Jeroen van de Pol

16 Chapter 1 Enlist a volunteer army In Kotters’ 8-step change model, enlisting a volunteer army means rallying a number of people around a common opportunity to get change in motion [25]. Within community pharmacy practice, this means some community pharmacists that are willing and able to pioneer within the field of community pharmacy in offering CPS to patients and participating in research. This can also be seen as the classic diffusion of innovations [41] with a volunteer army representing the innovators. Individual community pharmacists already started to design and implement CPS in daily practice. Some examples are the pharmacist-led clinical medication review focusing on patients’ personal goals (of which the benefits to society will be addresses later in this thesis in chapter 4), the HomeCome program developed to support patients who are being discharged from the hospital [15] and community pharmacists organizing collaborationwithGPs to position a community pharmacist at the GPs office [42 - 44]. A study concerning self-care management found that community pharmacists are capable of advising and supporting patients [45] and that patients with regard to CPS provided by community pharmacists are overall satisfied with CPS provided by community pharmacists [46]. The role of the community pharmacist is most successful when fully integrated within the primary care team [9, 47]. Next to benefits on health outcome and costs, research has found that community pharmacists could potentially play a role in alleviating time constraints that GPs and nurses are currently facing [48 - 50]. Despite the aforementioned initiatives and signs of the potential added value of CPS provision by community pharmacists, the strategic vision which emphasizes the focus on CPS provision cannot be considered to have been implemented nationwide and most community pharmacies are struggling with the shift towards CPS provision. This indicates that certain barriers are present that are difficult to overcome. According to the diffusion of innovations [41], this probably most likely affects the late majority and the laggards. Enable action by removing barriers Enabling action by removing barriers is the next step within Kotters’ 8-step change model. These barriers can differ with regard to the necessary change. Examples are removing inefficient processes and hierarchies to provide some degrees of freedom to implement change [25]. Specifically within the field of community pharmacy practice, barriers in the transition towards CPS provision need to be identified first. Some have already been identified and studied before and some are the main subject of the chapters further on in this thesis.