E-prescribing: a consultant, a pharmacist and a newsletter
A district hospital is introducing electronic prescribing across 14 wards in five months. The pharmacy lead (high influence, high interest) supports the principle but says the current build will slow discharge; the cardiology consultant (high influence, low stated interest) has publicly said 'we already prescribe safely'; junior doctors (high interest, low formal power) are anxious about login time; a patient group (low power, high interest) wants involvement; the regulator requires evidence of safe implementation. The current plan is a monthly newsletter to all staff plus one roadshow. A ward-level pilot found 23 prescribing errors in week one, mostly from unfamiliar screens. The chief pharmacist asks how to re-segment stakeholders and change the engagement approach.
1. Why is the current stakeholder plan unlikely to work, and how should stakeholders be re-segmented?
Read the worked answer
The plan is a single push channel for a mixed population. A monthly newsletter and one roadshow cannot build the trust, feedback and clinical ownership needed for a safety-critical change, and they do not differentiate by influence, impact or attitude.
Re-segment on more than power and interest:
- Power/interest: still useful for prioritisation, but not enough.
- Attitude: the pharmacy lead is a sceptical supporter; the consultant is a public sceptic with high influence; junior doctors are anxious supporters.
- Impact: ward nurses, junior doctors and pharmacy staff will carry the workflow change; the patient group is affected but not accountable for the build.
- Dynamism: the consultant's position may shift if evidence addresses safety; the regulator's stance depends on assurance evidence.
Implication: Segment by what each group needs and can influence. The pharmacy lead needs co-design and decision rights on discharge workflow. The consultant needs a private, evidence-based clinical conversation. Junior doctors need peer champions and quick login fixes. The patient group needs meaningful involvement in patient-facing information. The regulator needs an assurance plan with evidence. A newsletter can support awareness but cannot be the main engagement method.
2. How should the chief pharmacist engage the cardiology consultant and the pharmacy lead differently? Explain the judgement.
Read the worked answer
Cardiology consultant: He has high influence and a public position, so a public challenge would harden it. Engage privately with clinical evidence: the 23 pilot errors, their types, and the specific screens involved. Ask him to sponsor or join a clinical safety review and to help design order sets. The aim is to move him from 'we already prescribe safely' to 'here is what would make this safer'. Do not treat low stated interest as low impact; his specialty carries credibility.
Pharmacy lead: She is high influence and high interest, and her concern is operational and legitimate: discharge speed. She should be treated as a co-designer with real decision rights over the discharge workflow, not as a blocker to be managed. Give her a named route for build defects and a deadline for fixes. If the build genuinely slows discharge, the programme should fix or accept the risk, not communicate around it.
Judgement: The consultant needs evidence and clinical ownership; the pharmacy lead needs influence and technical response. Using the same channel for both would waste the pharmacy lead's constructive engagement and provoke the consultant.
3. What should the chief pharmacist do about the 23 pilot errors, and how does that affect stakeholder engagement?
Read the worked answer
Treat the errors as a patient-safety signal, not a communications problem. First classify them: were they caused by screen design, missing defaults, training, or underlying process? Stop or pause the rollout if the error type is severe and unresolved. Disclose the findings to the safety committee and the regulator with a remediation plan.
Stakeholder effect:
- The consultant's scepticism now has evidence behind it; engage him in the safety review rather than dismissing him.
- The pharmacy lead's discharge concern may be linked to the same screen design; co-design the fix.
- Junior doctors need to see that reported errors are acted on, or they will work around the system.
- The patient group should be told what happened and what changes, without clinical detail that breaches confidentiality.
Judgement: Hiding or downplaying the errors would destroy trust and increase regulatory risk. Using them as a shared improvement problem can convert sceptical clinicians into co-owners.