Background To meet emergent healthcare needs, innovations need to be implemented into routine clinical practice. Community pharmacy is increasingly considered a setting through which innovations can be implemented to achieve positive service and clinical outcomes. Small-scale pilot programmes often need scaled up nation-wide to affect population level change. This systematic review aims to identify facilitators and barriers to the national implementation of community pharmacy innovations. Methods A systematic review exploring pharmacy staff perspectives of the barriers and facilitators to implementing innovations at a national level was conducted. The databases Medline, EMBASE, PsycINFO, CINAHL, and Open Grey were searched and supplemented with additional search mechanisms such as Zetoc alerts. Eligible studies underwent quality assessment, and a directed content analysis approach to data extraction was conducted and aligned to the Consolidated Framework for Implementation Research (CFIR) to facilitate narrative synthesis. Results Thirty-nine studies were included: 16 were qualitative, 21 applied a questionnaire design, and 2 were mixed methods. Overarching thematic areas spanning across the CFIR domains were pharmacy staff engagement (e.g. their positive and negative perceptions), operationalisation of innovations (e.g. insufficient resources and training), and external engagement (e.g. the perceptions of patients and other healthcare professionals, and their relationship with the community pharmacy). Study participants commonly suggested improvements in the training offered, in the engagement strategies adopted, and in the design and quality of innovations. Conclusions This study’s focus on national innovations resulted in high-level recommendations to facilitate the development of successful national implementation strategies. These include (1) more robust piloting of innovations, (2) improved engagement strategies to increase awareness and acceptance of innovations, (3) promoting whole-team involvement within pharmacies to overcome time constraints, and (4) sufficient pre-implementation evaluation to gauge acceptance and appropriateness of innovations within real-world settings. The findings highlight the international challenge of balancing the professional, clinical, and commercial obligations within community pharmacy practice. A preliminary theory of how salient factors influence national implementation in the community pharmacy setting has been developed, with further research necessary to understand how the influence of these factors may differ within varying contexts. Trial registration A protocol for this systematic review was developed and uploaded onto the PROSPERO international prospective register of systematic reviews database (Registration number: CRD42016038876 ). Electronic supplementary material The online v...

This article considers employees' experiences of a major organisational redesign project, which sought to deploy robotics technologies to improve the performance of National Health Service pharmacy distribution in one part of the UK. The principles of Lean-type approaches partly informed the redesign project, with senior managers seeking to tap the benefits of new technologies to streamline processes, while also arguing that change would bring opportunities for up-skilling and inter-professional collaboration. The project managed to avoid some of the negative consequences for job quality predicted by the critical literature on Lean-type approaches in public services. However, employees' experiences varied, with some reporting new engagement in learning and collaborative service delivery 'nearer the patient', while others complained of fewer opportunities to rotate across a variety of job roles. More fundamentally, employees questioned management's assumption that new technologies and Lean-type approaches are crucial to improved performance and better jobs. For many employees, both performance and job quality were compromised by the 'leanness' of staffing models, which limited opportunities for development and contributed to work intensification. This tension is likely to remain a key theme in employment relations in the UK and beyond for as long as the public sector faces financial austerity.3

Stakeholders agree on the need to promote innovation in work organization in public services. This article deploys the concept of collaborative innovation to discuss employees' and managers' experiences of a major technology‐driven work redesign project within National Health Service pharmacy services in Scotland. The authors draw on extant literature on New Public Management (NPM) and collaborative approaches to innovation to frame more than 40 in‐depth interviews with managers and employees. They find that key components of collaborative innovation—related to joint problem‐solving, interdisciplinary working, and mutual learning—were important to the success of the redesign project and had positive impacts on job quality for some employees. The authors argue that researchers and policy makers should look beyond NPM‐driven models that have dominated some areas of the public innovation literature to consider the potential added value of collaborative innovation to improving both work and service delivery in the public sector.

Employer choice and job quality: workplace innovation, work redesign and employee perceptions of job quality in a complex healthcare setting Abstract This article examines employer choice in relation to job quality (JQ). Acknowledging the important role of market, institutional and technological constraints, we highlight the role of employer agency in shaping JQ by reporting on an employer-led service redesign initiative in hospital pharmacy services in Scotland. This redesign initiative aimed at upskilling employees and redirecting their work effort towards high value added, patient-facing work using robotics implementation. The article provides a critical assessment of the success of the initiative in enhancing JQ and explores a range of factors constraining and shaping employers' job quality choices.

Background With increasing demands on the National Health Service (NHS), Scottish Government-led pharmacy strategy has prioritised the development and expansion of outpatient services. Pharmacist-led outpatient clinics have been shown to reduce hospital admissions and improve patient outcomes. However, expanding these contemporary models of care has proved challenging, and there are few qualitative data about the factors affecting the provision of these. Aim This study aimed to explore the enablers and barriers to hospital pharmacists providing outpatient clinics within the largest health authority in Scotland, NHS Greater Glasgow & Clyde (NHSGGC). Method Between August and October 2020, one-to-one semi-structured interviews were conducted virtually using the videoconferencing platform Microsoft Teams ® , with NHSGGC hospital pharmacists who did or did not provide clinics. Audio-and video-recordings of the interviews were transcribed verbatim and underwent thematic analysis. Results 16 hospital pharmacists were interviewed; 50% were clinic providers and 50% were not. Analysis generated seven themes: clinical or service need, individual factors, clinic structure and processes, additional clinical skills and training, competing priorities, macro-level pharmacy working, and external stakeholder relationships. Many of these were interdependent and had the potential to be an enabler or a barrier to clinic provision, depending on the context or individual. ConclusionThe enablers and barriers to hospital pharmacists providing outpatient clinics are multifaceted, incorporating individual, systematic and professional factors. The implementation of new national professional curricula may help address many of these factors, however prospective research needs to accompany this vision.