Shane Desselle, RPh, PhD, FAPhA

Health care professionals, including in pharmacy, often interact with patients in precarious situations and must broach uncomfortable topics. As such, all pharmacy personnel must be trained and knowledgeable about appropriate communication with individuals from diverse cultural backgrounds. Cultural competency can be referred to within the context of health care as the ability to provide culturally and linguistically appropriate services.

 Cultural competency must not only be demonstrated by employees but must be ingrained in workplace culture and policies. To best serve patients, pharmacy staff must be cognizant of the influence that cultural beliefs might have on patients’ actions, attitudes, and health beliefs. Doing so creates empathy for those who behave unexpectedly regarding self-care or who do not respond to recommendations. Pharmacy staff members also must learn to appreciate different worldviews and be able to reach patients effectively when addressing optimal health behaviors, such as medication adherence.

This does not require that pharmacy staff members memorize every facet of culture relating to every single demographic component of patients. Rather, it requires staff to have a general knowledge of the patient population served and their choices related to behavior, food, household decision-making, manner of address or communication, and use of nontraditional therapies that come to bear on delivering optimal care. Delivering optimal care in this case also helps improve patient rapport and even engenders customer loyalty.

Because there are many cultures present in the United States, cultural competency training focuses on appreciation of differences, benevolence, compassion, empathy, and mutual respect. Effective communication is key in assessing and interpreting patient information. If performed ineffectively, miscommunication can lead to poorer patient outcomes.

A 2020 systematic review of 12 articles from 7 countries examined the salience of several domains in providing culturally competent care, including leadership and management styles that affect organizational culture.

 The analysis showed that individual practitioners must commit to cultural competency, but it begins at the top with leadership and management.

“If an organization employs a well-designed and implemented competency model, it can achieve the best outcomes and improve...performance and ultimately business consequences,” according to the results of a study published in BMC Public Health.

Pharmacy staff members must adapt and collaborate with patients. This connection could start simply by knowing what a culture deems appropriate in the medical setting and learning a few key phrases in a patient’s language. A specific example of how being more culturally competent can lead to positive results is seen in a study documenting how attendance rates for mammography screenings increased among ethnic minority women who were given culturally tailored educational intervention.

Connecting with patients on a personal level leads to more honest and open conversations, better adherence, and improved overall health outcomes. All employees, especially those on the front lines of customer interaction, must be trained to manage interactions accordingly. As the pharmacy profession rapidly grows in relevance and size, the standard of care must constantly improve to manage the growing diverse cultures seeking competent care. Cultural competency serves pharmacy staff members well when interacting with others in the health care setting but can also be leveraged to become a life skill when dealing with those outside the workplace.

There are many materials, programs, and training mechanisms that are useful in gaining greater cultural competence, many of them free. Technicians and other pharmacy professionals can up their game by availing themselves of these resources.

 at Touro University California College of Pharmacy in Vallejo.

 is a professor in the department of social, behavioral, and administrative sciences at Touro University California College of Pharmacy in Vallejo.

1, Cultural competence in health and human services. CDC. September 10, 2021. Accessed June 15, 2022. https://npin.cdc.gov/pages/cultural-competence

2. Fattahi H, Abolghasem Gorji H, Bayat M. Core competencies for health headquarters: a systematic review and meta-synthesis. 

. 2020;20(1):891. doi:10.1186/s12889-020-08884-2

3. Brevik TB, Laake P, Bjørkly S. Effect of culturally tailored education on attendance at mammography and the Papanicolaou test. 

. 2020;55(3):457-468. doi:10.1111/1475-6773.13271

Articles

Training and knowledge about appropriate communication with individuals of diverse backgrounds improves adherence, outcomes.

Cultural Competence Sets Pharmacy Professionals Apart

This series provides management tips every week, but what is “management” to begin with? We all think we know.

The word “manage” means to handle or direct with a degree of skill, to work upon or try to alter for a purpose, or to succeed in accomplishing. Management has been described as a process which brings together resources and unites them in such a way that collectively, they achieve goals or objectives in the most efficient manner possible. The classical view of management is that it is associated with multiple functions: forecasting, planning, organizing, commanding, coordinating, and controlling. The words “command” and “control” sometimes are taken pejoratively in modern society, and some might proffer different verbiage on occasion, but managers still do have to command and exert some control over resources to accomplish things. They must balance the everyday and practical all while allowing long-term mission and underlying management and leadership principles to guide them and translate those principles into effective communication that resonates with each and every employee. Pharmacy managers manage the implementation of services, including ones commensurate with everyday practice as well as newer, more patient-centered services.

Tang et al. conducted qualitative research (interviews) of participants in the Pharmacist and Data-driven Quality Improvement in Primary care (P-DQIP) program to link implementation factors with effectiveness in pharmacists’ proactive management of drug therapy risks.1 Three intervention functions (training, enablement, and environmental restructuring) were relevant and were served by 2 policy categories (guidelines and communication/marketing) and 8 managerial functions (instructions on how to perform a behavior, problem solving, action planning, prompts/cues, goal setting, self-monitoring, feedback, and restructuring the social environment).

In other words, if the organization issued guidelines and provided the proper communication for the rationale, prioritization/support, and basic fundamentals on how to execute the guidelines, the P-DQIP program was likely to be more effective in its goal of having pharmacists assist physicians with safe prescribing.

Additionally, pharmacy managers reinforce these communications, solve problems, develop plans of action, provide cues to employees, help set goals and targets for performing, monitor the program for effectiveness, provide and receive feedback from staff pharmacists, and use this feedback to tailor and sometime restructure the program as needed for maximum likelihood of success. What’s interesting about this type of research is that researchers do not go in with an expectation beforehand of what to find. These qualitative interviews allow the subjects—in this case pharmacy managers—to describe what has been successful in promoting their respective programs. Their thoughts are then organized by the researchers into the themes listed above. So, this advice comes directly from pharmacy managers themselves.

Managers manage. That sounds almost trite and banal, but it’s often overlooked. We are sometimes quick to assume that managers just push paper, but managers plan, organize, command, coordinate, and control. They also empower others to do the same. In this case, effective management results in a successful program that improves prescribing and patient safety. That’s a lot more important than merely pushing paper.

 Implementing Value-Added Pharmacist Services 

can be found in Pharmacy Management: Essentials for All Practice Settings, 5e.

is a professor of social and behavioral pharmacy at the Touro University California College of Pharmacy.

Tang J, Toma M, Gray NM, Delvaux J, et al. Pharmacist and data-driven quality improvement in primary care (P-DQIP): a qualitative study of anticipated implementation factors informed by the Theoretical Domains Framework. BMJ Open. 10(2): 

http://dx.doi.org/10.1136/bmjopen-2019-033574/

Pharmacy managers manage the implementation of services, including ones commensurate with everyday practice as well as newer, more patient-centered services.

Tip of the Week: Consider How to Manage Implementation of Services 

Medication therapy management (MTM) is at the heart of what pharmacists do. This is not a new responsibility, although some literature suggests otherwise. The name for this task has changed over the years and pharmacy has become more systematic in the implementation of medication management, but this has always been at the core of pharmacy.

Particular attention is rightfully paid to providing MTM services for entire populations, rather than simply to individual patients. In fact, it is the most vulnerable populations where pharmacy services might make the greatest difference. The “management” in medication therapy management is a critical piece. Without proper management, our services are inefficient and ineffective. Relying on foundational management concepts and even management theories can often make the difference between successful and unsuccessful approaches for these services.

Turner et al. examined the different factors that result in the successful implementation of community pharmacy MTM programs. Specifically, they took a closer look at organizational determinants such as implementation climate and innovation-values fit. These are part of implementation effectiveness paradigms, which were designed for complex innovations such as medication management programs, which often require coordinate efforts by multiple individuals to be successful.

A positive implementation climate would suggest that a pharmacy has formal policies to support implementation of an MTM program that includes things such as employee training and reward and recognition programs for implementation. This in turn affects employees’ shared perceptions about the extent to which the MTM program is supported and even expected.

Innovation-values fit refers to pharmacy employees’ perceptions about how well medication management programs align with the values of the pharmacy and the pharmacy profession. If the employee believes that the program is not a good fit, they will be less committed to it.

Turner et al. studied community pharmacies that participated in either the first or second year of the 3-year North Carolina Community Pharmacy Enhanced Services Network (NC-CPESN). Participating pharmacies received a survey assessing their structural characteristics, experience with NC-CPESN, and perceptions about implementation. They compared these responses across 2 outcome variables. One was implementation versus non-implementation of a comprehensive medication review (CMR) program for high-risk patients. The other was the program’s reach, which was calculated as the number of attributed high-risk patients receiving a CMR divided by the number of high-risk patients in the pharmacy’s catchment area as described from county health agencies.

In their analysis, researchers found that the implementation climate and perceptions of pharmacy had a significant impact on the success of the program and how many patients it reached. Additional analyses found that pharmacies located in rural areas were associated with lower implementation of CMRs per high-risk patient, and that pharmacies associated with the 340B program were associated with higher implementation.

The study results support the fundamental need for the “management” in MTM programs. Managers who institutionalized a culture of implementation and who provided an environment for employees to self-motivate and believe in the value of CMR services were able to successfully implement these programs and reach more patients. The pharmacy manager can do these things through such things as a rewards systems, well-defined policies and procedures, and also simply emphasizing the importance of reaching vulnerable patients as part of the pharmacy’s mission.

The Management in Medication Therapy Management 

Turner K, Trogdon JG,Weinberger M, Stoyer AM, et al. Testing the organizational theory of innovation implementation effectiveness in a community pharmacy medication management program: A hurdle regression analysis. Implementation Sci. 2018;13: 105.

Organizational determinants can play an important role in whether or not MTM programs are successful.

Tip of the Week: Focus On the “Management” in Medication Therapy Management

Mentorship is increasingly recognized as critical to the growth, development, and success, particularly for those in professional and scientific careers. The literature is burgeoning with accounts of mentoring programs, recommendations for all parties involved, and reviews of what works and what doesn’t in such programs.

Employers may or may not have a formal mentoring program. For those that do not, it might not be long before they develop one. Until that time, pharmacists can take it upon themselves to find a mentor. Although a relative few might scoff at the idea, most people will be pleasantly surprised and flattered that you have sought them out for mentorship, with the understanding that they are being looked up to and that it represents an opportunity for them to further develop, as well. Still, not everyone is cut out to be a terrific mentor.

Rolfe provides some recommendations for seeking mentorship.1 She recommends that individuals first discern the type of mentoring that they want, including:

A traditional mentor, where a person with experience and achievements shares their wisdom

A role model, or someone whose behaviors and attitude can by emulated

Developmental mentoring, or someone who listens and enables the mentee to set goals

Reciprocal mentoring, specifically a relationship where neither party is designated as mentor, but where you serve as a sounding board for one another’s ideas

Group mentoring, where one taps into the collective wisdom of a group of individuals each having their own strengths

Coaching, which is personalized training to improve performance

In actuality, good mentors and good mentoring programs probably encompass at least a portion of all aspects of these, and evidence suggests there are benefits to a more holistic mentoring approach. Rolfe is correct in that it is important to know what it is exactly you want and to set expectations ahead of time with the person you approach for mentoring.

Rolfe also points out desirable qualities of a mentor, including someone with terrific communication skills, who provides guidance without being directive, devotes time to the process, and maintains confidentiality when asked or as appropriate. Additionally, the mentor should be someone who is respected and who is themselves a voracious learner. Rolfe also encourages mentees to go beyond traditional boundaries, sometimes to seek a mentor who has retired or someone in another organization, or even someone in an entirely different field. Rolfe also reminds us that we do not want to be a clone of anyone else, so it is important to find someone who has checked their ego at the door and is not looking to replicate themselves and receive unmitigated praise.

Mentoring is such an important concept, transcending age and position. Pharmacists can have been in the field for many years and still benefit from mentoring. In fact, individuals perhaps benefitting the most from mentoring relationships are those who simultaneously mentor someone while being a mentee of someone else for entirely different reasons and acquisition of entirely different sets of skills.

Make sure to take stock of the outcomes of your mentoring relationship and determine how well it is working. There is nothing wrong with changing mentors. Pharmacy managers should promote a climate conducive to mentorship and development even in the absence of more formal programming.

Rolfe A. What to look for in a mentor. Kor J Med Educ. 2017;29(1):41-43.

Evidence suggests there are benefits to a more holistic mentoring approach.

Tip of the Week: Know What to Look for In a Mentor 

Although related to coaching, mentorship is a unique topic deserving of its own attention. Mentors are unique because they elect to invest in the growth of another individual by sharing their knowledge while providing support and guidance.

Although all of us have had managers or supervisors, not everyone has had the opportunity to experience true mentorship. Coaches and managers push us to perform for the purpose of achieving a set goal, but a relationship with a mentor is different because it is transformational and aimed at developing the individual. The relationship is based on trust, support, and feedback. Mentorship in pharmacy is particularly important because it may contribute to the development of competent, proficient, and motivated pharmacists to lead the profession and continue to advance the field.

A recent study of pharmacist mentors and mentees was conducted to evaluate the lived experiences that contribute to these relationships and gain insight on best practices for developing new mentorship relationships and programs.

 The results of the study found that mentoring provided a sense of pride, as pharmacists felt they were giving back to the profession and that the relationship may be lifelong in successful instances. Mentees reflected favorably on the experience of being mentored, the flexibility of their mentorship partner, and the program.

Notably, a lack of engagement and commitment from one party led to frustration from the perspective of both mentors and mentees.

 These findings highlight the reciprocal and symbiotic nature of the mentor and mentee bond and may be the foundation of building a successful relationship.

Mentoring is providing guidance, counseling, and direction to a novice for the purpose of refining and developing their skills and knowledge base and helping to advance the mentee’s personal and professional growth. Identifying a worthy mentee who demonstrates inherent motivation for personal and professional development is essential to form the relationship because it may require significant time and energy from both parties. Although the time commitment may be viewed as a drawback and could deter some from participating in mentorship, it is important to realize the benefits as well. The relationship is often rewarding for both parties, as the mentor may experience intrinsic satisfaction by contributing to others’ lives and observing their advancement, while the mentee may experience an improvement in self-worth, confidence, and professional identity.

For mentoring relationships to be successful, trust must be established through clear and open communication regarding expectations. Additionally, both mentors and mentees should determine whether their values align with one another.

 Pharmacy managers acting as mentors should go beyond coaching. Although coaching has certain benefits, as it offers enhanced consultation and guidance, mentorship entails a more intimate and vested approach.

 Ultimately, mentoring may be more effective for knowledge transfer, development, motivation, and employee engagement.

Importantly, the study acknowledges a lack of mentoring culture within pharmacy, as opposed to medicine and nursing, where an abundance of literature exists surrounding the human needs of mentors and mentees involved in a mentoring relationship.

 Pharmacy managers should recognize that there is a need to establish a culture of mentorship within pharmacy where collaboration, knowledge-sharing, and engagement are promoted. Creating a culture of mentorship means supporting employees by generating opportunities to build deeper relationships, offering an individualized and personalized development approach, and identifying strong role models to serve as mentors.

Organizations can place value in mentoring programs by investing in the mentors and providing training and rewards for exhibiting commitment to the program, in order to encourage participation and ensure the program’s sustainability. Even in the absence of a formal mentoring program, the pharmacy manager should indicate the importance of and value placed on informal mentorship, encouraging all employees to learn from and look out for one another.

Pharmacy Management: Essentials for All Practice Settings, 5e

 is a PharmD candidate at Touro University California.

 is a professor of social and behavioral pharmacy at Touro University California.

1. Mantzourani E, Chang H, Desselle S,Canedo J, Fleming G. Reflections of mentors and mentees on a national mentoring programme for pharmacists: An examination into relationships, personal and professional development. 

Mentorship in pharmacy is particularly important because it may contribute to the development of competent, proficient, and motivated pharmacists to lead the profession and continue to advance the field.



Tip of the Week: Build a Culture of Mentorship in Your Pharmacy

Most people suffer from physical and mental fatigue at various points in their lives and it may negatively impact our ability to respond to situations requiring high levels of focus and concentration. Pharmacists may also be faced with occupational fatigue, which is multifactorial in nature and includes physical, mental, and emotional aspects, sometimes resulting from excessive workload in combination with the sharp mental acuity they must maintain throughout their careers. Recognizing that pharmacists may be confronted with occupational fatigue is important to acknowledge and address, since operating in a diminished capacity can lead to increased medication errors and compromises in patient safety.

A recent study conducted to categorize pharmacists’ fatigue found that both physical and mental fatigue were identified as key domains.1 The study, conducted by Watterson et al, explored occupational fatigue in pharmacists to determine whether the same dimensional structures found in other health professions were applicable to them. Survey respondents represented a broad array of practice settings and cumulatively worked an average of 9.5 hours per day.

The results showed that both physical and mental characteristics contributed to occupational fatigue. Of the possible survey responses related to the physical domain of fatigue, the most frequently selected responses included feeling that energy decreased over the course of the day, feeling more tired later in the day versus the beginning, and feeling generally fatigued, in a broader sense.

The most common reasons selected for mental fatigue included difficulty thinking clearly, forgetting whether or not tasks had been completed, spending longer completing a task later in the day, and feeling like they were not performing at their best. Elements that were found to be germane among other professionals but were not reported among pharmacists included feelings of pain and taking shortcuts when providing patient care to ameliorate mental fatigue. Although pharmacists may stand for very long periods, they did not report feeling pain or discomfort. Pharmacists did not acknowledge that mental fatigue contributed to taking shortcuts in patient care, which may be attributed to liability concerns and to being especially dutiful.

Watterson et al. constructed a conceptual model of occupational fatigue in pharmacists, which shows that excessive demands of the work system lead to occupational fatigue and may result in burnout, decreased job satisfaction, compromised patient safety, and a reduction in information retention.

 Pharmacies are unique health care settings where pharmacists may not have access to the same level of information that other health care providers do, such as a patients’ medical records, but are expected to provide timely advice and recommendations regarding the patient’s health and wellbeing. One of the most distinctive aspects of pharmacy that sets it apart from other health care settings is that the business is often for-profit, which adds another dimension of demand.

The quadruple aim framework emphasizes that there are 4 interrelated tenets to improve health care: better outcomes, lower costs, improved patient experiences, and the wellbeing of the health care provider. Given that pharmacists have to juggle so many tasks that require a high level of cognitive function, a more concerted effort to conceptualize solutions to prevent occupational fatigue should be addressed.

Organizations and supervisors must ensure that employees do not feel overextended so that they can perform their required tasks with the appropriate mental acuity and necessary precision. When employees hint or openly share that they are feeling overextended, managers should acknowledge their concerns and work toward creative solutions. Potential solutions may be providing training for better time management, delegating tasks, and developing more efficient workplace processes to help reduce stressors.

Examining job descriptions, workflow, redundancies, unnecessary tasks, availability of adequate resources, appropriate staffing levels at the right times of the day, information technology functioning, and other operational processes can potentially shed light on a combination of approaches to optimize labor capital and mitigate fatigue. It is essential to create open communication between managers and staff to ensure timely feedback and avoid creating a culture where employees feel penalized for identifying areas of concern. Focusing on the mental and physical well-being of employees may lead to better performance and patient outcomes.

is a professor of social and behavioral pharmacy at Touro University California.

Watterson TL, Look KA, Steege L, Chui MA. Operationalizing occupational fatigue in pharmacists: An exploratory factor analysis. 

When employees hint or openly share that they are feeling overextended, managers should acknowledge their concerns and work toward creative solutions. 