Context: The role of services, provided by pharmaceutical organizations for visitors, increases every year. Aim: The main purpose of the article is to form and develop communicative competence in the process of continuous professional training in the sphere of communication of the pharmacist. Settings and Design: The quality of the pharmaceutical service depends on where, how, and by whom it was provided. In other words, the quality of the pharmaceutical service depends largely on the personality of the pharmacist and the circumstances in which it takes place. Materials and Methods: The study considers general principles of effective communication between pharmacists and consumers of pharmaceutical services, colleagues, doctors, and other medical workers. Results: This article presents the basic concepts of communication, its process, and communicative competence in pharmacy. Conclusion: Properly organized pharmaceutical activities and professional staff who possess communication skills are an indispensable condition for effective work of the pharmaceutical organization.
Keywords: Communication, communication skills, competence, patient, pharmaceutical service, pharmacy, service rules
|How to cite this article:
Umurzakhova G, Sultanbekov A, Issatayeva N, Zhakipbekov K, Shopabaeva A, Shertaeva C, Datkhayev U. Communication skills as one of the main competences of pharmacists. Ann Trop Med Public Health 2018;11:62-9
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Umurzakhova G, Sultanbekov A, Issatayeva N, Zhakipbekov K, Shopabaeva A, Shertaeva C, Datkhayev U. Communication skills as one of the main competences of pharmacists. Ann Trop Med Public Health [serial online] 2018 [cited 2020 Aug 10];11:62-9. Available from: https://www.atmph.org/text.asp?2018/11/3/62/272545
The development trend of the competitive pharmaceutical environment enhances the influence of nontarget determinants, including the pharmacists’ level of service culture. Given the social importance of the work of pharmaceutical organizations and constant contact with the population, the system of personnel management in pharmacy puts forward the role of the human factor. In the pharmaceutical organization, the human factor is of paramount importance, and along with professional training, it requires specialists to have good knowledge of social psychology. Under these conditions, for the activity of pharmaceutical organizations to be effective, it is particularly important to increase the role of communication skills and the importance of communicative competence for the effective interaction of pharmaceutical workers with patients.,
Learning the basics of communication skills expands the possibilities of future pharmacists in obtaining necessary knowledge, abilities, and practical skills in the culture and ethics of communication between consumers of pharmaceutical services, colleagues, and medical workers. In addition, effective communication between pharmacists and patients promotes the patient’s understanding of the prescribed treatment, which helps improve the compliance (satisfaction) of consumers of pharmaceutical services.
Moreover, the socio-psychological training of pharmacists can accelerate the development of such key qualities required in entrepreneurship as:
- Readiness for continuous innovation
- Ability to act in extreme situations
- Ability to make nonstandard decisions
- Initiativity and entrepreneurial spirit
- Readiness for continuous professional development
- Combination of professional and humanitarian culture.
|Materials and Methods|
The study involved a number of pharmaceutical organizations and enterprises of the cities of Kazakhstan – Almaty, Aktau, Aktobe, and Shymkent (about 400 respondents). The choice was made in the direction of anonymous questioning of specialists in the pharmaceutical industry to fully solve the tasks set. At the same time, to obtain representative results, according to the formula of irrevocable sampling, based on the total number of pharmacists, a questionnaire of 400 respondents is sufficient.
The representativeness of the sample was calculated according to the following formula:
Where, N – the required amount of output;
t – multiplicity of the average sampling error;
Δ – the limiting sampling error;
d2 – variance of the general totality;
N – number of the general totality for the irrevocable sample;
Δ – 0.05 (equivalent to a 5% error) t = 2, Σ =0.05;
Confidence probability γ = 0.95 (reliability of sampling – 95%);
d2 = S2 – (based on the preliminary survey – 0.25).
N – the number of the respondents sufficient for the survey.
Thus, the sample totality is reliable.
The study took into account the following criteria for the selection of participants:
- Number of participants: The subject of the study is 400 pharmaceutical workers, occupying the positions of specialists in the field of medicine quality and technology assurance as well as management personnel of pharmaceutical organizations of various forms of ownership in Kazakhstan
- Distribution by sex: There are no gender restrictions in this research
- Age: From 20 to 63 years, since pharmacists start their professional activity after completing vocational training and finish when they reach retirement age
- Nationality (ethnicity): There are no restrictions on national or ethnic origin
- Criteria for inclusion: The study included pharmaceutical staff as this is part of the purpose and objectives of the research
- Criteria for exclusion: Nonpharmaceutical staff
- Vulnerable groups: There are no vulnerable groups of study participants.
Proceeding from the above, the sociological method was selected for the study-anonymous questioning since this method is the most popular in the study of opinions in the field of pharmacy and is more economical, objective, and ethical.
We studied the need for employers and specialists in the sphere of medicinal products circulation in educational training programs through anonymous questioning. For this purpose, the following question was formulated: “What training topics of pharmaceutical staff are most in demand in your organization?” The respondents expressed the desire to improve their professional competence in the following subjects: “Communication skills of the pharmacist” (30%), “Pharmacology” (42%), and “Normative and legal aspects” (28%) [Figure 1].
|Figure 1: What training topics of pharmaceutical staff are most in demand in your organization?
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The need for learning communication skills and aspects of pharmacology is obvious.
A special place in pharmaceutical organizations, based on ethical norms of behavior, interpersonal and professional relationships, professional training of pharmacists, is occupied by general principles of effective communication between pharmacists, patients, colleagues, doctors, and other medical workers. Special, heightened demands are made on the psychological atmosphere of pharmaceutical organizations. Each pharmacist must be responsible for the professional level of performance of his or her duties, having a certain margin of communication skills. For understanding the meaning of communication skills, it is necessary to know what types of communication exist. Communication can be of two types:
- Productive communication [Figure 2]
Figure 2: Productive communication
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Where C is the communicator who transmits the message in the form of code;
M is the message in the form of a code (words);
R is the recipient (communicant) who receives the message in the form of a code, i.e., there is an act of interaction between people. If “R” perceives the message “M” and reacts correctly to the impact of “C,” then the C will receive feedback from the recipient. This feedback “perception” serves as an indicator of whether communication has taken place or not, i.e., feedback can be positive or negative. Therefore, communication is a closed system and is called a “communication process.”
- Unproductive communication [Figure 3]
Figure 3: Unproductive communication
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Interference or barriers in information are manifested when the message is encoded incorrectly, which means that information is decoded. They include the following:
- Productive communication [Figure 2]
- “Preconceived idea”– the tendency to deny everything that does not correspond to one’s own views
- “Stereotypes”– simplistic views on people, phenomena, and objects
- A different emotional state
- Lack of interest on the part of the interlocutor
- Bad relations, conflicts
- The tendency to draw conclusions based on one fact
- Different religious, political views
- Personal barriers: timidity, indulgence, arrogance, etc.
The communication process can be regarded in the same way as sending information with the aim to have an effect on another person. The purpose of this is to have 100% impact on the recipient. One can communicate with three effects:
- Body (posture, gestures, facial expressions)
- Tone of voice
- Words (everything about which we communicate).
The total proportion of all the effects of the communicator on the recipient can be viewed as follows [Figure 4]:
|Figure 4: The total proportion of all the effects of the communicator on the recipient
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- 55% – body movements
- 38% – tone of voice
- 7% – words.
There are several levels of communication among pharmaceutical staff:
- I level – Communication between pharmacists and pharmacy visitors
- II level – Communication between pharmacists and doctors
- III level – Communication between pharmacists.
Communication between pharmacists and doctors and between each other should be business and as less emotional as possible, especially when it takes place in front of pharmacy patients. Communication “pharmacist–pharmacist” and “pharmacist–doctor” is characterized by professional ethics, attention, benevolence, trust, and reasonable exactingness.
In more detail, we will discuss the 1st level of communication “pharmacist–patient,” which is the main one in the activity of subjects of the pharmaceutical organization. The style of communication with consumers, communication itself is one of the main components of service culture. The unqualified, awkward service of the population in the context of growing competition between pharmacies results into the deterioration of economic indicators for the organization, and a decrease in moral satisfaction from labor for staff. What is characteristic for communication in the field of pharmacy trade these days? On the one hand, the population is provided with an ever-increasing range of goods, and the number of pharmacies is increasing; however, on the other hand, the number of consumers is growing, and naturally, their requests become more complex and diverse. The pharmacist, providing the release of medicines, is the only representative of the pharmacy at the present stage, who has direct contact with the buyer. That is why the pharmacist most often needs knowledge and skills in the field of pharmaceutical ethics and deontology as well as communication skills, which form the basis of the rules of pharmaceutical consumer services.
In this connection, the following question was raised in the questionnaire: “Do pharmacists learn the skills of working with patients in your organization?” About 52% of the respondents answered negatively, which indicates the need to learn the rules of communication between the pharmacist and pharmacy patients [Figure 5].
|Figure 5: Do pharmacists learn the skills of working with patients in your organization?
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We present the 1st level of communication in the form of rules for an effective conversation between the pharmacist and patients:
1. Make sure that patients can hear what the pharmacist says
2. How to contact the patient. Greetings may vary depending on the circumstances or situations in a particular pharmacy. It may be appropriate to address patients who the pharmacist knows well by name. With patients who the pharmacist did not know before, the formal approach is the best option
3. How to start a conversation. Here, it is important to remember: the situation is controlled not by the one who speaks more but by the one who asks more successful questions and listens better. The first step will depend on the circumstances. The question: “What can I do for you?” demonstrates benevolence. As a rule, when communicating with the patient, pharmacists should spend less time (25%–30%) on asking questions and answering them, and most of the time (70%–75%) – on listening to the patient. Competently asked questions make it possible to understand what the person needs and what exactly should be offered. There are various types of questions, the main ones of which are presented in [Table 1]
|Table 1: Types of questions
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4. How to determine the topic of the conversation. The topic of the conversation is often determined by the pharmacist’s initial approach. In some cases, it is important for the pharmacist to wait for the initiative from the patient. In most cases, it is important that the pharmacist take the initiative on his or her own. The question: “What can I do for you?” is better than the simple phrase “Hello”
5. Communicate quickly if necessary. The average duration of the pharmacist’s speech is 3–5 min. However, he or she should not hurry. Within a few minutes, the pharmacist should evaluate: • Whether the patient is ready to receive and communicate • What his or her initial expectations are • Whether there are any hidden needs • To what questions the pharmacist should receive answers.
6. Try to remember the name of the patient. In situ ations where it is important to clarify the patient’s request, one should refer to the patient by name. For example: “This will take more time so that we are not mistaken when choosing medicines. What should I call you?”
7. Help patients focus on their problems. If patients are talkative, loquacious, or overly concentrated on their symptoms, the pharmacist may ask: “What is important to you at this time?”
8. Identify the treatment that was and is expected: “What medications do you actually take now?” or “What medications are you taking at the moment?” The inclusion of the words “actually” or “at the moment” can help patients show that they have not talked about all their treatments
9. Learn how to talk tactfully “yes” or “no.” If you want to express an unequivocal “yes,” say it. If you want to say “no” but want to emphasize it by a different technique, then use something like: “I’m afraid that the answer should be no, because.”
10. Try to show a neutral approach. Staying neutral is particularly difficult in cases of the patient’s expressed personal identity. In order for the pharmacist not to think about different patients, his or her work requires a wide range of communication skills and tolerance
11. Evaluate how the problem affects the patient: “Tell me how this affects the choice of medicines?”
12. Try to see problems from the perspective of the patient. What seems normal to you can be very important to the patient
13. Do not dominate especially when dealing with patients who are waiting for recommendations from the pharmacist. The patient, seeing that the pharmacist persistently convinces him or her to choose any medicine, may experience discomfort. Remember: the patient who has contacted you has a partner – the doctor who made the prescription. Your task is to establish partnership with the patient and if necessary with the attending doctor
14. Admit the areas of ignorance. It is easier for the pharmacist than for the doctor to admit his or her ignorance to the patient. However, he or she can refer to the doctor: “What does your doctor think about this?” or “Can you consult your doctor again?” Sometimes, it is appropriate to say directly: “I can call your doctor and clarify, if you agree?”
15. Communicate slowly as if you are in no hurry to serve the next patient. If the pharmacist has a lot of information, he or she should report it slowly and pause so that the patient can understand. Slow pronunciation is useful, but it is necessary to speak deliberately and clearly. Pharmacists always speak faster than patients and interrupt more often. Speaking slowly, the pharmacist wins in general when communicating with the patient
16. Interrupt with caution. If not interrupted, patients will talk for one and a half minutes on average. However, pharmacists usually interrupt after the 18th s and this can give the impression of harshness and impoliteness. The technique of interruption plays a key role, when the pharmacist needs immediate clarification of the decisive moments as he or she talks to the patient
17. Encourage the patient from time to time. Minor comments such as “yes,” “true,” or nodding can convince the patient that the pharmacist is listening and attention is focused directly on him or her
18. Increase positivity. If possible, the pharmacist should emphasize positivity. Do not say: “Taking medicines without doctor’s advice is harmful to the body.,” but better: “Repeated doctor’s consultations will help you better cope with the disease
19. Ignore possible provocations. The nonappropriate use of certain adjectives by some patients is irritating and sometimes insulting. Ideally, the pharmacist should not notice such adjectives and focus on nouns, if they are not offensive
20. Actively use nonverbal communication. Eye contact, gestures, and posture of the pharmacist are important in the communication process. No reasons (barriers, etc.) can justify bad communication, and they are simply the poor organization of the pharmacist’s work. The intonation of the voice matters, as it indicates a certain mood – anger, boredom, cheerfulness, impatience, joy, sadness, and contentment. The pharmacist should include nonverbal components in his or her communicative repertoire. A deep voice expresses power, while hesitation and mistakes in speech suggest that the talking person is not confident in him/herself
21. Use of the body language. The movement of the hands for emphasizing any points, an appropriate touch to the patient and the facial expression of the pharmacist can express appropriate attitude, emotional reactions. Clothing also plays a great role in nonverbal communication; it should be neat and relevant. It must be remembered that the body language is a two-way road, where not only the pharmacist but also the patient catches nonverbal messages. The body language invites to the conversation, for example: inclining with the purpose to listen to the patient; maintaining eye contact and attention; and nodding. Conversely, distracting nonverbal signs interfere with effective communication, for example: a restless turning of the pen; peeping at the clock; and avoiding eye contact. Here, it is appropriate to mention about the distance between the pharmacist and the patient. When providing services to patients, the pharmacist must choose the distance based on certain tactical techniques, which include studying the patient’s reactions when the pharmacist approaches or moves away in verbal contact. In the first case, the patient who does not want to approach will tend to move away or deviate. In these cases, the pharmacist should increase the contact distance. If the patient wants to reduce the distance, he or she may approach or bend over, and in these cases, the pharmacist may try to slightly reduce the distance
Kazakhstan is a multi-ethnic and multi-confessional state. Therefore, it is necessary for the pharmacist to master the skills of intercultural communication.
One of the known systematics, compiled on the basis of population studies in the field of intercultural communication, is the classification made by D. Morris (1992):
• The elbow zone (societies whose representatives stand so close to each other that their elbows can touch; e.g., the Spaniards, the French, the Italians, the Turks, and the Greeks) • The wrist zone (societies whose representatives stand in such a way that their wrists can touch; e.g., the Poles, the Hungarians, and the Romanians) • The fingertips zone (covering the inhabitants of Great Britain, Holland, and Nordic countries, where the distance of the outstretched hand is observed and no importance is placed on touching).
22. Joint decision-making. Joint decision-making is one of the basic requirements of medicine and pharmacy, aimed at equal responsibility for the health and treatment of patients. Allowing patients to enter the decision-making process and involving them in the treatment process, the pharmacist and the doctor can increase patients’ adherence to treatment. It should be remembered that patients will differ depending on how much they want to participate in decision-making, some feel more comfortable, placing decisions on their doctors and pharmacists
23. Summarize the completion of communication with the patient. Summarizing is an important condition for effective interaction between the pharmacist and the patient. Summarizing what the patient said is a tool for checking that the pharmacist has a precise understanding of the patient’s point of view. It includes the following aspects: highlighting what the patient said; inviting the patient to correct the interpretation of the pharmacist and provide further clarifying information. The advantage of summarizing is as follows: it demonstrates that the pharmacist listened attentively; shows the pharmacist’s interest in the patient’s medical history; gives the pharmacist an opportunity to explain something one more time; provides gathering of accurate information; and helps organize the thoughts of the pharmacist.
24. Know yourself. It is extremely important for the pharmacist to get feedback on his or her communication from colleagues. Psychologically, a good organization is noted for a systematic discussion of behavior with patients, when an expert asks for feedback from colleagues on the features of his or her communication (blamestorming, outside perspective). There are a number of developed trainings on feedback, where pharmacists learn the correct presentation of feedback. It is appropriate to designate several feedback rules: feedback must be descriptive, should not contain an estimate and should begin with such expressions as “I saw,” “I heard,” “I think,” and “I would say so.”
Based on the foregoing, it is possible to determine the main objective in the commodity policy of pharmaceutical organizations that provide services for the population of Kazakhstan – to increase the competitiveness of pharmaceutical services and manage their quality. To achieve this goal, it is necessary to ensure the solution of the following tasks:
• Quality realization of the sale of medicines, medical products, and patient care • Determination of the time spent by the pharmacy patient to purchase a pharmaceutical service.
The fulfillment of these tasks is related to the professionalism and communicative potential of pharmacists-specialists since their qualification and psychological preparation has an effect on whether the services of this pharmaceutical organization are sufficiently high-quality and competitive in the pharmaceutical market.
In 2008, Kazakhstan introduced the state Good Pharmacy Practice standard, the main requirements of which are patient orientation to preserve human health; orientation of each element of the pharmaceutical service to a separate person; provision of qualitative pharmaceutical services. The implementation of these requirements is impossible without compliance with the norms of pharmaceutical ethics and deontology when providing services to pharmacy visitors.
In this context, a significant place in pharmaceutical ethics and deontology should be taken by the development of normative provisions of a moral nature.
To implement the above tasks, pharmacists are advised to use certain rules of pharmaceutical consumer services as well as to form and develop the necessary communicative and professional skills for effective communication between the pharmacist and consumers of pharmaceutical services. Based on the above, when questioning the respondents, we raised the following question: Does your company have any “rules for providing pharmaceutical services to consumers?” Over 50% of the respondents answered negatively [Figure 6].
|Figure 6: Does your company have any “rules for providing pharmaceutical services to consumers?”
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Based on these data, we have developed and proposed the “Rules of pharmaceutical consumer services,” which are a set of methods for effective communication between pharmacists and patients. They include:
- Rules for coming into contact with the consumer
- Rules for identifying the needs and requests of the patient
- Rules for the presentation of goods
- Rules for dealing with the doubts and objections of the patient
- Rules for talking on the phone
- Rules for completing a conversation with the patient.
Their main purpose is to teach staff the rules for providing services to consumers of pharmaceutical services and then to assess how well the accepted rules are being implemented and meet the needs of patients.
We have developed an algorithm for the rules for providing services to consumers of pharmaceutical services [Figure 7].
|Figure 7: An algorithm for the rules for providing services to consumers of pharmaceutical services
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The application of the rules of pharmaceutical consumer services in the work of pharmacists can increase the quality and level of patient care within the pharmaceutical organization, the number of customers, the sales volume, and accordingly, the competitiveness of the pharmaceutical organization in the market.
The research results made it possible to identify the need of pharmacists to increase their competence in communication skills and to compile a textbook “Communication Skills” for students of higher medical educational institutions studying pharmacy (based on the sample educational program “Communication Skills” developed by the authors) as well as for managers and specialists of pharmaceutical organizations.
This textbook was introduced into the educational process of S. D. Asfendiyarov Kazakh National Medical University in Almaty, South Kazakhstan State Pharmaceutical Academy, in Shymkent and into a number of pharmaceutical organizations through the Association for the Support and Development of Pharmaceutical Activity of the South Kazakhstan Region of the Republic of Kazakhstan and the Department of the Control Committee of Medical and Pharmaceutical Activity in the South Kazakhstan Region of the Republic of Kazakhstan (the acts of introduction are available). In addition, a certificate of the state registration of the rights to the copyright object was received, namely to the textbook “Communication Skills” (the record in the state register of the Republic of Kazakhstan for No. 1682 dated August 10, 2016). The practical application of knowledge and skills in communication obtained through the textbook will improve the professional level of the modern pharmacist and the quality of patient care as well as attract customers, thereby increasing the volume of sales and competitiveness of pharmaceutical organizations.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]