Staff management

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Chapter: Hospital pharmacy : Managing services

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.


Selection strategy


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.


Job analysis, job description and personnel specification


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.


Table 19.2 Agenda for Change role criteria and relevant job information


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.


Recruitment and retention


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.


Staff appraisal


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.


Management of misconduct


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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