Relationship with other members of the healthcare team
The other members of the healthcare team that work directly with the pharmacist
The roles played by the other members of the healthcare team and how the pharmacist interacts with them
The role of technicians, dispensers and medicine counter assistants and their qualifications
The importance of leadership, delegation, negotiation and teamworking and how to achieve these
Introduction
Nowadays most pharmacists work as part of a team with other healthcare workers. If this team is to function efficiently to provide good pharmaceutical services to the public, then a good working relationship needs to be developed between all the members of the healthcare team. In many situations, the pharmacist will be the manager/supervisor or responsible person for the team. In other situations, the pharmacist may be part of a team but not responsible for the team, for example as a member of an ethics committee or team developing educational materials for use by ward staff in a hospital.
The relative position of the pharmacist in a team will determine the skills required to undertake an efficient role. If the pharmacist is responsible for the team, then the required skills will be leadership, managing/supervising and delegation. In order to delegate, the pharmacist must be confident the team has the required skills. If not, then an assessment of training needs and subsequent training will need to be organized. Negotiating skills will be needed and crucial if the pharmacist is part of, but not responsible for, a team. In such a situation, the pharmacist must be a good teamworker.
What is teamwork?
Teamwork can be defined as the process whereby people work together cooperatively to deliver goals. The goals will vary depending on the type of team but it is essential that these goals are well defined. In any team it is important that each member knows the role they play and how they contribute to the goals. The introduction of SOPs (see Ch. 11) has gone a long way in helping define each member’s role and responsibility as well as fulfilling UK clinical governance criteria (see Ch. 9).
The following skills and attributes are desirable for successful teamwork:
Listening skills – within any team all members should be encouraged to speak out and offer suggestions for improvement which in turn may trigger other ideas from the other team members.
Questioning skills – to always question why things are done the way they are and not to blindly accept something because that is the way it is always done.
Respect – treat others as you would want to be treated yourself. This comes back to being an effective leader. Effective leaders command respect. However, all members of the team should be treated with respect by the team leader and other team members for the role that they play in the team. All members and their role in the team are necessary for a productive, efficient team.
Helping – this is the true essence of teamwork and ensures that everyone is involved in reaching the goals.
Sharing – this means sharing ideas and information. If one person keeps important information to himself or herself, then the team will not function properly. Sharing also means that no one person should take the glory for the team’s efforts as everyone has had a part to play.
Collaborating – all members are encouraged to participate in the team and when there is a high level of collaboration an effective team emerges. This requires elements of trust, shared goals and clarity of roles.
Communication – a skill required in all areas including by e-mail, at meetings where face-to-face communication is important or the written word. It is crucial not to be misunderstood at any level.
The healthcare team
The healthcare ‘team’ can be defined in a number of ways and will depend on the work environment of the pharmacist.
In community pharmacy, the immediate team that the pharmacist works with on a day-to-day basis is made up of:
The terminology will vary depending on the individual company or business.
The community pharmacist will also be involved with external people, depending on their job role – the extended ‘team’:
A pharmacist providing services to residential or nursing homes will be in constant communication with the care home staff and a variety of clients, e.g. the elderly, children and psychiatric patients
Communication will take place with the GP practices and their staff on a regular basis depending on requirements, e.g. receptionists, practice managers, practice nurses, practice physiotherapists, asthma and stoma nurses, etc.
The pharmacist will be in contact with healthcare professionals in the local area, for example, community/district nurses, health visitors, psychiatric nurses, Macmillan nurses, physiotherapists
The community pharmacist may liaise with the local drug misuse teams depending on the services provided in that pharmacy
Other groups of professionals the pharmacist may have contact with include dentists, chiropodists and optometrists and social workers
Community pharmacists will have to work with local commissioners and their pharmacist representatives on clinical governance matters and contract negotiations.
This list is not exhaustive but gives an idea of the variety of people/professions the community pharmacist has to interact with on a daily basis when dealing with specific problems related to individual patients’ care, selection of drugs by the healthcare professional, dealing with drug interactions, etc.
In a hospital pharmacy, the pharmacist will interact with the pharmacy team as well as the healthcare professionals directly involved in the patients’ care on a daily basis and with far more ease of contact than the community pharmacist has with the GP. When dealing with the junior doctors and nursing staff in hospital, the pharmacist will have a teaching/supportive role while assuming an advisory role on the use and side-effects of drugs when dealing with more experienced staff. Hospital pharmacists will have contact with other professionals with regard to discharging patients into the community, such as social workers, physiotherapists, occupational therapists, dentists and the local drug misuse team. Within the hospital environment the pharmacist may have to become involved with the various hospital committees, e.g. drug safety, ethics, general administration, formulary, etc. and interact with a range of professional as well as administrative staff. In addition, hospital pharmacists will be in contact with community pharmacists to ensure a seamless supply of medicines to those patients discharged from hospital on specialized drug regimens.
The changing role of the pharmacist (see Ch. 1) has made it even more important that the pharmacist depends on their healthcare team to free up the time to allow them to deliver the various services required by the new pharmacy contracts. The pharmacist is moving further away from the traditional role of dispensing to advising patients and customers on their medicines and offering additional services.
The community healthcare team
Medicines counter assistants/healthcare assistants
From 1 July 1996 it has been a professional requirement in the UK that each member of staff whose work in a pharmacy will regularly include the sale of medicines, must have completed a course or be undertaking an accredited course relevant to their line of work. The regulatory body for England, Wales and Scotland, set the requirements for these courses and undertake a quality assurance process which leads to the course being accredited.
There is a requirement that the member of staff should be enrolled on an appropriate course within 3 months of starting their role and have completed it in 3 years.
The following training programmes for medicines counter assistants/healthcare assistants have been accredited by the GPhC:
Boots UK: ‘Healthcare Advisors’ Programme’
Buttercups Training: ‘Medicines Counter Assistant Course’
Chemist and Druggist (UMB Medica): ‘Counterpart’
CIG Healthcare Partnership: ‘Counterintelligence’
Medicines counter assistants/healthcare assistants will primarily be found in community pharmacy. Their training usually takes the form of ‘workbook-led on-the-job learning’, meeting the above requirements for accreditation with the pharmacist acting as the tutor. This allows the relationship to develop and the pharmacist to realize the potential and limitations of these members of staff.
Dispensing/pharmacy assistants
The training required is much more in-depth than for the medicines counter/healthcare assistant to reflect the variation in role and responsibilities. The job title will vary depending on the sector of pharmacy the person works in and indeed the company/business they work for – dispenser, dispensing assistant, pharmacy assistant, assistant technical officer, etc. Regardless of which sector of pharmacy they are working in, what they all have in common is that they are working under the supervision of the pharmacist.
Since January 2005, there has been the professional requirement that dispensing/pharmacy assistants are competent in the areas in which they are working to a minimum standard which is equivalent to the Pharmacy Services Skills S/NVQ level 2 (QCF) qualification or are undertaking such training.
This applies to staff working in the following areas:
Sale of OTC medicines and the provision of information to customers on symptoms and products
Prescription receipt and collection
The assembly of prescribed items including the generation of labels
Ordering, receiving and storing pharmaceutical stock
Preparation for the manufacture of pharmaceutical products, including aseptic products
Manufacture and assembly of medicinal products, including aseptic products.
To fulfil this requirement, a training programme relevant to the job needs to be completed within a 3-year time period and the member of staff should be enrolled on such a course within 3 months of starting their role. Exemptions to the minimum training requirements exist and include:
Pre-registration trainee pharmacists
Students currently studying for a pharmacy degree
Students currently studying on an Overseas Pharmacists’ Assessment Programme (OSPAP).
The dispensing/pharmacy assistant is a key member of the healthcare team, as they free up the pharmacist from the assembly processes involved in the dispensing of prescriptions.
Pharmacy technician
A pharmacy technician is someone who has undertaken a course that involves completing both knowledge and a competency-based qualification. The GPhC will either accredit programme providers such as the NPA and Buttercups or will recognize the qualifications provided by various awarding bodies, i.e. Edexcel, City and Guilds and SQA, which can be undertaken at various colleges and centres throughout the UK.
Once qualified, the pharmacy technician has to register with the GPhC if they want to practise as a Pharmacy Technician (a title protected by Law) in England, Wales and Scotland. Pharmacy Technicians are bound by the Standards of conduct, ethics and performance and must participate in continuing professional development (see Ch. 5).
The pharmacy technician may work in hospitals, community pharmacy, health centres, primary care trusts, prisons and the armed forces and in the pharmaceutical industry. We will focus on community and hospital pharmacy.
Community pharmacy
Pharmacy technicians are required to make up the prescriptions issued by doctors. These are checked by the pharmacist for accuracy and to make sure that the dosage and treatment are safe for that patient, i.e. a clinical check.
The role of the technician involves:
Reading prescriptions and translating doctor’s instructions
Counting solid dosage forms and measuring specific quantities of liquids
Preparing accurate labels for medicines
Selling medicines and other complementary preparations
Referring to the pharmacist when appropriate
Small-scale or individual preparation of extemporaneous products as requested by the doctor which are not supplied as ready to use by manufacturers
Maintaining and managing stock within the pharmacy
Being aware of the legal requirements relating to prescribing and supply of medicines.
There is considerable overlap with the dispensing/pharmacy assistant role, but with additional responsibilities. In community pharmacy, this may include training and development and management of other staff.
The pharmacy technician may choose to become an accuracy checking technician (ACT). This will require them to undertake a further period of study and the development of a portfolio of evidence to demonstrate their competence in this area. The requirement for most ACT courses is that the trainee must have successfully checked 1000 items error free in a defined period of time (usually 4 weeks), while keeping a diary of all items checked and any errors made while checking or dispensing and completing any assignments required by the employer. There is usually a final assessment, which requires them to check the accuracy of a set number of prescriptions.
An ACT plays a valuable role in the dispensing process. They will accuracy check prescriptions after the pharmacist has clinically checked them. This has not only been shown to be more accurate than pharmacist checking but also, more importantly, frees up the pharmacist to carry out other additional services.
Hospital pharmacy
The work in the hospital pharmacy setting for a pharmacy technician has many similarities to that in the community sector. However, the work has greater variation due to the different areas for care within hospital. These include:
Visits to the wards to take orders for medicines
Preparation of radioactive materials or working on clinical trials
The hospital pharmacy also employs ACT pharmacy technicians.
Other members of the pharmacy team
There are other people who can play an important role in the pharmacy team but they are not present in every pharmacy team at all times. These are pre-registration pharmacy trainees and also pharmacy undergraduates, either taking part in a period of vocational placement or working on a part-time basis in the pharmacy setting.
Pre-registration pharmacy trainees will have obtained an accredited degree in pharmacy (see Ch. 5). During the pre-registration year, the pharmacy trainee becomes a valuable member of the team as they learn to apply their university knowledge. The pre-registration pharmacy trainee is given guidance from their tutor throughout this period.
Pharmacy undergraduates may join the pharmacy team at any time; some working on a part-time basis at weekends, others for a period of time during the university breaks to gain experience of career pathways.
Role of the pharmacist in teamwork
The role of the pharmacist, both in the primary and secondary care setting, is changing. No longer can the pharmacist work in isolation; they must learn to become integrated members of both their immediate and extended teams, and so it is essential for the pharmacist to recognize that team leading, delegation, negotiation and teamworking are essential skills that they must possess.
Leadership
There have been many studies carried out to determine what it is exactly that makes good leaders. The majority of these studies lead to the conclusion that leadership is about the behaviour of the leader first and the skills that they possess second. It is about recognizing that people need to trust and respect you before they will listen and act on what you ask them to do.
In any one environment, there can be a number of different teams working together and sometimes one particular team will outperform the others. Why is this?
In all cases, it is attributable to the person leading the team and the fact that they possess such qualities as integrity, honesty, humility, courage, commitment, sincerity, passion, confidence, positivity, wisdom, determination, compassion and sensitivity. This makes their staff willing to go that ‘extra mile’ for them. Some people are naturally born with these behaviours already well developed but others, recognizing that these behaviours are important, can work to develop this side of their behaviours to achieve great leadership qualities.
A good leader will be able to use a number of different leadership styles depending on the situation they are faced with. Again some people have a dominant style of leadership, but to be truly great they need to look at all the other styles of leadership and develop these also.
As a pharmacist, it is crucial to know your own strengths and weaknesses and build on the weaknesses. This is where continuing professional development (CPD) is important (see Ch. 6). The correct behaviour, especially towards your team, is the key to being an effective leader and the following are some tips towards being respected as a leader:
Honesty and integrity: without this no-one in your team will respect you (see Ch. 7)
Never shout at people no matter how angry you get as this only serves to break down the relationships built with the team
Always lead by example: if you are not seen to be ‘doing’ then the message that sends to others is that it is not important to be hard working
Recognize when you need to work with your team to get tasks done: nothing should be beneath you and you should never be afraid to ‘get your hands dirty’
You need to treat all members of the team fairly and based on merit, not singling people out because they like the same football team, for example
You need to be seen to be dealing with any bad or unethical behaviour of team members. Ignoring this type of behaviour is giving out the message that you condone it
Listen to your team and try to understand their point of view: it is sometimes important to place yourself in someone else’s shoes to see their point of view. This does not mean you have to agree with everything but it will give you a better understanding of where they are coming from
Accept the responsibility for when things do not go as planned: do not blame the team or individuals within the team
Always give credit where credit is due, even for your own successes, because you would never have got there without your team behind you (‘Behind an able man there are always able men’ – Chinese proverb)
Provide support for the team so they know that they can trust you to act in their best interests
Always ask for opinions and ideas from the team so that they feel that they are involved in the decisions you may make, especially if things need to change. It is easier to handle change if the team members have been involved from the beginning
If you agree to do something then make sure you follow through: do not make empty promises as you will quickly lose the trust of your team
Encourage the development of your team, giving them responsibility for certain tasks that stretch their abilities without putting undue pressure on them
Be positive, even about things that have gone wrong: we can always learn from this and make things better the next time
Have fun in the workplace: your staff should feel happy in the work they do and in the environment they work in as they spend so much time there; there is no point being miserable
Remember why you are all there: what is the job in hand?
Seek feedback from others to find ways you can develop and improve your skills and behaviours and recognize that we never stop learning.
No pharmacist can do all the tasks themselves, so it is essential that they recognize that many tasks need to be delegated to the other team members.
Delegation
Good delegation will save you time, will develop your team and generally motivates all involved. It is not just a technique to free up time. Poor delegation will lead to frustration, demotivation among your team and failure of the task(s) involved, so it is essential that delegation is effective.
When delegating tasks one should follow the SMARTER mnemonic. To ensure success on completion then all delegated tasks must be:
Specific – if it is unclear what the task is, then how can it be completed effectively? Can this task, in fact, be delegated?
Measurable – you have to be able to measure when the task has been completed to know that success has been achieved. What is the end goal or measure to demonstrate this? This needs to be clearly defined.
Agreed – all parties must be in agreement to the task otherwise this is where frustrations and resentments start to form. Is the individual or team capable of doing the delegated task? Do they understand the bigger picture and where they fit in?
Realistic – if the task is not achievable, either because of timescales or lack of the necessary skills or resources, then this will only serve to demotivate the person involved.
Timebound – the task should not be so great that it cannot be completed in the timescales agreed; is it realistic? If it is an ongoing task then specific review dates need to be in place and adhered to and agreed outcomes clearly defined, e.g. generation of reports, targets reached, etc.
Ethical – you should not be asking your team to carry out a task that goes against their professional or moral ethics.
Recorded – this is important to celebrate the successes of your team if you keep a record of the tasks that have been completed and it also helps to learn from tasks that have not been completed and enables you to provide constructive feedback to your team when things do not go as planned.
It is extremely important for the pharmacist to be able to delegate various tasks within the pharmacy to suitably trained persons because it is no longer cost-effective for the pharmacist to be carrying out tasks that others are more than qualified to complete. Thus, this frees the pharmacist to get on with their job and leads to job satisfaction for all staff involved.
In order to get the members of the immediate and extended teams on board the pharmacist has to be aware of, and if necessary develop, their negotiation skills.
Negotiation
Negotiation is something that we do all the time in and out of the working environment and maybe do not realize it, e.g. deciding what to see at the cinema, where to go out to eat, what shift someone should work and for how long, etc.
Negotiation is usually considered as a compromise between people to get what we want. To be really effective in the team environment the compromise should allow both parties to be satisfied with the eventual outcome. The only time you may want to consider the win–lose negotiation is if you do not need to have an ongoing working relationship with the other party. This is something that is going to be very unlikely in the pharmacy setting. If the pharmacist always negotiates to ‘win’ then the working relationship within the team will eventually break down and the working environment will suffer. Ultimately, patient care deteriorates as no one works together.
Communication is the key link that will be used to negotiate and as such can be in a variety of ways (see Ch. 17). Body language is another area that the pharmacist may wish to develop as body language significantly influences a conversation.
For successful negotiation to occur the following should be considered:
Goals: what do you need to get from the negotiation and do you know what the other party wants? You need to be really clear why you are negotiating and think about what you will accept before entering into the negotiation.
Separate people from the problem: do not get caught up in personalities and relationships and focus on what the actual issues are. It will be a lot easier to justify a decision reached if the results are based on objective criteria.
Generate a variety of possible solutions – no matter how ridiculous they might first sound – before going on to decide the best option to meet everyone’s needs. Sometimes asking the other party ‘What do you think?’ might allow them to actually come up with a solution that you had not thought about but which fulfils everyone’s needs.
Pharmacists in both the primary and secondary care sector are now required to work very closely with their teams to deliver the government targets for access to health care. Pharmacists are dependent on the skills of their immediate teams to be able to fulfil these new roles and demonstrate that they meet the clinical governance requirements. This requires a great deal of teamwork both within the immediate teams and the extended teams.
Conclusion
Pharmacists may work well in their immediate teams but if they are to embrace the changing role of pharmacy and health care, then they need to extend their teamworking across a wide variety of healthcare professionals.
It is essential that pharmacists start to maintain a formal record of all their contributions and interactions within the wide variety of teams to demonstrate their invaluable contribution to patient care.
Key Points
Pharmacists need to work with a wide variety of other healthcare staff
Good communication skills are required to be an effective member of a team, together with the ability to respect, help, share and collaborate with others
A healthcare team will be either an immediate or an external team
The immediate team will be trained to carry out specific responsibilities
External team members could include many other healthcare professionals, other professionals and administrators
There are detailed requirements for qualifications required of different levels of pharmacy support staff
Some pharmacists will occupy leadership roles, which require a wide range of skills