Content area
Full Text
Introduction
The need, indeed the imperative, for pharmacists to become more patient-centred is now very clear. This vision, as outlined in the Blueprint for Pharmacy, 1 for pharmacists to provide "optimal drug therapy outcomes for Canadians through patientcentred care" has been accepted by all Canadian pharmacy organizations. This means a shift from dispensing and technical duties to a particular focus on services that improve patient outcomes. However, practice change of this nature has been discussed for many years, and few programs have been fully successful or sustainable over the long term.2,3 Efforts to better understand the lack of advancement in pharmacy practice have generally focused on barriers to practice change,4-8 and indeed many barriers have been identified, including pharmacists' time constraints, limited remuneration models, patient apathy and limited support from physicians and other pharmacists. Interestingly, documented efforts to remove these barriers9-11 have not resulted in sustained practice change, making one wonder if they really are true barriers or merely excuses. Do pharmacists really want to advance their practice? Can pharmacists change their approach to patient care? Or, are the classic barriers to practice change a convenient script, when the actual barrier is pharmacists' own psyche and culture?
Culture is a dominant force in shaping any profession. Culture can be understood as a "patterned system of perceptions, meanings and [shared values] about [a profession] which facilitates sensemaking amongst a group of people sharing common experiences...."12 Originating in the business literature is the notion that "culture eats strategy for breakfast...."13 That is, if professional culture and the approach to change do not align, practice change will remain elusive.14 Therefore, it may be that the traditional emphasis on the identification and removal of barriers to practice change has been misplaced. Rather, attention should be paid to better understanding pharmacy culture. In this paper, we explore some characteristics often associated with pharmacists. In turn, we hope to provide some preliminary insight into pharmacy culture and its influence on practice change.
What is pharmacy culture?
To date there has been limited research examining the culture of pharmacy. In 1999, an instrument was developed by researchers in the United States to assess students' impressions of pharmacy practice sites, to determine if these placement sites were incorporating the ideals of patient-centredness,...