qualitative insights into job satisfaction and dissatisfaction with management among community and...

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Research in Social and

Administrative Pharmacy 7 (2011) 306–316

Original Research

Qualitative insights into job satisfactionand dissatisfaction with management among

community and hospital pharmacistsJane Ferguson, M.Sc., B.Sc.a,*,

Darren Ashcroft, B.Pharm., M.Sc., Ph.D., MRPharmS.b,1,Karen Hassell, Ph.D., M.A(Econ), B.Sc., Dip.M.R.S., Cert.a,2

aThe Centre for Pharmacy Workforce Studies, The University of Manchester, Stopford Building, 1st Floor, Oxford Road,

Manchester M13 9PT, United KingdombThe Centre for Innovation in Practice, The University of Manchester, Stopford Building, 1st Floor, Oxford Road,

Manchester M13 9PT, United Kingdom

Abstract

Background: Job satisfaction research in pharmacy has predominantly been investigated using quantitativemeasures that have generally overlooked satisfaction with management.

Objective: This article explores pharmacists’ experiences and perceptions of management and examines theimplications for job satisfaction.Methods: Semi-structured interviews were conducted with a convenience sample of 11 community and 15hospital pharmacists in the North West of England (n¼ 26). The interview schedule was composed of

broad questions relating to job satisfaction and dissatisfaction, allowing for the exploration of originalthemes. Interviews were transcribed verbatim and entered into NVivo8. Template analysis was used to de-velop a hierarchical list of codes representing themes and the relationships between themes.

Results: Dissatisfaction with management emerged as a dominant aspect of pharmacists’ job dissatisfaction.Of the 26 pharmacists interviewed, 24 commented on their dissatisfaction with management, whereas only 8participants commented on positive experiences. Both hospital and community pharmacists expressed

dissatisfaction with their line management, and how the organizations they worked for were managed.Conclusions: Findings suggest that satisfaction with management is an important and significant contributorto job satisfaction overall. It would appear that pharmacists’ job satisfaction is compromised by poor linemanagement, lack of recognition, and support frommanagement, which may lead to an increase in turnover

and a reduction in job satisfaction.� 2011 Elsevier Inc. All rights reserved.

Keywords: Pharmacy; Job satisfaction; Management; Turnover

* Corresponding author. Tel.: þ44 (0)161 275 2421.1 Tel.: þ44 (0)161 275 4299.2 Tel.: þ44 (0)161 275 2422.

E-mail addresses: [email protected] (J. Ferguson), [email protected]

(D. Ashcroft), [email protected] (K. Hassell).

1551-7411/$ - see front matter � 2011 Elsevier Inc. All rights reserved.

doi:10.1016/j.sapharm.2010.06.001

mailto:[email protected]



307Ferguson et al. / Research in Social and Administrative Pharmacy 7 (2011) 306–316

Introduction

Job satisfaction is generally conceptualized asa person’s attitude toward their job.1 Althoughthere are various definitions of job satisfaction,2

the concept can be simply defined as the degree towhich people like their jobs.3 There is general agree-ment that job satisfaction is a multidimensional

construct.2,4 It is a particularly important conceptbecause of its known relationships to absenteeismand turnover,5,6 and mental and physical well-

being.7 Consequently, it would be beneficial to em-ployees and their employers, if emphasis wereplaced on identifying and enhancing certain fea-

tures of working life that are associated with highsatisfaction, and conversely, identifying and mini-mizing features that are associated with lower satis-faction or dissatisfaction.

Job satisfaction has been explored extensivelywith some groups of health professionals, includinggeneral practitioners8 and nurses.9 Yet, although

pharmacists represent a significant proportion ofthe health profession, there remains a paucity of re-search on the job satisfaction of pharmacists in the

UnitedKingdom (UK).10Much of the research con-cerning the job satisfaction of pharmacists has beenundertaken in the United States of America.6,11

Pharmacy workforce researchers and practitionershavebeenworking toaddress the gap in the literatureconcerning the job satisfaction of pharmacists.12-14

However, although it is positive to see an increase

in job satisfaction research in pharmacy, few in-depth qualitative studies have been carried out. Jobsatisfaction in pharmacy is more likely to have been

investigated using quantitative measures. Onlya small amount of qualitative work has exploredthe job satisfaction of pharmacists in the UK.

A study by Bond et al,15 supplemented a question-naire study by carrying out case studies. However,this was limited to community pharmacists and spe-cific to their feelings about contractual changes.

The case for improving management practicesand the impact of management on job satisfactionhas been made in the American nursing literature.

Findings fromquantitative andqualitative researchindicate that good relationships between managersand nurses positively influence job satisfaction and

turnover,16-19 with leadership style and empower-ment positively affecting nurses’ job satisfac-tion.20,21 In the late 1980s, a study investigating

pharmacists’ satisfaction with their line managerfound that pharmacists who were managed byother pharmacists were significantly more likely tobe satisfied with all aspects of their job. This same

study found that employees who reported havingfew conflicts or disagreements with their managerswere more satisfied with their choice of career, theiremployers, their jobs, and their supervisors than

those who reported having more conflicts.22

It would seem reasonable, therefore, to suggestthat an employees’ relationship with management

could have significant effects on job satisfaction.Yet, few empirical studies investigating the jobsatisfaction of pharmacists have included satisfac-

tion with management or supervision in theirmeasure. Of the studies that have14,23-25 only 1 ar-ticle, briefly discussed their findings with reference

to pharmacists’ satisfaction with supervision.26

Rajah et al (2001) found that senior grade hospitalpharmacists reported being more satisfied withtheir supervision than less senior grade pharma-

cists and speculate that this is because of lowergrade pharmacists receiving more supervisionthan senior grades, which may reduce their sense

of autonomy. Furthermore, although autonomyhas been associated with job satisfaction in non-pharmacy research,27 there is a little reported evi-

dence to indicate how pharmacists’ perceivedautonomy influences their job satisfaction. Conse-quently, it is apparent that an in-depth investiga-

tion of how managers affect the job satisfactionof pharmacists is warranted.

The recent proliferation of large pharmacychains in the UK has meant that pharmacists are

less likely to be independent contractors and morelikely to be employees, and therefore working undermanagers. In the UK, almost two-thirds (65.2%) of

actively employed pharmacists are working as anemployee, whereas, more than a quarter (27.4%) ofpharmacists are self-employed. Seven percent of

pharmacists were both employees and self-employed.28 Alongside, these changes an increasingnumber of pharmacists are choosing towork as self-employed ‘‘locums’’ rather than as permanent

employees. Despite this trend, few studies have in-vestigated why some pharmacists are choosing thismethod of working. Research has suggested that lo-

cum working allows pharmacists to have more con-trol, flexibility, and independenceover theirworkinglives.29 So again, being ‘‘managed’’ may be part of

the problem.The relationship between job satisfaction and

turnover has been researched in the pharmacy

literature. Job satisfaction has consistently foundto be associated with turnover in the pharmacyprofession.6,9,30,31Results from themost recentUKpharmacy workforce census showed that of those

308 Ferguson et al. / Research in Social and Administrative Pharmacy 7 (2011) 306–316

who left the profession, a significant percentage(29.8%) were not of retirement age. In addition,the census results indicated that over 1 in 10 phar-

macists reported considering leaving their sectoror profession altogether in the next 2 years.28

A study of National Health Service (NHS) workersfound that 35% of hospital pharmacists (n¼ 2398)

agreed that they often thought about leaving thehospital they worked for. Twenty-seven percentalso agreed that they would look for a new job in

another organization in the next 12 months.32

Although intention to quit does not always resultin actual quitting,10 it is nevertheless important to

understand the reasons behind these intentions,even if they do not always come to fruition. Previ-ous survey findings indicate the most frequentlycited reasons pharmacists gave for considering

leaving their jobs were lack of career development(20%), not being valued for their work (18%),and insufficient pay (16%).32 These findings reflect

the facets pharmacists reported beingmost dissatis-fied within the 2005 pharmacy workforce census,these being, pay and recognition for good work.28

However, quantitativemeasures of job satisfaction,including items such as ‘‘recognition you get forgood work,’’ can make it difficult to differentiate

to whom the pharmacist is referring.It is apparent that little is known about how

pharmacymanagers influence the job satisfaction ofpharmacists, or how the experiences of hospital and

community pharmacists differ, if they differ at all.An exploration of how the relationship betweenpharmacists and their managers influence job satis-

faction is particularly relevant given the alreadymentioned measurement issues, the lack of researchin this area, and the crucial impact of managers on

job satisfaction in other health professions.16 InLocke’s seminal work entitled ‘‘What is Job Satis-faction?,’’1 Locke argued that before we begin mea-suring a phenomenon, we must first attempt to

identify someof the attributes and characteristics in-volved. Consequently, an aim of this study was toprovide an in-depth qualitative perspective of man-

agement issues affecting community and hospitalpharmacists to provide a more complete picture ofhow pharmacists feel about how they are managed.

Method

This research explored the job satisfaction of

community and hospital pharmacists, as these2 sectors form the largest proportion of allpharmacists in the United Kingdom.12 However,

although community and hospital pharmacistshave different job descriptions and responsibilitiesand are managed differently at certain levels, they

do share some similarities in that their workingpractices are managed by the same governingand professional bodies. Consequently, ratherthan an in-depth exploration of just 1 sector, it

was deemed appropriate to explore job satisfac-tion and dissatisfaction in the 2 largest sectorsfor comparative purposes.

Ethical approval was obtained for this studyfrom an NHS research ethics committee. Com-munity and hospital pharmacists practicing in the

North West of England were contacted throughconvenience and snowball sampling. Approval isrequired to undertake research with NHS em-ployees. Approval was sought from 15 hospitals

across the North West of England. Five of the 15hospitals granted approval within the study timeframe. The author contacted hospital pharmacists

through heads of pharmacy departments whowere asked to disseminate information sheets topharmacists detailing the study. These contacts

were then asked to suggest other community orhospital pharmacists in their networks until suffi-cient data had been collected. The 11 community

pharmacists interviewed represented 10 differentcommunity pharmacies; however, all communitypharmacists indicated that they worked for largechains. Community and hospital pharmacists who

agreed to participant took part in a one-to-onesemistructured interview. The interview schedule(Appendix) was composed of broad questions re-

lating to job satisfaction and job dissatisfaction,allowing for the exploration of original themesrather than impose a priori concepts and job satis-

faction categories defined by the interviewer. Pre-defined job satisfaction topics identified in thepharmacy job satisfaction literature were avoidedas findings are generally driven by quantitative

questionnaires that have originally been devel-oped for use with nonpharmacists.13,24,33

Twenty-six semistructured interviews were car-

ried out in total. Twenty-two were face to face and4 were carried out over the telephone, as this wasmore convenient for those pharmacists. Interviews

were conducted between October and December2008. Initially, participants were taken froma convenience sample. The sample was limited to

pharmacists practicing within the North West ofEngland, and the sample size was guided by datasaturation.34 The literature suggests that each groupunder investigation should consist of participants

between 6 and 12.35 Interviews typically lasted for


30 minutes, and saturation was found to have beenreached after 11 interviews with community phar-macists and 15 interviews with hospital pharma-cists.36 Two participants failed to return their

biographical data forms, consequently some detailsare missing. Participant characteristics are summa-rized in Tables 2 and 3.

Interviews were digitally recorded and tran-scribed verbatim. Each transcript was read severaltimes by the main researcher, and the responses

were analyzed and coded using the templateanalysis (TA) approach to identify key themes.A selection of transcripts and codes were read by

the other members of the research team to verifythe interpretations of the author by establishingconsent and salience of themes rather than todevelop separate analyses.

TA method

Template analysis refers to a particular way ofthematically organizing and analyzing qualitative

data, such as interview transcripts or diary entries.The researcher produces a list of codes, whichrepresent themes and the relationships between

themes, most commonly following a hierarchicalstructure.37 Some themes will be developed a priori;however, the flexible nature of TA allows for mod-

ification throughout the process of analysis. TAtakes a ‘‘contextual constructivist approach,’’ inthat the researcher assumes multiple interpreta-tions of reality and therefore the phenomenon un-

der investigation. Interpretations depend on theepistemological position of the researcher and thecontext of the research, consequently, unlike con-

tent analysis, concern with the frequency of codesis irrelevant from this perspective, as the assump-tion that the frequency of a code is associated

with its importance cannot be made. The challengefor the researcher is to strike a balance between se-lectiveness and openness when developing the tem-plate. Too open and the researcher runs the risk of

creating an unwieldy and incoherent template, toorigid, and selective then important aspects of thedata may be ignored. Themes of only marginal rel-

evancemay supplement the richness of the interpre-tation and help to build a background to the theme.

Results

Pharmacists were free to talk about any aspect

of their job that provided them with satisfactionor led to their dissatisfaction. This meant thata wide variety of themes were discussed. Other

themes that were drawn from the interview tran-scripts included dissatisfaction with workload,which along with dissatisfaction with managementwas a major theme. Lack of skill utilization and

reduced autonomy were also reported as reducingjob satisfaction, but a source of satisfaction forothers. Hospital pharmacists in particular were

satisfiedwith the professional support they receivedat work. However, lack of professional support fortheir counterparts working in the community was

regarded as a source of job dissatisfaction. Patientsand colleagues were a double-edged sword, in thatalthough they were a significant source of job

satisfaction they also brought about dissatisfactionif working relationships were poor or patients weredifficult or disrespectful. The theme of ‘‘manage-ment’’ was particularly a dominant theme, which

was referred to by all the participants.

Template analysis

TAwas used to sort and organize codes relatingto dissatisfaction and satisfaction with manage-ment. Themes and subthemes are listed in Table 1.

Once management issues were organized into

themes, it appeared that dissatisfaction was gener-ally discussed in terms of dissatisfaction with 2 tiersof management. These being direct line manage-

ment and management of the organization (theemploying company for community pharmacistsand the NHS for hospital pharmacists). Of the 26

pharmacists interviewed, 24 commented on theirdissatisfaction with management, whereas 8 par-ticipants made a positive comment relating to their

satisfaction with management. However, job satis-faction, with the exception of 1 comment, wasalmost exclusively related to satisfaction with linemanagement. Although both community and hos-

pital pharmacists expressed dissatisfaction withline management and how their organizationswere managed, transcript extracts relating to job

satisfaction, again with the exception of 1 com-ment, were almost exclusively made by hospitalpharmacists. Each of the themes is illustrated by

quotations from interviewees. Participants areidentified by a participant number and their sectorof practice. Further details of participant charac-teristics can be found in Tables 2 and 3.

Dissatisfaction with line management

The following narratives illustrate how line

managers impact on turnover, autonomy, work-load, career progression, and the subsequentramifications of job satisfaction.

Table 2

Summary of participant characteristics

Sector of practice Frequency

Community 11

Hospital 15

Gender

Male 8

Female 18

Age range (yr)

!29 8

30-39 7

40-49 7

50-59 2

Missing 2

Total 26

Ethnicity

White British 17

White Irish 2

White other 1

Black Caribbean 1

Mixed other 1

Pakistani 1

Asian other 2

Missing 1

Total 26

Table 1

Template of themes and subthemes

Job dissatisfaction with line management and

management of the organization

A. Dissatisfaction with line management

i. Increase in intention to quit and actual quitting

ii. Disempowerment and lack of autonomy

iii. Manager imposing large workload

iv. Manager a barrier to career progression

v. Being managed by a nonpharmacist

vi. Lack of management training for pharmacists

B. Dissatisfaction with management of the

organization

i. Ineffective communication

ii. Ineffective NHS working practices

iii. Lack of support and pressure to meet targets

iv. Lack of autonomy and recognition

v. Change was slow to happen in the NHS

vi. Underfunding

Job satisfaction with line management and management

of the organization

A. Satisfaction with line management

i. Support and encouragement from line managers

B. Satisfaction with management of the organization

i. Achievable and appropriate targets


It would seem that managers can play highly

significant roles in how a person feels about theirjob and canbe apotential antecedent to turnover.Apoor relationshipwith linemanagement and lack ofcommunication was cited as precursors for leaving

for 2 hospital pharmacists who had actually lefttheir jobs andanotherwhowas considering leaving.One community pharmacist moved from the hos-

pital sector to work in the community because ofmanagement blocking career progression, whereasanother community pharmacist was contemplating

leaving the profession altogether because of nega-tive treatment from management:

I would consider working elsewhere. It’s some-

thing I’ve never, ever considered until new

management came in. [Participant 9, Hospital]

I’m looking at what’s currently out there [plan-

ning on leaving the profession]. You know

yourself what you’re capable of and what you

do on a daily basis but then to have to keep

explaining it to management, as I say nasty

emails on the phone or arguments on the phone

regarding certain matters. I understand they’ve

got to get results, it’s a business at the end of the

day but there’s ways and means of going about

that. [Participant 19, Community]

I mean the other thing about the hospital though

was there was too much politics there. I couldn’t

have coped. I was at the bottom of the pile.

[Participant 17, Community]

Some managers seemed to disregard that asprofessionals, pharmacists expect a certain amount

of autonomy in their work.Hospital pharmacists inparticular felt disempowered by their managers,this had led to a lack of autonomy:

Whatever you thought your priority was goes out

of the window because somebody more impor-

tant has asked you to do something. [Partici-

pant 9, Hospital]

Our job is not like a completely independent job,

it’d be nice to have a little bit more independen-

ce.it’d be nice just to be able to sort the problem

out there and then rather than have to go through

somebody else who knows less about it than you.

[Participant 26, Hospital]

It is a bit like working in a dictatorship working

here. [Participant 10, Hospital]

Often I think managers fail to trust their staff and

often don’t treat them like the grown up pro-

fessional adults that they are. [Participant 12,

Hospital]

All pharmacists interviewed commented thattheirworkloadswere high.However, not all directly

attributed this to their managers. Those that didcommented that their linemanagers put pressure on

Table 3

Individual participant characteristics

Participant

No.

Sector Gender Age

group

(yr)

Ethnicity

1 C F 21-30 Mixed other

2 C F 51-65 White British

3 H F 31-40 White British

4 H F 31-40 White

Irish





9 H M 41-50 White

Other



12 H M 31-40 White

Irish

13 H F 21-30 Black

Caribbean



16 C F 21-30 Asian

Other

17 C M d Asian

Other


19 C M 31-40 White British

20 C F d d



23 C M 41-50 White British

24 H M 31-40 Pakistani

25 H M 31-40 White British

26 H M 41-50 White British


them to reach targets, particularly in the communitysector, without the appropriate support:

You get threatened with all sorts of disciplinary

action. I mean I actually got a letter off my ex,

last area manager threatening disciplinary action

because I hadn’t done MURs for three weeks,

and the reason I hadn’t done it was because I was

on holiday. And I got told that I should have

done the extra before I went on holiday.There’s

just no support, whatsoever. As soon as you hit

a problem and you ring up for support and help,

they just don’t give it you.You know I’ve

worked with two staff and one staff, and the

company are either just not aware of it or they’re

not interested. [Participant 15, Community]

It’s just the pressure from management. if you

don’t meet your targets they’re just on your back,

and they just keep pushing you and pushing you

and you never get the feeling that they’re

satisfied, they never come to you and they never

say thank you basically.I have to get the stuff

out and I have to check myself and obviously

doing it myself it’s not very good because if

there’s a mistake then god forbid it’s going to

come back to me and I’m going to get struck off,

but nobody cares. I mean when you phone head

office they say ‘‘oh well we’re short staffed’’ and

you’re just left to deal with it yourself. So that’s

another problem. [Participant 16, Community]

I don’t like the amount of paperwork or the kind

of way management go about trying to get results

from people, you know nasty emails, arguments

over the phone etc just because you may not be

performing in one particular sector but you’re

doing nine out of ten of the other things that they

wanted you to do and there doesn’t seem to be an

awful lot of praise. It’s not a profession where

you get a lot of praise for doing good things.


It seems that line managers have the potentialto positively or negatively influence a person’scareer. Working under an unsupportive manager

had potentially detrimental ramifications for thecareers of the pharmacists working under them.This was a particular issue for hospital pharma-

cists, perhaps because there are more layers ofcareer progression in hospital pharmacy, whencompared with the community sector. One phar-macist had moved from the hospital sector to

work in the community because of managementimposing barriers to progression. Some pharma-cists felt that their career progression had been or

would be blocked by their line management, andthey had unequal opportunities or lack of careeradvancement because of issues, such as; person-

ality, favoritism, and long-hour cultures:

I was at the bottom of the pile. It’s favouritism,

who you like, who you don’t like. If I was

a manager of a certain department if I didn’t

like you I’d make sure you basically do what you

don’t like doing, but if I like you and were best

mates if there’s a job you want to do then you

would get it, or you’d be allowed to do it.


Also it depends on management. If you’ve got

somebody who doesn’t want you to be progress-

ing in your team, or it’s not working for

somebody, again you get barriers. [Participant

18, Hospital]

One thing I hate is people who’ve gone into

management and don’t deserve to be there and

can’t manage. And you know I’ve seen some bad

examples of that. And if you’re unlucky enough

to be under them it can be very difficult. So

sometimes it’s a case of you make an effort to try


and do things and there’s other people who put

barriers in your way. [Participant 25, Hospital]

You might be able to negotiate better working

hours for yourself and to a certain degree I have

been able to do that.Then you feel you’re being

awkward and you feel that the area managers

aren’t going to particularly like you andmaybe job

opportunities won’t be pushed your way because

you’re knownas the awkwardonewhowon’twork

Saturdays, and I’ve seen it happenwith a colleague

recently where she’s now got a bad reputation

amongst people at area level because she refused to

work till 8 o’clock three nights a week. [Participant

5, Community]

Working long hours as a means to career pro-gression was also mentioned by a hospital pharma-

cist who felt thatmanagement engendered a cultureof poorwork life balance for theirmore senior staff.

.it’s not unheard of for the senior management

team to be sending emails off at ten o’clock, eleven

o’clock at night. The management structure at

the moment, well they would say they don’t expect

people to work over their hours, just the mere fact

that theydo things sevendays aweek, andat eleven

o’clock at night and all the rest of it is almost like

silently creating this impression that well it’s

alright if you want to be a successful person then

you’ve got to do this. And I think the NHS

shouldn’t be working people into the ground.


Being line managed by nonpharmacists was anissue for participants, particularly in the commu-

nity sector where business agendas sometimesconflicted with pharmacists’ professional respon-sibilities. Some pharmacists felt that their linemanagers had little comprehension of their re-

sponsibilities and the pressures they faced in theworkplace. Furthermore, lack of understandingfrom management about what the role of a phar-

macist entailed had implications for workload:

Being managed by non-pharmacists is an absolute

bug bear. no one can understand the pressures

apharmacist is under.until they’vedone that job.

Your first day of qualification, suddenly it hits you

just ‘ohmygod I’m responsible for all this stuff and

if anything goes wrong it’s my fault’. And until

you’ve actually had that feeling and you’ve expe-

rienced that feeling of not being able to cope

because there’s just too much coming in.I think

a lot of the managers who manage pharmacists

have no appreciation forwhat it is. And that is very

frustrating. [Participant 5, Community]

What I find now is that if you have a line manager

who is not a pharmacist, they’re not empathetic

towards your cause. [Participant 19, Community]

Pharmacists are managed by non-pharmacists, so

non-pharmacists don’t understand what your

professional responsibilities are. So therefore,

ask you to do things which would be, potentially

outside that professional boundary but then

don’t understand why we turn around and say

‘can’t do it, it’s not allowed’. So again that puts

pressure on you cos they’re then trying to

discipline you or cause you some kind of grief

due to that. [Participant 23, Community]

One pharmacist felt that preregistration phar-macists and pharmacy students lackedmanagement

training. This meant that the transition from traineeto pharmacists or manager was more difficult:

If you look at pharmacy as a profession and what

you get taught at university, you get taught clinical

things, how drugs work and how the body works

and stuff, at the endof the day someof these people

who are in these lectures are going to be managers

yet no where along the line do they ever get taught

about management, about people management

skills, about general management, you go to your

pre reg year, you’re not taught how to timemanage

even. [Participant 25, Hospital]

Satisfaction with line management

Eight of the 26 interviewees made positivestatements relating tomanagement.Almost withoutexception, the statementswere related to satisfaction

with direct linemanagement andwere fromhospitalpharmacists in all instances except 1. It would seemthat although some managers are detrimental to

career progression, others had more positive expe-riences and their careers had been enhanced by thementoring and support they had received:

I mean my manager’s really good and she always

gives recognition where it’s due.Where I work

my manager does support me as much as she can.


And my line managers are very supportive and

very encouraging of me to try new things and ask

questions and to flourish which is quite different,

and that’s what I really hang onto, I really

appreciate the support from those line managers.


I’ve got a fantastic pair of managers. It’s a very

senior job within medicines management but I’ve

still got above me kind of very much another

leader, it’s like the responsibility isn’t totally on

my shoulders.my managers are really good,

very supportive. And I think what I really like

about it is they give me a lot of feedback, they

don’t just leave you to your own devices.And it

certainly makes a big difference working for good

bosses. [Participant 7, Hospital]


The previous manager was just very personable

and supportive and they would wander around

the department and have a laugh and a joke and

they were very proud of what the department had

achieved and would talk nationally about how

good the department was at conferences and

would talk about how they developed things,

and they were very, very full of praise for the

department. [Participant 9, Hospital]

Dissatisfaction with organizational management

Some pharmacists felt as though the managers

of their organizations failed to communicate effec-tively with employees and often felt in the darkabout decisions that would affect them, creating

problems in their day-to-day work:

It’s just like company stuff really that annoys me.

If the company stuff wasn’t there I’d really enjoy

my job.the company’s rubbish and it winds me

up.there’s just no communication whatsoever.they just never tell you what’s going on. [Partic-

ipant 1, Community]

Ineffective working practices imposed by NHSmanagement were mentioned by 2 hospital phar-

macists who felt as though decisions that affectedtheir work schedule, and consequently their worklife balance, were not properly thought through:

So although we need to provide an extended

hours service I think it’s ridiculous that you’ve

got pharmacists sitting around tearing re-orders

off paper until two am. it’s absolutely ridiculous;

it’s stupid. It’s a really silly system, so they need

to totally rethink that. [Participant 13, Hospital]

Community pharmacists, employed by largemultiples, felt particularly unsupported and pres-surized to meet targets imposed on them by the

managers of their organizations. This led to 1locum pharmacist avoiding working for 1 partic-ular company altogether:

The amountof support from the company aswell.like I say from management, the pressure all the

time. I’ve foundI’vehadnosupport in that respect

from the company. [Participant 19, Community]

I find some of the systems, like I don’t do a lot of

work for [company name] anymore cos they do

things like time the length of time your prescrip-

tions been in, when it goes out, it’s like micro

management and I find that interrupts the way I

want to do pharmacy really. So I do tend to pick

pharmacy chains according to their kind of ethos as

well. And if I don’t like their ethos then I don’t go

back, and quite often it’s this micro-management,

target driven, that would be what I don’t like, but

you know if you don’t like it you don’t go back.


Micromanagement by managers of the organi-zation led to a feeling of reduced autonomy for 1community pharmacist. Some pharmacists felt thelack of autonomy afforded to them devalued their

professional status:

I like it where the pharmacist is given some

discretion and control over how they operate

professionally. I don’t like it when it’s quite

obvious that head office is making all the ethical

decisions for you and head office is controlling

every last movement of you within the pharmacy.


NHSpharmacists commented that progress andchangewere slow to happen because of the complex

structure of the NHS and constraints from thenumber of management layers delaying decisionsor preventing change. This meant that pharmacistsfelt that some working practices were outdated:

I think it stems from the NHS being such a huge,

monstrous organisation. Things are very slow to

happen,. if you’re trying toprogress something, the

wheels turn so slowly and there are somany layers of

middle management [Participant 7, Hospital]

Satisfaction with management of the organization

A locum community pharmacist commentedthat the company she worked for did not impose

targets on their staff, this was the exception ratherthan the rule:

I still find it a very easy company to work for. It’s

not remote, they don’t tend to impose things

without consulting you or impose completely

ridiculous targets. [Participants 21, Community]

Discussion

This qualitative study explored communityand hospital pharmacists’ job satisfaction ordissatisfaction with line management and how

their organizations were managed, and addressedthe paucity of research in this area. In general,pharmacists were more able to identify, andprovide details of, aspects of management they

were dissatisfied with, when compared with as-pects they were satisfied with. Job satisfaction wascompromised by ineffective management from

line managers and organizational managers. Gen-erally, satisfaction with management was reducedfor both community and hospital pharmacists

when management failed to support their staff interms of organizing appropriate staffing levels andworkloads, pressurizing pharmacists to achieve


unreasonable targets. Poor line management anda lack of recognition led to an increase in turnoverfor somepharmacists, and in 1 case, a desire to leave

the profession all together. Further evidence wasfound that being managed by nonpharmacists de-creases job satisfaction. Findings from the Northand Kirk study (1990)22 were supported as several

pharmacists felt their professional boundarieswere sometimes compromised by the demands oftheir nonpharmacist managers who failed to under-

stand their professional legal and ethical responsi-bilities. If pharmacists prefer to be managed byother pharmacists, and professional orientation

has a significant effect on job satisfaction, then itwould seem reasonable to suggest thatmanagementskills should be included in pharmacy training.

The finding that some pharmacists had left their

jobs, or were thinking about leaving their jobs orprofession because of poor relationships withmanagement had reduced their job satisfaction,

supports previous quantitative findings linking jobsatisfaction to turnover.10,38,39 A poor relationshipwith a manager was referred to as ‘‘the last straw’’

by 1 pharmacist, and implicated in the turnover de-cisions for other pharmacists. This suggests thatsupport and recognition from management may

compensate for other areas of work pharmacistsmay be dissatisfied with, such as workload.

High workloads in pharmacy have been recog-nized for some time.15 This study found that job

satisfaction was compromised by increased work-loads, which were largely attributed to understaff-ing, lack of trained support staff, large volumes of

work, and target-driven work practices imposedby management. It is important to acknowledgethe implications of poorly managed workloads,

particularly as pharmacy is a growing profession,and consequently pharmacy managers are makingever-increasing demands of theirworkers.Work in-tensification is not only detrimental to the well-

being of pharmacists, but also for patients whocan be placed in danger when pharmacists areworking under stressful conditions.40 Pharmacy

managers and workforce planners have a responsi-bility to pharmacists and patients to protect themfrom the hazards of work intensification. However,

it should be noted that some of the problems re-ported by pharmacists may be symptomatic ofbroader organizational and economic issues, such

as the intensification of work and increasing useof targets, rather than being an indicator of poormanagement on the line managers’ part.

One locum pharmacist described how poor

organizational management influenced her

workplace choices, meaning that poorly organizedpharmacies were avoided. This supports previousfindings, which suggested that locums avoid work-

ing in places that are badly managed.29 It has beenfound that an increasing number of pharmacistsare choosing to work as locums.29 This could inpart be explained by the increase in corporate or

chain pharmacies where locum working is a copingstrategy that affords pharmacists some control overtheir working lives when the job itself lacks auton-

omy.Given thedisparity that already exists betweensupply anddemand,41 if pharmacists continue to re-duce their hours or opt towork as locums to protect

themselves from demands imposed by manage-ment, the gap between supply and demand is likelyto widen. Furthermore, Magirr et al (2004) foundthat pharmacy owners were more likely to perceive

themselves as autonomous when compared withthosewhoworkedpart-timeorwere locumpharma-cists.42 Given the increase in corporate or chain

pharmacies, and consequently fewer self-employedpharmacists, further erosion of autonomy is likely.

Participants provided qualitative details of

how managers failed to communicate with them,which supports the findings of the NHS staffsurvey, which found that staff felt communication

with management was ineffective.32 In terms ofline management, managers not involving theirstaff in decisions, which had direct implicationson their working practices, further compromised

job satisfaction and led pharmacists to feel theirautonomy was being compromised. It seems thatsome managers did not afford the freedom to their

staff to carry out their work in the ways that theythought best, which some participants felt under-mined their professional status.

Further evidence was also found for pharma-cists’ dissatisfaction with the amount of recogni-tion they receive for good work. It seems thatsome line managers provide little or no positive

feedback to their staff. Those who were satisfiedwith their line management commented frequentlyon the amount of support and encouragement

they felt they had received.Findings from this study suggest that lack of

support from management has potentially signif-

icant ramifications for the career progression ofthe pharmacists working under them. Some phar-macists felt that their line managers blocked their

career progression and did not treat staff equally.This meant that job satisfaction and career pro-gression for some pharmacists were influenced bythe manager they happened to find themselves

working for. This supports the literature from the


United States has reported a lack of promotionopportunity as a factor, which affects the retentionof pharmacists.39 Consequently, if pharmacists arenot able to progress through their careers as they

had imagined, an increase in turnover is likely tofollow.39 Perhaps more transparent career path-ways or more formalized training schemes that

are open to all could be a solution, rather than‘‘on the job’’ training that may be supported or ob-structed at the whim of line managers.

Limitations

The 11 community pharmacists interviewed

represented 10 different community pharmacies;however, although independent pharmacists andpharmacists working in small chains had been

invited to take part, all community pharmacistsindicated that they worked for large chains. The 15hospital pharmacists were recruited from 5 large

teaching hospitals. All interviews took place in theNorth West of England, which is mainly urban. Aproblem with convenience and snowball samplingis that sample members are unlikely to be repre-

sentative of the population.43 It would havestrengthened the study to have had a nonprobabil-ity sample reflecting views from pharmacists work-

ing in a diverse range of pharmacies.A further limitation is that those whoweremore

dissatisfied with their jobs and managers may have

been more inclined to take part in the study.Although there is no way of knowing whether thiswas the case, this may have been counterbalanced

by the way hospital pharmacists were recruited.Hospital pharmacists were recruited through headsof department,whomayhave beenmore inclined toencourage employees to take part if they felt their

staffwere satisfiedwith theirmanagement and jobs.

Conclusion

Thepharmacyprofession is undergoing a period

of change and expansion. However, the ability todeliver relies fundamentally on those who managethose changes and the capacity and capability of theworkforce. If pharmacists are to make a major

contribution to health care then this will requirea major amount of work and appropriate staffinglevels to ensure that pharmacists are supported

adequately. Pharmacy managers should recognizethe importance of professional orientation ofpharmacy managers. Pharmacy managers should

pursue an agenda linked to business and patientcare outcomes without compromising the well-being of pharmacists. Broadening professional

practice should be considered in the context of thewell-being of the pharmacists who implement, andare affected by the changes, and not just the publicwhom they are serving.

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Appendix

Interview schedule of pharmacists

Interview schedule Questions

qualitative insights into job satisfaction and dissatisfaction with management among community and...

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