This is where leadership and management are the most closely entwined.
Staff management
This is where leadership
and management are the most closely entwined. Developing the staff and aligning
them with the business needs of the organisation is probably the single most
difficult and least predictable aspect of management, being the most
challenging, the most frustrating and the most rewarding all at once. It is
also the aspect of management that has historically received the least
attention, frequently regarded as common sense and not requiring special
training. Whereas other aspects of managers’ jobs are thought to require
qualifications and training, the human aspect, compe-tence in handling and
getting the best out of people, was all too frequently regarded as something
that develops automatically without help: this can be a serious and potentially
costly error. The ability of a manager, at any level, to lead a group of staff,
create a vision, sell that vision, engage staff in how the vision will be
delivered and then manage the implementation plan needs a level of self and
team awareness that can be developed with training and feedback. Leading and
managing a team effectively can be difficult and can make a manager feel
isolated at times if decisions have to be made which are right for patients and
service development but are unpopular with staff. Leadership is the subject of
much narrative and broad reading with self-reflection as well as formal
training and the support of a good manager can help leadership skills develop.
The NHS leadership qualities framework provides a structured approach to the
elements of leadership, although iden-tifying the elements and performing as a
good leader are not the same.
The starting point
for the management of others is the selection of the right person for each job
advertised.
Every pharmacist
with responsibility for recruitment from preregistration onwards needs to be
skilled in staff selection. Pharmacists will have access to expert advice and
assistance on policies and procedures from human resource colleagues, but they
will not take over the responsibilities of the employing manager. The pharmacy
team’s performance remains the ultimate responsi-bility of the chief
pharmacist, but at all management levels an individual’s performance will only
be as good as the performance of the team – so getting the right people in the
team is crucial to success.
The ability to
choose the right person for the right job with the skills to complement the
rest of the team is essential. A review of the ability of the pharmacy team to
deliver its objectives must be undertaken before a post is advertised. The
following questions should be considered before the recruit-ment process
begins, so that the manager has considered whether the post in its current
format is needed or whether a different post or professional could fulfil the
current requirements:
·
What kind of team does the pharmacy department currently
have?
·
What roles does the department need individuals within the
team to fulfil?
·
What skills are needed to meet the departmental objectives?
·
What skills are currently present in the team members and
what are the gaps?
·
What type of professional is needed to fill the gap role and
so what changes in team composition are required?
·
What personal dynamics does the group entail?
Often, an important
source of information about the purpose and function of the pharmacy team comes
from the pharmacy business plan and trust objectives. Other issues to be
considered include service developments on the horizon, potential workload
volume changes, structural changes in the health service, professional
developments and political changes. A chief pharmacist or pharmacy team manager
must have a clear vision of both service and team development if he or she is
to create a team with the ability to meet its objectives. Once the role and skills
needed are decided the next step is producing the right job description.
Before placing a job
advertisement, the job description and person specifica-tion should be reviewed
to ensure they describe the role accurately – new staff members will quickly
become disillusioned if the post for which they have applied does not undertake
the role as described in practice. Table 19.2 illustrates the criteria used to
analyse a job and award its pay banding in the national Agenda for Change pay
scales using a points system. The job description should describe the role to
be undertaken and state the job-holder’s responsibilities and authority level.
Usually the accountability (who manages the post) is stated. There is no
standard format for job descriptions in the NHS, although local templates are
usually developed in departments or trusts. Additional sheets can be added to
the back of these forms by applicants for extra supporting information. When a
job advertisement generates a large response rate it is easier for the
shortlisting team to find all of the information pertaining to an applicant in
one place rather than certain elements on an application form and the remainder
on an accompanying curriculum vitae which repeats much of the information on
the form.
Factor Relevant : job information
Communication and relationship skills :
Details the provision and receipt of information and how complex it is, what
barriers need to be overcome by the post-holder and how much
agreement/cooperation may be required
Knowledge, training and experience : What are the qualifications, theoretical and
practical knowledge and experience needed for the role?
Analytical and judgement skills : What
level of complexity of facts requires comparison and interpretation by the
post-holder?
Planning and organisational skills : Is
there a range of planning required in the role? Over short- or long-term timescales
and with what level of adjustment?
Physical skills : What
physical skills obtained through practice are needed in the role? For example, are keyboard skills used, or is
there manipulation of pharmaceuticals?
Responsibility for patient care : What
is the level of clinical care provided and is there accountability for
services?
Responsibility for policy/service development
: Is there responsibility in the role for policy development or
simply the implementation of policy developed by others?
Responsibility for financial and physical
resources : What is the range of financial responsibilities, including
budgetary responsibilities?
Responsibility for human resources : Does
the post-holder manage or supervise staff?
Responsibility for information resources : Is
the post-holder responsible for the provision of information, and what type?
Responsibility for research and development : Does
the role involve research or audit?
Freedom to act : What
discretion does the post-holder have to work alone?
Physical effort : What
level of effort is required – mainly sitting, walking, moving objects or
people?
Mental effort : How
much concentration is required and what are the levels of interruptions?
Emotional effort : How
distressing is the role? Is the post-holder dealing with emotional
circumstances regularly?
Working conditions : How
often is the post-holder exposed to unpleasant conditions, e.g. body fluids,
cytotoxics?
A person
specification will also be provided for any role advertised and this will
identify the characteristics of the future post-holder. This includes the
skills, knowledge, experience, qualifications and attributes needed, but also
the personal characteristics that are required in the successful candi-date. A
person specification will describe the essential minimum standards for the post
as well as the desirable qualities that the best candidates may have. The
essential criteria for the post will, with the job description, have resulted
in the Agenda for Change pay scale of the post and so, to be appointed, a
candidate must possess all of the descriptors in the essential criteria. These
criteria are often separated into two categories in the person specification:
(1) A, to be demonstrated in the application form; and (2) I, to be
demonstrated at interview. It is important for applicants to ensure that they
provide supporting information to indicate that they meet any criteria
described as ‘application form essential’ in order to secure an interview. If a
number of applicants meet the essential criteria and the recruiters wish to
restrict the numbers of candidates interviewed, they may eliminate candi-dates
based on the criteria that are classified desirable that are requested at the
application form stage.
It is also useful to
remember that a person specification will often cite written communication
skills as a criterion to be demonstrated at the appli-cation stage and for this
reason application forms containing typographical errors and those not
coherently structured may be cast aside. In addition a form should not simply
regurgitate the criteria in the specification. Many applicants will state that
they are self-motivated, enthusiastic and have good organisational or team
skills without providing examples of past experience to demonstrate this. It is
for this reason that an application for any job needs to be well prepared and
it is advisable for applicants to ask someone to review the form before it is
submitted. This can be a review by a friend to check for typos and
understanding or it may be particularly useful to find someone who is regularly
involved in recruitment to give advice and guidance.
The aim of an
advertisement is to ensure a good range of applicants at a reasonable cost. The
choice of advertising medium is important: the Pharmaceutical Journal is the
obvious choice for pharmacist posts but local papers and in-house hospital
magazines can be better for other staff groups. Expense may prohibit this in
many organisations and the NHS jobs website is now commonly used to advertise a
range of pharmacy posts. Candidates looking for specific roles or jobs in
specific areas can sign up for alerts from the website to their work or home
e-mail. The content of the advertisement should encourage suitable people to
apply and discourage those who are not suitable. The information needs to be
informative and yet remain clear and concise. A telephone number is normally
given through which further information can be obtained.
It is advisable that
a potential applicant calls to make enquiries regarding a job. This will
familiarise the employer with the name of an applicant and a little bit about
them, which is a useful ice-breaker during an interview if an applicant is
called for one. If applying for a senior position, it is advisable to visit the
department and get a feel for the job and the team dynamics. While it is
important that the department wants the candidate to be part of that team, it
is essential that the applicant feels comfortable with the line man-ager, the
team and the strategic direction of the department. For an appoint-ment to be
successful it needs to be ‘best fit’ for both the applicant and the employer.
When the interview
stage arrives, candidates should be clear that they would accept the post if
the terms and conditions are suitable and they are offered it. It is
frustrating for an interview panel to offer a post to a candi-date who has
decided he or she does not want the job but cannot offer a reasonable
explanation for this decision.
Methods of selection
Most candidates for
pharmacy posts will be chosen following an interview. It is often difficult to
relax at interview but it is important that the candidate is open and honest so
that the panel can assess accurately the personality of the indi-vidual and
previous experience. An experienced interview panel should help put a candidate
at ease and will describe the framework for the interview before it starts. If
candidates have questions that they wish to ask there is usually time allocated
at the end. It is advisable that a candidate makes a list before arriving at
the interview as these questions may be forgotten in the pressure of the
moment. When preparing for interview there are some standard questions that are
often asked and can be anticipated by the candidate. Answers should not simply
be regurgitated but some preparation should help the interviewee relax while
providing some easy wins. Common themes include:
·
summarising career and achievements to date
·
why does the candidate have a particular interest in the job
advertised?
·
what will the candidate bring to the post?
In addition, the
person specification can provide hints towards the other questions that may be
asked. Criteria in the person specification that are recorded as ‘I for
interview’ should be assessed by questioning or via a presentation during the
interview. It is important to listen carefully to the questions posed to ensure
that the answers are appropriate, concise, honest and do not meander. It is
acceptable to pause before answering a question to think of the best response
or consider the most appropriate example when replying to a question, rather
than rushing in to provide an answer and then being less coherent with the
final reply.
It is now common
practice to ask candidates to give a presentation, usually at the beginning of
the interview. This will help identify the candidate’s communication,
presentation and influencing skills. It is important that the candidate keeps
to the allotted time and remembers mainly to discuss the pharmaceutical aspects
of the subject rather than providing lots of back-ground information, as this
will be what will interest the panel.
Prioritisation
exercises present candidates with a selection of situations that they are
required to place in order of priority. It is usual to be able to ask for
points of clarification or explanation in these exercises to aid
prioritisa-tion, to show that impulsive decisions are not being made before all
the facts are known.
Sometimes candidates
may be invited to meet informally with departmen-tal or other trust staff prior
to the interview during what is often described as ‘trial by buffet’. This is
usually reserved for more senior appointments. For the successful candidate it
is the first step towards building relationships with new colleagues and so it
is important to circulate during the session and speak to as many of the staff
as possible.
Psychometric testing
is sometimes used in senior management appoint-ments in a hospital, although
the costs and availability of trained personnel needed to administer and
analyse the tests limit their use.
The national
shortage of pharmacists has left every branch of the profession with vacancies.
The hospital sector has had to compete with higher rates of pay for junior
pharmacists in the community sectors of the profession and attractive locum
rates of pay. Furthermore, the establishment of prescribing adviser roles in
primary care trusts has provided some of the clinical oppor-tunities seen
within the hospital sector without the unsociable hours required to meet the
7-day nature of busy acute trusts. There are also issues with the recruitment
and retention of technicians resulting from their expanding roles and the
creation of new posts during the past decade.
Much work has been
undertaken by managers across the hospital sector to improve recruitment and
retention. Senior hospital pharmacist and technician posts at more senior levels
of Agenda for Change scales are more attractive if juniors take a longer-term
view of their career pathway. Other local enhance-ments are offered in some
organisations to attract the juniors for future progression. A greater emphasis
has been placed on providing vacation work for undergraduates. For some time
the extensive undergraduate programme developed by Boots has successfully
resulted in the attraction of newly qual-ified pharmacists into their
employment. In many hospitals a training package for vacation students has been
established to offer experience in many aspects of the services provided by
hospital pharmacy departments.
Rotational training
programmes have been established by managers to encourage applicants and to
improve retention within the hospital sector, and many organisations will offer
a guaranteed postgraduate clinical diploma place as part of their recruitment
strategy. The myth that it is difficult to transfer to the hospital sector once
a community or industrial career has been started is being dispelled now and
the skills offered by many pharmacists from other branches of the profession
are welcomed within UK hospitals. Work is being undertaken by many hospital
managers to develop accelerated clinical induction packages which will develop
the clinical knowledge required for a role in hospital pharmacy while
recognising other well-developed and valu-able skills on offer from a colleague
who has previously only practised outside the hospital sector.
One of the major
attractions of a career in hospital pharmacy is the well-developed roles of
support staff. Skill mix management has progressed over recent years, with
technical staff taking on more and more of the non-clinical roles previously
held by pharmacists. This is a positive direction as it leads to retention of
good technical staff and releases pharmacists’ time to deal with more in-depth
clinical issues at a ward level. Dispensaries in some hospitals are run as
‘pharmacist-free’ zones. Pharmacists are becoming more involved in
multidisciplinary team working at a ward level, attending ward rounds, giving
prescribing advice to medical staff or practising as independent prescribers
themselves, providing administration advice to nursing staff and getting
involved in aspects of discharge planning such as preparing discharge
prescriptions on behalf of the multidisciplinary team.
Flexible working
arrangements are a common feature of hospital phar-macies: job-sharing,
part-time hours, modified start and finish times, career breaks and so on.
There is also a growing need to meet the needs of patients and other clinical
staff better by providing services beyond conventional working hours.
As well as
attracting staff, retaining them is an important part of a manager’s role. One
aspect of this is to provide a comprehensive induction programme for new
appointees. The length and nature of the induction programme will depend on the
appointee’s experience and post. Typical features will be an introduction to
colleagues, an overview of the depart-mental and trust structures, information
about trust and pharmacy policies, procedures and guidelines, essential health
and safety information and train-ing at a ward and dispensary level.
Under the Agenda for
Change pay system all staff are required to demonstrate that they have core and
role-specific competencies (the knowledge and skills framework) and have met
their objectives to pass through what is described, under the system, as the
foundation gateway and receive their incremental pay award at the end of the
first year. As a result an initial induction should be followed up by regular
reviews during the first year as the manager must support the individual to
pass through this gateway by agreeing clear objectives with the new staff
member and ensuring he or she has a personal development plan which enables him
or her to achieve the necessary criteria. An annual appraisal is essential
thereafter to review performance, celebrate successes, agree objectives or
targets and identify training needs to support the employee’s achievement for
the coming year.
Ensuring the best
staff are appointed, retained and developed are all import-ant roles for the
pharmacy manager but occasionally things go wrong. Trusts have disciplinary
procedures to deal with misconduct and personnel depart-ments provide help and
advice to managers. The first step for minor problems (for example, lateness)
will be to counsel the staff member; this is not consid-ered part of the formal
process, but does give an opportunity for improve-ment. Discussion is
confidential, based on evidence and will give the member of staff an
opportunity to explain his or her viewpoint. Clear timescales, expected
standards and review dates have to be specified and agreed with the staff
member. If improvement is not achieved or if a more serious matter occurs, the
formal steps of the disciplinary policy will be followed. Usually the steps
are: verbal warning, written warning, final warning, dismissal. However, for theft,
assault or other very serious acts (usually called gross misconduct), dismissal
may follow the first event. Those undertaking perfor-mance management or
addressing misconduct are well advised to ensure written records are kept even
if counselling or a verbal warning is given it is important to confirm this to
the member of staff involved.
On appointment,
staff will be reviewed by occupational health staff to check suitability for
employment. Inevitably, staff have periods of sickness from time to time. Their
manager should be aware of these episodes and ensure appropriate certificates
are completed and records made upon the employee’s return to work. The aim of
any trust sickness absence (sometimes called attendance capability) policy is
to support staff to attend work and achieve their maximum potential whilst they
are there. Support from the hospital’s occupational health department can be
provided if needed and should be proactively advocated to support staff and
prevent sickness absence rather than being seen as the place where staff are
‘sent’ when their attendance is poor. Work itself can cause sickness – stress
or physical problems – so such causes need to be identified and addressed. When
underlying disease or disability is identified as the cause, efforts should be
made to adapt the job to retain the employee – an aspect of encouraging
diversity in the workplace. Repeated incidents of sickness absence and
therefore the ability of the employee to fulfil the role for which he or she
was employed may result in the formal stages of the procedure being implemented
and can result in dismissal.
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