Employee Reactions to Controlled Work Environments: The Dispensing of Anti-Cancer Drugs in Hospital Pharmarcies

There are many kinds of workplaces in which materials and processes involve threats to health and safety, both to consumers and employees. Formal work procedures, plus technology, can minimise risk but provide little scope for workplace flexibility or autonomy. It is difficult to see how, in such settings, the negative effects of routine and regulation on employees' attitudes can be ameliorated by providing greater discretion over the way in which work is performed. The stringent regulatory requirements of most countries also mean that relaxation of formal standards and procedures would be unlawful, as well as unwise. A question therefore exists over whether the solution to one type of problem, might in turn create other problems which could affect work and product quality. The regulatory environment, plus technology for anti-cancer drug dispensing in hospital pharmacies provides a case in point. Routine procedures to ensure patient safety generate aerosol particles. Inhalation of these is a workplace hazard for pharmacists that could result in cancer or birth defects. Australia was the first country to develop specific technology (SAA, 1994a; SAA, 1994b), and among the earliest to develop standardised work procedures for handling anti-cancer drugs. As well as setting out standardised procedures, these specified the technology of a cabinet for drug manipulation, specifically located in a clean room operating at positive pressure. Personnel are required to wear full protective clothing including face-masks and gloves. Most major Australian hospitals installed such facilities in the period 1985 - 1990 (Naismith, 1991). The use of these facilities has raised other work problems that are the focus of this study. The anti cancer drug facilities of eighteen hospitals, and two related organisations were included in the study. Sites were visited and pharmacy managers interviewed regarding technology, work regulation and other work environment issues. Following this a questionnaire was designed and administered to staff. Kabanoff, O'Brien and Dowling's (1978), facet job satisfaction index was used to explore the effect of these factors on job satisfaction (Roberts, et. al., 1993). The study was administered in December 1996 with responses returned anonymously to the principal investigator. 112 responses were received, representing 70% of pharmacists working in the facilities. The findings of the study revealed that the employees experience their work as both physically and mentally demanding. The pressures arising from regulation are exacerbated by poor facility design (particularly temperature control), ergonomics of the technology, isolation of personnel, and inefficiencies of workflow. The isolation is reduced where external windows, radios and other links to the external world are present. The best facilities from a human factor viewpoint were those where the chief pharmacists had been part of the project design team. Pharmacists were well aware of hazards presented by anti-cancer drugs with older staff (>35) being less concerned. As expected, females are more concerned about the potential for birth defects. 26% of the respondents find that the protective clothing increases their anxiety regarding risks to their health. A need for further training in, and validation of, routine technique is expressed. High work satisfaction is observed with males more satisfied than females. Females indicate less ability to change factors they do not like in their work. There appears to be little effect of negative aspects of the work environment on pharmacists job satisfaction, although these may be mediated by the high worth placed on their work. The study recommends that within the standards there needs to be better specification of design parameters - natural lighting, communication facilities, temperature control and layout - that are found to be the major problems in the work environment. It also suggests that the loss of autonomy is not an issue where the need for it is clearly understood and a high value is placed on the worth of the work.