Impact of a large-scale robotics adoption on the hospital pharmacy workforce

The National Health Service (NHS) regularly adopts new technologies which often result in the redesign of services, where large numbers of staff undergo organisational change. The NHS is made up of teams of people, all of whom continue to work interdependently providing safe and effective care throughout these times of change. Automation in pharmacy is becoming popular, with recent advancements involving the automation of the medicines supply chain. Previous ventures involving Automated Dispensing Systems (ADS) have been small-scale. Maximising efficiencies through automation relies on the effective introduction of technologies as well as the alignment of technical and social change, and there has been little exploration of how automation impacts on the staff experience and team effectiveness. In the literature there are numerous models available against which to compare and analyse the success of teams more generally. Underpinning many of these models is the Hackman model which proposes that team effectiveness is influenced by: the effort team members exhibit; the knowledge and skills team members possess; and the appropriateness of the performance strategies implemented. There is a gap in the literature on the impacts large-scale automation has on teams (and their success) in healthcare, specifically in pharmacy. Approved in August 2008, NHS Greater Glasgow & Clyde (GG&C) initiated a large-scale redesign (the PPSU Acute Pharmacy Redesign Programme). The Programme aimed to; provide a single procurement department for Glasgow pharmacy; have a centralised Pharmacy Distribution Centre (PDC); introduce ward-level ordering; and improve the current staff skill-mix while promoting the use of patients’ own medicines in hospital (Making the Most of Your Medicines or MMyM). Since opening in September 2010, the PDC (comprising 9 robots in total) is now the single facility responsible for the procurement and distribution of medicines to approximately 4000 destinations, and affected approximately 530 hospital pharmacy staff. This scale of pharmacy redesign has not been seen in any other automated schemes in the UK. The aim of the first study was to describe and evaluate NHS GG&C pharmacy staff experiences over the programme duration by different job roles/locations. Interviews were conducted with 36 pharmacy staff members from 4 hospital sites and the PDC, and 9 stakeholders, identified by members of the project Steering Group. Staff were interviewed about their experiences before, during and after the redesign. An inductive content analysis was performed, which produced two main themes: “The Work I Do” and “The Context of My Work”. The first theme allowed the exploration of the changes in staff job role, with a focus on tasks, work pace/control, morale, training/progression opportunities and voice/relationships. The second theme focused on social impacts of the redesign, including support, leadership, praise, reliability and trust of co-workers. Results showed that there was a lack of training available and morale was low in part due to this. There was no cohesive vision among participants as to why the redesign was happening. Hospital staff training was in theory available, yet completing training, and progressing into higher pay bands was not always feasible. Management were concerned with PDC technicians losing their clinical-skills as a result of a change in job location. PDC support workers experienced a gradual depletion of medicines knowledge due to this transition. The pharmacist role was seen as more social. Experiences between MMyM and non-MMyM staff were different in terms of how challenging, varied and social the work was. All roles within the PDC appeared to be less social compared with hospital roles. The aims of the second study were to apply Hackman’s model of team effectiveness in the context of the pharmacy team dynamics and performance and (based on this model) discuss the extent to which these teams were successful in the adoption of the automation. Hackman’s characteristics were applied to the pharmacy staff interviews (n=36). The results indicated that PDC and hospital teams exhibited 8 of the 23 characteristics: members have a variety of high-level skills; members contribute and are motivated equally; members are equally committed; members have personal and professional skills; relevant education and training is present; learning should be collective; members self-regulate; and there is clarity about task requirements, constraints, resources available and who the service user is. The “minimising of performance slippages” characteristic could be observed in one hospital team but not in the PDC. The teams did not exhibit 5 of the characteristics, indicating less success in these areas: autonomy is available; adequate feedback is available; excellent performance is rewarded; team size is appropriate; and relevant education and training is actually available. Nine of Hackman’s characteristics could not be commented on due to a lack of illustrative data. This thesis adds to the limited literature on the exploration of automation in healthcare, specifically pharmacy. Three main lessons can be concluded: staff consultation and engagement is critical to the successful redesign of services driven by technology; ensuring job role components are appropriate for job tasks is essential- technology adoption may require new skill sets and also cause other pre-existing skill sets to become lost; team effectiveness is an important focus within any organisational change programme, but less up-to-date models of team effectiveness may not be ideally applicable to teams utilising technology. These lessons align with current Scottish Government policy on pharmacy innovation and provide valuable key points for change implementers to support the continued adoption of automation locally, nationally and internationally.The National Health Service (NHS) regularly adopts new technologies which often result in the redesign of services, where large numbers of staff undergo organisational change. The NHS is made up of teams of people, all of whom continue to work interdependently providing safe and effective care throughout these times of change. Automation in pharmacy is becoming popular, with recent advancements involving the automation of the medicines supply chain. Previous ventures involving Automated Dispensing Systems (ADS) have been small-scale. Maximising efficiencies through automation relies on the effective introduction of technologies as well as the alignment of technical and social change, and there has been little exploration of how automation impacts on the staff experience and team effectiveness. In the literature there are numerous models available against which to compare and analyse the success of teams more generally. Underpinning many of these models is the Hackman model which proposes that team effectiveness is influenced by: the effort team members exhibit; the knowledge and skills team members possess; and the appropriateness of the performance strategies implemented. There is a gap in the literature on the impacts large-scale automation has on teams (and their success) in healthcare, specifically in pharmacy. Approved in August 2008, NHS Greater Glasgow & Clyde (GG&C) initiated a large-scale redesign (the PPSU Acute Pharmacy Redesign Programme). The Programme aimed to; provide a single procurement department for Glasgow pharmacy; have a centralised Pharmacy Distribution Centre (PDC); introduce ward-level ordering; and improve the current staff skill-mix while promoting the use of patients’ own medicines in hospital (Making the Most of Your Medicines or MMyM). Since opening in September 2010, the PDC (comprising 9 robots in total) is now the single facility responsible for the procurement and distribution of medicines to approximately 4000 destinations, and affected approximately 530 hospital pharmacy staff. This scale of pharmacy redesign has not been seen in any other automated schemes in the UK. The aim of the first study was to describe and evaluate NHS GG&C pharmacy staff experiences over the programme duration by different job roles/locations. Interviews were conducted with 36 pharmacy staff members from 4 hospital sites and the PDC, and 9 stakeholders, identified by members of the project Steering Group. Staff were interviewed about their experiences before, during and after the redesign. An inductive content analysis was performed, which produced two main themes: “The Work I Do” and “The Context of My Work”. The first theme allowed the exploration of the changes in staff job role, with a focus on tasks, work pace/control, morale, training/progression opportunities and voice/relationships. The second theme focused on social impacts of the redesign, including support, leadership, praise, reliability and trust of co-workers. Results showed that there was a lack of training available and morale was low in part due to this. There was no cohesive vision among participants as to why the redesign was happening. Hospital staff training was in theory available, yet completing training, and progressing into higher pay bands was not always feasible. Management were concerned with PDC technicians losing their clinical-skills as a result of a change in job location. PDC support workers experienced a gradual depletion of medicines knowledge due to this transition. The pharmacist role was seen as more social. Experiences between MMyM and non-MMyM staff were different in terms of how challenging, varied and social the work was. All roles within the PDC appeared to be less social compared with hospital roles. The aims of the second study were to apply Hackman’s model of team effectiveness in the context of the pharmacy team dynamics and performance and (based on this model) discuss the extent to which these teams were successful in the adoption of the automation. Hackman’s characteristics were applied to the pharmacy staff interviews (n=36). The results indicated that PDC and hospital teams exhibited 8 of the 23 characteristics: members have a variety of high-level skills; members contribute and are motivated equally; members are equally committed; members have personal and professional skills; relevant education and training is present; learning should be collective; members self-regulate; and there is clarity about task requirements, constraints, resources available and who the service user is. The “minimising of performance slippages” characteristic could be observed in one hospital team but not in the PDC. The teams did not exhibit 5 of the characteristics, indicating less success in these areas: autonomy is available; adequate feedback is available; excellent performance is rewarded; team size is appropriate; and relevant education and training is actually available. Nine of Hackman’s characteristics could not be commented on due to a lack of illustrative data. This thesis adds to the limited literature on the exploration of automation in healthcare, specifically pharmacy. Three main lessons can be concluded: staff consultation and engagement is critical to the successful redesign of services driven by technology; ensuring job role components are appropriate for job tasks is essential- technology adoption may require new skill sets and also cause other pre-existing skill sets to become lost; team effectiveness is an important focus within any organisational change programme, but less up-to-date models of team effectiveness may not be ideally applicable to teams utilising technology. These lessons align with current Scottish Government policy on pharmacy innovation and provide valuable key points for change implementers to support the continued adoption of automation locally, nationally and internationally

Systematic Screen of Histone H4 in Arabidopsis thaliana

Histones regulate diverse processes in eukaryotes and consequently, can have widespread effects on organismal fitness and development. Histones are a dynamic target for a variety of post-translational modifications (PTMs) and the assessment of histone function has typically been accomplished by mutating enzymes that catalyze and/or recognize these PTMs (i.e., writers and readers, respectively). Although considerable information has been gained in the past several decades by using this strategy, multiple issues such as writer/reader redundancy, unidentified writers/readers of histone PTMs, and writers/readers with additional non-histone targets can preclude the identification of new roles for histones and complicate the assessment of mutant phenotypes. To bypass these issues and provide a complementary strategy to study histones, large-scale histone replacement systems have been developed and optimized in yeast and fly model systems. However, such systems have never been implemented in plants in part due to the difficulty in eliminating endogenous histone genes that are typically present in many copies and different locations in plant genomes. Here, we present the development of a genetic strategy for the plant model organism Arabidopsis thaliana in which the expression of endogenous histone H4 can be completely replaced with modified H4 transgenes. We use histone H4, which is a single variant histone in plants that is encoded by the largest number of genes (8) among all functionally-distinct histone proteins, as a proof-of-concept for an experimental system allowing the direct assessment of histone function in plants. Our CRISPR/Cas9-based strategy allows for the simultaneous targeting of many histone genes for the generation of a background depleted of endogenous histone expression. We validated our platform by showing that a single transformation with our modified H4 transgenes can restore a wild-type phenotype, demonstrating that our system can be used for the rapid establishment of histone replacement in plants. Using this strategy, we established a collection of plants expressing different H4 point mutants targeting residues that may be post-translationally modified in vivo. To demonstrate the utility of this new H4 mutant collection, we screened it to uncover substitutions in H4 that alter flowering time, rosette morphology, DNA replication, chromatin structure, and gene silencing. We identified different mutations in the tail (H4R17A) and the globular domain (H4R36A, H4R39K, H4R39A, and H4K44A) of H4 that strongly accelerate the floral transition. Additionally, we used machine learning to identify H4 mutations that alter different morphometric traits in vegetative tissue. Finally, we identified several novel roles for H4 tail and globular domain residues in the regulation of endoreduplication, chromatin condensation, and transposon silencing. After these broad screens for histone function, we then performed targeted analyses of H4R17A mutants to determine a molecular mechanism responsible for the early flowering displayed by these mutants. We found that a conserved regulatory relationship between H4R17 and the ISWI chromatin remodeling complex in plants is responsible for the phenotypes observed in H4R17A mutants. Similar to other biological systems, H4R17 regulates nucleosome spacing via ISWI, and mutation of H4R17 results in large-scale changes to global nucleosome positioning and gene expression, leading to altered development. Overall, this work provides a large set of H4 mutants to the plant epigenetics community that can be used to systematically assess histone H4 function in A. thaliana and a blueprint to replicate this strategy for studying other histone proteins in plants. As this resource represents the largest collection of H4 point mutants in a multicellular organism, our work will enable new insights into the regulation of chromatin by histone H4 in multicellular eukaryotes

Victims’ Voices:Understanding the Emotional Impact of Cyberstalking and Individuals’ Coping Responses

Recent quantitative research has identified similar detrimental effects on victims of cyberstalking as those that arise from traditional stalking. The current study thematically analyzed one hundred victim narratives gathered by means of an online survey with a view to assessing the mental health and well-being implications of the experience of cyberstalking. Coping strategies employed by victims and the perceived effectiveness of each strategy were also explored. The findings suggest that the emotional impact of cyberstalking predominantly includes comorbid anxiety and depression. Common coping strategies adopted by victims in our sample include avoidant coping, ignoring the perpetrator, confrontational coping, support seeking, and cognitive reframing. Taken together, the findings demonstrate that the ramifications of cyberstalking are widespread, affecting psychological, social, interpersonal, and economic aspects of life. To adapt, some victims made major changes to both their work and social life, with some ceasing employment and others modifying their usual daily activities. The widespread negative effects of cyberstalking identified in this study highlight that this phenomenon should be a concern to both legal and mental health professionals, particularly as the comments made by our sample illustrate the current inadequacy of response and provision. Recommendations are discussed and provided for law enforcement and mental health professionals

Macmillan Pharmacy Service Project 2014 : Early Evaluation of Initial Community Pharmacy Palliative Care Training Programme

NHS Greater Glasgow & Clyde (GG&C) and Macmillan Cancer Support funded in 2013 the roll out of a new Macmillan Pharmacy Service following a successful development program across all six Community Health (and Care) Partnerships (CH(C)Ps). The University of Strathclyde was asked to support the early evaluation of an evolving training program for community pharmacy support staff within this new service. This report presents the evaluation of the training programme initial testing in NHS GG&C and the development of a questionnaire-based tool to measure the impact of the training delivered on practitioners and the patients/carers they support

See, Like, Share, Remember: Adolescents’ Responses to Unhealthy-, Healthy- and Non-Food Advertising in Social Media

Media-saturated digital environments seek to influence social media users’ behaviour, including through marketing. The World Health Organization has identified food marketing, including advertising for unhealthy items, as detrimental to health, and in many countries, regulation restricts such marketing and advertising to younger children. Yet regulation rarely addresses adolescents and few studies have examined their responses to social media advertising. In two studies, we examined adolescents’ attention, memory and social responses to advertising posts, including interactions between product types and source of posts. We hypothesized adolescents would respond more positively to unhealthy food advertising compared to healthy food or non-food advertising, and more positively to ads shared by peers or celebrities than to ads shared by a brand. Outcomes measured were (1a) social responses (likelihood to ‘share’, attitude to peer); (1b) brand memory (recall, recognition) and (2) attention (eye-tracking fixation duration and count). Participants were 151 adolescent social media users (Study 1: n = 72; 13−14 years; M = 13.56 years, SD = 0.5; Study 2: n = 79, 13−17 years, M = 15.37 years, SD = 1.351). They viewed 36 fictitious Facebook profile feeds created to show age-typical content. In a 3 × 3 factorial design, each contained an advertising post that varied by content (healthy/unhealthy/non-food) and source (peer/celebrity/company). Generalised linear mixed models showed that advertisements for unhealthy food evoked significantly more positive responses, compared to non-food and healthy food, on 5 of 6 measures: adolescents were more likely to wish to ‘share’ unhealthy posts; rated peers more positively when they had unhealthy posts in their feeds; recalled and recognised a greater number of unhealthy food brands; and viewed unhealthy advertising posts for longer. Interactions with sources (peers, celebrities and companies) were more complex but also favoured unhealthy food advertising. Implications are that regulation of unhealthy food advertising should address adolescents and digital media

Cognitive Style and Drinking to Cope:A Prospective Cohort Study

BACKGROUND AND AIMS: Having a negative cognitive style may lead someone to feel hopeless about his or her situation and be more likely to engage in coping-motivated drinking. We, therefore, aimed to investigate the association between cognitive style and drinking to cope. DESIGN: Prospective cohort study. SETTING: The former Avon Health Authority in South West England. PARTICIPANTS: A total of 1681 participants of the Avon Longitudinal Study of Parents and Children. MEASUREMENTS: Participants completed cognitive style questions at age 17 and a subset of drinking to cope questions at age 24. We used linear regression to test the association between cognitive style and drinking to cope, controlling for confounders. Alcohol consumption and dependence scales were included in a secondary analysis. FINDINGS: A 20-point increase (that was the standard deviation of the exposure variable) in cognitive style score at age 17 was associated with an increase of 0.24 in drinking to cope scores at age 24 after adjustment for confounding variables (95% CI) = 0.08-0.41, P = 0.003). We found no evidence of an association between cognitive style and alcohol consumption (coefficient = 0.03, 95% CI = -0.08-0.14, P = 0.591) before or after adjustment. There was evidence for an association with alcohol dependence, but this was not present after adjusting for confounders (coefficient = 0.01, 95% CI = -0.04-0.05, P = 0.769). CONCLUSIONS: In young adults in England, there appears to be a positive association between negative cognitive style and subsequent drinking to cope

Macmillan Rural Palliative Care Pharmacist Practitioner Project : Baseline Report 2013

The University of Strathclyde is funded to provide academic input into the NHS Highland project for 2 years (starting February 2013). The project is to be a demonstration project to inform national policy and will have direct relevance to the new proposal on the delivery of pharmacy services within NHS Scotland, ‘Prescription for Excellence’ (8). This opportunity gives NHS Highland access to the expertise developed through the previous Glasgow program and allows the University team to develop the evidence base for clinical practice within this area, and focus on developing rural pharmaceutical care capacity through the use of a community pharmacy - based practitioner

Impact of robotics-led organisational change on the pharmacy workforce - preliminary findings : report for the pharmacy & prescribing support unit, NHS Greater Glasgow & Clyde

This report looks at the preliminary findings on the impact of robotics-led organisational change on the pharmacy workforc

Employer choice and job quality : workplace innovation, work redesign and employee perceptions of job quality in a complex healthcare setting

This article examines employer choice in relation to job quality (JQ). Acknowledging the important role of market, institutional and technological constraints, we highlight the role of employer agency in shaping JQ by reporting on an employer-led service redesign initiative in hospital pharmacy services in Scotland. This redesign initiative aimed at upskilling employees and redirecting their work effort towards high value added, patient-facing work using robotics implementation. The article provides a critical assessment of the success of the initiative in enhancing JQ and explores a range of factors constraining and shaping employers' job quality choices