Academic journal article American Journal of Pharmaceutical Education

Use of a General Level Framework to Facilitate Performance Improvement in Hospital Pharmacists in Singapore

Academic journal article American Journal of Pharmaceutical Education

Use of a General Level Framework to Facilitate Performance Improvement in Hospital Pharmacists in Singapore

Article excerpt


Hospital pharmacists are essential members of the multidisciplinary team who promote rational and costeffective use of medicines and improve patientoutcomes by reducing morbidity, mortality, adverse drug events, and hospital length of stay. (1-8) The role of pharmacists using evidence-based practice to ensure patient safety and the best use of medicines has been endorsed by the World Health Organization (WHO) and government bodies at a global level. (9-11) As the burden of disease increases because of an aging population with multiple comorbidities, there is growing pressure on pharmacists to improve patient outcomes in all developed and developing countries. To maximize improved patient outcomes, it is essential to have an adequate supply of appropriately educated and clinically skilled pharmacists.

The Singapore government has responded to this changing landscape by increasing staffing levels of healthcare professionals by 40%, including funding extra pharmacists whose clinical role in Singapore is being increasingly recognized and developed. (12,13) Approximately 65% of hospital pharmacists in Singapore have less than 3 years of experience. Considering the relative inexperience of most pharmacists in Singapore, a regular structured system of clinical mentoring and practitioner development, including standards for practice, self-reflection, peer evaluation, feedback, and directed learning would be an added benefit to the academic postgraduate opportunities already available. In a survey of the Australian Hospital Pharmacy workforce, a third of pharmacists indicated that they would leave the department within 2 years if support for staff development were not available. (14) A structured, robust, evidence-based tool for practitioner development could assist in ensuring a competent workforce and act as a primary motivator to increase job satisfaction and, hence, retention. Such a tool could also identify common development areas for an entire cohort, direct training programs, and enable departments to set and monitor service standards.

While no single model may be appropriate for all cultures and contexts, there are significant global health and labor market drivers to suggest that a competency-based approach to professional development is sensible and sustainable. (15-17) The Competency and Education Development Group (CoDEG) in the United Kingdom used the Whiddett and Holyforde model as a basis for developing the General Level Framework, a competency-based performance-development tool for general- or foundational-level pharmacists (those with less than 3 years post-registration hospital experience). (18-21) The general pharmacist practitioner is the second of 4 levels of practice previously described by the CoDEG: registered pharmacist, general pharmacist practitioner, advanced pharmacist practitioner, and a consultant pharmacist.

The GLF was developed as a ward-based tool to facilitate the development and evaluation of the general pharmacist practitioner by means of direct observation of their practice. (22) This process was subsequently validated in general pharmacist practitioners in UK hospitals by Antoniou and colleagues. This study demonstrated that practitioners who received feedback on their performance and agreed upon a development plan using the GLF up to 3 times in a 12-month period reached and maintained a defined level of competence faster than did those who were observed without this intervention. (23)

The GLF provides a structure for the development of pharmacists in their professional capacity. It is not meant to replace formal qualifications but rather to complement them. The GLF is a useful tool for engendering awareness of practice standards, facilitating self-reflection, providing a platform for feedback, and planning needs-based learning under the guidance and accountability of a more experienced practitioner. Further, it enables the identification of strengths and setting of individualized learning objectives to target weaknesses. …

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