The concept of working remotely—mainly from home with professional communication and activities taking place virtually, via computer, telephone, and other devices—is not a familiar, nor natural one for most health care professionals. However, many aspects of health care have been radically altered by the effects of the COVID-19 pandemic, and as a result, remote work has become a widely discussed topic throughout health care, including the pharmacy. Determining the scope and duration of remote working capabilities will vary among pharmacy practices, but creating a structure for this process is crucial to the viability and success of such a program. Given that much remains to be discovered and clarified regarding COVID-19, we also must consider that remote working may well extend into the far term.
In 2017, United States Census data illustrated that 5% of Americans were working from home, and in 2018, the US Bureau of Labor Statistics reported that 29% of Americans could work from home.1,2 Despite these data, many industries have been slow to adopt remote work practices. And while the COVID-19 pandemic has, of course, forced practically all industries to implement some form of remote work, doing so has revealed both its benefits and challenges, two factors that must be balanced to meet specific and essential needs in pharmacy workflow. Fortunately, national pharmacy organizations have already issued support for working remotely in avenues such as the provision of direct patient care activities through order verification and medication product checking. That said, state regulations have provided inconsistent approaches to implementing a uniform standard as of yet.3
A Forced Hand
By March 2020, COVID-19 had spread to the United States and achieved a global pandemic designation. In response, numerous dramatic measures were enacted to mitigate the spread of the virus. Most universally was the push toward remote operations in any available capacity.
With clinical departments being tasked with shifting as many employees as possible to remote work, various strategies are needed not only to promote social distancing and reduce potential patient and staff exposure, but also to ensure that a healthy, unexposed workforce remains available in the event of a patient surge. As with other emergency use authorizations, this process was aided by the easing of restrictions on certain actions such as patient signatures, the expansion of HIPAA-compliant software, and other measures that have served as barriers to remote patient care in the past. While it is unclear how facilities will resume onsite operations and requirements once the pandemic has been brought under control, it is likely that many employers will retain certain elements of their remote working strategies and policies. Furthermore, the potential successes and failures of telehealth will influence policy at the state and national level and impact future health care delivery systems.
Moving Work to Remote Settings
The successful transition to remote work requires several factors, but as a pharmacy leader, two main areas to consider are maintaining consistent operations and supervising transparent collaboration.
Pharmacy operations are inherently suited to be on site given the fundamental element of medication storage and distribution throughout the hospital and health system. That said, acute care settings are aided by technology in the form of automated dispensing cabinets and centralized inventory management systems that can store and retrieve medications on demand. Retail and ambulatory settings benefit from packaging and dispensing technology in the forms of manual, semi-automated, and fully automated medication packagers or virtual pharmacist technologies (ie, telepharmacy). Departments of pharmacy have had success in utilizing a staffing rotation that places staff members on alternate days or in alternating blocks, employing as much remote work as technology will allow in a safe and compliant manner.
Clinical roles may switch more seamlessly to remote work. Both acute and ambulatory care settings have been able to utilize telehealth technology, with video or telephone, to complete clinical education and monitoring. The sustainability of these models in the future will rely on health care facilities’ ability to invest in software that meets regulatory requirements.4
Engagement, Collaboration, and Supervision
Maintaining staff engagement can be difficult when unaccustomed team members are thrust into remote work. Thus, implementing elements that foster a routine is an important step. Office hours, daily huddles, and more frequent touch points are all effective strategies when establishing a remote work routine. While increased engagement can help boost accountability and productivity, be careful not to micromanage. A common management pitfall with remote work is making employees tally and report out all the work they do on a daily basis. Studies have shown that this is not an efficient practice and may hinder engagement, whereas interactive meetings and collaborative touch points are more effective at boosting productivity and fostering engagement.4
Collaboration among team members also can be difficult when those members are working remotely (especially when unprepared for remote work). Social interactions at work often foster the positive relationships necessary to build strong, effective teams. Provide multiple methods for your staff to communicate, including audio/video conferencing technology and instant messaging. Encourage the use of video technology that enables simulated face-to-face conversation, as this can have a positive psychological impact on the remote workplace dynamic.5
Maintaining a proper sense of supervision over remote staff is a dynamic challenge. Most pharmacy directors are accustomed to working closely, in person, with their staff on a daily basis. As mentioned, micromanaging and forcing a tallying of work can be detrimental, so implementing creative and collaborative methods to evaluate ongoing remote work is essential. Setting daily goals or deadlines can bring about additional accountability as can the establishment or refinement of a supervisory hierarchy. Ensure support staff, such as pharmacy technicians, have a clearly designated pharmacist or other pharmacy leader who can provide supervision and guidance. Additional touch points or routing of technician work may be needed in the absence of direct communication.5
When Remote Work Is Not an Option
While some pharmacy work can be shifted remotely, there remains operational work that cannot; this work can be largely categorized into medication preparation and distribution activities, although there are other examples outside of these areas. Given this need, pharmacy leadership should work together to delineate appropriate and inappropriate remote work (particularly if there are multiple pharmacies in your health system subject to the same workflow).
Furthermore, be sure to clearly define the nature of additional or altered tasks that may be assigned to staff working from home. The pandemic (which has thrown remote work into a world-wide phenomenon) notwithstanding, it is rare for remote work responsibilities to perfectly align with onsite work. As certain pharmacy roles are better equipped for a remote transition, a re-evaluation of workflow to identify (and deploy) all opportunities for remote work should be performed. If a task can be done remotely, it should be done by a defined remote staff member. For example, a remote role could be developed to respond to medication messages and phone calls (ie, triage). Other strategies include scheduling staff in a combination of remote and onsite activities such that each staff member spends a block of time (days or weeks) on site, then that same block of time doing remote work. An additional consideration is the utilization of segregated areas for pharmacy work, such as non-sterile medication preparation and/or distribution activities.
Careful and clear framing for decisions regarding remote work should be presented, as some staff members may not understand why some coworkers are able to work from home and others are not. Post-pandemic, remote work will likely remain a significant aspect of medical practice, so these decisions should not simply reflect immediate needs, but also be applicable moving forward.
Pharmacy leaders will need to continue to evaluate the role of remote work in health system settings. It is highly likely that COVID-19 will shift some previous onsite work to a remote option. However, this decision will be health system-specific, and can be expected to be different depending on area-specific and site-specific factors.
Tyler A. Vest, PharmD, MS, BCPS, is a pharmacy manager of automated dispensing cabinetry and controlled substances and an interim pharmacy coordinator of medication delivery services at Duke University Hospital in Durham, North Carolina. He is also an assistant professor of clinical education at the UNC Eshelman School of Pharmacy. Tyler completed his pre-pharmacy studies at the University of Kentucky, and his Doctor of Pharmacy at the University of Cincinnati James L. Winkle College of Pharmacy. He is also a recent graduate with an MS in Pharmaceutical Sciences with a specialization in Health-System Pharmacy Administration from the UNC Eshelman School of Pharmacy. Tyler’s professional interests include acute care operations, leadership development, oncology, pharmacy technician advancement, distribution models, productivity and monitoring, and the medication use process.
Nicholas P. Gazda, PharmD, MS, BCPS, CSP, is the assistant director of specialty pharmacy at Cone Health in Greensboro, North Carolina. He oversees and maintains URAC/ACHC accredited specialty pharmacy operations at Cone Health, including the specialty pharmacy call center, mail-order program, and medication assistance program, as well as the embedded ambulatory clinical pharmacist program. Nick completed his BS and PharmD at the UNC Chapel Hill Eshelman School of Pharmacy. His professional interests include ambulatory care, specialty pharmacy, productivity, pharmacy operations, and financial management.
Remote Work Considerations Toolkit
When establishing a remote work structure, there are certain basic factors that must be accounted for. The following list indicates some of these considerations, but is not exhaustive. All pharmacies must determine the best structure for their own operations.
In addition to the technology used within the pharmacy and throughout the hospital, thoughtful consideration has to be given to the technological needs required for remote work to be successful. This includes proper computers with video conferencing tools, as well as secure access to the hospital or health system’s virtual private network (VPN) or other secure connection. Consider adding two-factor identification to ensure security. In the attempt to avoid using personal phones, voice-over-internet-protocol (VoIP) telephones are now quite common and should be considered for staff members who field phone calls. Overall, remote technology should be arranged to facilitate communication with onsite technology to avoid networking errors.
Given the sensitive nature of medical information, data and communication security is more important than ever when working remotely. With patient safety and protection top of mind, be sure to form a good working partnership with your facility’s IT department to maintain security for all remote staff work interactions. Pharmacy leaders remain accountable for the security of remote work, so clearly convey to remote staff the need for security, as well as provide the physical and virtual tools necessary to ensure it.
As standardization and workflow policies and procedures (P&Ps) are native to pharmacy operations, these same concepts should extend to remote work. Expectations should be clearly outlined and applicable P&Ps put forth to properly support remote work. Effective P&Ps will demonstrate how remote work decisions are evaluated, approved, and implemented, as well as the proper methods of documenting work. Key elements of remote work P&Ps include:
As pharmacy operations vary from site to site, remote workflows also vary. Therefore, each department within the pharmacy should have a dedicated remote work structure. Successful remote operations require smooth interoperability both from employee to pharmacy, and from employee to employee or department to department.
As the pharmacy leadership may also be required to perform remote duties, clear engagement cannot be overemphasized. The lack of in-person interaction can wreak havoc on morale if unchecked, so make every attempt to remain in communication with all staff, onsite and remote, and continue to include them in decision making and acknowledge accomplishments. As we emerge from the turmoil of the pandemic, embracing remote strategies and incorporating the lessons learned in this crash course will only serve to benefit the future of pharmacy practice.