B.C. patient care could be compromised by stresses put on pharmacists to meet alleged corporate performance quotas — or metrics, says a new report from the College of Pharmacists of British Columbia (CPBC).
“The findings underscore the urgent need for action to ensure that business practices do not compromise the safety, health and well-being of British Columbians,” the college said in its Pharmacy Workplace Practices Survey Preliminary Analysis & Results report.
Forty per cent of comments said pressures for business results resulted in direct harm to members of the public arising from dosage mistakes or dispensing the wrong medication.
However, the BC Pharmacy Association and some of the companies disagreed with the analysis.
The report said, that despite assurances from corporate and franchise pharmacies that business targets don’t exist, pharmacists surveyed have reported they are under pressure to meet financial targets, labour-based metrics, professional service targets, run rates, and/or other similar measures to increase profitability.
The college surveyed pharmacists anonymously on the issue in April. Some 2,199 people responded to the survey; more than 85 per cent of respondents were pharmacists, and of those, 59 per cent provided services at corporate or franchised pharmacies.
The survey was distributed to all 9,608 active registrants, including pharmacists, pharmacy technicians, and students to assess the prevalence and impact of business metrics as they relate to public safety.
“Overall, the results of the survey indicated the negative impacts of business targets on the delivery of safe and effective client care, as well as on the mental health and well-being of registrants, which is deeply concerning to the CPBC board,” CPBC CEO and registrar Suzanne Solven said in her introduction to the report.
The report outlined a number of pressures, including:
• needing to complete a certain number of procedures or assessments per shift;
• pressure to meet dollar targets for immunizations or injections within a time frame, prescription adaptations within a strict time frame, and dispensed prescriptions per shift;
• pressure to conduct a specific number of professional services per shift within a strict time frame;
• pressure to reduce labour hours to meet labour-based metrics; and,
• pressure to complete unnecessary medication reviews per shift.
“The pressure from parent companies to expand market share has resulted in numerous near-misses,” one respondent said. “The overwhelming workload makes it impossible to adhere to practice standards when providing services like counselling on medications, ultimately compromising the quality of care provided to patients. This situation not only jeopardizes patient safety, but also undermines the professional standards and expectations of pharmacists within the health-care system.”
In another situation, a company wanted a junior pharmacist fired for being too thorough in their work.
“During the peak of COVID and flu shot seasons, I have seen many pharmacists prioritize injections over thoroughly checking medications to maximize bonus income,” another respondent said. “One pharmacist, in a rush, gave a patient incorrect high blood pressure medication. The patient unknowingly took the wrong dosage for two months and requested a refill early. Upon investigating, I found that the pharmacist had made a mistake on the label of the medication and dispensed the wrong amount. Fortunately, the patient did not experience any adverse effect and was understanding of the mistake."
Companies respond
While Loblaws referred Glacier Media's questions to the association, London Drugs provided a detailed response.
“We have never had mandatory quotas for any of our pharmacists,” said Chris Chiew, vice-president of pharmacy and health care and merchandising services, in a statement.
“Although we review reports such as this with great interest, the majority of content does not pertain to London Drugs,” Chiew said. “This analysis unfairly labels all corporate pharmacies as one collective group, and the level of response from various chains may indicate pharmacists views differently with each employer.”
“While the report shares the percentage of respondents from each employer, the way the message is written and how the survey is summarized paints corporate pharmacies as an unsafe and undesirable place to work. London Drugs disagrees with this,” Chiew said. “It is already difficult for pharmacies to recruit pharmacists in a retail setting. This analysis adds to this challenge.”
“London Drugs has and will always prioritize patient care,” Chiew added.
He said with pharmacists increasingly relied on to support patient care in conjunction with other health-care practitioners, London Drugs believes it’s more important than ever to listen to its pharmacy team and continue to evolve patient offerings based on community needs and patient feedback.
Chiew said the report’s analysis over-generalizes the corporate pharmacy environment “given we operate differently from our competitors.”
“We were the first chain to install semi-private counselling booths at all our stores ensuring patients did not feel rushed when being serviced by our pharmacists,” Chiew said. “Our team is instrumental to our ability to deliver the highest standard of care possible for our patients and we give all our pharmacy staff mandatory, scheduled breaks.”
He said the company provides multiple streams of working environments, communications, and assistance programs for its employees.
Concern about equitable access to care raised
The survey found 66 per cent of respondents reported being pressured or directed to complete a specific number or dollar amount of medication reviews per shift, day, week, month, or quarter.
Meanwhile, comments with references to public safety and errors came up more frequently from registrants practicing in long-term care pharmacies than other pharmacies.
Bullying and harassment problems came up across all settings.
“However, registrants in long-term care pharmacies reported the highest percentage (15.7 per cent) of concerns in this area,” the data revealed. “This is more than twice the rate reported by registrants in hospital pharmacies (5.8 per cent), and notably higher than those in independent (9.6 per cent) and corporate (12.2 per cent) pharmacies.”
The highest number of respondents worked for Shoppers Drug Mart (23.17 per cent) followed by Pharmasave (7.13 per cent), Loblaws/Superstore (6.9 per cent), Save-On-Foods (5.37 per cent), Rexall (4.98 per cent), Sobeys/FreshCo, Safeway (4.53 per cent), Walmart (4.5 per cent), London Drugs (4.38 per cent) and I.D.A. (3.08 per cent).
Some 13.15 per cent of respondents identified themselves as independent.
The report said data suggests registrants in corporate and franchised pharmacies experience significantly higher pressure to meet dollar-based targets for services, as well as pressure to limit labour hours to meet business metrics.
“Additionally, registrants in corporate and franchised pharmacies report experiencing the most pressure to prioritize members of the public with simpler medication needs, which raises concerns about equitable access to care,” the report said.
BC Pharmacy Association concerned
In a statement to Glacier Media, the BC Pharmacy Association said it was concerned that the college released an anecdotal report on community pharmacy workplace issues and is recommending changes to pharmacy regulation without the involvement of the association representing both pharmacists and pharmacy companies.
"The report on workplace issues was developed from a voluntary, self-selecting survey sent to college registrants and was not conducted by an independent, professional research company,” the association said.
As such, the statement said, it is difficult for the association to recognize either the degree of accuracy the survey reflects or the potential effectiveness of the recommendations that flow from the anecdotal information it has gathered.
Should the Ministry of Health want to pursue the issues raised by the college that have led to this report, the BC Pharmacy Association said it would be pleased to cooperate in those efforts.
Still, the association said, it cannot endorse any conclusions or recommendations for “this critically important health-care profession that has been, and remains, on the front line of fighting COVID-19 and the flu through vaccination programs and which helps in timely access to care by assessing and prescribing appropriate treatment for 21 minor ailments and contraception.”
The association's website said it represents and advocates for more than 5,000 B.C. community pharmacists, pharmacies and pharmacy students across the province.
The College of Pharmacists of British Columbia, however, said it has a regulatory mandate to protect the public.
"We have been hearing more and more about pressures caused by performance targets in pharmacies and the potential threat to public safety," the college said in a statement to Glacier Media.
It said the survey was done to get a snapshot of the issue to gain preliminary insights that reflect the experience of registrants across British Columbia.
"Other provincial pharmacy regulators have conducted their own surveys with similar findings," the college said. "The problem is widespread and it’s real."
"We received thousands of verbatim comments from pharmacy professionals about the pressures caused by performance targets. Unsustainable workloads and staffing issues are impacting the mental health and well-being of registrants. Many expressed a fear of public harm.
"We cannot imagine any British Columbian or organization that would not be concerned by this issue. We stand by our report. We’d like to think that all those who care about pharmacy professionals have the same desire not to let these targets get in the way of public safety," the statement said.
The college said it looks forward to working with the government, the association and other partners to address the issues.
College suggestions
On June 27, the college board approved a multi-pronged, phased approach to addressing business metrics/targets, including 19 potential solutions.
Among the solutions being considered or developed:
• establishing a whistleblower program to facilitate the reporting of non-compliance with practice standards;
• exploring different fee schedules for non-compliance with practice standards, with higher fees for repeated or frequent infractions;
• working with other health-care regulators, government agencies, and other partners to influence positive change;
• exploring ways to strengthen enforcement of practice standards when business goals or metrics lead to non-compliance, ensuring pharmacy owners, including corporate and franchise entities, are held accountable;
• monitoring registrants’ workload volumes in relation to staffing levels and developing a staffing standard of practice.
“CPBC is acting now and beginning to develop or implement additional measures that will not only monitor and address the negative impact of business metrics on public safety, but also work to prevent such issues from arising in the future,” the report said.
