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Bustin DJ, Simmons R, Galdo J, Kucek ME, Logan L, Cohn R, Smith H. Feasibility of a contraceptive-specific electronic health record system to promote the adoption of pharmacist-prescribed contraceptive services in community pharmacies in the United States. JAMIA Open 2024; 7:ooae071. [PMID: 39040536 PMCID: PMC11262636 DOI: 10.1093/jamiaopen/ooae071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 04/12/2024] [Accepted: 07/10/2024] [Indexed: 07/24/2024] Open
Abstract
Objectives Pharmacists in over half of the United States can prescribe contraceptives; however, low pharmacist adoption has impeded the full realization of potential public health benefits. Many barriers to adoption may be addressed by leveraging an electronic health records (EHR) system with clinical decision support tools and workflow automation. We conducted a feasibility study to determine if utilizing a contraceptive-specific EHR could improve potential barriers to the implementation of pharmacist-prescribed contraceptive services. Materials and Methods 20 pharmacists each performed two standardized patient encounter simulations: one on the EHR and one on the current standard of care paper-based workflow. A crossover study design was utilized, with each pharmacist performing encounters on both standardized patients with the modality order randomized. Encounters were timed, contraceptive outputs were recorded, and the pharmacists completed externally validated workload and usability surveys after each encounter, and a Perception, Attitude, and Satisfaction survey created by the research team after the final encounter. Results Pharmacists were more likely to identify contraceptive ineligibility using the EHR-based workflow compared to the paper workflow (P = .003). Contraceptive encounter time was not significantly different between the 2 modalities (P = .280). Pharmacists reported lower mental demand (P = .003) and greater perceived usefulness (P = .029) with the EHR-based workflow compared to the paper modality. Discussion and Conclusion Pharmacist performance and acceptance of contraceptive services delivery were improved with the EHR workflow. Pharmacist-specific contraceptive EHR workflows show potential to improve pharmacist adoption and provision of appropriate contraceptive care.
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Affiliation(s)
| | - Rebecca Simmons
- Division of Family Planning, University of Utah, Salt Lake City, UT 84132, United States
| | - Jake Galdo
- CPESN Health Equity, Nashville, TN 37217, United States
| | - Mary E Kucek
- OvaryIt, LLC, Lancaster, PA 17601, United States
| | | | - Rich Cohn
- Independent Consultant, Chapel Hill, NC 27516, United States
| | - Heather Smith
- Department of Obstetrics and Gynecology, Women & Infants Hospital, Providence, RI 02905, United States
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May A, Raber H, Tingey B, Locke AB, Mullin S, Nickman NA, Qeadan F. The association between number of learners and pharmacist and technician levels of burnout. Am J Health Syst Pharm 2024; 81:370-384. [PMID: 38237931 DOI: 10.1093/ajhp/zxad339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024] Open
Abstract
PURPOSE Little is known about the relationship between learner load and pharmacist and pharmacy technician burnout. Therefore, the purpose of this study was to examine the association between burnout and the number of learners (residents, students, and new employees) assigned to pharmacists or pharmacy technicians. METHODS A validated survey to measure burnout and professional fulfillment was administered to employees of a university health system's pharmacy service in 2019. A threshold analysis determined the optimal cutoff for number of learners trained that maximized the ability to predict binary outcomes. Chi-square and Fisher's exact tests were used, and effect sizes between percentages were reported. Finally, the adjusted associations between number of learners and outcomes were assessed using logistic regression. RESULTS A total of 448 pharmacy staff members were included in the analysis. Of those, 57% (n = 254) worked in ambulatory care, 27.4% (n = 122) worked in an inpatient setting, and 15.7% (n = 70) worked in infrastructure. Pharmacists working in an inpatient setting who reported training 4 or more learners per year indicated significantly higher rates of burnout than those training fewer learners on both a single-item burnout assessment (64.3% vs 31.0%; P = 0.01; effect size, 0.68) and a 10-item burnout assessment (54.8% vs 13.8%; P = 0.01; effect size, 0.91). Similar results were not observed in pharmacists working in ambulatory care and infrastructure positions or in pharmacy technicians. CONCLUSION Added precepting and training responsibilities may be associated with higher levels of burnout among pharmacy team members, particularly inpatient pharmacists.
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Affiliation(s)
- Alisyn May
- ARUP Health & Wellness, Salt Lake City, UT, USA
| | - Hanna Raber
- University of Utah College of Pharmacy, Salt Lake City, UT, USA
| | - Ben Tingey
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA
| | - Amy B Locke
- Osher Center for Integrative Health, University of Utah, Salt Lake City, UT, USA
| | | | - Nancy A Nickman
- University of Utah College of Pharmacy, Salt Lake City, UT, USA
| | - Fares Qeadan
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA
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Wash A, Moczygemba LR, Brown CM, Crismon ML, Whittaker TA. A narrative review of the well-being and burnout of U.S. community pharmacists. J Am Pharm Assoc (2003) 2024; 64:337-349. [PMID: 37967722 DOI: 10.1016/j.japh.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/26/2023] [Accepted: 11/08/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVES The purpose of this narrative review is to summarize the literature on well-being and burnout among community pharmacists in the U.S. and provide recommendations for future research. METHODS Relevant literature was identified by searching PubMed for combinations of keywords such as "burnout" and "well-being" combined with "pharmacists." Titles and abstracts were reviewed for relevancy, and full text articles were reviewed when applicable. RESULTS While burnout is defined by its 3 core symptoms of emotional exhaustion, depersonalization, and low personal accomplishment, well-being is more challenging to define and measure, which has led to it being less studied. Community pharmacists faced high rates of burnout, low quality of life (QOL), and extreme fatigue prior to the COVID-19 pandemic, a situation that has likely only worsened. Factors such as workload, the type of community pharmacy, the level of education or training of the pharmacist, and stress may be some of the contributors to high rates of burnout. Clinician burnout may be related to high rates of mental health disorders seen in pharmacists, may impact patient safety and satisfaction, and may affect productivity and costs to employers and the healthcare system overall. There has been no research into interventions or strategies to support well-being and reduce burnout among community pharmacists, but having a workplace that is perceived as supporting well-being may have some impact. Recommendations for future research include the following: (1) define well-being, (2) explore why various factors support well-being or contribute to burnout, (3) determine the impact of community pharmacists experiencing well-being or burnout, and (4) develop strategies to support well-being and reduce burnout that are specific to community pharmacy. CONCLUSION There is a sparsity of evidence regarding community pharmacist well-being and burnout. Further research is needed to generate the evidence needed to support interventions that are specific to the unique work setting of community pharmacists.
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Zeeman JM, Pickering ES, Nana AA, Harris SC. Assessing Workplace Factors That Influence Burnout and Identifying Recommendations to Support Well-being in Pharmacy Faculty. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100628. [PMID: 37981071 DOI: 10.1016/j.ajpe.2023.100628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/30/2023] [Accepted: 11/13/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE Creating environments that promote well-being is critical as studies have shown that burnout, and thus poor well-being, results in poor health outcomes and declining workplace retention. While studies have measured the prevalence of burnout in pharmacy faculty, a gap exists regarding workplace factors that impact faculty well-being. The purpose of this study was to assess factors influencing pharmacy faculty burnout and identify recommendations to improve faculty well-being. METHODS Full-time pharmacy faculty were invited to participate in this exploratory study. Focus groups were divided by faculty rank (ie, assistant, associate, full professor). A semistructured interview format was used to identify factors contributing to faculty burnout and fulfillment as well as solicit suggestions for strategies to improve well-being. Inductive coding was used to identify themes. RESULTS Eleven faculty participated in 4 focus groups: 6 assistant professors in 2 focus groups (n = 3 faculty/focus group), 3 associate professors in 1 focus group, and 2 full professors in 1 focus group. Common factors influencing faculty burnout included overwhelming workload, workplace inefficiencies, and unexpected factors. Factors contributing to faculty fulfillment included impact, having a passion for work, and connecting with others. Recommendations for improving well-being included school-level well-being initiatives from leadership, encouraging work-life balance, and implementing intentional well-being initiatives and resources. CONCLUSION Participants identified several workplace factors that contribute to burnout and faculty fulfillment. This study fills a critical gap in the literature regarding factors that influence pharmacy faculty well-being and burnout and can inform strategies for fostering faculty well-being in pharmacy education.
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Affiliation(s)
- Jacqueline M Zeeman
- University of North Carolina at Chapel Hill, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Emily S Pickering
- University of North Carolina at Chapel Hill, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Akina A Nana
- University of North Carolina at Chapel Hill, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Suzanne C Harris
- University of North Carolina at Chapel Hill, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA.
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Watterson TL, Chui MA. Subjective Perceptions of Occupational Fatigue in Community Pharmacists. PHARMACY 2023; 11:84. [PMID: 37218966 PMCID: PMC10204370 DOI: 10.3390/pharmacy11030084] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/24/2023] Open
Abstract
INTRODUCTION Community retail pharmacists are experiencing unsafe levels of stress and excessive demands within the workplace. One aspect of workload stress that has been overlooked among pharmacists is occupational fatigue. Occupational fatigue is a characteristic of excessive workload including increased work demands and reduced capacity and resources to complete the work. The goal of this study is to describe the subjective perceptions of occupational fatigue in community pharmacists by using (Aim 1) a previously developed Pharmacist Fatigue Instrument and (Aim 2) semi-structured interviews. METHODS Wisconsin community pharmacists were eligible to participate in the study and recruited via a practice-based research network. Participants were asked to complete a demographic questionnaire, a Pharmacist Fatigue Instrument, and semi-structured interview. Survey data were analyzed using descriptive statistics. Interview transcripts were analyzed using qualitative deductive content analysis. RESULTS Totally, 39 pharmacists participated in the study. From the Pharmacist Fatigue Instrument, 50% of the participants stated they had times where they were not able to go above and beyond standard patient care on more than half of the days they worked. A total of 30% of the participants reported that they found it necessary to take short-cuts when providing patient care on more than half of the days they worked. Pharmacist interviews were separated into overarching themes including mental fatigue, physical fatigue, active fatigue, and passive fatigue. CONCLUSIONS The findings highlighted the pharmacists' feelings of despair and mental fatigue, fatigue's connectedness to interpersonal relationships, and the complex nature of pharmacy work systems. Interventions aimed at improving occupational fatigue in community pharmacies should consider key themes of fatigue that pharmacists are experiencing.
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Affiliation(s)
- Taylor L. Watterson
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 750 Highland Avenue, Madison, WI 53705, USA
| | - Michelle A. Chui
- Social and Administrative Sciences Division, University of Wisconsin-Madison School of Pharmacy, 777 Highland Avenue, Madison, WI 53705, USA
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Abilmona R, Dimassi H, Aboulhosn R, Chamoun N. Burnout and coping strategies among health system pharmacists in Lebanon: a cross-sectional study. BMC Health Serv Res 2023; 23:424. [PMID: 37131192 PMCID: PMC10152435 DOI: 10.1186/s12913-023-09422-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 04/19/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Burnout in health system pharmacists has been studied in several countries. To date, no data exists on burnout among healthsystem pharmacists in Lebanon. This study aimed to determine the prevalance of burnout, identify factors and describe coping strategies related to burnout among healthsystem pharmacists in Lebanon. METHODS A cross-sectional study utilizing the Maslach Burnout Inventory- Human Services Survey for Medical Personnel (MBI-HSS (MP))was conducted in Lebanon. A convenience sample of hospital pharmacists in Mount Lebanon and Beirut area filled a paper-based survey in person or via a phone interview. Burnout was defined as having an emotional exhaustion score ≥ 27 and/or depersonalization score ≥ 10. To identify factors associated with burnout, the survey also contained questions on socio-demographic characteristics, professional status, hospital characteristics, professional stressors and professional satisfaction. Participants were also asked about their coping strategies. To adjust for potential confounding, a multivariable logistic regression was used to estimate the adjusted odds ratios of factors and coping strategies associated with burnout. The authors also evaluated burnout according to the broader definition, emotional exhaustion score ≥ 27 or depersonalization score ≥ 10 or low personal accomplishment ≤ 33. RESULTS Of the 153 health system pharmacists who were contacted, 115 filled the survey (response rate of 75.1%). The overall burnout prevalence reported was n = 50 (43.5%) and was largely driven by high emotional exhaustion n = 41(36.9%). Following multivariate logistic regression, seven factors were associated with increased burnout: older age, B.S. in Pharmacy degree, involvement in student training, no involvement in procurement, divided attention at work, overall dissatisfaction with career, dissatisfaction to neutrality with balance between professional and personal life. Low personal accomplishment was noted in n = 55 (49.5%). The main coping strategies identified were holidays, leisure, hobbies, sports activities, and relaxation. There was no association between the coping strategies used and burnout. The prevalence of burnout according to the broader definition was n = 77 (67%). The factors associated with the broader definition of burnout were older age, overall dissatisfaction with career and dissatisfaction with work life balance. CONCLUSION Approximately n = 50(43.5%)of health system pharmacists in Lebanon may be at risk for burnout. If using broader definitions incorporating all three subscales of the (MBI-HSS (MP)), the prevalence of burnout was n = 77(67%). This study highlights the need to advocate for pratice reforms to improve the low personal acoomplishment and recommends strategies to mitigate burnout. Further research to assess the current prevalence of burnout and evaluate effective interventions in alleviating burnout amongst health system pharmacists is needed.
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Affiliation(s)
- Rosa Abilmona
- Lebanese American University Medical Center-Rizk Hospital, Department of Pharmacy, Beirut, Lebanon
- Lebanese American University, School of Pharmacy, P.O. Box S-23, Byblos, Lebanon
| | - Hani Dimassi
- Lebanese American University, School of Pharmacy, P.O. Box S-23, Byblos, Lebanon
| | - Rafah Aboulhosn
- Lebanese American University, School of Pharmacy, P.O. Box S-23, Byblos, Lebanon
| | - Nibal Chamoun
- Lebanese American University, School of Pharmacy, P.O. Box S-23, Byblos, Lebanon.
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Chen Z, Foo ZST, Tang JY, Sim MWC, Lim BL, Fong KY, Tan KH. Sleep quality and burnout: A Singapore study. Sleep Med 2023; 102:205-212. [PMID: 36706670 DOI: 10.1016/j.sleep.2022.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 11/30/2022] [Accepted: 12/30/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Improved sleep hygiene is postulated to be protective against burnout. Previous studies assessing a potential association between poor sleep quality and burnout showed incongruent results. OBJECTIVE To investigate the relationship between sleep quality and burnout. DESIGN Setting and Participants: A survey was conducted in a large health care cluster in Singapore and included health care staff from different professions (N = 4777). The Maslach Burnout Inventory - Human Services Survey was used to measure burnout across 3 sub-scales: Emotional Exhaustion, Depersonalization and Personal Accomplishment, while the Pittsburgh Sleep Quality Index (PSQI) was used to gauge the participants' sleep quality. Multi-variable general linear model ANOVA was used for correlation analysis. RESULTS There is a strong correlation between sleep quality and all 3 burnout sub-scales. PSQI is associated with Emotional Exhaustion (F value = 90.65, P-value <.0001), Depersonalization (F value = 49.46, P-value <.0001) and Personal Accomplishment (F value = 12.29, P-value <.0001). PSQI shows a significant linear upward trend with Emotional Exhaustion (linear contrast = 957.06, P-value <.0001) and with Depersonalization (linear contrast = 521.92, P-value <.0001). With Personal Accomplishment, PSQI shows a significant linear downward trend (linear contrast = 123.61, P-value <.0001). CONCLUSION Poor sleep quality is progressively and linearly associated with burnout and its 3 sub-scales. Future studies that evaluate interventions which improve sleep quality among health care workers may be useful in reducing burnout and improving patient care.
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Affiliation(s)
- Zhengyong Chen
- Duke-NUS Medical School, Singapore; SingHealth Duke-NUS Institute for Patient Safety & Quality, Singapore.
| | - Zann Sue Ting Foo
- SingHealth Duke-NUS Institute for Patient Safety & Quality, Singapore
| | - Joo Ying Tang
- SingHealth Duke-NUS Institute for Patient Safety & Quality, Singapore
| | - Mabel Wan Chi Sim
- SingHealth Duke-NUS Institute for Patient Safety & Quality, Singapore
| | - Boon Leng Lim
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - Kok Yong Fong
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore
| | - Kok Hian Tan
- SingHealth Duke-NUS Institute for Patient Safety & Quality, Singapore
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Johnston K, O’Reilly CL, Scholz B, Georgousopoulou EN, Mitchell I. The "affected" pharmacist and the "business as usual" pharmacist: Exploring the experiences of pharmacists during COVID-19 through cluster analysis. J Am Pharm Assoc (2003) 2023; 63:144-150.e2. [PMID: 36270908 PMCID: PMC9519361 DOI: 10.1016/j.japh.2022.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/10/2022] [Accepted: 09/22/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND The global coronavirus disease 2019 (COVID-19) pandemic has necessitated considerable changes in the delivery of pharmacy services, with pharmacists experiencing increasing demands and a high rate of burnout. The ability to categorize pharmacists based on their burnout risk and associated factors could be used to tailor burnout interventions. OBJECTIVE This study aimed to identify subgroups (profiles) of pharmacists and use these profiles to describe interventions tailored to improve pharmacist's well-being. METHODS A survey was disseminated to pharmacists working in Australia during April and June 2020. The survey measured demographics, burnout, and psychosocial factors associated with working during COVID-19. A two-step cluster analysis was used to categorize pharmacists based on burnout and other variables. RESULTS A total of 647 survey responses contained data that were used for analysis. Participants were mostly female (75.7%) and working full time (65.2%). The final cluster analysis yielded an acceptable two-cluster model describing 2 very different pharmacist experiences, using 10 variables. Cluster 2 (representing 53.1% of participants) describes the "affected" pharmacist, who has a high degree of burnout, works in community pharmacy, experiences incivility, is less likely to report sufficient precautionary measures in their workplace, and has had an increase in workload and overtime. In contrast, cluster 1 (representing 46.9% of participants) describes the profile of a "business as usual" hospital pharmacist with the opposite experiences. Interventions focused on the "affected" pharmacist such as financial support to employ specialized staff and equitable access to personal protective equipment should be available to community pharmacists, to reduce the risk to these frontline workers. CONCLUSION The use of cluster analysis has identified 2 distinct profiles of pharmacists working during COVID-19. The "affected" pharmacist warrants targeted interventions to address the high burnout experienced in this group.
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Affiliation(s)
- Karlee Johnston
- Correspondence: Karlee Johnston, BSPharm, MClinPharm, Adv.Prac.Pharm, FSHPA, Lecturer, Australian National University Medical School, Florey Bldg., 54 Mills Rd., Acton ACT 2601, Australia. (K. Johnston)
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Raber H, May A, Tingey B, Qeadan F, Morrow E, Mullin S, Nickman NA, Tyler LS. Burnout, professional fulfillment, sleep impairment, and self-compassion within an academic medical center pharmacy department. Am J Health Syst Pharm 2022; 79:1551-1561. [PMID: 35723936 DOI: 10.1093/ajhp/zxac172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE To examine the prevalence of burnout, professional fulfillment, sleep impairment, and self-compassion within an academic medical center pharmacy department across varying job titles and practice settings. METHODS In fall 2019, pharmacy staff completed a REDCap-based survey that consisted of a validated instrument relating to burnout, professional fulfilment, sleep-related impairment, and self-compassion. Burnout was measured by both single-item and extended 10-item questions on the survey. Survey outcomes from each domain were compared between pharmacists and pharmacy technicians/interns, as well as among practice settings (inpatient, ambulatory care, and infrastructure). RESULTS A total of 593 surveys were completed by pharmacy personnel, representing a preliminary response rate of 71.8% (593/826). A total of 505 survey responses were analyzed (235 [46.5%] for pharmacists and 270 [53.5%] for pharmacy technicians/interns). Inpatient pharmacists reported the highest level of burnout (50.7%) followed by ambulatory care pharmacists (29.3%) and those working in infrastructure (24.3%). Pharmacy technicians working in infrastructure reported the highest level of burnout (36.4%), followed by inpatient (30.8%) and ambulatory care (28.3%) pharmacy technicians. There was no association between job type or location and burnout according to both single-item and 10-item burnout measures. A higher rate of burnout, sleep impairment, and decreased self-compassion and a lower rate of professional fulfillment were observed for inpatient pharmacists compared to pharmacists in ambulatory care or infrastructure. Except for higher rates of reported professional fulfillment, a similar trend was observed for pharmacy technicians. CONCLUSION Burnout was reported across the pharmacy team regardless of practice site.
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Affiliation(s)
- Hanna Raber
- University of Utah College of Pharmacy, Salt Lake City, UT, USA
| | - Alisyn May
- University of Utah College of Pharmacy, Salt Lake City, UT, USA
| | - Ben Tingey
- University of Utah Department of Family & Preventive Medicine, Salt Lake City, UT, USA
| | - Fares Qeadan
- University of Utah Department of Family & Preventive Medicine, Salt Lake City, UT, USA
| | - Ellen Morrow
- Resiliency Center, University of Utah Health, Salt Lake City, UT, USA
| | | | - Nancy A Nickman
- University of Utah College of Pharmacy, Salt Lake City, UT, and Pharmacy Services, University of Utah Health, Salt Lake City, UT, USA
| | - Linda S Tyler
- University of Utah Health, University of Utah College of Pharmacy, Salt Lake City, UT, USA
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Allinson M, Obeid L, Cornes K. Community pharmacists' experiences of working during lockdown. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 5:100121. [PMID: 35252954 PMCID: PMC8886682 DOI: 10.1016/j.rcsop.2022.100121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 02/14/2022] [Accepted: 02/25/2022] [Indexed: 11/30/2022] Open
Abstract
Background Transmission of the novel coronavirus strain, SARS-CoV-2, caused many health services to reach crisis points worldwide. As infection rates rose, many countries implemented ‘lockdown’ periods where only essential services could remain open; this included community pharmacies in the UK. This study retrospectively explores the experiences of community pharmacists during the first lockdown period of the pandemic in the UK, helping us to learn for the future if another pandemic were to arise. Objective The objectives of this study were to explore the main professional and personal worries and concerns that pharmacists experienced during the first UK lockdown. Key practical issues specific to COVID-19 were investigated: staffing levels, precautionary measures undertaken, workload issues, medicines shortages, support, and guidance. In addition, the perceived effectiveness of support available to community pharmacists was examined. Methods Community pharmacists in the Stoke-on-Trent and Staffordshire regions of the UK were invited to participate in a semi-structured telephone interview. Participants were recruited until no new themes emerged. Interviews were transcribed verbatim, and thematic analysis was undertaken using the Framework Approach. Results In total, 29 community pharmacists were interviewed across Stoke-On-Trent and Staffordshire, with interviews lasting on average for 20 min. Fifteen interviewees were from independent pharmacies and 14 from large-chain pharmacies. Five themes emerged from the data: difficulty maintaining staffing levels; precautionary measures undertaken for staff and patients; increase in dispensing volume; dealing with medicines shortages; and perceptions of support varied, with guidance reported to be initially slow and conflicting. Conclusion Overall, this study highlights the crucial role that community pharmacists in the UK played in ensuring patients still received their medication and health advice, despite the challenging circumstances in which they found themselves. Community pharmacies need appropriate support, recognition, and funding to enable them to remain sustainable and continue to provide a critical service in the face of possible future pandemics.
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Holden RJ, Abebe E, Russ-Jara AL, Chui MA. Human factors and ergonomics methods for pharmacy research and clinical practice. Res Social Adm Pharm 2021; 17:2019-2027. [PMID: 33985892 PMCID: PMC8603214 DOI: 10.1016/j.sapharm.2021.04.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Human factors and ergonomics (HFE) is a scientific and practical human-centered discipline that studies and improves human performance in sociotechnical systems. HFE in pharmacy promotes the human-centered design of systems to support individuals and teams performing medication-related work. OBJECTIVE To review select HFE methods well suited to address pharmacy challenges, with examples of their application in pharmacy. METHODS We define the scope of HFE methods in pharmacy as applications to pharmacy settings, such as inpatient or community pharmacies, as well as medication-related phenomena such as medication safety, adherence, or deprescribing. We identify and present seven categories of HFE methods suited to widespread use for pharmacy research and clinical practice. RESULTS Categories of HFE methods applicable to pharmacy include work system analysis; task analysis; workload assessment; medication safety and error analysis; user-centered and participatory design; usability evaluation; and physical ergonomics. HFE methods are used in three broad phases of human-centered design and evaluation: study; design; and evaluation. The most robust applications of HFE methods involve the combination of HFE methods across all three phases. Two cases illustrate such a comprehensive application of HFE: one case of medication package, label, and information design and a second case of human-centered design of a digital decision aid for medication safety. CONCLUSIONS Pharmacy, including the places where pharmacy professionals work and the multistep process of medication use across people and settings, can benefit from HFE. This is because pharmacy is a human-centered sociotechnical system with an existing tradition of studying and analyzing the present state, designing solutions to problems, and evaluating those solutions in laboratory or practice settings. We conclude by addressing common concerns about the implementation of HFE methods and urge the adoption of HFE methods in pharmacy.
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Affiliation(s)
- Richard J Holden
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Center for Aging Research, Regenstrief Institute, Indianapolis, IN, USA; Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Sciences Institute, Indianapolis, IN, USA.
| | - Ephrem Abebe
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, USA
| | - Alissa L Russ-Jara
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, USA
| | - Michelle A Chui
- Social & Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
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Enz S, Hall ACG, Williams KK. The Myth of Multitasking and What It Means for Future Pharmacists. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2021; 85:8267. [PMID: 34965913 PMCID: PMC8715974 DOI: 10.5688/ajpe8267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 03/30/2021] [Indexed: 06/14/2023]
Abstract
Objective The primary purposes of this study were to determine the extent to which multitasking affects the speed and accuracy with which Doctor of Pharmacy students identify prescription errors and whether there is a relationship between students' self-perception of their multitasking ability and their actual ability.Methods One hundred twenty-one second-year pharmacy students enrolled in the required course Introduction to Dosage Forms spent one week in an experimental (multitasking) condition and one week in a control (undistracted) condition. Subjects were given 10 minutes to check 10 prescriptions and record any identified filling errors. A cellular phone was placed in each room. Subjects in the experimental (multitasking) condition answered a call from a researcher posing as a talkative customer during the prescription-checking task while subjects in the control condition were not interrupted by a cell phone call during the task. Subjects' completion times and accuracy were recorded.Results When subjects were multitasking, they took significantly longer to complete the prescription-checking task than when they were not multitasking. Furthermore, when subjects were multitasking, they scored significantly lower on the prescription-checking task than when they were not multitasking. Finally, students' self-perceptions of their multitasking abilities were not related to the speed with which they completed the prescription-checking task nor to their accuracy.Conclusion Multitasking negatively affects speed and accuracy of prescription verification in student pharmacists. Our procedure can be used as an in-class activity to demonstrate the limits of attention and to shape how future pharmacists practice.
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Affiliation(s)
- Stephanie Enz
- Butler University, College of Pharmacy & Health Sciences, Indianapolis, Indiana
| | - Amanda C G Hall
- Butler University, College of Liberal Arts & Sciences, Indianapolis, Indiana
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13
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Identification of Workplace Social Sustainability Indicators Related to Employee Ergonomics Perception in Indonesian Industry. SUSTAINABILITY 2021. [DOI: 10.3390/su131911069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sustainability indicators have provided a breakthrough for companies to assess their performance in supporting corporate sustainability. There is no standard framework for these support-defining indicators to conduct a social sustainability performance assessment. There is a limitation of quantitative social sustainability indicators appropriate for performing ergonomic concept assessments. Ergonomics, as a field concerning people and their interactions with the environment, in particular, the workplace, can play a role in social sustainability, besides its conventional approach of workplace re-engineering. Three major areas of ergonomics were analyzed. The indicators were established based on a review of the literature and confirmed using a factor analysis that covered all major aspects of workplace ergonomics. The factor analysis aimed to reduce the complexity of workplace social sustainability indicators related to ergonomics. The final result integrated 73 indicators into 17 indicators based on three major areas of ergonomics. The findings showed that the best workplace social sustainability indicators were divided into five factors: employee well-being, safety concerns, workplace comfort, musculoskeletal health, and environmental concerns. It would be very beneficial for the industry and the government to support corporate social sustainability and the global sustainability index.
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Johnston K, O'Reilly CL, Scholz B, Georgousopoulou EN, Mitchell I. Burnout and the challenges facing pharmacists during COVID-19: results of a national survey. Int J Clin Pharm 2021; 43:716-725. [PMID: 33851288 PMCID: PMC8043093 DOI: 10.1007/s11096-021-01268-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/08/2021] [Indexed: 11/30/2022]
Abstract
Background COVID-19 has impacted the psychological wellbeing of healthcare workers and has forced pharmacists to adapt their services. Objective To measure burnout and describe the work and psychosocial factors affecting pharmacists during COVID-19, and to compare males and females. Setting An online survey was distributed to a convenience sample of pharmacists practicing in any setting in Australia during April and June 2020. Method The survey collected demographic data, burnout scores using the validated Maslach Burnout Inventory (MBI), psychosocial and work-related variables using questions adapted from previous surveys. It was tested for readability by a group of pharmacists and academic clinicians before distribution via social media and professional organisations. Main outcome measure Burnout was calculated using mean MBI scores, descriptive statistics were used to report work and psychosocial variables and Pearson's chi-square compared males and females. Results Overall, 647 responses were analysed. Most participants were female n = 487 (75.7%) with hospital n = 269 (42.2%) and community n = 253 (39.9%) pharmacists well represented. Mean (SD) for emotional exhaustion (possible range 0-54) and depersonalisation (possible range 0-30) were 28.5 (13.39) and 7.98 (5.64), which were higher (increased burnout) than reported pre-COVID-19. Personal accomplishment (range 0-48, lower scores associated with burnout) mean (SD) 36.58 (7.56), was similar to previously reported. Males reported higher depersonalisation indicating more withdrawal and cynicism. Working overtime, medication supply and patient incivility were reported to affect work. Conclusion Pharmacists are experiencing burnout, with work and psychosocial factors affecting them during COVID-19. Knowledge of this and that males experience more depersonalisation is valuable to inform advocacy and interventions to support pharmacists.
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Affiliation(s)
- Karlee Johnston
- ANU Medical School, ANU College of Health and Medicine, The Australian National University, Acton, ACT, Australia.
| | - Claire L O'Reilly
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney NSW, Australia
| | - Brett Scholz
- ANU Medical School, ANU College of Health and Medicine, The Australian National University, Acton, ACT, Australia
| | - Ekavi N Georgousopoulou
- ANU Medical School, ANU College of Health and Medicine, The Australian National University, Acton, ACT, Australia
| | - Imogen Mitchell
- ANU Medical School, ANU College of Health and Medicine, The Australian National University, Acton, ACT, Australia
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Valdez RS, Holden RJ, Rivera AJ, Ho CH, Madray CR, Bae J, Wetterneck TB, Beasley JW, Carayon P. Remembering Ben-Tzion Karsh's scholarship, impact, and legacy. APPLIED ERGONOMICS 2021; 92:103308. [PMID: 33253977 DOI: 10.1016/j.apergo.2020.103308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 06/12/2023]
Abstract
Dr. Ben-Tzion (Bentzi) Karsh was a mentor, collaborator, colleague, and friend who profoundly impacted the fields of human factors and ergonomics (HFE), medical informatics, patient safety, and primary care, among others. In this paper we honor his contributions by reflecting on his scholarship, impact, and legacy in three ways: first, through an updated simplified bibliometric analysis in 2020, highlighting the breadth of his scholarly impact from the perspective of the number and types of communities and collaborators with which and whom he engaged; second, through targeted reflections on the history and impact of Dr. Karsh's most cited works, commenting on the particular ways they impacted our academic community; and lastly, through quotes from collaborators and mentees, illustrating Dr. Karsh's long-lasting impact on his contemporaries and students.
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Affiliation(s)
- Rupa S Valdez
- Department of Public Health Sciences, University of Virginia, VA, USA; Department of Engineering Systems and Environment, University of Virginia, VA, USA.
| | - Richard J Holden
- Department of Medicine, Indiana University, IN, USA; Indiana University Center for Aging Research, Regenstrief Institute Inc, IN, USA; Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Sciences Institute, IN, USA
| | - A Joy Rivera
- Department of Patient Safety, Froedtert Hospital, WI, USA.
| | - Chi H Ho
- Department of Public Health Sciences, University of Virginia, VA, USA.
| | - Cristalle R Madray
- Department of Community Development and Planning, University of Maryland Medical System, MD, USA.
| | - Jiwoon Bae
- Department of Public Health Sciences, University of Virginia, VA, USA.
| | - Tosha B Wetterneck
- Department of Family Medicine and Community Health, University of Wisconsin, WI, USA; Department of Industrial and Systems Engineering, University of Wisconsin, WI, USA.
| | - John W Beasley
- Department of Family Medicine and Community Health, University of Wisconsin, WI, USA; Department of Industrial and Systems Engineering, University of Wisconsin, WI, USA.
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin, WI, USA; Center for Quality and Productivity Improvement, Wisconsin Institute for Healthcare Systems Engineering, WI, USA.
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Johnston K, O'Reilly CL, Cooper G, Mitchell I. The burden of COVID-19 on pharmacists. J Am Pharm Assoc (2003) 2021; 61:e61-e64. [PMID: 33189556 PMCID: PMC7580693 DOI: 10.1016/j.japh.2020.10.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/23/2020] [Accepted: 10/18/2020] [Indexed: 12/16/2022]
Abstract
The unprecedented changes brought about by the global coronavirus disease 2019 (COVID-19) pandemic have had important impacts on society. The pandemic has provided an opportunity to highlight the crucial role pharmacists play in the provision of health care. The critical and unique role of pharmacists in pandemics and other disasters has been highlighted in the past (severe acute respiratory syndrome and Ebola outbreaks) and more recently with reports of the contributions of pharmacists during the global COVID-19 pandemic. Many reports have documented that health care professionals are experiencing significant psychological morbidity as a result of providing essential care and services during the global COVID-19 pandemic. In these reports, pharmacists are not well represented, and, therefore, it is essential to understand the impact of COVID-19 on pharmacists across multiple practice settings. This is particularly true as the experiences of pharmacists working through previous pandemics and disasters, and the associated psychological burden, are likely to offer insights and be useful in supporting the psychological well-being of pharmacists during the global COVID-19 pandemic. Research into the effect of the global COVID-19 pandemic on pharmacists should improve the understanding of the impact and the psychological morbidity associated with their role as frontline health care professionals.
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Correction. J Am Pharm Assoc (2003) 2020; 61:e61. [PMID: 33139202 DOI: 10.1016/j.japh.2020.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Wang H, Or CKL. Effects of Text Enhancement, Identical Prescription-Package Names, Visual Cues, and Verbal Provocation on Visual Searches of Look-Alike Drug Names: A Simulation and Eye-Tracking Study. HUMAN FACTORS 2020; 62:1102-1116. [PMID: 31465699 DOI: 10.1177/0018720819870700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Simulation and eye tracking were used to examine the effects of text enhancement, identical prescription-package names, visual cues, and verbal provocation on visual searches of look-alike drug names. BACKGROUND Look-alike drug names can cause confusion and medication errors, which jeopardize patient safety. The effectiveness of many strategies that may prevent these problems requires evaluation. METHOD We conducted two experiments that were based on a four-way, repeated-measures design. The within-subject factors were text enhancement, identical prescription-package names, visual cues, and verbal provocation. In Experiment 1, 40 nurses searched for and selected a target drug from an array of drug packages on a pharmacy shelf mock-up. In Experiment 2, the eye movements of another 40 nurses were tracked while they performed a computer-based drug search task. RESULTS Text enhancement had no significant effect on the drug search. Nurses selected the target drugs more quickly and easily when the prescriptions and drug packages shared identical drug name formats. The use of a visual cue to direct nurses' attention facilitated their visual searches and improved their eye gaze behaviors. The nurses reported greater mental effort if they were provoked verbally during the drug search. CONCLUSION Efficient and practical strategies should be adopted for designs that facilitate accurate drug search. Among these strategies are using identical name appearances on drug prescriptions and packages, using a visual cue to direct nurses' attention, and avoiding rushing nurses while they are concentrating. APPLICATION The findings aim to inspire recommendations for work system designs that will improve the visual search of look-alike drug names.
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Watterson TL, Look KA, Steege L, Chui MA. Operationalizing occupational fatigue in pharmacists: An exploratory factor analysis. Res Social Adm Pharm 2020; 17:1282-1287. [PMID: 33004303 DOI: 10.1016/j.sapharm.2020.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/31/2020] [Accepted: 09/20/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Quadruple Aim recognizes that caring for the healthcare employee is necessary to optimize patient outcomes and health system performance. Although previous research has assessed pharmacists' workload, this study is the first to describe pharmacist occupational fatigue-a characteristic of excessive workload that inhibits workers' abilities to function at normal capacity. OBJECTIVE (s): The purpose of this study was to describe occupational fatigue in pharmacists using exploratory factor analysis (EFA)-assessing whether dimensional structures used to describe occupational fatigue in other health professions fit pharmacist perceptions. METHODS A model was created to conceptualize two "fatigue" domains found in the literature-physical fatigue (ex. Physical discomfort) and mental fatigue (ex. trouble thinking clearly). These domains were operationalized and used to create a survey that was distributed to licensed pharmacists at a conference. An EFA was conducted to identify the key domains underlying pharmacist perceptions of fatigue. RESULTS A total of 283 surveys were distributed, and 115 were returned and useable. Respondents were primarily white, female, and worked 9.5 h-per-day on average. The EFA suggested a statistically significant two-factor model (Χ2 9.73, p = 0.28), which included physical fatigue (α = 0.87) and mental fatigue (α = 0.82) dimensions. CONCLUSIONS The EFA yielded a structure similar to what was anticipated from the literature. While working, pharmacists may not be aware of fatigue related short-cuts or lapses that pose risks to patient safety. This study is just the first step in promoting systematic interventions to prevent or cope with fatigue and prevent the patient, pharmacist, and institutional outcomes.
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Affiliation(s)
- Taylor L Watterson
- Social & Administrative Sciences Division at the University of Wisconsin-Madison, School of Pharmacy, Madison, WI, USA.
| | - Kevin A Look
- Social & Administrative Sciences Division at the University of Wisconsin-Madison, School of Pharmacy, Madison, WI, USA
| | - Linsey Steege
- University of Wisconsin-Madison, School of Nursing, Madison, WI, USA
| | - Michelle A Chui
- Social & Administrative Sciences Division at the University of Wisconsin-Madison, School of Pharmacy, Madison, WI, USA
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Ta'an WF, Al-Dwaikat TN, Dardas K, Rayan AH. The relationship between occupational stress, psychological distress symptoms, and social support among Jordanian healthcare professionals. Nurs Forum 2020; 55:763-771. [PMID: 32761634 DOI: 10.1111/nuf.12494] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 07/03/2020] [Accepted: 07/19/2020] [Indexed: 11/27/2022]
Abstract
Occupational stress is a major problem for healthcare providers, with some professionals experiencing higher numbers of stressful situations than others. Although it is difficult to eliminate stress in professionals' daily lives, providing social support can lower psychological distress symptoms. This study aims to investigate the relationship between occupational stress and social support, and the effects of social support on psychological distress symptoms of healthcare professionals. A cross-sectional descriptive design was utilized. Self-administered questionnaires were completed by a convenience sample of 211 participants (physicians, nurses, and pharmacists) from a Jordanian hospital. Bivariate analyses were used to examine the relationships between the study variables. Multiple regression analyses were used to determine if occupational stress, demographic characteristics, and social support predict depression, anxiety, and stress. Results showed that healthcare professionals with more social support showed less depression than those with a lower score of social support. Females had higher scores of depression and anxiety than males. Pharmacists had significantly higher occupational stress than both nurses and physicians. Occupational stress negatively influences healthcare professionals' mental health. To improve the productivity and psychological wellbeing of healthcare professionals, occupational stress should be diminished by implementing effective management approaches to facilitate social support for healthcare professionals.
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Affiliation(s)
- Wafa'a F Ta'an
- Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Tariq N Al-Dwaikat
- Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Khulod Dardas
- Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
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Abstract
OBJECTIVE To describe the syndrome of physician burnout within neonatology, its relation to neonatal quality of care, and outline potential solutions. FINDINGS Burnout affects up to half of physicians, including up to one-third of neonatologists, at any given time. It is linked to suicidality, substance abuse, and intent to leave practice, and it is strongly associated with reduced quality of care in the published literature. Resilience and mindfulness interventions rooted in positive psychology may reduce burnout among individual providers. Because burnout is largely driven by organizational factors, system-level attention to leadership, teamwork, and practice efficiency can reduce burnout at the level of the organization. CONCLUSIONS Burnout is common among neonatologists and consistently relates to decreased quality of patient care in a variety of dimensions. Personal resilience training and system-wide organizational interventions are needed to reverse burnout and promote high-quality neonatal care.
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Affiliation(s)
- Daniel S. Tawfik
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA 770 Welch Road, Suite 435, Palo Alto, CA, USA 94304
| | - Jochen Profit
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA; California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
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22
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Temte JL, Beasley JW, Holden RJ, Karsh BT, Potter B, Smith P, O'Halloran P. Relationship between number of health problems addressed during a primary care patient visit and clinician workload. APPLIED ERGONOMICS 2020; 84:103035. [PMID: 31983397 DOI: 10.1016/j.apergo.2019.103035] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 07/09/2019] [Accepted: 12/13/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Primary care is complex due to multiple health problems being addressed in each patient visit. Little is known about the effect of the number of problems per encounter (NPPE) on the resulting clinician workload (CWL), as measured using the National Aeronautics and Space Administration Task Load Index (NASA-TLX). METHODS We evaluated the relationship between NPPE and CWL across 608 adult patient visits, conducted by 31 clinicians, using hierarchical linear regression. Clinicians were interviewed about outlier visits to identify reasons for higher or lower than expected CWL. RESULTS Mean NPPE was 3.30 ± 2.0 (sd) and CWL was 47.6 ± 18.4 from a maximum of 100. Mental demand, time demand and effort accounted for 71.5% of CWL. After adjustment for confounders, each additional problem increased CWL by 3.9 points (P < 0.001). Patient, problem, environmental and patient-physician relationship factors were qualitatively identified from interviews as moderators of this effect. CONCLUSION CWL is positively related to NPPE. Several modifiable factors may enhance or mitigate this effect. Our findings have implications for using a Human Factors (HF) approach to managing CWL.
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Affiliation(s)
- Jonathan L Temte
- University of Wisconsin School of Medicine and Public Health, Department of Family Medicine and Community Health, 1100 Delaplaine Court, Madison, WI, 53715, USA.
| | - John W Beasley
- University of Wisconsin School of Medicine and Public Health, Department of Family Medicine and Community Health, 1100 Delaplaine Court, Madison, WI, 53715, USA; University of Wisconsin, Department of Industrial and Systems Engineering, 1415 Engineering Drive, Madison, WI, 53706, USA
| | - Richard J Holden
- Indiana University School of Medicine, Department of Medicine 545 Barnhill Dr., Emerson Hall 305, Indianapolis, IN, 46202, USA
| | - Ben-Tzion Karsh
- University of Wisconsin, Department of Industrial and Systems Engineering, 1415 Engineering Drive, Madison, WI, 53706, USA.
| | - Beth Potter
- University of Wisconsin School of Medicine and Public Health, Department of Family Medicine and Community Health, 1100 Delaplaine Court, Madison, WI, 53715, USA
| | - Paul Smith
- University of Wisconsin School of Medicine and Public Health, Department of Family Medicine and Community Health, 1100 Delaplaine Court, Madison, WI, 53715, USA
| | - Peggy O'Halloran
- Eau Claire City-County Health Department, 720 2nd Ave, Eau Claire, WI, 54703, USA
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McQuade BM, Reed BN, DiDomenico RJ, Baker WL, Shipper AG, Jarrett JB. Feeling the burn? A systematic review of burnout in pharmacists. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1218] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Brianna M. McQuade
- Department of Pharmacy Practice; University of Illinois at Chicago College of Pharmacy; Chicago Illinois
| | - Brent N. Reed
- Department of Pharmacy Practice and Science; University of Maryland School of Pharmacy; Baltimore Maryland
| | - Robert J. DiDomenico
- Department of Pharmacy Practice; University of Illinois at Chicago College of Pharmacy; Chicago Illinois
| | - William L. Baker
- Department of Pharmacy Practice; University of Connecticut School of Pharmacy; Storrs Connecticut
| | - Andrea G. Shipper
- Health Sciences and Human Services Library; University of Maryland; Baltimore Maryland
| | - Jennie B. Jarrett
- Department of Pharmacy Practice; University of Illinois at Chicago College of Pharmacy; Chicago Illinois
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Tawfik DS, Scheid A, Profit J, Shanafelt T, Trockel M, Adair KC, Sexton JB, Ioannidis JPA. Evidence Relating Health Care Provider Burnout and Quality of Care: A Systematic Review and Meta-analysis. Ann Intern Med 2019; 171:555-567. [PMID: 31590181 PMCID: PMC7138707 DOI: 10.7326/m19-1152] [Citation(s) in RCA: 250] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Whether health care provider burnout contributes to lower quality of patient care is unclear. PURPOSE To estimate the overall relationship between burnout and quality of care and to evaluate whether published studies provide exaggerated estimates of this relationship. DATA SOURCES MEDLINE, PsycINFO, Health and Psychosocial Instruments (EBSCO), Mental Measurements Yearbook (EBSCO), EMBASE (Elsevier), and Web of Science (Clarivate Analytics), with no language restrictions, from inception through 28 May 2019. STUDY SELECTION Peer-reviewed publications, in any language, quantifying health care provider burnout in relation to quality of patient care. DATA EXTRACTION 2 reviewers independently selected studies, extracted measures of association of burnout and quality of care, and assessed potential bias by using the Ioannidis (excess significance) and Egger (small-study effect) tests. DATA SYNTHESIS A total of 11 703 citations were identified, from which 123 publications with 142 study populations encompassing 241 553 health care providers were selected. Quality-of-care outcomes were grouped into 5 categories: best practices (n = 14), communication (n = 5), medical errors (n = 32), patient outcomes (n = 17), and quality and safety (n = 74). Relations between burnout and quality of care were highly heterogeneous (I2 = 93.4% to 98.8%). Of 114 unique burnout-quality combinations, 58 indicated burnout related to poor-quality care, 6 indicated burnout related to high-quality care, and 50 showed no significant effect. Excess significance was apparent (73% of studies observed vs. 62% predicted to have statistically significant results; P = 0.011). This indicator of potential bias was most prominent for the least-rigorous quality measures of best practices and quality and safety. LIMITATION Studies were primarily observational; neither causality nor directionality could be determined. CONCLUSION Burnout in health care professionals frequently is associated with poor-quality care in the published literature. The true effect size may be smaller than reported. Future studies should prespecify outcomes to reduce the risk for exaggerated effect size estimates. PRIMARY FUNDING SOURCE Stanford Maternal and Child Health Research Institute.
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Affiliation(s)
- Daniel S Tawfik
- Stanford University School of Medicine, Stanford, California (D.S.T., T.S., M.T.)
| | - Annette Scheid
- Brigham and Women's Hospital and Harvard Medical School, llBoston, Massachusetts (A.S.)
| | - Jochen Profit
- Stanford University School of Medicine, Stanford, California, and California Perinatal Quality Care Collaborative, Palo Alto, California (J.P.)
| | - Tait Shanafelt
- Stanford University School of Medicine, Stanford, California (D.S.T., T.S., M.T.)
| | - Mickey Trockel
- Stanford University School of Medicine, Stanford, California (D.S.T., T.S., M.T.)
| | - Kathryn C Adair
- Duke University School of Medicine, Duke University Health System, and Duke Patient Safety Center, Durham, North Carolina (K.C.A., J.B.S.)
| | - J Bryan Sexton
- Duke University School of Medicine, Duke University Health System, and Duke Patient Safety Center, Durham, North Carolina (K.C.A., J.B.S.)
| | - John P A Ioannidis
- Stanford University School of Medicine, Stanford University School of Humanities and Sciences, and Meta-Research Innovation Center at Stanford (METRICS), Stanford, California (J.P.I.)
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Legenza L, Nickman NA, Drews FA, Rim M, Tigh J, Kelly MP, Tyler LS. Assessment of perceived workload in academic health center community pharmacies before and after implementation of a central call center. Am J Health Syst Pharm 2019; 76:1794-1805. [PMID: 31612926 DOI: 10.1093/ajhp/zxz200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Results of a study to determine whether reducing pharmacy phone call workload through implementation of a pharmacy services call center (PSCC) led to decreased employee workload, improved efficiency, and increased pharmacist availability for patient care are reported. METHODS A pre-post study was conducted using the NASA Task Load Index (NASA-TLX) instrument. Pharmacists, pharmacy technicians at 7 academic health center community pharmacies, and PSCC staff provided NASA-TLX data over 5 days during 3 data collection periods before and after PSCC implementation. Perceived workload was measured as an overall workload score (OWS) and mean scores for 6 NASA-TLX workload dimensions (mental demand, physical demand, temporal demand, performance, effort, and frustration). RESULTS Relative to pre-PSCC values, mean postimplementation OWS scores significantly decreased in all 7 pharmacies (from 33.3 to 29.1 overall, p < 0.001) but especially in small pharmacies (from 31.7 to 27.6, p < 0.001). Scores for the physical demand and frustration dimensions were low in both the PSCC and in the 7 pharmacies, while scores for the performance dimension remained high (range, 6.8-8.3). In general, scores for all other measured NASA-TLX dimensions decreased after PSCC implementation, more so at smaller pharmacies. The PSCC staff mean OWS score increased over time (from 26.8 to 28.6, p < 0.0001) but remained near the overall pharmacy average of 29.1. CONCLUSION Use of the NASA TLX allowed for a direct subjective measurement of workload as perceived by pharmacy and PSCC employees before and after PSCC implementation. Long-term effects of the PSCC on workload should be assessed.
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Affiliation(s)
| | - Nancy A Nickman
- University of Utah, Salt Lake City, UT, and Pharmacy Services, University of Utah Health, Salt Lake City, UT
| | | | - Matthew Rim
- Ambulatory Pharmacy Services, University of Utah Health, Murray, UT
| | - Jeremy Tigh
- University of Utah College of Pharmacy, Salt Lake City, UT
| | - Michael P Kelly
- Ambulatory Pharmacy Services, University of Utah Health, Salt Lake City, UT
| | - Linda S Tyler
- University of Utah Health, Salt Lake City, UT, and University of Utah College of Pharmacy, Salt Lake City, UT
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26
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Webster S, Kane C, Brown C, Warhurst H, Sedgley S, Slaughter W. Pediatric Pharmacy Services: Current Models and Justification for Expansion. J Pediatr Pharmacol Ther 2019; 24:438-444. [PMID: 31598108 DOI: 10.5863/1551-6776-24.5.438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Despite recommendations from numerous health care bodies, some hospitals that care for children have struggled to establish or expand pediatric pharmacy services. The current state of dedicated pediatric operational and clinical pharmacy services was characterized by results from a survey of hospitals that provide care to pediatric patients. The discussion of quality of care, safety, and financial impact is meant to provide concepts for justification of pediatric pharmacy service expansion.
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Garcia CDL, Abreu LCD, Ramos JLS, Castro CFDD, Smiderle FRN, Santos JAD, Bezerra IMP. Influence of Burnout on Patient Safety: Systematic Review and Meta-Analysis. ACTA ACUST UNITED AC 2019; 55:medicina55090553. [PMID: 31480365 PMCID: PMC6780563 DOI: 10.3390/medicina55090553] [Citation(s) in RCA: 153] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/16/2019] [Accepted: 08/23/2019] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Several factors can compromise patient safety, such as ineffective teamwork, failed organizational processes, and the physical and psychological overload of health professionals. Studies about associations between burn out and patient safety have shown different outcomes. Objective: To analyze the relationship between burnout and patient safety. Materials and Methods: A systematic review with a meta-analysis performed using PubMed and Web of Science databases during January 2018. Two searches were conducted with the following descriptors: (i) patient safety AND burnout professional safety AND organizational culture, and (ii) patient safety AND burnout professional safety AND safety management. Results: Twenty-one studies were analyzed, most of them demonstrating an association between the existence of burnout and the worsening of patient safety. High levels of burnout is more common among physicians and nurses, and it is associated with external factors such as: high workload, long journeys, and ineffective interpersonal relationships. Good patient safety practices are influenced by organized workflows that generate autonomy for health professionals. Through meta-analysis, we found a relationship between the development of burnout and patient safety actions with a probability of superiority of 66.4%. Conclusion: There is a relationship between high levels of burnout and worsening patient safety.
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Affiliation(s)
- Cíntia de Lima Garcia
- Laboratório de Delineamento de Estudos e Escrita Científica, Centro Universitário Saúde ABC (CUSABC) Convênio Acre/FMABC-007/2015, Santo André, São Paulo 09060-870, Brazil
- Departamento de Enfermagem, Faculdade de Juazeiro do Norte (FJN), Juazeiro do Norte, Ceará 63010-475, Brazil
- Departamento de Enfermagem. Faculdade de Medicina ESTACIO de Juazeiro do Norte (ESTACIO FMJ), Juazeiro do Norte, Ceará 63.048-080, Brazil
| | - Luiz Carlos de Abreu
- Laboratório de Delineamento de Estudos e Escrita Científica, Centro Universitário Saúde ABC (CUSABC) Convênio Acre/FMABC-007/2015, Santo André, São Paulo 09060-870, Brazil.
- Programa de Mestrado em Políticas Públicas e Desenvolvimento Local, Escola Superior de Ciências da Santa Casa de Misericórdia (EMESCAM), Vitória, Espírito Santo 29045-402, Brazil.
- Laboratório de Escrita Científica, Escola Superior de Ciências da Santa Casa de Misericórdia (EMESCAM), Vitória, Espírito Santo 29045-402, Brazil.
- Graduate Entry Medical School, University of Limerick, V94 T9PX Limerick, Ireland.
| | - José Lucas Souza Ramos
- Laboratório de Escrita Científica, Escola Superior de Ciências da Santa Casa de Misericórdia (EMESCAM), Vitória, Espírito Santo 29045-402, Brazil
| | - Caroline Feitosa Dibai de Castro
- Laboratório de Escrita Científica, Escola Superior de Ciências da Santa Casa de Misericórdia (EMESCAM), Vitória, Espírito Santo 29045-402, Brazil
| | - Fabiana Rosa Neves Smiderle
- Laboratório de Escrita Científica, Escola Superior de Ciências da Santa Casa de Misericórdia (EMESCAM), Vitória, Espírito Santo 29045-402, Brazil
| | - Jaçamar Aldenora Dos Santos
- Laboratório de Delineamento de Estudos e Escrita Científica, Centro Universitário Saúde ABC (CUSABC) Convênio Acre/FMABC-007/2015, Santo André, São Paulo 09060-870, Brazil
- Laboratório de Escrita Científica, Escola Superior de Ciências da Santa Casa de Misericórdia (EMESCAM), Vitória, Espírito Santo 29045-402, Brazil
- Departamento de Enfermagem. Universidade Federal do Acre (UFAC), Rio Branco, Acre 69.915-900, Brazil
| | - Italla Maria Pinheiro Bezerra
- Laboratório de Delineamento de Estudos e Escrita Científica, Centro Universitário Saúde ABC (CUSABC) Convênio Acre/FMABC-007/2015, Santo André, São Paulo 09060-870, Brazil
- Programa de Mestrado em Políticas Públicas e Desenvolvimento Local, Escola Superior de Ciências da Santa Casa de Misericórdia (EMESCAM), Vitória, Espírito Santo 29045-402, Brazil
- Laboratório de Escrita Científica, Escola Superior de Ciências da Santa Casa de Misericórdia (EMESCAM), Vitória, Espírito Santo 29045-402, Brazil
- Programa de Mestrado em Ciências da Saúde da Amazônia, Bolsista CAPES Brasil, Universidade Federal do Acre (UFAC), Rio Branco, Acre 69.915-900, Brazil
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Healthcare Workers: Occupational Health Promotion and Patient Safety. J Med Syst 2018; 42:159. [PMID: 30019171 DOI: 10.1007/s10916-018-1013-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 07/10/2018] [Indexed: 10/28/2022]
Abstract
The purpose of the present study was to explore the relation of work-related risk factors and well-being among healthcare workers and the impact on patient safety, using the Health and Work Survey (INSAT) and Mental Health Continuum - Short Form (MHC-SF). A sample of 361 Portuguese healthcare workers participated in this study. The results indicate some significant work-related risk factors: for emotional well-being, Impossible to express myself (β = -0.977), Not having recognition by superiors (β = -1.028) and Have to simulate good mood and/or empathy (β = -1.007); for social well-being, Exposed to the risk of sexual discrimination (β = -2.088), Career progress is almost impossible (β = -1.518), and Have to hide my emotions (β = -2.307); finally for psychological well-being Exposed to the risk of sexual discrimination (β = -2.153), Career progress is almost impossible (β = -1.377), and Have to simulate good mood and/or empathy (β = -3.201). The results showed high levels of well-being despite the exposure of several risk factors at workplace. Regarding the work-related risk factors, the study showed that most of the participants are exposed to several risk factors at workplace (ranging from environmental risk factors, biological to physical), although psychosocial risk factors (work relations with superiors and colleagues, employment relations, and emotional demands) are the ones that most impact on well-being.
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Healthcare Staff Wellbeing, Burnout, and Patient Safety: A Systematic Review. PLoS One 2016; 11:e0159015. [PMID: 27391946 PMCID: PMC4938539 DOI: 10.1371/journal.pone.0159015] [Citation(s) in RCA: 819] [Impact Index Per Article: 102.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 06/24/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To determine whether there is an association between healthcare professionals' wellbeing and burnout, with patient safety. DESIGN Systematic research review. DATA SOURCES PsychInfo (1806 to July 2015), Medline (1946 to July 2015), Embase (1947 to July 2015) and Scopus (1823 to July 2015) were searched, along with reference lists of eligible articles. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Quantitative, empirical studies that included i) either a measure of wellbeing or burnout, and ii) patient safety, in healthcare staff populations. RESULTS Forty-six studies were identified. Sixteen out of the 27 studies that measured wellbeing found a significant correlation between poor wellbeing and worse patient safety, with six additional studies finding an association with some but not all scales used, and one study finding a significant association but in the opposite direction to the majority of studies. Twenty-one out of the 30 studies that measured burnout found a significant association between burnout and patient safety, whilst a further four studies found an association between one or more (but not all) subscales of the burnout measures employed, and patient safety. CONCLUSIONS Poor wellbeing and moderate to high levels of burnout are associated, in the majority of studies reviewed, with poor patient safety outcomes such as medical errors, however the lack of prospective studies reduces the ability to determine causality. Further prospective studies, research in primary care, conducted within the UK, and a clearer definition of healthcare staff wellbeing are needed. IMPLICATIONS This review illustrates the need for healthcare organisations to consider improving employees' mental health as well as creating safer work environments when planning interventions to improve patient safety. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: CRD42015023340.
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Shah MH, Peikari HR. Electronic Prescribing Usability: Reduction of Mental Workload and Prescribing Errors Among Community Physicians. Telemed J E Health 2016; 22:36-44. [DOI: 10.1089/tmj.2014.0246] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mahmood Hussain Shah
- Lancashire Business School, University of Central Lancashire, Preston, United Kingdom
| | - Hamid Reza Peikari
- Department of Management, Ragheb Isfahani Higher Education Institute, Esfahan, Iran
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Memarian B, Mitropoulos P. Production practices affecting worker task demands in concrete operations: A case study. Work 2015; 53:535-50. [PMID: 26519017 DOI: 10.3233/wor-152179] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Construction work involves significant physical, mental, and temporal task demands. Excessive task demands can have negative consequences for safety, errors and production. OBJECTIVE This exploratory study investigates the magnitude and sources of task demands on a concrete operation, and examines the effect of the production practices on the workers' task demands. METHODS The NASA Task Load Index was used to measure the perceived task demands of two work crews. The operation involved the construction of a cast-in-place concrete building under high schedule pressures. Interviews with each crew member were used to identify the main sources of the perceived demands. Extensive field observations and interviews with the supervisors and crews identified the production practices. RESULTS The workers perceived different level of task demands depending on their role. The production practices influenced the task demands in two ways: (1) practices related to work organization, task design, resource management, and crew management mitigated the task demands; and (2) other practices related to work planning and crew management increased the crew's ability to cope with and adapt to high task demands. CONCLUSIONS The findings identify production practices that regulate the workers' task demands. The effect of task demands on performance is mitigated by the ability to cope with high demands.
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Affiliation(s)
- Babak Memarian
- Exposure Control Technologies Research, CPWR - The Center for Construction Research & Training, Silver Spring, MD, USA
| | - Panagiotis Mitropoulos
- Department of Civil, Construction and Environmental Engineering, San Diego State University, San Diego, CA, USA
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Johnson SJ, O'Connor EM, Jacobs S, Hassell K, Ashcroft DM. The relationships among work stress, strain and self-reported errors in UK community pharmacy. Res Social Adm Pharm 2014; 10:885-895. [PMID: 24485754 DOI: 10.1016/j.sapharm.2013.12.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 12/18/2013] [Accepted: 12/18/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Changes in the UK community pharmacy profession including new contractual frameworks, expansion of services, and increasing levels of workload have prompted concerns about rising levels of workplace stress and overload. This has implications for pharmacist health and well-being and the occurrence of errors that pose a risk to patient safety. Despite these concerns being voiced in the profession, few studies have explored work stress in the community pharmacy context. OBJECTIVES To investigate work-related stress among UK community pharmacists and to explore its relationships with pharmacists' psychological and physical well-being, and the occurrence of self-reported dispensing errors and detection of prescribing errors. METHOD A cross-sectional postal survey of a random sample of practicing community pharmacists (n = 903) used ASSET (A Shortened Stress Evaluation Tool) and questions relating to self-reported involvement in errors. Stress data were compared to general working population norms, and regressed on well-being and self-reported errors. RESULTS Analysis of the data revealed that pharmacists reported significantly higher levels of workplace stressors than the general working population, with concerns about work-life balance, the nature of the job, and work relationships being the most influential on health and well-being. Despite this, pharmacists were not found to report worse health than the general working population. Self-reported error involvement was linked to both high dispensing volume and being troubled by perceived overload (dispensing errors), and resources and communication (detection of prescribing errors). CONCLUSIONS This study contributes to the literature by benchmarking community pharmacists' health and well-being, and investigating sources of stress using a quantitative approach. A further important contribution to the literature is the identification of a quantitative link between high workload and self-reported dispensing errors.
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Affiliation(s)
- S J Johnson
- Organisational Psychology, Manchester Business School, Booth Street East, Manchester M15 6PB, UK.
| | - E M O'Connor
- Organisational Psychology, Manchester Business School, Booth Street East, Manchester M15 6PB, UK
| | - S Jacobs
- Manchester Pharmacy School, University of Manchester, UK
| | - K Hassell
- Social Pharmacy, Manchester Pharmacy School, University of Manchester, UK
| | - D M Ashcroft
- Pharmacoepidemiology, Manchester Pharmacy School, University of Manchester, UK
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Karsh BT, Waterson P, Holden RJ. Crossing levels in systems ergonomics: a framework to support 'mesoergonomic' inquiry. APPLIED ERGONOMICS 2014; 45:45-54. [PMID: 23706573 PMCID: PMC7732189 DOI: 10.1016/j.apergo.2013.04.021] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 04/22/2013] [Accepted: 04/24/2013] [Indexed: 05/02/2023]
Abstract
In this paper we elaborate and articulate the need for what has been termed 'mesoergonomics'. In particular, we argue that the concept has the potential to bridge the gap between, and integrate, established work within the domains of micro- and macroergonomics. Mesoergonomics is defined as an open systems approach to human factors and ergonomics (HFE) theory and research whereby the relationship between variables in at least two different system levels or echelons is studied, and where the dependent variables are human factors and ergonomic constructs. We present a framework which can be used to structure a set of questions for future work and prompt further empirical and conceptual inquiry. The framework consists of four steps: (1) establishing the purpose of the mesoergonomic investigation; (2) selecting human factors and ergonomics variables; (3) selecting a specific type of mesoergonomic investigation; and (4) establishing relationships between system levels. In addition, we describe two case studies which illustrate the workings of the framework and the value of adopting a mesoergonomic perspective within HFE. The paper concludes with a set of issues which could form part of a future agenda for research within systems ergonomics.
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Affiliation(s)
- Ben-Tzion Karsh
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Patrick Waterson
- Human Factors and Complex Systems Group, Loughborough Design School, Loughborough University, Loughborough, UK
| | - Richard J. Holden
- Departments of Medicine and Biomedical Informatics, Vanderbilt University, Nashville, TN, USA
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Karsh BT, Waterson P, Holden RJ. Crossing levels in systems ergonomics: a framework to support 'mesoergonomic' inquiry. APPLIED ERGONOMICS 2014. [PMID: 23706573 DOI: 10.1016/j.apergo.2013.1004.1021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
In this paper we elaborate and articulate the need for what has been termed 'mesoergonomics'. In particular, we argue that the concept has the potential to bridge the gap between, and integrate, established work within the domains of micro- and macroergonomics. Mesoergonomics is defined as an open systems approach to human factors and ergonomics (HFE) theory and research whereby the relationship between variables in at least two different system levels or echelons is studied, and where the dependent variables are human factors and ergonomic constructs. We present a framework which can be used to structure a set of questions for future work and prompt further empirical and conceptual inquiry. The framework consists of four steps: (1) establishing the purpose of the mesoergonomic investigation; (2) selecting human factors and ergonomics variables; (3) selecting a specific type of mesoergonomic investigation; and (4) establishing relationships between system levels. In addition, we describe two case studies which illustrate the workings of the framework and the value of adopting a mesoergonomic perspective within HFE. The paper concludes with a set of issues which could form part of a future agenda for research within systems ergonomics.
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Affiliation(s)
- Ben-Tzion Karsh
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
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Carayon P, Karsh BT, Gurses AP, Holden R, Hoonakker P, Hundt AS, Montague E, Rodriguez J, Wetterneck TB. Macroergonomics in Healthcare Quality and Patient Safety. REVIEW OF HUMAN FACTORS AND ERGONOMICS 2013; 8:4-54. [PMID: 24729777 PMCID: PMC3981462 DOI: 10.1177/1557234x13492976] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The US Institute of Medicine and healthcare experts have called for new approaches to manage healthcare quality problems. In this chapter, we focus on macroergonomics, a branch of human factors and ergonomics that is based on the systems approach and considers the organizational and sociotechnical context of work activities and processes. Selected macroergonomic approaches to healthcare quality and patient safety are described such as the SEIPS model of work system and patient safety and the model of healthcare professional performance. Focused reviews on job stress and burnout, workload, interruptions, patient-centered care, health IT and medical devices, violations, and care coordination provide examples of macroergonomics contributions to healthcare quality and patient safety. Healthcare systems and processes clearly need to be systematically redesigned; examples of macroergonomic approaches, principles and methods for healthcare system redesign are described. Further research linking macroergonomics and care processes/patient outcomes is needed. Other needs for macroergonomics research are highlighted, including understanding the link between worker outcomes (e.g., safety and well-being) and patient outcomes (e.g., patient safety), and macroergonomics of patient-centered care and care coordination.
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Affiliation(s)
- Pascale Carayon
- University of Wisconsin-Madison. Johns Hopkins University. Northwestern University. Clemson University. Vanderbilt University
| | - Ben-Tzion Karsh
- University of Wisconsin-Madison. Johns Hopkins University. Northwestern University. Clemson University. Vanderbilt University
| | - Ayse P Gurses
- University of Wisconsin-Madison. Johns Hopkins University. Northwestern University. Clemson University. Vanderbilt University
| | - Richard Holden
- University of Wisconsin-Madison. Johns Hopkins University. Northwestern University. Clemson University. Vanderbilt University
| | - Peter Hoonakker
- University of Wisconsin-Madison. Johns Hopkins University. Northwestern University. Clemson University. Vanderbilt University
| | - Ann Schoofs Hundt
- University of Wisconsin-Madison. Johns Hopkins University. Northwestern University. Clemson University. Vanderbilt University
| | - Enid Montague
- University of Wisconsin-Madison. Johns Hopkins University. Northwestern University. Clemson University. Vanderbilt University
| | - Joy Rodriguez
- University of Wisconsin-Madison. Johns Hopkins University. Northwestern University. Clemson University. Vanderbilt University
| | - Tosha B Wetterneck
- University of Wisconsin-Madison. Johns Hopkins University. Northwestern University. Clemson University. Vanderbilt University
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Chui MA, Look KA, Mott DA. The association of subjective workload dimensions on quality of care and pharmacist quality of work life. Res Social Adm Pharm 2013; 10:328-40. [PMID: 23791360 DOI: 10.1016/j.sapharm.2013.05.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 05/15/2013] [Accepted: 05/16/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Workload has been described both objectively (e.g., number of prescriptions dispensed per pharmacist) as well as subjectively (e.g., pharmacist's perception of busyness). These approaches might be missing important characteristics of pharmacist workload that have not been previously identified and measured. OBJECTIVES To measure the association of community pharmacists' workload perceptions at three levels (organization, job, and task) with job satisfaction, burnout, and perceived performance of two tasks in the medication dispensing process. METHODS A secondary data analysis was performed using cross-sectional survey data collected from Wisconsin (US) community pharmacists. Organization-related workload was measured as staffing adequacy; job-related workload was measured as general and specific job demands; task-related workload was measured as internal and external mental demands. Pharmacists' perceived task performance was assessed for patient profile review and patient consultation. The survey was administered to a random sample of 500 pharmacists who were asked to opt in if they were a community pharmacist. Descriptive statistics and correlations of study variables were determined. Two structural equation models were estimated to examine relationships between the study variables and perceived task performance. RESULTS From the 224 eligible community pharmacists that agreed to participate, 165 (73.7%) usable surveys were completed and returned. Job satisfaction and job-related monitoring demands had direct positive associations with both dispensing tasks. External task demands were negatively related to perceived patient consultation performance. Indirect effects on both tasks were primarily mediated through job satisfaction, which was positively related to staffing adequacy and cognitive job demands and negatively related to volume job demands. External task demands had an additional indirect effect on perceived patient consultation performance, as it was associated with lower levels of job satisfaction and higher levels of burnout. IMPLICATIONS/CONCLUSIONS Allowing community pharmacists to concentrate on tasks and limiting interruptions while performing these tasks are important factors in improving quality of patient care and pharmacist work life. The results have implications for strategies to improve patient safety and pharmacist performance.
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Affiliation(s)
- Michelle A Chui
- Social & Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison, 777 Highland Avenue, 2513 Rennbohm Hall, Madison, WI 53705, USA.
| | - Kevin A Look
- Social & Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison, 777 Highland Avenue, 2513 Rennbohm Hall, Madison, WI 53705, USA
| | - David A Mott
- Social & Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison, 777 Highland Avenue, 2513 Rennbohm Hall, Madison, WI 53705, USA
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Cimiotti JP, Aiken LH, Sloane DM, Wu ES. Nurse staffing, burnout, and health care-associated infection. Am J Infect Control 2012; 40:486-90. [PMID: 22854376 DOI: 10.1016/j.ajic.2012.02.029] [Citation(s) in RCA: 441] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 02/13/2012] [Accepted: 02/13/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Each year, nearly 7 million hospitalized patients acquire infections while being treated for other conditions. Nurse staffing has been implicated in the spread of infection within hospitals, yet little evidence is available to explain this association. METHODS We linked nurse survey data to the Pennsylvania Health Care Cost Containment Council report on hospital infections and the American Hospital Association Annual Survey. We examined urinary tract and surgical site infection, the most prevalent infections reported and those likely to be acquired on any unit within a hospital. Linear regression was used to estimate the effect of nurse and hospital characteristics on health care-associated infections. RESULTS There was a significant association between patient-to-nurse ratio and urinary tract infection (0.86; P = .02) and surgical site infection (0.93; P = .04). In a multivariate model controlling for patient severity and nurse and hospital characteristics, only nurse burnout remained significantly associated with urinary tract infection (0.82; P = .03) and surgical site infection (1.56; P < .01) infection. Hospitals in which burnout was reduced by 30% had a total of 6,239 fewer infections, for an annual cost saving of up to $68 million. CONCLUSIONS We provide a plausible explanation for the association between nurse staffing and health care-associated infections. Reducing burnout in registered nurses is a promising strategy to help control infections in acute care facilities.
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Holden RJ, Brown RL, Scanlon MC, Karsh BT. Pharmacy workers' perceptions and acceptance of bar-coded medication technology in a pediatric hospital. Res Social Adm Pharm 2012; 8:509-22. [PMID: 22417887 DOI: 10.1016/j.sapharm.2012.01.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 01/12/2012] [Accepted: 01/13/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The safety benefits of bar-coded medication-dispensing and administration (BCMA) technology depend on its intended users favorably perceiving, accepting, and ultimately using the technology. OBJECTIVES (1) To describe pharmacy workers' perceptions and acceptance of a recently implemented BCMA system and (2) to model the relationship between perceptions and acceptance of BCMA. METHODS Pharmacists and pharmacy technicians at a Midwest U.S. pediatric hospital were surveyed following the hospital's implementation of a BCMA system. Twenty-nine pharmacists' and 10 technicians' self-reported perceptions and acceptance of the BCMA system were analyzed, supplemented by qualitative observational and free-response survey data. Perception-acceptance associations were analyzed using structural models. RESULTS The BCMA system's perceived ease of use was rated low by pharmacists and moderate by pharmacy technicians. Both pharmacists and technicians perceived that the BCMA system was not useful for improving either personal job performance or patient care. Pharmacy workers perceived that individuals important to them encouraged BMCA use. Pharmacy workers generally intended to use BCMA but reported low satisfaction with the system. Perceptions explained 72% of the variance in intention to use BCMA and 79% of variance in satisfaction with BCMA. CONCLUSIONS To promote their acceptance and use, BCMA and other technologies must be better designed and integrated into the clinical work system. Key steps to achieving better design and integration include measuring clinicians' acceptance and elucidating perceptions and other factors that shape acceptance.
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Affiliation(s)
- Richard J Holden
- Department of Medicine, Vanderbilt University, Nashville, TN, USA.
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Chui MA, Mott DA. Community pharmacists' subjective workload and perceived task performance: a human factors approach. J Am Pharm Assoc (2003) 2012; 52:e153-60. [PMID: 23229977 PMCID: PMC3624990 DOI: 10.1331/japha.2012.11135] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To measure the association of three categories of community pharmacists' subjective workload with perceived performance in pharmacists' tasks. DESIGN Cross-sectional descriptive study. SETTING Wisconsin, September 2009. PARTICIPANTS 224 Wisconsin community pharmacists. INTERVENTION Web-based or mailed survey. MAIN OUTCOME MEASURES Self-reported workload in task-, job-, and organization-related categories and their association with perceived performance on completing a profile review, checking the accuracy of a prescription, and providing a patient consultation for a new medication. RESULTS Multivariate regression analysis showed that performing a profile review was positively associated with monitoring demands (reacting quickly to prevent problems) and significantly negatively associated with external task demands (interruptions, rushing). The task of verifying prescription accuracy was positively associated with monitoring demands and negatively associated with volume demands (having enough time to get work done). Patient consultation performance was positively associated with cognitive (using skills and knowledge) and monitoring demands and negatively associated with external demands. CONCLUSION These findings revealed the importance of measuring workload demands after separating the demands into categories and that different work demands are associated with performance of different tasks. As a result, no one solution will improve performance, and specific work environments must be considered when crafting solutions.
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Affiliation(s)
- Michelle A Chui
- School of Pharmacy, University of Wisconsin–Madison, 53705, USA.
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Abstract
Conventional wisdom suggests that the "human factor" in critical care environments is reason for inadequate medication and patient safety. "Human factors" (or human factors engineering) is also a scientific discipline and practice of improving human performance. Using decades of human factors research, this paper evaluates a range of common beliefs about patient safety through a human factors lens. This evaluation demonstrates that human factors provides a framework for understanding safety failures in critical care settings, offers insights into how to improve medication and patient safety, and reminds us that the "human factor" in critical care units is what allows these time-pressured, information-intense, mentally challenging, interruption-laden, and life-or-death environments to function so safely so much of the time.
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Affiliation(s)
- Matthew C Scanlon
- Department of Pediatrics, Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA.
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