Pharmacy Burnout: A Review of the Literature

1
Pharmacy Burnout A Review of the Literature

• John Pedey-Braswell
• PHARM 535 Winter 2004

2
Challenges to the Profession

• Paradigm Shift towards Payment for Cognitive
  Services Rather than Product Dispensing
• Stagnant or Shrinking Payments from State
  Medicaid Plan and Third Party Insurance Payors
• Senate Bill 6088 Therapeutic Interchange Program
  with Preferred Drug List
• Increasing Complexity of Third Party Formulary
  Systems Coupled with Pharmacy Audits
• CPOE, Dispensing Automation
• Research Questions Toll on Patients, Employees,
  SAFETY

3
What Will Be the Impact on Health Care Providers?
4
Characteristics of a Burnout-Prone Workplace

• Constant Demands for Perfection
• Workers Discouraged from Expressing Grievances
• Employees Expected to Give Extra Effort without
  Extra Rewards
• No Reinforcement for Suggestions about Improving
  Morale
• Staff Encouraged to Interact Only with Peers
• Repetitive Work Activities that Do Not Change
  Much Over Time
• Minimal Additional Help Provided for Tasks that
  Require Extra Effort
• Emotional Feelings of Employees Downplayed
• Preachy Leadership Styles

5
Characteristics of a Burnout-Prone Workplace

• Frequent Changes in Policy without Time to
  Evaluate Them
• Rigid Role Definitions for Employees
• Playfulness Considered Unprofessional and
  Inappropriate
• People Discriminated Against Based on Age, Sex,
  Race (Job Title?)
• Very Little Emphasis on Positive Feedback
• Very Little Concern About Comfort of the Work
  Environment
• Policy and Enforcement of Policies Constantly
  Shifting
• Attitudes of Supervisors Makes Employees Feel
  Ineffective or Underappreciated
• Employee Morale is Low and People Feel that They
  Accomplish Very Little
• Source Anthony F. Grasha, Ph.D,
  University of Cincinnati

6
Literature Search Methodology

• PubMed, International Pharmaceutical Abstracts,
  CINAHL, Health and Psychosocial Instruments
• No Restrictions on Language, Publication Date
• Desired Tested Validity in Pharmacy Employee
  Population
• MESH Search Terms Pharmacpermutations - Job
  Satisfaction, Psychological Stress, Occupational
  Stress, Stress, Burnout
• Very Little Literature

7
Findings

• Many Instruments Developed and Used Only Once
  No Reliability and Validity Data
• Two Instruments with Reliability and Validity
  Data PLUS Moderate Use Maslach Burnout Inventory
  (MBI), Health Professions Stress Inventory (HPSI)
• No Data Since Early-Mid 90s, Field of Pharmacy
  has Changed Markedly Since Then
• Work Done by Alan Wolfgang (HPSI) at Georgia,
  Holly Mason and Graduate Students (MBI) at Purdue

8
Maslach Burnout Inventory

• Developed by Christina Maslach (Berkeley) and
  Susan E. Jackson (NYU)
• First edition 1981, based on research done in
  late 70s. Third edition 1996.
• 22 items divided into 3 subscales
• Emotional Exhaustion 9 items
• Depersonalization 5 items
• Personal Accomplishment 8 items
• Self-Administered 10-15 minutes to fill out
• Factor Structures and Norms for USA Pharmacists
  1989, Mason and Lahoz.
• 1258 APhA Members Mostly Middle-Aged White
  Males
• 1994 Gupchup. Structures and Norms in HMO
  Pharmacist 101 RPhs from 38 states
• Validity?

9
Health Professions Stress Inventory

• Developed 1987 by Alan P. Wolfgang, Pharmacy
  Professor at University of Georgia
• Purpose Create an Instrument that Could be Used
  to Compare the Levels and Sources of Stress
  Experienced by a Variety of Health Professionals
• Based on Data from 291Physicians, 379 Nurses, and
  387 Pharmacists
• 30 Potentially Stressful Job Situations Scored
  0 (never) - 4 (very often) Likert Scale. Max
  Score 120

10
Future Research

• Neither instrument is perfect for assessing
  small changes in the workplace. Need to find
  additional test of job satisfaction, or add
  questions to survey.
• Absenteeism? Employee Retention?
• Determine if MBI needs to be re-validated.
• Funding to administer test
• Population to test HMC, UWAMC, control
  populations
• RPhs Notoriously Poor Responders to Surveys How
  to Minimize Respondent Burden?
• Impact of changes on other HCPs