Date post: | 24-Dec-2015 |
Category: |
Documents |
Upload: | marlene-houston |
View: | 213 times |
Download: | 0 times |
A diary study of community pharmacists’ mental workloadDr Hannah Family, Prof Marjorie Weiss, Dr Jane Sutton Department of Pharmacy & Pharmacology
When she said she wanted to study my
brain, this wasn’t quite what I was expecting
Image source: With thanks to LocumPharmacist on Flikr https://www.flickr.com/photos/easylocum/5281553506
Why are we interested in community
pharmacist’s mental workload?
http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/PublicationsAndStatistics/PressReleases/PressReleasesNotices/fs/en?CONTENT_ID=4091698&chk=yNYBq7
“it is just impossible these days it is like a relentless treadmill” (Pharmacist 49)
Image Credit: physical-activity-120112-M-2021D-019 by MilitaryHealth(2002). Source: https://www.flickr.com/photos/militaryhealth/8652397443/in/photolist-ebzNjg-4TQjyn-gZ2tdh-gYekTE-pc3KEs-4Zdaq7-nU8XXw-qgETzk-4RLoPV-6LY11P-b75E9M-6XYHki-a93DgW-4yTFMR-DMDsQ-6XX4B8-oNa3ft-85BBbw-4v1SMp-6wkxgF-6wpJBQ-ERoSZ-oXvZoe-EJEkP-bgP7PX-kL7qV-6wkxwH-6wkxYr-pEwkEf-q7nDUQ-7D4Ypf-pPNyrV-6t447u-aevGpq-6Rkaen-a8bDv5-a88Lmc-arvWre-a88HED-a88HTg-a8bCRN-a88KCt-a88K26-a88Jer-a88JB2-nqzYDQ-s1Poc-pxXX7d-4N44Gw-pxVTf6
Dispensing factory(Gidman, 2011)
Since 2005 the number of dispensed medicines has risen by 39%
Since 2005 locally commissioned services have increased by 69.3%
Since 2005 MURs have increased by 1789%!!
(Prescribing and Primary Care team, 2012, 2013)
Workload isn’t just about the number of services you offer…
MENTAL WORKLOAD• A multidimensional construct that describes the demands made of an
individual’s limited information processing capacity.
• The level of demand made is the product of the interplay between an individual’s characteristics, the environment in which the task is carried out and the task characteristics.
This is the first study of community pharmacists’ mental workload during a typical day in their practice
How do you measure mental workload?
The NASA Task Load Index (Hart & Staveland, 1988)
The diary study
• Part of a larger mixed methods study• Ethical review and approval (for whole study) from the University of Bath
Research Ethics Approval Committee for Health
Recruitment• Participants recruited from a group of 104 strategically recruited
pharmacists who had taken part in an earlier phase of the research• 50 CPs Expressed an interest in participating & were posted/emailed a
diary
Response Rate• 40 diaries returned (response rate 38%)• 186 mental workload ratings from the diaries (average 4.65 ratings per
participant)• Participants paid £5 highstreet voucher on return of diary
Diary• 7 x Mental Workload Ratings + pharmacy “busyness”• Demographics & Services Offered
Participant Demographics
Characteristics Sex
Male 19 Female 21
Mean Age in years (range) 39.4 (24-61) Ethnicity White 30
Mixed 3 Asian 4 Chinese 2 Black 1
Type of Pharmacy the pharmacist participant was working in the day they completed the mental workload diary
Supermarket 7 Multiple 16 Small-Medium Chain
3
Independent 9 Locum 4
Pharmacist’s working hours Full-time (N) 29 Part-time (N) 11
Mean number of years of community pharmacy experience (range) 16.25 (1-40)
Table 1: Characteristics of CPs who participated in the MWL diary study
Bivariate correlations revealed no relationship between participant sex, age, pharmacy experience or the type of community pharmacy the CPs worked
Questionnaire Item
Working hours
Mean Std. Deviation
Std. Error Mean
t (df)
P Effect size (r)
How busy is the pharmacy at the moment?
Full time 5.38 2.73 .23 1.37 (184)
p>.05 Part time 4.75 2.75 .40
Mental Demand
Full time 6.34 2.52 .22 .51 (184)
p>.05 Part time 6.13 2.46 .35
Physical Demand
Full time 4.69 2.64 .23 5.00 (111.40)
p<.001 .42 Part time 2.90 1.94 .28
Temporal Demand
Full time 5.94 2.89 .25 .48 (184)
p>.05 Part time 5.71 2.87 .41
Performance Full time 2.46 1.96 .17 2.83 (184)
p<.01 .20 Part time 1.58 1.44 .21
Effort Full time 6.70 2.25 .19 1.71 (184)
p>.05 Part time 6.04 2.48 .36
Task Frustration
Full time 4.70 3.20 .27 1.35 (184)
p>.05 Part time 3.98 3.13 .45
Overall MWL Full time 5.14 1.99 .17 2.29 (184)
p<.05 .17 Part time 4.39 1.86 .27
Mental workload and working hours
Full-time = >35 hours a week, 138 ratings from F/T CPs, 48 from P/T CPs
Table 2: MWL and pharmacy busyness ratings made by CPs who work full-time and those who work part-time
Mental Workload Throughout the Day
Figure 1: Graph of the NASA-TLX MWL items and pharmacy “busyness” plotted against time of day
Peak in performance concern around 7am
concern
Mental Workload Throughout the Day
Figure 1: Graph of the NASA-TLX MWL items and pharmacy “busyness” plotted against time of day
Time pressure
Mental demand
Mental effort
concern
Mental Workload Throughout the Day
Figure 1: Graph of the NASA-TLX MWL items and pharmacy “busyness” plotted against time of day
Peaks in all facets *except performance*
11am 5pm
concern
Shifts from low to high or high to low volume of work
predicted increases in near
miss reports(Grasha, 2002)
Mental Workload Throughout the Day
Figure 1: Graph of the NASA-TLX MWL items and pharmacy “busyness” plotted against time of day
Peaks in time pressure,
performance concern and
task frustration
2pm
concern
Dispensing incidents were found to occur
during prolonged periods of moderate
workload or after a busy period.
Possibly due to a fatigue after-
effectJames et al
(2013)
Image Credit: physical-activity-120112-M-2021D-019 by MilitaryHealth(2002). Source: https://www.flickr.com/photos/militaryhealth/8652397443/in/photolist-ebzNjg-4TQjyn-gZ2tdh-gYekTE-pc3KEs-4Zdaq7-nU8XXw-qgETzk-4RLoPV-6LY11P-b75E9M-6XYHki-a93DgW-4yTFMR-DMDsQ-6XX4B8-oNa3ft-85BBbw-4v1SMp-6wkxgF-6wpJBQ-ERoSZ-oXvZoe-EJEkP-bgP7PX-kL7qV-6wkxwH-6wkxYr-pEwkEf-q7nDUQ-7D4Ypf-pPNyrV-6t447u-aevGpq-6Rkaen-a8bDv5-a88Lmc-arvWre-a88HED-a88HTg-a8bCRN-a88KCt-a88K26-a88Jer-a88JB2-nqzYDQ-s1Poc-pxXX7d-4N44Gw-pxVTf6
Does it matter if my mental workload is high?
When Mental Workload is high or low, it can affect the way our brain processes information and the way we carry out tasks, and make us
more susceptible to making errors
This usually happens without conscious awareness that it has
changed
Spot the Difference (#EZDrugID)
Conclusions• Sufficient evidence to warrant future investigation of mental workload in
community pharmacy (and other pharmacy sectors)• Mental effort and mental demand underline the high levels of concentration
CPs feel they need to maintain throughout their shift• Peaks in time pressure, task frustration and performance concern following
the lunch hour• Performance concern ratings hint at key times of day when CPs need time
to mobilise mental resources
Implication for practice = undertake non-safety critical tasks until CPs feel “in the zone”
Main Limitations• Volume of work wasn’t measured at the time of the ratings• Relatively small sample size
Thank you to..
• You for listening!• My participants• The pharmacy organisations and pharmacists who have supported and
promoted my research to date
Any Questions?
References
• Gidman, W. (2011). Increasing community pharmacy workloads in England: causes and consequences. International Journal of Clinical Pharmacy, 33(3), 512-520. doi: 10.1007/s11096-011-9498-x
• Grasha, A. F. (2002). Tools for the reflective practitioner: using self-monitoring, personal feedback and goal setting to reduce error Health Notes: Quality Assurance - Preventing Medication Errors (Vol. 1, pp. 19-24). San Francisco (CA): Calafornia State Board of Pharmacy
• Hart, S. G., & Staveland, L. E. (1988). Development of the NASA-TLX (Task Load Index); results of empirical and theoretical research. In P. A. Hancock & N. Meskkati (Eds.), Human Mental Workload. Amsterdam, Netherlands: North-Esland.
• James, K. L., Barlow, D., Bithell, A., Hiom, S., Lord, S., Pollard, M., . . . Whittlesea, C. (2013). The impact of automation on workload and dispensing errors in a hospital pharmacy. International Journal of Pharmacy Practice, 21(2), 92-104.
• Prescribing and Primary Care team. (2012). General Pharmaceutical Services in England 2002-03 to 2011-12: Health and Social Care Information Centre. Available at: http://www.hscic.gov.uk/catalogue/PUB08860/gen-pharm-eng-2002-03-2011-12-rep.pdf
• Prescribing and Primary Care team. (2013). General Pharmaceutical Services in England 2003-04 to 2012-13: Health and Social Care Information Centre. Available at: http://www.hscic.gov.uk/catalogue/PUB12683/gen-pharm-eng-200304-201213-rep.pdf