Pan Assortment Pune Presentation By Sarmistha, Rachana & Preyesh

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Pan Assortment Pune Presentation By Sarmistha, Rachana & Preyesh

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Pan Assortment Pune Presentation By Sarmistha, Rachana & Preyesh

  1. 1. Case Study Rx for Improvement: A Case Study in an Outpatient Pharmacy n an era of ever-decreasing Jyme Arthur I staffing and that there is a 7% reimbursement for healthcare vacancy rate, while both inpatient services, increased fiscal restraint, and outpatient hours have and a very real shortage of critical increased (Pedersen et al., 2003; professionals, an urgent need ASHP, 2002). Prescription drug exists for imaginative approaches volume is predicted to grow about for increasing efficiency and 29% between 2000 and 2005, effectiveness in the delivery of while the number of pharmacists healthcare services. This case study is expected to increase only about describes one such effort pursued 4.5% in that time period (Eder, in the outpatient pharmacy of a 2002). large academic medical center in A recent American Hospital the Southwest. Significant changes Association publication indicated were introduced and sustained by that approximately 21% of institu- utilizing simple but innovative tional pharmacist positions are methods for involving an extremely currently unfilled (Anderson, 2002). busy work group in the problem Because of U.S. demographics, identification, root-cause analysis, there has been a 47% increase in the solution generation, and ultimate number of prescriptions filled since implementation of a major process 1992, but for the same period the improvement. number of licensed pharmacies has only grown by 2.9% (Parks, 2001). Review of the Literature In an astonishing note, buried in an annual report of retail pharmacies, Employee Satisfaction a chain of drug stores proudly Concerns regarding employee announced that it was rolling out satisfaction are particularly relevant “a one-half hour lunch program today, due to increasing volumes for pharmacists—perhaps the first of prescriptions and an alarming large chain in the nation to make shortage of pharmacists. Current this move” (Zappier, 2001). This research shows that there has been proud announcement, allowing an 8.5% decrease in pharmacy 36 THE JOURNAL FOR QUALITY & PARTICIPATION Spring 2005
  2. 2. pharmacists to actually take a lunch break, speaks to important interaction between the pharmacist and the frantic pace of the profession. Only technology has the patient (Eder, 2002). enabled the industry to keep up with the increase in volume, while the shortage of personnel continues. Technological Improvements By far the greatest efforts to improve the dispensing process have focused on technological solutions. “With Customer Satisfaction The increase in volume challenges the overworked the graying of America and increased prescriptions pharmacy staff to maintain job satisfaction, while relative to the flat growth in pharmacists, technology simultaneously trying to please their customers. One is critical to meeting the healthcare needs of the industry survey identified the community” (Parks, 2001). main factor in “choice of Additional technological The long waits for prescriptions pharmacies…is the time spent solutions involve electronic by pharmacists in counseling patient signature capture, were legendary, prompting the those patients, recommending barcode scanning of each technicians to inform customers ancillary products, and helping prescription, (Eder, 2002), to be prepared to wait up to them manage their disease.” hand-held personal digital Among the biggest drivers of assistant (PDA) use to transmit two to three hours. Both patient satisfaction are ‘friendly prescriptions via fax to patients and employees were and courteous pharmacists’” pharmacies (Parks, 2003), and highly dissatisfied. (Frederick, 2002). automated robotics, which The greatest area of customer can “automate the dispensing dissatisfaction in pharmacies is of 1,750 prescriptions per wait times. “Customers hate waiting 20, 30 minutes, hour” (Drug Store News, 2003). These technological or longer to pick up their prescriptions” (Fried, 1998). advances “relieve some of the stress level…and have More worrisome, “Today, a significant number of raised job satisfaction…” (White-Sax, 2003). A major stumbling block regarding adoption of these prescriptions written by physicians are never filled, programs is the need for multiple stakeholders to work often because patients do not want to wait...” (Health & together to reduce the time and cost of integrating Medicine Week, 2003). The literature is replete with ideas these systems...” (Drug Store News, 2003). Bringing all of how to make the wait less painful, such as developing the necessary stakeholders together to formulate an “Internet lounge” in the waiting area, (Drug Store optimum solutions, and more important, to guide the News, 1999). The pharmacist is caught between a need to implementation brings us to the core of the case study. spend time counseling patients, which delays filling the next prescription, thus contributing to the long wait. Case Study: Outpatient Pharmacy Improves Processes Environmental Enhancements The literature points to many attempts to ease Chartering a Team the dispensing process and reduce stress levels for Similar to situations cited in the literature, the pharmacists. The Brooks Pharmacy chain recently outpatient pharmacy in this large academic medical introduced a double-layer counter system (Zappier, center was faced with steadily increasing volumes of 2001). Rite Aid introduced a new pharmacy prototype prescriptions to fill, in a physical working environment that reconfigures the space and the workflow behind that hadn’t changed in more than a decade. While the pharmacy counter. The reconfiguration created significant technological enhancements had been significantly more work area, and positioned the implemented, such as bar coding and robotics for pharmacist as much as possible in front of the automatic prescription fill, the complaints about customer and away from the computer screen. The customer service issues continued to mount. The long pharmacy technicians work the drop-off area, and waits for prescriptions were legendary, prompting the enter the information into the computer system. This technicians to inform customers to be prepared to wait allows the pharmacist to fill the prescription and then up to two to three hours. Both patients and employees were highly dissatisfied. present it to the customer. This sets the stage for the www.asq.org 37
  3. 3. The medical center leadership requested that If benefit information is not captured upon the Office of Performance Improvement charter a registration, the process in the pharmacy is delayed Performance Improvement because the technicians (PI) team to undertake the must gather the informa- Since there were so many opportunities challenge of turning the tion and determine if the for improvement, the team decided situation around. As the medication reimbursement literature noted, bringing is included in the patient’s that the best approach would be to the multiple stakeholders plan. Therefore, the work on several areas in parallel. All together to work on team sampled the online solutions is essential. In demographic information the while, the focus of the team was to this case, the division for 50 randomly selected improve the patient satisfaction and head, the director, two patients to determine the employee satisfaction while focusing on supervisors, a physician, percentage in which benefit a clinic administrator, information was captured improving overall business processes. a representative from upon registration. Only pharmacoeconomics, 10% of those patients facilities management, were found to have that managed care, two pharmacists, and two volunteers information included. This was improved to 50% after (who were also former patients) were asked to serve implementing process changes. on the team. The team identified three elements of the project Root-Cause Analysis mission: A detailed root-cause analysis was performed with the PI team to identify process delays. Additionally, the 1. Improve patient satisfaction. team decided to involve the busy pharmacy staff itself • Reduce wait time. in the root-cause analysis by printing a customized • Improve patient satisfaction survey scores. fishbone diagram to be completed by each employee at • Reduce patient complaints. his/her workstation. One hundred percent participation 2. Improve employee satisfaction. was rewarded with a pizza party. The PI team also organized a roundtable discussion • Improve Work Environment Scale (WES) scores. with a large group of volunteers, who were also former • Reduce attrition. patients. The purpose of that gathering was to ask for 3. Improve business practices. more improvement ideas. • Improve collection of benefit information in patient registration, therefore increasing charge Where Do We Begin? capture. Since there were so many opportunities for • Decrease mean fill time. improvement, the team decided that the best approach would be to work on several areas in parallel. All the Baseline Data Collection while, the focus of the team was to improve the patient The team gathered baseline data for all three project satisfaction and employee satisfaction while focusing elements. The patient satisfaction scores were divided on improving overall business processes. As such, in into five general areas: handle financial issues, sharing the months that followed, the team succeeded in: information, caring attitude, wait time, and overall • Renovating the waiting area. satisfaction. These were rated on a 5-point Likert scale, • Remodeling the actual pharmacy work in which 1 was unsatisfactory, and 5 was very satisfied. environment. The WES was administered to establish a baseline • Opening an additional cashier’s booth. for employee satisfaction with their environment. The group scored higher than national healthcare workers • Ordering a point-of-sale system that provided on work pressure and lower than average on physical tracking of the transaction throughout the entire comfort elements. filling process. 38 THE JOURNAL FOR QUALITY & PARTICIPATION Spring 2005
  4. 4. Figure 1: Comparison: Baseline to Pilot Figure 3: Outpatient Pharmacy Patient Satisfaction Survey Follow-Up 100 Mean Score Strongly Disagree: 1 78.15 80 Minutes April 60 5 Strongly Agree: 5 1999 34.95 40 4 Nov. 3 20 1999 2 0 Feb. 1 Pilot Baseline 2000 0 Mean Fill Time June Handle Financial Caring Wait Overall 2001 Issues Information Time Figure 2: Individual Chart: Outpatient Pharmacy Mean Time to Fill Rx Figure 4: Outpatient Pharmacy Work Environment After 3/6 Scale Results Time to Verify in Minutes Significant Significant Decrease Increase in in Work Physical Pressure Comfort UCL= 8.00 69.420 A 7.00 B Mean= C 6.00 Average Score C 44.109 5.00 B A LCL= 4.00 18.798 1/03 1/05 1/07 1/11 1/13 1/18 1/20 1/24 1/26 1/28 2/01 2/03 2/07 2/09 2/11 2/15 2/17 2/22 2/24 2/28 3/01 3/03 3/07 3/09 3/13 3/15 3/17 3.00 2.00 1.00 Implementing revised pharmacy data screens for • 0.00 collection of patient insurance information. Involvement Co-worker Cohesion Supervisor Support Autonomy Task Orientation Work Pressure Clarity Managerial Control Innovation Physical Comfort Developing an electronic prescription order entry • system. Developing a “wait watcher” brochure to manage March 1999 5.89 5.83 5.94 6.28 5.39 7.56 5.61 4.50 4.78 2.67 • July 2001 5.16 5.6 6.6 6.12 5.8 6.04 5.92 4.92 5.92 6.56 patient expectations. No No No No No Yes No No No Yes Significant Establishing a permanent help desk staffed by • a=.05 hospital volunteers. 5.43 5.24 4.82 5.2 5.7 5.65 4.5 5.57 3.9 3.77 National Healthcare Workers Shifting staff schedules to accommodate daily • Dimension prescription volume fluctuations. Adding a telephone triage system to include Internet • access to the refill process. a baseline of 78.15 minutes to the pilot rate of 34.95 minutes, a reduction of approximately 44 minutes. Piloting an “express line” concept. • The Final Results The “Express Line” Pilot The pilot energized the entire pharmacy to work The express line was a simple concept. The process even harder on improvements. A chart was devised separated levels of prescriptions at the front window that plotted prescription fill times and volumes of into “fast fills” and “routines.” This involved providing prescriptions processed every day. These data were dedicated personnel to the express line process (one easily available electronically and were posted by the order entry technician and one pharmacist), and supervisors on a very large poster in the middle of increased staffing for an existing automatic dispensing the pharmacy. unit (robotics) from 8 hours to a full 12 hours. The PI staff helped the pharmacy staff to under- The results of the pilot were compelling, as shown in Figure 1. The overall mean fill time decreased from stand the project by “setting up shop” in a tiny alcove www.asq.org 39
  5. 5. in the back of the pharmacy to do PowerPoint pre- “Drug Emporium Looks to Ease Pharmacy Wait Time,” Drug Store News, February 1, 1999, Vol. 21 Issue 2, 4, pp.1-9. sentations about the data and the successes achieved to date. Everyone soon understood that a statistical Eder, R. “Chains Sharpen Pharmacy Efficiencies With Technology and New Designs,” Drug Store News, August 12, 2002, p. 63. shift in the mean of the fill time was the goal. When that day came, there were celebrations throughout “E-Script Service Expanded Through Partnership,” Health & the pharmacy. Medicine Week, March 17, 2003, p. 15. Figure 2 illustrates the statistical shift in the mean Frederick, J. “Diabetics Demand Personal Attention From Chain fill time from the 78 minutes to 44 minutes. That Pharmacy,” Drug Store News, March 25, 2002, p. 6. success was accompanied by the hoped-for statistically Fried, L. “New Rite Aid Commercials Highlight Pharmacy significant shift in patient satisfaction shown in Figure 3. Advantages,” Drug Store News, September 7, 1998, p. 3. Additionally, the repeat measure of employee Parks, L. “Chains Upgrade Technology, Increase Pharmacy satisfaction with their work environment in Figure 4 Efficiency,” Drug Store News, December 17, 2001, Vol. 23 Issue 18, showed significant improvements in physical comfort p. 62, 2p, 1c. and lessened work pressure. Parks, L. “Technology Unites Rx Operations,” Drug Store News, April 28, 2003, p. 103. Conclusion Pedersen, C.A., et al. “ASHP National Survey of Pharmacy Practice The staff continues to monitor volume and fill in Hospital Settings: Dispensing and Administration—2002,” times, and the pharmacy has increased improvement American Journal of Health-System Pharmacists, 2003, 60, pp. 52-68. activities to involve the staff in everyday “Kaizen” White-Sax, B. “Efficiency is Aim at Northwest,” Drug Store News, efforts. The experience in this pharmacy is an excellent April 28, 2003, p. 111. example of the importance of involving and energizing Zappier, A. “Technology is Key to Maximizing Pharmacy the “frontline” staff to participate in improving its own Efficiencies at Brooks,” Drug Store News, August 20, 2001, p. 59. work environment and performance, which, in turn, ultimately improves the service to the customer. Jyme Arthur has managed a group in the Performance References Improvement Office at M.D. Anderson Cancer Center Anderson, R.W. “Health-System Pharmacy: New Practice in Houston, TX, for the past six years. She was a Framework and Leadership Model,” American Journal of Health- System Pharmacists, 2002, Vol. 59, pp. 1163-72. director of education for large medical centers for 13 years, followed by a period as a management “Annual Report of Retail Pharmacy,” Drug Store News, August 20, 2001, p. 59. consultant. She has taught courses in leadership, change management, and innovation in an MBA program. Contact “Central-Fill Expansion is Prescription for Success,” Drug Store News, January 20, 2003, p. 52. her at jarthur@mdanderson.org. 40 THE JOURNAL FOR QUALITY & PARTICIPATION Spring 2005

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