management exam 2 learning objectives

why workforce information matters

Workforce research helps the profession understand:

- Who pharmacists are and where they work.

- Their workloads and work activities.

- Their experiences of work-life and well-being.

- Whether employers provide safe, positive workplaces.

- What conditions contribute to employees staying or leaving.

why workforce information matters for employers

This information helps managers identify problems and decide where resources and support are needed.

workforce issues are interconnected and longstanding and easily preventable by managers

Without adequate resources, organizations struggle to invest in staffing, and staffing affects workplace well-being.

what do workforce studies examine

- Employment characteristics.

- Workload.

- Work activities.

- Work-life.

- Employer and organizational factors supporting safe, positive environments.

limitations of workforce studies

Self-report: Findings depend on what respondents report.

Lower response rate: Not everyone invited participates.

Limited representativeness: Respondents do not necessarily represent the entire pharmacist population.

workforce studies (problems in different settings)

Community pharmacy has the greatest proportion reporting excessively high workload among these settings.

Hospital and managed care also have substantial workload concerns.

Workforce problems are not limited to community pharmacy.

workforce studies (highest satisfaction)

Industry has the highest reported satisfaction in this slide, while community pharmacy has lower satisfaction than the other settings shown.

However they still have their disadvantages: no go decision can result in reduction in force

employee turnover vs quits

Employee turnover: The rate at which employees leave a company and are replaced by new employees.

Quits: Generally voluntary separations initiated by the employee.

The quit rate can indicate employees' willingness or ability to leave:

More opportunities can make leaving possible.

Limited opportunities can make people feel stuck.

People who feel stuck may focus on surviving rather than doing their best.

quiet quitting

remaining in a position while not doing an optimal job.

management concern is whether available resources are being used effectively. Would prefer to fill a position with someone who wants to be there.

Common reasons why employees leave

1. engagement and culture

- Advancement and career opportunities.

- Respectful treatment.

- Recognition.

2. well being and worklife balance

- Family or medical circumstances.

- Relocation.

- Work schedules.

3. pay and benefits

4. managers and leaders

42% of turnover was preventable or involved issues employers could address. Employers can improve retention by recognizing and responding to concerns rather than assuming departures are unavoidable.

David Rock's SCARF model

Status

- what employees need: Recognition, appreciation, success, and a sense that their work matters

- workplace concern: Feeling unrecognized or undervalued

Certainty

- what employees need: Clear expectations and knowing what to expect from the employer

- workplace concern: Job duties or employer behavior not matching expectations

Autonomy

- what employees need: Control over work and decisions

- workplace concern: Micromanagement or inability to use professional judgment

Relatedness

- what employees need: Connection, belonging, and shared experiences

- workplace concern: Isolation or lack of teamwork

Fairness

- what employees need: Fair treatment and equal opportunities

- workplace concern: Unequal access to recognition, bonuses, or praise

Why autonomy is especially important in pharmacy

Pharmacists want to make decisions in patients' best interests.

tension between being treated as:

- A health professional who needs autonomy.

- An employee treated like a "widget" within a company.

becomes particularly frustrating when someone who is not a clinician directs care without understanding the pharmacist's patient advocacy.

How managers use SCARF

Employees may not directly announce that they want to leave.

Managers should listen for concerns during:

- One-on-one meetings.

- Informal conversations.

- Discussions about management style.

- Requests to participate in decisions.

APhA/NASPA survey reports disagreement with the following statements:

- Able to adjust personnel training, roles, and responsibilities to pharmacy need

- Team members are sufficiently educated or trained

- Team members are fully engaged within their permitted scope

- Employer actively seeks my opinion

These findings connect to autonomy, status, support, and workplace relationships.

Other workforce findings show concerns with:

- Supervisor and coworker support.

- Freedom to decide how to work.

- Recognition.

- Valued contributions.

- Respect.

- Trust in leadership.

Financial costs of turnover

Direct replacement costs: Up to 50-60% of annual salary.

Total turnover costs: Can range from 90-200% of annual salary.

Tangible costs in the workforce

- Recruiting

- Hiring

- Onboarding and training

- Tests, background checks, and drug screening

- Temporary employees or staffing agencies

Intangible costs in the workforce

- Loss of institutional memory

- Decreased productivity and stalled projects

- Increased workload for remaining employees

- Lower morale

- Effects on customer retention

- Harm to company reputation

Institutional memory is employees' knowledge of how the organization works and its history. Replacing a person does not automatically replace that knowledge.

Remaining employees may temporarily absorb extra work, but prolonged additional demands can wear them out.

burnout definition

Chronic, unaddressed workplace stress

Emotionally exhausted, becoming detached from patients or the job, feeling that nothing you do is enough

- Chronic stress

- Emotional exhaustion

- Cynicism and detachment

- Ineffectiveness or lack of accomplishment

moral distress definition

Internal or external constraints prevent needed action

Knowing what care is needed but being unable to provide it

- A pharmacist knows a patient needs detailed counseling about complex medications but lacks sufficient time.

negative effect on patient care, reduced job satisfaction, burnout, leaving the profession

moral injury definition

Deep, lasting harm related to moral conflict or betrayal (concept arose from studying military personnel)

Loss of hope, trust, or integrity; anger, shame, guilt, or futility

demands that can undermine well being

- excessive workload

- unmanageable schedules

- inadequate staffing

- interruptions and distractions

- time pressure

resources that support well being

- meaning and purpose

- supportive organizational culture

- alignment of values and expectations

- job autonomy

- professional relationships

operational vs relational drivers that lead to burnout

operational

- unsafe conditions

- excessive demands

- insufficient staffing

relational

- distrust

- conflicting values

- lack of voice

- unfair treatment

consequences of poorly managed conditions

Relationship problems.

Alcohol or substance use.

Depression.

Suicide.

Physical, mental, and career harms.

Lower-quality care and more errors.

Lower patient satisfaction.

Reduced productivity.

Turnover.

Recruitment and retention difficulties.

why are pharmacists more prone to substance use

Access to medications.

False sense of control or safety from pharmacology knowledge.

Workplace stress.

Unpleasant environments.

Perfectionism.

factors that cause medication errors

High workload and understaffing.

Inconsistent support-staff competency.

Patient expectations and demands.

Interruptions and distractions.

quintuple aim

Improve population health.

Reduce costs.

Improve patient experience.

Support clinician well-being.

Advance health equity.

resources that help support pharmacist workforce sustainability

1. national academy of medicine

2. ASHP

3. well being index

measures likelihood of burnout, meaning in work, severity of fatigue, risk of medical error

responsibilities vs rights

responsibilities

- Practice honestly and with integrity

- Seek employment aligned with professional goals

- Continue lifelong learning

rights

- A workplace free from discrimination

- A workplace free from bullying

- Conditions and support needed to fulfill professional responsibilities

what is bias

Prejudice in favor of or against a thing, person, or group compared with another.

Usually involves an unfair judgment.

Conscious or explicit bias: The person is aware of the bias.

Unconscious or implicit bias: The person is not consciously aware of the bias.

why does unconscious bias exist

The brain encounters more information than it can consciously process.

Unconscious processing helps preserve energy and maintain readiness to respond to threats.

Thinking requires energy, so the brain uses shortcuts to reduce the work involved.

What are heuristics?

Mental shortcuts used in decision-making.

Tend to operate automatically at a subconscious level.

Help reduce the complexity of decisions.

Operate under uncertainty.

How can heuristics lead to biased behavior?

Mental shortcuts can bring unconscious biases into our judgments.

Biases can influence the assumptions we make.

Those assumptions can influence our behavior.

Shortcuts can be useful, but they can also produce inaccurate or detrimental judgments.

When are we more likely to rely on unconscious bias?

When stressed.

When tired.

When hungry.

When hurried or pressured to rush.

When facing ambiguity or uncertainty.

When feeling stretched.

What develops or reinforces unconscious bias?

Family.

Neighborhood.

Culture and ancestry.

Education.

Religion.

Media.

What aspects of decision-making and interaction can bias affect?

Perceptions: How we see other people and reality.

Attitudes: How we react toward certain people.

Behavior: How receptive or friendly we are.

Attention: Which aspects of a person we focus on.

Listening skills: How actively we listen to what certain people say.

Microaffirmations: How much or how little we comfort certain people in particular situations.

What workplace activities can unconscious bias affect?

Recruitment and attracting people to the organization.

Interactions between employees.

Team design, dynamics, and teamwork.

Team progress and recognition.

Interviewing and hiring.

Assignments and task delegation.

How can bias affect team assignments and recognition?

Can influence which teams receive acknowledgment.

Can influence which teams receive less popular work.

Can affect the tasks assigned to individual employees.

What are the potential outcomes of workplace bias?

Employee turnover.

Legal issues.

Limited representation because the group becomes homogeneous.

Reduced sense of belonging.

Reduced motivation.

Impeded positive organizational change.

How can workplace bias increase turnover?

Employees may leave because of the biases they experience.

Turnover creates costs for the organization.

Why can hiring only for "fit" be problematic?

Can produce a group of people with the same mindset.

May limit representation and available perspectives.

Avoiding conflict is not always beneficial.

Some conflict helps groups consider situations more fully and reach better outcomes.

What types of diversity can improve a group's work?

Diversity of thought.

Diversity of experience.

Diversity of talents.

Why are belonging and inclusion important?

A sense of belonging supports inclusion.

Inclusion allows people to:

- Learn.

- Contribute.

- Challenge the status quo.

Without inclusion, employees may not participate in these ways.

Why should pharmacy students and managers understand unconscious bias?

Students will encounter bias in the workplace.

Understanding bias helps them recognize what they are experiencing.

Managers and supervisors need to minimize its influence.

Which six biases should students know?

Stereotype.

Affinity.

Halo.

Horns.

Attribution.

Confirmation.

What is stereotype bias?

Attributing certain characteristics to all members of a group.

Overgeneralizing a belief about a group.

What examples illustrate stereotype bias?

Assuming everyone who attended Purdue is very smart because the school is known for engineering.

Assuming single employees have more free time and can work long hours, nights, and weekends.

Why are stereotypes problematic?

Group membership does not establish an individual's abilities or circumstances.

what is affinity bias

A real or perceived connection with someone because you share something.

That connection can influence how you evaluate the person.

May arise from wanting to avoid uncomfortable situations or make quick decisions.

What examples illustrate affinity bias?

Connecting over attending the same high school.

Sharing hobbies or activities.

Belonging to the same fraternity.

What problems can affinity bias create?

Can produce a group that looks or thinks exactly like the interviewer.

Strong personal connection may cause the interviewer to overlook red flags.

The interviewer may fail to notice that the candidate lacks required skills.

halo and horns bias

halo

- One positive attribute creates a generalized positive impression.

- The attribute casts a positive "glow" over everything else about the person.

horns

- One negative attribute creates a generalized negative impression.

- The attribute casts a negative "cloud" or "shadow" over everything else.

What is attribution bias?

Explaining someone's behavior through their character rather than the situation.

Forming an opinion from a single instance.

What examples illustrate attribution bias?

Someone is late, so we label them lazy, unserious, or arrogant.

Someone has an employment gap, so we assume they are hiding something or are untrustworthy.

What is confirmation bias?

Seeking information that supports an existing opinion or belief.

Focusing on proving that we are right.

Overlooking information that does not support the belief.

Why does confirmation bias occur?

We want to be right.

Preconceived information allows faster processing.

Being open to new ideas requires effort.

How can the six biases be distinguished?

Stereotype: "People in this group have this characteristic."

Affinity: "We share something, so I feel connected to you."

Halo: "One positive attribute makes my overall impression positive."

Horns: "One negative attribute makes my overall impression negative."

Attribution: "Your behavior reflects your character rather than your situation."

Confirmation: "I seek information that supports what I already believe."

What strategies help reduce stereotype bias?

Use a blind hiring process.

Use work samples to test skills required for the role.

Ask forward-looking hypothetical questions.

Assess skills rather than relying only on prior experience or group attributes

What strategies help reduce affinity bias?

Recognize shared interests and separate them from qualifications.

Focus on skills and experiences.

Consider culture add rather than culture fit.

Use diverse interview panels.

Assess skills.

What strategies help reduce halo and horns bias?

Use a blind process.

Use work examples instead of relying on résumés or CVs.

Use structured interviews.

Use scoring criteria.

What strategies help reduce attribution bias?

Consider the entire person and their experience.

Avoid judging from one behavior.

Give the person the benefit of the doubt.

Ask questions and check assumptions.

What strategies help reduce confirmation bias?

Ask open-ended questions about weaknesses or setbacks and how they were addressed.

Conduct additional research before deciding.

Challenge your own thinking.

Seek others' opinions.

What general strategies reduce recruitment bias?

Understand the types of bias.

Form a diverse hiring team.

Identify GRRR: goals, roles, resources, and rules.

Watch for conditions that increase susceptibility to bias.

What should a diverse hiring team include?

A variety of perspectives.

members may include:

- People from different departments.

- Staff.

- Students.

What does GRRR stand for?

Goals: What the team wants to accomplish.

Roles: What each team member is responsible for.

Resources: What tools or assessments are needed.

Rules: How the hiring process will be standardized.

What rules support a standardized interview process?

Blind review.

Purposeful questions.

Slowing down.

Using a rubric.

Applying a consistent process to every candidate.

Why does standardization reduce bias?

Reduces the influence of personal connection.

Keeps attention on required skills and talents.

Provides a framework for deliberate evaluation.

Supports consistent ratings.

What are examples of competency-driven questions?

Collaboration: "Tell me about a time when you needed information from someone who was not very responsive. What steps did you take and what was the outcome?"

Helping colleagues: "When you see a colleague struggling with their workload or overwhelmed, how have you approached the situation?"

Independent work: "Describe a project you completed and how you managed it," assuming clear direction was received.

What four gaps increase susceptibility to recruitment bias?

Lack of time.

Lack of direction.

Lack of consistency.

Lack of information.

Why is rushing to fill a vacancy problematic?

May prevent selecting the best-skilled person.

May prioritize eliminating the vacancy over meeting required competencies.

Recruitment timelines should be purposeful.

What should be decided before recruitment?

What the organization wants to accomplish.

What the position requires.

Who the organization is seeking.

Which competencies are necessary for success.

What roles can reduce bias during hiring deliberations?

Candidate advocate: Advocates for the candidate.

Devil's advocate: Looks for weaknesses or holes.

Values alignment checker: Checks alignment with company values.

Consistency checker: Compares statements with the CV and job requirements.

What happens before a candidate is interviewed?

Obtain approval for the position.

Write the job description.

Use neutral language.

Define the position's purpose.

Define its responsibilities.

Attract applicants to the organization.

What are the five placement steps in hiring

Application.

- Screens basic qualifications.

Screening.

- Uses criteria and/or tests to narrow the applicant pool to qualified applicants.

Interviewing.

- Ask candidates questions in an organized, purposeful way.

Selection.

- Review interview notes and ask key questions

Hiring.

- Extend an offer to the best candidate.

HCAHPS

Hospital Consumer Assessment of Healthcare Providers and Systems.

It surveys patients about the quality of care received during a hospital stay.

It provides a way to compare patient experiences across hospitals.

Surveys are administered 48 hours to six weeks after discharge.

Explain the relationship between CMS, HCAHPS, and Press Ganey.

HCAHPS

- The survey measuring patients' hospital experiences.

CMS

- Helped develop the survey. Uses results in value-based purchasing and hospital reimbursement.

Press Ganey

- A CMS-approved survey vendor. Sends surveys, collects and tabulates responses, and reports results to CMS.

Explain the relationship between CMS, HCAHPS, and Press Ganey + connection to reimbursement

Medicare pays hospitals through diagnosis-related groups, or DRGs.

Poor HCAHPS performance can reduce reimbursement.

may cause a reduction from $7,000 to $6,000.

The purpose is to encourage hospitals to prioritize patient satisfaction.

Design a pharmacy program to improve HCAHPS scores.

Example program: Discharge medication education with bedside delivery and a pharmacy hotline.

Review the patient's name, medications, and care. Introduce yourself and explain your pharmacy role. Review the medication list with the patient. Give the patient pharmacy contact information or a hotline card.

Design a pharmacy program to improve HCAHPS scores. Why can this help improve scores

Pharmacy students visited patients before discharge.

They discussed medication purposes and important side effects.

They provided a hotline number.

The hospital's HCAHPS results improved dramatically the following year.

Define Net Promoter Score, or NPS.

NPS measures how likely someone is to recommend a product or service.

promoters

- rate it a 9-10

passives

- rate it a 7-8

detractors

- rate it a 0-6

how to calculate net promoter score

NPS = % promoters − % detractors.

The possible range is −100 to +100.

drivers that affect NPS score

Prescription accuracy.

Time required to fill prescriptions.

Delivery process and packaging.

Whether staff seemed to care.

Ease of contacting the pharmacy.

Customer service.

Overall pharmacy experience.

NPS score + reimbursement

Organizations may review specific patient populations or services.

Some contracts include minimum patient-experience expectations.

Poor performance may affect preferred status or network participation.

Design a pharmacy program to improve NPS.

Step 1: Identify the drivers.

- Look for recurring problems.

Step 2: Target the problem.

- Choose a realistic intervention.

Step 3: Standardize the response.

- Establish clear expectations for staff.

- Explain how to handle common problems.

Step 4: Measure and adjust.

- Review patient feedback and NPS.

how to do good service recovery

Service recovery rebuilds trust after a problem.

Preventing every problem is unrealistic.

How staff respond strongly affects satisfaction.

Start with empathy. Then solve the problem.

Understanding the organization helps you navigate your workplace

Learn how work is organized.

Learn who makes decisions.

Learn how decisions are made.

Learn who reports to whom.

Understand your role within the organization.

how does understanding how the workplace is structured help evaluate professional autonomy

Autonomy concerns control over professional work.

This includes who can perform the work.

It also includes how the work is performed.

Pharmacists want to use their education, training, and experience.

Organizational knowledge helps you choose an employer.

Assess whether its values align with yours.

Consider whether it provides sufficient autonomy.

Understand its support and advancement opportunities.

Decide whether your skills would be better used elsewhere.

how can organizational knowledge help identify what brings career fulfillment

Consider your values, interests, strengths, and needs.

Organizational behavior has roots in several sciences.

Psychology:

- Individual behavior.

- Motivation.

- Job satisfaction.

Sociology:

- Individual roles within larger systems.

- Organizational structures.

- Behavioral norms.

Social psychology:

- How individuals influence others.

- Communication patterns.

- Group functioning.

The organizational framework starts with values.

Values explain the organization's beliefs and purpose.

Goals express those values.

Structure supports goal achievement.

Climate reflects employees' perceptions of the work environment.

The external environment places pressure on the organization.

Responsibility and accountability differ.

Responsible: Performs the work.

Accountable: Owns the work and ultimately answers for it.

A manager may be accountable without performing the tasks.

climate vs culture in an organization

Climate is the psychological atmosphere of the organization.

- reflects employee perceptions of the work environment.

- produced by organizational structure.

- includes trust, morale, job satisfaction

Culture is the shared meaning held by organizational members.

- describes "how we do things here."

- It includes established ways of operating.

- Culture describes how things happen,

what is culture in an environment influenced by

The organization's purpose.

Its structure.

Organizational ethics.

Morals.

Values.

Beliefs.

Rules for work.

culture affects climate

A weak culture may involve:

- Vagueness.

- Unclear expectations.

- Ambiguity.

- Inconsistency.

- May show low trust, morale and less support

A strong culture may involve:

- shared direction

- There is alignment.

- There is clarity.

- It can enhance performance

Inclusion + culture

Feeling included may reflect a strong culture.

Feeling excluded may reflect a weak culture.

Describe the basic components of traditional organizational forms.

Formalization

- Job standardization.

- Work should happen consistently to some degree.

Centralization

- Decision-making is concentrated at a single point.

Division of labor

- The degree to which activities are organized into separate jobs.

Vertical differentiation: Authority

Describes the depth of the hierarchy.

Shows the chain of command.

Includes levels between the top and entry-level positions.

Groups people according to authority.

Horizontal differentiation: Tasks

Groups employees and resources according to tasks.

Specific job functions are assigned to specific people.

Functions depend on education, training, and what people are enabled to do.

Spatial Differentiation

Geographic dispersion of an organization's offices, plants, and personnel