Valerie Wasem

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.

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.

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

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

Tip of the Week: Fatigue Must Be Addressed in the Pharmacy Workforce

Pharmacy education typically deals with subjects such as pharmacology, medication management, and patient safety. Although knowledge of these topics is vital to the success of students, a more diverse skill set is necessary for them to excel on rotations and in their future careers.

This focus on clinical knowledge may be thought of as a “uni-professional” approach.

 Although necessary, it can be an impediment to optimal practice when pharmacists are members of a collaborative in which they are expected to work closely with other health care professionals. Beneficial in these settings is the “multiprofessional” approach, with its emphasis on abilities beyond clinical knowledge, that creates effective teams.

 By strengthening their organizational citizenship behaviors (OCB), students can develop useful skills like leadership, good communication, and self-efficacy.

OCB can be defined as voluntary actions that are not part of a formally defined role and are performed without the expectation of recognition or compensation.

 In many ways, OCB mirrors the core values of the Oath of a Pharmacist, in which practitioners pledge to devote themselves to a lifetime of service through their profession.

 Advocating for continual improvement of care, the welfare of humanity, and the advancement of health equity may not be in the formal job description of most pharmacists, but they are behaviors that the best pharmacists exhibit. These OCB virtues can greatly benefit pharmacy students and new graduates.

OCBs can be further broken down into these components: altruism, sportsmanship, consciousnesses, courtesy, and civic virtue, all of which are essential to promoting collegiality while enhancing a group’s or department’s productivity.

 Civic virtue encompasses the behaviors of an individual who is a reliable participant in an organization. Altruism takes civic virtue a step further. Rather than merely completing the minimum of work, individuals exhibiting altruism take the initiative to help others without expecting anything in return. This behavior likely comes from employees who are highly engaged.

Collegiality is the cooperation among colleagues, and sportsmanship describes those behaviors that allow people to avoid conflict.

 Individuals who demonstrate sportsmanship maintain a positive attitude even when they don’t get their way and are not upset when their recommendations are not followed. It is essential for budding pharmacists to develop these behaviors in order to engage in effective conflict resolution, which is an important part of working in a team.

Those who exhibit OCBs are also likely to demonstrate higher levels of self-efficacy and personal initiative. In turn, people who have greater self-efficacy feel confident in their ability to perform tasks and contribute to organizational citizenship through their personal initiative.

 These individuals are more likely to attend voluntary meetings and assist colleagues with work-related problems because they are typically more organized and thus able to accommodate extra tasks. Students and newly graduated pharmacists who demonstrate OCBs will impress preceptors and pharmacy managers with their initiative and positivity.

In addition to greater productivity and better morale, ethical leadership—the modeling of ethical behavior, fair treatment of others, and the putting of ethics into practice

—has also been linked to OCBs. A recent study of nurses found
that ethical leadership was shown to enhance their trust in management and promote psychological well-being, thereby positively influencing organizational citizenship behaviors.

 This finding establishes an important link between OCBs and how contagious positivity translates into the health professionals’ work.

The principles of ethical leadership are not unlike the core values taught in pharmacy school, including beneficence, nonmaleficence, autonomy, and justice. Pharmacy students can go beyond classroom learning and incorporate these principles in their lives and in their leadership style when managing support personnel. Practicing these behaviors makes it clear to others that you are a reliable and valued member of the team who can be looked upon as a role model. In addition, other team members are likely to follow suit and model your behavior.

Pharmacy students can demonstrate ethical leadership by being open to change and by adapting practices to best fit a given situation. They can also adopt a collegial stance during conflict resolution by considering the opinions of everyone involved and being compassionate and fair as they seek a solution.

Applying altruism, sportsmanship, consciousnesses, courtesy, and civic virtue in the workplace can foster interprofessional communication and help students and newly graduated pharmacists further their careers. OCBs create a win-win for students and graduates, their colleagues, supervisors, organization, profession, and the patients they serve.

 at the Touro University California College of Pharmacy in Vallejo, California.

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

1. Ascione FJ. Preparing pharmacists for collaborative/integrated health settings. 

. 2019;7(2):47. doi:10.3390/pharmacy7020047

2. Yaakobi E, Weisberg J. Organizational citizenship behavior predicts quality, creativity, and efficiency performance: the roles of occupational and collective efficacies. 

. 2020;11:1-18. doi:10.3389/fpsyg.2020.00758

3. Oath of a pharmacist. American Pharmacists Association. Accessed March 11, 2022. https://pharmacist.com/About/Oath-of-a-Pharmacist

Organizational Citizenship Behavior: The Good Soldier Syndrome

5. Podsakoff NP, Whiting SW, Podsakoff PM, et al. Individual- and organizational-level consequences of organizational citizenship behaviors: a meta-analysis. 

6. Huang N, Qiu S, Yang S, et al. Ethical leadership and organizational citizenship behavior: mediation of trust and psychological well-being. 

. 2021;14:655-664. doi:10.2147/PRBM.S311856

Students and new graduates can excel in their career through leadership,
communication skills, and self-efficacy.

Leveraging Organizational Citizenship Behaviors to Impress Preceptors and Pharmacy Managers

Many community pharmacies struggle to maintain healthy profit margins, as they experience waning dispensing revenues resulting from competition along with continuously tight reimbursement levels and fees assessed by pharmacy benefits managers (PBMs). Because of this, pharmacies must be on the hunt to diversify their revenue streams.

The prospect of offering various patient-centered services has long been a possibility in this regard. Pharmacy leaders must leverage their entrepreneurial skills to ensure their pharmacy identifies new areas of opportunity that correspond with evolving patient population needs and a key ingredient in adopting an entrepreneurial mindset is innovation.

A recent survey of community pharmacies examined factors associated with their service offerings. The survey elicited the type and frequency of services offered and included multiple possible responses, such as health screenings, disease state management, medication management services, point-of-care testing, medication reconciliation, complex non-sterile compounding, immunizations, and medication therapy adjustments. On average, community pharmacies offered 3 of the 8 services, with a larger number provided by supermarket and chain pharmacies and fewer by mass merchandiser pharmacies.

The results showed that innovation was the strongest element associated with the number of services offered. Innovation was measured as the sum of 3 items based on a 5-point Likert scale, wherein survey respondents were asked to select responses to the following statements: 1) “Our pharmacy is known as an innovator among pharmacies in our area,” 2) “We promote new, innovative services in our pharmacy,” and 3) “Our pharmacy provides leadership in developing new services.”

 Doucette et al. described innovation as a tendency to perform activities that develop and bring new services into markets.

Of the factors tested, perceived workload, pharmacy staffing, and involvement with an interprofessional care team were also positively correlated with the number of services provided. However, an increase of more than 3 technicians was negatively correlated and adequacy of resources was not shown to be significant.

These findings are relevant because they underscore the importance and value associated with innovation in any retail setting, whether a large chain or smaller independent pharmacy. Instilling innovation into the community pharmacy setting means applying creative and critical thinking skills to accomplish practical goals. Thanks to their high level of public accessibility, pharmacists are well positioned to contribute to the development of novel patient care approaches which could lead to viable business opportunities.

Furthermore, innovation is a skill that can be honed and nurtured. Pharmacy managers can cultivate an innovative mindset amongst staff members by adopting an attitude that is welcoming to change, which also establishes trust by welcoming new ideas and encouraging collaborative brainstorming. In doing so, managers are promoting a culture of innovation where employees feel safe and supported to express their creativity, offer solutions, and provide constructive feedback. Fostering this type of work culture may also result in better employee engagement.

Pharmacy managers can leverage innovation to identify and implement new services. The concept of innovation has broad applicability and may benefit many different types of pharmacy managers if instituted along with the goals of the pharmacy’s business model.

Pharmacy Management: Essentials for All Practice Settings, 5e.

Valerie Wasem is a PharmD Candidate at Touro University California. 

Shane P. Desselle, PhD, is a Professor of Social and Behavioral Pharmacy at Touro University California.

Doucette WR, Rippe JJ, Gaither CA, Kreling DH, Mott DA, Schommer JC.Influences on the frequency and type of community pharmacy services. 

Moczygemba LR, Desselle SP. Entrepreneurship and innovation. In: Zgarrick DP, Desselle SP, Moczygemba LR, & Alston G (Eds.). 

. New York: McGraw Hill; 2020: pp.657-670.

Pharmacy managers can cultivate an innovative mindset amongst staff members by adopting an attitude that is welcoming to change.

 Tip of the Week: Innovation Influences New Pharmacy Services

Appointment-based model (ABM) medication synchronization is a system that streamlines the delivery of prescription medications by aligning patients’ medications so that they can be easily picked up once or twice per month. In addition to being associated with improved adherence for patients on multiple medications, synchronization also provides better convenience for patients with limited transportation and mobility.

Organization and careful planning are essential in order to have successful and sustained implementation of ABM medication synchronization. If the appropriate systems, software, processes, procedures, and staff do not support the new service, then ultimately neither pharmacy performance nor patient outcomes will benefit, and both may actually suffer. Medication synchronization may be beneficial but understanding how to integrate the service into operations is just as important as offering the service itself.

A study of 155 community pharmacies aimed to examine characteristics associated with adoption of medication synchronization programs as well as the impact of this service on patient adherence outcomes and pharmacy performance. The findings of the study indicated that pharmacies which adopted medication synchronization were not significantly associated with total medication adherence performance.

 The study examined the effect of medication synchronization on total performance score (e.g., costs, utilization, adherence) and on medication adherence measures specifically (e.g., diabetes, statins, antihypertensives) and did not find an effect regardless of how performance was measured.

The study also found that a prevailing characteristic was the presence of a clinical pharmacist on staff, which significantly increased adoption of the medication synchronization program, but yet still did not establish a specific role that the clinical pharmacist played in supporting the program.

 The results of the study suggest that a standard process needs to be developed for these interventions to be successful in practice.

Furthermore, the findings of the study are meaningful because they demonstrate that although medication synchronization may have a positive effect on patient adherence when examined at the individual level, the benefits are not as readily apparent when examined at the pharmacy’s performance level, thus highlighting the need to evaluate successful implementation strategies and sustained execution within the pharmacy.

Pharmacy managers can be integral to the success of medication synchronization programs. They must confront any misconceptions that merely adopting a program alone will lead to improved pharmacy performance. As with any new service being offered in the pharmacy, careful consideration must be given to the appropriate support systems in place.Pharmacy managers can approach integrating the service as they would with other potential new service offerings, by establishing the appropriate systems software, workflow procedures, manuals, staff training, and feedback mechanisms to allow for modifications. Pharmacy managers can also leverage pharmacy technicians in implementing ABM medication synchronization as their role continues to expand.

Ultimately, medication synchronization is an important tool because it can benefit the pharmacy in a variety of ways, including through increased prescriptions fills which translate into more revenue, reduced inventory due to anticipated and reliable prescription refill frequency patterns, and decreased number of patient calls regarding refill questions and requests. Medication synchronization programs will also likely result in greater patient satisfaction and could perhaps facilitate customer loyalty. The pharmacy manager, though, cannot just assume that the program will work and be optimized without proper planning for long-term sustainability, incorporating it into strategic planning, and managing its operation in conjunction with other services being offered.

is a PharmD candidate at Touro University California.

Renfro CP, Turner K, Seeto J, & Ferrari SP. Medication synchronization adoption and pharmacy performance. 

Medication synchronization may be beneficial, but understanding how to integrate the service into operations is just as important as offering the service itself.

Tip of the Week: Medication Synchronization Works Best When Properly Planned for Sustainability  

Effective time management is a challenge for most people, but it may be particularly difficult for community pharmacists. Pharmacists in the community setting have the added pressure of ensuring patient safety while multitasking between prescription verification, managing staff members, and patient consultations. Burnout, increased workload, and enhanced responsibilities despite the lack of time and resources are issues that face many pharmacists.

Although pharmacists may be busy during seemingly every moment of the day, it is important to realize that there are opportunities where time can be saved. Efficiently utilizing the hours in the workday and recognizing downtime can be huge assets in promoting productivity and enhancing pharmacy workplace performance. Reflecting on the essential tasks that need to be performed and optimizing the efficiency of nonessential duties are keys to identifying areas that can be improved to maximize the potential of the workday.

A recent time-and-motion study of various pharmacy settings examined how pharmacists utilize their time throughout the workday to identify inefficiencies, boost productivity, and decrease wasted time.

 Essential tasks such as consultations, responding to patient questions, and verifying prescriptions accounted for 66% of retail pharmacists’ workday.

 Approximately 15% of the workday included nonessential functions such as calling insurance companies, following up with physicians, and working at the prescription pick-up window. All of these are tasks that could have been delegated to other pharmacy staff, thereby freeing up the pharmacist to focus on higher-value responsibilities.

These findings are relevant because they highlight the opportunity for pharmacists to focus their efforts on medication outcomes and patient-centered care rather than on responsibilities that can be assigned to others. Pharmacists’ primary role is as medicine experts who are responsible for preventing medication errors and protecting patients’ safety. Pharmacists in the aforementioned study spent just 31% of their time verifying prescriptions and medication orders.

Optimizing time spent on essential tasks and delegating nonessential duties enables the pharmacist to focus on patient-centered care and enhances the productivity of other pharmacy staff members. Pharmacy managers should prioritize duties while concurrently encouraging employees’ self-efficacy to take initiative and minimize inefficient downtime (notwithstanding some purposeful downtime to rest and recharge). Managers cannot and should not supervise every task of each employee all day.

Therefore, managers must effectively communicate the overall intention or desired end result of business goals while allowing employees the flexibility to efficiently utilize resources to arrive at the end goal.

 Operational goals should be formulated with feedback from employees, customers, and management, and the list should be clear, concise, and should align with the overarching vision of the business.

 Clearly identifying roles, defining responsibilities, and setting expectations for employees prompts smoother workflow operations.

Additionally, expanding positions of other pharmacy staff members by incorporating workflow redesign such as tech-check-tech can help pharmacy evolve by gaining efficiencies without compromising patient safety.

 Role-modeling effective time management behaviors can assist other staff members and can also carry through into our daily lives even outside the workplace. Effective time management also limits stress and enhances wellbeing. There are a number of resources for pharmacists seeking effective time management strategies in general, in addition to specific literature that relates to pharmacy operations. Time management is an essential skill for the pharmacist and should be honed, as multiple stakeholders including patients, employees and managers stand to benefit from decreasing wasted time and focusing efforts on high-value essential functions.

 is a PharmD Candidate at Touro University California.

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

Negaard BJ, Lyons KP, Nichol CL, & Polgreen LA. What does a pharmacist do? A time and motion study. 

Alston GL, & Wynn W (2020). Chapter 8: Operations management. Zgarrick DP, Desselle SP, Moczygemba LR, & Alston G (Eds.), 

Although pharmacists may be busy during seemingly every moment of the day, it is important to realize that there are opportunities where time can be saved. 

Tip of the Week: Improving Efficiency Benefits Everyone

Throughout the unprecedented COVID-19 pandemic, health care providers proved to be resilient, stretching themselves beyond their designated roles to provide the care that the public required. Pharmacists and pharmacy technicians, in particular, showcased their ability to adapt and respond during times of crisis by emerging as key players for vaccine administration efforts. The COVID-19 pandemic highlighted pharmacy technicians as an underutilized asset, as pharmacy technicians met the demand for immunizers by filling the role while concurrently proving they were capable and proficient.

A recent systematic review showed that trained pharmacy technicians practicing at an advanced scope—such as providing accuracy checks of dispensed medications, taking medication histories, and optimization of stock or other costly items—provides an economic benefit to their workplace with annual savings ranging from a few thousand to nearly $90,000.

 Additionally, advanced technician practice also results in time savings for the community pharmacist, which further enables patient-centric care.

 However, according to a 2020 online survey distributed to a national sample of community pharmacists, there may be some barriers to overcome regarding pharmacists’ level of confidence in continued advancement of technician responsibilities.

It has been said that “without technicians assuming new responsibilities in the pharmacy, the evolution in practice we have long discussed might not take place.”

 Several Management Tips and other articles in 

 have discussed advanced technician roles and have described strategies for adequate supervision of workflow and support personnel. However, from the results of the studies mentioned here and elsewhere, it is important that pharmacy managers and professional leaders also advocate for technicians, as they otherwise do not have the sort of gravitas and strength in professional organizations that we do as pharmacists.

Pharmacy managers can speak to corporate management on behalf of technicians, present to Boards of Pharmacy about the need for technician growth, and reassure technicians of their value in the organization. Most of us have witnessed firsthand what an advocate can do for us or someone else. Effectively managing and respecting technicians is a great start but advocating for them helps to ensure the viability and growth of our profession.

Additional information about Pharmacy Technicians can be found in 

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

1. Banks VL, Barras M, Snoswell CL. Economic benefits of pharmacy technicians practicing at advanced scope: A systematic review. 

2. Adams AJ, Martin SJ, Stolpe SF “Tech-Check-Tech”: A review of the evidence on its safety and benefits. 

3. Sparkmon W, Barnard M, Rosenthal M, Desselle S, Holmes, E. Community pharmacist perceptions of increased technician responsibility. 

4. Adams AJ, Desselle S, Austin Z, Fenn T. Pharmacy technicians are people, too! Let’s consider their personal outcomes along with other pharmacy outcomes. 

Effectively managing and respecting technicians is a great start but advocating for them helps to ensure the viability and growth of our profession. 