Implementing a medicines dispensing service in a university pharmacy: A qualitative study of experiential learning and work system factors

BACKGROUND: Dispensing can be a strategic clinical service when organized around the care process. Such models are relevant in university affiliated pharmacies (UPh), where service delivery is integrated with experiential education. However, their implementation may be challenged by organizational resistance. This study explored barriers and facilitators to implementing a medicines dispensing service model from a sociotechnical perspective. METHODS: A qualitative study was conducted in a UPh. Participants were pharmacist preceptors, faculty members, and pharmacy interns (n = 18). Data were collected in May 2023 via open-ended online questionnaire and participant observation. Deductive framework analysis was informed by the Systems Engineering Initiative for Patient Safety (SEIPS) 101 model. Themes were interpreted according to their impact on operational and sustainability dimensions of the service. RESULTS: Facilitators were mainly related to people and organizational conditions, including appointment-based service organization and supportive organizational culture. In contrast, barriers involved work system components: people and socio-organizational (e.g., intern turnover); task and technology (e.g., administrative overload and fragmented digital tools); and external (e.g., unstable medicine procurement). Participants perceived users as satisfied, although some prioritized access to medicines over the clinical value of the encounters. CONCLUSION: Implementation of clinical dispensing in UPh appears to be facilitated by appointment scheduling, team commitment, and a supportive organizational culture. However, compensatory work emerging from barriers imposed by fragmented digital tools, administrative burden, and unstable medicine supply chains was perceived to hinder educational processes and, consequently, the quality of patient care. Targeting these work system barriers may be essential to sustain both high quality care and experiential training.