The formulation of pharmaceutical policy is a critical component of healthcare planning, made more important given that medicines are the ubiquitous technology in the diagnosis, treatment and prevention of disease and constitute a significant proportion of health care expenditure. Pharmacists need to inform policy development that will, in its implementation, offer opportunity to deliver greater rationality, safety, effectiveness and economy to the medicines use process and where patients experience enhanced health outcomes. This is the second of two articles directed to this specific issue focusing on how policy and strategic change can be affected. This is discussed from three overlapping perspectives - from the point of view of skills, that is, the skills or tactics needed to be employed to effect change; secondly, from a structural standpoint in terms of what positional arrangements exist that could be positively exploited; and thirdly, the subject, particularly its relevance to the contemporary situation. These approaches are then exemplified through a worked example on medication safety and its application in practice.