The development and validation of a global advanced development framework for the pharmacy workforce: a four-stage multi-methods approach

The ALF [17] was the initial reference framework. Content and cultural validation was conducted by reviewing established national advanced competency frameworks in Australia [25], the United Kingdom [26], and Singapore [27], and advanced frameworks under development in Jordan [personal communication] and Indonesia [28]. When this study was conducted, published evidence and personal experience indicated that these were the only countries with national generalised advanced competency development frameworks [4, 7, 8]. The project team, which included representatives from Australia, the United Kingdom, Jordan, and Indonesia, conducted the initial content and cultural validation of the ALF. The validation resulted in a draft Global Advanced Development Framework (GADF) consisting of six clusters with 34 developmental competencies [29]. The first cluster, “Expert professional practice”, is applicable and adaptable for all work sectors and specialities. The remaining five clusters, namely “Building working relationship”; “Leadership”; “Management”; “Education, training and development”; and “Research and evaluation” are generic domains that are applicable independent of the practice sector of pharmacists [29]. Each competency cluster has three defined phases of advancement to support practitioner progression (“Advanced Stage 1”; “Advanced Stage 2”; and “Advanced Stage 3”). “Advanced Stage 1” describes a practitioner who performs well and is at the early stages of advancement. “Advanced Stage 2” describes a practitioner who is an expert in their area of practice, able to manage complex situations and recognised as a leader locally/regionally. “Advanced Stage 3” describes a practitioner who is recognised as a leader in an area of expertise (nationally, and often internationally) [29].

This draft framework was further validated using a transnational one round modified Delphi peer reference group. It was conducted between 21st August and 2nd September 2019. In contrast to the usual Delphi technique [30], no ratings were used in the feedback process, and the agreement method was implicit (qualitative) rather than explicit. Twenty-two expert members from 16 countries (see Table 1) were purposively recruited from the FIP global expert network based on their expertise in competency development processes in their organisation. The experts were initially briefed in an online meeting about the project’s aims. They were subsequently invited to provide feedback on the framework using an online questionnaire. The online questionnaire was developed by the project team, in which the questionnaire items elicited feedback on any gaps or missing competencies; any cultural, language and conceptual issues with competencies; comprehensiveness of the framework’s three stages of advancement (i.e. whether they were reasonable and understandable); and general comments (see Supplementary material 1 for the lists of questions). The questionnaire was completed by twenty-one experts, with one expert not responding. The feedback was collated thematically into a Microsoft Excel worksheet. Subsequently, a collaborative online meeting was involving the project team members to discuss and integrate the feedback into the framework. Following this, the draft framework (GADF version 0) was created and launched for broader profession-wide engagement and feedback at a global conference in September 2019 [31].

Simultaneously with the launch of the framework draft, an online questionnaire was distributed to the global pharmacy community to seek feedback on continuing relevance and validity of the framework. The global community refers to FIP member organisations, FIP members and any pharmacists who access the online questionnaire through their network. The questionnaire was adapted from the outcome of the modified Delphi technique stage (see Supplementary material 1). The survey was open for six months, and two reminders were sent through the social media network of FIP and the mailing list of FIP members. Feedback obtained from the survey was analysed in textual form and categorised according to the following themes: (1) feedback about the framework, (2) its dissemination, and (3)implementation. The initial categorisation which was conducted by the main author was further reviewed by the other researchers for consistency and validity.

To gain further insights on framework implementation, an invitation was distributed to the experts in countries with demonstrated expertise in the adoption of an advanced competency framework. The countries included those with existing national advanced competency frameworks and these were Australia, Singapore, the United Kingdom, Indonesia and Jordan. Experts who were involved in the development and implementation of the national advanced competency frameworks in the respective countries were invited to share their experiences. The experts were also asked to suggest contact persons who could share implementation experience at the institutional level and personal experience using the framework. An online case study form tailored to the individual, institutional and national implementation was developed (see Supplementary material 1 for the question list). A codebook thematic analysis with a pre-defined framework building from case study questions was carried out [32]. For institutional and national case studies, the pre-defined framework was (1) Drivers, (2) Development process, (3) Implementation, and (4) Impact. While for the individual case study, the pre-defined framework used was (1) Context of using the framework; (2) Use of the framework for professional and/or career development; (3) Additional tools and resources which could assist engagement with the framework; and (4) Barriers to utilising the framework. The themes were defined as topic summaries of responses to the case study questions.

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.

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.

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.

“Clinical governance is a term that widely western countries (or more focusing on UK system). I do not think non-English speaking countries would be able to understand this.” [Japan].

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 [29], 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 the examination of practitioners.

“Will the GADF be associated with recommendations for the development of formal career progression systems at country level, that are linked to competency assessment and certification (and that could eventually be linked to requirements for certain positions, or with remuneration scales, for example)?” [Netherlands].

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.

“The basic concept should be translated into actual and up-to-date adapted global and local statements which from the strategic perspective translate into (national) actions and priorities with specific topics depending on regulatory and legal conditions for pharmacists working in the different pharmaceutical areas.” [Switzerland].

To support the implementation of the framework at the national level, it was suggested that an online platform consisting of tools and instructions 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.

“I think it would be helpful to use this as a Member Organization (MO) benefit. I suggest that FIP develops some guidance documentation around how this Framework can be used.” [New Zealand].

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.

“Let us build the Global framework of Global Pharmacy Training development and practice embracing individual national and regional towards global desired standards.” [Zambia].

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.

“Advertising and marketing this to physicians and other healthcare professions. Cost-benefit evaluation to demonstrate all of this. [At the end] it’s the patient.” [United States].

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 a 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 [33].

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.