Enhancing Pharmacy Faculty Well-Being and Productivity While Reducing Burnout

Abstract

Objective. To explore methods that pharmacy programs can use to redefine their work environment to reduce stress, improve well-being, and increase faculty productivity.

Findings. To demonstrate a culture of support, organizations should consider a five-fold approach to enhancing and maintaining faculty well-being, including optimizing faculty and staff support, establishing a faculty development and mentoring program, permitting flexibility in work schedules, improving productivity of meetings, and managing communication tools. Individuals can also take measures to improve their well-being, including controlling email, giving attention to faculty citizenship, implementing stress reduction and coping techniques, and maintaining boundaries between work and home.

Summary. This article discusses approaches that have been shown to reduce burnout and provides strategies organizations and individuals can implement to improve productivity and faculty well-being. While certain areas, such as faculty wellness and productivity, have been well-studied in the pharmacy and health professions literature, significant gaps were identified in other areas, including alternate work arrangements. In some cases, data from the business sector can be extrapolated to pharmacy education; however, inferences from effective corporate strategies may not be transferable to the culture and expectations of academia. While there is significant overlap between institutional and individual strategies, a culture of communication, collaboration, support, and citizenship is foundational. There is no single strategy that will work for everyone, and flexibility is important to develop an individualized approach.

INTRODUCTION

The Centers for Disease Control and Prevention (CDC) defines well-being as “a positive outcome that is meaningful for people and for many sectors of society because it tells us that people perceive that their lives are going well.” ¹ Health benefits and lifestyle satisfaction aside, faculty who have high levels of well-being may be more productive and more engaged in their organization, the profession, and their community. Optimizing the well-being of pharmacy faculty is vital to promoting success among individual faculty, schools, and colleges of pharmacy, and the Academy as a whole. Burnout, which is the culmination of emotional exhaustion, depersonalization, and decreased personal accomplishment, threatens this ideal. ^{2, 3} As a call to action for pharmacy education, Darbishire and colleagues published a commentary in 2020 in which they stated, “the Academy must proactively evaluate, develop, and implement strategies to minimize faculty burnout.” ⁴

As is the case in other health professional schools, pharmacy faculty are prone to burnout. ^{2, 3} In a 2012 survey of 811 US pharmacy faculty members, 64% reported that they were very or extremely satisfied with their current position in academia. ³ However, only 37% of respondents indicated being very or extremely satisfied with their work-life balance, suggesting that while pharmacy faculty enjoy their careers, their work impedes their ability to achieve the balance they desire. ³ A second survey conducted in 2014 assessed the prevalence of burnout and sought to identify associated factors among pharmacy practice faculty. In this study, 41% and 11% of respondents reported high levels of emotional exhaustion and depersonalization, respectively, while 24% reported low levels of personal accomplishment. ² Emotional exhaustion and depersonalization were higher and perceptions of personal accomplishment were lower among faculty with young children and those who indicated not having a hobby, while emotional exhaustion and depersonalization were especially prevalent among faculty without a mentor. ² Gender also appears to play a role in faculty burnout, as female faculty members who responded to the survey reported higher rates of emotional exhaustion and lower rates of personal accomplishment. ²

Despite the plethora of evidence demonstrating the pervasiveness of burnout among pharmacy faculty and the detrimental effects burnout has on individual and institutional well-being, evidence-based interventions that address how to mitigate burnout in pharmacy academia are lacking. ⁵ Just as an academician relies on the literature to guide best practices in teaching and research, administrators and individuals in positions of leadership should rely on quality of work/life studies to guide organizational decisions and policy development. The 2020-2021 Department Chair Community of the American Association of Colleges of Pharmacy (AACP) Council of Faculties was charged with exploring strategies for enhancing well-being and minimizing burnout among pharmacy faculty.

This review provides an overview of strategies that can be adopted to encourage faculty well-being and productivity while mitigating the risk of burnout. This review was informed by a literature review, conversations among members of the Department Chair Committee of the AACP Council of Faculties, and discussions with stakeholders during the 2021 AACP Interim Meeting.

Institutional Approaches to Support Well-being

The influence an organizational culture can have on faculty well-being cannot be understated. For instance, a competitive environment, when taken to the extreme, can negatively influence stress levels within and across units. In contrast, a culture of collaboration improves morale and propagates positivity among colleagues. Furthermore, a culture of modeling and leading by example can promote teamwork and effective group dynamics.

Institutional approaches should begin with a thorough evaluation of factors associated with faculty burnout and a commitment to identifying and meeting faculty needs. ⁴ When faculty perceive they are supported by their institution, feelings of burnout are mitigated. There are several effective ways to demonstrate a culture of institutional support, including providing resources for professional development in teaching, scholarship, and service; acknowledging appreciation for faculty effort; aligning faculty and institutional goals; providing guidance, feedback, supportive mentoring and encouragement; and reassuring faculty of their value. ⁵ An institutional culture of support develops when these behaviors are modeled by administrators and permeate through faculty interactions with each other. Other behaviors from administrators that demonstrate a culture of institutional support include promoting transparency in expectations of faculty and staff, developing clear criteria for tenure and promotion, following through on commitments, providing adequate staff support, creating orientation programs for new faculty, engaging faculty in the decision-making process, encouraging social interaction and relationship building, providing wellness and stress reduction programs, and rewarding faculty achievements in a manner that is equitable. ⁵

Department chairs have significant responsibility when it comes to promoting a healthy organizational culture at their institutions. ⁵ First and foremost, one of the most important things a chair can do is develop effective individual coping mechanisms to prevent the likelihood of burnout in themselves. As is often said, chairs have one of the most difficult jobs at a university, serving as a bridge between the faculty and the administration. Given the high expectations of the position, chairs must first “put on their own oxygen masks” before they can assist others, because the ramifications of a burned-out chair can be significant. After achieving individual resilience to burnout, chairs can use several other strategies to help prevent burnout in their faculty. These behaviors include, but are not limited to, effective communication, empowering others, promoting collegiality, and establishing a judgement-free culture.

To demonstrate a culture of support, organizations should consider a five-fold approach to enhancing and maintaining faculty well-being that includes optimizing faculty and staff support, establishing a faculty development and mentoring program if one is not already in place, permitting flexibility in work schedules, improving productivity of meetings, and managing communication tools.

Institutions can adopt many strategies to optimize faculty and staff support, including reevaluating workflow and responsibilities, optimizing roles of support staff to improve efficiency, considering alternative work models such as job sharing, and investing in wellness programs. In addition, institutions can provide support for child or elder care, such as establishing a care center on campus, connecting with a local care center, and/or providing financial support to employees (eg, negotiating reduced rates or offering flexible spending programs).

During annual faculty performance reviews, department chairs and faculty can work together to identify current challenges and then develop strategies for improvement. For example, if a faculty member struggles to manage their teaching workload, the chair or the faculty member should consider alternatives to managing workflow (eg, working smarter, not harder), reallocating teaching responsibilities, and/or identifying activities that can be allocated to support staff. Where possible, creating technological solutions may improve efficiency (eg, simplifying or consolidating software platforms and use of learning management software to assist faculty and staff).

For faculty with clinical practice responsibilities, similar considerations apply. For example, chairs should meet with leaders at practice sites to set/realign patient care expectations so that faculty are able to satisfy their other academic responsibilities (eg, didactic teaching, service, scholarship) that may not be apparent to colleagues at clinical practice sites. To ensure continuity of patient care, multiple faculty can share patient care responsibilities (eg, have a rotating schedule for coverage) and/or collaborate with practice site staff. These strategies not only have the potential to improve faculty contributions to practice site goals but can also improve faculty workload balance.

Job sharing, where two people work on a part-time or reduced-time basis to perform a job normally fulfilled by one full-time person, can be beneficial for some faculty. In addition to the flexibility, Sacks and colleagues cite other advantages to job sharing, such as peer mentorship and collective brainstorming on ideas and problems. ⁶ It also can be beneficial for clinical faculty to provide more continuity in covering patient care activities. To realize the full benefits of job sharing, faculty must remember that it is the sharing of one position rather than the splitting of one job into two independent part-time jobs. ⁶ Finally, an investment in wellness programs for faculty and staff demonstrates a culture of institutional support. If an institution is not able to develop their own wellness program, outsourcing to existing programs should be done, and made available either free or at very low cost. Faculty and staff should be given protected time to participate in wellness programs.

In addition to optimizing support with the strategies discussed above, faculty development and mentoring are key aspects to a culture of institutional support. This begins by developing an organized approach to onboarding new faculty and continues by providing collaborative mentoring, taking a longitudinal approach to faculty development, setting clear expectations, and providing ongoing review of performance and progress towards goals. ⁷ Faculty development and mentoring can be a key to attracting and retaining talented pharmacy faculty. ^{7, 8}

While faculty development begins with new faculty, it does not end there. Faculty development in the areas of new technology, teaching, scholarship, service, and work-life balance are needed throughout the beginning, mid, and advanced stages of a career in academia. Furthermore, faculty can be empowered to teach each other about their areas of skill and interest, having the added benefit of strengthening relationships while creating a longitudinal approach to faculty development. Including the organization as a partner in collaboration with a mentor and mentee can support morale within an organization while also mitigating faculty burnout. ⁸ This model can also reduce workplace stress, lessen the risk of attrition, improve recruitment, and expand the pool of mentors within an organization long-term (ie, when a mentee transitions into the role of mentor). Consequently, mentoring not only strengthens individual faculty members, but the organization as a whole. In 2008, Fuller and colleagues published a call to action, stating, “Colleges of pharmacy that determine they do not have an effective mentoring program should strongly consider implementing the triad model of mentoring,” where the organization is added to the typical dyad model of a mentor and protégé. ⁸ Although this call is more than a decade old, it continues to resonate within the Academy.

Beyond faculty development and mentoring, institutional support for openness to flexible options to balance work and life demands can mitigate faculty stress and improve job satisfaction. When institutions and supervisors provide flexibility in scheduling responsibilities for faculty, the faculty can be empowered to arrange their time in a manner that allows them to be most productive, while still meeting organizational expectations and needs. A recent Gallup poll found that 51% of respondents prefer a job that offers flextime. ⁹ Greater flexibility can improve autonomy to manage one’s own workload. ¹⁰ This in itself can improve efficiency and productivity and increase happiness, personal worth, and morale. Options for greater flexibility that organizations can consider include a compressed work week, telecommuting one or more days per week, and a flexible schedule that would allow the faculty member to come and go during the day. The Harvard Business Review encourages employers to allow employees to have a bigger role in determining the work schedules that are best for them, while still meeting the needs of the institution. ⁹ These options for creating flexible schedules would need to be applied equitably across faculty positions.

Furthermore, flexibility is increasingly important to workers and can impact recruitment and retention. Millennial and Generation Z workers list work schedule flexibility as a major influence in considering potential employers. ¹¹ The Flex Jobs 2019 Annual Survey found that 30% of workers reported leaving a position because of non-flexible work options. ¹² One potential mechanism to create work flexibility is to adopt a four-day work week, as one 2020 Harris Poll found that 82% of US employees surveyed said they preferred a reduced work week, even if they had to work longer days. ¹³ Several countries, including the United Kingdom, Spain, Finland, New Zealand, and Japan, have embraced the four-day work week in the corporate world with positive results. ¹⁴ One example includes Perpetual Guardian, a company in New Zealand, that implemented a four-day work week and realized improved productivity and employee satisfaction. ¹⁴ Another example is Microsoft Japan, which gave employees Fridays off and netted a 40% increase in productivity. ¹⁵ Employers who are using the four-day work week report enhanced well-being, improved mental and physical health, and reduced absenteeism.

There are advantages and disadvantages to a four-day work week. Reported advantages include increased employee productivity/efficiency, satisfaction, morale, retention, happiness, and personal worth; stronger families and communities; cost savings related to transportation and dependent care costs; and reduced absenteeism, anxiety, stress, and burnout. ¹⁰ The primary disadvantage of a four-day work week is fatigue resulting from longer work days, if a 40 hour work week is maintained. This may increase stress and reduce productivity in some cases. Moreover, not all faculty models are amenable to a four-day work week. For instance, while a program could schedule didactic teaching within a four-day work week, it would be difficult for faculty with clinical and experiential education responsibilities and those who are partially compensated by the practice site to easily adopt this model. Similarly, a four-day week could present additional challenges for faculty in leadership roles as issues might occur at work on their off days that require their attention.

Another factor in creating a culture of institutional support is ensuring meetings are meaningful and productive. Meetings in academic departments are ubiquitous and often maligned as a huge waste of time. Nevertheless, meetings have a functional role in supporting the operational goals of an academic unit. They also serve as a platform for institutional discourse and are a reflection of institutional culture. ¹⁶ Meetings that are well-designed and purposeful can strengthen connections between participating faculty and the values of the institution. On the other hand, meetings that are inefficient or unnecessary may be a detriment to faculty well-being and productivity.

In his often-cited book, Death by Meeting, Patrick Lencioni highlights many possible pitfalls that face the organizers of institutional meetings. ¹⁷ One is the creation of “meeting stew,” or the tendency to pack too many unrelated topics into the same agenda. A few simple rules for organizing an academic meeting can help to minimize negative perceptions. An agenda that includes a purpose, outcome, and plan for each item should be sent to all attendees ahead of the meeting. ¹⁸ Meeting attendees should be engaged in a time-limited discussion on each topic, with a goal of achieving closure before the meeting is scheduled to end. ¹⁹ Leaders should be cognizant of the need, length, frequency, and focus of meetings, as well as the people who truly need to attend them to accomplish the institution’s goals. Obviously, some meetings are necessary, but some issues often addressed in meetings could be handled by email or executive decision. Lastly, restricting meeting days or times can be a useful strategy in helping faculty with time management.

Similar to meetings, email is a communication tool that can have positive and negative impact on faculty well-being. If not managed effectively, email can contribute to a sense of overload ²⁰ and a blurring of boundaries between work and home, which adds to stress and increases burnout. ²¹ Email can also increase workload and disrupt concentration, reducing productivity. ²² Furthermore, to be useful sources of information for later use, emails require a manageable and logical system of sorting and filing.

While various strategies for managing email are reported (eg, sorting, prioritizing, archiving), ²³ many appear to have very little effect on stress associated with email volume. ²⁰ Other strategies that are applicable to improving wellness, such as setting email expectations modeled by leadership and promoting the use of alternative communication tools, show promise. ²⁴ Setting boundaries around work and home time by maintaining good “email hygiene” is one strategy that has been emphasized. Late-night emails from leadership can infectiously transpire a specific pattern within a team or an organization; this can set a poor example of work habits. ²⁵ Effective leaders should emphasize and model the importance of scheduling both focused work time without electronic interruptions and consistent downtime. ²⁵ This applies even more when working remotely, where the definitions of work and home are blurred. Organizations can promote better email hygiene and improve wellness by discussing expectations for monitoring and responding to email and promoting common downtimes. ²⁴ In one example, email-free hours were instituted from 10:00 PM to 7:00 AM weekdays and all weekend days when everyone, including leadership, agreed to refrain from communication except in a true emergency. ²⁵ An automated solution for those who work best at odd hours may be to use a program that will delay sending emails until normal work hours and thus unburden others of the expectations to check and respond outside of regular business hours.

Additional strategies to improve email management focus on efficiency and clarity. By eliminating needless emails such as “Thanks” and “Got it,” email volume can be reduced. Implementation of such an approach should be preceded by a company or unit-wide conversation around email acknowledgements to change the culture and avoid the perception of lost emails or a lack of gratitude. Other ideas include creating template emails for common responses or using communication tools other than email (eg, instant messaging apps, telephone, or video conferencing). Different tools have benefits for different forms of communication, such as collaborations that require dialogue or depend upon the use of shared documents. A unit-wide discussion about the most appropriate use of each tool is likely to produce better results.

While institutional culture and expected norms can be sources of stress and overload, individuals can also adopt strategies to increase their own productivity, improve job satisfaction, reduce stress, and mitigate the persistent creep of work into their home lives. These include controlling email, giving attention to faculty citizenship, implementing stress reduction and coping techniques, and maintaining boundaries between work and home.

While it would require an institutional shift to make widespread changes in email practices, individuals can apply several strategies to improve well-being so they do not interfere with important career building tasks. ²⁸ Faculty can mitigate interruptions and the time they spend on email by turning off email alerts and scheduling times to work on email during the day. Studies suggest that checking email fewer times per day reduces stress and improves several measures of well-being. ²⁶ In one study, processing email in batches at scheduled times and self-planned interruptions for email led to greater feelings of daily productivity and less stress as compared to workers who used auto reminders for email notifications. ²⁷ Strategies for managing others’ expectations for email responses include putting a notification in your signature line that advises when you regularly check email. ²⁹ The subject line can also be used more effectively to convey the response the sender desires from the recipient by using terms such as “action required,” “sign,” “info,” “decision,” “request,” or “coordinate.”

An AACP Council of Faculties Faculty Affairs Committee was charged in 2014 with defining faculty citizenship as it relates to pharmacy education. The committee’s published definition was “a pattern of behaviors by pharmacy faculty members that promotes the welfare of the school or college of pharmacy, and as a consequence, the larger university structure.” ³⁰ The key distinction between service and citizenship is that citizenship goes beyond the required and defined set of service activities that are part of one’s contract and is seemingly a set of informal expectations that exist within the culture of a program. ³⁰

Positive faculty citizenship behaviors have been suggested to include intentional civility in interactions with faculty, staff, and students; verbal and nonverbal signs of respect; and self-motivated collaboration and cooperation on departmental, teaching, and scholarly activities. ³¹ These patterns of behavior promote the institution and profession and contribute to a positive and productive work environment. ³⁰ Faculty should take care to be aware of how their manifestations of stress may potentially cause negative interactions with others, decreasing productivity and harming a workplace culture. Similarly, rewards and recognition of positive faculty citizenship can also lead to more enhanced organizational culture.

Stress is complex and it is often difficult to establish a cause-effect relationship between stress generators and burnout. Regardless, stress in any form can impact productivity and success. ³² The vast majority of literature on the subject of reducing personal stress suggests benefits to lifestyle modifications, physical activity, mindfulness meditation, relationship building, social networking, consulting a mentor, delegating assignments, reducing tasks, and using smart time management strategies. Determining the cause(s) of stress is a critical first step in identifying effective strategies for reducing or eliminating it. Second, an individual’s motivation and willingness to try these suggested strategies is central to lessening stress. Third, recognizing that there is no shame in reaching out to others for help. Likewise, department chairs, supervisors, and experienced mentors should remain proactive in reaching out to individuals who are showing signs of stress or openly disclose their need for assistance. Colleagues who show palpable signs of stress must be provided with necessary support and help, which may require professional help or counseling beyond what the workplace is able to provide. Open communication is of paramount importance to determine the root cause(s) of stress in order to provide personalized support and advice. ^{33, 34}

By prioritizing realistic personal and professional goals while keeping work-life balance in focus, faculty can create healthy boundaries between work and home. This may include advocating for oneself to supervisors if workload expectations are unrealistic and becoming comfortable with declining to take on additional responsibilities. It may also include finding others within and outside of your organization to collaborate with on projects to better distribute workload.

CONCLUSION

This article discusses approaches that have been shown to reduce burnout and provides strategies organizations and individuals can implement to improve productivity and faculty well-being. While certain areas such as faculty wellness and productivity are well studied in the pharmacy and health professions literature, significant gaps were identified in other areas, including alternate work arrangements. In some cases, data from the business sector can be extrapolated to pharmacy education; however, inferences from effective corporate strategies may not be transferable to the culture and expectations of academia. While there is significant overlap between institutional and individual strategies, a culture of communication, collaboration, support, and citizenship is foundational. There is no one strategy that will work for everyone; thus, flexibility is important to develop an individualized approach. A key element in this process is that both the institutional leadership and individual faculty must be motivated and willing to make well-being a priority, helping to improve faculty productivity, job satisfaction, and work-life balance.