Introduction

Nearly a half-century of research has described the issues and concerns associated with job stress, moral distress, work overload, burnout, and level of control within the pharmacy profession. After decades of discussion and engagement in diverse strategies by pharmacy stakeholders combined with rapid changes in the practice models of pharmacy and an ever-changing, evolving health care system, it is clear that the pharmacist workforce is currently at a critical juncture. The well-being and resilience of the pharmacist workforce must be effectively and efficiently addressed by all pharmacy stakeholders.

To address this important issue, a collaboration was formed between the American Association of Colleges of Pharmacy (AACP), the Accreditation Council for Pharmacist Education (ACPE), the American Pharmacists Association (APhA), the National Association of Boards of Pharmacy (NABP), and the National Alliance of State Pharmacy Associations (NASPA) and the Enhancing Well-Being and Resilience Among the Pharmacist Workforce: A National Consensus Conference was planned and conducted.

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The objectives of the consensus conference were to:

• Evaluate factors that contribute to well-being and resilience at the individual, organizational, and profession levels.
• Develop strategies that could improve pharmacist well-being and resilience and decrease moral distress within individuals, managers, organizations, and the profession.
• Identify and prioritize strategies that will drive change and fuel improvements in well-being and resilience.
• Develop actionable recommendations that guide organizations and individuals in implementing positive change.

Diverse stakeholders within the profession—representing pharmacists and employers from across practice settings, schools and colleges of pharmacy, and professional organizations—came together in Chicago from July 17–19, 2019, and engaged in a thoughtful and intentional process to discuss issues and concerns associated with well-being, moral distress, work overload, and burnout. The goal of the conference was the development and approval of meaningful and actionable recommendations that can be effectively implemented broadly to address this important issue.

Consensus Recommendations

A total of 50 recommendations were developed and approved by consensus to provide immediate, viable, and sustainable solutions to create improvements in critical areas related to well-being and resilience for pharmacy professionals at the societal level, at the organizational level, and the individual level. The intent of these recommendations is broad, with opportunities for action by any individual or organization within the pharmacy profession to effect change within their spheres of influence.

The accepted consensus recommendations reflect opportunities to support meaningful and actionable change by addressing improvement of:

• Pharmacist work conditions and patient safety
• Payment models
• Relations between pharmacists and employers
• Pharmacist and student pharmacist well-being
• Well-being education and training
• Communications
• Data, information, and research on pharmacist well-being

It is anticipated that accepted recommendations will be broadly implemented across the profession to effect meaningful change. It is anticipated that additional insights and action plans will be developed by organizations, individuals, and other stakeholders to contribute to improving the well-being and resilience of the pharmacist workforce.

Recommendations Related to the Improvement of Pharmacist Work Conditions and Patient Safety

• Employers must prioritize patient safety, quality of care, and pharmacist well-being when setting workload expectations and ensure the pharmacy workforce is adequately staffed, trained, and utilized to complete the expected work volume.
• Employers, payers, accreditors, and regulators should assess the relevance, frequency, and need for required administrative tasks in order to reduce burdens that detract from quality patient care and compromise pharmacists’ well-being.
• Employers should promote professional autonomy, seek pharmacy team input, and encourage open communication to effectively establish and meet patient care and business objectives (e.g., quotas/metrics/goals) and achieve shared success.
• Employers should provide pharmacists with mandatory, scheduled, uninterrupted meal breaks away from the pharmacy workflow to promote pharmacist well-being and improve patient safety.
• Employers and boards of pharmacy should adopt a Just Culture approach to management of medication errors that focuses on system improvement within a learning culture.
• Employers should implement workflow and technology solutions that facilitate effective and efficient provision of patient-centered care, decrease pharmacist burden, and alleviate moral distress.
• Employers should support staffing and scheduling models that allow pharmacists flexibility to establish and maintain relationships with their pharmacy team, their patients, and their local communities.
• The National Association of Boards of Pharmacy should work with its membership and stakeholders to craft model language related to meal breaks and other working conditions that prioritize the delivery of safe and effective patient care.
• State boards of pharmacy should evaluate legislative and regulatory requirements to streamline and remove unnecessary burden on pharmacists and their ability to safely provide patient care.
• Professional associations should work with boards of pharmacy to disseminate information about state statutes and rules related to well-being, working conditions, and burnout.
• Employers and pharmacist managers should advocate for expanded roles for pharmacy technicians and support technician career advancement to enhance the pharmacist’s ability to provide patient care.

Recommendations Related to the Improvement of Payment Models

• The pharmacy profession should actively engage and partner with other health professional organizations, patient advocacy groups, regulators, and pharmacy benefit managers/payers that represent top market share to (1) drive transparency and expose PBM/health plan payment models that create patient safety issues, and (2) eliminate the erosion in reimbursement that compromises sustainability of and investment disincentivizes organizations from investing in pharmacist-provided patient care services.
• Professional associations should collaborate with other stakeholders to advocate for legislative changes in payment models focused on fair compensation for pharmacist professional services by medical and pharmacy payers independent of medication products, devices, or supplies.

Recommendations Related to the Improvement of Relations Between Pharmacists and Employers

• Employers and pharmacist managers should create a culture that facilitates open communication and trust, which empowers the pharmacy workforce to identify and actively participate in creating solutions to address burnout.
• Pharmacists should establish and communicate mutually agreeable boundaries with managers, supervisors, patients, and other health professionals without fear of retribution.
• Employers and pharmacist managers should conduct root cause analyses to understand pharmacist burnout and moral distress within their workforce, create viable solutions to address identified issues, and routinely conduct follow-up assessments.
• Employers should hold forums to hear the concerns of frontline pharmacists, implement solutions, and communicate actions made toward addressing the identified issues.
• Pharmacists should actively engage in productive dialogue with employers—without fear of retribution—to improve awareness of issues that negatively affect well-being and resilience and identify and implement solutions.
• Employers should train and sensitize non-pharmacist managers and supervisors about the professional requirements and expectations of pharmacists as health care providers, including strategies to support a positive and safe work environment.
• Employers, pharmacist managers, and practicing pharmacists should work to ensure job fit by being mutually transparent and authentic about requirements, expectations, responsibilities, and anticipated challenges for specific pharmacy positions.

Recommendations Related to the Improvement of Pharmacist and Student Pharmacist Well-being

• Pharmacists should assume their professional responsibility to proactively identify personal stressors, learn self-care techniques, and consistently apply strategies that address well-being and help prevent burnout.
• Employers and schools and colleges of pharmacy should establish trauma and second victim support programs and resources, including access to respite time to help pharmacists and student pharmacists recover and cope with situations (e.g., armed robberies, suicides, natural disasters, tragic medication errors, and terroristic threats) that affect their safety, well-being, and professional confidence.
• Pharmacist managers should prioritize and model well-being and resilience for their workforce.
• State boards of pharmacy should consider the relationship between pharmacist well-being and patient safety when promulgating rules and regulations that govern the practice of pharmacy.
• Employers and pharmacist managers should allow flexibility for pharmacists to engage in a variety of professional opportunities and practice responsibilities to reduce redundancy that leads to burnout.
• Employers should reward and incentivize employees to engage in well-being activities.
• Pharmacist managers should engage in ongoing leadership training that includes communications, team building, staff development, advocacy, pharmacist burnout, moral distress, and workism and implement these skills to effectively lead their workforce.
• Employers and schools and colleges of pharmacy should establish strategic plan priorities that facilitate the development of a culture of well-being and resilience.
• The Accreditation Council for Pharmacy Education should require the inclusion of annual well-being assessments for students, faculty, and staff to facilitate regular dialogue, destigmatize behavioral health, and guide organizational initiatives within schools and colleges of pharmacy.
• The Accreditation Council for Pharmacy Education should integrate concepts related to well-being and resilience into accreditation standards and guidance.
• The American Society of Health-System Pharmacists should revise residency accreditation standards to include well-being of residents and preceptors as a critical factor.
• Professional associations should adopt and prioritize the findings from the Enhancing Well-being and Resilience Among the Pharmacist Workforce: A National Consensus Conference.

Recommendations Related to the Improvement of Well-being Education and Training

• Employers, pharmacy associations, and schools and colleges of pharmacy should provide education and training on how to effectively manage angry and abusive individuals and address situations in which personal safety may be compromised.
• Employers, pharmacist managers, and pharmacists should apply a change-management approach to prepare and support the pharmacy workforce in responding and adapting to changes in pharmacy practice.
• Schools and colleges of pharmacy should incorporate ongoing education, self-evaluation, and reflection for student pharmacists, faculty, staff, preceptors, and graduate students on topics of well-being, resilience and behavioral health.
• All faculty, staff, student pharmacists, and preceptors should complete formal training that addresses behavioral health awareness (e.g., Mental Health First Aid and Question. Persuade. and Refer.).
• The pharmacy profession should leverage existing programs (e.g., the APhA Institute on Substance Use Disorders and state pharmacy recovery networks) in order to address the consequences of burnout.
• Professional associations should develop and deliver training, tools, and resources that teach strategies and skills related to personal well-being and professional resilience, and address behavioral health issues.
• Professional associations and schools of pharmacy should develop and deliver training that teaches strategies and skill sets to effectively manage personal financial issues that affect well-being.

Recommendations Related to the Improvement of Communications

• Professional associations should support the Pharmacists for Healthier Lives outreach campaign to enhance public perceptions of the pharmacist’s role in improving health outcomes.
• Accreditors should utilize standard assessment processes and solicit user feedback to continuously improve the clarity and value of guidance documents.
• Professional associations should develop a unified communications approach that is accessible to all pharmacists and consolidates relevant information to reduce professional isolation and communication overload.
• Conference proceedings and recommendations should be widely disseminated by pharmacy organizations, including using the subscriber data from CPE Monitor® to reach all relevant stakeholders.

Recommendations Related to the Improvement of Data, Information, and Research on Pharmacist Well-being

• Professional associations and schools and colleges of pharmacy should conduct research to establish national standards related to pharmacy metrics that promote patient safety and pharmacist well-being.
• Professional associations and state boards of pharmacy should support dissemination of profession-wide surveys that assess well-being and patient safety and advocate for pharmacists to complete them.
• The American Association of Colleges of Pharmacy should collect and disseminate well-being and resilience best practice tools and approaches being used in schools and colleges of pharmacy.
• Professional associations should advocate for research of pharmacist work environments to evaluate aspects that lead to burnout and identify best practices, and pursue funding sources to support these efforts.

Recommendations Related to the Improvement of Pharmacist Professional Development

• Employers should partner with professional associations and schools and colleges of pharmacy to provide and encourage access to mentors, role models, career options, and relatable stories to help pharmacists and student pharmacists improve their competence and confidence throughout their careers.
• Employers and schools and colleges of pharmacy should provide training and resources to support pharmacists and student pharmacists in all settings and roles to enhance business and people-management skills.
• Employers should support networking and engagement opportunities that promote professional collegiality between pharmacists and other health care team members.

Disclaimer: The sponsoring organizations (APhA, AACP, ACPE, NABP, and NASPA) recognize that pharmacists well-being is a critical factor and supported the Consensus Conference's approach to identify the central issues that are found across the landscape of pharmacists, pharmacy practice, pharmacy regulation, and patient care. The sponsoring organizations commit to review each of the recommendations and, where possible and appropriate for their individual organizations, work to implement the recommendations as well as work with the other sponsoring organizations and all interested stakeholders to collectively address and provide solutions to this timely and concerning issue for the profession.