When procedures meet practice in community pharmacies: qualitative insights from pharmacists and pharmacy support staff

Objectives: Our aim was to explore how members of
community pharmacy staff perceive and experience the
role of procedures within the workplace in community
pharmacies.
Setting: Community pharmacies in England and
Wales.
Participants: 24 community pharmacy staff including
pharmacists and pharmacy support staff were
interviewed regarding their view of procedures in
community pharmacy. Transcripts were analysed using
thematic analysis.
Results: 3 main themes were identified. According
to the ‘dissemination and creation of standard
operating procedures’ theme, community pharmacy
staff were required to follow a large amount of
procedures as part of their work. At times,
complying with all procedures was not possible.
According to the ‘complying with procedures’ theme,
there are several factors that influenced compliance
with procedures, including work demands, the high
workload and the social norm within the pharmacy.
Lack of staff, pressure to hit targets and poor
communication also affected how able staff felt to
follow procedures. The third theme ‘procedural
compliance versus using professional judgement’
highlighted tensions between the standardisation of
practice and the professional autonomy of
pharmacists. Pharmacists feared being unsupported
by their employer for working outside of procedures,
even when acting for patient benefit. Some support
staff believed that strictly following procedures
would keep patients and themselves safe. Dispensers
described following the guidance of the pharmacist
which sometimes meant working outside of
procedures, but occasionally felt unable to voice
concerns about not working to rule.
Conclusions: Organisational resilience in
community pharmacy was apparent and findings
from this study should help to inform policymakers
and practitioners regarding factors likely to influence
the implementation of procedures in community
pharmacy settings. Future research should focus on exploring community pharmacy employees’ intentions and attitudes towards rule-breaking
behaviour and the impact this may have on patient
safety.