The Grace Allen Young Memorial Lecture 2018

THE GRACE ALLEN YOUNG
MEMORIAL LECTURE 2018

Preserving the Legacy of Pharmacy
Excellence in Jamaica through

Quality Mentorship

November 18th 2018

Speaker: Mrs. Donna McKoy MPH, DipPharm, RN

OBJECTIVES:

To identify characteristics of Pharmacy Excellence

To explore the elements of a successful mentorship relationship

To highlight the contribution of mentorship to professional development

To identify current practices in mentorship that preserve Pharmacy Excellence

Shortly after I received the topic for this memorial lecture, I was doing my devotions when I came across the story in Mark 3 that told of Jesus choosing 12 men from varying backgrounds to be his disciples. It came to me then that mentorship has really been around for a very long time. Here we had someone who was an expert in his field, who chose persons to teach and to pass on his skills. The disciples were following Jesus so they were already interested in receiving the call to a new career. The twelve men were provided with direction, advice and assisted in acquiring the skills necessary to become a professional. They would eventually be left on their own to raise the dead, drive out demons and teach others about the gospel. They developed a close yet respectful relationship, keeping in touch with each other and their mentor. The disciples saw Jesus as their role model and tried to follow his example. He shared his expertise in the development of new professionals who would usher in a new wave of professionals called Christians. After Jesus died, they continued practicing what they had learned, they supported each other and went on to mentor others in order to maintain the level of excellence in their profession. Fast forward to our time.

Looking back over our few years and speaking with more mature pharmacists, we hear about the respect that was afforded pharmacists in the community. They were called “dispensers” then as the community saw them as the persons in charge of drugs.These dispensers were mentored by doctors and they in turn mentored pharmacists in a profession that was coming into its own.Then the profession of pharmacy evolved to specific training programmes for pharmacists, instead of apprenticeship, and more persons were trained to practice.The delivery of care to the patient continued to be at the fore-front of practice and the continual improvement in service delivery was a goal.The value of the relationship between other members of the health-care team was important to the delivery of patient-centered care as mentoring relationships developed and the knowledge and experience of the team increased.Doubtless, there was formal and informal mentoring in play throughout the years of pharmacy practice and it will continue.What is important to ensure is that as the culture and behaviours change, we don’t lose the value of learning from each other in an environment of mutual respect. As we strive to maintain excellence in pharmacy practice, we keep the patient in the centre and hone our skills with continued education, building on experience and benefitting from quality mentorship.

I am sure that we can all remember individuals who provided us with formal or informal mentoring; those who through their deportment showed themselves worthy of emulating.Some took us under their wings and encouraged our growth and some may not have been aware that we were watching and learning.I recall a few through my professional career as a registered nurse and as a pharmacist.There were Nursing Sisters who were seemingly hard on young nurses but they made sure we got the experience we needed and supported us when we needed it.The same was true for pharmacy.Senior pharmacists ensured that we did what was correct and that we understood the basic standards of our pharmacy practice.

Mrs. Grace Allen Young was one of my mentors who was outstanding in her drive for excellence and her expectations of the same from those with whom she worked. I had the pleasure of working with her at the PSJ in preparation for the Commonwealth Pharmacy Conference being hosted by Jamaica.She worked with the organizing committee, shared with us, encouraged ideas and suggestions and we operated as a team.We met again when I completed my hours of work experience in the Standards and Regulation Department I the MOH at the end of the Public Health degree. Out of these interactions came a job offer as she sought to challenge me to take on the role of being the Registrar for Health Institutions and Facilities within the Ministry of Health. Mrs. Allen Young made time for discussions about the work being done, gave suggestions and encouraged innovation.When we were attempting a new approach to monitoring health facilities, she accompanied me on visits to some facilities. That was the measure of the kind of support she gave.Our relationship developed to a friendlier one in which she knew about my children and grandchildren and I knew about her Mom.We worked well together, she as my Director/boss and me as her mentee. I saw her demand excellence from not only me but all those with whom she had contact.One memorable occasion was when I wrote a letter and took it for her signature, as was the custom.I had to go through 2 corrections before she was satisfied that she could place her signature on it. It seemed tedious at the time, but the take away from it was that if you hold yourself to a high standard, your work needs to be reflective of that, no matter how insignificant it may seem. Mrs. Allen Young was one of my finest mentors.

Who then can we say is a mentor?

A mentor is someone who is a role-model and helps the mentee to develop his/her career, providing support and sharing experiences.This person may be one’s superior with the ability to affect career progression; or may be someone in a lower position with a wealth of knowledge to pass on; or the mentor may be one’s own peers with whom experiences and lessons are shared. As we collaborate, we increase the activities of our brains and learning has a long-term effect.My classmates and myself benefitted a lot from the mentorship received from the Chief Pharmacist at KPH. As it turned out, so did a lot of pharmacy interns before and after us. The measure of her influence was shown on Facebook through the glowing tributes she received. Hers was not a one-off mentoring but a definite legacy of quality mentorship.We were taken through our paces, encouraged to address clinical issues that arose and discussions were held frequently that helped us to expand our thoughts and apply our newly acquired knowledge. I do not recall ever being turned away from her door, she was always available and encouraging. Our role model was a true professional even when she was annoyed. A mentor to many without realizing it, she has maintained friendships with her mentees over the years.I am sure there are other pharmacists who have provided similar mentorship experiences to young pharmacists both in the community pharmacies and in the hospitals.

My experience of peer mentorship was most profound in nursing school where we lived together, partied together, worked together and studied hard together. When we saw a patient with a condition that was new to us, we got together to share what we had learnt.Our common goal was to make our tutors proud, learn all we could and practice to the highest standards.We supported each other as we made a conscious decision not to leave anyone behind when we graduated.To this day, we have maintained friendships and communicate now on Whatsapp. I missed this sharing in the dispensing classes where we were not allowed to speak to each other even though in the actual practice of pharmacy we collaborate to the benefit of the patient. We can however, see peer mentoring in the big brother/sister programme that operates in the School of Pharmacy. Newer students are paired with a more advanced student who would be sharing and guiding in a mentoring relationship. From the feedback that I have received, this has more to do with sharing past papers but has the potential to be more than that.The mentor and mentee may choose each other and this suggests some mutual commonality and the earlier development of a successful mentoring relationship.Both parties need to be clear on their expectations and meet often enough to ensure that the relationship is beneficial.We all know that the best way to find if you understand a concept is to explain it to someone else. Of course, it stands to reason that we can only provide mentorship in the field in which we have knowledge and some expertise. The story was told of an artist who liked to hide behind his paintings in the art gallery to hear the comments of visitors. Shoemaker commented on shoes. Artist impressed and commended him on his observations. Encouraged, he commented on other areas of the painting going out of area of expertise. Artist advised, Not above the shoes Shoemaker, not above the shoes. I digress to point out that if we don’t qualify to advise in a given area, we should not try to do so.

To continue, mentors who keep abreast of developments within the field of pharmacy are better positioned to contribute to the growth of the next generation of pharmacists. They can provide perspectives that can help to mold and encourage new pharmacists as well as reviving the interests of the mentor in his/her own career. Mentorship benefits not only the mentee but also the mentor. I am blessed to be working among an enthusiastic group of young pharmacists from whom I am able to learn about new paradigms and new technologies while sharing with them my experiences as an older pharmacist. If we reflect on mentoring in our profession, we find formal and informal mentors who show interest in their career and are not hesitant in sharing their knowledge and experience simply to help the mentees reach their goals.This goal is to achieve a level of proficiency and effectiveness in the workplace and so provide the service that the customer/patient desires.Let us not forget that the patient is central to the work of the pharmacist. As so astutely observed by a pharmacist, we are the last stop for the patient in their journey through the health system.To us they bring their questions and their frustrations. Are we prepared to rise and provide the excellent service that is expected? To quote the International Pharmaceutical Federation and WHO, “The mission of pharmacy practice is to contribute to health improvement and to help patients with health problems to make the best use of their medicines.” Are we showing the “better angels of our nature”? Are we being good role models not only for young pharmacists but persons in our community?

Confucius once said: “If three people are walking together, among them there are certainly those who can be my teacher. I choose aspects that are good and I learn from them. When I see aspects that are not desirable, I use those as reference in order to correct my own shortcomings.”

Note that some persons exist to show us how to be while some exist to show us how not to be; either way there is a lesson to be learnt.

How would we define Pharmacy Excellence?It begins with our attitude and approach to our job and our colleagues.If we know our roles, if we are knowledgeable, if we strive to be the best and give of our best, we are on our way to providing excellent service. Pharmacists should be prepared to work to the highest professional standards.Some of these standards or levels of quality, have been established within some organizations and employee performance is measured by them.They are the means by which the same quality of service is kept throughout the profession.We all come from varied backgrounds and have different personalities but we are all held to the same standard of care.This by no means requires us to be robotic. In providing excellent service, pharmacists should be innovative in ways that bring healthcare closer to the patient and that ensures that the patient get the maximum benefit from our service and the medicines we provide.This means that we operate not only behind the counter but in the clinical settings, in the communities and in settings that we have established as a means of reaching the patients e.g. Diabetes Education clinics, Behaviour change sessions, Asthma clinics.The pharmacist no longer is the person expected to package prescription items as other skilled workers have that responsibility, freeing the pharmacists to perform at a higher level and in less traditional roles.Persons who are considering becoming a pharmacist or have just entered the profession may still perceive pharmacy as working behind the counter in the hospital or community setting. Working to change this and expand the role of the pharmacist involves thinking outside the box and being excited and rejuvenated by the possibilities.Without seeming to be promoting the National Health Fund, I must commend them on their move towards excellence in pharmacy practice.As stressful as it is right now to be working in a system where all the kinks have not been fully sorted out, it is possible to see the vision of having pharmacy services be patient friendly and patient focused. I recall a moment in the pharmacy late one afternoon. The team was working feverishly to dispense the medications to a group of tired patients. One patient started playing religious music on the phone and singing and before we knew it, there was an impromptu choir singing in the most melodious way. I found it a balm for my soul as I am sure it was for them. Patients are having increased access to medications and to healthcare both through the government programmes and through NHF. I pause to submit my disclaimer: I have not received any funding from the government for this and while I work part-time with the NHF I do not stand to gain personally from mentioning their programmes. I am aware that there is controversy about the effect of said programmes on the community pharmacies but bearing in mind the focus on the patient, I am confident that both the private sector and the government will come to an amicable agreement.Excellence in pharmacy practice is our goal and in an ever-evolving practice we as pharmacists will find ways to provide services that will enhance the use of the medicines we provide.

We can say then that the aim of Quality Mentorship is produce a professional who will provide excellent service, one who will exceed the customer’s expectations.This mentorship will have an impact on

  1. The image of the pharmacist
  2. Patient outcomes
  3. The image of the healthcare service
  4. Finances- use of limited resources, getting return customers

One of the challenges we have in Jamaica is the low levels of health literacy.Our culture accommodates a lot of advice from persons who have no knowledge of health.Remember the shoemaker.We hear vendors in some health centres and around rural towns expounding the virtues of whatever potion as a cure for some condition and which will allow them to stop taking medication.Surprisingly, people are willing to take the little plastic bag of powder or the bottle of coloured liquid for consumption and a cure not knowing what it contains.This is why our message needs to be culturally applicable.In talking to our patients, we can identify the myths and beliefs that would prevent them listening to or receiving the health message.In the delivery of superior care we utilize the confidential corner and make sure that what is said there remains there.Sometimes it is not the beliefs of the patient that affects proper use of medicines but it is the interpretation of an instruction.I was happy to have learnt from the pharmacy Council CE how the hearing impaired interpret what seemed to us as a simple instruction.We did not realize that for someone whose first language is not English as we learnt it, there may be a difficulty understanding the written language.Our role as pharmacists in maintaining the legacy of pharmacy excellence is to anticipate and address these needs, those of our disabled communities, those of our low-literacy patients trying to navigate the health system.So, we can see that communication is important.The how, the when, the what and the frequency.

The broadening of the sphere of pharmacy has already started as new avenues are opened.Pharmacists can be trained to administer vaccines and so become more visible in the community.Already mentioned was the ability to become a Diabetes Educator which also allows for entrepreneurship.There are now more posts for Clinical Pharmacists in the hospitals where pharmacists can take their place on clinical rounds.This is not to say that we couldn’t have done it before but this new opening fosters wider acceptance of the pharmacist as the “medicine specialist”. The leadership in our profession must now look upward and outward in motivating and inspiring our young professionals to be the best and continue to provide excellent service.Our ability to do this has to consider the prevailing culture and accommodate this in the development of a quality mentoring programme.

Our ability to maintain a legacy of Pharmacy Excellence hinges upon our recognition of the changes in our culture and how it has affected the attitudes of the students and new professionals. I am not sure which generation we are now seeing as this new nomenclature of Generation X and XY etc. has gone way over my head so like the previously mentioned artist suggested, that is out of my sphere of expertise.Suffice it to say that those who are charged with the task of training and developing the new professionals are finding that they have to make the necessary adjustments to meet the needs of these students. The newer generations have different expectations of the workplace and operate in different ways. Recognition of this is important as programmes and courses are organized to accommodate the new kind of student.It is laudable to note that applicants to the pharmacy programme are given Psychometric tests to highlight their strengths and weaknesses so that mentors can focus on specific areas for development. Research has shown that persons who receive quality mentoring are more satisfied and have a greater commitment to their profession. There are standards that have been set for internship and students continue to be given the choice of facilities.While on internship, the students are monitored and have to complete assignments while working in the facilities.A note of caution would be to ensure that interns/mentees are not utilized as a part of the workforce and miss the wider learning opportunities.

Maybe the time has come for us to be looking at a formal programme for mentoring with the matching of mentors and mentees, programme objectives and goal setting.In this formal structure, both mentors and mentees would be trained thus setting the stage for the relationship to be beneficial. There would be communication on what is expected of the relationship by both parties as they become psychologically prepared for the programme. This may also involve sharing personal information that may be relevant to the mentee’s performance e.g. having to travel a long distance to work or having a sick relative at home. Within this mentor/mentee relationship there should be respect or a positive regard for each other with the mentor understanding the difficulties that a mentee may be experiencing in navigating the path to professional development.The mentee should also understand and respect the limitations of the mentor’s time. Another aspect of the mentor/mentee relationship is the encouragement of the mentee to balance work and family life so that he/she does not become overwhelmed.The need to be reliable and able to work independently would be covered in the objectives and would be understood early in the relationship.

The goal of the Mentorship programme would be to produce a person who would display the attributes of a true professional.

What are some of the attributes we would see as a result of Quality Mentoring?

  • Knowledgeable about the job
  • Shows willingness to learn
  • Cooperative and gets along with others
  • Shows respect
  • Avoids behaviours that can cause trouble in the workplace
  • Lives up to commitments

Quality mentorship will help to re-orientate persons, give them confidence in their ability to practice but most of all, help persons to know themselves.I will share a story about knowing yourself.

During a visit to Bellevue, a visitor asked the Matron how they decided whether or not to admit a patient. “Well,” said Matron, “we fill up a bathtub, then we offer a teaspoon, a teacup and a bucket to the patient and ask him/her to empty the bathtub.”

“Oh, I understand,” said the visitor. “A normal person would use the bucket because it’s bigger than the spoon or the teacup.”

“No.” said Matron, “A normal person would pull the plug out. Do you want the bed near the window?”

Let us look at ourselves in terms of being professionals and all that goes with it. Whereas the definition of a Professional has changed with time the general idea remains the same; that of a person who works well, conducts him/herself in an exemplary manner and is generally one who can be recommended to move to even greater tasks. This means then that anyone who has a job can be a professional, from the street-sweeper to the Chief Executive Officer in an organization.When I lived in Kingston, my daughter and I would walk very early in the morning before getting ready for work.On our route was a street-sweeper who was as committed to his job as none that I had met before.He swept the street as if it was inside his house and he never failed to be pleasant. He was clean, neat and never smelled of perspiration. That was a professional.

Some persons go through rigorous training, belong to Associations and have jobs form which they earn a lot of money. Some persons are trained for short periods of time, maybe on the job, and do not have the best conditions in which to work. Within both groups, the true professionals will be evident in their attitudes and behaviour.

There are many highly trained workers who are well paid and who would be considered anything but professional, for lots of different reasons.All the diplomas, degrees and certificates don’t mean a lot if the person doesn’t know how to act. I’m sure we can think of unprofessional persons we’ve had to encounter.

Then we have the matter that sometimes gives us a bit of difficulty; how to dress.A man once said “Clothes make the man. Naked people have little or no influence on society.”

Most of us have uniforms prescribed by the organization or have fashioned one for ourselves to make it easier on the budget. There are times however when we allowed to be out of uniform. The most basic mistake at those times is to under dress. If we are unsure, be conservative (simple, not flashy).Remember that we are not dressing to attract attention, we are dressing to underscore your professionalism and competence. There is a difference in dressing to go out for fun and dressing for a work-related activity. It gets especially important when the activity is interviewing for a job as the same clothes is not appropriate to be worn on the two occasions (job and fun). Remember, like everything else at work, you are being sized up at all times and the little things count. When dressing for your career, remember that you want to be noticed for the quality of your work, not the horrible miscalculation of your clothes.Dress for the task at hand.

Having said all that, where does it take us? Not very far if we don’t put the wheels in motion to move us a few steps further.We now need to make a conscious decision to identify our goals and courageously move towards it.Very few of us are happy to remain in one position for our entire lives. We have to make the dreams of the mentee be outstanding in some way while being happy within themselves. We should encourage them to take full responsibility for their own health, their careers, their finances, their relationships, their emotions, their habits and their spiritual beliefs. This moves them towards an inner balance that will help to create the life they truly desire. What are some of the things that are necessary to do?

  • Time management – master your use of time and become more productive. Avoid putting things off; procrastination is the thief of time.
  • Motivation- Develop that burning desire to keep you moving towards your goals
  • Goals – Set realistic goals, make a plan and achieve results
  • Courage – Reach inside of you for the strength to take action in spite of fear.Confront and solve the hard problems of life.
  • Work – build a career you are passionate about.Take advantage of opportunities to grow within the organization.
  • Money – Achieve more financially without compromising your integrity
  • Balance – Enjoy the peace that comes when you have balanced all the areas of your life.

We give thanks that we have been blessed with the opportunity and the wherewithal to positively influence young minds and keep our profession moving in the direction of excellence and high standards.We thank all those who have mentored others and have left behind a legacy that can withstand the test of time.So, let us all continue to do the best we can, to as many as we can for as long as we can.

References

Mentoring Month: Insights From Historical Figures … – The Epoch Times
https://www.theepochtimes.com/mentoring-month-insights-from-historical-figures-in-ancient-china_1940040.html
Accessed November 12, 2018

The differences between coaching and mentoring – UCL
http://www.ucl.ac.uk/hr/od/coaching/differences.php
Accessed November 8, 2018

The Difference Between Coaching and Mentoring by Vicky Webster and Martin Webster (Eds.)
https://www.leadershipthoughts.com/difference-between-coaching-and-mentoring/
Accessed November 8, 2018

The 10 Biggest Breakthroughs in the Science of Learning | Brainscape …
https://www.brainscape.com/blog/2012/10/breakthroughs-science-of-learning-2/
Accessed November 12, 2018

How to Cultivate a Pharmacy Culture of Excellence
https://www.pharmacytimes.com/contributor/lester-nathan-ms/2016/01/how-to-cultivate-a-pharmacy-cultur
Accessed November 12, 2018

Joint FIP/WHO guidelines on good pharmacy practice
https://www.fip.org/uploads/database_file.php?id=331
Accessed November 8, 2018

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