0: Welcome to the AJP podcast,
a podcast for pharmacists by pharmacists where we discuss current
events, relevant topics, and emerging issues. I'm your host, Carlene McMaugh,
and together with the AJP,
I'm bringing you the opinions and expertise of different pharmacists to discuss
their views and insights on topics relevant to pharmacists.
Please like and rate each episode and subscribe to the podcast so you don't miss
an episode.
1: So thank you Michael Dooley for making the time to speak with me today.
Can I just ask you to tell us about yourself?
2: Yes, thanks Carlene, look, I'm Michael.
I'm the director of pharmacy at the Alfred Hospital
in Melbourne,
which is a large hospital network with the
Alfred Hospital corporate hospital,
centering hospital and services for Melbourne sexual health and a range of
outreach programmes.
So it's a very large health service and I look after the pharmacy
services across all those campuses.
And we have a range of services that are both focusing on our patients who are
within the hospital,
but also our ambulatory patients who may be being treated in the home or
through our outpatient clinics and such.
And I'm very fortunate I work alongside a great
team of advanced practitioners from
interns through to residents,
through to very specialised pharmacists working across a whole range and working
alongside some great other practitioners, our nursing colleagues,
medical and other allied health colleagues who we work very closely with.
I also have a position as a professor of clinical pharmacy within Monash
University and that is a great collaboration which allows us to be
able to also collaborate on research projects.
And I supervise a number of PhD students as well.
And I've been fortunate enough to sit on a range of working groups
and reference groups and committees across
Australia and in Victoria focusing on medication use and shortages.
So I have a reasonable
portfolio that includes both developing practice and supporting practitioners
and having input into medication use and safety across a range of
areas.
1: Thank you.
Can I please ask you to share some of the key challenges facing the hospital
sector, such as transitions of care?
2: Yeah, look, I think the hospital sector,
like all sectors has a range of challenges and they probably
encompass everything from
the challenges associated with expectations,
both from patients and their families,
and also expectations of practitioners.
It's a challenging environment just because of the nature of the
diversity that we see in hospitals and that may be from outpatient clinics
through to intensive care units, emergency departments,
and the services that are provided both in very large acute
services through to those that are rural and regional.
So the challenges are there around the complexity associated with,
I mean the services that are provided
and the nature of the pressures that are
associated with those, whether that be just due to workload,
just due to the diversity of patients,
just due to the challenges of providing care across a range of settings
as those patients transition into hospitals and out of hospitals.
So there are a range of challenges and we've seen this
continuing to grow as our services get more complicated as patients get
more complicated as treatments get more complicated.
1: Thank you.
Can you tell me more specifically as well about some of the challenges specific
to pharmacists,
whether it be quality use of medicines and medical medicine safety working in
the sector?
2: Yeah, look, I think the challenges of pharmacists
fall into a number of areas.
I mean there's the challenges of the system that we have to work in.
We are just one member of one cog of a very big system
playing an very important role.
But there's the challenges of the system and how it's designed and how hospitals
are designed and how our funding is designed and how the
PBS is designed. So it's working within that system where
we work alongside a diverse group of other health practitioners.
So it's the challenges in that system.
I think there's the expectations of patients and their carers and their
families as to
the care they would like to be provided.
We are all at some stage patients ourselves and
patients rightly should have the choice associated with their care and be able
to choose what happens to them as best they can.
And so I think that's a real challenge is how do we balance the system and how
do we balance the needs of the patients and the expectations of the patients.
And then there's the challenges associated with being the complexity of care.
As we see
more patients presenting with more complex conditions, comorbidities,
we see the treatments,
the medicines getting more and more complicated every day,
the range of therapies available, the combinations of therapies,
how we administer them, how we dose, how we educate,
growing,
and then we see our scope of practise also expanding.
And with that comes how do we educate, how do we make sure we support
the individual pharmacists who are providing those,
providing those roles across so many different settings.
And then I think it's how do we look after our workforce?
How do we make sure their role is and their work is done in a way that
we look after their wellbeing, that we recognise them, that we develop them,
that we provide those support.
So I think they're all the key things that go into quite a
degree of
complexity associated with the individual pharmacists providing care is the
system, is the patient's, is their role,
and then is how we support them and of course the medications
that go with that.
1: Thank you. So I thought I'd ask you more specifically about the
P-S-A-C-S-I.
So what made you decide to chair the PSA leadership group?
2: Look, I think all the things we've been talking about at the moment
show that those challenges that we see,
I'm in a fortunate position that I've been able to
see those challenges that are faced by pharmacists, which we've just discussed.
And I think we need to be able to support
pharmacists to be able to take on those responsibilities and to be able to
practise safely and to be able to provide care that we want to
provide, but do that in a way that we still look after their wellbeing,
that they're remunerated appropriately,
that we put the supports in place for them to practise.
So I think it's motivated me to be involved
in hospital pharmacy practise group such as this is really,
there's so much we want to be able to do,
there's so much that there's so many opportunities,
but we need to be able to support practitioners in undertaking those
roles. And a group such as this I see as being
able to work through how do we develop those services,
how do we develop the practitioners, but how do we support them?
And I think the key bit that I think is interesting to me is how do we put those
supports in place to be able to
grow the opportunities for pharmacists to practise and to impact on
patient's care and on the care that Australians receive.
But how do we do that and how do we help them do that in a supportive manner,
whether that be through educational programmes,
whether that be through advocacy, whether we do that through changes in policy,
I think
those individuals who are in leadership positions with that
comes the responsibility to really support those going forward.
And I just see it as a way of contributing.
1: Thank you.
So you have a great panel of pharmacists in the hospital pharmacy practise,
CSI with you.
Can you please tell me about them and their experience in pharmacy as well?
2: Yeah, look,
I mean that's always one of the wonderful things in putting together
like-minded individuals who are very passionate about what they're
doing and very passionate and being able to contribute and help.
And there's a number of the team that's been
put together to start the work in this space In regards to this group is
pretty diverse. I mean,
we've got a number of people
who have led and continue to lead hospital pharmacy
programmes.
We have Ian Coombes rom Queensland who's been instrumental over the
long time in leading and developing services.
We have Richard who's in
South Australia leading the pharmacy,
I suppose pharmacy programme there and doing wonderful
work, Lisa,
who many of the few will be know of
Lisa's long time and passionate involvement in education and
advancing services, not only across all sectors.
And then we have people who have probably been around a little less time
and getting that flavour of some people who have got probably earlier on in
their career who are working across a
range of things, a range of areas, whether that be community medication reviews,
hospital settings,
is getting that balance of people who have been around for a while. But
also I think as important is the insight and the
engagement of those that are developing in the services who
have, I suppose,
fresher eyes that can often give those
insights that are even more important than some of us who have been possibly in
roles for a long period of time. So the group
that we put together is trying to get a mix of those that are working in the
acute sector, hospital acute sector.
We have Bavini who's from the Northern Territory are working across all of the
Northern Territory. So we've been trying to get a flavour of those that have
got a lot of experience versus those that have got some new eyes,
those that are in different states, those are in private and public sector
and those that are early career.
So I think it's a wonderful group to be working with
and no doubt there'll be others that will come on board that will be able to
support
and challenge the thinking in regards to what we should be
doing for hospital practise going forward.
1: Thank you.
Can you please share with us what you hope to achieve through the leadership
group?
2: I think I need,
the key bit I think is working through
ways to support
hospital pharmacy practise and the transitions associated with practice.
I mean hospital pharmacies includes those aspects associated
with looking after patients who are hospitalised,
but also many of our patients are transitioning either through
coming into hospital or leaving hospital,
going into other settings or in ambulatory care.
So really the main,
what I would like to achieve I think is been able to put like-minded
individuals together to really set a bit of a vision
for the organisation and for others. That's the key bit I think,
is
developing a vision and engaging with those that got
their, I think heart and soul in the space. We really want to
have a vision work alongside and with those that have
got their heart and soul in working across hospitals and in those
transition points so that we can work through what's the
best way to support practitioners. If we can support practitioners,
we can expand their roles and responsibilities, we can provide care better,
which is I think what we'd all like to achieve.
But also we'd like to achieve that by being looked after in the workplace,
be remunerated the right way to be respected and
have our role within those multidisciplinary
groups work alongside other practitioners.
So I think it's really about having a group that can help set the
vision
and can work alongside those who are passionate about what they do to
support both the services, but most importantly support the practitioners,
the pharmacists who are providing those services so that they can do the
things they want to do and be supported to do that.
1: Can you tell me why in your opinion it is important to have an organisation that
represents all areas of pharmacy practice?
2: I think it's really, I think, look,
I work in a hospital and sometimes we get very,
very focused on what happens if it's inside the four walls.
We know that
care is provided across all the sectors.
And what we do in hospitals is what happens to patients
in the ambulatory setting in their home,
in wherever they live is incredibly important.
Those links
that follow the patient journey are credibly important.
The practitioners who work across those settings,
whether it be in community practise, whether it be
gps, whether it be residential age facilities,
wherever those links are incredibly important. I think
we need to be able to continue to develop those links.
We need to continue to be able to develop services that follow the
patient.
We need to be able to continue to support practitioners who work
across the different settings.
And so I think a real strength here is
this group will be able to look more
broadly looking at focusing on our patients
and how we practise in the hospital setting,
but most importantly how we integrate those practices,
how we have those collaborations across,
not just the hospital setting. So I think from the organisational perspective,
I think is fantastic to be able to work
and collaborate with individuals across such a
wider space. Our patients
most of the time will
be in hospitals for part of their care,
but most of the patients that we look at is they're not with us in the four
walls, they're outside.
So now I think and having the ability to work within PSA where
there is that ability to advocate,
influence and support practitioners more widely is a fantastic strength.
1: Can you tell us about pharmacists working across all sectors?
How can they better collaborate for better patient outcomes?
2: Look, I think the most important thing,
I think one of the most important things is having and understanding what
everyone else does, what everyone else's role is.
I think we learn more,
we often assume a lot about others and we don't always
understand their challenges or even their
expertise as pharmacists, we often
think that others don't understand what we know and what we do.
And I think that's probably right.
We might not know exactly what a GP does,
or we might not know the challenges associated with nurses who work in
different settings. We have assumptions.
So I think what's really important is that we get to,
I think the first thing is understanding what we do,
but also understanding what others do. What are their expertise,
what are their challenges? And by understanding that we can then
be able to collaborate where we can share our expertise and we can fill gaps.
But also it allows us to understand where there's a commonality.
The challenges for an individual practitioner,
whether that be a nurse or a pharmacist,
they're often the same degrees of isolation.
So I think understanding
within pharmacy and what pharmacists do in different settings is probably the
first place. We often don't,
people often working in hospitals don't necessarily understand the challenges
associated with someone working,
doing reviews by themselves. As an isolated pharmacist,
a community pharmacist may not necessarily fully understand the challenges
associated with working in a hospital.
So I think breaking down some of those barriers where people can share their
experiences, understand their expertise of others,
and understand that commonality of the challenges is a really good place to
start.
And I think then I've noticed when working with
medical staff, working with nursing staff,
I probably learn learning more about what they do.
I learn more about what my role is and where I can add value rather than that
thinking, that's where I add value.
So I think understanding what other pharmacists do in other settings is
incredibly important. And I think understanding
what other practitioners do and their challenges is incredibly important as
well.
1: So as you've mentioned as well,
there has been increasingly diverse roles for pharmacists working across all
sectors. And what do you think is needed to support them?
2: I think most people,
when you ask pharmacists to explore what are their
challenges, probably
some of the key challenges is how do people keep up to
date?
And what I mean by that is there's keeping up to date around therapeutics,
medications, and that is one component.
Keeping up to date about how practise is changing I think is incredibly
important.
I think the other challenges around
having the workforce that is supported.
So for example, making sure that people are able to
be supported in regards to their own practise,
be supported around where their practise fits in with others,
but at the same time be supported. So they've
getting remunerated the right way,
but also that they've got that they're wellbeings looked after,
that they're getting supported,
not only relating to their knowledge or practises as a pharmacist,
been supported as an individual.
Is their wellbeing taken into account?
Is the workload reasonable?
If they're in challenging situations, are they being supported in regards to
their health? So I think
there's components associated with the individual knowledge and therapeutics
where practises is changing,
where the system is changing, whether that be technology,
telehealth funding.
So I think it all goes back to the complexity of the environment.
There's the complexity associated with the environment,
there's the complexity associated with the therapeutics,
there's the complexity associated with patients,
there's complexity associated with medications, and all those four things
is the real challenge.
1: And I guess I'm going to ask you why pharmacists should join the CSI.
2: Look, I think it's like everything.
If you want to set a vision and you want to be able to take into account
what people really want and need and
to support their professional practise,
you need input. And what you need is
people contributing their own vision,
people contributing their perspectives.
If we only listen to what we've seen ourselves,
we we can get a very narrow perspective.
I think what we need to do is,
and what we want with this group is to be able to support
practitioners, but also influence practise going forward. To do that,
we need to understand what people need,
understands their challenges, understand their priorities,
and that way you can then
work together to develop a shared vision of where we want to get to,
and then use the expertise of the practitioners that have all
that understanding of the challenges that faces them. So I think
it's really inviting individuals that
want to shape the future of practise,
who want to
contribute to that, to have input.
So we need to hear from others,
we need to broaden the expertise.
We need to focus on what people need. And to do that we actually,
you need to hear
what those who have got their heart and soul
into this area of practise.
And we need their guidance. We need their passion,
we need their collaborations to actually determine the
vision and then shape the future. And so I would be saying to people,
if you're interested in this space and you want to be able to influence it and
you want to be able to contribute to it, then get involved. And.
1: I might ask you one more question.
Where would you hope to see the hospital practise CSI in a year's time?
2: I'd like to see it being relevant.
I think it's okay to put a team of people with
a lot of experience together.
I would like to see that it's engaging,
that if those that are working in this space are trying to influence it,
that they see this as a way forward to contribute.
So I think in a year's time it would be
are we hearing people's voices? Are we hearing
what people would like to achieve?
And are people contributing to that
in a positive way and in an exciting way and in a
passionate way. You can't solve everything quickly, you can't
do everything. But I think in a year's time,
I think it would be good that people believe there is a vision and there is
an opportunity to influence the future. So that would be,
I think the optimistic, big picture
perspective I would like to see
and have some surprises. I'd like to be surprised by what people
want and want to achieve.
I'd love to see people who are coming out of the woodwork, so to speak,
who have got some expertise, who have got some insight,
who have got some experience, who have got some passion,
who maybe haven't necessarily been able to
contribute in the way they would like to, and is giving them an opportunity.
There are wonderful,
fantastic pharmacists out there doing great things who want to support
others,
and it would be lovely to be able to see this as an opportunity for
those individuals and the individuals I'd like to work alongside being having
that chance to work together.
1: Fantastic.
Can I ask you if there's anything you'd like to share that I haven't asked you?
2: No. Look, I think
this is all about how do we continue to shape
practise and going forward.
I think that's the key bit here. And I think the most important thing here
is having input from those who
are working and contributing to the care of patients across this sector
and getting them engaged and giving them a voice and
helping put together an approach where there's the potential to be able to,
I dunno, shape and influence the future is the key bit for me.
And I think that's
practitioners who have been around for a while who have had a lot of experience,
but also those that are new practitioners and those that trying
to
improve care and practise.
So we want to see people getting involved
across the breadth and depth of the profession.
And I'm pretty excited that there will be,
I would like to be very optimistic that there's going to be
a great opportunity to put people together to be able to make a difference.
1: Thank you. Thank you so much.
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