Sample description
Table 1 provides information on the sample description for each stage. The five countries included in the initial validation and case studies gathering were: Australia, Singapore, the United Kingdom, Indonesia and Jordan. Experts from 16 countries participated in the modified delphi stage and experts from additional 15 countries provided feedback during the external engagement stage. In total, 31 countries were represented in this study.
Table 1
Study’s stage and sample description
Stage
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Sample description
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1. Initial content and cultural validation
(n: five countries)
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Two categories of countries:
a. Countries with established advanced competency frameworks: Australia, Singapore and the United Kingdom;
b. Countries with advanced competency framework drafts: Indonesia and Jordan.
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2. Transnational modified Delphi peer reference group
(n: 21 experts)
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Twenty-one experts with the following countries and expertise:
a. Country: Algeria (1); Argentina (1); Australia (2); Canada (1); Croatia (1); Indonesia (1); Japan (1); Jordan (1); Nigeria (2); Portugal (1); Qatar (1); Sudan (1); Syria (1); The Netherland (3); United Kingdom (1); United States (2).
b. Expertise in*: The competency development process (4); Education and training (6); Interprofessional collaboration (1); Leadership (8); Management (17);Policy and advocacy (2); Pharmacy practice and service development (4); Research and evaluation (13); Scientific development (3).
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3. Transnational external engagement with the global pharmacy leadership community
(n: 29 experts)
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Twenty-nine responses were received from the following countries and broad affiliations:
a. Country: Algeria; Germany; Ghana (3); India; Indonesia; Kuwait; Malawi; New Zealand; Nigeria (2); Norwegia; Pakistan (3); Portugal; Rwanda; South Africa; Switzerland; United Arab Emirates; Zambia; Zimbabwe (2); do not provide country information (5)
b. Expertise: Worked in university (n:10); practitioners (n:7); professional organisation (n:5); affiliation not provided (n: 7)
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4. Case studies from countries at the individual (n: 7), institutional (n:2) and national (n: 5) levels.
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a. Seven individual case studies from: Australia (a hospital pharmacist); Singapore (3 hospital pharmacists and a primary care pharmacist), and the United Kingdom (2 hospital pharmacists)
b. Two institutional case studies from Australia and the United Kingdom (university setting).
c. Five national case studies (Australia, Singapore, United Kingdom, Indonesia and Jordan)
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*One expert can have multiple expertise
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Insert Table 1 here.
Feedback about the framework
Modifications to the ALF were mostly made during the transnational modified delphi peer reference group (stage II). Most modification was to adapt the competency items and descriptors to be applicable across sectors and scopes of practice of pharmacists. In terms of the comprehensiveness of the competency staging, some experts queried whether the framework applies beyond a few years of pharmacists’ career (foundational stage) or if it applies from day 1 of their professional career. Some feedback received was also related to the need for more explanations to describe some terms that may differ across countries, such as core and defined areas, defined practice, resources (scope of resources to be managed), etc. Table 2 provides a summary of suggestions to the framework.
Table 2
Modifications to the framework
Part of the framework
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Suggestions/modifications
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Actions to the framework and relevant competency items
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Cluster 1. Expert professional practice
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Expert skills and knowledge
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A missing gap related to prescribing practice.
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This feedback was not incorporated considering prescribing practice may not be available in all countries.
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Patient care responsibilities
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This competency may not be relevant to non-patient-facing role (eg. academic, industry, regulatory, pharmaceutical sciences...).
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This competency: “patient care responsibilities” was modified to “developing professional expertise”.
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Reasoning and judgement
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It might be good to have some wording related to problem solving.
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“Problem-solving skills” was added to this competency item.
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Cluster 2. Working with others
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Communication
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“Patients, colleagues and clinicians” seems to be only relevant for those working in patient care setting.
Consider adding a component of empowerment in the communication skills.
Perhaps there is need to have a separate competency for “communication” with patients and other healthcare professionals.
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“Patients, colleagues and clinicians” was modified to “relevant stakeholders.”
An ability to “empower” was added to this competency item.
This feedback was not incorporated into the framework to provide a broader and flexible concept of global workforce advancement.
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Teamwork and consultation
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“Across boundaries” needs to be described further.
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“Across boundaries” was modified to “across boundaries (profession/sector/area)”.
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Cluster 3. Leadership
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Strategic context
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The descriptor of advanced stage 3 at the “strategic context" competency item, which is to “create national healthcare policies”, might not apply to practitioners.
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This descriptor was modified to “demonstrate active participation in creating relevant local, national, regional or global policies.” This is because the focus of this competency item was about active participation in the policy creation, which could be done at the local, national, regional or global levels.
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Governance
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“Clinical governance” was deemed challenging to translate in other languages.
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“Clinical governance” was modified to “Standard, quality and accountability”.
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Innovation
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it is not clear what “requires limited supervision” means.
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“Required limited supervision” was modified to “often requires supervision for others”.
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Cluster 4. Management
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Managing change
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The descriptors for advanced stage 3 of “managing change” should include the ability to promote, initiate and/or lead a process of change, not only to manage change.
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This descriptor was modified to “Demonstrates ability to promote, initiate and/or lead a process of change at a higher level.”
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Strategic planning
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The experts suggested further descriptions of the competency descriptor related to the “strategic planning” by considering countries' political and economic instability.
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This descriptor was modified to include skills in “adapting the planning based on organisational politics changes in the internal and external environment”.
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Cluster 5. Education, training and development
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Conducting education and training
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This competency is not only about conducting teaching effectively but also to deliver teaching and feedback effectively.
Perhaps this competency could refer to advanced degrees or credentials in the education part.
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Conduct teaching efficiently was modified to “Deliver teaching and feedback effectively.”
This feedback was not incorporated into the framework to provide a broader and flexible concept of global workforce advancement.
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Links practice and education
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Involvement in the education and training in some countries is not only related to formal education but also in other ways.
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The stage 1 descriptor, which includes “formal education” was modified to “Participates in the delivery of education and training”
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Educational policy
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Policy on workforce does not only include education, but also planning and development.
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“Workforce education” was modified to “workforce education, planning and development.”
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Cluster 6. Research and evaluation
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Develops and evaluates research protocols
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There was no research structure in the clinical setting of this competency – so this competency may not be relevant in the country.
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This feedback was not incorporated into the framework because this competency was essential for advancing pharmacy practice.
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Establishes research partnerships
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The word “Specialist” in the competency descriptor provides a narrow context of competency.
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Remove “specialist” in the “specialist research” to provide a broader term to the description.
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Any other comments
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Stages in the framework
-Advanced stage 1
-Advanced stage 2
-Advanced stage 3
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The application of the staging related to if this framework applies beyond a few years of pharmacists’ career (foundational stage) or if it applies from day 1 of their professional career. Also, how this framework relates to the current global competency framework for early career pharmacists.
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The staging levels are further described in the footnotes.
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Insert Table 2 here.
Feedback about framework dissemination and implementation
Respondents in the modified delphi (stage II) suggested development of a handbook to guide the use of the framework. In addition, a glossary defining some of the main concepts contained in the advanced competency framework was deemed necessary, considering the concept of advancement was new in some countries. Some respondents commented on the staging within the framework and the means to assess this. They queried how the staging relates to years of experience, position in the workplace, and the use of scoring metrics for the assessment. This was further explained in the handbook [24], in which the emphasis is on the development of competencies from the Global Competency Framework (foundation level) towards the advanced framework stages 1, 2 and 3, and not on examination of practitioners.
Feedback obtained during external engagement with the global pharmacy community (stage III) recommended a stakeholder engagement to support the dissemination of this framework including local and national pharmacy organisations, universities, students, and early career organisations. Another suggestion was to translate the concept into global and local statements and then into national actions and priorities. To support the implementation of the framework at the national level, it was suggested that an online platform consisting of tools and instruction on how to use the framework should be developed to accompany the framework. This platform should facilitate personalised results and frequent self-evaluation reminders, informing which areas and clusters practitioners are good at and need to develop further. On a global level, building a database of training mapped to this validated GADF was suggested, to share examples for individual nations and regions to use in their advancement towards global desired standards. Working collaboratively with other healthcare professionals was also recommended to test this framework and it was also suggested the need to conduct cost-benefit evaluation to demonstrate how the framework implementation impacts patients.
Framework drivers, development, implementation and impact at the national and institutional levels
At the national level, one of the drivers of advanced competency framework development reported in the United Kingdom was the need for pharmacy education and training transformation to support pharmacists' role in patient safety. Ongoing development in several designated areas of speciality practice reported in Australia triggered the need to look at what would be a useful curriculum, roadmap and developmental framework. Another driver reported in Singapore was a need for a clear career pathway to support and motivate pharmacists throughout their careers. The career pathway could be supported by a framework that defines expected competency levels for pharmacists at different levels of seniority and experience. These drivers were also similar to the reason reported in the institutional case studies on why they adopted the competency framework in their organisation, namely, to support the education and development of their staff, to formalise advanced pharmaceutical care skills and competencies recognition; and to have clear and identified pathways for further practitioner advancement following on from initial post-registration foundation training.
There were some variations in competency framework development reported in the national case studies. In Australia for example, the development process included groups of all pharmacy bodies who agreed on national core competencies, which were then adopted by member organisations in the country. A similar approach was seen in the United Kingdom, where the professional leadership body established an expert group to review the framework and reflect practice across all sectors and scope of practice. The Singapore case study described a collaboration with the Ministry of Health in initially developing the framework, followed by the introduction of the framework in healthcare institutions. In Indonesia and Jordan case studies, the development included translation, adoption and adaptation, and national engagement phases to ensure the framework is culturally applicable. Institutional case studies reported that the development process included referring to the curriculum or training programme to map with the competency framework.
Across the case studies, framework implementation at the national level was sometimes accompanied by a recognition or credentialing system to award advanced practitioner status. For instance, in Australia, a portfolio-based impact demonstration was utilised with an advisory group steering the process. The framework was then further incorporated into the national competency standards to outline a clear journey of increasing performance for each domain and competency. In Singapore, the framework was implemented as a developmental tool, and a guidebook was developed so practitioners could use the framework actively in practice. Portfolio training workshops and regular engagement with pharmacy leaders were also conducted to promote the adoption of the framework. In the United Kingdom, the framework is used for the consultant credentialing pathway. Institutional case studies reported that the advanced competency framework was implemented as part of a suite of training programmes and as a basis of portfolio where students collected workplace evidence mapped to the framework.
Some impacts of the framework implementation were highlighted in the submitted case studies. The case study of Singapore reported that the advanced framework has allowed senior pharmacists to advance systematically since it was first introduced in 2016. In the United Kingdom, the advanced framework has underpinned a formal credentialing process for consultant pharmacists which has been recognised across professions. In Australia, in alignment with the national foundation competency framework, the advanced framework provides a clear career path for pharmacists from when they were students. Also, a formal recognition system of pharmacists’ stages of advancement was developed, and linked to remuneration [27].
Utilisation, support needed and barriers in using the framework from individual perspectives
Table 3 provides information on how individuals use the framework, what additional tools and resources are needed to support the framework implementation, and what barriers exist to the framework implementation. From the context of using the framework, most individual case studies highlighted the use of the framework for their personal growth and development. They also used the framework to map toward national standards and link with their scope of practice and job roles. Practitioners used the framework for professional and career development to develop their portfolios, support their job applications, and support other team members in building their portfolios. Individual case studies also described the use of the framework in the workplace, related to providing evidence of advancement, attaining specific job grades linked with promotion, and developing targeted programmes for staff in the workplace. Case studies informed a need for tools and resources to support the framework, workshops or courses related to framework implementation, support in mentoring and coaching, and others related to engagement with stakeholders and recognition in the job roles. Case studies highlighted personal barriers in the framework implementation, particularly related to time-consuming processes and value for pharmacists. Incentives and motivations were deemed beneficial for the successful implementation of the framework.
Table 3
Utilisation, support needed and barriers in using the framework from individual perspectives
Category
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Findings
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Context of using the framework
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For personal growth and development
1. To track self-growth, progress and achievement over time;
2. To facilitate self-reflection in order to review where they are and to acquire skillsets for self-directed learning;
3. To focus on targeted areas for personal growth and development.
To map towards national standards and demonstrate impact for patient care
1. To work towards national pharmacy standards;
2. To collate evidence for detailing career and impact on patient care.
To link with scopes of practice and roles
1. To benchmark in taking specific 'advanced' practitioner roles;
2. To chart journey based on job scope.
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Use of the framework for
professional and/or career development
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1. To develop a personal portfolio: Portfolio guides career development, track progress, and identifies areas for improvement.
2. To support the job application: By supporting the application to attain a consultant post.
3. To support other team members: Mentoring and guiding other pharmacists through the portfolio development process and mentoring them to identify their strengths and weaknesses for addressing their developmental gaps.
4. To provide evidence of advancement in the workplace: As a result of pharmacists being recognised as advanced practitioners, employers will have tangible evidence of their employees' enhanced capability.
5. To attain specific job grades – linked with promotion: This framework has been mapped to the job grades. Each job grade must achieve a specific competency level in a specific area.
6. To develop targeted programmes for staff in the workplace: With the framework in place, workplace managers can identify common weaknesses among their employees and devise training programmes to address them.
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Additional tools and resources which could assist engagement with the framework
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Tools and templates to support the framework
1. Provide templates and examples of portfolios for practitioners on similar career paths.
2. Provide an online modifiable portfolio template where practitioners can build their portfolios and upload evidence in the system.
3. Provide a training roadmap to help practitioners identify the courses required to reach their desired performance level.
Organise workshops or courses related to:
1. Reflective writing;
2. Portfolio building and assessment;
3. How to gather effective evidence;
4. Peer review learning;
5. Providing feedback.
Provide support in mentoring and coaching
Provide support to set up mentors or coaches who can provide feedback and facilitate the development of practitioners; this could be organised in the workplace.
Other supports
1. Provide resources to allow and support pharmacists to protect their time in reflecting and writing up their portfolios.
2. Organise peer review sessions.
3. Engage with other professional organisations to foster collaboration in providing an impact on patient care.
4. Engage with the early career workforce to introduce them to the idea of an advanced practice framework at an early stage and help them incorporate it into their long-term career goals.
5. Promote the recognition and utilisation of the framework in the job roles.
6. Promote the use of the framework as part of re-validation processes for pharmacists.
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Barriers to utilising the framework
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Micro-level barriers - individual
1. The process of collecting evidence and building a portfolio is time-consuming and intensive. There is no time allotted for personal growth and advancement in individual job plans.
2. Lack of pharmacist’s motivation, where pharmacists may not see the immediate benefits of creating their portfolio as a value-add to their career development.
3. Questions on the value of this framework for senior practitioners remain related to what happens when a practitioner attains expert for all domains.
4. The unfamiliarity of the process of gathering evidence for portfolio and understanding the competency standards.
5. The ability to write reflectively varies greatly between individuals; this may affect practitioners’ integrity and morale.
Meso-level barriers – workplace
1. A flat organisational chart and lean staffing structure create difficulty for practitioners in collating evidence for advancement.
2. Limited link on how professional recognition system or credentialling provide additional benefits in the workforce or additional roles, responsibilities, or remuneration.
3. There are a limited number of vacancies for promotion even if practitioners have the necessary skills and experience to move up in the organisation.
Macro-level barriers -national
1. How to get buy-in from the whole workforce since the framework is not 'mandated';
2. How to implement the framework consistently throughout all the institutions within the nation;
3. Lack of specific performance indicators for assessing the framework's effectiveness and impact;
4. Lack of education supervisors to support in mentoring and coaching.
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Insert Table 3 here.