The unexpected importance of workplace resilience in pharmacy practice

All pharmacists and technicians who work in day-to-day, patient-facing practice experience the stresses, rewards, opportunities and challenges of being a healthcare professional. 

There have been long-standing concerns regarding the mental health and wellbeing of healthcare professionals, and a recognition that psychological occupational stress and burnout can directly lead to negative health outcomes for patients^​1​. Increased risk of medication errors, absenteeism, presenteeism, decline in empathy and poorer interpersonal communication skills have all been identified as significant problems when individual healthcare professionals experience workplace stress^​2​. 

Resilience in pharmacy: a study

One solution is to improve resilience within the profession. While most agree that resilience is essential, both for individual healthcare professionals and for professions as a whole, there is less agreement on what resilience actually is, how it is developed and sustained, and who should take responsibility for it. 

Resilience has been described as “a dynamic, positive, adaptive process where individuals maintain or regain mental wellbeing and functionality despite significant stressors and adversity”^​3​. This type of widely accepted definition tends to emphasise personal responsibility for managing environmental stress, rather than attempting to change the circumstances that trigger stress and adversity in the first place. They have led to well-intentioned suggestions of strategies — such as doing yoga, keeping a mindfulness journal, taking up exercise or engaging in meditation — as ideas for helping individuals reach a new equilibrium with their environment. Many self-help books, workshops and peer support networks have focused on strategies such as these as the best way to help people manage difficult and stressful times.

But do these personal changes work in a profession like pharmacy? And are they effective when the circumstances that triggered stress and burnout in the first place do not change? To understand the dynamics of resilience within a real-world context of extraordinary stress and uncertainty, our team of researchers in Canada undertook a real-time study to examine resilience during the early months of the COVID-19 pandemic^​4​. 

We used the stress, uncertainty and complexity of that unprecedented period as a context for observing how individual pharmacists adapted — or did not adapt — to the ever-changing circumstances around them.

As researchers, we were interested in examining how ‘resilience’ evolved in real time for pharmacists and technicians working in community pharmacies. We expected that some individuals would manage, and perhaps even thrive — we anticipated these people might find psychological satisfaction and moral purpose in remaining at their stations and doing the best they could in difficult circumstances. 

We expected our study would end with a list of activities (e.g. running, journaling, yoga) that contributed to resilience and we hoped our study would help other community pharmacists learn from their experiences to undertake high-value resilience-building activities for themselves.

Workplace resilience versus personal resilience 

The results of our study were entirely unexpected. The strongest predictors of which pharmacists stayed resilient and which pharmacists did not were not individual choices and practices, but the choices and decisions made by organisations, pharmacy managers and employers.

Regardless of the size of the pharmacy, its location (urban, rural or suburban) and ownership type (independent owner-operator or large multiple/chain), a consistent theme emerged: the resilience of individual pharmacists was directly related to the working conditions and managerial choices made by employers and managers. We identified five main working conditions and choices.

1. Multitasking versus focused workflow

There is a long tradition and culture within pharmacy of multitasking being the default, expected work practice. Many community pharmacists wear it as a badge of honour that they are busy people who thrive in multitasking environments. 

Our study found, however, that multitasking heightened occupational stress and increased the likelihood of burnout. Pharmacies that had reoriented their workflows to allow pharmacists to concentrate time and attention on single or related tasks for periods of time had pharmacists that maintained their resilience. Where pharmacy managers defaulted to a more chaotic and multitasking workflow, their pharmacists experienced heightened occupational stress, dissatisfaction and risk of burnout.

2. 12-hour versus 8-hour shifts

Many healthcare professionals have longer-than-usual shifts of 12 hours versus the more common 8 hours. It has been argued this allows healthcare professionals to monitor patients over a period of time, especially during an acute phase of an illness. Some prefer a 12-hour shift, as it means they spend fewer days at work each week, even if each of those days is longer and more intensive. Working 12-hour shifts can be particularly attractive for those with family responsibilities.

We found, however, that longer shifts were not good for personal resilience and wellbeing. The cognitive and emotional burden of long shifts, particularly on consecutive days, can lead to a form of exhaustion that predisposes the person to burnout and ultimately ends up damaging resilience.

3. Team versus individual scheduling practices

Any pharmacy manager knows the challenges associated with scheduling staff. In many cases, the scheduling preferences of individual team members are given priority to maintain workplace tranquility. In some cases, given critical skills shortages, managers are simply thankful for anyone registered to practice who will show up, or they are forced to rely on temporary locum/relief staff to fill in shifts. This kind of scheduling scramble is problematic with respect to resilience. 

Pharmacies that maintained consistency in scheduling practices, and those who looked to schedule teams rather than individuals, had pharmacists and technicians who demonstrated greater resilience. 

4. Technology

The spread of technology (including AI) in community pharmacy has been rapid and extensive. The term ‘human factors’ describes an approach to technology integration that focuses on users and on making their experience more intuitive, seamless and simply less stressful.

Participants in this research highlighted optimal and less optimal managerial practices with respect to technology that influenced their personal resilience. Where human-factors approaches were used by managers to thoughtfully implement new technologies, these technologies reduced occupational stress and enhanced resilience. By contrast, where technologies were simply implemented without sufficient training or thoughtfulness around the effects on workload and workflow, this significantly increased stress and heightened risk of burnout.

5. Staffing support

One of the most stressful issues community pharmacists faced during the COVID-19 pandemic was needing to keep up with the ever-changing requirements around social distancing, crowd management and other public-health guidance related to keeping clients safe.

During the early months of the COVID-19 pandemic, some pharmacies hired dedicated wayfinding staff to provide customers with wayfinding support (so they were not wandering aisles looking for items) and enforce the maximum number of people allowed in a pharmacy. Hiring extra staff to relieve pharmacists of this kind of work (which was necessary, but stressful and time consuming) was nominated by study participants as an example of thoughtful managerial practice that enhanced resilience. 

Another example is lunch and coffee breaks. Many pharmacists find it impractical to take proper breaks or sit-down lunches, creating both physiological and psychological stress. Some employers recognised the importance of supporting staff by providing them with coffee and sandwiches during their shifts. For a relatively small amount of money, the goodwill of such gestures, coupled with the practical impact of reducing non-professional/personal work and stress, was described by research participants as “significant”.

Unexpected conclusion

The expected personal resilience strategies (e.g. yoga, exercise, meditation) were not significantly protective or predictive of who would thrive and who would struggle in the face of challenging workplace conditions. While individuals had their own preferences and capacity to engage in such personal, resilience-building activities, their impact overall appears to have been less helpful than employer-led managerial decisions.

These findings led to an interesting and unexpected conclusion — that pharmacy professionals would be better off being generally unresilient human beings who had the good fortune of working within a resilient work environment that supported them, than being personally and psychologically resilient and having the bad fortune of working in an unsupportive, unresilient workplace.

Practical steps to support resilience in pharmacy

Managerial decisions matter when it comes to the mental health, wellbeing and psychological safety of pharmacy professionals. The examples supplied by the pharmacists interviewed in this study show that changes are possible if managerial will and resources exist. 

To further explain these findings, a series of practical articles will be published in The Pharmaceutical Journal over the coming weeks. Each article in this series will explore the topics discussed above in more detail, looking at the structure of pharmacy practice and identifying ways in which management decisions can support pharmacists’ resilience.

These resources are aimed at identifying specific techniques that owners, managers and pharmacy leaders should consider to better support their workforce and unlock its full potential.