How to make the pharmacy workplace inclusive for neurodivergent team members

Introduction

Neurodiversity describes the differences between human brains and celebrates the different ways in which different people see the world^​1​. Most of the population can be described as ‘neurotypical’, and the minority that diverge neurologically from this can be described as ‘neurodivergent’^​2​.

In the UK, it is estimated that one in seven people are neurodivergent^​3​, although many go through life without a formal diagnosis. For example, only 120,000 UK adults have been formally diagnosed with attention deficit hyperactivity disorder (ADHD),​ but the actual number of adults with ADHD is believed to be around 2.6 million^​4,5​.

All employers are legally obligated to provide reasonable adjustments for staff with disabilities, but bias and discrimination mean that three in five disabled people do not disclose their disability to employers^​6​. It is likely that many pharmacy teams are therefore neurodiverse, even if management is not aware of this, but specific data are absent; a 2023 survey by the General Pharmaceutical Council (GPhC) found that the majority of registered pharmacists and pharmacy technicians chose the option ‘prefer not to say’ or did not record any answer about whether they have a disability (see Table)^​7​. The data gathered by the GPhC on disability do not record the different types (e.g. physical, hearing or visual impairment or neurodivergence).

Neurodiverse teams have been shown to be 33% more efficient^​8​; however, standard workplace procedures and customs can interfere with neurodivergent people’s ability to work to their full potential. Neurodivergent people are up to three times more likely to be bullied than neurotypical people, which can lead to low self-esteem and vulnerability^​9​. 

This article explains the changes that can be made to the pharmacy workplace to make it more inclusive for neurodivergent colleagues, focusing on changes that would be useful specifically for people with autism, ADHD, dyslexia, dyspraxia and sensory-processing differences.

How to create an inclusive pharmacy environment

Unless they choose to disclose this information, it is not possible to know if there are any neurodivergent colleagues within a pharmacy team. Neurodivergence does not always look like the stereotypes we see in the media and neurodivergent colleagues are highly likely to copy neurotypical traits and suppress neurodivergent traits or ‘mask’ to fit into the society around them^​10​. Fearing discrimination, neurodivergent colleagues may choose not to let their managers or fellow colleagues know and others may not know themselves that they are neurodivergent^​10​. 

Workplaces need to be inclusive for everyone and this ensures that neurodivergent people can thrive at work regardless of whether they (or their managers) know they are neurodivergent. People should not have to ask for everything they need, as it should already be in place^​11​. As business owners and managers, it is important to get to know colleagues’ communication and learning preferences. The ‘Manual of Me’ is a useful, free resource that can help pharmacy team members identify and communicate these preferences^​12​.

Use of neuro-affirming language

Language is important when addressing colleagues and patients. In general, the neurodiverse community uses neuro-affirming, identity-first language. This means referring to an ‘autistic person’, not a ‘person with autism’. The phrase ‘person with autism’ could be taken to imply that there is something wrong with that person that needs fixing; neurodivergent people are not broken — they are different, not less^​13​.

The term ‘with autism’ feeds into the medical model of disability rather than the societal model, which is more representative and inclusive. This societal model of disability describes a world that is disabling to neurodivergent people, necessitating the requirement for reasonable adjustments to support disabled people^​14​. It is, however, important to reflect a person’s own language.

It is also important to stay up to date with terminology. For example, ‘Asperger’s syndrome’ is no longer used as a diagnosis because it has been merged with others into autism spectrum disorder^​15​. Other out-of-date terms include ‘high functioning’ and ‘low functioning’ — the correct term is ‘high and low support needs’, which more accurately aligns with the neurodivergent experience. Support needs differ between individuals and will change throughout life; they can even change monthly^​16​. Instead of thinking of the autism spectrum as linear, with people being ‘more’ or ‘less’ autistic, the neurodivergent community talks of ‘spiky profiles’ (see Figure)^​17​. This refers to the fact that all people, both neurodivergent and neurotypical, have different strengths and weaknesses^​18​.

The Pharmaceutical Journal

Understand there are different approaches to communication

Communication issues between neurodivergent and neurotypical people are often referred to as the ‘double empathy problem​’^​19​. Communication issues have historically been seen as a problem that neurodivergent people must learn to overcome to fit into a neurotypical society, when in fact it is the responsibility of all people to better understand each other and be open-minded when judging how best to communicate​.

For example, when beginning a conversation, neurotypical people often cycle through small talk before moving on to the main subject​, whereas neurodivergent people tend to prefer meaningful conversation, often about their special interests, which they may talk about at length (commonly referred to as ‘infodumping’)^​20​. Eye contact is often described as an important component of effective communication but this can be difficult for many neurodivergent people. Some choose to avoid it altogether, or they may concentrate so intently on achieving the ‘correct’ level of eye contact that they miss important points in the conversation^​19​.

It is a common neurotypical trait in the UK to ‘sugar coat’ or speak indirectly about a sensitive point, because it is seen as more polite. This can be confusing for neurodivergent people, who often rely on literal, direct language and their own directness is sometimes misinterpreted as rudeness. Neurotypical people also tend to use more implications, innuendo and changes in tone when speaking. Neurodivergent people may not use or understand tone. On the other hand, some neurodivergent people can be hypersensitive to tone^​; therefore, clear and specific language, without idioms or colloquialisms should be used^​19​.

Empathy can also manifest differently: while neurotypical people typically mirror emotions and focus on the person,​ neurodivergent people may show empathy by retelling a related story; this can be perceived as selfish​ but is simply a different way of showing empathy^​19​.

Neurodivergent people may ask many questions to clarify a situation, including repeatedly asking some questions to fully process information, sometimes owing to delays in auditory processing^​21​​.

With verbal communication, neurodivergent people may rely on scripts often practised many times in their head and it can be disconcerting for them if the conversation does not go as planned. They may also experience echolalia, where they may repeat phrases or quotes from films or TV shows. Some neurodivergent people may be non-speaking, this can be permanent or minimal and everything in between. Accommodations should be made for this, such as the use of pictorials^​22​.

Socialising

Neurotypical people often enjoy social activities, particularly in groups, and may be disappointed by those who decline such events​. We all have a ‘social battery’ that can become depleted. For neurodivergent people, this battery can be further depleted by using executive functioning skills, coping with sensory issues and masking. Spending time alone can be the neurodivergent way of recharging a social battery^​23​. This could be accommodated by staggering lunch times to make break rooms less crowded, as well as reducing exposure to food smells and reducing the need to engage in small talk. People must also not be judged for opting out of social activities outside of work and not excluded socially if they choose to do activities alone.

Physical environment

The environment can have a huge impact on neurodivergent people with sensory-processing differences: strong smells, fluorescent lighting or the low-level hum of electrical equipment can overwhelm and affect the person’s ability to communicate effectively^​24​. Although the physical environment of a pharmacy, dispensary or ward can be hard to change, the use of natural light as much as possible can help to mitigate some of this; also, allowing the use of ear plugs or defenders can help to dampen overwhelming sounds. Encouraging movement breaks outside can help to give neurodivergent team members a break from overstimulating environments.

Practical ways pharmacy teams can create an inclusive environment

Normalise the use of resources

‘Stimming’ is short for ‘self-stimulation’; examples include hand-flapping, finger-rubbing, jumping up and down, feet-rubbing, finger-clicking, humming, self-talking and hair twirling^​10​. All people stim to some extent, but neurodivergent people stim more often, as it helps to regulate emotions, reduce anxiety and increases focus. Normalising the use of fidget resources (such as fidget spinners or fidget cubes) in the pharmacy environment and allowing people to stim openly can mean neurodivergent team members can regulate and mask less, as well as helping them focus during work. 

Encourage body doubling — where another person is present when completing a task — which can be done virtually or via an app. The other person might undertake the task as well or simply be present to help support and keep the individual on track; for example, working alongside a colleague who is accurately checking prescriptions to ensure the task is done without any distraction, helping with executive function struggles^​25​. Timers can be used by those who have time-blindness to keep them on task.

Allow mental health days

Those who are neurodivergent are more prone to mental health issues; for example, half of all autistic people experience depression^​26​. Mental health days should be encouraged to help emotional regulation and avoid overwhelm and neurodivergent burnout^​16​. These should be logged as sickness rather than holiday entitlement and company absence policies should be updated to accommodate this. 

Provide quiet spaces

Providing a quiet space to work or to decompress, where possible, can help avoid overwhelm and reduce anxiety to help neurodivergent people regulate and help with sensory processing^​10​. 

Improve meeting protocols

Meetings can be a source of high anxiety for neurodivergent people. The demands of masking, using executive functioning skills and processing information on the spot can be high. Some of this anxiety can be removed by making cameras optional for online meetings and allowing time for people to reflect and submit ideas after the meetings in their preferred format. Provide context for any meeting: having no context can ruin the whole day for a neurodivergent person, as they may be filled with dread, thinking the worst^​16​. ​This could be caused by rejection sensitivity dysphoria, which means a person can take everything personally and perceive rejection in all situations^​27​.

Send a formal agenda prior to meetings and follow-up with minutes afterwards. This will allow time for those who struggle with auditory processing to digest the content. Applications, such as Microsoft Teams and Zoom, allow meetings to be recorded with auto-generated closed captions, which allows meetings to be watched again by those who struggle with processing delays.

Allow flexibility in the working day

Travel can be particularly stressful and tiring for neurodivergent people. The modern reliance on apps for timetables, maps and tickets, stresses owing to delays, time blindness and the sounds and smells of public transport can be an overwhelming experience. It can leave neurodivergent people tired and so time to regulate should be allowed before starting work. Be flexible and open to changing start and end times to avoid rush hours. However, having a set routine can help some neurodivergent team members, so having a regular shift pattern might make travelling more predictable and therefore less overwhelming.

In some pharmacy environments, although understandably not all, hybrid working may be possible. It allows team members to optimise their environment and the times at which they work best; this autonomy results in reduced anxiety and helps with sensory processing.

Communicate clear expectations

Make sure that all pharmacy job descriptions, rules and procedures are clear, specific and readily available. During recruitment, interview questions should be sent in advance for all interviews and two-stage questions should be avoided to ensure candidates have time to process information and give their best answer, not enduring undue pressure^​28​. New starters should be offered the opportunity to experience the workplace before they start — this gives them a chance to test the levels of light and noise and figure out the best way to travel to work (with no time pressure). 

Training

Pharmacy students and trainees should be provided with templates or samples​ to help them understand what is expected; submission of evidence should also not be limited to just the written medium and allowing alternative methods, such as voice notes or oral submissions, would be more inclusive to all types of learners^​21​.

Instructions should be both verbal and written, to be more inclusive of people processing information differently. Big tasks should be broken down into smaller milestones to avoid overwhelm and help with executive functioning^​29​.

All materials must be accessible, which means using suitable combinations of typeface, text colour and background colour. The British Dyslexia Association’s Dyslexia Style Guide is a good resource for detailed information on fonts and colours to use (or avoid)^​30​. Accessibility requirements apply to all resources and signage within the pharmacy. Ensure emails are compatible for screen readers; for example, ensure hyperlinks are shortened and colour is not used for differentiation or emphasis^​31​. Emails should be short and to the point. They could be structured using the ‘what, when, why’ format (what exactly do you need, when exactly do you need each bit by and why do you need each bit to be done) — this provides context, deadline and keeps emails precise^​16​.

Conclusion

Creating an inclusive pharmacy environment comes down to having empathy and compassion, actively listening to people and being aware and accepting of neurodiversity. Provide an open and honest work environment where people feel able to disclose confidential information and ask for whatever they require without fear of negative consequences.

Everyone works differently and to ensure the best results from the team it is important to provide as many reasonable adjustments as possible to support those who may be struggling.