Intern pharmacists as change agents to improve the practice of nonprescription medication supply: provision of salbutamol to patients with asthma

BACKGROUND: Earlier work established an evidence practice gap during provision of nonprescription salbutamol (albuterol). Pharmacist interns are hypothesized to be in a position to improve professional practice in the community pharmacy setting. OBJECTIVE: To explore the potential of intern pharmacists to improve the professional practice of community pharmacy staff in the provision of nonprescription salbutamol. METHODS: Intern pharmacists (n = 157) delivered an asthma intervention in 136 pharmacies consisting of an educational activity to pharmacy staff and a health promotion campaign to consumers. Post-intervention, simulated patients presented to 100 intervention and 100 control community pharmacies with a request for salbutamol. The appropriate outcome was medical referral for poor asthma control and correction of poor inhaler technique. Incidence and quantity of patient assessment and counseling provided during the visit were also assessed. Logistic regression was used to determine the predictors of medical referral. RESULTS: A doubling in the rate of medical referral was seen in the intervention group (19% vs 40%; p = 0.001). Assessment of reliever use frequency was the main predictor of medical referral (OR = 22.7; 95% CI 9.06 to 56.9). Correction of poor inhaler technique did not improve; however, a reduction in salbutamol supplied without patient assessment (23% vs 8%; p = 0.009) or counseling (75% vs 48%; p < 0.001) was noted. CONCLUSIONS: A doubling in the rate of medical referral showed a clear improvement in professional practice during the provision of nonprescription salbutamol. The improved patient outcome in the intervention group was due to increased assessment of reliever use frequency. Identification of poor inhaler technique remained near zero in both groups, which suggests that intern pharmacists were able to improve the current practice of community pharmacies yet were unable to establish a new practice behavior. This study provides evidence that intern pharmacists can act as change agents to improve pharmacy practice.

From practice to field:a multi-level model of practice-driven institutional change

This article develops a model of practice-driven institutional change - or change that originates in the everyday work of individuals but results in a shift in field-level logic. In demonstrating how improvisations at work can generate institutional change, we attend to the earliest moments of change, which extant research has neglected; and we contrast existing accounts that focus on active entrepreneurship and the contested nature of change. We outline the specific mechanisms by which change emerges from everyday work, becomes justified, and diffuses within an organization and field, as well as precipitating and enabling dynamics that trigger and condition these mechanisms. © Academy of Management Journal.

Evaluating local strategic partnerships:theory and practice of change

Local Strategic Partnerships (LSPs) are a major recent innovation in English local governance. As the 'partnership of partnerships' in a locality, the ability of the LSP to provide an arena for community leadership and joined up service delivery is vital to the Local Government Modernisation Agenda. Drawing on material from the national evaluation of LSPs, this paper assesses their progress. A theory of change (ToC) approach was adopted in the evaluation, and the paper shows how this approach was developed and utilised. The main findings from the evaluation are then presented and discussed. In conclusion, the article draws some wider conclusions both about the strengths and weaknesses of the ToC approach and about LSPs themselves.

All change? Managers' experience of organizational change in theory and practice

Purpose - This paper aims to examine the usefulness of organizational change theory for management practice. Design/methodology/approach - The authors present an exploratory, empirical study of managers who were taught organizational change theory as part of a postgraduate degree. Building on the study findings, they analyse managers' subsequent experiences of organizational change; of how they use change theory in practice and the impact on their practice of their earlier formal study. Findings - The paper finds that the complexities of managing change in practice reflect distinctive organizational environments and cultures. The skills and knowledge which managers found most useful were those that enabled them to "make sense" of the organizational change they subsequently experienced. The main impact of their earlier studies was to prompt informative, discursive and reflective approaches to change management. Practical implications - The paper discusses the implications for future teaching of organizational change and the development of organizational change theory. Originality/value - The qualitative findings of the study add to, and help to explain, earlier research findings on the questions of how managers' experience change, how they use organizational change theory and its impact on their practice. © Emerald Group Publishing Limited.

Financial crisis and the change in the practice of applying common charge costs

The global financial crisis has not left the members of the EU untouched. Financial results have significantly dropped, businesses were folded in great numbers, the rate of employment decreased, social tension got fortified, and so did the national deficits in the budget in the majority of the countries. The decisive members of the community reacted fairly quickly to the challenges of the global economic crisis, and among the steps taken there were simultaneously ones to boost the economy and others to lower the expenses of the expenditure. The author examines what role was given to the steps in taxation policy as indirect regulating tools, and that how the decisions brought touch upon the previously issued harmonization strategy.

Behavioral Perspectives on Organizational Change: Practice Adoption, Product Culling, and Technological Search

This dissertation explores the complex process of organizational change, applying a behavioral lens to understand change in processes, products, and search behaviors. Chapter 1 examines new practice adoption, exploring factors that predict the extent to which routines are adopted “as designed” within the organization. Using medical record data obtained from the hospital’s Electronic Health Record (EHR) system I develop a novel measure of the “gap” between routine “as designed” and routine “as realized.” I link this to a survey administered to the hospital’s professional staff following the adoption of a new EHR system and find that beliefs about the expected impact of the change shape fidelity of the adopted practice to its design. This relationship is more pronounced in care units with experienced professionals and less pronounced when the care unit includes departmental leadership. This research offers new insights into the determinants of routine change in organizations, in particular suggesting the beliefs held by rank-and-file members of an organization are critical in new routine adoption. Chapter 2 explores changes to products, specifically examining culling behaviors in the mobile device industry. Using a panel of quarterly mobile device sales in Germany from 2004-2009, this chapter suggests that the organization’s response to performance feedback is conditional upon the degree to which decisions are centralized. While much of the research on product exit has pointed to economic drivers or prior experience, these central finding of this chapter—that performance below aspirations decreases the rate of phase-out—suggests that firms seek local solutions when doing poorly, which is consistent with behavioral explanations of organizational action. Chapter 3 uses a novel text analysis approach to examine how the allocation of attention within organizational subunits shapes adaptation in the form of search behaviors in Motorola from 1974-1997. It develops a theory that links organizational attention to search, and the results suggest a trade-off between both attentional specialization and coupling on search scope and depth. Specifically, specialized unit attention to a more narrow set of problems increases search scope but reduces search depth; increased attentional coupling also increases search scope at the cost of depth. This novel approach and these findings help clarify extant research on the behavioral outcomes of attention allocation, which have offered mixed results.

Implementing change in practice: Part 2- the change process

Pain management in premature and sick babies has long been recognisedas a vital component of neonatal care; however practices pertaining to painassessment and administration of analgesia remain variable in Neonatal Units(NNU). Sucrose has been identified as an effective agent in reducing pain during minorpainful procedures in premature babies but the uptake has been modest.This article (part 2) follows on from an earlier article on evidence to support theimplementation of sucrose administration as a measure for pain relief for minorprocedures (part 1) and will centre on practice-based change in the NNU and reflecton the strategies used as well as the effectiveness of the proposed change. A theoreticalchange model will be used as a framework to help unpack the influencesinherent within the change process.

Implementing Change in Practice: Audit of Sucrose CPG's into practice in the NNU

This poster explained how the implementation of Sucrose into the NNU and how that change in practice came about; it also provided statistics illustrating the uptake of use of Sucrose and the changes in practice through audit

Research in practice: Bringing behavioural change from lab to studio

Design influences behaviour, whether it's planned or not. Service Design has a great opportunity to lead the emerging field of design for behavioural change, helping guide and shape experiences to benefit users, service providers and wider society. In this article, presented as an evolving conversation between research and practice, Nick Marsh (EMC Consulting) and Dan Lockton (Brunel University) discuss and explore design patterns for influencing behaviour through Service Design, and how Service Designers and academics can work together for social benefit.