Workflow Management Is Critical for Everyone

Color Coded Urgency for Prescriptions; Courtesy: J&D Pharmacy

Ghada Abukuwaik, RPh, at CureMed Pharmacy in Clifton, NJ

In a competitive environment, it’s more important than ever for independent pharmacies to increase patient care and decrease costs. They cannot afford high overhead costs or inefficiencies behind the counter.

“Today, pharmacies have to be at the top of their game,” says Ryan Summers, PharmD, owner of Summers Pharmacy in Clinton, MO.

At the same time, patients expect more from their pharmacies. “Patients don’t just compare pharmacies to other pharmacies,” Summers says. “They compare us to nonpharmacy organizations that have a high level of customer satisfaction.”

One important way to improve customer service and staff efficiencies is to incorporate a workflow management process. The pharmacy will be more organized. Prescriptions will be filled by priority. Technicians and clerks will have a better sense of their individual responsibilities.

From the patient perspective, workflow management helps improve medication safety since there is an orderliness to filling prescriptions. The pharmacist, because he or she is less involved in the filling of prescriptions, has more time to counsel patients about their medications, which can lead to improved adherence and less side effects. 

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“Workflow management is important to both the pharmacy staff and patients,” says Stephen A. Brown, JD, PharmD, adjunct professor in the Department of Pharmaceutical, Social, and Administrative Sciences at Samford University in Birmingham, AL. “With the correct workflow management process, pharmacists and nonpharmacist personnel can operate at the top of their abilities. There is a sense of well-being among the staff.”

Many software programs are available to help independent retail pharmacies implement a workflow management system-each distinct in their own way. But they have a number of common traits:

• Each system clearly orders and prioritizes the tasks at hand,  from the time the prescription comes into the pharmacy through to checkout. 

• Employees, whether they are pharmacists, technicians, or clerks, know their individual responsibilities during their shifts. 

• Prescriptions are prioritized so the pharmacist knows which ones to verify immediately and which can wait. 

• There are checks and rechecks to ensure the proper medication is getting to the right patient. 

“The main objective of workflow management is to align the team,” says Ghada Abukuwaik, RPh, president and head pharmacist of CureMed Pharmacy in Clifton, NJ. Employees better understand what they’re doing and the tasks they are expected to perform. “It’s essential to running a successful pharmacy.”

A successful pharmacy breeds customer trust. “The last thing you want as a pharmacist is to have customers watching as the staff tries to locate their prescriptions,” says Michael Fapore, RPh, owner of The Medicine Shoppe in Somerset, PA. “Workflow builds patient confidence.”

Before Implementing Workflow, Do Your Homework

When Michael Fapore, RPh, decided to implement a new workflow management system in his pharmacy, The Medicine Shoppe, in Somerset, PA, he stressed patience with his staff. “I’m glad I did because we had some rough times at first,” he says.

Part of those rough times stemmed from the fact that his old software program could not support the improvements in the pharmacy’s workflow that Fapore wanted, despite assurances from the developer that it could.

The results were not pretty. 

“The day we opened, we had a mess,” Fapore says. “The system wouldn’t work as we wanted.”

Fapore and his staff were able to muddle through on a temporary fix for several months before he purchased a new software program that could accomplish everything he wanted.

Once the new system was implemented, Fapore began to see the changes in patient safety and staff efficiencies he had envisioned through workflow management. 

While it was a tough lesson, Fapore learned that there must be demonstrable proof that a software program can handle the type of workflow management system the pharmacist wants. 

“The first thing I would tell [pharmacists] is before they start, make sure their software can support the objectives,” he says. “Demand a demo to make sure it will work the way they want it to work. We did not do this, and it made it a lot tougher for us in the beginning.

“We found out the hard way that not all computer systems are set up to manage workflow,” Fapore maintains.

Greater Confidence in Patient Safety 

Patient safety was the No. 1 issue that prompted Fapore to implement a new workflow management system. 

In the old workflow system at his pharmacy, the pharmacist would enter all data into the computer, and the technicians would count, fill, and place the prescription at the end of the counter for the pharmacist to check. With a large amount of prescriptions coming in at any one time, Fapore wasn’t always sure at the end of the day that everything was done correctly. “It was hectic,” he says.

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In the new system, the process of filling prescriptions is broken down into various subsets. Technicians, working at their own workstations, know their individual responsibilities-entering prescription information, assembling the prescription or troubleshooting insurance questions.

There are several safety checks before the prescription gets to the pharmacist for a final check. For example, the technician filling the prescription identifies the medication by bar code. The system prevents the prescription from being filled if the incorrect bar code is scanned. 

When the medication gets to the pharmacist for the final check, its image appears on a computer screen, along with its drug utilization review data. “This is something the old system did not have,” Fapore notes. “It’s a big plus for patient safety.”

Repetitive mistakes are less common with the new workflow management system. That’s not to say mistakes are a thing of the past.

“We usually catch something every day, and although 99% are minor errors, we are able to correct them and educate our staff to reduce these errors in the future,” Fapore says.

When there is a mistake, Fapore can see where it occurs, and he can discuss the steps to take to avoid similar errors in the future with the responsible employee.

The new system gives Fapore peace of mind. “I want to be confident that all prescriptions are correct,” he says. “I know there is no guarantee we will be mistake-free. However, our new workflow management system gives us the best opportunity to safely deliver prescriptions to our patients.”

Building a Better Operation

Independent pharmacies have to offer an array of services that appeal to the customer to remain competitive, says Summers, who opened Summers Pharmacy in 2013 after being employed at large retail chain. He has since added five more pharmacies through acquisition or openings

While offering more services sets independents apart, it creates challenges that can only be overcome with proper workflow management procedures, he points out.

“There are so much more that employees have to learn and be able to do in an independent pharmacy,” Summers notes. “To take care of patients today, there has to be more services such as multidose packaging and medication synchronization. Each service offered is another point where employees have to be trained and another point where something could go wrong.”

Workflow management makes other changes easier, he adds. “It’s much easier to add systems, services, and processes, as well as to make adjustments, when there is a workflow process. There is no worry that employees will feel stressed, overworked or overloaded when we add to our customer offerings.”

When Don Grove, RPh, was building his new store, J&D Pharmacy in Warsaw, MO, a decade ago, he experimented with workflow, even though he was unfamiliar with the concept. But he had a vision of how he wanted the pharmacy to operate. “I was mentally doing workflow,” he says.

He designed a system that includes inventory carousels, prescription bags that hang instead of being placed in bins, separate pharmacy and technician workstations, video counseling kiosks, and urgency color-coded transparent bundling bags. At the same time, the pharmacy was redesigned to reduce interruptions by patients and allow for more transparent interactions among employees.

Grove’s goal is to make it possible for one pharmacist to fill as many as 400 to 500 prescriptions a day.

As a result of the workflow management system, J&D Pharmacy achieved what Grove refers to as a “double oxymoron.” Not only was there an increase in volume, but also in accuracy and employee satisfaction. “It isn’t easy to achieve an increase in all three,” he stresses. 

Involving Employees

Employee buy-in is critical. Without it, there isn’t much chance that workflow management, or any new system, will succeed. Buy-in might be the hardest part of implementing a workflow process, Summers says.

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While buy-in can be reached in different ways, with or without employee input, the workforce needs to be brought into the process at an early stage. Every employee should know why workflow management is important and its ultimate goals once implemented. 

Pharmacists will find that some employees will resist change for as long as possible. “Change is hard,” Summers says. “Employees have to be able to trust the process. Sometimes, that’s not the easiest thing.”

One aspect is that employees must come to terms with no longer being able to pick and choose the tasks hey perform. For a workflow management system to be successful, technicians and clerks should know all tasks and responsibilities. “They need to be able to step into someone else’s role without a loss of productivity,” Summers notes.

Regularly scheduled meetings with staff to discuss successes and where improvements can be made ensures that buy-in will continue long after implementation. 

“Our team preferred to be on the same page in terms of goals and productivity numbers,” Abukuwaik says. “They wanted to see our progress and discuss the next goals, and they wanted to know how they could raise their own productivity scores. The meetings gave our team members a sense of ownership in mastering workflow management.”

In the day-to-day work of the pharmacy, workflow management delivers improvements. 

“The system really helps with the relationship between the pharmacist and technicians and clerks,” Summers says. “Everyone knows what they’re supposed to do. It makes for a great workplace environment.”

Enhancing Customer Service

Customer service is paramount. The traditional view of customer service is based on quick, reliable, and accurate service.

The customer has been to the doctor’s office, sometimes waiting for a long period of time before being seen. Or they have sick children, or they themselves are sick. Whatever the case, they don’t want to spend a lot of time in the pharmacy.

“Our main goal is to get them in and out as quickly as possible,” says Max Caldwell, PD, owner of Caldwell Pharmacy in Wynne, AR. “But in a high-volume store, pharmacists must utilize as much technology as they can to make that waiting time as short as possible.”

Workflow management allows independent pharmacists to extend customer service into the area of counseling. Because the pharmacy’s workflow is orderly, where technicians and clerks take care of their areas of responsibilities, pharmacists have the time to counsel patients.

“We have time to visit with our patients,” Caldwell says. “We can do whatever we can to take care of their needs for OTC and prescription products.”

In-depth counseling-more than just repeating label instructions-can mean better medication adherence, fewer side effects and improved safety, because patients will have a better idea of how to take their medications properly. There is also time for follow-up conversations to discuss any other medication issues.

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“The pharmacist can counsel patients who haven’t started taking their medications because they’re afraid of the side effects, or point them in the right direction if there are side effects,” Summers says. This type of customer service not only can improve the health of the patient, it can create a patient-pharmacist relationship based on trust. “If we can meet the expectations that scripts are filled quickly but also provide high-quality counseling, then we have satisfied patients,” Samford’s Brown stresses. Patients will come back and grow to appreciate the role of pharmacists and staff in improving their health. 

“Workflow management is the key,” he adds. “It makes the dispensing quicker and frees up the pharmacist for quality patient interactions.”