Canadian Pharmacists Journal - May/June 2019 - 158

840374
research-article2019

CPHXXX10.1177/1715163519840374C P J / R P CC P J / R P C

COMMENTARY

Commentary

Report from the 2018 National Summit on
Wicked Problems in Community Pharmacy
Andrea Bishop, PhD; Beverley Zwicker, BSc(Pharm)
Wicked problems are those that are seemingly impossible to solve because of their interconnectedness, complexity
and unpredictability.1 Pharmacy is increasingly tackling wicked
problems that threaten and undermine pharmacy practice,
including worsening workplace conditions, increased financial pressures and waning professionalism.2 While a number of
workplace and system barriers have been identified,3 we have
not yet applied what is known from the fields of organization
and behavioural sciences to fully explore them. This work is
needed in order to move forward.
Recognizing the need for a new approach, the Nova Scotia
College of Pharmacists (NSCP) hosted a 2-day National Summit
on Wicked Problems in Community Pharmacy in April 2018.
The aim of the summit was to better position the profession to
develop a theoretically sound and unified approach to address
the complexity of the current state of the profession through
a shared understanding of behavioural science. The summit
brought together 120 pharmacy practice stakeholders representing regulators, employers, researchers, educators, practitioners
and members of professional associations, government and
patient safety organizations. The summit program included presentations from pharmacy practice researchers and experts across
Canada, including Dr. Zubin Austin (University of Toronto),
Dr. James Barker (Dalhousie University), Dr. Lisa Dolovich (University of Toronto/McMaster University), Dr. Kelly Grindrod
(University of Waterloo), Dr. Lisa Guirguis (University of Alberta),
Dr. Jennifer Isenor (Dalhousie University), Dr. Andrea Murphy
(Dalhousie University), Dr. Ross Tsuyuki (University of Alberta)
and Dr. Nancy Winslade (Winslade Consultants).
Participants reflected on these presentations and the results
of a presummit participant survey to explore current challenges
and to support a shared understanding of the complexity and
interconnectedness of the issues among stakeholder groups.
Behaviours identified as underpinning the issues brought
forward by participants included 1) ineffective collaboration

between stakeholders, 2) pharmacists' lack of confidence in
applying and practising to their full scope, 3) slow adoption of
technology and connectivity of patient records, 4) inability to
resolve patient care and business models, 5) lack of empowerment for pharmacists as members of the patient's care team
and 6) the acceptance of strained staffing models and burdensome workloads by pharmacy practitioners.
Renowned behavioural science expert Prof. Susan Michie
(University College London) and colleague Dr. Fabiana Lorencatto (University College London) introduced participants to how a behavioural science approach could be used
to understand and design strategies to combat the above
behaviours. Using the example of pharmacist empowerment
through improved communication with the public and other
health care providers, participants then applied the theoretical
domains framework (TDF) and the capability-opportunitymotivation-behaviour (COM-B) model.4,5 The TDF and
COM-B model have both been widely used within health
care to facilitate behaviour change and improve the success of policy and practice change. Using a behavioural science approach provides 3 key advantages: 1) it discourages
decision-making based on the principle of "it seemed like a
good idea at the time"; 2) it allows for a deeper dive of the
behaviours underpinning issues, moving beyond groupthink
to identifying problems that can be addressed; and 3) it provides a systematic method and common language by which
pharmacy stakeholders can tackle wicked problems cohesively.
Key takeaways from the summit included the shared agreement that further discussion is needed within the pharmacy
community to better explore the complexity and interconnectedness of the issues, including the creation of a central repository
of identified pharmacy practice challenges and the creation of a
pan-Canadian committee to coordinate future collaboration.
Postsummit participant feedback indicated that continuing this work is of interest to stakeholders across Canada.

C P J / R P C * M ay / J u n e 2 0 1 9 * V O L 1 5 2 , N O 3

https://us.sagepub.com/en-us/journals-permissions

Canadian Pharmacists Journal - May/June 2019

Table of Contents for the Digital Edition of Canadian Pharmacists Journal - May/June 2019