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