Hospital pharmacy leader perspectives on advocating for clinical pharmacy services: A national survey

Abstract Purpose Although numerous research studies have demonstrated the positive impact of clinical pharmacy services, these benefits do not translate into sustained practice changes without support from hospital pharmacy leaders. Factors influencing leadership decisions to expand pharmacy services remained unclear. This study aimed to identify barriers to implementing pharmacy practice model changes and gain insights on potential methods of overcoming these barriers from the hospital pharmacy leader perspective. Summary We conducted a national, cross-sectional survey of hospital pharmacy leaders using the REDCap platform, distributed via email over three weeks between September to October 2025. The survey included questions about perceptions related to implementation of practice model changes, resources/evidence used to justify clinical positions, barriers to expanding clinical pharmacy services, and demographics of healthcare systems they represented. The survey included Likert-scales and open-ended questions. The primary outcome was types of evidence most compelling to justify clinical pharmacist positions. Secondary outcomes included resources currently in use for decision-making and perceived barriers. The survey highlighted key factors influencing administrative decision-making regarding the expansion of clinical pharmacy services and revealed significant barriers to justifying clinical positions related to knowledge gaps, underscoring the need for further research to develop evidence-based metrics that capture the comprehensive benefits that clinical pharmacists can offer. Conclusion This survey provided valuable insights into hospital pharmacy leader perspectives on resources and evidence needed to support expanded pharmacy services and justify clinical pharmacist positions. These insights can inform future research by ensuring that metrics that are both clinically and administratively significant are included in outcomes. Key points While clinical pharmacy services are known to improve patient care, their benefits do not lead to expanded and/or sustained practice changes without hospital pharmacy leader support. This cross-sectional survey of hospital pharmacy leaders identified perceptions, resources and barriers to justifying clinical pharmacist positions. This study highlights gaps in hospital pharmacy leader perceptions and knowledge, providing a foundation for developing evidence-based tools and targeted strategies to expand clinical pharmacy services, improve quality of care, and support clinician sustainability.