Jugglers and tightrope walkers: The challenge of delivering quality community pharmacy services

INTRODUCTION: This is the first exploration of service providers’ attitudes and beliefs of quality and quality improvement in the community pharmacy setting in the UK. MATERIALS AND METHODS: A series of interviews and focus groups was conducted with stakeholders from the pharmacy profession in the UK. Interviews were semi-structured and conducted face-to-face or by telephone. Focus groups were conducted with naturally-occurring groups i.e. at pharmacy conferences. Interviews and focus groups were audio-recorded, transcribed and analysed systematically using an interpretive approach. RESULTS: Forty-two individuals participated across four focus groups and four interviews. A maximum variation sample was achieved in terms of pharmacist and pharmacy characteristics. Participants were generally positive about the need for quality and quality improvement and provided multifaceted and interlinked interpretations of quality and acknowledged its dynamic nature “quality moves forward”. The challenge of standardising practice whilst providing person-centred care emerged: “you don’t want to lose the personal touch, but you can’t have people having a variable experience and one day it’s fantastic and the next day it isn’t”. A variety of quality measurement methods were identified including direct observation (by internal and external agents) and feedback (mystery shoppers, colleagues, regulatory inspectors, service users), suggesting that standardisation was also needed in terms of future quality measurement. There was a tendency to report negative events as triggers for improvement. Future initiatives could adopt more positive approaches including positive deviants “There’s nothing more powerful than people who’ve come up with something really good sharing it with their other colleagues”. DISCUSSION: The results are being used to develop and evaluate future quality improvement initiatives in this sector. These are likely to be targeted at organisational, team and individual levels.