This study has identified the defined clinical pharmacy competencies needed to help drive and develop hospital pharmacy education and workforce development in Austria. The previous absence of competency framework adoption presented an opportunity to adapt the European hospital pharmacy competency framework (CTF) to align with the national direction for healthcare workforce development for Austria and the aspirations of the WHO and Council of Europe for patient safety.

The adaptation of the European CTF to a bespoke national competency framework for hospital pharmacists in Austria is described in this study. It uses the CONFERD-HP recommendations for reporting competency framework development in health professions [25] and the PRISMA 2020 guidance for reporting systematic reviews. The review protocol was registered with PROSPERO and the competency framework underpinned by European Common Training Framework (CTF) ensuring peer review and robustness in research design. However, the limitations of this study arise from several sources of information not being included. This is as a result of only documents in the English language being included, potentially omitting any bespoke competency frameworks developed in non-English speaking countries. Furthermore, the updated Core Competency Framework for Pharmacists of the PSI and the updated Professional Standards for Hospital Pharmacy Services of the RPS were not included as the review was conducted in early 2022 and the updated competency framework and professional standards version were published in December 2022 and November 2022, respectively. Of note, the first versions of the Core Competency Framework for Pharmacists, as well as the Professional Standards for Hospital Pharmacy Services, are no longer accessible. The lack of standardised wording of competencies made mapping difficult as many were too broad and generic for easy interpretation. The expert panel, while representative of the hospital pharmacy organisation in Austria, was small and may have lacked the benefit of an increased diversity in expertise, potentially biasing the viewpoints and feedback provided on the competency framework. In addition, participants were not entirely representative of all Austrian Federal States. The competency framework provides an overview of necessary (behaviour) competencies for hospital pharmacists and should always be considered within the legal authorisations in Austria.

The CTF Working Group 3, in which Austria participated, was tasked with "securing the strong engagement in, and support of, national governments, competent authorities and the European Commission for the project" [26]. This is an essential step in the implementation of competency frameworks worldwide, as the mere act of developing a competency framework is not enough to evoke a change in overall hospital pharmacy practice. Despite the paucity of robust studies, it is evident that competency frameworks have implications for resources, organisational structures, legal frameworks and education that need to be considered at a country and organisational level [27]. In 2018, the Austrian Ministry of Health, set out its “strategy for patient safety” which clearly mandated the expansion and, where necessary, creation of legal frameworks and requirements to promote a patient safety culture as well as the promotion of education, training and continuing education in the field of patient safety for all healthcare professionals [28]. According to the European Observatory on Health Systems and Policies (2021), Austria has more doctors and nurses than the EU average [29] while having substantially fewer hospital pharmacies and pharmacists than the EU norm [30]. As a result, traditional hierarchical healthcare structures are very ingrained and the scope for a role expansion of hospital pharmacists is curtailed. A recent cross-sectional study investigating the patient safety culture in ten Austrian hospitals, identified significant differences in the perception of patient safety among the 1525 participants from different professional healthcare groups [31]. While it found considerable room for improvement, pharmacy staff were not included in the study, which is symptomatic of the traditional healthcare structures, where pharmacists are strongly associated with more traditional roles such as logistics, procurement and production and less so with medication and patient safety [32]. This is mirrored in many other central European countries who are equally struggling to evolve into more patient facing roles [33, 34]. As a result, countries need to invest in stakeholder analysis studies to identify how competency frameworks can be implemented into existing national healthcare structures and education.

Reforms to the global pharmacy education standards and the development of supporting competency frameworks for lifelong learning are now being used to regulate career entry, benchmark standards of practice and facilitate expertise development [27, 35, 36]. Competency frameworks help to reshape (further-) education by defining the competencies and skills needed by hospital pharmacists and adapting the education and training accordingly [37, 38]. Austria has a further education program allowing licensed pharmacists to become specialist hospital pharmacist (aHPh). The aim of this specialist three-year part-time education program is to impart advanced knowledge and practical skills in hospital pharmacy (specialisation) [39]. The curriculum content is decided upon by the further education commission and includes clinical pharmacy, production and management topics, however it is not stated if it aligns with any of the European or global pharmacy competency frameworks [39]. Given the emphasis of the pharmacy profession worldwide to develop a competent and adaptable pharmacy workforce, more has to be done to offer competency based driven education and assessments [40, 41]. A current lack of robust implementation and success data for competency-based pharmacy education calls for more studies identifying the needs of patients, learners, healthcare systems and that of academic institutions, especially in the face of fast paced technological changes [42].

This clinical pharmaceutical competency framework provides the necessary basis for the expansion of the legal and professional practice of hospital pharmacists and the amendment to the Austrian Pharmacy Act by the Health Ministry. The competency framework is currently being considered by both the AAHP and the Austrian Chamber of Pharmacists, for its potential contribution to further legal advancement of the Austrian hospital pharmacists role description.

Obtaining views from all other stakeholder groups (patients, medical and pharmaceutical organisations, government and non-government organisations, healthcare insurance agencies etc.) will be required to determine implementation barriers and facilitators within the Austrian national healthcare service. Obtaining the view of the hospital pharmacist workforce may also provide further validity to the bespoke competency framework developed.