University of Connecticut



Workplace Woes in PharmacyA four-part web-based presentation on problems in the pharmacyLEARNING OBJECTIVESAt the end of this continuing pharmacy education activity, the pharmacist and pharmacy technician should be able to:LIST ways to deal with difficult managers who micromanage, are hostile, or lack supervisory skillsDETERMINE approaches to deal with coworkers whose skills, competencies, and teamwork abilities need improvementLIST several ways to improve one’s own skill set and career planRECALL strategies to deal with poor healthcare literacy; “non-customers”; angry or abusive patients; and patients whose expectations have been disappointed 1. You work in a pharmacy where employees consistently complain that not everyone receives all necessary information in a timely manner. Which of the following is the best approach to increase the likelihood that your supervisor will disseminate information faster and more uniformly?A. Contact the Workplace Bullying InstituteB. Ask for rapid re-contracting and restructuring C. Use the “managing up” and PAST/CANDID techniques*D. Analyze your supervisor’s strengths and limitationsANSWER: CRATIONALE: Micromanaging is not technically workplace bullying. Some supervisor simply are insecure or under tremendous pressure. Rapid re-contracting and restructuring are actions employees can expect when a peer is promoted from among his coworkers. Using the “managing up and PAST/CANDID techniques is the best approach, as it allows you to understand why your supervisor is micromanaging. It also provides techniques to increase communication. Analyzing your supervisor strengths and limitations, while wise, falls short of solving the problem.2. You arrive at work a few minutes late due to a traffic jam on one of the main arteries into your city. In the last year, you have never been late. Your boss says sarcastically, “Nice of you to grace us with your presence. Get to work!” Later in the day, as you leave for lunch, your boss says, “Make every effort to get back on time, okay? Don’t repeat that routine from this morning!” You’ve often seen her treat other employees like this, and she tends to harp on any small mistake. Which of the following is the BEST way to approach this situation?A. Ignore it; supervisors who behave like this generally stop these behaviors if they get no response.B. Document this instance of poor behavior and every subsequent instance and elevate your concern to your supervisor’s supervisor or human resources.*C. Treat your supervisor exactly the way she treats you; generally, individuals who behave this way do not like to be treated similarly and will modify their behavior.D. Understand that this individual thinks she is funny. Laugh it off.ANSWER: BRATIONALE: Individuals who behave in this manner whether they are supervisors or not generally do not stop these behaviors if you ignore it. Sometimes it actually escalates the problem. It is also unwise to treat someone in this way or to just simply brush it off as funny. Instead, begin documenting episodes of treatment like this and take it to your human resources department or the supervisor’s supervisor.3. Which of the following would be the most effective way to increase workplace effectiveness for a supervisor who has been promoted from among his or her peers, and falls into the Neglectful/Cheerleader quadrant of Angela Duckworth’s Leaders Grid?A. Contact the hiring official and let him know that he has made a poor choice by selecting this individual.B. Try to overcome the urge to take any action; with time this person will develop the leadership skills necessary to supervise.C. Purchase Angela Duckworth’s book, attach an anonymous note to it telling the supervisor he needs more skill, and leave it in his mailbox.D. Approach the individual in a nonconfrontational way, and discuss the impact of the supervisor’s skill deficits. Work together to make improvements.*ANSWER: DRATIONALE: Contacting the hiring official will not necessarily make a change in the supervisor’s behavior and may introduce mistrust in the workplace. And, people do not necessarily develop leadership skills simply by occupying a position for a period of time. Anonymous comments are unlikely to help. The best way to address this is to approach the individual alone or with your coworkers in a nonconfrontational way, discuss the impact of his or her skill deficits and work together to make improvements.4. Which of the following is NOT an appropriate ground rule when a peer is promoted to a supervisory position in your department?A. Establish new, clear boundaries for everyone in the workplaceB. Agree that after-hours gripe sessions are now off-limitsC. Set expectations and SMART goals for everyone quicklyD. Continue to socialize extensively with the newly promoted supervisor*ANSWER: DRATIONALE: When a peer is promoted, it’s important that everyone understands new, clearer boundaries. After-hours chatting and gossiping should be off limits, and it’s important for the supervisor to set expectations that are specific, measurable, achievable, realistic, and time tagged for everyone. The supervisor will by necessity need to develop a new and different social circle, and socialize with subordinates only periodically. You all can still remain friends, but it needs to be a more measured and circumspect kind of friendship.5. Please select the statement that is TRUE:A. Metrics are part of a performance system used by pharmacies to measure pharmacy and staff performance (e.g. # of prescriptions/day, # of prescriptions/hour, number of vaccines administered).*B. The Institute for Safe Medication Practices conducted a study and found that most pharmacists believe that performance metrics eliminate the likelihood of dispensing errors.C. The Institute for Safe Medication Practices indicates that reward for perfect performance results in an underreporting of errors, practice barriers, and risks.D. If patients are rewarded when time guarantees are not met, it sets the tone for a collaborative relationship between the pharmacy staff and the patient.ANSWER: ARATIONALE: Metrics are a part of the performance system used by pharmacies to measure pharmacy and staff performance. The Institute for Safe Medication practices indicates that most pharmacists believe that performance metrics contribute to dispensing errors. It also indicates that punishment for imperfect performance results in an underreporting of errors, practice barriers, and risks. When pharmacies reward patients if they exceed time expectations, it sets the tone for an adversarial relationship between the pharmacy staff and the patient.6. You work in a very fast-paced pharmacy. Often, you have to multitask. Because you have seniority in your department, other employees often—as often as every eight minutes—come to you for advice or solutions to difficult problems and interrupt what you are doing. Choose the approach that is most likely to be helpful:A. Practice deep breathing and simply answer each question or problem in order as your coworkers present them.B. Focus on multitasking skills; with practice, you’ll be able to respond to emails and text, answer questions, and attend meetings all at the same time.C. Learn to sort activities into four quadrants based on their importance and urgency, and deal with the most important and urgent first.*D. Learn to sort activities into four quadrants based on the requester and the nature of the problem, dealing with dispensing or medication issues first.ANSWER: CRATIONALE: Individuals who are official or unofficial leaders often are inundated with problems and questions. Deep breathing and multitasking are not solutions. Sorting activities into four quadrants based on their importance and urgency can help identify the issues of most importance. Other activities can be scheduled at a different time.7. Pharmacists and pharmacy technicians who wish to advance in their career can often do so by networking across departments, building expertise in new areas, and cultivating charisma. Developing skills in areas where pharmacies lack expertise can help employees advance. Which of the following are areas where pharmacies often lack expertise?A. Drug information, patient counseling, and medication therapy managementB. Scheduling, cash register operation, and processing insurance claimsC. Prescription data entry, follow-up with clinicians, and stocking shelvesD. Customer relations, inventory management, and record management*ANSWER: DRATIONALE: All of the items listed in the first three selections (drug information, patient counseling, medication therapy management, scheduling, cash register operation, processing insurance claims, prescription data entry, follow-up with clinicians, and stocking shelves) are fairly normal activities in the pharmacy. Many pharmacies find that their staff lacks expertise in customer relations, inventory management, and record management.8. Your pharmacy’s records have numerous deficits. Errors and ambiguities are common, and many of your staff document sloppily. This reflects poor teamwork. Select the BEST way to increase urgency so that employees document better.A. Explain that patients and healthcare providers have access to records, and records that are full of errors decrease trust, and increase the likelihood that patients will go elsewhere for care.*B. Suggest that staff prepare their documentation in pencil so that they can erase and make corrections in the likelihood of an error.C. Take a heavy-handed approach indicating that people need to make corrections immediately or else they will be fired.D. Have one individual in the department create a corrective action plan and then distribute it to employees to follow.ANSWER: ARATIONALE: Ensuring that all stakeholders understand the problem and the need to fix it is the best way to increase urgency, so in this case explaining the consequences of poor documentation is the correct answer. Staff should never prepare records in pencil. Heavy-handed approaches are unlikely to work and having the staff agree upon a corrective action plan that says WHO will DO WHAT and BY WHEN works better than having an individual create the plan.9. Your pharmacy is part of a pilot program with a drug company. Each time a patient appears to refill of one of their seven new drug-device combinations, you are supposed to dispense a specific patient handout. Additionally, one of your staff is supposed to demonstrate how to use the drug-device combination. One problem with this program is that the drug company doesn’t send the demonstration device in advance. You have to ask for the devices. Choose the statement that will be LEAST LIKELY to result in improvement.A. Create a project sheet; identify WHO will contact the company to ask for demo devices and WHEN.B. Consider using students to accomplish this task and schedule periodic proactive updates.C. Augment your resources with videos that you pull from the Internet or create yourself.D. Order one demonstration device at a time, calling for a new one if the old one breaks.*ANSWER: DRATIONALE: Creating a project sheet that is specific in its detail, using students, and augmenting your resources with videos are all good solutions. Ordering one demonstration device at a time is problematic because if the device breaks, you’ll have no demonstration device at all while you wait for new one to arrive.10. You work in a community pharmacy and you worry because many of your patients are not receiving guideline-directed care.?You have no access to the electronic medical record, and you do not know the prescribers in this area very well. Often when you call, your call goes directly to voicemail at the prescriber’s office. What is one way that you could improve the likelihood that your patients will receive guideline-directed care?A. Develop a store-specific card that you give to patients so they can give it to their prescribers. On it, it should just say, “Call me about this patient’s medication,” and include your phone number. B. Conduct some direct to consumer advertising when patients pick up their prescriptions; educate the patient to discuss necessary care with the appropriate physician.*C. Ensure that patients have written patient information sheets about every drug in their medication regimen.D. Don’t worry about this problem: it takes approximately seven years for clinicians to accept guideline recommendations.ANSWER: BRATIONALE: If you develop a store specific card, it would be best for it to include guideline recommended therapies and identify the one the patient is lacking. That will help patients communicate with their doctors.??Many patients don’t read the written patient information sheets, and the information sheets only provide drug specific information, not guideline recommendations. While it does take a while for clinicians to accept guideline recommendations, pharmacists and pharmacy technicians can help speed up the process when they engage patients in active discussion about specific elements of care.11. Please choose the statement that is TRUE:A. Things that one employee find stressful generally are stressful to all of the other employees in the pharmacy.B. Stress management strategies are formulated so that once you complete the strategy, you no longer find a trigger stressful.C. Many employees think that high workload is the primary stressor in the pharmacy; periods of low workload are, too.*D. When the workload is extremely high in the pharmacy, employee should plan on working through lunch to reduced workload and thus, stress.ANSWER: CRATIONALE: Things that one employee find stressful don’t necessarily bother other employees. Stress management strategies are formulated so that the individual can use them on an ongoing basis. Although high workload can be a stressor, other triggers can also create stress and those triggers include low workload, uncontrollable ambient temperature, noise and a host of other conditions. When the workload is high in the pharmacy, working through lunch will not reduce stress. Employee should plan on taking breaks to de-stress.12. Erin is a 33-year-old pharmacy technician who is currently going through divorce. She tends to be inattentive at times, and frequently breaks down in tears at work when she talks about her situation. Which of the following is the best way to deal with Erin in the workplace?A. Ignore her inattentiveness and crying. This will pass once she gets used to the idea of divorce.B. Assure Erin that divorce rates are falling and reconciliation is likely. Tell her to stop crying.C. Divorce is the singularly most traumatic event that can happen in a person’s life. Be understanding.D. Support Erin with empathetic mechanisms, and use them with others in the similar situations later.*ANSWER: DRATIONALE: Ignoring inattentiveness and crying is not helpful to Erin. No one can tell whether a divorce will proceed or a couple will reconcile and telling someone to stop crying is totally ineffective. Several traumatic events can occur in life that cause tremendous upheaval in a person’s life. The most traumatic tends to be death of a child, but divorce comes in second. Finding empathetic mechanisms to support Erin is the best answer because it’s likely that throughout your career, you will have to work with people who are experiencing traumatic personal events and need your support and understanding.13. Mohammed works for an independent pharmacy that employs 14 pharmacists and technicians altogether. He has worked there for two years. He and his wife are preparing to adopt a child, and his wife does not have paid maternity leave at her job. He wishes to take leave to care for his child for 12 weeks. He has accrued 17 weeks of leave. Select the statement that best describes how he should proceed.A. He should approach his employer and discuss details like when the child is expected to arrive, how much leave he has accrued, and whether or not the employer would approve that leave.*B. He should apply for leave under the Family and Medical Leave Act because it allows him to take 12 workweeks of leave in a 12 month period for the placement of a child in the home for adoption.C. He should resign his job, maintain his professional network, maintain his skills, plan his continuing education carefully, and plan to seek employment once he is ready to return to work.D. He should stop worrying about staying home with the child, and instead focus on arranging childcare and making sure he has a plan B in case his childcare falls through.ANSWER: ARATIONALE: Mohammed should approach his employer and discuss the details, because it’s possible that his employer would allow him to take his leave to be at home with the child. He is not covered by the Family and Medical Leave Act because the employer is too small (the threshold is 50 employees). It’s probably not necessary for him to resign his job, and it’s premature to assume that he will not be allowed to take leave to care for the child.14. Joe Elders owns four independent pharmacies located in a medium-size American city. Recently, one of his pharmacy managers submitted his resignation. Joe needs to find a new pharmacy manager for the site, and has approached a number of his employees (all of whom have graduated from pharmacy school within the last seven years). None of them are interested in the position. What is the best explanation for Joe’s situation?A. Although young pharmacists are interested in advancing, they prefer to take managerial positions in large organizations with corporate structures.B. These young pharmacists acknowledge that the ability to manage people has almost nothing to do with technical or clinical savvy, and feel unprepared.*C. Pharmacy schools spend a significant amount of time teaching students to be managers and they are well aware that the responsibility can be overwhelming.D. Most clinical pharmacists enter the field because they hope to move into managerial positions, the Joe is just unlucky to have hired people who are disinterested.ANSWER: BRATIONALE: The shortage of pharmacy leaders is significant and it occurs across all pharmacy practice settings. Pharmacy schools don’t have room in their curriculum to prepare students to take on managerial responsibilities, and clinical skills are entirely different than those needed for managerial positions. Many young pharmacists shy away from taking leadership in managerial positions because they acknowledge that the mid-ability to manage people has almost nothing to do with that clinical or technical savvy. They feel unprepared.15. You are working with Agatha, a woman in her 30s who has tremendous interest in everyone else’s personal lives. She approaches you and says that she heard that your coworker Jared’s wife and is cheating on him. She asks you if you’ve heard anything about it, and when you give her a noncommittal answer, she pushes the issue. What is the best way to respond to her?A. Tell her what you’ve heard about Jared and his wife and compare notes with her and others present.B. Continue to offer “nonanswers” and excuse yourself to go to the bathroom for 30 minutes.C. Say that you have no idea what’s going on, and furthermore you don’t care.D. Say you don’t talk about others’ personal l lives and it’s a kindness if everyone avoids gossiping.*ANSWER: DRATIONALE: When situations like this develop, the best thing to do is to point out to the individual who is gossiping that gossip can be destructive in the workplace, and make the person aware of his or her behavior. Thus, answer D is correct.16. Which of the following is NOT an appropriate solution when pharmacy staff is having difficulty communicating with non-English speaking customers?A. Look for resources to aid communication including language lines in translation websitesB. Ask the patient if the person accompanying him or her speaks English and can translateC. Speak English louder and slower, continuing to smile throughout so you seem friendly*D. Consider looking for bilingual staff of priority for the next time that you have a vacancy ANSWER: CRATIONALE: Numerous resources are available to help communicate with non-English-speaking customers. Sometimes, customers who don’t speak English arrive at the pharmacy with an escort or a child who might be able to help. In this case pharmacy staff should be careful to ensure that the patient consents to having his or her information discussed. Hiring bilingual staff is in a way to improve communication. Speaking louder and slower is the worst answer.17. Ellen is a petite, quiet pharmacy technician. The customer approaches her and asks for a prescription that he says was called in earlier in the day. Ellen cannot find the prescription, and she can find no indication that the prescription was indeed called in. When she tells him that, he explodes and begins yelling at her about everyone’s incompetence. What is the best way for Ellen to proceed?A. Ellen should respond in kind. When customers are rude, emotional, or abrasive they should expect the same in return.B. Ellen should listen to what the customer is saying, and ignore how the customer is saying it. Using the Q-tip principle, she should then say, “The issue I can actually help you with is…”*C. Ellen should escort the customer to the counseling room, asking to have a seat, and promptly ignore him.D. Ellen should ask if he has ever considered taking his business elsewhere since he is so terribly upset with the service here. ANSWER: B RATIONALE: There is no excuse for rudeness, even if someone is rude to you in a care setting. One never knows what someone else is dealing with, and pharmacy staff should be careful to not take others’ bad behaviors as a personal assault. Instead, Ellen should listen to what the customer is saying and use the time that the customer is complaining to identify positive ways that she can deal with his problem.18. Which of the following statements is TRUE?A. When employees are required to do something (e.g. make phone calls to customers) because an organization’s metrics requires them, their hands are tied; they simply must perform those duties. B. When employees are required to do something because an organization’s metrics require it, they should track the number of times that they meet with resistance or problems and tell management.*C. The sole purpose of metrics is to monitor employee performance.D. Large chain pharmacy track metrics. Employees who do not like metrics should move to a different type of organization.ANSWER: BRATIONALE: All types of organizations use metrics, and that includes chain pharmacies, independent pharmacies, and manufacturing pharmacies. Employees to understand that metrics are designed to monitor employee performance, but they are also used to increase improve flow and ensure customer satisfaction. When a metric interferes with workflow, annoys customers, or is not particularly useful, employees should track the problem and use metrics to fight bad metrics.19. Your pharmacy has a notoriously difficult customer who is argumentative whenever he comes into the store. He seems to have a particular affinity for one employee, and if that employee is on duty, he goes out of his way to ask annoying questions. How can you help your coworker?A. Step closer to your coworker and become part of the conversation, diffusing the situation if possible.*B. You cannot help your coworker. People who target others are impossible to discourage.C. Stand behind her and make hand signals at the customer indicating he should cease and desist.D. Leave the area and encourage other coworkers to do the same.ANSWER: ARATIONALE: When coworkers are dealing with difficult customers, often, just approaching the difficult situation and standing next to your coworker will cause the difficult customer to de-escalate his or her behavior. You can help your coworker, but you’ll have to do so by being supportive (and not by making hand signals to the customer or leaving the area). Never leave a coworker with a visibly disturbed customer.20. Approximately 15 patients are in line at the register waiting for prescriptions. One of them is an elderly woman who was recently discharged from same-day surgery and is clearly in pain. Two are parents holding screaming children. A customer arrives, rushes forward and tries to cut in line. The impatient customer calls out that he needs his prescription right now and can’t wait because he has to take his daughter to dance lessons. How do you respond?A. Spend a moment explaining the safety and clinical aspects of filling a prescription. That is, market your profession properly.*B. Make every effort not to make any eye contact with the impatient customer, and slam your counting tray and prescription bottles around.C. Say, “I completely understand that you’re in a hurry. You need to understand that some other people are to.” Then go back to work.D. Call out, “Attention! Attention! Do any of the 15 of you who are here waiting for prescriptions and have been here for more than 20 minutes mind if this individual jumps the line?”ANSWER: ARATIONALE: Many people have absolutely no idea what pharmacy staff does behind the counter. When patients are in a hurry, it’s important to have some standard language that you can use to explain the importance of safety and clinical review in the dispensing process. This is an opportunity to market your profession properly. Avoiding eye contact, employing aggressive behaviors, saying that you understand (when you may not), or asking other patients who are clearly in distress to wait; these actions are inappropriate. ................
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