Exploring the associations of culture with careers and the mediating role of HR practices:A conceptual model

Purpose: The conceptual framework developed in the present study aims to highlight the importance of human resource (HR) practices as a mediator between national culture and employees' careers. Design/methodology/approach: The approach taken is a literature review and the development of a conceptual model. Findings: The paper contributes to the literature by focusing on how culture via HR practices might influence career success. Drawing on Hofstede's cultural dimensions, five propositions are developed regarding the impact of culture on career‐relevant HR practices, and how these practices are likely to influence employee career success. Research limitations/implications: Culture's effect should not be overstated. Looking at the propositions, it is possible that the influence of HR practices on career success is more pronounced than the direct effects of culture on career success. Future work is needed to measure and compare the relative strength of different associations as well as the possibility that other HR dimensions relevant to the study of career success may exist. Originality/value: At a general level, there is ample evidence of the impact of culture on the effectiveness of a variety of individual outcomes. The paper focused on the mediating role of HR practices as opposed to advancing hypotheses about direct relationships between culture and career success

Pharmacist joint-working with general practices: evaluating the Sheffield Primary Care Pharmacy Programme. A mixed- methods study

yesBackground: The NHS in the UK supports pharmacists’ deployment into general practices. This article reports on the implementation and impact of the Primary Care Pharmacy Programme (PCPP). The programme is a care delivery model that was undertaken at scale across a city in which community pharmacists (CPs) were matched with general practices and performed clinical duties for one half-day per week. Aim: To investigate (a) challenges of integration of CPs in general practices, and (b) the perceived impact on care delivery and community pharmacy practice. Design & setting: This mixed-methods study was conducted with CPs, community pharmacy employers (CPEs), scheme commissioners (SCs), and patients in Sheffield. Method: Semi-structured interviews (n = 22) took place with CPs (n = 12), CPEs (n = 2), SCs (n = 3), and patients (n = 5). A cross-sectional survey of PCPP pharmacists (n = 47, 66%) was also used. A descriptive analysis of patient feedback forms was undertaken and a database of pharmacist activities was created. Results: Eighty-six of 88 practices deployed a pharmacist. Although community pharmacy contracting and backfill arrangements were sometimes complicated, timely deployment was achieved. Development of closer relationships appeared to facilitate extension of initially agreed roles, including transition from ‘backroom’ to patient-facing clinical work. CPs gained understanding of GP processes and patients’ primary care pathway, allowing them to follow up work at the community pharmacy in a more timely way, positively impacting on patients’ and healthcare professionals’ perceived delivery of care. Conclusion: The PCPP scheme was the first of its kind to achieve almost universal uptake by GPs throughout a large city. The study findings reveal the potential for CP–GP joint-working in increasing perceived positive care delivery and reducing fragmented care, and can inform future implementation at scale and at practice level

Examination of England’s New Medicine Service (NMS) of complex health care interventions in community pharmacy

Background: Community pharmacies are increasingly commissioned to deliver new, complex health interventions in response to the growing demands on family doctors and secondary health care services. Little is known about how these complex interventions are being accommodated and translated into the community pharmacy setting and whether their aims and objectives are realized in practice. The New Medicine Service (NMS) is a complex medicine management intervention that aims to support patients’ adherence to newly prescribed medicines for a long-term condition. Objective: This study explores the recent implementation of the NMS in community pharmacies across England. It also seeks to understand how the service is becoming manifest in practice and what lessons can be learned for future service implementation. Methods: Structured, organizational ethnographic observations and in situ workplace interviews with pharmacists and support staff were undertaken within 23 English community pharmacies. Additionally, one-toone, semi-structured interviews were carried out with 47 community pharmacists and 11 general practitioners (GPs). Observational and interview data were transcribed and analysed thematically and guided by Damschroder’s consolidated framework for implementation research. Results: The NMS workload had been implemented and absorbed into pharmacists’ daily routines alongside existing responsibilities with no extra resources and little evidence of reduction in other responsibilities. Pharmacists were pragmatic, simplifying, and adapting the NMS to facilitate its delivery and using discretion to circumvent perceived non-essential paperwork. Pharmacist understanding of the NMS was found to impact on what they believed should be achieved from the service. Despite pharmacists holding positive views about the value of the NMS, not all were convinced of its perceived benefits and necessity, with reports that many consultations did not identify any problems with the patients’ medicines. GPs were generally supportive of the initiative but were unaware of the service or potential benefits. Poorly developed existing pharmacist-GP relationships impeded implementation. Conclusions: This study identifies the multifaceted and complex processes involved in implementing a new community pharmacy service in England. Community pharmacy workflow, infrastructure, and public and professional relationships all affect NMS implementation. Greater prior engagement with the pharmacy workforce and GPs, robust piloting and a phased rollout together with ongoing support and updates, are potentials strategies to ensure future implementation of pharmacy services meet their intended aims in practice

Repeatability of beach morphology change under identical wave forcing

Laboratory investigations of beach morphology change under wave action are undertaken to gain insight into coastal processes, design coastal structures and validate the predictions of numerical models. For the results of such experiments to be reliable, it is necessary that they are repeatable. The equilibrium beach concept, that beach morphology will evolve to a quasi-static equilibrium shape for a given forcing suggests that experiments should be repeatable to some degree. However, sediment transport in turbulent breaking and broken waves is complex and highly variable and the level of repeatability at different temporal and spatial scales is challenging to measure, as such, previous work has restricted comparisons to small numbers of waves. Here we use the results of two identical, 20-h large-scale wave flume experiments to investigate the repeatability of sediment transport and beach morphology change under waves at timescales down to individual swash events. It is shown that while flow characteristics from identical swash events are very repeatable, the sediment transported can be very different in both magnitude and direction due to differences in turbulence, sediment advection and morphological feedback. Over longer periods containing multiple matching swash events however, the beach responds in a very similar manner, with the level of morphological repeatability increasing with time. The results also demonstrate that gross swash zone sediment transport remains high even as a beach profile approaches quasi-equilibrium, but the proportion of individual swash events that cause large sediment fluxes (>±7.5 kg/event/m) reduces with time. The results of this laboratory study indicate that beach morphology change has a level of determinism over timescales of several minutes and longer, giving confidence in the results from physical modelling studies. However, the large differences in sediment transport from apparently identical swash events questions the value in pursuing numerical predictions of sediment transport at the wave-by-wave timescale unless the reversals in sediment transport between apparently near identical swash events can also be predicted

The impact of a supplementary medication review and counselling service within the oncology outpatient setting

The impact on the care of breast cancer patients, of a pharmacy technician-led medication review and counselling clinic, provided in an outpatient setting, was investigated using a controlled randomised study. Compared to the controls, clinic patients showed a significantly improved level of understanding of their chemotherapy support medication (95% CI for difference in mean knowledge rating scores=2.165–2.826, P<0.001) and a significant reduction in the median number of support items required (two compared to five in the control, P<0.001). This resulted in a significant reduction in mean medication expenditure per patient (£26.70 vs £10.20, 95% CI for the mean difference in cost £6.72–£26.26, P<0.001). The clinic was also associated with significant reductions in chemotherapy delays (P<0.001) and dose reductions due to side effects (P=0.003). Other benefits from the clinic were a reduction in pharmacy dispensing time and a highly significant reduction in pharmacy time spent resolving post-clinic prescription queries (P<0.001). Taking into account the initial technician training cost, the scheme represented an annual saving to the Trust of over £15 000. The clinic serves as a model for those wishing to improve outpatient services to breast cancer patients