Healthy Living Pharmacy HLP Leadership Leyla Hannbeck MSc

Healthy Living Pharmacy (HLP) Leadership Leyla Hannbeck MSc MRPharm. S Chief Pharmacist Twitter: @Leyla. Hannbeck

What we will cover today. . . • • • Changes in pharmacy and the direction of travel What you need to know about Healthy Living Pharmacies Qualities seen in great leaders and how this relates to pharmacy Change management How to build a great team – lead, motivate, delegate, develop self and others Communication and how to build rapport How to give feedback How to manage a conflict situation Group works, examples and action plan

Challenges facing the NHS • Self-created health issues affect many people Ø 1 in 5 adults smoke Ø 1/3 drink too much alcohol Ø Just under 2/3 are overweight or obese • • Ageing population Increased prevalence of chronic diseases Acute and episodic care Care across primary, secondary, community and social settings lacking continuity • Money

Priority • Prevention! • Preventing premature mortality • Preventing chronic disability / reducing its impact • Prevention programmes to improve financial sustainability

Pharmacists support the NHS and patients with. . . • Prevention ü Weight loss ü Alcohol management ü Stop smoking • Detection ü ü Monitoring (BP, INR, blood glucose) Hepatitis C, HIV testing STIs (e. g. chlamydia) Referral / signposting • Medicines optimisation

HLP quality logo/mark • NPA registered the HLP logo on behalf of all pharmacy organisations ØWith permission from Portsmouth LPC ØTo protect it for community pharmacy ØEnsure this quality logo/mark had a future

Health Champions • Each HLP must have a trained Health Champion • Engage proactively with local community • Use every interaction opportunity for health promotion • “Make every contact count” • Improve health, reduce mortality, help reduce health inequalities

Health Champion accreditation • Undergo training for the “Understanding Health Improvement” Level 2 award ØAccredited by the Royal Society for Public Health • Recognised national qualification

GPh. C standards / NHS requirements • Before being accredited as a HLP: ØPharmacy must meet the requirements of the GPh. C standards for registered pharmacy premises ØPharmacy must meet the requirements of the NHS Terms of Service of Pharmacists NHS under the NHS (Pharmaceutical and Local Pharmaceutical Services Regulations) 2013

PHE: vision • Accelerate the roll-out of the HLP concept • Establishment of a national awarding body for the HLP quality mark • Quality assurance process • Revised quality criteria • NHS England to consider if, when and how to embed aspects of the HLP framework into the community pharmacy assurance framework (CPAF)

HLP quality criteria for Level 1 • Part of the assessment of compliance process for HLPs • Sets out behaviours, activities and physical environment which must be evidenced • Evidence contributes towards achieving and maintaining HLP status • Specific quality criteria relevant to three enablers

Healthy Living Pharmacy (HLP)? • It is a concept which was originally developed in 2009 as a means of improving provision and access to local pharmacy services in Portsmouth • A level 1 framework, commissioned by Public Health England based on the original HLP model, was released in 2016 • This allows pharmacy contractors to achieve level 1 through self assessment

What are the aims of an HLP? • Aims of HLP: ü Health champion to provide lifestyle interventions and pharmacy support § E. g. Offering brief advice on various health issues such as smoking cessation and alcohol consumption ü Services and support delivered from pharmacy premises fit for purpose ü Engagement with local stakeholders (e. g. other healthcare professionals and the local community) to improve patient care

Why become an HLP? • HLP level 1 accreditation is worth 20 quality points under the new pharmacy funding quality payment scheme • This is worth a minimum of £ 1, 280 • The HLP-related quality points can be claimed at either the April or November review points

Checklist for getting HLP accredited • Key requirements: ü At least 1 FTE qualified Healthy Living champion (HLC) – certificate required ü Pharmacy owner or pharmacist leadership trained – certificate required ü Suitable consultation room ü Provide MUR, NMS, NHS flu vaccination services • If flu vaccinations are not provided, then there should be active referrals to other NHS providers ü Health promotion zone – display HLP logo prominently once accredited

Checklist for getting HLP accredited • The following criteria must also be completed and evidenced: ü Staff awareness of local public health and pharmaceutical needs (e. g. JSNA, PNA) ü Communication skills ü Proactive community engagement by whole pharmacy team, able to signpost to local service providers as appropriate ü Commissioner engagement – lists of local contact information ü Data collection – IG SOP and IT/internet system accessible in consultation room ü Promote environmental sustainability

Examples of evidence collection • Certificates – e. g. HLC, leadership training (required when claiming completion of training; certificates for assessment and/or training) • Minutes of pharmacy meeting notes showing HLC sharing learning with the pharmacy team • HLP action plan • Written feedback from pharmacy team members to their team leader • Photos of the pharmacy team engaging with the public (consent), consultation room, pharmacy, HLP logo location, recycling bins, paper disposal system, outreach work

Examples of evidence collection • Case studies of local outreach programmes conducted by pharmacy • Health and wellbeing notice board – local public health services / initiatives information • Health and wellbeing information in a range of formats (e. g. DVDs, plasma screen, leaflets etc) • Signposting information folder • Lists of local public health commissioners and their contact details along with examples of correspondence with them (e. g. emails, letters)

HLP action plan Area for improvement / Objective / Goal Actions to be taken When by Who is responsible Support / resources available Outcome HLC training and certification Identify suitable member of pharmacy team to train, source training (NPA), book, payment, allocate time to undertake 30 April 2017 Joe Bloggs e. g. Funding to undertake training, training time for individual, training provider identified - NPA Training undertaken by [a] on [date], certificate available Team leadership Source training (NPA), book, allocate time to attend 31 May 2017 Pharmacist/Phar macy owner e. g. Funding to undertake training, training time for individual, training provider identified - NPA Training undertaken by [a] on [date], certificate available MUR Continue to provide service Ongoing Pharmacist Service provision maintained NMS Continue to provide service Ongoing Pharmacist Service provision maintained Health promotion zone Identify relevant local health topics to promote. Review and update at least every two months Review every two months and update HLC Time to research local issues and update the information. Local health campaigns and resources can be used HLC regularly updates content and patients are using the resources

Next steps ü Download the HLP level 1 quality criteria document • Available through the NPA website ü Complete each component and compile evidence for each in a HLP folder ü Once all components are completed, register with the Royal Society of Public Health (RSPH) as a level 1 HLP • Registration information to follow ü Quality payment can only be claimed once level 1 HLP is achieved • This can be in either April or November 2017

Leadership

HLP Leadership Quality Criteria • An individual of the pharmacy team has undergone leadership training internally or through an organisation that maps to/encompasses the following competencies: Ø Demonstrating personal qualities – developing self-awareness, managing yourself, continuing personal development, acting with integrity Ø Working with others – developing networks, building and maintaining relationships, encouraging contribution, working within teams Ø Setting direction – identifying the contexts for change, applying knowledge and evidence, making decisions, evaluating impact • Pharmacists and their teams engage and effectively lead multidisciplinary teams to maximise the contribution of pharmacy teams to improve and protect the public’s health. • There is a clear leader within the team who is responsible for creating an ethos of proactive health and wellbeing within the pharmacy. • There is effective leadership within the team that encourages the best use of team members’ skills and creates an environment that supports and mentors other team members. • The leader, jointly with the pharmacy team has developed an action plan on achieving Level 1 HLP. • Training and learning needs are reviewed and assessed any identified training needs are met in order to ensure that pharmacists and their teams are competent to deliver quality public health services and support the public and patients to achieve good health outcomes.

Four things great leaders know 1. Where the organisation is going 2. Self awareness (strength and weaknesses) 3. What is going on – how people feel 4. How to build a strong team

1. Where the organisation is going • Clear direction is the foundation for all work accomplished by the team • Explain organisation’s overall business objectives and goals – be realistic • Have defined and thorough written business-planning in place – include accurate financial measures and targets in all business projects • Be sure that each member of the team: ü knows the mission ü can articulate that mission ü understands the role they play in fulfilling the mission

2. Self awareness • Realistic self appraisal that matches the judgement of those working for you – peers and subordinates • Combine personal humility with professional will • Aim to lead a great business rather being a great business leader

3. What is going on – how people feel • What is the emotional temperature of your organisation • Be emotionally in tune with the people in your organisation – but do not spend your time worrying if everyone is happy • Understand that change provides an emotional response • Successful change involves allowing people some space and time to feel angry, resentful and afraid as well as exited, hopeful and energised

Change management Focuses on people Process includes: 1. Aligned with the organisation’s overall plans – senior team onboard 2. Get buy in from those involved and affected 3. Thorough planning and assessing – involving the right people in the process 4. Effective communication 5. Getting people ready to adapt (relevant information and training) – Follow up

4. How to build a strong team • • • Surround yourself with talented people The right “people are you most important asset” Do not rush when hiring people – hold out for the best If someone does not work out do act promptly Encourage the team to have their say COMMUNICATE Do not micromanage talented people – adapt a flexible style Energize your people Learn the art of motivation ‘You can accomplish anything in life, provided you do not mind who gets the credit’ – President Harry S Truman

How to build a strong team – motivation 1. Motivate yourself first – be more pleasant to work with 2. Get to know your employees – where they come from and where they are going 3. Set SMART goals 4. Delegate authority – make them take charge of the task 5. Have a reward system – promotion, more responsibility 6. Promote trust and collaboration

high Skills Low Motivate Delegate §Identify constraints §Praise and endorse §Give additional responsibility §Praise and endorse §Collaborate on decisions Direct Advise Teach and train §Indentify the issues and constraints §Teach and train §Provide guidance §Praise and endorse where needed Low Will High

Employee performance recognition • True recognition can be a powerful motivator • Studies show that employees who receive recognition are more likely to: ü Be highly engaged ü To perform their best ü More likely to be innovative

Two types of performance recognition The employee’s ongoing effort: ü Informal ü Casual ü Frequent ü Delivered through email or thank you note The employee going over and beyond: ü Typically more formal ü Accompanied by award (e. g. bonus)

How to build a strong team – delegation 1. Be clear about the task – what do you want to achieve 2. Select the right individual or team based on ability and skills 3. Explain the task and expectations thoroughly and confirm that they have understood this 4. Consider any resource, training needs, equipments, budget etc 5. Agree deadlines and the time frame for the task 6. Offer support 7. Feedback

Feedback • Seek to change behaviours not personality • Be balanced – well thought feedback • Recognise conflict avoidance behaviour in yourself • Take time to give regular feedback • Treat people with respect

How to build a strong team – developing others • Embrace innovation • Create an inclusive culture with strong business ownership • Enable others (and yourself) to do what they do best through effective career development and task planning • Develop yourself and others by passionately seeking to learn, coach, and teach • Consider different approaches of all types to get desired business results - flexibility

Group activity

Communication Ø Body language (visual) 55% Ø Tone of voice (vocal) 38% Ø Words (verbal) 7%

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. Don’t be ridiculous It’ll cost too much That’s not my responsibility We don’t have time We’ve never done that before That’s not the way we do things around here We’re not ready for that It will never sell We tried that before and it didn’t work It simply can’t be done It’s too radical of a change It’s not really our problem Let’s get back to reality Let’s form a committee to decide. We have done alright without it all this time. It won’t work here Okay, but if it doesn’t work, you’re the one who’s going to get the blame I don’t personally agree, but if you insist. Are you crazy?

The laws of forgetting v We forget 50% of what we hear immediately v We forget 75% of what we hear within two months v Of the 25% we do remember, only 60% is correct, plus we add things that were never said in the first place!

Group activity

Demonstrating the ability to build strong relationships

As you interact with new people that you want to build lasting win-win relationships with and influence consider the following linear model: Influence Trust Appreciation and Respect Rapport

Rapport • • Relate to others in a way that creates trust and understanding Mirroring / matching Focus on the person wants and needs – not on yourself Be observant, sincere and flexible to the situation

PRINCIPLES FOR ESTABLISHING RAPPORT The time frame to establish rapport in the initial meeting-conversation is 19 -34 seconds The key for a win-win relationship is to establish credibility.

APPRECIATION AND RESPECT üUse their Name üBe Interested üBe a Good Listener üAppreciation üAppeal to Motives üMake them Feel Important üDon’t Criticize/Condemn/Complain üIdea is Theirs

Group Work

What do you do when a relationship breaks = conflict

What causes conflict? • Difference in opinion and personality • Bad communication • Unfair treatment • Lack of motivation • Harassment and bullying

What is long terms outcome of conflict? • Absence • Poor performance • Stress • Misconduct

Managing conflict situations Eight easy steps: 1. Present the issue using “I” messages 2. Clarify and define the issue 3. Seek to understand the other person’s position 4. Give your point of view 5. Agree on the problem 6. Explore and discuss possible solutions 7. Jointly choose an alternative as a tentative solution 8. Follow up

FOUR PERSONALITY TYPES • The Owl/Analytic • The Shark/Driver • The Bumble Bee/Expressive • The Panda/Amiable

High Energy Owl Shark Bumble Bee Panda Lower Energy Formal Informal People Oriented Task Orientated Predictable, likes stability Dominant likes to be in control Friendly, talkative Patient, easygoing

Owl the Analytic • • • Be sincere – lower your tone of voice Explain details Provide proof to back up any claims Answer questions precisely Be conservative Do not use many hand gestures Lean in and demonstrate your interest in what is being shared Slow down and listen Don’t ask too many personal questions Be diplomatic and courteous Avoid criticizing their decisions

Shark the Driver • • Do not appear disorganized Stress fast and efficient, new and innovative Speed up if you need to and talk faster Give direct answers to their questions Show confidence Listen Avoid telling them what to do

Bumble Bee the Expressive • • • Be friendly, not dominating Use gestures and body language If needed, raise your energy level Use layered questions that are peer focused Tell how others will benefit Provide chance for them to verbalize Do not display impatience Do not talk about yourself Don’t dwell on the details

Panda the Amiable • • • Slow down Relax Present in a logical order Speak with a sincere tone of voice Show empathy and genuine concern for their feelings Ask about how they feel (emotion) Listen patiently Give direct answers Do not oversell or stress new concepts or ideas

“ While technical competency is considered crucial for a professional, a vast majority of the most highly rated skills relate to behaviours. Reliability, honesty, integrity, continuous learning, listening carefully and good negotiation skills are most valued in professional communities!!” Ken Pasternak – Author, Educator and Banker

ACTION PLAN

Action plan • Allows you to take into account all areas of required action • Breaks down the achievement process into manageable parts • Define all necessary actions • Assign responsibility to individuals for delivering the actions within agreed timescales • Review the action plan regularly • Ensure actions are being completed

Action plan: example Task Actions 1 1 a) 1 b) 1 c) 2 2 a) 2 b) 2 c) 3 3 a) 3 b) 3 c) By whom By when Possible issues (optional)

Ade Williams • Superintendent Pharmacist of Bedminster Pharmacy, Bristol • C + D Pharmacy Team of the Year 2016 • The Pharmacist Best HLP 2016

The story: Bedminster HLP accreditation journey • Omitted to achieving HLP accreditation. • With the aim to deliver good health outcomes for their community – improve customer footfall. • Along this journey they won recognition locally and nationally. • Clear evidence of patients benefiting from the positive difference the team makes. • Better relationship with local surgeries and commissioners.

What they did. . . Recognised that their professional practice did not bring much professional and personal fulfilment. They were aware that, financially, it was not allowing the pharmacy team to embrace a service led model needed for their viability. Shared a vision of what they could become for their community and also get that professional and personal fulfilment. So too was making each step of the journey simple and also embracing the great support and resources the LPC provided.

Leading the team ü Facilitating time to access training. ü Creating a work environment where doing more was not going to put pressure on the team. ü Appreciating the different talents and skills of colleagues and employing this on our projects. ü Learning from colleagues, their life experience and examples also helped. üPlacing patient care at the centre of my deliberations. “Making all things professional but fun has been our bonus. ”

Challenges • Work environment and culture – doing more was not at the cost of safety. • Adhering by professional standards. • Trying to avoid creating financial pressures coupled with greater work load. • Requirement for a lot of innovative thinking. • Building professional accountability into everything whilst exploring different ideas and solutions.

Communication • Regular team discussions and a culture of openness and mutual respect. • Everyone is valued and no one is infallible, least of all the manager. • Training colleagues on how to communicate messages clearly and take into account any diversity of different first languages in the team. • Everyone is a learner with a responsibility to share. We also have peer evaluation and critique of our efforts to aid learning and improvement. “My role is not to be the lead or star player but to facilitate the success of every individual’s endeavour by mentoring. ”

The breakthrough “The breakthrough really was realising that the team had taken ownership of the project and were putting forward plans and innovative ideas beyond my initial concepts. The project became their project and now it's our daily way of practicing. ”

Relationships with local surgeries • Proactive approach in the relationship with local general practices. • Seeking to tell them how the pharmacy team can help relieve their pressures through offering various services. • Regular meetings with local practices to update each other on the work. • Look for opportunities to support each other as well as address any areas of conflict. • Organising mutual team training visits for the pharmacy team and local GPs staff “At this meeting I also have another team member with me so they appreciate that problem solving in our pharmacy does not just lie just with the pharmacist. ”

Relationships with local commissioners ü Encouraging team passion and commitment to excellence into all pharmacy service provisions. ü Allow team members to take ownership of different services the pharmacy provides. They contact the commissioners to discuss service specifications, ways to innovate the service to deliver better outcomes in our locality. ü Regularly invite commissioners to visit the pharmacy and work with the LPC to do likewise. ü Encourage a team commitment to continual development and sharing knowledge. ü Take time to provide feedback, suggestions and insight of your experience providing services. “This is a team culture is locally recognised. ”

Kiran Patel • Owner, Beautychem Pharmacy, London • The Pharmacist Sexual Health Champion, 2016

The story: Beautychem HIV screening service • Introduced an HIV point of care screening service • Got recognition locally with other healthcare providers and commissioners

What they did • Identified that they needed change • Explained to the team that the way forward for pharmacy is by offering services, not selling shampoo” • Carried out a shop refit to get the right environment

Leading the team • The pharmacy Health Champions went on training courses and then came back to train the whole team on how to implement the service • Ongoing staff training every one to two months including role plays • Observing how team members provide the service to customers, and then giving constructive feedback

Challenges • The most difficult aspect was getting the staff to change their ways of working “ We overcame this by having meetings beforehand, where our expectations were clearly communicated to the team, so they understood what was expected”

Communication Regular meetings, including training via role plays: Ø Choose a date that suitable for all staff, in the evening. Ø After the training session, go out for a meal as a team”

Relationships with local surgeries • The Health Champions are a big part of this • Regular meetings with receptionists, chiropodists, other healthcare workers etc to discuss what each person does • Get a good understanding of their respective roles and explain your role

Relationships with local commissioners • Being a clinical lead can allow building a good relationship with the local CCG. • Regular meetings where pharmacist can provide input from the perspective of pharmacies at the local face, and ensure that commissioners are aware of what is or isn’t workable in practice.

l. hannbeck@npa. co. uk twitter: @Leyla. Hannbeck