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July 11, 2019

ASHP, Well-Being, and You

Dear colleagues,

Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

There is a great deal of national attention on the issue of healthcare provider burnout, which is affecting our pharmacists, pharmacy residents, student pharmacists, and pharmacy technicians at unprecedented rates.

As many of you know, burnout is a syndrome characterized by emotional exhaustion, depersonalization, and low personal accomplishment. Moreover, there is a significant correlation between poor well-being of healthcare professionals and worsening patient safety. In May 2019, the World Health Organization clarified that burnout is an occupational phenomenon caused by chronic workplace stress that needs to be monitored and better understood. It’s also an expensive problem. Research conducted at the Mayo Clinic estimates that burnout costs the U.S. healthcare system $4.6 billion every year.

A healthy and thriving clinician workforce is essential to ensure optimal patient health outcomes and safety. That’s why ASHP has been a leader in well-being and resilience (WBR) for nearly 40 years. We first addressed this as a critical practice issue in a 1982 AJHP article that explores recognizing, reversing, and preventing hospital pharmacist burnout.

In 2017, ASHP became the pharmacy sponsoring organization of the National Academy of Medicine (NAM) Action Collaborative on Clinician Well-Being and Resilience. This four-year initiative is raising the visibility of clinician burnout, improving baseline understanding of challenges to clinician well-being, and advancing evidence-based solutions to improve patient care by caring for the caregiver. ASHP is a member of the NAM Action Collaborative Conceptual Model Working Group which is charged with identifying factors that affect clinician well-being and resilience. The goal is to create urgency and understanding of the issue while being careful not to oversimplify the complexity of it. In addition, we recently participated in a NAM meeting in Chicago, focused on redesigning the clinical learning environment to enhance well-being. ASHP member Kofi Andoh, a rising third-year student at Notre Dame of Maryland University School of Pharmacy in Baltimore, was one of five participants selected to share his perspective on the stressful demands placed on students.

To further assess the issue of workplace burnout, ASHP recently conducted a national survey of nearly 2,000 people with help from The Harris Poll. The results show that almost three-quarters (74%) of respondents are concerned about burnout among healthcare professionals. Furthermore, one in four Americans surveyed believes hospital pharmacists (26%) and retail pharmacists (25%) are experiencing burnout. These data show that pharmacy workforce stress is visible to our patients, which is why ASHP has made addressing pharmacy workforce well-being a top priority.

In June 2018, the ASHP House of Delegates approved a new professional policy on clinician well-being and resilience. At our Summer Meetings last month, the House of Delegates reinforced our commitment to WBR by approving a new policy on suicide awareness and prevention, the most tragic and extreme consequence of burnout. The policy recognizes the vital role of the pharmacy workforce in suicide prevention, and the importance of maintaining the health and well-being of both our patients and our colleagues.

June was National Employee Well-Being Month, and in honor of Global Wellness Day on June 8, we launched an online portal – Wellbeing & You – as a resource for pharmacists, pharmacy residents, student pharmacists, and pharmacy technicians. This website is also a place for colleagues to share their experiences with burnout and to pledge their commitment to strengthening personal and workplace resilience. I encourage you to visit the site to learn about burnout, view ASHP’s webinars on WBR, check out the ASHP State Affiliate Toolkit, and contribute to the ASHP Connect Community on Clinician Well-Being and Resilience.

Join ASHP’s movement to combat burnout by sharing your stories and taking the pledge. Keep your eye out for #WellbeingWednesday on social media, where we’ll offer even more WBR tips, member stories, and resources.

Please know that ASHP is here to support you in your career in every way we can and that we will continue to provide you with valuable WBR resources. Thank you for being a member of ASHP, and for everything you do for your patients.

Sincerely,
Paul

December 17, 2018

ASHP Continues to Lead on Pharmacy Workforce Well-Being & Resilience

Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

I am pleased to share with you that over the last year ASHP has continued to increase our efforts to support the well-being and resiliency of the pharmacy workforce. ASHP is an original sponsor of the National Academy of Medicine (NAM) Action Collaborative on Clinician Well-Being and Resilience and is honored to support the pharmacy profession on this important patient care and workforce issue. As the NAM Action Collaborative on Clinician Well-Being and Resilience approaches the two-year mark, I would like to share some updates with you on our efforts to help address this important issue facing pharmacists, pharmacy residents, student pharmacists, and pharmacy technicians.

These past 15 months, through the NAM Action Collaborative and ASHP’s own organizational efforts, we have raised the visibility of clinician burnout, depression, stress, and suicide. Over that time, ASHP has developed resources, educational programming at our national meetings, and community connections for members to learn more about the issue. Former U.S. Surgeon General Vivek Murthy kicked off our 2018 ASHP Summer Meetings by challenging attendees to include well-being as the core of what we do as healthcare workers.

Summer Meetings attendees also heard about some of the science behind resilience and were introduced to interventions for building individual and team resilience through two interactive presentations by Dr. Bryan Sexton, Director of the Duke Patient Safety Center. Conversations on the topic continued in the ASHP House of Delegates, where delegates approved an ASHP policy on Clinician Well-Being and Resilience. We are very pleased to have an official professional policy for members to reference as they begin and continue discussions at their institutions. Efforts by the ASHP House of Delegates also helped form a joint ASHP Council and Commission session on the pharmacists’ role in suicide prevention during the 2018 ASHP Policy Week.

We know that burnout is associated with compromised patient safety and a loss of productivity in the healthcare workforce. As such, we continue to help advance pharmacy-specific research on resilience and well-being. ASHP recently partnered with the Pharmacy Technician Certification Board (PTCB) and Duke University Health to study the prevalence of burnout in pharmacy technicians and identify resources to support this important and growing segment of ASHP’s membership. While both NAM and ASHP are improving baseline understanding of challenges to clinician well-being, we are reminded that this is a local issue that requires local solutions to address it. ASHP members continue to share their strategies on how to foster the creation of resilience in clinical learning and managing preceptor burnout. If you traveled to Anaheim for the recent Midyear Clinical Meeting, there were multiple educational sessions on workforce well-being. Many of these sessions were recorded and will be available on ASHP eLearning in early 2019.

NAM recently kicked off a consensus study to examine systems approaches to improve patient care by supporting clinician well-being. ASHP nominated M. Lynn Crismon, Dean, University of Texas, College of Pharmacy, to serve on this committee, which will issue a report with recommendations for system changes to streamline processes and manage complexity, minimize the burden of documentation requirements, and enhance workflow and teamwork to support the well-being of all clinicians and trainees. In the meantime, the NAM clinician well-being knowledge hub continues to grow with solution strategies for leaders, organizations, and individuals, including ASHP contributions to a discussion paper on implementing optimal team-based care to reduce clinician burnout. ASHP state affiliates are also an important part of the conversation, and ASHP has created a state affiliate toolkit on well-being and resilience to assist them in their state-level efforts.

Our continued work in advancing workforce well-being and resilience is ultimately growing a foundation for long-term culture change. We have enhanced our SSHP Recognition Program for the 2018–2019 academic year to encourage our students to address the issue. We know that many of you are working on well-being and resilience within your organizations, and we would appreciate hearing from you. We encourage you to share your stories through our community on ASHP Connect. Or, maybe you know of an individual or an organization that is demonstrating positive progress on resilience and supporting a healthy and engaged workforce. If so, we encourage you to fill out this brief survey so that we can create case studies others can learn from.

I hope you share our enthusiasm about this very important work to support the resilience and well-being of the entire pharmacy workforce and about the impact this work will have on improving patient care.

Thanks so much for being an ASHP member and for everything you do for your patients and pharmacy teams. I look forward to sharing more with you in the future as ASHP’s efforts continue in this important area. Have a safe holiday season.

Sincerely,

Paul

October 5, 2018

Pharmacy and the Art of Resilience

PAUL MILLIGAN, PHARM.D., a Medication Safety Pharmacist at BJC HealthCare in St. Louis, has worked in the pharmacy profession for 35 years. His career, while incredibly rewarding, has required him to contend with plenty of daily stress, manage the expectations of doctors and other practitioners at busy healthcare facilities, and regularly face the pressure that comes with saving lives. When the rewards of the job don’t outweigh the struggle, however, Dr. Milligan said it can leave him feeling burned out.

Pharmacy Sculpture

Pharmacists are increasingly suffering from professional burnout, which is why Dr. Milligan was immediately interested when the National Academy of Medicine (NAM) Action Collaborative on Clinician Well-Being and Resilience issued a call for submissions for original artwork from healthcare professionals. The organization’s goal was to curate a digital art gallery that shows how clinicians are affected by burnout. By allowing healthcare providers to creatively express their experiences with burnout, Expressions of Well-Being: An Art Exhibition captures critical moments in their journey toward well-being.

Paul Milligan, Pharm.D., used sculpture to capture the moment a clinician holds a patient’s hand to make them feel safe and comfortable.

Dr. Milligan, who serves as Director-at-Large of the ASHP Section of Inpatient Care Practitioners, has created sculptures as a hobby for the last decade and welcomed the opportunity to submit his artwork for a project that is so close to his heart. He sent images of two of his works, and one was accepted for the project. He named the sculpture “Treat the Person, Treat Yourself,” at title that aptly sums up the professional mission that has carried him through his career.

“I wanted to capture that moment when a clinician is holding a patient’s hand and making them feel safe and comfortable,” he said. “It is really a two-way street at that point. These are the moments that I remember most, the ones that keep me going.”

Opioid Imagery

ASHP member Elizabeth Canterbury, Pharm.D., an emergency department resident at SwedishAmerican Hospital in Rockford, Ill., is another contributor to the NAM collaborative’s digital art gallery. She saw the project as a way to comment on current challenges plaguing the healthcare system.

”Don’t Slip“ was created by Elizabeth Canterbury, Pharm.D., who used Photoshop to superimpose a photo of herself on a chair with prescription bottles spilling on the floor.

Dr. Canterbury submitted a powerful image of herself on a chair superimposed with prescription bottles spilling on the floor, an image she created with the magic of Photoshop. The work is a commentary on the opioid epidemic, which in 2016 alone killed more than 42,000 Americans, according to the Centers for Disease Control and Prevention (CDC).

At age 26, Dr. Canterbury is closer to the beginning of her career, but she’s already found ways to stay levelheaded and avoid burnout. In addition to her artwork, she remains involved in activities that allow her to network with colleagues, which provides an outlet to voice her concerns with like-minded people.

“Holding leadership positions and taking advantage of opportunities like attending ASHP’s Midyear Clinical Meeting and doing a resident rotation at ASHP headquarters have helped me stay engaged and feel like I am contributing to the growth of the profession in addition to helping the patients I see on a day-to-day basis,” she explained.

A Portrait of Pharmacy

Evan Slagle, Pharm.D., BCPS, Antimicrobial Stewardship Pharmacist at Penn State Health St. Joseph in Reading, Pa., has also found solace and stress relief in activities outside of his job. Dr. Slagle, an avid runner, lived in South Philadelphia while attending the Jefferson College of Pharmacy. He would frequently go for runs toward the northern end of the city. The route would always take him past the Edgar Allen Poe National Historic Site, a tribute to the beloved 19th-century writer.

Evan Slagle, Pharm.D., BCPS, based “Imp of the Perverse” on a portrait of Edgar Allen Poe.

Dr. Slagle became fixated on a mural of Poe at the site. The writer, Dr. Slagle said, approached the themes of depression and anguish in uniquely expressive ways. One day, Dr. Slagle felt especially inspired after his run. The endorphins were rolling, he said, and so he sat down to recreate the portrait as best he could recall it. It took him four hours to complete, and he then submitted the work to the collaborative’s digital art gallery.

Over time, Dr. Slagle has come to realize that creative expression through art is a way to help him process the stress of his job. In fact, doing so became a necessity early in his career. Dr. Slagle initially dropped out of his PGY1 residency program because of stress, but later completed his PGY1 at a different hospital.

“I experienced burnout before I could define it,” he said. “Detaching yourself a little bit from the work and getting some perspective is the key. You need to totally separate yourself from time and the constant bombardments you get on a daily basis. We all need a reprieve from that.”

 

By Jessica Firger

 

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April 9, 2018

ASHP Leading the Way on Well-Being & Resilience

Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

THE FOCUS ON CLINICIAN BURNOUT as a growing public health problem is gaining significant momentum. ASHP is an original sponsor of the National Academy of Medicine (NAM) Action Collaborative on Clinician Well-Being and Resilience and is honored to lead the pharmacy profession on this issue. We recognize that a healthy and thriving clinician workforce is essential to ensuring optimal patient health outcomes and safety. Therefore, ASHP is committed to fostering and sustaining the well-being, resilience, and professional engagement of pharmacists, pharmacy residents, student pharmacists, and pharmacy technicians. In his inaugural address, ASHP President Paul Bush called for a three-pronged approach to supporting the pharmacy workforce: building staff resilience, providing technician training and support, and encouraging clinicians to be leaders. ASHP’s commitment to improving pharmacy workforce well-being and resilience can be read here and is embedded within our recently revised Strategic Plan (Goal 4, Our Patients and Their Care).

Burnout is associated with a loss of productivity in the healthcare workforce. If you extrapolate this loss to a national level, it is equivalent to the elimination of seven graduating classes of medical schools. And healthcare worker burnout is not the only concern; a bidirectional relationship exists between burnout and medical error. For example, one study found that nursing burnout resulted in increased healthcare-associated infections. At the individual clinician level, burnout presents as emotional exhaustion (i.e., compassion fatigue), depersonalization and cynicism, and a low sense of accomplishment. At the healthcare-system or institution level, it is associated with medical errors, loss of productivity, added malpractice claims, and increased risk of patient harm. Currently, we don’t have a deep research portfolio specific to the pharmacy workforce, but we hear from you that it is an issue that needs to be addressed, and ASHP stands ready to help.

The Action Collaborative formally kicked off in January 2017 and has three goals related to increasing understanding of and identifying evidence-based solutions for clinician well-being and resilience. ASHP is actively contributing to discussions on individual and external factors that impact well-being and resilience as part of the conceptual model working group. Since the risk of clinician burnout spans all ages, stages, and career paths, this working group is tasked with identifying a model that captures the complexity of clinician well-being and resilience without oversimplifying the contributing factors. A new conceptual model was recently created to illustrate the interrelated and interlocking factors affecting clinician well-being and burnout while simultaneously conveying a vision and solutions. ASHP is a contributing author to the discussion paper that details the journey in constructing this new model.

In addition to our collaboration with NAM and contributions through the working group, ASHP is engaging our members on pharmacy well-being and resilience by:

If your organization has been working on resilience efforts to support wellness of its employees, we would love to hear from you. We encourage you to share your stories through our community on ASHP Connect. Or, maybe you know of an individual or an organization that is demonstrating positive progress to start the conversation on resilience and supporting a healthy and engaged workforce. If so, we encourage you to send us these ideas, and we can take these concepts back to the national conversation on this topic.

Thanks so much for being an ASHP member and for everything you do for your patients and pharmacy teams.

Sincerely,

Paul

April 13, 2017

Celebrating Former ASHP CEOs: Henri R. Manasse Jr., Ph.D., Sc.D. (Hon.), FFIP

Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

AS PART OF ASHP’s yearlong 75th anniversary celebration, I will be recognizing our three former Chief Executive Officers: Drs. Henri R. Manasse Jr., Joseph A. Oddis, and Gloria Francke. This blog will recognize our most recent CEO, Dr. Manasse, who served ASHP from 1997 to 2011.

Dr. Manasse came to ASHP after a long and illustrious career as a leader in academic healthcare. He was Vice President for Health Sciences at The University of Iowa and Chairman of the Board of the University of Iowa Health System. Prior to that, he was interim Vice Chancellor for Health Services at the University of Illinois at Chicago Medical Center, and Dean and Professor of Pharmacy Administration at the University of Illinois at Chicago College of Pharmacy. In 1988 he served as president of the American Association of Colleges of Pharmacy. He is also a member of the prestigious National Academy of Medicine (formally the Institute of Medicine) of the National Academy of Sciences and a recipient of pharmacy’s highest honor, the Harvey A.K. Whitney Lecture Award.

Dr. Manasse came to ASHP during a time of transition and change, and he helped the society become an even more outward-facing organization. Under his leadership, ASHP became increasingly engaged in proactive government advocacy and formed strong relationships with a wide variety of stakeholders in medicine, nursing, standards-setting bodies, hospital organizations, payers, and many others. He played a vital role after the 1999 Institute of Medicine Report, “To Err is Human,” to take ASHP’s longtime focus on patient safety, and work with stakeholders in all segments of society to help drive fundamental changes that have helped improve patient safety throughout the entire healthcare system.

In 2006 he served as Chair of the Board of Governors of the National Patient Safety Foundation and co-chaired the Safe Practices Steering Committee and the Advisory Committee for Executive Leadership of the National Quality Forum. He also chaired The Joint Commission’s Sentinel Event Alert Advisory Committee and served on the U.S. Food and Drug Administration’s Drug Safety and Risk Management Advisory Committee. In 2005, he was elected as the Professional Secretary of the Board of Pharmaceutical Practice of the International Pharmaceutical Federation. He also served on the Board of Advisors of the Association of Academic Health Centers project on the Future of the Health Professions Work Force.

Dr. Manasse’s time as CEO was also a period of growth for ASHP in numerous areas including membership, educational conferences, residency accreditation, publishing, and many others. He also oversaw the formation of many of ASHP’s highly successful pharmacy practice sections and forums, which include the Sections of Clinical Specialists and Scientists, Ambulatory Care Practitioners, Pharmacy Informatics and Technology, Inpatient Care Practitioners, Pharmacy Practice Managers, and the Student and New Practitioners Forums.

Henri was and still is a strong advocate for the leadership roles that pharmacists play as direct patient care providers. He has been a longtime advocate for the enhanced roles that educated, PTCB certified, and licensed pharmacy technicians must play to ensure that all patients have access to a pharmacist on the interprofessional team who is responsible for their medication therapy. Dr. Manasse has dedicated his nearly 50-year career to continuously elevating the entire pharmacy profession with the singular goal of ensuring that medication use is optimal, safe, and effective for all people all of the time.

I had the pleasure of chairing the ASHP CEO Search Committee that led to Dr. Manasse’s selection and later serving as Treasurer of ASHP during Henri’s time as CEO. Our time together and ongoing friendship is something that I will always value. Henri is a true leader and has been a mentor to countless pharmacists, student pharmacists, ASHP staff members, board members, and many others.

As we celebrate ASHP’s 75th anniversary, please join me in thanking Dr. Manasse for his exceptional contributions to ASHP and to the entire pharmacy profession.

Sincerely,

Paul

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