PHARMACY WAITING TIME

Reengineering and Automating Pharmacy Systems

How long is too long to wait for a prescription? With a trend of continual patient complaints about pharmacy wait times, this health plan needed an answer to this question. By understanding the relationship between wait times and satisfaction, the plan was able to focus on individual pharmacies in need of improvement. A comprehensive implementation of automated systems and reengineered work processed helped meet member requirements for prompt pharmacy service.

As early as 1990, this plan was concerned with wait times at its pharmacies. Expanded hours, employee flex time, and patient queuing systems failed to demonstrate more than a minimal improvement. A 1992 survey of its members showed that satisfaction with wait time in the pharmacy deteriorated dramatically for members who had to wait longer than 15 minutes. By 1994, member satisfaction had reached an all-time low in two of the nine clinic pharmacy locations. With clinic administrators progressively more concerned about these complains, the plan decided to intensify its efforts in attacking the pressing issue of pharmacy waiting time.

The targeted population consisted of all members with an encounter at an ambulatory medical center. The performance measure used was the percentage of patients who were satisfied with pharmacy waiting time. A survey was used to define satisfied patients as those giving a score of "4" or "5" on a 5-point satisfaction scale.

The plan used a sampling methodology to derive its measures. A random sample was selected for each of nine medical centers every other week. The plan collected and reported survey results by center and by quarter. The 1994 results varied by quarter and by center from a low of 36% to a high of 78%. The plan established its baseline of 60% from the 1994 third-quarter average of all clinics' satisfaction rates.

SEASONAL VARIATION Many health care processes show seasonal variation. Flu outbreaks, holidays, and school calendars can all result in a varying demand for health care services, and a variation in a plan's ability to respond. Appropriate quarter-to-quarter comparisons are needed to ensure that seasonal variation is not responsible for what appear to be meaningful changes. This plan focused on third-quarter results, to minimize the impact of seasonal variation.

After examining its baseline data, the plan set a performance goal of 85% of members satisfied with pharmacy waiting time. A benchmark was not established by the plan for this initiative.

To further understand the factors leading to dissatisfaction, the plan analyzed the member survey data by pharmacy. The plan found that two specific clinic pharmacies, "Clinic A" and "Clinic B," scored significantly lower on the satisfaction measure than the other clinic pharmacies.

Because Clinic A and Clinic B serviced approximately 40% of the plan's total population, their low satisfaction scores were particularly worrisome. A preliminary analysis of the situation showed that the two pharmacies in question were undersized for the volume of prescriptions being handled.

The plan decided to focus not only on plan-wide interventions, but also specifically on Clinic A and Clinic B.

Discussions between the director of pharmacy services and the pharmacy supervisors resulted in strategies that included maximizing the use of physical space, using staff more effectively, and providing additional staff training programs.

The process began in Clinics A and B with the redeployment of staff. Clerical technicians were deployed to deal with customers during high-volume periods. Pharmacy technicians working during the early morning shift were assigned the task of tracking down refill requests more than two days old. Other tasks, such as the breaking down of wholesale orders, bulk compounding, and cashing out, were scheduled during low-volume periods; one day per week was designated to replenish floor stock.

The telephone refill-request process was enhanced by implementing a voice-mail system. Counter space was freed up by using a cart to process mail-out prescription orders.

TARGETED INTERVENTION With two pharmacies experiencing greater dissatisfaction than the others, this plan was able to impact satisfaction by prioritizing its interventions at the poorly performing facilities. This targeted intervention was made possible by a survey methodology that ensured an adequate sample from each center and reported results by pharmacy.

The plan also implemented network-wide changes. An automated refill process replaced the previous manual system. This time-saving system allowed physicians to obtain online information. A computer enhancement of the plan's information systems also allowed the transfer of prescriptions from one pharmacy site to another, so prescriptions might be filled at alternate pharmacy sites.

To enhance an overall sense of responsibility for customer service, the plan set targets for patient satisfaction for supervisory personnel.

The first measurement, based on data from the third quarter of 1995, showed an overall satisfaction with pharmacy wait times of 73%. This represented a statistically significant improvement. Dramatic improvements at the two-targeted clinics improved the satisfaction rate at Clinic A to 59% and at Clinic B to 72%.

At Clinic A, a team comprised of the pharmacy supervisor, director of pharmacy services, center administrator, and a representative from the health plan's management engineering department was formed to look at barriers to improvement. They concentrated their analysis on space constraints, an increasingly difficult problem as prescription volume continued to rise.

Changes at Clinic A were geared to rethinking internal traffic, reconfiguring space, and addressing and managing waiting time on a day-to-day basis. The clinic changed its staffing schedule to meet growing demand. It implemented a real-time measurement system, with clocks showing pharmacy staff the current waiting time.

The clinic relocated large equipment to improve physical access to the pharmacy. It opened a separate pediatric pharmacy to decrease traffic at the main pharmacy. Mail-order pharmacy services were relocated to the pediatric pharmacy as another step to manage volume.

Additional terminals and laser printers were added to work stations to increase productivity and efficiency. The system's capacity was increased when prescription and call slips could be accepted by fax. A floating staff position was also created to supplement staff during peak volume periods according to priority and workload.

At Clinic B, changes were also made. Additional pharmacy sites were opened, and personnel were shifted to support this change. Mail-order prescription services were centralized to free up space. At the end of 1996, Clinic B moved to a new and larger facility to provide the ultimate solution to the problem of size and configuration of the physical plant. This, coupled with the opening of new facilities at other locations, decreased prescription volume to a manageable overall level of about 500 to 750 prescriptions per day.

Pharmacy hours at all clinics were expanded so that opening times was at 8:00 AM on weekdays and at 8:30 AM on weekends. Hours to for automated refill services were expanded in the early morning hours to increase accessibility, and the system was upgraded. To encourage the use of the voice mail and mail-order prescription services, fliers were distributed to members.

AUTOMATION Automated processes can greatly increase efficiency. Here, the automated refill process allowed physicians to garner information about prescription/refill history without having to request patient medical records. Attention to laser printers, fax machines, and voice-mail systems allowed staff to work "smarter."

The second remeasurement, based on third-quarter data from 1996, showed that the plan had exceeded its 85% goal of plan-wide satisfaction rating with pharmacy wait times.

The results for Clinic A improved significantly with a satisfaction rate of 86%. Clinic B also made significant positive gains in satisfaction, reporting an 88% rate.

The plan continued its interventions by rolling out a new cash register system that used bar code technology, speeding up the cash collection process.

Data from the third quarter 1997 showed a plan-wide satisfaction rate of 88%, with Clinic A reporting an 86% rate, and Clinic B an 84% rate. These results were not statistically different from 1996 data; the plan had maintained its improvement.

The plan's staff continues its efforts to maintain good access to pharmacy services with additional refinements and enhancements of the plan's existing systems. By focusing on automating processes when appropriate, and by constantly rethinking their resource needs and uses, this plan's staff successfully met their goal for this initiative.