Exploring Pharmacy Service Factors Shaping Tertiary Care Hospital Service Quality in Karachi: A Qualitative Study

Abstract

Pharmacy services play a significant role in patient safety, cost management and operational efficiency in tertiary care hospitals. In low- and middle-income countries (LMICs), however, e.g. in Pakistan, pharmacists are frequently restricted to dispensing and procurement tasks. This underuse results in the lack of efficient use of resources, increased healthcare expenses, and the unattended chance to improve patient care. There is further complication due to the absence of qualitative studies that would entrap the understanding and experience of pharmacy-led practice by the key stakeholders in LMIC hospital environments. In the attempt to address this gap, the present research investigated the perception of pharmacists, administrators, and clinicians in tertiary care hospitals in Karachi. Guided by the Resource-Based View (RBV) and Scientific Management Theory (SMT), semi-structured interviews were conducted with 10 participants, and data were analyzed using a hybrid thematic analysis approach. Six major themes emerged: patient-centered care, operational efficiency, cost-effectiveness, clinical integration, communication and collaboration, and Intravenous-to-oral (IV to PO) therapy conversion. Stakeholders consistently described pharmacists as both strategic resources and operational enablers who improve safety, reduce wastage, and streamline workflows. The impact of this study lies in demonstrating that investing in and integrating pharmacy services can transform hospital performance in LMICs. Beyond cost savings and efficiency, pharmacists contribute to safer, more coordinated, and patient-centered care. These insights provide evidence for healthcare leaders and policymakers to strengthen institutional support, expand pharmacists’ roles, and design sustainable models of hospital pharmacy practice that can improve both organizational outcomes and patient well-being in resource-limited settings.