Licensees’ roles in responding to patient concerns

Background

Whether due to miscommunication, misunderstandings, or errors, every pharmacy team will encounter patients with concerns. ACP’s complaints department hears from some of these individuals, who may bring forward concerns about practice issues, including drug errors or incidents, or a lack of professionalism demonstrated by regulated members.

When a member of the public contacts ACP with a concern, ACP often encourages individuals to first try speaking directly with the regulated member or the licensee at the pharmacy. Concerns can often be resolved through a direct, open, and honest dialogue.  

When licensees prepare their pharmacy teams with the right skills, information, tools, and resources to effectively address patient concerns, these events can either be prevented, or if necessary, be easily resolved, and are less likely to escalate. Licensees must prepare their pharmacy teams to prevent, respond to, and learn from patient concerns. Most patient concerns can be resolved at the pharmacy level to everyone’s satisfaction when the licensee empowers their pharmacy team to value, welcome, acknowledge, and effectively respond to patient concerns.

Advice to protect you, your patients, and your profession

1. Advice for licensees in preventing patient concerns
   1. Stay informed
      1. Part of the licensee’s leadership role is to stay informed and engaged, reviewing and ensuring their team’s compliance with practice requirements, including the
         1. Code of Ethics (principles 1, 2, 3, 4, 10)
         2. Standards of Practice for Pharmacists and Pharmacy Technicians (standards 1, 2)
         3. Standards of Practice for the Operation of Licenced Pharmacies (standard 6)
         4. provincial and federal legislation governing pharmacy practices.
   2. Develop policies and procedures
      1. Licensees must develop clear policies and procedures outlining how patient concerns are handled and must ensure all staff understand and adhere to them. These policies and procedures should contain appropriate resources for staff to be respectful, empathetic, and effective when responding to concerns.
      2. Resources such as the Health Quality Council of Alberta’s ReSPOND/ReLATE tool or the Patient Concerns Management Framework are useful to reference when developing these documents.
   3. Proactive communication
      1. Help your pharmacy team understand, practise, and implement proactive communication. Proactively sharing information with patients helps prevent misunderstandings or miscommunication from escalating. Giving patients the information they need to understand the services that a pharmacy provides leads to informed expectations. Sharing information about how long those services will take and why helps build understanding and acceptance. Sharing information about the potential risks and benefits about a service helps a patient provide informed consent.
2. Advice for licensees in responding to patient concerns
   1. Empowering environment
      1. Create an environment at the pharmacy where the patient feels empowered to bring their concerns to members of the pharmacy team. Patients are subject to a power imbalance in their professional relationships with their healthcare providers, including their pharmacy teams. By creating an environment in which patients feel not only welcome but empowered to bring their concerns forward, licensees create opportunities for patients to partner with their pharmacy teams and resolve their concerns in a more collaborative and positive manner.
   2. Active listening
      1. Coach and practice with your pharmacy team to listen actively. When a patient presents a concern, the pharmacy team member must be attentive and listen without interruptions. This means paying attention to not only the words, but to the patient’s emotions, assumptions, and what they are not saying as well. Consider the patient’s needs, values, preferences, and culture in context with the patient’s concerns. Pharmacy environments are busy, but often, dedicating time and space for these conversations prevents more complex issues from arising. When allocating time for these patient interactions, ensure the pharmacy is equipped with adequate staffing and resources to both maintain pharmacy operations and focus on these conversations. Initial efforts to offer compassion, information, and support may reduce the patient’s frustration, repair trust, and provide context to help the patient.
      2. Active listening includes
         1. letting the patient express their concern,
         2. gathering any additional information with questions, and
         3. acknowledging their concern and deducing the issue behind that concern.
   3. Take it seriously
      1. In many cases, when ACP’s complaints team hears from a patient, it is due to the pharmacy professional’s perceived lack of acknowledgement and response. Ensuring your pharmacy team has the information and the ability to effectively respond to concerns will support conflict resolution. Once the pharmacy professional and patient have a common understanding of the issue behind the patient’s concern, the pharmacy team member should recognize the patient’s perspective and show a willingness to deal with the problem immediately.
      2. Immediate action demonstrates accountability to the patient’s concerns and shows that their concerns are being taken seriously. This can prevent a minor situation from escalating. It is important to not respond in a manner in which the patient feels dismissed; this includes avoiding
         1. language that seems dismissive, including humour; and
         2. using generic blanket statements like “it’s the law” or “I did (or didn’t) do that because ACP requires me to do that.”
      3. A critical element of responding to concerns is an apology.¹ A genuine apology demonstrates compassion, validates the experience of the patient, and helps restore the relationship. The nature of the apology will depend on the information known at the time of the conversation. Generally,
         1. an apology during an initial disclosure may simply express regret for what has occurred;
         2. a further apology with an admission of responsibility may be made in a later meeting if indicated by the systematic analysis of the incident; and
         3. regardless of the specific words used, the apology must be sincere and relevant to the harm experienced.
      4. An apology is not considered an admission of liability. In Alberta, Section 26.1(2)(a) of the Alberta Evidence Act (RSA 2000, C.A., 18) states that “an apology made by or on behalf of a person in connection with any matter does not constitute an express or implied admission of fault or liability by the person in connection with that matter” and “shall not be taken into account in any determination of fault or liability in connection with that matter.” Section 26.1(3) further states that “evidence of an apology made by or on behalf of a person in connection with any matter is not admissible in any court as evidence of the fault or liability of the person in connection with that matter.”
      5. Providing clear direction and expectations supports the entire pharmacy team’s ability to respond to patient concerns in a consistent and appropriate manner and empowers them to resolve concerns. There are also situations that require support from a specific team member, including situations where you as the licensee should be involved. It is important to have clear roles within your pharmacy team to ensure your pharmacy team members know who to refer to about issues they are unable to resolve themselves. There are some concerns that any regulated member should be able and empowered to resolve. For other more complex matters, regulated members need to know when to refer to the licensee for assistance and support.
3. Advice for licensees in learning from patient concerns
   1. Team debrief and feedback
      1. Debriefing and analyzing after a patient concern helps the entire pharmacy team identify and understand what caused the concern and learn from it.² As the licensee, it is important to create opportunities to reflect on these incidents and learn from them as a team. As the leader in the pharmacy, you have the responsibility to mentor your team members, share your knowledge, and provide them with ongoing opportunities to learn, reflect, and grow as pharmacy professionals.
      2. Team debriefing should focus on improving practice and preventing a reoccurrence of similar concerns, rather than singling out or blaming individuals.³ Licensees should be mindful that members of the pharmacy team who were involved with the patient concern may need personal support.
   2. Documenting patient concerns
      1. Patient concerns and related actions should be documented to facilitate the continuous quality improvement process in the pharmacy.
   3. Reviewing documents and processes
      1. When patient concerns occur, this presents a valuable opportunity to reflect on your pharmacy’s guiding documents to ensure your policies and procedures continue to effectively describe a process to address and resolve concerns expressed by patients. This is also an opportunity to ensure all team members are aware of and understand these documents.
4. Advice for licensees in empowering your team
   1. Effectively managing patient concern incidents and empowering your pharmacy team to respond to patient concerns with care and compassion will help the entire pharmacy team develop a stronger sense of trust and respect with your patients.

1. Information in section 2 (b)(ii) based on the Health Quality Council of Alberta’s “A Guide to Disclosure of Harm: A Resource for Healthcare Providers.” ↩︎
2. Refer to the Standards for the Operation of Licenced Pharmacies (standards 6.6 – 6.8). ↩︎
3. Refer to the Health Quality Council of Alberta’s Just Culture website. ↩︎