Developing Soft Skills for Sustainable Community Pharmacy Practice Through a Competency-Based Modular Programme

1. Introduction

Since the COVID-19 pandemic, there has been increasing discussion about the healthcare workforce crisis [1,2]. Issues such as staff shortages, burnout, the second victim phenomenon, and employee turnover have become global concerns [3-6]. By aligning the needs of employees and the healthcare system, it is possible to enhance the capacities of both and ensure a sustainable healthcare system [7]. In 2020, the World Health Organization (WHO) introduced the World Patient Safety Day Goals 2020–2021 to mark Patient Safety Day. Goal 2 focuses on reducing work-related stress and burnout, while Goal 4 aims to prevent violence against healthcare professionals [8]. In 2021, WHO launched the Global Patient Safety Action Plan 2021–2030, which, for the first time, recognised the importance of soft skills (non-technical, cognitive and interpersonal [9]) in healthcare practice and patient safety [10]. Furthermore, in collaboration with the International Labour Organization, the WHO released the 2022 guide Caring for Those Who Care [11], providing strategies for creating supportive environments for healthcare workers.

Although pharmacists' roles as healthcare professionals are defined by clinical pharmacy and pharmaceutical care [12,13], they are often under-recognised by general practitioners [14]. Collaboration at the primary care level remains limited. A potential reason is the lack of funding integration, as pharmacists are not employed under national health insurance systems [15]. Despite these challenges, pharmacists' roles in primary care are expanding, with advanced services like medication reviews and even prescribing being implemented [16-18]. The WHO UNESCO FIP Pharmacy Education Taskforce highlighted the need for additional pharmacist training to prepare for future practice [19]. As studies show reluctance among pharmacists to accept responsibility for therapy outcomes [20, a shift in educational approaches is essential to meet these evolving demands.

Traditional systems for continuous professional development (CPD) for pharmacists have focused on technical skills, with soft skills only recently gaining attention [21]. The International Pharmaceutical Federation (FIP) Competency Framework defines clusters of these skills for both early practitioners and educators, highlighting the need for competency-based education [22-24]. As advanced practice standards align with competencies, their development directly impacts practice quality and safety [25,26]. Adverse pharmaceutical care outcomes often stem from compromised standards, further underscoring the need to strengthen pharmacists' soft skills [27,28].

In Serbia, pharmacists self-assess these skills as well-developed, yet CPD programmes have traditionally excluded such topics and lacked accreditation for licence renewal [29]. This intervention aimed to support community pharmacy professionals in Serbia in evolving roles and pharmacy business sustainability through a competency-based modular development programme.

2. Materials and Methods

2.1. Study Design and Tools

The research was designed as an interventional study with community pharmacy professionals at the national level in Serbia. Academic and practice experts developed the modular programme, named "Galenika Academy", based on a literature review and practical experience, in line with the healthcare guideline Intervention Mapping: A Process for Developing Theory and Evidence-Based Health Education Programs [30] and the International Pharmaceutical Federation’s competency framework [25]. The process included (i) defining programme objectives according to previous needs assessment, (ii) selecting theory-based intervention methods and practical strategies, (iii) designing and organising online lectures, tests, and courses, (iv) accreditation by national bodies, and (v) generating plan for evaluating programme outcomes using the renowned Kirkpatrick model.

The Ethics Committee of the Pharmaceutical Chamber of Serbia approved the evaluation of this programme (Reference number: 75/5-4, dated October 8th, 2024) with the previous consent for data usage from the association for continuous medical education EduMed and Galenika a.d. Beograd (Reference number: 380, dated March 22nd, 2024).

The study followed the Template for Intervention Description and Replication (TIDieR) guide [31] and the Defined Criteria to Report Innovations in Education (DoCTRINE) guidelines [32]. The complete method is illustrated in Figure 1 for detailed visual review.

2.1.1. Defining Programme Objectives According to the Previous Needs Assessment

A group of five experts from academia and practice, including pharmacists, psychologists, human resource managers, and experienced trainers in soft skills development, assessed needs based on the available literature [27,29], regulatory changes [33-35], and the necessity to support pharmacists for advanced practice [25]. The programme objectives include (i) developing organisational, management, personal, and professional competencies for pharmacists and pharmacy technicians in community pharmacies; (ii) enhancing staff resilience and motivation to accept responsibility for outcomes; (iii) ensuring the sustainability of pharmacy operations; (iv) promoting advanced pharmacy services and improving patient safety; and (v) reducing staff turnover.

2.1.2. Selecting Theory-Based Intervention Methods and Practical Strategies

The approach involved building on previous research and successful practices in training and CPD [36]. It drew from theoretical literature to ensure a solid conceptual foundation, while empirical training methodologies were applied to guarantee practical relevance. The programme also considered accreditation for professional licence renewal, aligning with regulatory requirements and previous practices [21,36] as well as fostering motivation for learning, ensuring its effectiveness and sustainability within the professional framework.

2.1.3. Designing and Organising Online Lectures, Tests, and Courses

Strategic plans were tailored to implementers and implementation sites to ensure effective delivery. Course curricula, learning materials, tests, and training modules were developed in alignment with the FIP Development Goals and Competency Framework [22,37,38]. Educational activities were carefully designed to address competency clusters, specific competencies, and expected behaviours outlined in the FIP framework. These materials were pilot-tested with a group of five expert practitioners to ensure their relevance and effectiveness before broader implementation.

2.1.4. Specifying Adoption and Implementation Plans

The programme was accredited by the Health Council of Serbia and the Pharmaceutical Chamber and integrated into the professional licensure renewal system for nationwide accessibility. Collaboration was established with the Association for Continuous Medical Education (EduMed), the Pharmaceutical Chamber of Serbia, and partnerships with healthcare institutions and pharmacy chains to enhance credibility and participation. Most educational sessions were planned via EduMed’s online platform, aligning with previous research to maximise accessibility and efficiency [39], while on-site courses were tailored for smaller groups of pharmacy owners and key managers [40]. Industry support played a crucial role in programme implementation. To ensure sustainability, a learning mobile application "Galiverse" was developed, offering pharmacists 24/7 access to video recordings of previous educational sessions and accredited license renewal tests (free for pharmacists and available in mobile application stores).

2.1.5. Generating a Plan for Evaluating Programme Outcomes

A programme evaluation plan was developed using the Kirkpatrick model [41] at three levels, assessing participants' satisfaction and engagement, knowledge, skills, and attitudes gained. Engagement was assessed through analysis of participation data from the EduMed platform, the official programme organiser, while knowledge was evaluated using accredited tests approved by the Pharmaceutical Chamber of Serbia for professional licence renewal, in line with national continuing professional education regulations. A validated self-reported satisfaction questionnaire was developed by a group of five experts in pharmaceutical practice, psychology and human resources management. Five practice experts validated this questionnaire according to Polit and Beck’s guideline [42], with the final version consisting of 14 questions on the created programme and 7 demographic questions (Supplementary material 1). Satisfaction-related questions were measured using a 5-point Likert scale (1 – Very dissatisfied, 2 – Dissatisfied, 3 – Neutral, 4 – Satisfied, 5 – Very satisfied). A satisfaction questionnaire was distributed to assess participants’ satisfaction, attitudes, and self-reported competence improvement.

2.2. Setting, Sampling, and Recruitment

The study included 5,107 pharmacy professionals employed in community pharmacies in Serbia. Participants were required to have (i) an active working licence issued by the Pharmaceutical Chamber of Serbia and (ii) a working position in a community pharmacy at the moment of attending of programme. Recruitment was purposive using snowball sampling [43] with email invitations to all members from the EduMed database (15,000 pharmacy professionals), ensuring diversity in gender, age, educational level, working position, and geographic location.

2.3. Data Collection

Data collection was conducted by two researchers (I.Z. and T.M.) analysing the EduMed database. At the start of the registration on the platform, the pharmacy professionals agreed to the membership conditions. They consented to personal data to participate in the research, previously anonymised and coded. The previously validated satisfaction survey was sent online via the EduMed platform to the email addresses of participants who attended 80% or more of the available educational sessions.

2.4. Data Analysis, Interpretation, and Storage

All raw data from the EduMed platform was coded and stored in Microsoft Word and Excel. The lead researcher ensured secure electronic storage with restricted access to personal computers. Descriptive statistics were conducted using SPSS software (SPSS 29.0 for Windows, SPSS Inc., Chicago, IL, USA). Data analysis included attendance, test performance, and exam success rates. Satisfaction survey data of participants attending ≥80% of sessions were analysed separately. Statistical significance was set at p<0.05. The chi-square test examined the relationship between programme attendance and pharmacy professionals' outcomes with Phi, Cramer’s V, and contingency coefficient to assess the strength of relationships.

3. Results

3.1. Demographic Characteristics of the Programme Participants

In the total sample (5,107), most participants were female (91.8%) and pharmacists (67.2%), employed in private pharmacies (84.5%), mostly in large cities (45.2%). The response rate for educational calls was 34.1% (the total number of EduMed base participants was 15,000). Around 15% of the total sample attended over 80% of the educational sessions (766 participants). Of them, 93.5% were female and pharmacists (60.9%), employed in private pharmacies (85.7%), and from large cities (46.8%).

3.2. Demographic Characteristics of the Satisfaction Survey (Participants Who Attended ≥ 80% of the Education)

The satisfaction survey received a 29% response rate. Sociodemographic data for 222 respondents show an average age of 43 years and 17 years of work experience. The majority were female (91.4%), with 48.2% holding a master’s degree. Most participants were pharmacists in community pharmacies (66.2%) and worked in private pharmacies (87.0%). Detailed sociodemographic information is provided in Table 1.

3.3. Participant Engagement and Performance Outcomes

3.3.1. Online Education: Webinars Accessible to the Entire Pharmacy Community

Between 2021 and 2025, 25 online webinars were delivered via the EduMed platform, following the FIP competency framework and covering clusters such as Organisation and Management and Professional/Personal, with additional impact on Pharmaceutical Public Health and Emergency Response. The sessions addressed topics like resilience, burnout, second victims, communication, teamwork, performance management, employee development, risk management, business decision-making, professionalism, and ethics. Participants were invited to webinars using the EduMed database, which covers the entire pharmacy community in Serbia. All topics are summarised in Table 2, with a detailed mapping of each competence to the level of expected behaviour.

During the entire programme period, a total of 10,427 participants attended the webinars, with the most popular being "Small school of resilience for healthcare professionals – burnout" (787 participants), "Why is time management important for pharmacists in pharmacies?" (752 participants), and "Risk management in pharmaceutical care" (734 participants). Other well-attended sessions included "Why digital communication and leadership are important for pharmacists?" (650 participants) and "Why negotiation is important for pharmacists?" (570 participants). Of the total participants, 5,107 were unique individuals, representing approximately 34% of the entire pharmacy community.

3.3.2. Accredited Tests: Available to All Pharmacy Professionals

For the same period (2021-2025), 15 online tests were accredited by the Health Council of Serbia for pharmacist licence renewal. For the first time in Serbia, training on soft skills for pharmacy professionals was accredited. The tests covered certain competencies from the FIP framework, most aligned with the webinar topics. Key themes included pharmacy as a business system, business skills requirements, time management, teamwork, performance management, decision-making in pharmacy practice, negotiation, practice research, and employee development. Each test contained 20-40 questions, required 2-4 hours of study from pre-provided materials, and took 30 minutes to 1 hour to complete. Tests awarded 2-4 CPD points for licence renewal. Access codes for the tests were sent to participants after each webinar, and from 2023, following the launch of the "Galiverse" learning mobile application, the tests became available to all pharmacists via the application throughout the entire accreditation period. All tests are summarised in Table 3, with detailed information on each test.

Additionally, there were 8,252 test accesses. As shown in Table 2, Table 3 and Table 4, the evaluation of the accredited education programme reflects strong participant engagement. Notably, 928 individuals participated in the "Teamwork of health professionals as a prerequisite for patient safety" test, with 722 achieving a pass rate of 77.8%. The "Resilience of health professionals as a prerequisite for patient safety" test had the highest success rate, with 482 out of 506 passing (95.3%). On the other hand, the "Creating and managing teams in pharmaceutical organisations" test saw a success rate of 61.0%, with only 292 out of 479 participants passing.

3.3.3. Onsite Trainings for Pharmacy Managers

Between 2021 and 2025, five onsite training sessions were organised for pharmacy owners and managers of key pharmacy chains. The aim was to empower and develop participants who are responsible for on-site staff development, influencing the growth of the pharmacy business. Topics included building effective relationships, leadership, performance management, employee development, change management, and time management. The educational objectives and expected outcomes for each training session are summarised in Table 4. The sessions were designed for smaller participant groups, following the training methodology and available resources. In the total period, 61 unique participants attended the management onsite training courses, with 20 managers completing all five modules.

3.4. Galenika Academy Satisfaction Questionnaire Results

Chi-square results indicated a significant relationship between participation and participants’ outcomes (p < 0.001). Of those who were aware that they attended 80% of the training, 84% were very satisfied with the content, 85.1% with the quality and choice of speakers, and 67.3% of those aware of the mobile application were very satisfied with it. However, 77.8% of them expressed high satisfaction with the test preparation materials, while 67.3% were very satisfied with the mobile application, and 73.6% of mobile application users were very satisfied. Furthermore, 83.6% of those who felt they improved their competencies through the programme were very satisfied with its quality, 81.1% would recommend it, and 75.6% were very satisfied with the content within the application. Among those who were very satisfied with their competency improvement, 92.2% were highly satisfied with the programme's content, 90.7% with the test preparation materials, 79.8% with the mobile application, and 96.9% with the programme’s impact on business sustainability. Detailed statistical results are presented in Table 5.

4. Discussion

The "Galenika Academy" programme has effectively addressed a wide range of competencies within the clusters of organisation and management and personal and professional competencies, with elements of public health from the FIP framework. Over its four-year existence, more than a third of the pharmacy workforce has engaged with the offered training, acquiring knowledge, initiating skills, and earning CPD points for licence renewal. Cross-tabulation analysis highlights the impact of the programme on satisfaction and self-perceived competence improvement, revealing clear links between programme participation and its positive effects on pharmacists and pharmacy practice.

The most attended webinars were on topics that, while familiar to participants, were also of perceived benefit in delivering pharmaceutical care, personal life, and career development. A similar pattern emerged with the accredited tests, where those available for longer periods saw higher completion rates. The success rate of test completion also reflects participants' interest and perception of the importance of developing specific competencies.

Pharmacists directly involved with patients mainly focused on burnout and second victim prevention, resilience, teamwork, communication, conflict management, time management, and risk management skills. In contrast, managers expressed greater interest in skills that could directly contribute to the business performance of their organisations. The demand for onsite training for owners and managers was notably high; however, due to resource limitations, the number of participants was restricted. Participants of these training sessions have been empowered and motivated to further support the programme within their pharmacy organisations and to create internal development programmes within pharmacy chains.

The highest percentage of those who attended the majority of the educational sessions expressed satisfaction with the programme, the quality of the training, the choice of lecturers, and improvements in personal competencies while also recognising the programme's impact on business operations. They are likely to recommend the programme to colleagues seeking further development.

The programme has aligned both its content and delivery methods with the latest trends, recommending changes in CPD activities for pharmacists worldwide [44,45]. Additionally, the incorporation of competencies relevant to emergencies reflects contemporary research trends [46]. Soft skills are increasingly recognised as essential for advancing pharmaceutical practice, as well as the impact of management and leadership competencies on employee satisfaction within pharmacies [47]. This, in turn, enhances work motivation and potentially improves outcomes in pharmaceutical care [48]. Global initiatives in healthcare professional development have also sparked research into the development of such skills, with several pilot projects already underway [49,50].

These results provide valuable guidelines for potential training and educational programmes for pharmacy professionals to be implemented for handling and preventing primary healthcare crises in the future. They could have a positive effect on employee satisfaction and the quality and sustainability of pharmaceutical practice.

Considering that community pharmacists are not yet included in educational-change research studies and development projects like other healthcare professionals, further recommendations for all stakeholders involved in education, regulation, and pharmaceutical development would be to engage with global research initiatives and implement and evaluate similar projects on an international scale and assess the impact on real-life practice.

Strengths and Limitations

This study's strengths include its rigorous methodology and, to the best of our knowledge, the first programme of its kind for pharmacy professionals. The sample reflects Serbia’s pharmacy population [51]. The intervention aligned with the FIP Competency Framework, improved digital adaptability, and offered a scalable, accredited model. A limitation is the small satisfaction survey sample, limiting generalizability. Data protection regulations also restricted access to some personal data, ensuring participant privacy.

5. Conclusions

To our best knowledge, this modular programme is the first accredited to develop soft-skills competencies among community pharmacy professionals, highlighting potential links to improvement in practice standards. According to participants’ self-assessment, this programme improved skills, resilience, and pharmacy operations, with positive effects on patient outcomes, warranting further research in a real-practice environment.