title: Challenges of standardized continuous quality improvement programs in community pharmacies: the case of SafetyNET-Rx.
abstract: BACKGROUND
  Research on continuous quality improvement (CQI) in community pharmacies lags in comparison to service, manufacturing, and various health care sectors. As a result, very little is known about the challenges community pharmacies face when implementing CQI programs in general, let alone the challenges of implementing a standardized and technologically sophisticated one.
  
  
  OBJECTIVE
  This research identifies the initial challenges of implementing a standardized CQI program in community pharmacies and how such challenges were addressed by pharmacy staff.
  
  
  METHODS
  Through qualitative interviews, a multisite study of the SafetyNET-Rx CQI program involving community pharmacies in Nova Scotia, Canada, was performed to identify such challenges. Interviews were conducted with the CQI facilitator (ie, staff pharmacist or technician) in 55 community pharmacies that adopted the SafetyNET-Rx program. Of these 55 pharmacies, 25 were part of large national corporate chains, 22 were part of banner chains, and 8 were independent pharmacies. A total of 10 different corporate chains and banners were represented among the 55 pharmacies. Thematic content analysis using well-established coding procedures was used to explore the interview data and elicit the key challenges faced.
  
  
  RESULTS
  Six major challenges were identified, specifically finding time to report, having all pharmacy staff involved in quality-related event (QRE) reporting, reporting apprehensiveness, changing staff relationships, meeting to discuss QREs, and accepting the online technology. Challenges were addressed in a number of ways including developing a manual-online hybrid reporting system, managers paying staff to meet after hours, and pharmacy managers showing visible commitment to QRE reporting and learning.
  
  
  CONCLUSIONS
  This research identifies key challenges to implementing CQI programs in community pharmacies and also provides a starting point for future research relating to how the challenges of QRE reporting and learning in community pharmacies change over time.
authors.affiliation: Gerald Schwartz School of Business, St. Francis Xavier University, Antigonish, NS, Canada. tboyle@stfx.ca
authors.forename: Todd A
authors.initials: TA
authors.lastname: Boyle
authors.forename: Neil J
authors.initials: NJ
authors.lastname: MacKinnon
authors.forename: Thomas
authors.initials: T
authors.lastname: Mahaffey
authors.forename: Kellie
authors.initials: K
authors.lastname: Duggan
authors.forename: Natalie
authors.initials: N
authors.lastname: Dow
mesh_terms: D001291:Attitude of Health Personnel; D003157:Community Pharmacy Services / Q000458:organization & administration / Q000592:standards*; D019983:Guideline Adherence; D006801:Humans; D007407:Interviews as Topic; D007858:Learning; D008508:Medication Errors / Q000517:prevention & control*; D009674:Nova Scotia; D009937:Organizational Objectives; D061214:Patient Safety / Q000592:standards; D010595:Pharmacists / Q000458:organization & administration / Q000523:psychology; D010596:Pharmacy Technicians / Q000458:organization & administration / Q000523:psychology; D017410:Practice Guidelines as Topic; D016730:Program Development; D015397:Program Evaluation; D036301:Qualitative Research; D011785:Quality Assurance, Health Care / Q000458:organization & administration / Q000592:standards*; D058996:Quality Improvement / Q000458:organization & administration / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000458:organization & administration / Q000592:standards*; D013997:Time Factors