title: Balancing collaborative and independent practice roles in clinical pharmacy: a qualitative research study.
abstract: BACKGROUND
  Clinical pharmacists (CPs) with a scope of practice operate as direct care providers and health care team members. Research often focuses on one role or the other; little is understood about the dynamic relationship between roles in practice settings.
  
  
  OBJECTIVE
  To identify the challenges CPs face in balancing dual roles as direct care providers and health care team members and the implications for CP effectiveness and quality of care.
  
  
  METHODS
  Pharmacists were interviewed with a primary purpose of informing an implementation effort. Besides the implementation, there were emergent themes regarding the challenges posed for CPs in negotiating dual roles. This study is, therefore, a secondary analysis of semistructured interviews and direct observation of 48 CPs, addressing this phenomenon. Interview data were entered into NVivo 10 and systematically analyzed using an emergent thematic coding strategy.
  
  
  RESULTS
  Pharmacists describe role ambiguity, where they perform as direct providers or team members simultaneously or in quick succession. They note the existence of a "transaction cost," where switching causes loss of momentum or disruption of work flow. Additionally, pharmacists feel that fellow providers lack an understanding of what they do and that CP contributions are not evaluated accurately by other health professionals.
  
  
  CONCLUSIONS
  It is a challenge for CPs to balance the distinct roles of serving as collaborators and primary providers. Frequent role switching is not conducive to optimal work efficiency or patient care. Our findings suggest concrete steps that medical centers can take to improve both CP worklife and quality of patient care.
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), ENRM VAMC, Bedford, MA, USA Megan.McCullough@va.gov.
authors.forename: Megan B
authors.initials: MB
authors.lastname: McCullough
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), ENRM VAMC, Bedford, MA, USA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Solomon
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), ENRM VAMC, Bedford, MA, USA.
authors.forename: Beth Ann
authors.initials: BA
authors.lastname: Petrakis
authors.affiliation: VA New England Healthcare System, ENRM VAMC, Bedford, MA, USA.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Park
authors.affiliation: Clinical Pharmacy Practice Program and Outcomes Assessment, VA Pharmacy Benefits Management Services VACO, Ackworth, IA, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Ourth
authors.affiliation: Clinical Pharmacy Services and Healthcare Services Research, VA Pharmacy Benefits Management Services VACO, San Diego, CA, USA.
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Morreale
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), ENRM VAMC, Bedford, MA, USA Boston University School of Medicine, Boston, MA, USA.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Rose
mesh_terms: D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D006801:Humans; D010348:Patient Care Team; D010595:Pharmacists; D010607:Pharmacy Service, Hospital / Q000379:methods*; D024382:Professional Role; D036301:Qualitative Research
keywords: Veterans Affairs; direct care providers; health care teams; pharmacy services; quality of care; role ambiguity; worklife