The implementation of pharmaceutical services in public hospitals in Mexico: an analysis of the legal framework and organizational practice

Background: The implementation of pharmaceutical services in hospitals contributes to the appropriate use of medicines and patient safety. However, the relationship of implementation with the legal framework and organizational practice has not been studied in depth. The objective of this research is to determine the role of these two factors (the legal framework and organizational practice) in the implementation of pharmaceutical services in public hospitals of the Ministry of Health of Mexico. Methods: Semi-structured interviews were conducted with four groups of actors involved. The analysis focused on the legal framework, defned as the rules, laws and regulations, and on organizational practice, defned as the implementation of the legal framework by related individuals, that is, how they put it into practice. Results: The main problems identifed were the lack of alignment between the rules and the incentives for compliance. Decision-makers identifed the lack of managerial capacity in hospitals as the main implementation barrier, while hospital pharmacists pointed to poor regulation and the lack of clarity of the legal framework as the problems to consider. Conclusions: Although the legal framework related to hospital pharmaceutical services in Mexico is inadequate, organizational factors (such as adequate skills of professional pharmacists and the support of the hospital director) have facilitated gradual implementation. To improve implementation, priority should be given to evaluation and modifcation of the current legislation along with the development of an ofcial minimum standard for activities and services in hospital pharmacies.

Background: The implementation of pharmaceutical services in hospitals contributes to the appropriate use of medicines and patient safety. However, the relationship of implementation with the legal framework and organizational practice has not been studied in depth. The objective of this research is to determine the role of these two factors (the legal framework and organizational practice) in the implementation of pharmaceutical services in public hospitals of the Ministry of Health of Mexico. Methods: Semi-structured interviews were conducted with four groups of actors involved. The analysis focused on the legal framework, defned as the rules, laws and regulations, and on organizational practice, defned as the implementation of the legal framework by related individuals, that is, how they put it into practice. Results: The main problems identifed were the lack of alignment between the rules and the incentives for compliance. Decision-makers identifed the lack of managerial capacity in hospitals as the main implementation barrier, while hospital pharmacists pointed to poor regulation and the lack of clarity of the legal framework as the problems to consider. Conclusions: Although the legal framework related to hospital pharmaceutical services in Mexico is inadequate, organizational factors (such as adequate skills of professional pharmacists and the support of the hospital director) have facilitated gradual implementation. To improve implementation, priority should be given to evaluation and modifcation of the current legislation along with the development of an ofcial minimum standard for activities and services in hospital pharmacies.