Pharmacy Burnout A Review of the Literature John
Pharmacy Burnout: A Review of the Literature John Pedey-Braswell PHARM 535 Winter 2004
Challenges to the Profession n n n Paradigm Shift towards Payment for Cognitive Services Rather than Product Dispensing Stagnant or Shrinking Payments from State Medicaid Plan and Third Party Insurance Payors Senate Bill 6088: Therapeutic Interchange Program with Preferred Drug List Increasing Complexity of Third Party Formulary Systems Coupled with Pharmacy Audits CPOE, Dispensing Automation Research Questions: Toll on Patients, Employees, SAFETY
What Will Be the Impact on Health Care Providers?
Characteristics of a Burnout. Prone Workplace 1. 2. 3. 4. 5. 6. 7. 8. 9. Constant Demands for Perfection Workers Discouraged from Expressing Grievances Employees Expected to Give Extra Effort without Extra Rewards No Reinforcement for Suggestions about Improving Morale Staff Encouraged to Interact Only with Peers Repetitive Work Activities that Do Not Change Much Over Time Minimal Additional Help Provided for Tasks that Require Extra Effort Emotional Feelings of Employees Downplayed Preachy Leadership Styles
Characteristics of a Burnout. Prone Workplace 10. 11. 12. 13. 14. 15. 16. 17. 18. Frequent Changes in Policy without Time to Evaluate Them Rigid Role Definitions for Employees Playfulness Considered Unprofessional and Inappropriate People Discriminated Against Based on Age, Sex, Race (Job Title? ) Very Little Emphasis on Positive Feedback Very Little Concern About Comfort of the Work Environment Policy and Enforcement of Policies Constantly Shifting Attitudes of Supervisors Makes Employees Feel Ineffective or Underappreciated Employee Morale is Low and People Feel that They Accomplish Very Little Source: Anthony F. Grasha, Ph. D, University of Cincinnati
Literature Search Methodology n n n Pub. Med, International Pharmaceutical Abstracts, CINAHL, Health and Psychosocial Instruments No Restrictions on Language, Publication Date Desired Tested Validity in Pharmacy Employee Population MESH Search Terms: Pharmac*permutations - Job Satisfaction, Psychological Stress, Occupational Stress, Burnout Very Little Literature
Findings n n Many Instruments Developed and Used Only Once – No Reliability and Validity Data Two Instruments with Reliability and Validity Data PLUS Moderate Use: Maslach Burnout Inventory (MBI), Health Professions Stress Inventory (HPSI) No Data Since Early-Mid 90 s, Field of Pharmacy has Changed Markedly Since Then Work Done by Alan Wolfgang (HPSI) at Georgia, Holly Mason and Graduate Students (MBI) at Purdue
Maslach Burnout Inventory n n n Developed by Christina Maslach (Berkeley) and Susan E. Jackson (NYU) First edition 1981, based on research done in late 70 s. Third edition 1996. 22 items divided into 3 subscales: l Emotional Exhaustion – 9 items l Depersonalization – 5 items l Personal Accomplishment 8 items Self-Administered: 10 -15 minutes to fill out Factor Structures and Norms for USA Pharmacists 1989, Mason and Lahoz. l 1258 APh. A Members – Mostly Middle-Aged White Males l 1994 Gupchup. Structures and Norms in HMO Pharmacist – 101 RPhs from 38 states Validity?
Health Professions Stress Inventory n n Developed 1987 by Alan P. Wolfgang, Pharmacy Professor at University of Georgia Purpose: Create an Instrument that Could be Used to Compare the Levels and Sources of Stress Experienced by a Variety of Health Professionals Based on Data from 291 Physicians, 379 Nurses, and 387 Pharmacists 30 Potentially Stressful Job Situations – Scored 0 (never) - 4 (very often) Likert Scale. Max Score 120
Future Research n n n n Neither instrument is perfect for assessing small changes in the workplace. Need to find additional test of job satisfaction, or add questions to survey. Absenteeism? Employee Retention? Determine if MBI needs to be re-validated. Funding to administer test Population to test: HMC, UWAMC, control populations RPhs Notoriously Poor Responders to Surveys – How to Minimize Respondent Burden? Impact of changes on other HCPs
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