WORKERS at the Hospital pharmacy are strained, stressed and feel “dismissed” by senior managers, a new review has found.
The independent review also said there were operations being carried out in cramped spaces and an “unjust culture” resulting from “long-standing issues” within the department.
Top British pharmacists Martin Keble and Phil Southworth, who carried out the Jersey General Hospital Pharmacy Review at the request of the Health Department, said a major cultural reset was needed at the pharmacy.
Cultural issues identified included some staff reportedly facing “punitive measures” for taking sick days and occasionally coming into work even when feeling unwell.
And they felt strained, stressed and “dismissed” by senior managers.
External pressures (such as global medication shortages) were also identified, as well as lengthy queues which have been plaguing the pharmacy for months.
Health Minister Tom Binet opted to send the review directly to the media, saying he had decided to “change the usual process” of waiting for a formal submission to be made to the next Health Advisory Board meeting and make the review public.
Carried out in the first half of June and dated 7 July, the review includes the views of current and former Hospital pharmacy staff, senior management and the Health Minister, who met reviewers.
Deputy Binet said he had received the report (the Health Advisory Board have also received a copy), hospital pharmacists had been made aware of the findings, and what he labelled an “action plan” was in development.
This will be submitted to the advisory board in September, he said.
Deputy Binet added: “This review is the latest in our ongoing programme of work to improve patient care across the entire Health Department.
“Improvements were already being made while this review was taking place, some of which resulted in reducing the queues to collect prescriptions at the Hospital.
“Other changes will also be taken forward while the action plan is being completed.”
Recommendations
In the review, 54 short, medium and long-term recommendations were made, encompassing culture, workforce, workload, education and training.
Reviewers insisted that prescriptions for private patients issued by consultants should be taken to community pharmacies.
Lack of strategic direction when it came to pharmacy, medicines and training was also cited as a problem.
Milestones and targets in the short, medium and long term, were non-existent, the reviewers said – and this omission should be remedied with a strategy co-produced through staff engagement and involve regular monitoring of progress.
The department could then use the strategy as an opportunity to “agree a way of resetting the culture for the department”.
“Collaboration with other hospitals across the Channel Islands may offer some efficiencies in aspects of the pharmacy services provided,” it added.
Culture
Cultural issues within Health have been the subject of several reports and reviews in the past, including one by Professor Hugo Mascie-Taylor which found serious issues with governance at the Hospital.
The two pharmacy reviewers said that staff “showed signs of being upset and angry at the previous and current position, including with leadership teams”, with some “sceptical” that this review would effect change and “nothing changed from the others”.
Staff said they felt dismissed or not listened to by senior managers when trying to raise concerns or suggest ideas for improvement, and there was an “unjust culture with confidential information sometimes shared and HR policies not being followed regularly”. This had resulted in “feelings of not being able to speak up or listened to”, and some situations where concerns were raised to the “Freedom To Speak Up” Guardians.
“They also felt there was an overall lack of communication and poor visibility of senior leaders within the department,” the review added.
One recommendation was for a “monthly coffee” with the chief pharmacist for all new starters and any other staff.
Within 12 months, the reviewers want to see a monthly improvement board introduced for all staff, where representatives from across the pharmacy department meet to discuss, review, and implement improvement ideas.
Staffing issues and a ‘cramped environment’
The reviewers also recommended a major restructuring of the department which would see the chief pharmacist’s role divided and shared among other senior members.
This individual has previously been expected “to lead and manage the hospital service as well as the external pharmacy demands described above”, the reviewers said.
“This is not manageable and is likely to have contributed to some of the issues described throughout this report.”
And to help ease pressures that members of staff were reporting, the reviewers recommended boosting the numbers of posts.
Easing these pressures would also be helped by temporarily employing remote agency workers, according to the report.
The reviewers were clear that these would not “replace” on-site staff but could deliver “significant parts of the workload that releases them to focus on appropriate activities”.
The dispensary is described as a “cramped environment” with a “complex system” of 22 places to look for prescriptions and “unnecessary delays”.
More staff are needed to manage these workload stresses, the report stated, including three pharmacy receptions, and reviewing the operations in the dispensary.
Education and training
The reviewers found there was no strategy for education or training staff in the department, as well as a lack of supervision and constructive feedback during trainee placements.
The only sessions which had been undertaken were on the topic of “resilience” but staff “were not positive about the sessions in terms of time out of the busy day attending” and “found very limited value from the tools and techniques provided with the sessions”.
“There has been a lack of management development, and resilience, within the department,” it added.
“It is possible that this is a result of significant challenge put on managers by successive senior managers, leading to breakdown, resignation or refusal to apply for managerial roles.”
The reviewers recommended developing an education and training strategy for all staff groups within a year.
