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As healthcare reform takes shape, many challenges face hospital pharmacists. An opportunity exists to combine the principles of patient‐focused care and pharmaceutical care to redesign the role of pharmacy. To achieve this objective, pharmacy departments should adopt business concepts such as process re‐engineering. Process re‐engineering is a change management tool which aims to produce dramatic improvement in performance measures by re‐designing the process. The goal of restructuring is to increase the amount of time pharmacists spend providing pharmaceutical care to patients. The pharmaceutical care concept is a method of delivering pharmaceutical care services that match individual patient needs with the services provided. This article describes many hospital pharmacy department transitions to a patient focused care environment by adopting the patient focused care concept and the process re‐engineering to improve the quality of patient care through systems improvement.

Examines the concept of patient‐focused care and how it fits into hospital process re‐engineering. Describes the project undertaken at the Derbyshire Royal Infirmary, to implement patient‐focused care and care pathway development in accident and emergency, and trauma and orthopaedics. Concludes with an insight into how care pathways have been used to improve hospital documentation, reduce duplication of information and provide a rich source of data for effective clinical audit.

Highlights the importance of responding to the individual needs of patients, from a personal and general viewpoint. The reforms to health care organization have provided one mechanism for reconciling both patients′ and the community′s need for quality services, but not necessarily the individual. Within a hospital, a philosophy centred on individual patient needs; “patient focused care” provides a way of making explicit quality choices for the individual as well as the community served. While patient focused care is open to many interpretations, argues that in quality terms it is an important milestone as is the first quality approach which makes explicit reference to the patient.

Drawing on the author’s personal experience within the UK National Health Service, outlines at the macro level what information is needed, and why, in facilities management. Suggests that top‐level data gathering is a priority, describes the processes required, and finally considers the advantages of sharing information with competitors and others.

Discusses five elements of patient‐focused care (PFC). Clarifies issues surrounding the first element ‐ aggregating patients ‐ and debates the strengths and weaknesses of the second element ‐ centralizing services in PFC units. Explores arguments for and against the third element ‐ multiskilling and cross‐training ‐ including staff activity in conventional hospitals and PFC units, in depth. Discusses the structure of PFC teams and their management. Describes the main components of the fourth PFC element ‐ integrated carepaths ‐ and explores their role in clinical audit, computerization and seamless care. Examines the costs of PFC by comparing actual with expected costs. Makes managerial, clinical, educational and research implications throughout for staff working in or with PFC units.

Multi‐skilling has been the most enduring element of patient‐focused care in the UK. A recent report from the Manchester University Health Service Management Unit (HSMU) extended the multi‐skilling debate and offered a framework for changing National Health Service workforce policy along multi‐skilling lines. Examines the main HSMU issues in the light of broader empirical and other evidence. Assesses the strengths, weaknesses, opportunities and threats to multi‐skilling. Concludes that multi‐skilling protagonists still face a number of challenges.

This study explores how nurses working in a large, metropolitan hospital make sense of the managed care change. Findings from 24 nurse interviews suggest that nurse sensemaking has generated interpretations of managed care change that are grounded in the caregiving role. Study results show that nurses view managed care with ambiguity. Nurses understand managed care change as instrumental in encouraging collaboration and affecting patient care quality. Implications are drawn regarding the importance of identity construction to the sensemaking process and illustrate the paradox of change in the managed care era. Although nurses view collaboration and professional empowerment as positive outcomes of managed care, further analysis reveals that these values function ideologically, promoting managed care concerns over worker interests. Concertive control – a team‐based process which shifts organizational control from management to employees – is explored as a way that workers act in accordance with management decisions and uphold traditional power structures.

Second in a series of articles looking at developments within the NHS. Looks at factors such as business process re‐engineering and patient‐focused care. Highlights the features of both and suggests that the latter is a health‐care variant of the former. Examines the educational implications of such developments, suggesting that they will present a major challenge in the next few years.

The purpose of this paper is to demonstrate that, if teams in healthcare focus on the patient using the framework of a care pathway, change can occur without the overt need to “manage” it directly.

In this paper the relevant literature is reviewed and it is demonstrated that if this approach is used it also provides a means for addressing difficult professional and organisational issues that are often unresolved in broader projects of organisational change. This is not presented as a panacea or the solution to all change projects, rather the contention here is that it is one means among many that can be used to bring about important changes in practice.

The paper finds that care pathways represent a useful tool, which teams can use to work through the contextual and practical issues involved in changing practice.

The paper describes the development of integrated care pathways, which can be regarded as a fortunate fusion of managerial and professional concerns.

The implementation of the Patient Protection and Affordable Care Act has facilitated the development of an innovative and integrated delivery care system, Accountable Care Organizations (ACOs). It is timely, to identify how health care managers in rural health clinics (RHCs) are responding to the ACO model. This research examines RHC managers’ perceived benefits and barriers for implementing ACOs from an organizational ecology perspective.

A survey was conducted in spring of 2012 covering the present RHC network working infrastructures – (1) Organizational social network; (2) organizational care delivery structure; (3) ACO knowledge, perceived benefits, and perceived barriers; (4) quality and disease management programs; and (5) health information technology (HIT) infrastructure. One thousand one hundred sixty clinics were surveyed in the United States. They cover eight southeastern states (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee) and California. A total of 91 responses were received.

RHC managers’ personal perceptions on ACO’s benefits and knowledge level explained the most variance in their willingness to join ACOs. Individual perceptions appear to be more influential than organizational and context factors in the predictive analysis.

The study is primarily focused in the Southeastern region of the United States. The generalizability is limited to this region. The predictors of RHCs’ participation in ACOs are germane to guide the development of organizational strategies for enhancing the general knowledge about the innovativeness of delivering coordinated care and containing health care costs inspired by the Affordable Care Act.

RHCs are lagged behind the growth curve of ACO adoption. The diffusion of new knowledge about pros and cons of ACO is essential to reinforce the health care reform in the United States.