Hospitals, pharmacy HR environment evolving to more positive, respectful

Bad attitudes need not apply

The days of hospitals putting up with a "House, M.D." personality are fading away as pharmacy managers and others find that hospital cultures are moving toward a more respectful atmosphere.

"Big business, at least in health care, is definitely interested in becoming safer with a more respectful workplace," says Lindsey R. Kelley, PharmD, MS, manager of pharmacy operations at UPMC Presbyterian Shadyside in Pittsburgh, PA.

"What we've found over time is that being more respectful to employees tends to get more input from people who could have prevented an adverse event," Kelley says. "So we work to create an environment where people aren't afraid to speak up and say what they feel."

This culture of accountability lets staff know that everyone within a department should be in tune with the department's mission, vision, and philosophy, she explains.

There even should be peer accountability in which one pharmacist is comfortable going to another pharmacist or to a pharmacy technician and saying, "This is the expectation for our shift, and this wasn't done. Was there something else that happened on this shift, and what can I do to help you out?" Kelley suggests.

A culture of accountability encompasses a culture of respect that transcends departmental lines.

For instance, pharmacists should feel safe and respected when working with physicians, nurses, and other disciplines.

"Occasionally, you come into a situation of working with someone outside your department, and you're trying to work together on something, but you can't get that communication working," she says. "Also there are situations where you have emotionally charged conversations."

If these conversations take place within the department then departmental rules and policies can be invoked. If the conversation is with someone from another department, then it might be necessary to take this issue to a departmental leader for resolution.

For example, there was a pharmacy technician who was very upset when she returned from working on a unit, Kelley recalls.

"She stated this particular nurse was being very disrespectful to her," she says. "I got the information about who it was, what was the issue, and what was her response."

Then Kelley spoke to the nurse's unit director, who welcomed the information. Together the two met with the nurse, explaining how the technician needed to work on that unit and asking what could they do to help the technician be successful in this role.

"The nurse said, 'I didn't realize I had been short with her. I didn't intend that, and I'm sorry,'" Kelley says. "A lot of times it's a miscommunication."

Hypothetically, a pharmacist might call a nurse or physician about a patient, and the other person raises his or her voice and displays disrespect in the conversation. This is another instance in which the pharmacist should contact senior leadership to seek a resolution, she adds.

Besides the aesthetic and possible safety benefits of moving to a culture of respect, there are pragmatic reasons for emphasizing this kind of change in the hospital pharmacy.

For instance, pharmacy directors often find as they hire new pharmacy graduates that this younger generation's expectations from an employer are different from the Baby Boomer generation's expectations. Younger pharmacists might expect continual feedback, including positive reinforcement, and they will take silence as a sign that something is wrong, Kelley says.

"The pharmacists I graduated with are much more used to hearing feedback," she says. "You receive a lot of feedback at school, and you just become accustomed to it, so you start wondering if you've done something wrong if you don't hear anything."

Pharmacy directors need to keep this in mind and maybe change the way they handle new employees.

"ASHP actually has spent the last several meetings with specific programs around generational differences," Kelley says. "There can be a gap between the director of pharmacy and the staff in terms of [generational differences]."

One suggestion might be to ask new pharmacists how they would like to receive feedback, Kelley says.

"You can find out immediately, and you're not guessing," she explains. "It does take responsibility on the part of whoever is asked the question to know how they like feedback."

Feedback can be given orally, in written format, or in a variety of ways.

"I like multiple types of feedback," Kelley says. "If I do something wrong, then let me know immediately and follow-up later with a deeper conversation."

Likewise, workplaces are moving further in the direction of providing positive reinforcement to affect growth and change.

"A lot of times people correlate human resources with a negative connotation or disciplinary action," Kelley says. "We are trying to use positive reinforcement like our 'Nice Work' card."

The Nice Work card is any type of note card in which one staff member fills out something positive about another employee, recognizing their extra effort.

"It can be something as simple as helping them with a task or trading shifts or doing something outside of their job responsibility," Kelley says. "Our staff has started using those to recognize each other."

Also, the management team will provide a gift certificate to one person who received the Nice Work card and whose name was drawn in a given quarter, she adds.

"We post these cards on a bulletin board where everyone can see them in an administrative office," Kelley says. "So people can see who is getting recognized for doing nice work."