What Does Resilience Look Like in Community Pharmacies?

Medication safety has traditionally involved studying errors after they occur and designing policies to prevent their reoccurrence (the “Safety-I” approach). Safety-II instead focuses on understanding everyday adaptations to reduce errors and on how patient safety is actively maintained. Helping pharmacy systems adapt without compromising safety requires an understanding of system resilience—the capacity to adjust as conditions change. This study examined the pharmacy work environment to understand how the organization and its staff adapt to changing demands and sustain safe outcomes while building system resilience into everyday practice. Thirty-six hours of observation were conducted at six community pharmacies, focused on staff roles, workflow processes, communication and coordination, tools and technology. Coding was guided deductively using resilience frameworks and then inductively to develop resilience narratives. Overall pharmacy resilience was characterized broadly by work system resilience, staff resilience, and opportunities for resilience. Resilience-related activities were performed by pharmacists, technicians, and even patients and included using tools/technology to maximize patient safety. Staff learned not only from failures but also from routine processes that produced successful outcomes. Representative quotes for each resilience feature are provided. Pharmacy staff demonstrated resilience numerous times during the observation period. A Safety-II approach is a useful data-driven way to improve medication safety.