How important is Starting the Conducting better ... · tips for overcoming those barriers. What are communication skills? Effective communication is an essential part of building

TheTransitionTimes

How important iscommunication?

Starting theconversation

Communicationresources

But there’s no time!

H E L P I N G Y O U N A V I G A T E C H A N G E

Conducting betterpatient interviews

October 2008

s a f e e f f e c t i v e r e s p o n s i b l e p h a r m a c i s t p r a c t i c e

The communication issueThis month marks the launch of theRxA/ACP sponsored public awarenesscampaign. The campaign broadcasts thewide scope of pharmacist services andencourages patients to develop arelationship with a pharmacist. Are youprepared to build those relationships?

The key to developing and maintainingrelationships is good communication.Effective pharmacist-patientcommunication goes beyond the simplesharing of facts. Pharmacists must useeffective listening strategies and showempathy for the patient. The result will bemore productive patient counseling,greater compliance, and improved patientsatisfaction and health.

Just as athletes routinely practice basicskills, we too must continually practice

communication skills or they risk gettingout of shape pretty quickly. Whether it hasbeen a while since your pharmacycommunications classes, or you would liketo learn new approaches to familiarsituations, we hope you find “news youcan use.”

Suite 1200, 10303 Jasper Ave NWEdmonton, AB T5J 3N6

Telephone: (780) 990-0321Toll free: 1-877-227-3838

Fax: (780) 990-0328pharmacists.ab.ca

How to get the mostout of this issue

There’s a lot of information hereand you may not need all of it rightnow. However, we encourage you

to keep this as a handy resource.

The information is divided into sectionscorresponding to the stages of interactionwith a patient.

Whether you read all of it, or just the sectionsyou relate most to, we hope you come awaywith new ideas and renewed confidence inyour abilities to really get to know and helpyour patients.

Before you do anything else...answer these two questions:1. How do I really want to practice pharmacy?2. What am I willing to do to make that vision of my practice a reality?

Until you know the answers to thesequestions, all the tips in the world won’tmake a difference. The busy-ness of yourdays and crises of the moment will sweepaway your good intentions unless youhave clearly defined goals and a plan tokeep you on track.

To formulate your goals and plan,consider “What is my commitment to mypatients? What gives me the mostsatisfaction in my workday?” If you feelpressured for time, ask, “What changes

could I make to give me 30 seconds morewith each patient?” In just 30 seconds,you can introduce yourself by name,make eye contact with the patient, ask afocused question that elicits a specificresponse, and listen attentively. All ofthose actions will help you establishbetter patient relationships. If even thatwill take too much time, ask “Which 25%of my patients would benefit most from30 more seconds of attention?” and startfocusing on them.

October 2008 TheTransitionTimes alberta college of pharmacists

How important is communication?Effective communication is critical.Pharmacists, particularly those incommunity practice, “are often the lasthealth professionals to see a patientbefore the latter embarks on self-treatment. Thus, they have an importantrole in reinforcing and clarifyingpreviously presented information,explaining and justifying procedures,offering suggestions, providingreassurance and responding to patients’questions.”1

Researchers have found2 that highcommunication performance results inhigher patient satisfaction scores, higherperceptions of quality, higher levels of

trust, and behavioral intention scoresthat reflect a greater willingness to use and recommend the pharmacist.

Cautionary tales:the researchPatients desire a relationship withtheir pharmacist, but need help to getthe conversation started.

Patients seek a close relationship witha knowledgeable and respectfulcommunity pharmacist and alsoreport an interest in engaging ininformed decision-making, includingdiscussions regarding medicationoptions, side effects, and concernsabout rising medication costs. Yet fewreport feeling comfortable initiatingsuch discussions, due to either notbeing able to identify the pharmacistor a sense that the pharmacist was toobusy to talk with them.3

A 2006 American PharmaceuticalAssociation (APhA) survey found thatnearly two of every three people (65%)filling a prescription for the first timewere likely to ask their pharmacist a

Words are, of course, the mostpowerful drug

used by mankind.

– Rudyard Kipling

The two words“information” and“communication”

are often usedinterchangeably, but they signify quite different

things. Information is giving out;

communication is getting through.”

- Sydney J. Harris

High communication performance results in 1. higher patient satisfaction scores, 2. higher perceptions of quality, 3. higher levels of trust, and 4. behavioral intention scores that

reflect a greater willingness to use and recommend the pharmacist.

2


3

question. At the same time, however,officials at the pharmacy group weredistressed to learn that personalrelations between pharmacists andpatients appear to be suffering.4

Only 20% of the consumers polled forthe 2006 survey said that they are on afirst-name basis with their pharmacist.This finding is a source of concern forAPhA because “previous pharmacyconsumer surveys have found thatpatients who know their pharmacistby name are much more likely toseek advice.”

Finally, in 2007 the Canadian Councilon Learning reported that 60% ofadult Canadians lack the capacity toobtain, understand and act uponhealth information and services andto make appropriate health decisionson their own.

Crowded pharmacies, rushedpharmacy staff, low literacy, culturaldifferences, embarrassment, and manyother factors can be barrierspreventing patients from asking thequestions they want, and need,answers to. The following pages offertips for overcoming those barriers.

What arecommunicationskills?Effective communication is an essential part of building andmaintaining good relationships. It iscomprised of many skills that helppeople to understand and learn fromeach other, develop alternateperspectives, and meet each others’needs.

Communication is not just what we say,but how we say it, where we say it, and,sometimes most importantly, what wechoose not to say.

Communication skills are verbal and non-verbal words,phrases, voice tones, facial expressions,gestures, and body language that youuse in the interaction between you andanother person.

Verbal communication is the ability to explain and present yourideas in clear English, to diverseaudiences. This includes the ability totailor your delivery to a given audience,using appropriate styles andapproaches, and an understanding ofthe importance of non-verbal cues inoral communication. Oralcommunication requires thebackground skills of presenting,audience awareness, critical listening,and body language.

Non-verbal communication is the ability to enhance the expressionof ideas and concepts without the use ofcoherent labels, through the use of body

language, gestures, facial expressionsand tone of voice, and also the use ofpictures, icons, and symbols. Non-verbal communication requiresbackground skills such as audienceawareness, personal presentation, andbody language.5

So, communication is much more thanjust the words you choose. Given theincreased complexity of pharmacist-physician and pharmacist-patientinteractions, the changing modes ofhealth care, and the ideal role of thepharmacist as part of an integrated careteam, accurate and clear communicationis crucial.

Understanding

As with any time you meet someonenew, there is the potential for the “startof a beautiful friendship” or anencounter both of you may want toforget. What can you do to make thefirst meeting a success?

Make sure the patient is talking more than you are! Although you are the medicationexpert, your job is not to tell the patienteverything you know. Rather, it is toestablish their level of knowledge andperceptions and then give them only theinformation they can really use.

Create a “safe” space for conversation

This does not refer to a physical space(although that’s important too), but anatmosphere in which patients feelcomfortable and free to talk about or listento any topic, no matter how sensitive itmay be. Empathetic listening, open bodylanguage, “mirroring” and paraphrasingare some techniques you can use to createsafe conversational spaces. Phrases such as“I have two minutes right now and I wantto make sure this medication is the best fitfor you. What questions do you have?”also make the patient feel important and atease, while setting a conversational timeboundary that fits your schedule.

Use language that encourages dialogue

The way in which a question is asked,both the tone and the words, determineshow it will be answered. Make sure youget focused, insightful responses by usingopen-ended questions and a pattern ofquestioning that logically guides thepatient. The following examples offerpatterns that may work for you.

If the patient is coming to you with anew prescription, ask:6

� What did your doctor tell you themedication is for?

� How did the doctor tell you to take it?

� What did the doctor tell you to expect?

These open-ended questions workbecause they:

� are non-threatening to patients;

� frame patients as being activeauthorities over their own health; and

� allow you to assess howknowledgeable patients are abouttheir condition and medication. Thiswill help you know what type ofcounseling patients require.

Other examples of open-ended questionsinclude:

� What can I do for you?

� How can I help?

� Tell me what’s going on?

Caution: Although “How are you?” isopen-ended, it is so ambiguous that itrarely yields useful information. Try amore focused question for better results.

If a patient comes to you for a refill, youcan use another series of open-endedquestions to assess the patient’sknowledge and correct any complianceissues. Try:

� What do you take the medication for?

� How do you take it?

� What kind of problems are youhaving? or What effects are younoticing?


4

Starting the conversation

I’ve never learned anything

while I was talking.

– Larry King

The problem withcommunication ...

is the illusion that it has beenaccomplished.

– George Bernard Shaw


Many elements combine to form asuccessful patient interview: creating anatmosphere of trust and comfort, askingthe right questions in a way that gets theresponses you need, really listening tothe answers, and being prepared if youneed to deliver negative news. The tipsin this next section will help you withall of these elements so that both youand the patient get the most from yourtime together.

Steps of a successful interview

1. Greet the patient and introduceyourself by name. Remember thatpatients who know their pharmacist’sname are more likely to seek advice.

2. Explain the interview process.

3. If not already there, direct the patientto the consultation area.

4. Explain why you need to collect theinformation, what you will do withit, and that it will be treatedconfidentially. Let them know theywill be an active participant and thatthe quality of their input impacts thequality of the decisions made. Fullinformation makes for effectivesolutions.

5. Indicate how long the interview willlast.

6. Pay attention to body language –yours and theirs.

7. Ask questions and practice activelistening.

8. Communicate at an appropriateeducational level and avoid medicaljargon. Consider using non-verbalaids such as diagrams, brochures, orobjects to help the patientunderstand.

How to be a good listenerGood listening skills help us get alongwith others and work better at our jobs.People who listen save time and seemsmarter and more understanding.7

Listening is hard because so manythings fight for our attention. Thespeaker and the listener must both workhard when communicating to makesure each one gets the message.

Have one conversation at a time

Listening to two things at one timemeans you can’t hear or think abouteither one.

Let others finish talking

To listen well, you must stop talking.Don’t interrupt or put words in theother person’s mouth.

Make eye contact

Be sure to look the speaker in the facemost of the time, especially look ather/his eyes. If you forget to make eyecontact, the speaker may think you arebored, withdrawn, or simply notlistening. Also be culturally sensitive:some individuals may be uncomfortablewith too much direct eye contact.

continued

5

Conducting better patient interviews

A good listener isnot only popular

everywhere,but after a while he gets to know

something. – Wilson Mizner

Asking the right questionstakes as muchskill as giving

the rightanswers.

– Robert Half


Take a listening position

Sit or stand in a comfortable position withyour body aimed in the general area wherethe speaker is. Be aware of other non-verbals: placement of arms, leaningforward when necessary, head nodding,degree of personal space, smiling.

Don’t be turned off by how others talk

Try to listen to what a person says and nothow he or she says it. It is easier to listen tosome people than others; make the effortfor everyone.

Make sure you heard right

If you didn’t hear or don’t understandwhat someone said, have them say it again.Ask them to explain it. Paraphrase, usingquestions such as:

� What I hear you saying is ...

� In other words ...

� So basically how you felt was ...

� What happened was ...

� Sounds like you’re feeling ...

Know what the other person wants

Ask yourself, “Why are we talking? Is whatthey have to say important?” Attempt toput yourself in the other person’s shoes interms of trying to understand how theyfeel, while also not becoming consumedwith their difficulties. Incorporate yourown self-care so that you do not burn out.

Watch body language

Body language is a person’s gestures, toneof voice, body posture, and facialexpressions. It may say more than words.

Listen to what the other person DOESN’T say

People don’t like difficult situations. Theymay not look at you, use unnatural words,or pause a lot. Ask questions to help themexpress their full thoughts.

Don’t let “red flag” or “hotbutton” words throw you

Some words can upset us. This stops usfrom listening. When you hear things thatmake you angry or upset, try to listenanyway.

Blocks to listening8

The speaker’s control of the message

A two-way flow of information keepslisteners focused and involved. Sometimesthe speaker’s control of the message is toorigid and this blocks a two-way flow.Examples: lecturing, advice giving,reprimanding.

Assumptions

Assumptions are often not accurate andthey certainly prevent the listener fromfocusing on what’s being said. If you’reassuming, you’re not listening.

Silent counter-arguments

Listeners who find themselves challengedby what they hear may begin formulatingtheir own counter-arguments while themessage is still en route. The listener,though still apparently listening, hasshifted focus to refuting what the speakerhas “mistakenly” said.

Distractions

Other things in the environment, in yourown mind, and other stimuli get in the wayto truly attending to what another person issaying.

Interruptions

In our haste to share our own ideas, we cutothers off. This conveys to the speaker thatyou do not value what they have to say.

We have two ears and one mouth so that we

can listen twice as much as we speak.

– Epictetus

6


7

Improving patientcounsellingThe key to effective patient counsellingis giving the appropriate information atthe appropriate time in the appropriateway. Easy, right?

Unfortunately, pharmacy degrees don’tautomatically bestow psychic powers.You can’t know how much the patientknows or how willing they are to receivenew information. Therefore, you needtools to uncover the information.

In addition to open-ended questions,active listening, and technology such aselectronic health records, there aretechniques you can use to get morethorough answers to your questionsand greater acceptance of yoursuggestions.

Eliciting patient input

One practical technique for elicitingquestions and providing information is in the elicit-provide-elicit model.9

� Elicit what the patient does/does notwant to know.

� Provide information.

Be neutral. Do not use “you.” Instead use phrases such as “Otherpeople find ...” or “What happens tosome is ... ”

� Elicit the patient’s reaction. Now usethe word “You.”

For example, “What do you make ofthis?”

This technique will help you set thepatient at ease, assess their knowledge,and gauge their readiness for changeand/or new information.

continued

Tell me and I’llforget. Show me

and I’ll remember.Involve me and I’ll understand.

– Confucius

Most conversations

are simplymonologues

delivered in thepresence of a

witness.– Margaret Miller

The greatestcompliment that

was ever paid me was when

someone asked mewhat I thought, and attended to

my answer. – Henry David

Thoreau


8

Dealing with patients’ emotionsand behaviour 10

Communication becomes more difficultwhen stress, worry, illness, and emotionsare thrown into the mix. Knowing how todiffuse emotions can help you get to theroot of problems more easily and can makereaching an agreeable resolution easier foryou and your patients.

Confirming patient understanding

After you have collected the information,charted a plan, and counseled the patienton a prescription, confirm that theyunderstand the directions. You can do thisby saying, “Just to make sure I didn’t leaveanything out, please tell me how you aregoing to take your medication.” When youlisten to the patient describe the process intheir own words, you will be able to hear ifthey truly understand.

Note that asking close-ended questionssuch as “Do you understand?” or “Anyquestions?” will not yield the same results.An embarrassed or timid patient mayanswer “yes” even if they don’t reallyunderstand.

Emotion/behaviour Recommended reaction

Denial: questioning diagnosis andinformation provided

� Empathize, listen� Repeat information that patient may not

have absorbed due to shock� Provide additional information� Reassure (avoid false reassurance)

Anger: blaming, questioning, feelinghelpless, complaining

� Listen: let the patient vent, then try tofind source of anger

� Do not return anger� Empathize

Depression: silent, crying, grieving � Listen� Empathize� Help patient focus on what can be done

Bargaining: confused, trying to weighoptions

� Listen� Provide information� Provide decision-making tools

Acceptance of situation: calm andresigned

� Allow privacy� Empathize� Offer to help keep comfortable

Lonely � Allow time to talk� Refer to support groups

Disoriented, abstract behaviours � Listen� Avoid trying to reason� Contact family/care givers� Refer to support group or treatment

In our society, “any” is associated with “none”, as in, “I don’thave any bananas.” When patients hear “Do you have anyquestions?” it subconsciously triggers a blocking mechanism.Instead of perceiving an invitation to share information, patientsinterpret this phrase as a signal that the conversation is done.

Lisa Guirguis, PhD, is an Assistant Professor with the Faculty ofPharmacy and Pharmaceutical Sciences at the U of A. She draws onher keen interests in pharmacy and language as she instructs first-yearcommunications classes and researches pharmacist communicationpractices.

Lisa’s #1 communication tipAvoid asking: “Any questions?”


9

Communicatingnegative information11

Emotions often run high when actions haveresulted in negative consequences.Whether it is an adverse drug reaction or amishandling of information, the way youhandle a negative incident with the patientwill have far-reaching repercussions.

How things are said – the tone of voice, thewords used, the attitude and approach ofthe pharmacist – are all important forhealth professionals to attend to whencommunicating with others aboutunsatisfactory situations. The following aresome communication techniques andsuggested dialogue.

Be prepared

Know the details of what happened,consider factors that led to the incident,and know what your options are to remedythe situation.

Deal with and understandpersonal emotions

Panic, fear, embarrassment, anger are allemotions experienced by parties involvedin a negative incident. Make a consciouseffort to breathe deeply and focus on theindividuals not the outcomes.

Choose words carefully

Words are powerful. Avoid “trigger”words and questions that tend to raiseemotions or lead to further questions orconcerns.

Use helping words and words ofagreement as much as possible. This caninclude phrases such as: “You’re right,this shouldn’t have happened.”

“That may be, and ...” “It may seem thatway, and ...” “I’m as concerned aboutthis as you.”

� Focus on the patient. The patient is theinjured party and the healthprofessional’s personal concerns aresecondary, even if the instinct may befor self-protection.

� Be aware of non-verbal language.Portray confidence and caring throughpositive body language such asstanding erect, nodding whenlistening to the patient, keeping thevoice low.

� Before asking questions and verifyingthat an incident has occurred,empathize with the patient’s feelings.

� Deal with anger appropriately. Allowexpressions of anger but do not take itpersonally. Empathize andacknowledge the anger.

� Reassure the patient. Reassure that thesituation will be handledappropriately, that this is not a usualoccurrence and that you’re genuinelyconcerned.

� Avoid leading questions or blaming.

� Do not ascribe blame or make excuses.

� Explain what will be done.

� Follow-up. Provide information onhow you fixed the problem(e.g., new policy, results of aninvestigation) and offer furtherapology and thanks.

Instead of … try … Why?

but and, however “But” negates what was just said: “I’msorry about this, but I’ll check into it.”

starting questionswith “why”

Is there a reason ... Questions starting with “why” can makepeople feel defensive.

error, mistake medicationincident or adversemedication event

Some people believe that the words“error” and “mistake” should not be usedas these words are loaded with blame andcan trigger an emotional response as suchas anger or fear, as well as give theimpression that one individual is to blameand should be punished.

problem issue, question,situation

Problem has a negative connotation

Kind words can be short and easy

to speak, but their echoes are

truly endless.– Mother Teresa

of Calcutta

They may forgetwhat you said, but they will never forget

how you made them feel.

– Carl W. Buechner


Communication resources for pharmacistsCommunication resources abound. Thefollowing represent just a small samplingof pharmacist-specific offerings available inAlberta.

Continuing Education and Training

� A distance-learning course, DirectPatient Care: A Curriculum forLearning, from the Canadian Society ofHospital Pharmacists includes materialon improving pharmacist-patientrelationships. www.cshp.ca

� Canadian Management Centre offersmany programs that focus oncommunication and interpersonal skills,including dynamic listening skills,assertiveness training, communicationexcellence for frontline staff andfundamentals of emotional intelligence.www.cmctraining.org

� WorldWideLearn is an online educationdirectory. It offers communications,customer service and teamworkbuilding courses for a general audience,as well as many CE lessons on clinicalsubjects for pharmacists.www.worldwidelearn.com

� Pharmacy Gateway, home of PharmacyPractice and Pharmacy Post, offers a widerange of online CE programs. All CElessons for pharmacists are approved byCCCEP. www.pharmacygateway.ca

� Treating Patients with C.A.R.E. is acommunications skills programdeveloped by the Institute forHealthcare Communication (IHC) thatcan be used with all staff who havecontact with patients - frommaintenance, housekeeping andreception staff to clinicians. Theprogram is delivered by localfacilitators, supported by the HealthQuality Council of Alberta (HQCA).Over 25 qualified individuals are nowdelivering the hands-on workshop inAlberta. www.hqca.ca

� The ReLATE/ReSPOND Toolkit assistshealth care professionals by outliningcommunication strategies to buildpositive patient-provider relations,including how to establish rapport andrespect the perspective of patients and

families while providing and explaininginformation in an empathetic way. It canbe obtained upon request from theHQCA. www.hqca.ca

� Toastmasters International is a non-profit organization that hosts clubsacross Canada to help membersimprove their communication andleadership skills. www.toastmasters.org

Publications/Articles

� 10 Steps to Customer Satisfaction is a 20-page supplement published by Drug Store News. It offers in-depthinformation on how to improvecustomer relationships. You candownload the report atwww.pharmacysatisfaction.com

� Success Skills: Working Effectively withPeople by U.S.-based pharmacyleadership coach Sara White, offerspharmacy-specific advice on improvingrelationships with superiors,subordinates, peers, and otherhealthcare providers.www.ajhp.org/cgi/content/full/64/21/2221

� Influencing Prescribing Through EffectiveCommunication Skills by Shaun F. Youngand Andrea K. Macleod and publishedin the American Journal of Health-SystemPharmacy focuses on how pharmacistscan communicate their evidence-basedknowledge to healthcare providerseffectively.www.medscape.com/viewarticle/518685

Books

� Communication Skills for Pharmacists(Bruce Berger, APhA Publications)provides practical advice on buildingrelationships.

� Communication Skills in Pharmacy Practice(William Tindall, Robert Beardsley andCarole Kimberlin, Lippincott Williams& Wilkins) presents communicationconcepts, theories and skills as well assample dialogues and practical exercisesfor applying the material.

� Handbook of Communication Skills (OwenHargie, editor, Routledge) details boththe theory and practice ofcommunication skills. It has receivedwidespread recognition as the key textin the field of interpersonalcommunication, bringing together thescholarship of notable writers fromEurope, the USA and Australia.

� Pharmacists Talking with Patients: A Guideto Patient Counseling (Melanie Rantucci,Lippincott Williams & Wilkins), writtenby a Canadian pharmacist, outlinesways to incorporate effective patientcounselling into pharmacy practice andshares ways to develop strongcounselling techniques.

� Interpersonal Communication inPharmaceutical Care (Helen Meldrum,Haworth Press) details the essentialinterpersonal skills needed in pharmacypractice.

10


11

Congratulations to the pharmacists whohave received authorization for additionalprescribing and administering drugs byinjection!

The ranks have doubled since weintroduced our first fifteen additionallyauthorized prescribers. Joining with theinitial group of successful pilot participantsare fifteen more pharmacists who steppedforward to advance their practice and theservice they offer their patients. These newleaders in the profession are:

� Alison Alleyne - Red Deer

� Nyanza Austin-Bishop - Calgary

� Jennifer Bonnetta - Calgary

� Cynthia Brocklebank - Calgary

� Anita Brown - Okotoks

� Yoko Dozono - Calgary

� Michelle Foisy - Edmonton

� Cindy Jones - Athabasca

� Jason Kmet - Calgary

� Christal Lacombe - Calgary

� William Leung - Sherwood Park

� Michelle MacDonald - Airdrie

� Darsey Milford - Bellevue

� Ann Thompson - Edmonton

� Anita Warnick - Calgary

We would also like to congratulate the 87pharmacists who have received theirauthorization to administer drugs byinjection. Their dedication to advancing theprofession and providing their patients theutmost care is admirable.

References1 Hargie, Owen, Handbook of Communication

Skills, Routledge, New York, 1994

2 Bentley, John P. ; Stroup, Lindsey J. ;Wilkin, Noel E. ; Bouldin, Alicia S., “Patientevaluations of pharmacist performance withvariations in attire and communicationlevels”, Journal of the American PharmacistsAssociation, Vol. 45, No. 5, 2005, pp. 600-607

3 Excerpts from Aug. 19, 2007news release,“Health care disparities start at the localpharmacy, study shows”, University ofCalifornia, San Francisco website(http://pub.ucsf.edu/newsservices/releases/200708152/)

4 Pharmacy Times, Dec. 2006

5 Adapted from “How to Improve MyCommunication Skills”, OSCE home website,(http://www.oscehome.com/Communication-Skills.html)

6 Questions in this article were adapted from:McDonough, Randy P., Bennett, Marialice S.,“Improving Communication Skills ofPharmacy Students Through EffectivePrecepting”, Am J Pharm Educ. 70(3): 58,June 15, 2006

7 Material adapted from the University ofNebraska Cooperative Extension and theNebraska Health and Human ServicesSystem document “Educational materialsto support Employment First”(http://extension.unl.edu/welfare/listener.htm)

8 Texas Women’s University, CounselingCentre (www.twu.edu/o-sl/counseling/SelfHelp026.html)

9 Rollnick, S., Mason, P., Butler, C., Healthbehavior change: A guide for practitioners,Churchill Livingstone, New York, 1999

10 Excerpted from Rantucci, Melanie,Counselling special patient groups,(www.pharmacygateway.ca/pdfs/2004/08/NovoCE_Aug.pdf)

11 Adapted from Rantucci, Melanie, Stewart,Ian, Stewart, Christine, Focus on SafeMedication Practices, Lippincott, Williams andWilkins, 2007.

Recognizing the new practice leaders


12

There never is, and there never will be,enough time to do everything you want.That being said, it’s amazing how time canbe found for priorities. It brings to mindthe classic time managementdemonstration:

� Start with a bucket, some large stones(enough to fill the bucket), some smallstones, some sand and water.

� Put the large stones in the bucket – is itfull? Not yet.

� Put the small stones in around the bigrocks – is it full? Not yet.

� Put the sand in and give it a shake – is itfull? Still no.

� Put the water in. Now it’s full.

� The point: unless you put the largestones in first, you won’t get them in atall.

You have to decide what the “large stones”will be in your practice. What comes first?There is no denying that many currentpractice models and incentive programsare designed to encourage high volumedispensing instead of high pharmaceuticalcare and we know change won’t happenovernight. However, nothing changes ifthere is no demand for change.

Practice evolution is inevitable. The currentmodel under which most pharmacistswork is disappearing. The status quo is notsatisfactory or sustainable. The dispensingfunction is being centralized and/or

automated, pharmacy technicians will soonbe playing a larger role, the health systemcan’t/won’t pay for inefficient use ofprofessionals, pharmacists are not receivingthe professional recognition or jobsatisfaction possible, and patients are notgetting as much benefit as they could frompharmacists’ skills. Something has got tochange – and it is.

The Alberta Pharmacy Practice ModelsInitiative (PPMI), introduced by RxA, isexploring new ways for pharmacists to usetheir clinical skills (www.rxa.ca/ppmi). Thescope of practice has expanded to includeprescribing and injections, opening upwhole new areas of patient care. Pharmacygraduates are entering the workforce withnew skills and expectations for the deliveryof care. Future possibilities will be limitedonly by apathy or an unwillingness to stepup to the new opportunities.

Start small: the changes don’t have to bemonumental.

“But there’s no time!”If we wait for the moment

when everything, absolutely everything,

is ready, we shallnever begin.

– Ivan Turgenev

The best way to predict the

future is to create it.

– Peter Drucker

5 things you can do right now You can incorporate the following five communication practices to improve communicationwith your patients right now. Each tip takes only seconds, but yield sizable benefits.

Introduce yourself by name to each patient (see page 3 for why this is important).

Make eye contact with each patient (see page 5).

Ask focused, open-ended questions (see page 4).

Take a listening position (see page 6).

Be prepared to diffuse emotions (see page 8).

Now it’s up to you: Will you make

things happen, watch things

happen, or ask, “What happened?”

1

2

3

4

5

Documents

How important is Starting the Conducting better ... · tips for overcoming those barriers. What are communication skills? Effective communication is an essential part of building