Identifying perceptions of academic reform in pharmacy using a four-frame organizational change model

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Abstract

Background

In an ever-changing environment, pharmacy education is in the race to catch up and excel to produce competent pharmacists. Examining academic institutions, including schools of pharmacy, their internal systems and framework, it seems appropriate to view these institutions using multiple lenses. Bolman and Deal conceptualized a method to examine organizations using four constructs (structural, human resource, political, and symbolic). The Eastern Mediterranean Region (EMR), with deep-rooted pharmacy education and practice was the setting for this research.

Objectives

To explore factors affecting academic reform in undergraduate pharmacy education in the EMR from stakeholders' and students' perspectives; and to apply Bolman and Deal's four-frame organizational change model to explore how these issues might be viewed.

Methods

A multiple-method approach was employed and involved collecting, analyzing and integrating qualitative semi-structured interview data with open-ended questions in a survey. Cross-sector stakeholder sample from various EMR countries was recruited and interviewed. Final year pharmacy students from one school of pharmacy in Jordan were surveyed.

Results

Emergent themes were indicative that academic reform was addressed by all frames of the Bolman and Deal model. Structural and political frames received substantial weighing pointing to the importance of curricular reform, collaboration and leadership. A need for skillful and role-model teaching academic staff was highlighted, and in harmony with the human resource frame. Issues within the symbolic frame were readily apparent in the data and spanned the other three frames in relation to heritage, customs and cultural barriers.

Conclusions

Issues pertinent to academic reform in pharmacy were presented. Viewing change in pharmacy schools from multiple perspectives highlighted the need for structural changes to pharmacy programs, human resource management, political will, leadership, and collaboration. The importance of understanding cultural aspects of organizations is critical as it is these that provide identity to any organization and help reformers better manage change.

Introduction

Change is a constant force that can pose major problems of adjustments at the operational and strategic levels of any organization.1 It is generally accepted that any organization is required to undergo change to stay competitive, keep up with innovations in technology, increase efficiency or adapt to new governmental or professional mandates, and these require the skillset to manage change. In undergraduate education, interest in institutional change and transformation began to gather momentum in the early 1990s, as more critics saw a need to delve into issues facing American colleges.2 It was the 1993 landmark report of the Wingspread Group on Higher Education that first warned about the status of education in universities and colleges in the United States.3 The findings of this report indicated that higher education was not meeting society's needs and recommended that “higher education must help to create a nation of learners by being engaged more thoroughly in all of the education enterprise”.3 Following from this, Barr and Tagg in 1995 introduced the notion of the learning (as opposed to the teaching) institution, being an institution that produced learning in students rather than an institution that provided instruction to students.4 They argued that once this shift is made, everything has the potential for change in undergraduate education. The arrival of this concept led to measurable movement to embrace this paradigm change in many advanced institutions and across disciplines.5

Similarly, a paradigm shift in healthcare education from structure- and process-based education to competency-based education and measurement of outcomes, driven by increased accountability and responsibility to the public, was introduced early this century to produce competent healthcare providers, including pharmacists.6 Today, pharmacy education consists of preparing pharmacy students with the appropriate knowledge, skills, values and behaviors, (i.e. competencies) to render them safe, effective and consistent performing professionals.7 However, the profession of pharmacy remains in a perpetual state of evolution in response to constant forces that are driving further university pharmacy educational change. One such force is a shift in the mindset of consumers, due to sociopolitical change, higher educational attainment, and readily accessible medical and drug information, which led to a rise in consumer expectations in regard to being communicated and involved with their care.8, 9 Globalization also has led to wider dissemination of ideas, values and methods, reflected in global standards of pharmacy practice.10, 11, 12 These standards are designed to support professional change by regular updating of standards of practice and curricula review, to maintain contemporary practice and meet the needs of patients as they evolve. The World Health Organization, UNESCO, and the International Pharmaceutical Federation (FIP) (amongst other organizations) have been at the frontline advocating fundamental educational reforms in pharmacy that address quantity, quality and relevance of pharmacists to improve health outcomes of individuals and societies around the world.13, 14

It is noteworthy that the push to change has been termed variously and includes but not limited to “educational renaissance,” “curricular reform,” “curricular transformation,” and/or “curricular reengineering.”15 Examples of changes to education in pharmacy around the world are abundant in the literature and include: curricular redesign, establishment of Doctor of Pharmacy (PharmD) degrees, introduction of new courses and innovative teaching methods.16, 17, 18, 19, 20, 21 All changes aspire to advance education and to produce better-equipped pharmacists. However, change or reform in pharmacy education can be a challenging task. Examples of reform in undergraduate pharmacy education include a recent study by Katajavuori et al. on curriculum reform.22 This study highlighted that reform is a multifaceted process which requires the involvement of stakeholders including teachers and students. Ksoter et al. in another study also described implementation of competency-based pharmacy education as a “formidable task”, and to be successfully achieved, “conscious choices and decisions on all organizational levels are needed to achieve consistency between learning tasks, feedback to students, teacher roles, and organization of the curriculum”.23

It is not surprising that organizational change and diffusion of innovation in undergraduate education have often proven complex and difficult to implement.24 The literature provides a vast array of strategic change management theories that can be applied for a better understanding of the process of change.25 Whilst each theory, model or perspective differs in approach, they have in common the attempt to answer the “why”, “how”, and “when” aspects of change.

One diagnostic model of change was synthesized by Bolman and Deal in 1984.26 They argue that four ‘frames’- structural, human resource, political and symbolic-can be used to approach organizational issues to assess changes that are needed. The four-frame model is described in Table 1. Examples of what constitutes these frames in the context of undergraduate education include: the structural frame commonly depicted by accreditation standards, vision and mission statements, program offerings, policies governing admission criteria, course rules and regulations, curriculum and training, research and funding, academic cadre and qualifications, and organizational charts. The human resource frame is described in terms of concepts related to revenue, professional development, autonomy, community, recognition, and engagement amongst academicians.27 The political frame represents different interests that compete for power or scarce resources, collaboration and coalitions, conflict and motivations that underlie change and those resistant to it.28 In the symbolic frame, universities are often viewed as “ivory towers” where the work culture is characterized by excessive working hours, high levels of competitiveness, economically driven as opposed to education-driven, publications-focused, and need for high rankings.29 It is advocated by Bolman and Deal that complex human organizations, such as educational institutions, require multidimensional understanding of organizational needs, challenges and contexts, in order to devise appropriate actions.30 Viewing an organization through only one frame is limiting. Managers and leaders often show a preference for one or two frames, but are encouraged to use all four frames for a balanced and efficient organization.30

The Eastern Mediterranean region (EMR) is constituted of 22 countriesd and approximately 580million inhabitants.31 Despite shared cultural and language similarities, the EMR is a region marked by sharp socioeconomic and political disparities between sub-regions.32 A recent study33 highlighted that international frameworks including the FIP's Global Framework on Quality Assurance of Pharmacy Education, are pressing pharmacy stakeholders to consider and facilitate pharmacy educational reform in many EMR countries. The EMR has many pharmacy schools steeped in tradition and the research has uncovered a myriad of barriers and facilitators affecting the ability of pharmacists to attain competencies required to practice.33 Pharmacists' responsibilities and scope of practice varies in the region, spanning from the traditional dispensing role in community pharmacy with limited patient-centered involvement, to advanced clinically orientated and patient-focused hospital pharmacy practice in some countries.34 Whilst pharmacy educators in the region strive to produce qualified pharmacy graduates equipped with essential knowledge and competencies needed for practice, there is “a concern for the possibility of a substantial mismatch between the practice of pharmacists and the pharmacy education provided to them”.34 Nevertheless, pharmacy education in the region has witnessed much advancement over the years, and studies have highlighted that pharmacy students are well-equipped with knowledge, but are in need of competency-based training to enhance their skills.35

Against this backdrop, the aim of this study was to explore region-specific factors affecting academic reform (referring to higher education reform) in undergraduate pharmacy education in the EMR from professional stakeholders' and students' perspectives; and to apply Bolman and Deal's four-frame organizational change model to explore how these issues might be viewed.

Section snippets

Study design

In order to gain a deeper understanding of this under-researched topic, a multiple-method approach was employed in this study.36, 37 This involved collecting, incorporating and analyzing data from qualitative semi-structured interviews with professional stakeholders, together with responses to open-ended questions in a survey of pharmacy students. An advantageous characteristic to multiple-method research is the possibility of triangulation. Triangulation refers to the use of multiple methods

Results

A total of 81 participants, including 49 students, from fifteen EMR countries were recruited (Table 2). Representation of professionals spanned various sectors of pharmacy practice in the region: academia (deans of pharmacy schools and senior lecturers), hospital pharmacy (directors of pharmacy and clinical pharmacists), community pharmacy, professional bodies (e.g. pharmaceutical society), and governmental agencies (e.g. Ministry of Health) (Table 3). All professional participants had

Discussion

This study showcased the perspectives and opinions of stakeholders from the EMR to delve deeply into issues that need to be considered when embarking on a mission to reform or change education in pharmacy. The results of this study indicated that the Bolman and Deal four-frame model on organizational change30 can be used to evaluate and analyse academic reform in pharmacy education.

Academic reform or academic change in pharmacy education is not novel or uncommon. On the contrary, academic

Conclusion

This qualitative research examined factors affecting academic reform in pharmacy education in the Eastern Mediterranean Region. The findings conclude that to be truly responsive to the calls for change in pharmacy undergraduate education, institutions have to rethink influences that may contribute to this change through four possible constructs: structural, political, human resources, and symbolic. While leaders in education may have a preference for one of the four frames or lenses, most ought

Declaration

The authors have no conflicts of interest to declare.

Acknowledgments

The authors gratefully acknowledge the academics at the Faculty of Pharmacy, Applied Science Private University and Dr Dalal Alnatour, whose contribution in managing student data collection made this study possible. We are also very grateful to all participants in this study who gave up their time to share their opinions and views.

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