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The purpose of this paper is to explore the importance of lean leadership in an implementation in a Chinese hospital, considering a particular focus on the attitudes of nursing professionals while identifying specific cultural or institutional factors in China that might affect the implementation.

The authors use Harrison et al.’s (2016) framework to explore the outcomes of a nine-month action research project whereby the authors observed the process and outcomes of implementing lean in a pharmacy intravenous admixture service of a Chinese hospital.

The implementation of lean had positive results, which improved the efficiency of the operation, reduced the work start time and the amount of staff, and improved clinical satisfaction. In the process of implementation, nursing professionals showed a positive attitude toward the implementation and showed no obvious resistance under the positive influence of the head nurse. The combination of Chinese cultural characteristics, nursing culture and strong leadership enabled lean success.

The unit moved from self-management to a systemized process of using lean concepts and methods, it is an important change for hospital managers.

Institutional pharmaceutical services have widely evolved over the past 20‐30 years. Hospital pharmacy practice has changed from a profession concerned chiefly with the bulk preparation and distribution of drug products to one centred on ensuring optimal drug therapy. Whereas hospital pharmacists were charged with maintaining large drug stock on nursing units, many of them now provide individualised patient therapies. The practice of hospital pharmacy has therefore become one encompassing all aspects of drug therapy, from the procurement of drugs and drug delivery devices, their preparation and distribution, to their most appropriate selection and use for each patient. Hospital pharmacy services have traditionally had little involvement at the key stages in patients’ hospital care. This leads to the conclusion that the model of clinical pharmacy practice adopted by many pharmacy department hospitals is no longer appropriate for the demands of today’s health‐care services. Reviews many new models proposed for clinical pharmacy practice including an integrated model for providing a pharmaceutical care management approach in the health‐care system. This model is a response to the failures of traditional drug therapy. It is primarily an idea about how health professionals and patient should integrate their work to obtain outcomes important to patients and clinicians.

Pharmaceutical care has caused considerable attention in the pharmacy literature, because this concept alters the care and services that pharmacists provide to the public. In the pharmaceutical care concept, pharmacists must ultimately accept their responsibility not only to dispense drugs but also to identify, correct and prevent drug‐related problems. Pharmaceutical care represents a significant transition in the profession of pharmacy, where the primary focus is the patient and outcomes of care rather than the distribution of drug products. This article evaluates the concept of pharmaceutical care as a standard of quality care for many hospital pharmacy practices. As pharmacy directors accept this concept and pharmacists begin to provide pharmaceutical care, it is important to elaborate the concept further.

The purpose of this paper is to explore parenteral nutrition (PN) practices in hospital pharmacies of Kuwait and identify potential avenues for quality improvement in this service.

A descriptive, qualitative study about PN practices was conducted from June 2012 to February 2013 in Kuwait. Data were collected via in-depth semi-structured interviews with the head total parenteral nutrition (TPN) pharmacists at seven hospitals using a developed questionnaire. The questionnaire obtained information about the PN service at each hospital including the existence of nutritional support teams (NSTs), PN preparation practices, quality controls and guidelines/protocols. The interviews were audio-recorded, transcribed verbatim and analyzed for content.

Seven hospitals in Kuwait provided PN preparation service through TPN units within hospital pharmacies. Functional NSTs did not exist in any of these hospitals. All TPN units used paper-based standard PN order forms for requesting PN. The content of PN order forms and PN formulas labeling information were inconsistent across hospitals. Most of the prepared PN formulas were tailor-made and packed in single compartment bags. Quality controls used included gravimetric analysis and visual inspection of PN formulations, and less consistently reported periodic evaluation of the aseptic techniques. Six TPN units independently developed PN guidelines/protocols.

This study revealed variations in many aspects of PN practices among the hospitals in Kuwait and provided recommendations to improve this service. Standardization of PN practices would enhance the quality of care provided to patients receiving PN and facilitate national monitoring. This can be accomplished through the involvement of healthcare professionals with expertise in nutrition support working within proactive NSTs.