The Complexity of Service Implementation

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It’s quite difficult to search the pharmacy literature, open a text book, talk to a pharmacy faculty member, or attend a conference where you don’t hear or see the terms “value-added service”, “cognitive service”, “medication therapy management” or similar such. And that’s not necessarily a bad thing. In fact, it’s probably a good thing. But, we have to keep in mind that developing and implementing these services is not easy. Past Tips have discussed the need for budgeting, strategic planning, business planning, and other tools needed to get a service up and running.  Once up and running, a service will go through various stages of its “life cycle” in much the same way that a new product does.

Garcia-Cardenas et al discuss the complex nature of implementing professional pharmacy services.1 They point to the large gap existing between service development and implementation. They add further that implementation had been seen as a passive process, assuming that the diffusion and dissemination of information would translate these services into routine practice. Domains related to implementation include: professional service (service methodology, patient recruitment), pharmacy staff (motivation, self-efficacy, knowledge), pharmacy process (organizational culture, teamwork, workflow), local environment (patient demographics, collaborative working relationships), and system (policy, legislation). They point to the need to understand the interplay existing among all these domains. For example, the oft-cited barrier “lack of time” to implement services should be treated in a multi-faceted way. Lack of time might result from poor workflow design, imbalanced staffing at the wrong times, lack of leadership, lack of priority, inadequate technological resources, improperly trained staff who otherwise could handle responsibilities more efficiently, and/or other.

Pharmacy managers hopefully have done some great homework and initial experimentation to develop a service. Implementation will take some time to perfect them. When determining the facilitators and barriers to success following their development, the manager must understand the inter-relatedness of operations, human resources, organizational culture, marketing, and financial implications to develop systematic and comprehensive strategies to address what would otherwise be referred to as a “simple” factor, such such as lack of time or lack of incentives.

Additional information about Implementing Value-Added Services can be found in Pharmacy Management: Essentials for All Practice Settings, 5e. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to Pharmacy Management: Essentials for All Practice Settings, 5e. If your institution does not provide access, ask your medical librarian about subscribing.

1Garcia-Cardenas C, Perez-Escamilla B, Fernandez-Llimos F, Benrimoj SI. The complexity of implementation factors in professional pharmacy services. Res Social Adm Pharm. 2018;14:498-500.


Shane Desselle

Professor of Social and Behavioral Pharmacy, Touro University California

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Shane Desselle about 1 year ago

It’s like that commercial for T. Rowe Price. One has to understand how changes in one aspect of the business, affect its other aspects.