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OBJECTIVES: To establish whether undertaking cross-sector pharmacy apprenticeship training to become a pharmacy assistant equally split across the two main pharmacy sectors improves training experience and cross-sector understanding. METHODS: A mixed method approach was utilised to explore the experiences of 10 pharmacy apprentices, their employers and education provider. Questionnaires were used to explore apprentices' experiences and views following each 6-month placement. Seven pharmacy employers and the education provider were invited to take part in telephone interviews. Questionnaires were analysed using simple frequencies; qualitative data were analysed thematically. KEY FINDINGS: Ten apprentices were recruited, and nine apprentices returned questionnaires from at least one placement. Three hospital-based employers, four community employers and one education provider were interviewed. All participants had found the pilot positive and the cross-sector training to have been a useful experience. Employers noted that the pilot provided the apprentice with valuable insight into the patient's journey and the opportunity to share learning across sectors. Employers also commented that more information regarding the nature of the training would have been useful to help better structure the placement for the apprentice. CONCLUSIONS: This paper explores the benefits and challenges of employing a pharmacy apprentice and utilising a novel cross-sector training model. Findings have potential relevance to the training of other pharmacy staff, including pharmacy technicians and pharmacists. They offer early insights into the potential value of pharmacy apprenticeships for training pharmacy assistants, particularly if these are set up across the two main sectors hospital and community pharmacy.

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BACKGROUND: While efforts have been made to bring about quality and safety improvement in healthcare, it remains by no means certain that an improvement project will succeed. This suggests a need to better understand the process and conditions of improvement. The current study addresses this question by examining English community pharmacies attempting to undertake improvement activities. METHOD: The study used a longitudinal qualitative design, involving a sample of ten community pharmacies. Each pharmacy took part in a series of improvement workshops, involving use of the Manchester Patient Safety Framework (MaPSaF), over a twelve-month period. Qualitative data were collected from the workshops, from follow-up focus groups and from field notes. Template analysis was used to identify themes in the data. RESULTS: The progress made by pharmacies in improving their practice can be described in terms of a behavioural change framework, consisting of contemplation (resolving to make changes if they are required), planning (deciding how to carry out change) and execution (carrying out and reflecting on change). Organizational conditions supporting change were identified; these included the prioritisation of improvement, a commitment to change, a trusting and collaborative relationship between staff and managers, and knowledge about quality and safety issues to work on. CONCLUSIONS: Our study suggests a process by which healthcare work units might undergo improvement. In addition to recognising and providing support for this process, it is important to establish an environment that fosters improvement, and for work units to ensure that they are prepared for undergoing improvement activities.

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OBJECTIVE: Procedural violations are known to occur in a range of work settings, and are an important topic of interest with regard to safety management. A Safety-I perspective sees violations as undesirable digressions from standardised procedures, while a Safety-II perspective sees violations as adaptations to a complex work system. This study aimed to apply both perspectives to the examination of violations in community pharmacies. DESIGN: Twenty-four participants (13 pharmacists and 11 pharmacy support staff) were purposively sampled to participate in semi-structured interviews using the critical incident technique. Participants described violations they made during the course of their work. Interviews were digitally recorded, transcribed verbatim and analysed using template analysis. SETTING: Community pharmacies located in England and Wales. RESULTS: 31 procedural violations were described during the interviews revealing multiple reasons for violations in this setting. Our findings suggest that from a Safety-II perspective, staff violated to adapt to situations and to manage safety. However, participants also violated procedures in order to maintain productivity which was found to increase risk in some, but not all situations. Procedural violations often relied on the context in which staff were working, resulting in the violation being deemed rational to the individual making the violation, yet the behaviour may be difficult to justify from an outside perspective. CONCLUSIONS: Combining Safety-I and Safety-II perspectives provided a detailed understanding of the underlying reasons for procedural violations. Our findings identify aspects of practice that could benefit from targeted interventions to help support staff in providing safe patient care.