? How can we better manage interruptions to allow for focused uninterrupted time? How can we best use under-used skills and competence as pharmacists, and delegate necessary, and minimise unnecessary, technical work with support from our technician colleagues? How can we make sure we have an excellent team able to operate excellently both in terms of capacity and competence, a healthy culture, and an enjoyable supportive workplace? 

How can we manage and employ pharmacists in a way that supports them bringing their best to their work, without micromanagement, but with open adult discussions around shared needs and expectations? How can we get the most from our technology in order to streamline our work and processes? (what’s necessary to input — excellent computer, camera and printer speed? A dispensing process that is LEAN and reduces re-work?) All food for thought, and worth giving some time and consideration to. 

Lunch breaks, prescription workflow planning, and upskilling of our colleagues are three ways as examples that some of us could improve our workplace motivation. Repeated interruptions are draining, and this idea of ‘pharmacist accessibility’ at the behest of everyone coming through the door is both unreasonable and likely to burn-out pharmacists, as well as lead to checking errors. 

Don’t get me started about the idea that sales of all ‘P’ medicines must be ‘supervised’ by the pharmacist. Is this at the same time as they’re checking, dealing with prescription queries, liaising with GPs and other healthcare professionals, etc, along with a plethora of other tasks and demands that many of us may not be in a position to delegate day-to-day. A concept of ‘supervision’ of ‘sales’ that is in any way comprehensive is surely unreasonable? 

Many of us are lucky to have trained colleagues at the counter who can manage customer interactions, and have us there as a back-up. It is not humanly possible for a pharmacist to listen to a patient interaction at the counter, while properly checking a prescription, in order to ensure patient safety. This is before all the other queries and interruptions that aren’t public-facing. Nor is it possible, or necessary, to have counselling the counter that is so comprehensive that the patient remembers little of it, not least that they can discern which was the most important element for them of the 10 or so things they were told. What is it we are taught about presentations in college? ‘Have one main point that you want your audience to take away.’ 

It’s time to get real, train-up our non-pharmacist colleagues with the support of our regulator, training providers and third-level institutions, afford them autonomy. We must allocate our limited pharmacist time where we can be most effective for patients, in order to ensure they get their medicines, vaccinations, and pharmacist support in the most impactful way possible for their, and our, physical and mental health. 

Mastery is the second element of the three motivating factors which Dan Pink explores. This is about growth mindset, and we can hire for and coach our staff in this. We want to cultivate this in ourselves as pharmacists, and in our hires, and to develop an ‘I can be better’ mindset. One can be better if one puts in the work; this is the key. One must stretch oneself in order to develop necessary and desirable skills. One must continue to strive for mastery, while knowing that one will never fully achieve it, as one will keep raising the standards for oneself. 

The third element is ‘Purpose’. This is about being engaged in something bigger than oneself, as the main element. This is one’s one sentence at work: ‘I want to be known as the kindest, and most professional healthcare provider in the town’, or perhaps ‘I want to have the best possible workplace culture in order to deliver for our patients, colleagues, our business, and our family.’ 

You get the idea, although what’s motivating for one person in their ‘one sentence’ could be very different to someone else. Also, asking oneself daily, ‘did I get a little better today?’ as the process element of this. In the case of our work, this may be a better colleague, a better pharmacist, a better confidante, a better team player, a better leader, or a better friend. 

With a winter ahead of us, I hope some of the above offers some of us a sense of personal empowerment, positivity and possibility when it comes to our present workforce challenges, and how we can more creatively and constructively work together to better thrive as employers, employees and pharmacists.