Transitions in pharmacy practice, part 5: walking the tightrope of change.

A systematic process for reformulating the practice-related attitudes and values of pharmacists to help them adapt to a new practice model is described. The key to motivating pharmacists to commit to practice change lies in fostering a change in intrinsically held professional attitudes and values, not in emphasizing a structured extrinsic reward system. As a systematic process by which managers can motivate their staff to change attitudes and values, the authors offer a customization of the taxonomy of learning in the affective domain proposed by Krathwohl, supplemented by contributions from the literature on the diffusion of innovation, dissonance theory, the transtheoretical model, and instructional psychology. Krathwohl's taxonomy shows affective learning as a five-level hierarchy with stages within each level. Managers can guide practitioners through the first four levels. Practitioners who have been socialized for the distributive model and who then adopt a new practice model such as pharmaceutical care will start by simply receiving information about the new model. Next, they will actively respond to learning about the model and begin to value it as desirable. As their regard for the new model grows, they will reorganize practice priorities. Managers can help pharmacists adopt a new practice model by guiding them through stages of attitude and value formation.