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Influence of ownership type on role orientation, role affinity, and role conflict among community pharmacy managers and owners in Canada
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Research in Social and Administrative Pharmacy 6 (2010) 280–292
Original Research
Influence of ownership type on role orientation, role affinity, and role conflict among community pharmacy managers and owners in Canada Jason Perepelkin, B.A., B.Comm., M.Sc., Ph.D.a,*,1, Roy Thomas Dobson, B.Sc. Pharm, M.B.A., Ph.D.b a
Department of Management and Marketing, Edwards School of Business, University of Saskatchewan, 25 Campus Drive, Saskatoon, Saskatchewan, S7N 5A7, Canada b Division of Pharmacy & Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
Abstract Background: Ownership of community pharmacies is increasingly being controlled by a relatively small number of corporate entities. The influence of this ownership type should not be ignored, because ownership has the ability to impact pharmacy practice. Objectives: To examine the relationship between ownership type and community pharmacy managers with regard to role orientation, role affinity, and role conflict. Methods: This study consisted of a cross-sectional survey of community pharmacy managers in Canada by means of a self-administered postal questionnaire sent to a stratified sample of community pharmacies. Statistical analysis consisted of exploratory factor analysis with reliability testing on identified constructs. Frequencies, 1-way analyses of variance, and Scheffe post hoc tests were used to determine significant differences among groups, including ownership structure, on each of the constructs. Results: A total of 646 completed questionnaires were received (32.9% response rate). Most of the respondents were males (60.8%), with slightly less than half of the respondents identifying their practice type as an independent pharmacy (44.6%). There were 5 multi-item scale constructs (professional orientation, business orientation, professional affinity, business affinity, and role conflict) arising from the data, which were analyzed against the pharmacy ownership structure (independent, franchise, corporate) independent variable. Analysis revealed significant differences for 3 of the 5 constructs; however, no differences were seen regarding the 2 professionally focused constructs. Conclusions: Community pharmacy managers/owners are generally oriented to their professional role; however, those working in a corporate pharmacy environment are less oriented to their business role when compared with those working in an independent or franchise pharmacy environment. Further research is needed to identify different practice cultures that may exist in various practice settings and the extent to which these cultures attract or define the managers working in them. Ó 2010 Elsevier Inc. All rights reserved.
* Corresponding author. Tel.: þ1 306 966 6327; fax þ1 306 966 6327. 1 Jason Perepelkin will be Assistant Professor of Social and Administrative Pharmacy, College of Pharmacy & Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada, beginning January 1, 2010. E-mail address: [email protected] (J. Perepelkin). 1551-7411/$ - see front matter Ó 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.sapharm.2009.11.001
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Keywords: Community pharmacy; Managers; Management; Role orientation; Conflict
Background Most community pharmacists practice their profession within an overtly commercial environment. On a daily basis, pharmacists must balance both professional and business responsibilities: providing a range of medication-related goods and services while selling health- and non-healthrelated commodities for profit.1 Within the commercial environment of community pharmacy, many pharmacists are seeking a more service-oriented, patient-focused approach with greater emphasis on the use of their clinical skills.2-6 Although these ‘‘new’’ pharmacy services may be more reflective of the professional goals of pharmacy, they are generally perceived as less reliable sources of revenue than other aspects of community practice, such as increased prescription volume.7,8 Therefore, community pharmacy managers, who are uniquely positioned between the professional and business aspects of practice, must make strategic decisions that seek to improve patient care to align with objectives of the profession while being cognizant of earning profits. By default, businesses look to capitalize on profits. In community pharmacy, this can place professional objectives at odds with the business (nonprofessional) objectives of the pharmacy. Indeed, the rebranding of ‘‘retail pharmacy’’ as ‘‘community pharmacy’’ suggests the profession’s own awareness of a tension between commerce and professionalism.9 As well, with increasing prescription volumes and a shortage of pharmacists, pressures are increasing on pharmacists and pharmacy managers to work faster, harder, and longer to ensure patient and business needs are being addressed. Adding to the pressure of higher workloads, managers must also deal with the sometimes conflicting demands of superiors and subordinates within the pharmacy organization. As pharmacists seek to redefine and expand their role in health care, the ownership structure of community pharmacy also is changing from predominantly small-scale entrepreneurial pharmacists to large-scale corporate, nonpharmacist ownership; increasingly, community pharmacists are employees of large, corporate entities.10-12 As large corporations with a more decidedly business focus come to dominate community pharmacy,
opportunities to develop and introduce cognitive services may be limited. Role strain/ambiguity resulting from the demands of commercialism and professional altruism can occur when pharmacists are required to practice in a commercial environment while attempting to maintain their sense of professionalism.13-16 Moreover, a loss of professional orientation results when health care is treated like a commodity.17 If the relationship between pharmacists and patients is seen as a commercial one, it is likely to follow the ‘‘rules of commerce and the laws of torts and contracts rather than the precepts of professional ethics.’’18 The professional ethic of a corporate employee may be displaced by the ethic of the market that is less demanding.17,18 When a professional practices within an organizational setting, professional ideals may conflict with the principles of the employing organization.19 Gradually, but at an increasing rate, health professionals, including pharmacists, are becoming employees in nonprofessional organizations where professional employees are outnumbered by nonprofessional employees.20-23 As most pharmacists are employed in an organizational setting, there also exists an increasing likelihood of conflict between professional and organizational objectives.24,25 With changing ownership come the different organizational structures within which pharmacists practice their profession. Additionally, conflict can arise when professionals are employed in large, bureaucratic organizations, because professionalism and bureaucracy center on fundamentally different principles of organization.26 This study was conducted to measure the perceived importance and preferences of community pharmacy managers about the potentially competing professional and business aspects of community practice and to understand how ownership structuredindependent, franchise, or corporatedrelates to these dual roles. Specifically, how is ownership type related to orientation to practice, practice affinity, and conflict for community pharmacy managers? To operationalize and define the 3 ownership structures, independent pharmacies are those of single ownership of less than 5 pharmacies.
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Franchise pharmacies are generally part of a regional or national brand, with the franchisee having some form of revenue sharing with a head office; there may be some autonomy in local marketing, buying, merchandising, and professional services, but the majority is coordinated from a head office.27 While corporate pharmacies have 5 or more pharmacies under a single ownership, including pharmacies in grocery stores and mass merchandisers, and employ pharmacy managers who are generally salaried employees of the head office, the head office directs all marketing, merchandising, buying, and professional programs, and there is little to no adapting to the local market.27
Methods Data source and collection A self-administered questionnaire was mailed to community pharmacy managers across Canada. Contact information was obtained directly from provincial regulatory agencies, and a master list was compiled of 6342 community pharmacy managers. A sample size of 2000 was chosen to increase power and the chance of receiving the desired 600 completed questionnaires or a 30% response rate. The figure of 600 completed questionnaires was based on the calculation of a population size of 6342, with a confidence level of 99% and a margin of error of 5%. From the list of 6342, a random, stratified sample of 2000 community pharmacy managers was extracted based on the number of community pharmacy managers in each of the 9 provinces (British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Newfoundland and Labrador, Prince Edward Island, New Brunswick, and Nova Scotia). Out of the 10 Canadian provinces, contact information was not sought or obtained for community pharmacy managers in 1 province, Quebec, because ownership of a pharmacy in the province is restricted to a licensed pharmacist. Thus, it would not be possible to compare them with other ownership structures within the province. With regard to the random, stratified sample, each province was assigned a representative proportion of the total sample of 6342 community pharmacies. For example, British Columbia had 962 of the 6342 (15.2%) community pharmacies from the 9 provinces. Therefore, to maintain a proportional sample, 304 of the 2000 (15.2%) community pharmacies that made up the study
sample were randomly selected (using a random number generator) from the 964 community pharmacies in British Columbia. Data collection consisted of up to 4 separate mailings. The first mailing was a letter stating the study overview and purpose that went out to the entire sample. The overview letter was followed up 1 week later with a package being sent to the entire sample that included a cover letter restating the purpose of the study, a copy of the study questionnaire, and a prestamped return envelope. Two weeks later, a reminder postcard was sent to those in the sample who had not yet responded, reminding them of the purpose of the study. The final mailing went out 4 weeks after the study had begun, which included a cover letter; copy of the questionnaire, in case the initial one was misplaced; and a return stamped envelope. Four weeks after the final mailing, data collection concluded. Responses were anonymous, because all responses were immediately recorded in a database, and any data presented are done so in aggregate form only. For data collection purposes, there was an identification number on each questionnaire; however, this was done only to send reminders to initial nonresponders. Measures The self-administered postal questionnaire was developed using the available literature on role orientation, bureaucracy, professionals in organizations, and questionnaire design and measurement. Items used to measure respondents’ orientation to practice (importance attached to various occupational tasks) were primarily based on the works of Quinney28 and Kronus,29,30 who examined the role orientation, role strain, and occupational values of employee community (retail) pharmacists. In recognizing that some occupations, such as pharmacy, incorporate 2 or more roles, rather than a single, well-defined role, Quinney28 examined the potential for conflict in the divergent professional and business roles of pharmacists and observed that structural strain is built into the occupational role of pharmacists and that pharmacists have to adapt to these roles. Kronus,29,30 building on the work of Quinney,28 examined whether there was a distinction between a business orientation and the desire for monetary reward, and a professional orientation and the desire to be altruistic. She observed neither a support for exclusive roles between a business orientation and the desire for monetary
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reward nor a direct link with the professional role and altruism. However, she reported that pharmacy managers, compared with owners, do not feel the pressure to be profitable, because the stability of an organizational income dilutes the connection between a business role orientation and profit-making motivations for managers. Both Quinney28 and Kronus29,30 used a 4-point Likert scale, whereas we used a 5-point scale to include a neutral response category. There were some minor changes to the wording of the items to better reflect the time period and the sample population. To measure respondents’ practice affinity (the level of satisfaction of various occupational tasks), items were largely drawn from the work of Hornosty,31 who used and adapted the work of Quinney.28 Hornosty31 examined subjective role orientation, conflict, and satisfaction of pharmacy students as they prepared to enter into the profession. Unlike Quinney28 and Kronus,29,30 who identified a 2-dimensional typology (professional and business), Hornosty31 identified a 3-dimensional typology (clinical, traditional, managerial) and suggested that those with a managerial role orientation and perceptions of a dual role (professional and business) appear to reduce the potential for role conflict, but those with a clinical orientation had an increased potential for role conflict. However, the study population for Hornosty31 was pharmacy students, many of whom felt that their clinical role could be saved by not entering community pharmacy practice or that they would be able to resist organizational pressures to maintain the professional role. With regard to measuring potential conflict experienced by respondents, items were primarily drawn from the work of Mott et al,32-36 who explored a number of issues, including workload, stress, and job satisfaction, and the organizational environment. In their findings, they found an increased level of conflict for pharmacists in chain and mass merchandiser pharmacies when compared with pharmacists in independent pharmacies. There was also a greater level of role conflict for men compared with women. Mott et al32-37 used a 7-point Likert scale on agreement; in this study, the scale was changed to reflect the frequency with which the respondent was faced with a situation on a 5-point, Likert scale anchored by ‘‘never’’ and ‘‘always.’’ As a result, the wording of most items was changed to reflect the change in the scale.
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The instrument was pretested with 5 community pharmacy managers not part of the study and 6 academics on the lead author’s doctoral committee. From the pretesting, only minor grammatical changes were made. Ethics approval was received from the University of Saskatchewan’s Behavioural Research Ethics Board on February 28, 2007. Data analysis All statistical tests were performed using SPSS 15.0 for WindowsÒ (SPSS, Chicago, IL). Exploratory factor analysis with orthogonal, varimax rotation with Kaiser normalization and reliability tests was performed to reduce the number of items measured and used for analysis by combining 2 or more items that are related to create a single variable (construct) item.38,39 When analyzing results of the principal component analysis, items in a section that broke into distinct groups were extracted, and reliability tests were performed to assess the likelihood of loading those groups into a construct. Cronbach’s alpha was used to assess internal consistency.38-43 A Cronbach’s alpha greater than 0.70 (a O 70) was used for items in a grouping to be loaded into, and kept in, a construct.38-41,44,45 Once a construct was developed, frequencies, 1-way analysis of variance (ANOVA), and Scheffe post hoc tests were used to determine significant differences among groups. Nonparametric analysis was conducted for all constructs using the Bonferroni test. Parametric and nonparametric independent t tests were also performed. And finally, a general linear model was developed, including the independent variable pharmacy ownership structure and the control variables age, sex, region, and years with employer. Pharmacy ownership structure Pharmacy types identified in the questionnaire (discrete response categories) were subdivided into 3 categories according to their ownership structure: independent (independent and small chain), franchise, and corporate (large chain, grocery store, department store, and mass merchandiser). Pharmacy ownership structure was the main independent variable for this study. Nonresponse bias To assess the potential for nonresponder bias, the method of early versus late responder analysis was completed.24,46-48 The cutoff point for early
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responders was anyone responding before the final mailing (cover letter, additional copy of questionnaire), and therefore, late responders were those respondents returning the questionnaire after the final mailing.
Results Response rate and demographics At the end of data collection, a total of 646 responses were received. The sample of 2000 community pharmacy managers was reduced to 1961; 38 were deemed undeliverable and 1 pharmacy was in a long-term care home (the pharmacy manager felt the questionnaire did not reflect their practice). The final response rate was 32.9% (646/ 1961). Most of the respondents (393, 60.8%) identified themselves as males. The average age of respondents was 44 years, with a range of 24-77 years. More than half of the respondents (398, 61.6%) identified themselves as pharmacy managers, with 33.3% (215) identifying themselves as owners. Of the remaining respondents who stated their position, 1.1% identified themselves as pharmacists (3) and others (4) (eg, dispensing physician). Regarding pharmacy type, 288 were independent (independent and small chain), representing 44.6% of respondents; 119 were franchise, representing 18.4% of respondents; and 229 were corporate chain (large chain, grocery store, department store, and mass merchandiser), representing 35.4% of respondents. One mail order pharmacy and 9 ‘‘other’’ were excluded from the main independent variable, because these pharmacies were not deemed community pharmacies and did not reflect the focus of the study. Practice orientation Of the 11 activities presented to the study participants, the greatest importance (more than 90% of respondents) was placed on professional activities, such as encouraging the proper use of medications and being part of the health care team (Table 1). Least important were nonprofessional activities, such as arranging displays and offering a variety of sundry goods, although approximately one-quarter of respondents rated these activities as important or very important. Being a good businessperson and maintaining a business establishment were important to most respondents and fell within the range of some
professional activities, such as dispensing medications and mentoring students and interns. Practice affinity Regarding the 11 activities presented to the study participants, the vast majority of respondents (O90%) indicated a preference for patient counseling, keeping up-to-date with health- and drug-related issues and providing information to other health care professionals (Table 2). Activities associated with nonprofessional aspects of pharmacy operation were disliked by most of the pharmacy managers. Most of the respondents also indicated a preference for the operational activities associated with the operation of the pharmacy dispensary, such as dispensing prescriptions and managing the dispensary. Organizational experiences Most respondents indicated being in a welldefined organizational structure, as suggested by a high degree of certainty about their level of authority and having clear goals and objectives (Table 3). Most also reported a low level of conflict between the professional and business aspects of their jobs. When it came to ‘‘bucking’’ company policy, however, the respondents were somewhat more equivocal, though more reported being willing to go against company policy than not go against company policy to carry out professional duties. Constructs Constructs identified from the study data are displayed in Table 4. From the 11 items measured under orientation to practice, 2 viable constructs were identified. Professional orientation contained 5 items: attending professional meetings and conferences; being part of the health care team; reading the professional literature; public service, such as presentations to community groups; and mentoring students and interns. As is witnessed in the items included in the construct, professional orientation related to aspects of practice that are professionally focused. Business orientation included 4 items: being a good businessperson, arranging counter and shelf displays, offering a variety of sundry goods, and maintaining a business establishment. The business orientation construct centered on aspects of practice that were deemed to focus on business-related tasks. Two items did not load into either construct and were not included in any further analysis: dispensing prescriptions and encouraging the proper use of medications.
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Table 1 Role orientation toward organizational tasks Activity Being part of the health care team (PO) Reading the professional literature (PO) Mentoring students and interns (PO) Attending professional meetings and conferences (PO) Public service, such as presentations to groups (PO) Being a good businessperson (BO) Maintaining a business establishment (BO) Arranging counter and shelf displays (BO) Offering a variety of sundry goods (BO) Encouraging the proper use of medications Dispensing prescriptions
Unimportanta N (%)
Neutral N (%)
Importantb N (%)
Total N (%)
2 (0.4) 4 (0.6)
29 (4.5) 43 (6.7)
606 (93.8) 791 (91.2)
637 (98.6) 636 (98.5)
20 (3.1)
125 (19.3)
496 (76.8)
641 (99.2)
46 (7.7)
141 (21.8)
455 (70.4)
642 (99.4)
58 (9.0)
179 (27.7)
401 (62.1)
638 (98.8)
29 (4.5)
94 (14.6)
517 (80.1)
640 (99.1)
24 (3.7)
101 (15.6)
512 (79.3)
637 (98.6)
266 (41.2)
208 (32.2)
166 (25.7)
640 (99.1)
281 (43.5)
206 (31.9)
146 (22.6)
633 (98.0)
2 (0.4)
2 (0.3)
635 (98.2)
639 (98.9)
16 (2.5)
63 (9.8)
561 (86.9)
640 (99.1)
PO, item in professional orientation construct; BO, item in business orientation construct. a Combined unimportant and very unimportant. b Combined important and very important.
From the 11 items measured under practice affinity, 2 viable constructs were identified. Professional affinity contained 3 items: keeping abreast with health- and drug-related matters, providing information and advice to physicians and other health care professionals, and counseling patients regarding prescription and over-the-counter-related matters. The professional affinity construct focused on the level of gratification respondents had with professional aspects of practice. Business affinity included 4 items: selling nonmedication-related items, management of cash, management of ‘‘front store’’ stock, and management of dispensary stock. The items included in the business affinity construct focused on the level of gratification respondents had with various business aspects of practice. Four items did not load into either construct and were not included in any further analysis: dispensing prescriptions, selling nonprescription medications, management of dispensary personnel, and management of front store personnel. From the 6 items measured under organizational experiences, 1 viable construct was identified. Role conflict items included being required to do things in one’s job that are against professional judgment, receiving incompatible requests from 2 or more people, and having to choose between the
business and professional aspects of pharmacy. As is evident by the items included in the construct, the role conflict construct focused on the conflicting professional and business role for respondents. Three items did not load: feeling certain about the amount of authority; being provided with clear, planned goals and objectives for the job; and willingness to ‘‘buck’’ a company rule or policy to carry out my professional duties. Comparative analysis The constructs were compared (1-way ANOVA) using the independent variable pharmacy ownership type (Table 5). No statistical differences were revealed based on type of pharmacy ownership for either professional orientation or professional affinity. Comparative analysis of the business orientation and business affinity constructs resulted in statistically significant differences among respondents in corporate pharmacies, and those in franchise and independent pharmacies (P ! .001). For business orientation, respondents in corporate pharmacies reported attaching less importance to the business-orientated aspects of practice than those in franchise and independent pharmacies. By means of analysis of business affinity, respondents in corporate chain pharmacies reported less
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Table 2 Role-related satisfaction with organizational tasks Activity Counseling patients regarding prescription and over-the-counter-related matters (PA) Keeping abreast with health- and drug-related matters (PA) Providing information and advice to health care professionals (PA) Management of dispensary stock (ordering, inventories, storage, etc.) (BA) Management of ‘‘front store’’ stock (buying, inventories, storage, etc.) (BA) Management of cash (daily reports, deposits, change, etc.) (BA) Selling nonmedication-relateditems (cosmetics, newspapers, etc.) (BA) Dispensing prescriptions Selling nonprescription medications Management of personnel (including supervision and training of pharmacists and pharmacy technicians) Management of personnel (including supervision and training of nonprofessional staff)
Dislikea N (%)
Neutral N (%)
Likeb N (%)
Total N (%)
3 (0.5)
7 (1.1)
627 (97.0)
637 (98.6)
6 (0.9)
35 (5.4)
597 (92.5)
638 (98.8)
7 (1.1)
36 (5.6)
596 (92.3)
639 (98.9)
70 (10.9)
153 (23.7)
414 (64.1)
637 (98.6)
287 (44.4)
184 (28.5)
158 (24.5)
629 (97.4)
295 (45.6)
194 (30.0)
142 (22.0)
631 (97.7)
354 (54.8)
194 (30.0)
86 (13.3)
634 (98.1)
22 (3.4) 16 (2.5) 51 (7.9)
57 (8.8) 57 (8.8) 100 (15.5)
555 (85.9) 548 (84.8) 486 (75.2)
634 (98.1) 621 (96.1) 637 (98.6)
144 (22.3)
171 (26.5)
314 (48.6)
629 (97.4)
PA, item in professional affinity construct; BA, item in business affinity construct. Combined dislike and dislike very much. b Combined like and like very much. a
of an affinity for the business aspects of practice than those in either franchise or independent pharmacies. Comparative analysis of the role conflict construct revealed a significant difference between corporate chain and independent respondents, with the former reporting a higher level of role conflict. General linear model A series of general linear models among ownership types and the 5 constructs were conducted while controlling for sex, age, and years with employer (Table 6). Generally confirming the results of the comparative analysis, the business affinity and role conflict constructs revealed differences regarding pharmacy ownership structure; those in independent pharmacies liked the business aspects of practice more than those in corporate pharmacies, and there was more conflict reported by respondents in corporate pharmacies compared with those in independent pharmacies. Female respondents reported greater levels of professional orientation and affinity than male respondents. There were no differences regarding age. Although differences emerged for the professional orientation and business affinity
constructs regarding years with employer, those who were with their current employer the longest reported a greater orientation toward the profession and a greater affinity for the business aspects of practice than those who were with the employer for a shorter period. Discussion The findings of this study suggest a high level of professionalism among pharmacy managers and owners, both with the importance they place on professional activities and their own stated preference to be engaged in professional activities. However, the respondents readily acknowledge the importance of and preference for some business aspects of their managerial positions, especially as they relate to supporting the professional operations of the community pharmacy. The participants in this study appear to be successful in balancing the dual roles of a health profession manager and may also suggest the legitimate place within community pharmacy culture for both roles.29,30 This high level of support did not extend to ‘‘front store’’ managerial responsibilities. Historically, a community pharmacy manager would expect to derive a high proportion of the pharmacy’s income
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Perepelkin & Dobson/Research in Social and Administrative Pharmacy 6 (2010) 280–292 Table 3 Organizational environment role-related experiences Item
Never N (%)
I am willing to ‘‘buck’’ a company rule or policy in order to carry out my professional duties I receive incompatible requests from 2 or more people (RC) I often have to choose between the business and professional aspects of pharmacy (RC) I feel certain about the amount of authority I have I am provided with clear, planned goals and objectives for my job I am required to do things in my job that are against my professional judgment (RC)
Rarely N (%)
Sometimes N (%)
43 (6.7)
105 (16.3)
255 (39.5)
143 (22.1)
262 (40.6)
100 (15.5)
Often N (%)
Always N (%)
Total N (%)
91 (14.1)
112 (17.3)
606 (93.8)
168 (26.0)
33 (5.1)
4 (0.6)
610 (94.4)
272 (42.1)
195 (30.2)
66 (10.2)
2 (0.3)
635 (98.3)
4 (0.6)
18 (2.8)
111 (17.2)
244 (37.8)
255 (39.5)
632 (97.8)
18 (2.8)
50 (7.7)
158 (24.5)
219 (33.9)
181 (28.0)
626 (96.9)
293 (45.4)
255 (39.5)
72 (11.1)
7 (1.1)
3 (0.5)
630 (97.5)
RC, items in role conflict construct.
from nonprofessional goods and services, and a pharmacist assuming a management position could expect to take on significant nonprofessional responsibilities. The study findings suggest that, for pharmacy managers, the businessperson role may not be desirable when extended beyond professional managerial responsibilities. No significant differences arose among groups of the 3 ownership types regarding professional orientation. This result was somewhat unexpected, because prior studies have shown that bureaucratically based professionals eventually become dedicated to the advancement of his/her bureaucracy by seeking to advance personally within the organization.49 This contradictory finding may suggest corporate pharmacy managers, as pharmacists/ professionals, identify more with professional objectives than with the more business-oriented objectives of their employers.50 As a result,
maintaining a professional orientation may create conflict for corporate managers if the professional objectives and ideals of the profession differ from the principals of the employing organization.26,51 However, this result may not hold true if higherlevel management (eg, regional/district managers) was included in the study population. For the business orientation construct, differences arose between the corporate chain respondents and the franchise and independent respondents. One explanation for this result is that franchise and independent managers have a more personal connection to the financial viability and long-term success of the pharmacy than corporate managers. Along with being the owner or franchisee come the inherent risks and rewards of operating a business.1,9,24,52-58 Corporate managers may choose to practice in a corporate environment to avoid the risks and responsibilities of
Table 4 Role orientation, role affinity, and role conflict constructs Construct
Number of items
Scale
Range
Mean (SD)
Alpha coefficient
Professional orientation Business orientation
5 4
5-25 4-20
20.2 (2.57) 13.4 (2.78)
0.738 0.749
Professional affinity Business affinity
3 4
3-15 4-20
13.6 (1.46) 11.3 (3.08)
0.736 0.735
Role conflict
3
Very unimportant (1) to very important (5) Dislike very much (1) to like very much (5) Never (1) to always (5)
3-15
6.2 (1.97)
0.691
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Table 5 Comparative analysis of constructs by pharmacy ownership type (n ¼ 636) Construct
Pharmacy ownership type Independent (n ¼ 288)
Professional orientation Business orientationa Professional affinity Business affinitya Role conflictb
F-Value (Sig.) Franchise (n ¼ 119)
Corporate chain (n ¼ 229)
Mean
Mean
Mean
20.04 13.86 13.45 11.80 5.85
20.25 13.6 13.64 11.98 6.31
20.33 12.88 13.66 10.33 6.55
0.83 8.19 1.44 18.37 8.14
(P ¼ .44) (P ! .001) (P ¼ .24) (P ! .001) (P ! .001)
Sig., significance. a Scheffe’s test (P ! .05) Corporate chain significantly different from independent or franchise. b Scheffe’s test (P ! .05) Corporate chain significantly different from independent.
independent pharmacy or desire to be an owner, just as not all pharmacists want to practice hospital pharmacy.6,52-54,56,59-66 The professional affinity construct did not display any significant differences among the 3 ownership types. This finding is contrary to the
being an owner or franchisee, as supported by the findings of Kronus.29,30 In addition, the choice to practice in a corporate environment may be based more on a desire to avoid the more overtly business-orientated aspects of practice. The reality is that not all pharmacists want to practice in an
Table 6 General linear models of the constructs by ownership type Type III sum of squares
df
Mean square
F
Sig.
R2 (Adj. R2)
Professional orientation Ownership Sex Age Years with employer
7.269 35.146 12.446 69.044
2 1 2 4
3.635 35.146 6.223 17.261
0.559 5.405 0.957 2.654
0.572 0.021a 0.385 0.033a
0.078 (0.052)
Business orientation Ownership Sex Age Years with employer
39.413 6.710 19.887 22.645
2 1 2 4
19.707 6.710 9.944 5.661
2.691 0.916 1.358 0.773
0.069 0.339 0.258 0.543
0.045 (0.018)
Professional affinity Ownership Sex Age Years with employer
8.670 31.633 4.570 10.341
2 1 2 4
4.335 31.633 2.285 2.585
2.092 15.266 1.103 1.248
0.125 0.001a 0.333 0.290
0.055 (0.028)
Business affinity Ownership Sex Age Years with employer
92.749 0.001 26.188 152.926
2 1 2 4
46.374 0.001 13.094 38.232
5.345 0.000 1.509 4.407
0.005a 0.994 0.222 0.002a
0.082 (0.056)
Role conflict Ownership Sex Age Years with employer
23.647 10.730 8.661 13.444
2 1 2 4
11.823 10.730 4.331 3.361
3.360 3.049 1.231 0.955
0.036a 0.081 0.293 0.432
0.054 (0.025)
a
Statistically significant (P ! .05).
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literature, which suggests that employees in larger, bureaucratic organizations eventually begin to identify more with the goals and objectives of the organization, as opposed to their profession.49 Corporate managers may be resisting the situational pressure that can exist within organizations for employees to behave in a particular manner, and this resistance is more likely if the proposed action is not congruent with professional ethics.24,25 Similar to the business orientation construct, differences were observed among corporate respondents and franchise and independent respondents for the business affinity construct. Again, the personal connection for franchise and independent respondents may explain this difference.1,9,24,52-58 Franchise managers may be viewed as falling between independent and corporate managers, but on business aspects, they tended to align with independent respondents. This may be explained by the fact that although franchise respondents have little to personally gain or lose financially than independent respondents, it is generally more than those in corporate pharmacies who risk little beyond their wage and potential bonuses. There is also the issue of organizational structure, in that independent and franchise pharmacies are generally less complex, with ownership more directly involved in the day-to-day operations of the business. Similar to the independent pharmacy owner, the franchisee is financially invested in the business; however, they are required at varying levels to follow policies and procedures of a larger corporate entity to maintain a consistent image and brand. In corporate pharmacies, the pharmacy manager is an employee within a variety of levels of organizational management: from management within the larger retail environment, as is the case with mass merchandisers and grocery store, and some large chains to the district/regional manager and the various levels of management at corporate headquarters, including vice presidents and the chief executive officer. These larger, more complex business structures and the resulting levels of bureaucracy are magnified if the organization is part of a multinational corporation. In this study, corporate pharmacy managers reported more conflict than independent managers, and this is consistent with the management literature.7,9,19,24,25,28-30,67 This conflict may be explained by the fact that a corporate pharmacy
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manager does not own the pharmacy. There is a separation of the professional and higher managerial level. As a result, these pharmacy managers may be more limited in their ability to substantially affect the managerial decisions made at the upper levels of the organization. The manager in a corporate pharmacy is, therefore, more likely to experience conflict in managing the demands of the professional pharmacy practice, which may not align with the corporate mission/direction.14,16,26,28,49 The formalization of work may not be consistent with the corporate pharmacy manager’s view of the ideal concept of pharmacy practice, whereas independent pharmacy managers may be better able to align business practices with the professional ideals of pharmacy practice.68,69 Limitations Several limitations are acknowledged, including respondents’ self-report. This factor along with a 32.9% response rate may preclude the findings’ generalizability to all of Canada or other regions/nations. There also is the possibility that some of the sample members did not respond to the survey because of company policy. The role conflict construct was retained despite it having an alpha value below the a O 0.70 criterion (0.691). Future research on the population of pharmacy managers and owners may require role conflict measures that are broader than the ones used in this study, because the study population for Mott et al32-37 was licensed pharmacists, not specifically pharmacy managers and owners as in this study. This would also hold true when attempting to measure other aspects of the unique role that managers and owners hold in community pharmacy. As with any survey research, there is the potential for nonresponse bias between responders and nonresponders. For this study, a nonresponder survey was not conducted; however, no statistically significant differences were observed among early and late responders regarding their pharmacy ownership structure, sex, or age.
Conclusion Community pharmacy managers are oriented to their professional role; however, those working in a corporate pharmacy environment are less oriented to their business role. It would appear that those practicing in a corporate pharmacy are
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different from those practicing in independent and, to some degree, franchise pharmacies. Further research is needed to identify different practice cultures that may exist in various practice settings, the extent to which these cultures attract or define the managers working in them, and the resultant potential for role conflict.
Acknowledgments The authors would like to thank the community pharmacy managers who took time out of their busy schedules to complete and return the questionnaire and the provincial regulatory agencies for providing the contact information for community pharmacy managers in their respective province.
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Original Research
Influence of ownership type on role orientation, role affinity, and role conflict among community pharmacy managers and owners in Canada Jason Perepelkin, B.A., B.Comm., M.Sc., Ph.D.a,*,1, Roy Thomas Dobson, B.Sc. Pharm, M.B.A., Ph.D.b a
Department of Management and Marketing, Edwards School of Business, University of Saskatchewan, 25 Campus Drive, Saskatoon, Saskatchewan, S7N 5A7, Canada b Division of Pharmacy & Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
Abstract Background: Ownership of community pharmacies is increasingly being controlled by a relatively small number of corporate entities. The influence of this ownership type should not be ignored, because ownership has the ability to impact pharmacy practice. Objectives: To examine the relationship between ownership type and community pharmacy managers with regard to role orientation, role affinity, and role conflict. Methods: This study consisted of a cross-sectional survey of community pharmacy managers in Canada by means of a self-administered postal questionnaire sent to a stratified sample of community pharmacies. Statistical analysis consisted of exploratory factor analysis with reliability testing on identified constructs. Frequencies, 1-way analyses of variance, and Scheffe post hoc tests were used to determine significant differences among groups, including ownership structure, on each of the constructs. Results: A total of 646 completed questionnaires were received (32.9% response rate). Most of the respondents were males (60.8%), with slightly less than half of the respondents identifying their practice type as an independent pharmacy (44.6%). There were 5 multi-item scale constructs (professional orientation, business orientation, professional affinity, business affinity, and role conflict) arising from the data, which were analyzed against the pharmacy ownership structure (independent, franchise, corporate) independent variable. Analysis revealed significant differences for 3 of the 5 constructs; however, no differences were seen regarding the 2 professionally focused constructs. Conclusions: Community pharmacy managers/owners are generally oriented to their professional role; however, those working in a corporate pharmacy environment are less oriented to their business role when compared with those working in an independent or franchise pharmacy environment. Further research is needed to identify different practice cultures that may exist in various practice settings and the extent to which these cultures attract or define the managers working in them. Ó 2010 Elsevier Inc. All rights reserved.
* Corresponding author. Tel.: þ1 306 966 6327; fax þ1 306 966 6327. 1 Jason Perepelkin will be Assistant Professor of Social and Administrative Pharmacy, College of Pharmacy & Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada, beginning January 1, 2010. E-mail address: [email protected] (J. Perepelkin). 1551-7411/$ - see front matter Ó 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.sapharm.2009.11.001
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Keywords: Community pharmacy; Managers; Management; Role orientation; Conflict
Background Most community pharmacists practice their profession within an overtly commercial environment. On a daily basis, pharmacists must balance both professional and business responsibilities: providing a range of medication-related goods and services while selling health- and non-healthrelated commodities for profit.1 Within the commercial environment of community pharmacy, many pharmacists are seeking a more service-oriented, patient-focused approach with greater emphasis on the use of their clinical skills.2-6 Although these ‘‘new’’ pharmacy services may be more reflective of the professional goals of pharmacy, they are generally perceived as less reliable sources of revenue than other aspects of community practice, such as increased prescription volume.7,8 Therefore, community pharmacy managers, who are uniquely positioned between the professional and business aspects of practice, must make strategic decisions that seek to improve patient care to align with objectives of the profession while being cognizant of earning profits. By default, businesses look to capitalize on profits. In community pharmacy, this can place professional objectives at odds with the business (nonprofessional) objectives of the pharmacy. Indeed, the rebranding of ‘‘retail pharmacy’’ as ‘‘community pharmacy’’ suggests the profession’s own awareness of a tension between commerce and professionalism.9 As well, with increasing prescription volumes and a shortage of pharmacists, pressures are increasing on pharmacists and pharmacy managers to work faster, harder, and longer to ensure patient and business needs are being addressed. Adding to the pressure of higher workloads, managers must also deal with the sometimes conflicting demands of superiors and subordinates within the pharmacy organization. As pharmacists seek to redefine and expand their role in health care, the ownership structure of community pharmacy also is changing from predominantly small-scale entrepreneurial pharmacists to large-scale corporate, nonpharmacist ownership; increasingly, community pharmacists are employees of large, corporate entities.10-12 As large corporations with a more decidedly business focus come to dominate community pharmacy,
opportunities to develop and introduce cognitive services may be limited. Role strain/ambiguity resulting from the demands of commercialism and professional altruism can occur when pharmacists are required to practice in a commercial environment while attempting to maintain their sense of professionalism.13-16 Moreover, a loss of professional orientation results when health care is treated like a commodity.17 If the relationship between pharmacists and patients is seen as a commercial one, it is likely to follow the ‘‘rules of commerce and the laws of torts and contracts rather than the precepts of professional ethics.’’18 The professional ethic of a corporate employee may be displaced by the ethic of the market that is less demanding.17,18 When a professional practices within an organizational setting, professional ideals may conflict with the principles of the employing organization.19 Gradually, but at an increasing rate, health professionals, including pharmacists, are becoming employees in nonprofessional organizations where professional employees are outnumbered by nonprofessional employees.20-23 As most pharmacists are employed in an organizational setting, there also exists an increasing likelihood of conflict between professional and organizational objectives.24,25 With changing ownership come the different organizational structures within which pharmacists practice their profession. Additionally, conflict can arise when professionals are employed in large, bureaucratic organizations, because professionalism and bureaucracy center on fundamentally different principles of organization.26 This study was conducted to measure the perceived importance and preferences of community pharmacy managers about the potentially competing professional and business aspects of community practice and to understand how ownership structuredindependent, franchise, or corporatedrelates to these dual roles. Specifically, how is ownership type related to orientation to practice, practice affinity, and conflict for community pharmacy managers? To operationalize and define the 3 ownership structures, independent pharmacies are those of single ownership of less than 5 pharmacies.
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Franchise pharmacies are generally part of a regional or national brand, with the franchisee having some form of revenue sharing with a head office; there may be some autonomy in local marketing, buying, merchandising, and professional services, but the majority is coordinated from a head office.27 While corporate pharmacies have 5 or more pharmacies under a single ownership, including pharmacies in grocery stores and mass merchandisers, and employ pharmacy managers who are generally salaried employees of the head office, the head office directs all marketing, merchandising, buying, and professional programs, and there is little to no adapting to the local market.27
Methods Data source and collection A self-administered questionnaire was mailed to community pharmacy managers across Canada. Contact information was obtained directly from provincial regulatory agencies, and a master list was compiled of 6342 community pharmacy managers. A sample size of 2000 was chosen to increase power and the chance of receiving the desired 600 completed questionnaires or a 30% response rate. The figure of 600 completed questionnaires was based on the calculation of a population size of 6342, with a confidence level of 99% and a margin of error of 5%. From the list of 6342, a random, stratified sample of 2000 community pharmacy managers was extracted based on the number of community pharmacy managers in each of the 9 provinces (British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Newfoundland and Labrador, Prince Edward Island, New Brunswick, and Nova Scotia). Out of the 10 Canadian provinces, contact information was not sought or obtained for community pharmacy managers in 1 province, Quebec, because ownership of a pharmacy in the province is restricted to a licensed pharmacist. Thus, it would not be possible to compare them with other ownership structures within the province. With regard to the random, stratified sample, each province was assigned a representative proportion of the total sample of 6342 community pharmacies. For example, British Columbia had 962 of the 6342 (15.2%) community pharmacies from the 9 provinces. Therefore, to maintain a proportional sample, 304 of the 2000 (15.2%) community pharmacies that made up the study
sample were randomly selected (using a random number generator) from the 964 community pharmacies in British Columbia. Data collection consisted of up to 4 separate mailings. The first mailing was a letter stating the study overview and purpose that went out to the entire sample. The overview letter was followed up 1 week later with a package being sent to the entire sample that included a cover letter restating the purpose of the study, a copy of the study questionnaire, and a prestamped return envelope. Two weeks later, a reminder postcard was sent to those in the sample who had not yet responded, reminding them of the purpose of the study. The final mailing went out 4 weeks after the study had begun, which included a cover letter; copy of the questionnaire, in case the initial one was misplaced; and a return stamped envelope. Four weeks after the final mailing, data collection concluded. Responses were anonymous, because all responses were immediately recorded in a database, and any data presented are done so in aggregate form only. For data collection purposes, there was an identification number on each questionnaire; however, this was done only to send reminders to initial nonresponders. Measures The self-administered postal questionnaire was developed using the available literature on role orientation, bureaucracy, professionals in organizations, and questionnaire design and measurement. Items used to measure respondents’ orientation to practice (importance attached to various occupational tasks) were primarily based on the works of Quinney28 and Kronus,29,30 who examined the role orientation, role strain, and occupational values of employee community (retail) pharmacists. In recognizing that some occupations, such as pharmacy, incorporate 2 or more roles, rather than a single, well-defined role, Quinney28 examined the potential for conflict in the divergent professional and business roles of pharmacists and observed that structural strain is built into the occupational role of pharmacists and that pharmacists have to adapt to these roles. Kronus,29,30 building on the work of Quinney,28 examined whether there was a distinction between a business orientation and the desire for monetary reward, and a professional orientation and the desire to be altruistic. She observed neither a support for exclusive roles between a business orientation and the desire for monetary
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reward nor a direct link with the professional role and altruism. However, she reported that pharmacy managers, compared with owners, do not feel the pressure to be profitable, because the stability of an organizational income dilutes the connection between a business role orientation and profit-making motivations for managers. Both Quinney28 and Kronus29,30 used a 4-point Likert scale, whereas we used a 5-point scale to include a neutral response category. There were some minor changes to the wording of the items to better reflect the time period and the sample population. To measure respondents’ practice affinity (the level of satisfaction of various occupational tasks), items were largely drawn from the work of Hornosty,31 who used and adapted the work of Quinney.28 Hornosty31 examined subjective role orientation, conflict, and satisfaction of pharmacy students as they prepared to enter into the profession. Unlike Quinney28 and Kronus,29,30 who identified a 2-dimensional typology (professional and business), Hornosty31 identified a 3-dimensional typology (clinical, traditional, managerial) and suggested that those with a managerial role orientation and perceptions of a dual role (professional and business) appear to reduce the potential for role conflict, but those with a clinical orientation had an increased potential for role conflict. However, the study population for Hornosty31 was pharmacy students, many of whom felt that their clinical role could be saved by not entering community pharmacy practice or that they would be able to resist organizational pressures to maintain the professional role. With regard to measuring potential conflict experienced by respondents, items were primarily drawn from the work of Mott et al,32-36 who explored a number of issues, including workload, stress, and job satisfaction, and the organizational environment. In their findings, they found an increased level of conflict for pharmacists in chain and mass merchandiser pharmacies when compared with pharmacists in independent pharmacies. There was also a greater level of role conflict for men compared with women. Mott et al32-37 used a 7-point Likert scale on agreement; in this study, the scale was changed to reflect the frequency with which the respondent was faced with a situation on a 5-point, Likert scale anchored by ‘‘never’’ and ‘‘always.’’ As a result, the wording of most items was changed to reflect the change in the scale.
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The instrument was pretested with 5 community pharmacy managers not part of the study and 6 academics on the lead author’s doctoral committee. From the pretesting, only minor grammatical changes were made. Ethics approval was received from the University of Saskatchewan’s Behavioural Research Ethics Board on February 28, 2007. Data analysis All statistical tests were performed using SPSS 15.0 for WindowsÒ (SPSS, Chicago, IL). Exploratory factor analysis with orthogonal, varimax rotation with Kaiser normalization and reliability tests was performed to reduce the number of items measured and used for analysis by combining 2 or more items that are related to create a single variable (construct) item.38,39 When analyzing results of the principal component analysis, items in a section that broke into distinct groups were extracted, and reliability tests were performed to assess the likelihood of loading those groups into a construct. Cronbach’s alpha was used to assess internal consistency.38-43 A Cronbach’s alpha greater than 0.70 (a O 70) was used for items in a grouping to be loaded into, and kept in, a construct.38-41,44,45 Once a construct was developed, frequencies, 1-way analysis of variance (ANOVA), and Scheffe post hoc tests were used to determine significant differences among groups. Nonparametric analysis was conducted for all constructs using the Bonferroni test. Parametric and nonparametric independent t tests were also performed. And finally, a general linear model was developed, including the independent variable pharmacy ownership structure and the control variables age, sex, region, and years with employer. Pharmacy ownership structure Pharmacy types identified in the questionnaire (discrete response categories) were subdivided into 3 categories according to their ownership structure: independent (independent and small chain), franchise, and corporate (large chain, grocery store, department store, and mass merchandiser). Pharmacy ownership structure was the main independent variable for this study. Nonresponse bias To assess the potential for nonresponder bias, the method of early versus late responder analysis was completed.24,46-48 The cutoff point for early
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responders was anyone responding before the final mailing (cover letter, additional copy of questionnaire), and therefore, late responders were those respondents returning the questionnaire after the final mailing.
Results Response rate and demographics At the end of data collection, a total of 646 responses were received. The sample of 2000 community pharmacy managers was reduced to 1961; 38 were deemed undeliverable and 1 pharmacy was in a long-term care home (the pharmacy manager felt the questionnaire did not reflect their practice). The final response rate was 32.9% (646/ 1961). Most of the respondents (393, 60.8%) identified themselves as males. The average age of respondents was 44 years, with a range of 24-77 years. More than half of the respondents (398, 61.6%) identified themselves as pharmacy managers, with 33.3% (215) identifying themselves as owners. Of the remaining respondents who stated their position, 1.1% identified themselves as pharmacists (3) and others (4) (eg, dispensing physician). Regarding pharmacy type, 288 were independent (independent and small chain), representing 44.6% of respondents; 119 were franchise, representing 18.4% of respondents; and 229 were corporate chain (large chain, grocery store, department store, and mass merchandiser), representing 35.4% of respondents. One mail order pharmacy and 9 ‘‘other’’ were excluded from the main independent variable, because these pharmacies were not deemed community pharmacies and did not reflect the focus of the study. Practice orientation Of the 11 activities presented to the study participants, the greatest importance (more than 90% of respondents) was placed on professional activities, such as encouraging the proper use of medications and being part of the health care team (Table 1). Least important were nonprofessional activities, such as arranging displays and offering a variety of sundry goods, although approximately one-quarter of respondents rated these activities as important or very important. Being a good businessperson and maintaining a business establishment were important to most respondents and fell within the range of some
professional activities, such as dispensing medications and mentoring students and interns. Practice affinity Regarding the 11 activities presented to the study participants, the vast majority of respondents (O90%) indicated a preference for patient counseling, keeping up-to-date with health- and drug-related issues and providing information to other health care professionals (Table 2). Activities associated with nonprofessional aspects of pharmacy operation were disliked by most of the pharmacy managers. Most of the respondents also indicated a preference for the operational activities associated with the operation of the pharmacy dispensary, such as dispensing prescriptions and managing the dispensary. Organizational experiences Most respondents indicated being in a welldefined organizational structure, as suggested by a high degree of certainty about their level of authority and having clear goals and objectives (Table 3). Most also reported a low level of conflict between the professional and business aspects of their jobs. When it came to ‘‘bucking’’ company policy, however, the respondents were somewhat more equivocal, though more reported being willing to go against company policy than not go against company policy to carry out professional duties. Constructs Constructs identified from the study data are displayed in Table 4. From the 11 items measured under orientation to practice, 2 viable constructs were identified. Professional orientation contained 5 items: attending professional meetings and conferences; being part of the health care team; reading the professional literature; public service, such as presentations to community groups; and mentoring students and interns. As is witnessed in the items included in the construct, professional orientation related to aspects of practice that are professionally focused. Business orientation included 4 items: being a good businessperson, arranging counter and shelf displays, offering a variety of sundry goods, and maintaining a business establishment. The business orientation construct centered on aspects of practice that were deemed to focus on business-related tasks. Two items did not load into either construct and were not included in any further analysis: dispensing prescriptions and encouraging the proper use of medications.
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Table 1 Role orientation toward organizational tasks Activity Being part of the health care team (PO) Reading the professional literature (PO) Mentoring students and interns (PO) Attending professional meetings and conferences (PO) Public service, such as presentations to groups (PO) Being a good businessperson (BO) Maintaining a business establishment (BO) Arranging counter and shelf displays (BO) Offering a variety of sundry goods (BO) Encouraging the proper use of medications Dispensing prescriptions
Unimportanta N (%)
Neutral N (%)
Importantb N (%)
Total N (%)
2 (0.4) 4 (0.6)
29 (4.5) 43 (6.7)
606 (93.8) 791 (91.2)
637 (98.6) 636 (98.5)
20 (3.1)
125 (19.3)
496 (76.8)
641 (99.2)
46 (7.7)
141 (21.8)
455 (70.4)
642 (99.4)
58 (9.0)
179 (27.7)
401 (62.1)
638 (98.8)
29 (4.5)
94 (14.6)
517 (80.1)
640 (99.1)
24 (3.7)
101 (15.6)
512 (79.3)
637 (98.6)
266 (41.2)
208 (32.2)
166 (25.7)
640 (99.1)
281 (43.5)
206 (31.9)
146 (22.6)
633 (98.0)
2 (0.4)
2 (0.3)
635 (98.2)
639 (98.9)
16 (2.5)
63 (9.8)
561 (86.9)
640 (99.1)
PO, item in professional orientation construct; BO, item in business orientation construct. a Combined unimportant and very unimportant. b Combined important and very important.
From the 11 items measured under practice affinity, 2 viable constructs were identified. Professional affinity contained 3 items: keeping abreast with health- and drug-related matters, providing information and advice to physicians and other health care professionals, and counseling patients regarding prescription and over-the-counter-related matters. The professional affinity construct focused on the level of gratification respondents had with professional aspects of practice. Business affinity included 4 items: selling nonmedication-related items, management of cash, management of ‘‘front store’’ stock, and management of dispensary stock. The items included in the business affinity construct focused on the level of gratification respondents had with various business aspects of practice. Four items did not load into either construct and were not included in any further analysis: dispensing prescriptions, selling nonprescription medications, management of dispensary personnel, and management of front store personnel. From the 6 items measured under organizational experiences, 1 viable construct was identified. Role conflict items included being required to do things in one’s job that are against professional judgment, receiving incompatible requests from 2 or more people, and having to choose between the
business and professional aspects of pharmacy. As is evident by the items included in the construct, the role conflict construct focused on the conflicting professional and business role for respondents. Three items did not load: feeling certain about the amount of authority; being provided with clear, planned goals and objectives for the job; and willingness to ‘‘buck’’ a company rule or policy to carry out my professional duties. Comparative analysis The constructs were compared (1-way ANOVA) using the independent variable pharmacy ownership type (Table 5). No statistical differences were revealed based on type of pharmacy ownership for either professional orientation or professional affinity. Comparative analysis of the business orientation and business affinity constructs resulted in statistically significant differences among respondents in corporate pharmacies, and those in franchise and independent pharmacies (P ! .001). For business orientation, respondents in corporate pharmacies reported attaching less importance to the business-orientated aspects of practice than those in franchise and independent pharmacies. By means of analysis of business affinity, respondents in corporate chain pharmacies reported less
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Table 2 Role-related satisfaction with organizational tasks Activity Counseling patients regarding prescription and over-the-counter-related matters (PA) Keeping abreast with health- and drug-related matters (PA) Providing information and advice to health care professionals (PA) Management of dispensary stock (ordering, inventories, storage, etc.) (BA) Management of ‘‘front store’’ stock (buying, inventories, storage, etc.) (BA) Management of cash (daily reports, deposits, change, etc.) (BA) Selling nonmedication-relateditems (cosmetics, newspapers, etc.) (BA) Dispensing prescriptions Selling nonprescription medications Management of personnel (including supervision and training of pharmacists and pharmacy technicians) Management of personnel (including supervision and training of nonprofessional staff)
Dislikea N (%)
Neutral N (%)
Likeb N (%)
Total N (%)
3 (0.5)
7 (1.1)
627 (97.0)
637 (98.6)
6 (0.9)
35 (5.4)
597 (92.5)
638 (98.8)
7 (1.1)
36 (5.6)
596 (92.3)
639 (98.9)
70 (10.9)
153 (23.7)
414 (64.1)
637 (98.6)
287 (44.4)
184 (28.5)
158 (24.5)
629 (97.4)
295 (45.6)
194 (30.0)
142 (22.0)
631 (97.7)
354 (54.8)
194 (30.0)
86 (13.3)
634 (98.1)
22 (3.4) 16 (2.5) 51 (7.9)
57 (8.8) 57 (8.8) 100 (15.5)
555 (85.9) 548 (84.8) 486 (75.2)
634 (98.1) 621 (96.1) 637 (98.6)
144 (22.3)
171 (26.5)
314 (48.6)
629 (97.4)
PA, item in professional affinity construct; BA, item in business affinity construct. Combined dislike and dislike very much. b Combined like and like very much. a
of an affinity for the business aspects of practice than those in either franchise or independent pharmacies. Comparative analysis of the role conflict construct revealed a significant difference between corporate chain and independent respondents, with the former reporting a higher level of role conflict. General linear model A series of general linear models among ownership types and the 5 constructs were conducted while controlling for sex, age, and years with employer (Table 6). Generally confirming the results of the comparative analysis, the business affinity and role conflict constructs revealed differences regarding pharmacy ownership structure; those in independent pharmacies liked the business aspects of practice more than those in corporate pharmacies, and there was more conflict reported by respondents in corporate pharmacies compared with those in independent pharmacies. Female respondents reported greater levels of professional orientation and affinity than male respondents. There were no differences regarding age. Although differences emerged for the professional orientation and business affinity
constructs regarding years with employer, those who were with their current employer the longest reported a greater orientation toward the profession and a greater affinity for the business aspects of practice than those who were with the employer for a shorter period. Discussion The findings of this study suggest a high level of professionalism among pharmacy managers and owners, both with the importance they place on professional activities and their own stated preference to be engaged in professional activities. However, the respondents readily acknowledge the importance of and preference for some business aspects of their managerial positions, especially as they relate to supporting the professional operations of the community pharmacy. The participants in this study appear to be successful in balancing the dual roles of a health profession manager and may also suggest the legitimate place within community pharmacy culture for both roles.29,30 This high level of support did not extend to ‘‘front store’’ managerial responsibilities. Historically, a community pharmacy manager would expect to derive a high proportion of the pharmacy’s income
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Perepelkin & Dobson/Research in Social and Administrative Pharmacy 6 (2010) 280–292 Table 3 Organizational environment role-related experiences Item
Never N (%)
I am willing to ‘‘buck’’ a company rule or policy in order to carry out my professional duties I receive incompatible requests from 2 or more people (RC) I often have to choose between the business and professional aspects of pharmacy (RC) I feel certain about the amount of authority I have I am provided with clear, planned goals and objectives for my job I am required to do things in my job that are against my professional judgment (RC)
Rarely N (%)
Sometimes N (%)
43 (6.7)
105 (16.3)
255 (39.5)
143 (22.1)
262 (40.6)
100 (15.5)
Often N (%)
Always N (%)
Total N (%)
91 (14.1)
112 (17.3)
606 (93.8)
168 (26.0)
33 (5.1)
4 (0.6)
610 (94.4)
272 (42.1)
195 (30.2)
66 (10.2)
2 (0.3)
635 (98.3)
4 (0.6)
18 (2.8)
111 (17.2)
244 (37.8)
255 (39.5)
632 (97.8)
18 (2.8)
50 (7.7)
158 (24.5)
219 (33.9)
181 (28.0)
626 (96.9)
293 (45.4)
255 (39.5)
72 (11.1)
7 (1.1)
3 (0.5)
630 (97.5)
RC, items in role conflict construct.
from nonprofessional goods and services, and a pharmacist assuming a management position could expect to take on significant nonprofessional responsibilities. The study findings suggest that, for pharmacy managers, the businessperson role may not be desirable when extended beyond professional managerial responsibilities. No significant differences arose among groups of the 3 ownership types regarding professional orientation. This result was somewhat unexpected, because prior studies have shown that bureaucratically based professionals eventually become dedicated to the advancement of his/her bureaucracy by seeking to advance personally within the organization.49 This contradictory finding may suggest corporate pharmacy managers, as pharmacists/ professionals, identify more with professional objectives than with the more business-oriented objectives of their employers.50 As a result,
maintaining a professional orientation may create conflict for corporate managers if the professional objectives and ideals of the profession differ from the principals of the employing organization.26,51 However, this result may not hold true if higherlevel management (eg, regional/district managers) was included in the study population. For the business orientation construct, differences arose between the corporate chain respondents and the franchise and independent respondents. One explanation for this result is that franchise and independent managers have a more personal connection to the financial viability and long-term success of the pharmacy than corporate managers. Along with being the owner or franchisee come the inherent risks and rewards of operating a business.1,9,24,52-58 Corporate managers may choose to practice in a corporate environment to avoid the risks and responsibilities of
Table 4 Role orientation, role affinity, and role conflict constructs Construct
Number of items
Scale
Range
Mean (SD)
Alpha coefficient
Professional orientation Business orientation
5 4
5-25 4-20
20.2 (2.57) 13.4 (2.78)
0.738 0.749
Professional affinity Business affinity
3 4
3-15 4-20
13.6 (1.46) 11.3 (3.08)
0.736 0.735
Role conflict
3
Very unimportant (1) to very important (5) Dislike very much (1) to like very much (5) Never (1) to always (5)
3-15
6.2 (1.97)
0.691
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Table 5 Comparative analysis of constructs by pharmacy ownership type (n ¼ 636) Construct
Pharmacy ownership type Independent (n ¼ 288)
Professional orientation Business orientationa Professional affinity Business affinitya Role conflictb
F-Value (Sig.) Franchise (n ¼ 119)
Corporate chain (n ¼ 229)
Mean
Mean
Mean
20.04 13.86 13.45 11.80 5.85
20.25 13.6 13.64 11.98 6.31
20.33 12.88 13.66 10.33 6.55
0.83 8.19 1.44 18.37 8.14
(P ¼ .44) (P ! .001) (P ¼ .24) (P ! .001) (P ! .001)
Sig., significance. a Scheffe’s test (P ! .05) Corporate chain significantly different from independent or franchise. b Scheffe’s test (P ! .05) Corporate chain significantly different from independent.
independent pharmacy or desire to be an owner, just as not all pharmacists want to practice hospital pharmacy.6,52-54,56,59-66 The professional affinity construct did not display any significant differences among the 3 ownership types. This finding is contrary to the
being an owner or franchisee, as supported by the findings of Kronus.29,30 In addition, the choice to practice in a corporate environment may be based more on a desire to avoid the more overtly business-orientated aspects of practice. The reality is that not all pharmacists want to practice in an
Table 6 General linear models of the constructs by ownership type Type III sum of squares
df
Mean square
F
Sig.
R2 (Adj. R2)
Professional orientation Ownership Sex Age Years with employer
7.269 35.146 12.446 69.044
2 1 2 4
3.635 35.146 6.223 17.261
0.559 5.405 0.957 2.654
0.572 0.021a 0.385 0.033a
0.078 (0.052)
Business orientation Ownership Sex Age Years with employer
39.413 6.710 19.887 22.645
2 1 2 4
19.707 6.710 9.944 5.661
2.691 0.916 1.358 0.773
0.069 0.339 0.258 0.543
0.045 (0.018)
Professional affinity Ownership Sex Age Years with employer
8.670 31.633 4.570 10.341
2 1 2 4
4.335 31.633 2.285 2.585
2.092 15.266 1.103 1.248
0.125 0.001a 0.333 0.290
0.055 (0.028)
Business affinity Ownership Sex Age Years with employer
92.749 0.001 26.188 152.926
2 1 2 4
46.374 0.001 13.094 38.232
5.345 0.000 1.509 4.407
0.005a 0.994 0.222 0.002a
0.082 (0.056)
Role conflict Ownership Sex Age Years with employer
23.647 10.730 8.661 13.444
2 1 2 4
11.823 10.730 4.331 3.361
3.360 3.049 1.231 0.955
0.036a 0.081 0.293 0.432
0.054 (0.025)
a
Statistically significant (P ! .05).
Perepelkin & Dobson/Research in Social and Administrative Pharmacy 6 (2010) 280–292
literature, which suggests that employees in larger, bureaucratic organizations eventually begin to identify more with the goals and objectives of the organization, as opposed to their profession.49 Corporate managers may be resisting the situational pressure that can exist within organizations for employees to behave in a particular manner, and this resistance is more likely if the proposed action is not congruent with professional ethics.24,25 Similar to the business orientation construct, differences were observed among corporate respondents and franchise and independent respondents for the business affinity construct. Again, the personal connection for franchise and independent respondents may explain this difference.1,9,24,52-58 Franchise managers may be viewed as falling between independent and corporate managers, but on business aspects, they tended to align with independent respondents. This may be explained by the fact that although franchise respondents have little to personally gain or lose financially than independent respondents, it is generally more than those in corporate pharmacies who risk little beyond their wage and potential bonuses. There is also the issue of organizational structure, in that independent and franchise pharmacies are generally less complex, with ownership more directly involved in the day-to-day operations of the business. Similar to the independent pharmacy owner, the franchisee is financially invested in the business; however, they are required at varying levels to follow policies and procedures of a larger corporate entity to maintain a consistent image and brand. In corporate pharmacies, the pharmacy manager is an employee within a variety of levels of organizational management: from management within the larger retail environment, as is the case with mass merchandisers and grocery store, and some large chains to the district/regional manager and the various levels of management at corporate headquarters, including vice presidents and the chief executive officer. These larger, more complex business structures and the resulting levels of bureaucracy are magnified if the organization is part of a multinational corporation. In this study, corporate pharmacy managers reported more conflict than independent managers, and this is consistent with the management literature.7,9,19,24,25,28-30,67 This conflict may be explained by the fact that a corporate pharmacy
289
manager does not own the pharmacy. There is a separation of the professional and higher managerial level. As a result, these pharmacy managers may be more limited in their ability to substantially affect the managerial decisions made at the upper levels of the organization. The manager in a corporate pharmacy is, therefore, more likely to experience conflict in managing the demands of the professional pharmacy practice, which may not align with the corporate mission/direction.14,16,26,28,49 The formalization of work may not be consistent with the corporate pharmacy manager’s view of the ideal concept of pharmacy practice, whereas independent pharmacy managers may be better able to align business practices with the professional ideals of pharmacy practice.68,69 Limitations Several limitations are acknowledged, including respondents’ self-report. This factor along with a 32.9% response rate may preclude the findings’ generalizability to all of Canada or other regions/nations. There also is the possibility that some of the sample members did not respond to the survey because of company policy. The role conflict construct was retained despite it having an alpha value below the a O 0.70 criterion (0.691). Future research on the population of pharmacy managers and owners may require role conflict measures that are broader than the ones used in this study, because the study population for Mott et al32-37 was licensed pharmacists, not specifically pharmacy managers and owners as in this study. This would also hold true when attempting to measure other aspects of the unique role that managers and owners hold in community pharmacy. As with any survey research, there is the potential for nonresponse bias between responders and nonresponders. For this study, a nonresponder survey was not conducted; however, no statistically significant differences were observed among early and late responders regarding their pharmacy ownership structure, sex, or age.
Conclusion Community pharmacy managers are oriented to their professional role; however, those working in a corporate pharmacy environment are less oriented to their business role. It would appear that those practicing in a corporate pharmacy are
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different from those practicing in independent and, to some degree, franchise pharmacies. Further research is needed to identify different practice cultures that may exist in various practice settings, the extent to which these cultures attract or define the managers working in them, and the resultant potential for role conflict.
Acknowledgments The authors would like to thank the community pharmacy managers who took time out of their busy schedules to complete and return the questionnaire and the provincial regulatory agencies for providing the contact information for community pharmacy managers in their respective province.
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