Research Paper International Journal of

Pharmacy Practice International Journal of Pharmacy Practice 2015, 23, pp. 439–446

Change management in pharmacy: a simulation game and pharmacy leaders’ rating of 35 barriers to change Aurélie Guérina, Denis Lebela, Kevin Hallb and Jean-François Bussièresc a

Pharmacy Department, CHU Sainte-Justine, Montreal, QC, bFaculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB,

Canada, and cFaculty of pharmacy, Université de Montréal, Montreal, QC

Keywords barriers; change management; pharmacy; simulation game Correspondence Mr Jean-François Bussières, Pharmacy Department, Centre Hospitalier Universitaire Sainte-Justine (CHUSJ), 3175, Chemin de la Côte-Sainte-Catherine, Montréal, QC H3T 1C5, Canada. E-mail: [email protected] Received November 21, 2013 Accepted May 25, 2015 doi: 10.1111/ijpp.12199 Ethics committee approval: No Ethics committee approval was needed for this study.

Abstract Objectives The primary objective was to rank barriers to change in pharmacy practice. Our secondary objective was to create a simulation game to stimulate reflection and discussion on the topic of change management. Methods The game was created by the authors and used during a symposium attended by 43 hospital pharmacy leaders from all regions of Canada (Millcroft Conference, Alton, Ontario, June 2013). The main theme of the conference was ‘managing change’. Key findings The simulation game, the rating of 35 barriers to change and the discussion that followed provided an opportunity for hospital pharmacy leaders to reflect on potential barriers to change, and how change might be facilitated through the use of an organized approach to change, such as that described in Kotter’s eightstep model. Conclusions This simulation game, and the associated rating of barriers to change, provided an opportunity for a group of hospital pharmacy leaders in Canada to reflect on the challenges associated with managing change in the healthcare setting. This simulation game can be modified and used by pharmacy practitioners in other countries to help identify and rank barriers to change in their particular pharmacy practice setting.

Introduction Pharmacy leaders and managers are expected to establish and maintain high pharmacy practice standards, ensure compliance with laws and regulations and effectively and efficiently manage resources. At the same time, they are expected to respond to the challenges they face in a healthcare environment that is changing at a rapid pace. Strategies that worked in the past may no longer be effective in today’s environment.[1] Pharmacy leaders must be prepared to not only adapt to new circumstances, but also to lead change.[2] Change management is a competency that effective pharmacy leaders learn to master. There is an abundant literature published about change management with more than 4000 published titles in the getAbstract database alone.[3] In Pubmed, change management is covered under the MeSH term ‘Organizational innovation’ and includes more than 23 000 titles.[4] Ferlie et al. have proposed a multilevel framework for change in the © 2015 Royal Pharmaceutical Society

context of improving the quality of health care in the United Kingdom and United States.[5] The authors noted that attention must be given ‘to issues of leadership, culture, team development, and information technology at all levels’.[5] Others have proposed different approaches to transformational change in healthcare systems.[6–13] Although there are numerous publications that describe the evolution of pharmacy practice,[14–18] there are only a limited number of publications that deal with specific change management initiatives in pharmacy. In a qualitative study, Gastelurrutia et al. conducted 33 semi-structured interviews with community pharmacists and identified 12 factors that facilitated practice change in community pharmacies in Spain.[19] Feletto et al. tested a pharmacy ‘change readiness wheel’ when implementing a pharmacy asthma management service in Australia and concluded that ‘change is not as straightforward as it may appear and is a multi-step process over time’.[20] Doucette et al. surveyed 400 licensed U.S. pharmacists to assess the extent of pharmacy practice change that International Journal of Pharmacy Practice 2015, 23, pp. 439--446


had occurred in recent years.[21] The authors concluded that ‘many pharmacies reported that some aspects of their practice have changed, such as collecting patient information and documenting care’.[21] However, few participants reported that significant changes, such as asking patients to pay for pharmacy services, had occurred. Roberts et al. have also published a number of papers on practice change and its understanding.[22–24] Tsuyuki and Schindel proposed that the Kotter model of change management could be used as a tool for accelerating practice change in the pharmacy setting.[25] The steps proposed by Kotter for maximizing the potential for achieving meaningful change are: (1) instill a sense of urgency; (2) build a guiding coalition; (3) create a vision and supporting strategies; (4) communicate the vision; (5) empower employees to take action; (6) generate short-term gains; (7) consolidate improvements and produce more change; and (8) anchor new approaches in the culture.[26] Our primary objective was to identify and rank barriers to change in pharmacy practice. Our secondary objective was to create a simulation game to stimulate reflection and discussion on the topic of change management.

Methods Patients and settings The participants were all pharmacy leaders (n = 43) attending the invitational Millcroft Pharmacy Leadership Conference (Alton, Ontario, Canada. 7 June 2013).

Creation of the simulation game Following a brief literature review of Kotter’s eight-step process for leading change, the authors and several colleagues conducted a brainstorming session and identified a list of 35 barriers to change that could apply to pharmacy practice.[26] Kotter’s model was chosen because it is simple, well known and has been used in the healthcare sector. A number of barriers were identified for most of the steps in the Kotter model. A barrier to change was considered as anything that could hinder or slow the implementation of a pharmacy practice change. The simulation game used a negotiation-based format that was designed to be played by up to eight groups, with four to six individuals in each group. Each group represented a virtual pharmacy department. The authors identified one member of each group to act as the leader of the virtual department. That person was responsible for ensuring that the game was completed within the allotted time (e.g. 60 min). Each group was provided with 41 construction blocks in a mix of four colours. The four colors of the blocks were used to represent four pharmacy practice domains: drug © 2015 Royal Pharmaceutical Society

Change management in pharmacy

distribution, clinical services, research and management. The game board had only 28 spots for placement of the blocks, so participants had to decide how many blocks of each pharmacy domain (clinical, drug distribution, research and management) that they wanted to include in their pharmacy model. Each table group had the opportunity to build their ideal pharmacy department but also faced the challenge of reaching agreement among the group members on what that ideal pharmacy should look like with respect to the clinical, drug distribution, research and management services that would be part of their ideal pharmacy. Although other domains, such as education, could have been included, the authors decided upon these four major domains to facilitate the timely completion of the game. Each person, including the ‘director of pharmacy’, was randomly given a game card with three sections. Game cards were developed to promote participation by all group members and to create situations where opposition to change would emerge. Each person also received a role, such as director of pharmacy, drug distribution coordinator, research coordinator, automation and information technology pharmacist, pharmacology and therapeutics’ committee pharmacist, intensive care unit pharmacist, internal medicine pharmacist, and pharmacy technician. The game card also described their personality characteristics, values, biases and their and their priorities/specific objectives related to pharmacy services (drug distribution, clinical services, etc.). Each player was instructed to pursue their character’s priorities as they played the game and not share the content of their game card. Table 1 provides a description of the content of the eight game cards. The simulation game and the tools used in the game were pre-tested with a group of eight pharmacy residents for clarity and understanding. As a result of the testing, minor changes were made regarding the game instructions and time allocation.

Playing the simulation game The game was conducted in English, with supplemental instructions provided in French for those who requested it. Participants were notified that participation in the simulation game was voluntary and that the authors planned to publish the results of the simulation game. No ethics approval was sought from an institutional human ethics research committee, considering the nature of the simulation. Conference attendees had previously been placed at tables in the conference room as part of the overall planning for the conference. The seating arrangements were designed to create groups at each table that represented a balance of individuals from each region of the country. The same seating arrangements were maintained for the simulation game. The game took a total of 60 min, including the time required to provide International Journal of Pharmacy Practice 2015, 23, pp. 439--446

International Journal of Pharmacy Practice 2015, 23, pp. 439--446

Always has something to say or add to a discussion; likes to interrupt other people.

A little bit frustrated fellow; can be aggressive in making his point, particularly if nobody seems to be listening to him. A funny fellow having a good time at work and in his life; will use humour to make his point; likes to laugh and make others laugh. A question person; always asking questions, but rarely has answers to those questions

ICU pharmacist

Research coordinator

Distribution coordinator

Automation and IT pharmacist

Pharmacy technician

P & T pharmacist

Very techno wise fellow with always a technical solution to any kind of problem

Has personal healthcare and emotional problems; job should not create more stress in our life Very nice fellow, with good attitude; very helpful in a group dynamic; helps decisions to be made efficiently

Not a funny fellow at all; no joke please and make sure the group focus on the task; this is not party time!

Pharmacy director

Internal medicine pharmacist

Personality characters

Description of the content of the eight game cards


Table 1

Not very clear ins his explanations because he uses a lot of jargon, technical tips and never ending answers

A leader that make things happen; did not go into pharmacy because of a healthcare problem but makes a difference in a group dynamic; might return to school

Can we keep things simple please

Takes into account all voices and likes it when other people have questions too !

Job should be fun because life is short !

Rigor, rigor, rigor !

Equality . . . likes it when everything is equal

Dislikes chaos and makes sure one person talks at a time


Wants to add more management staffing to get some additional time for IT implementation, exploration, development, etc.

Likes the model as it is and believes that the system swill decide for us anyway, no matter what we want Will find the best compromise for the game, taking into account external and internal pressure

Wants to increase research and clinical staffing (green and red blocks); pharmacy management is the one thing everyone can do; does not like the director at all. Wants to increase distribution staffing (e.g. blue blocks) in the model as distribution is the basis of pharmacy practice. Wants to increase clinical staffing (red blocks); all spheres of pharmacy practice are important but clinical is our future

Wants to increase management staffing (yellow blocks) as the current challenges are enormous and without more resources, he might leave the hospital Wants to increase clinical staffing (red blocks); what would pharmacy be without clinical pharmacists!


Let’s win the game (e.g. complete the model and follow the game leader rule because not following the rule means losing the game), lead the group, and make model more coherent than the initial version To add at least 2 yellow blocks; will pretend that 1 yellow block can replace 2 blue or 2 red because machines can replace people, do not get sick and make work more efficient

To add 1 or 2 red block (s) to the model and not reduce anyone; let us see what the institution will say ; let us find a way to reduce any pharmacy staffing reductions; pharmacy should stand up and argue for its indispensability To make change at all

To add 2 more blue and may trade with any other fellow; while funny, he must win.

To add two red (clinical) blocks to the model by reducing the blue (drug distribution) blocks; may make deals with others to overwhelm the blue (drug distribution) supporters. To add 2 green to the model and wants to reduce yellow to barely its minimum (e.g. 1 or 2)

To add two yellow blocks to the model, no matter what’s taken out ; you must succeed

Specific objectives related to the game

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Table 2

Change management in pharmacy

Simulation game instructions

You are at a departmental retreat and are seated with a group of your colleagues who have been assigned the task of making important decisions about the future of your pharmacy department. You all work for a 500-bed teaching hospital. The pharmacy department offers a fairly comprehensive range of services. The department operates a unit dose drug distribution system, with a reasonably comprehensive, centralized intravenous admixture program. Some automation technologies are in use and the pharmacy has a pharmacy information system that includes a number of decision-support functionalities, such as drug interaction and drug dosage checking. Your department is perhaps mid-way towards full implementation of the medication management standards of Accreditation Canada. The department provides experiential training to both undergraduate and post-graduate pharmacy students (residents) and your department supports and participates in clinical research. Your pharmacy department is currently described by the mega block model that is on your table. Theses blocks illustrate the current pharmacy practice model. By model we mean the importance of each domain of pharmacy (i.e. drug distribution, pharmaceutical care, research and management). Each colour represents a domain of your pharmacy model: blue (drug distribution), red (pharmaceutical care), green (research) and yellow (management). Teaching is embedded in each colour since experiential training is provided to students who work in each of the domains (drug distribution, patient care, research and management). Your current model includes 28 blocks. Each pharmacy member at your table has a game card that describes their role, a personality characteristic that they have, their personal values, a bias that they have, and a specific objective that you have for this planning game with your colleagues. Do not share this information with the other members at your table. At the signal of the game leader, the table members will begin to discuss how they could improve the current pharmacy practice model by altering the relative weight of each of the four pharmacy domains (drug distribution services, clinical services, research and management). The game leader may interrupt the game at any time to inform each pharmacy department of government or CEO decisions that may affect your decisions. The game will last 20 min.

verbal and written instructions at the start of the session and to wrap-up the session at the conclusion of the game (Table 2). A photo of the ideal pharmacy model that was created by each of the eight teams was taken for viewing by all conference participants and subsequent discussion later during the conference.

some of the major barriers that the groups had encountered. The comments received were anonymously recorded by the authors. The comments were reviewed by the authors, but no in-depth analysis was conducted.

Analysis Rating the importance of barriers to change After the teams had completed the simulation game, each participant was given a questionnaire to fill out, along with the list of 35 barriers to change that had been identified. A short demographic section was included in the questionnaire. Each participant was asked to rate how important each barrier was, considering both what they had experienced during the game and in their own practice experience. The following rating scale was used: ‘very important = 1, important = 2, somewhat important = 3, not at all important = 4’. The rating exercise was conducted in an effort to have the participants give some thought to the various barriers that often have to be overcome when change is being planned and implemented. Each participant was also invited to provide written comments about the simulation game at the end of the questionnaire.

Follow-up with participants The following day, the eight different models of an ideal pharmacy, based on the distribution of blocks representing clinical, drug distribution, research and management services, were reviewed by the conference participants. The groups had encountered many challenges as they tried to create the ideal pharmacy model. The discussion that followed focused on © 2015 Royal Pharmaceutical Society

Using each individual’s rating for the 35 barriers, an average rating for all participants was calculated for each of the 35 barriers to change. No other statistical analysis was conducted.

Results Demographics of the participants Forty-five per cent of the participants were in the age range of 41–50 years of age; 30% were in the range of 51–60 years of age; 17.5% were in the range 30–40 years of age; 5% were under 30 years of age and 2.5% were more than 61 years of age. Table 3 shows the distribution of roles given to the participants. The simulation game was conducted on 7 June 2013 at the invitational Millcroft Pharmacy Leadership Conference held in Alton, Ontario, Canada. All of the pharmacy leaders in attendance at the conference (n = 43) participated in the simulation game. Table 4 shows, in decreasing importance, the average rating of the importance of the 35 barriers to change, as rated the by pharmacy leaders. Lack of leadership, lack of a common vision and lack of a clear game plan or strategic vision were rated as the most important barriers to change by the participants. International Journal of Pharmacy Practice 2015, 23, pp. 439--446

Aure´lie Gue´rin et al.

Table 3


Distribution of roles randomly given to pharmacy leaders for the game simulation and average rating for the 35 barriers per team Groups A (n = 5)

B (n = 6)

C (n = 6)

D (n = 5)

E (n = 6)

F (n = 5)

G (n = 4)

H (n = 6)












Roles Pharmacy director Intensive care unit pharmacist Research coordinator Distribution coordinator Internal medicine pharmacist Pharmacology and therapeutics’ committee pharmacist Pharmacy technician Automation and information technology pharmacist

Table 4









Rating of barriers to change by pharmacy leaders post-simulation

Kotter’s model[27]

Barriers to change

Pharmacy leaders rating

2 3 3 4 6 3 5 6 2 1 4 3 4 5 3 5 5 5 3 5 6 2 6 2 4 3 3 5 2 2 2 5 5 2 7

Lack of leadership Lack of common vision Lack of clear game plan or strategic vision Lack of effective communication throughout the implementation Lack of formal support from the management team to make change a real priority Lack of strategic support within the hospital Lack of culture conducive to change Lack of feedback/support/encouragement from the management team Lack of collaboration Lack of a sense of urgency Lack of understanding about what the individuals targeted by the change are to do Lack of favorable impact on patient outcome Lack of prior and adequate consultation with individuals targeted by the change Lack of identification of the individuals likely to stand in the way of change Lack of anticipation of the real impacts of the change Lack of identification of the individuals likely to stand in the way of change Lack of financial resources Lack of adequate training of the targeted individuals specifically focused on the change to be implemented Lack of identification of potential barriers to change Lack of general training on managing change Lack of easy-to-follow outcome indicators of change Lack of consideration of the resistance expressed by some individuals targeted by the change Lack of readjustments/corrections made to the processes being implemented Lack of conducive work environment Lack of an optimal description of the tasks of the individuals targeted by the change Lack of confidence Lack of scientific basis or conclusive data to justify the change Lack of human resources Lack of consideration of the worries of the individuals targeted by the change Lack of legitimacy of the identified individuals involved Lack of formally identified individuals involved Lack of material resources Lack of scientific/technical expertise on the team Lack of adequate autonomy given to those targeted by the change Lack of consideration of previous change failures

1.4 1.5 1.5 1.7 1.8 1.9 2.0 2.0 2.0 2.0 2.1 2.1 2.1 2.1 2.1 2.1 2.2 2.2 2.3 2.3 2.3 2.3 2.3 2.4 2.4 2.4 2.4 2.4 2.4 2.5 2.5 2.6 2.6 2.6 2.7

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Figure 1

Change management in pharmacy

Ten top barriers mapped into the Kotter model.

Figure 1 illustrates the most important barriers to change, classified according to the Kotter model by the participants through the simulation game.[26] Most comments were provided verbally by the participants. Although they appreciated the simulation game, they mentioned they were surprised by the number of potential barriers and expressed their difficulty in ranking with accuracy a long list of items. A few mentioned they are usually aware of the personality and characteristics of stakeholders in a change process while the game did not allow the participants to learn anything about the roles that others within the group would be playing. Some participants also felt that they needed to know more information about the ‘simulation hospital’ in order to make relevant decisions.

Discussion Among the top-10 barriers identified by the participants, at least one barrier was deemed to be relevant for six of the eight steps of the process proposed by Kotter.[26] Using a simulation game has strengths and limitations. In terms of strengths, the simulation game developed was simple, fun and could be conducted with little investment and with different audiences. It allowed interactions and discussions followed by reflections about barriers to change. In terms of limitations, participants were given only a short period of time to execute the simulation game and rank the list of 35 barriers to change. A longer time period could have © 2015 Royal Pharmaceutical Society

been allowed. Limited instructions were given about the nature of the hypothetical hospital (e.g. the hospital’s programmes of care or workload volumes), within which the participants were asked to design their ideal pharmacy department. Some participants felt that they needed that information in order to make decisions about the emphasis that should be placed on each of the four domains (drug distribution, clinical, research and management). A more comprehensive description of that hospital could be developed and provided. Participants were asked to indicate the importance of all barriers, whereas some respondents indicated that they did not have enough time to thoughtfully consider and rate the importance of all 35 barriers to change. Although list of barriers provided is not exhaustive, we believe that this initiative did achieve its goal of facilitating a discussion of change management by the pharmacy leaders in Canada who participated in the simulation game and the rating of barriers to change. Any barrier may block a proposed change, regardless of its relative position in a ranking. Although the ranking proposed by participants may put an emphasis on some barriers, we believe that pharmacy leaders should consider all possible barriers as they undertake change initiatives. Particular attention should be given to the common barrier of ‘past experience’, where a change initiative failed (‘been there, done that, and know it won’t work’). The simulation game does not allow us to understand why pharmacy leaders have ranked that important barrier at the very last position of their International Journal of Pharmacy Practice 2015, 23, pp. 439--446

Aure´lie Gue´rin et al.


ranking, but we do hope people learn from their success and failure and do consider that in change management. To our knowledge, there is not similar ranking of barriers to change by pharmacy leaders that has been published. In 2000, Balas et al. published a paper in which they examined the time it took for nine clinical interventions to be adopted, following the landmark trial(s) that had demonstrated their clinical effectiveness.[27] They reported that there was an average 3.2% increase in the use of the intervention per year. Put another way, the authors reported that on average it would take 15.6 years to reach a rate of use of 50% for a proven clinical intervention. A look at the more than 20 years of data that have been collected by the Hospital Pharmacy in Canada survey suggests that the adoption of innovations in pharmacy practice, such as the adoption of unit dose and IV admixture systems, has been similarly slow with respect to their uptake.[17] Clearly, there are many reasons why pharmacy managers and practitioners should be interested in accelerating the process of change. We could find only a few reports concerning the use of simulation games to increase awareness of pharmacy management concepts.[28–31] Our simulation game provided an opportunity for hospital pharmacy leaders to consider how change in their organization might be managed more effectively. Although we did not conduct a formal assessment of the simulation game’s effectiveness, feedback provided by participants as part of the conference evaluation form indicated that the game achieved its intended purpose of facilitating the discussion and reflection on change management that it was designed to achieve.

Conclusions This simulation game and the associated rating of barriers to change provided an opportunity for hospital pharmacy leaders in Canada to reflect on the challenges associated with

References 1. Manasse HR Jr. Health-system pharmacy’s imperative for practice model change. Am J Health Syst Pharm 2012; 69: 972–978. 2. Zellmer WA. The future of healthsystem pharmacy: opportunities and challenges in practice model change. Ann Pharmacother 2012; 46: S41–S45. 3. getAbstract (1999–2015). Summary search strategy: change management. [online] /en/search/?query=change +management&allFormats=true &allSources=true

managing change in the healthcare setting. The slow adoption of innovations in the healthcare setting represents a lost opportunity for everyone who relies on the healthcare system to provide the best possible healthcare services. Strategies to accelerate the rate of adoption of healthcare innovations need to be pursued. Simulation games can serve as a starting point for reflection and discussion related to the management of change. Others could adapt and use a similar game to engage managers and staff in the early stage of change initiatives. This simulation game can be modified and used by pharmacy practitioners in other countries to help identify and rank barriers to change in their particular pharmacy practice setting.

Declarations Conflict of interest The Author(s) declare(s) that they have no conflicts of interest to disclose.

Funding This work received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Authors’ contributions DL and JFB contributed to the original design and conception of the study. AG, DL and JFB prepared the simulation game. AG, DL, KH and JFB approved by consensus the list of criteria to be used. JFB presented the simulation game to the participants. AG and JFB acquired the data. AG, DL, KH and JFB analyzed and interpreted the data. AG and JFB wrote the first draft. AG, DL, KH and JFB revised the draft critically for important intellectual content.AG, DL, KH and JFB approved the final version to be published. All Authors state that they had complete access to the study data that support the publication.

&allCategories=true&allRatings =true&allPublicationYears=true &languageIds=1 (accessed 24 December 2014). 4. PubMed (2015). Organizational Innovation [Mesh]. [online] http://www Organizational+Innovation%22%5 BMesh%5D (accessed 24 December 2014). 5. Ferlie EB et al. Improving the quality of health care in the United Kingdom and the United States: a framework for change. Milbank Q 2001; 79: 281–315. 6. Lukas CV et al. Transformational change in health care systems: an

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organizational model. Health Care Manage Rev 2007; 32: 309–320. Harrison MI et al. Building capacity for a transformation initiative: system redesign at Denver Health. Health Care Manage Rev 2009; 34: 42–53. Harlos K et al. Mining the management literature for insights into implementing evidence-based change in healthcare. Healthc Policy 2012; 8: 33–48. Al-Balushi S et al. Readiness factors for lean implementation in healthcare settings – a literature review. J Health Organ Manag 2014; 28: 135–153. Agency for healthcare research and quality (2014). TeamSTEPPS 2.0. © 2015 Royal Pharmaceutical Society







Change management in pharmacy

Module 8 – Change management. [online] professionals/education/curriculum -tools/teamstepps/instructor/ fundamentals/module8/ igchangemgmt.html (accessed 24 December 2014). Prosci (2015). ADKAR® Model. [online] adkar-model/overview-3/ (accessed 24 December 2014). Kritsonis A. Comparison of change theories. Int J Manag Bus Adm 2005; 8: 1–6. [online] http://www Journal%20Volumes/Kritsonis,%20 Alicia%20Comparison%20of %20Change%20Theories%20IJMBA %20V8%20N1%202005.pdf (accessed 24 December 2014.) Brio Conseils (2012). Qu’est-ce qu’une bonne démarche de gestion de changement? [online] http://www -de-mesure-efficace-en-gestion-du -changement%E2%80%A6-le-modele -des-phases-de-preoccupations-de -celine-bareil-de-hec-montreal/ (accessed 24 December 2014). Pedersen CA et al. ASHP national survey of pharmacy practice in hospital settings: prescribing and transcribing2013. Am J Health Syst Pharm 2014; 71: 924–942. Pedersen CA et al. ASHP national survey of pharmacy practice in hospital settings: monitoring and patient education-2012. Am J Health Syst Pharm 2013; 70: 787–803.

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16. Pedersen CA et al. ASHP national survey of pharmacy practice in hospital settings: dispensing and administration-2011. Am J Health Syst Pharm 2012; 69: 768–785. 17. Hospital Pharmacy in Canada Editorial Board (2013). Hospital Pharmacy in Canada Report 2011/2012. [online] hpc2/content/rep_2012_tocF.asp (accessed 24 December 2014). 18. European Society of Hospital Pharmacists (2010). EAHP’s 2010 survey of hospital pharmacy practice in Europe. Survey 2010. [online] http://www -2010-survey-hospital-pharmacy -practice-europe (accessed 24 December 2014). 19. Gastelurrutia MA et al. Facilitators for practice change in Spanish community pharmacy. Pharm World Sci 2009; 31: 32–39. 20. Feletto E et al. Practice change in community pharmacy: using changemanagement principles when implementing a pharmacy asthma management service in NSW, Australia. Int J Pharm Pract 2013; 21: 28–37. 21. Doucette WR et al. Organizational factors influencing pharmacy practice change. Res Social Adm Pharm 2012; 8: 274–284. 22. Roberts AS et al. Understanding practice change in community pharmacy: a qualitative research instrument based on organisational theory. Pharm World Sci 2003; 25: 227–234.

23. Roberts AS et al. Understanding practice change in community pharmacy: a qualitative study in Australia. Res Social Adm Pharm 2005; 1: 546–564. 24. Roberts AS et al. Practice change in community pharmacy: quantification of facilitators. Ann Pharmacother 2008; 42: 861–868. 25. Tsuyuki RT, Schindel TJ. Changing pharmacy practice: the leadership challenge. Can Pharm J 2008; 141: 174–180. 26. Kotter J (2015). The 8-Step process for leading change. [online] http:// -principles/changesteps/changesteps. (accessed 24 December 2014). 27. Balas EA, Boren SA. Managing clinical knowledge for health care improvement. Yearb Med Inform 2000; 65–70. 28. Bregman D et al. An internet-based simulation system for training and development of regional-healthcarecenters managers. Stud Health Technol Inform 2009; 150: 789–793. 29. Mann BD et al. The development of an interactive game-based tool for learning surgical management algorithms via computer. Am J Surg 2002; 183: 305–308. 30. Renet S et al. Prioritizing pharmaceutical activities: a simulation exercise. Can J Hosp Pharm 2012; 65: 119–124. 31. Renet S et al. Prioritizing pharmaceutical activities: a simulation with pharmacy residents. J Pharm Pract 2013; 26: 366–374.

International Journal of Pharmacy Practice 2015, 23, pp. 439--446

Change management in pharmacy: a simulation game and pharmacy leaders' rating of 35 barriers to change.

The primary objective was to rank barriers to change in pharmacy practice. Our secondary objective was to create a simulation game to stimulate reflec...
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