A Call to Action for Evidence-based, Outcomes-driven Conflict Management Styles

Conflict management is a carefully crafted art, forged in the fires of discomfort and experience. With expanding pharmacy practice, it is time to explore conflict management, and its necessity in this current climate.

A recent PubMed and Cochrane Review search resulted in significant number of articles dating back to the 1970s and 1980s. The amount of literature published within the last decade seemingly declined—with minimal focus on clinical pharmacy, and less initiated within the United States.^1-3

Why was conflict management such a hot topic then? Why is there not more recent literature on this subject? Have we perfected the art?

First, it’s imperative to recognize the emergence of clinical pharmacy practice in the 1970s. Prior to this, hospital pharmacy was well established; but in 1973, the first article describing improved outcomes with the assistance of clinical pharmacy services was published in the medical journal Circulation.^4,5 In 1975, the American Association of Colleges of Pharmacy published the Millis Commission’s Report which publicly concluded that pharmacy was indeed a clinical profession; and pharmacy curricula should include clinical training.

The first pharmacist-run anticoagulation clinic was initiated in 1979.⁶ In the 1980s, the Association of Health-System Pharmacists (ASHP) began differentiating residency accreditation standards by clinical specialties. There was also an influx of pharmacy-related clinical literature published during that decade.^5,7 Based on this movement, more articles on conflict management may have been published due to potential infringement of these expanding roles on other professions, or simply observation bias.

The Millis Commission’s Report provides more pieces to the puzzle. Authors noted a deficient among pharmacists in communication, analytical, and management skills.⁷ In a follow-up report, authors concluded there was a need for behavioral and social sciences emphasis in pharmacy curricula.⁸ Pharmacy schools have since integrated conflict management and interprofessional education into their curricula; so, many may perceive the topic as redundant or unnecessary. However, there is still a need for current literature.

Pharmacists are integrated into health care teams, but that presence varies on an individual, statewide, national, and international basis.^9,10 In 2013, the American Medical Association House of Delegates created a resolution calling pharmacy inquiries about the rationale for controlled substances unwarranted.¹¹ In the last few years, as pharmacists work to develop collaborative practice agreements, pushback still exists in various states to expand these clinical roles.¹²

Clinical roles are also shifting interprofessionally. Pharmacy technicians are gaining more responsibilities, such as transcribing refills, and administering vaccines. Conflict may persist within the pharmacy if unclear roles exist, self-identity feels threatened, management styles vary, or demotivation occurs—potentially compromising patients’ quality of care.

Anytime advancements within a workplace become available, it may cause competition between colleagues. Technician career advancement opportunities are sparse; and when opportunities arise, tension and conflict may result. Learning how to prevent or manage these situations is not always easy nor comfortable, but can be a preventive measure in ensuring conflict is avoided or resolved. Having a proactive relationship with conflict management strategies allows for levels of psychological safety in the workplace.

Overall, as pharmacists and technicians, we should be publishing, and advocating for our profession. We could all benefit from improved communication skills, and that includes techniques in handling conflict.

REFERENCES

• Gouveia WA. Hospital pharmacy and industry—conflict and collaboration. Am J Hosp Pharm. 1984;41(7):1391-4.
• Sobczak CL. Pharmacy and primary nursing: potential for conflict and cooperation. Nurs Adm Q. 1977;1(2):89-97.
• Hammel RJ, Curtiss FR, Heinen JS. An evaluation of job and life satisfaction, role conflict, and role ambiguity among young pharmacy practitioners. Pharm Manage Comb Am J Pharm. 1979;151(1):29-37.
• Mckenney JM, Slining JM, et al. The effect of clinical pharmacy services on patients with essential hypertension. Circulation. 1973;48(5):1104-11.
• Carter BL. Evolution of Clinical Pharmacy in the USA and Future Directions for Patient Care. Drugs Aging. 2016;33(3):169-77.
• Carter BL, Helling DK. Ambulatory care pharmacy services: the incomplete agenda. Ann Pharmacother. 1992;26(5):701-8.
• McCarthy RL, Schafermeyer KW, Plake KS. Introduction to Health Care Delivery, A Primer for Pharmacists. Jones & Bartlett Publishers; 2012.
• Millis JS. Looking ahead—the report of the Study Commission on Pharmacy. Am J Hosp Pharm. 1976;33(2):134-8.
• Shrader S, Dunn B, et al. Incorporating Standardized Colleague Simulations in a Clinical Assessment Course and Evaluating the Impact on Interprofessional Communication. Am J Pharm Educ. 2015;79(4):57.
• Rathbone AP, Mansoor SM, et al. Qualitative study to conceptualise a model of interprofessional collaboration between pharmacists and general practitioners to support patients' adherence to medication. BMJ Open. 2016;6(3):e010488.
• Menigham TE. Strength in interprofessional collaboration. PharmacyToday. 2013;19(8):10-12,14-16.
• Centers for Disease Control and Prevention. Advancing Team-Based Care Through Collaborative Practice Agreements: A Resource and Implementation Guide for Adding Pharmacists to the Care Team. Atlanta, GA: CDC; 2017.