March 19, 2019
Inside: Every minute gained is dollars gained. Learn what one expert says about making your pharmacy workflow more efficient.
Drop off, input, fill, verify, dispense.
Everyday pharmacy workflow may seem straightforward, but every pharmacy does it differently. And many pharmacists don’t actively think about how to make improvements.
Without putting additional, meaningful thought into your workflow, your business can become inefficient, inaccurate, and can even drop in Star Ratings, according to Jake Galdo, Pharm.D., BCPS, CGP, clinical assistant professor at Samford University in Birmingham, Ala.
“I think the biggest thing is just putting quality into the workflow,” Galdo said.
The most common workflow mistake is not having clearly articulated—and written—standard operating procedures, Galdo said. Creating codified operating procedures ensures that each employee understands his or her role in the pharmacy, and how to execute that role in harmony with the rest of the team.
“If I’m the pharmacy owner or the manager, and I don’t tell you how I expect you to work or what your job description is, then it’s going to be chaos,” Galdo said.
How detailed your operating procedures need to be depends on your pharmacy’s size. A pharmacy with 100 employees will need more specific procedures than a location with just one pharmacist and one technician.
Depending on the size of your location, the kinds of tasks outlined in your manual will vary. For a smaller staff, you may only need to outline large responsibilities, such as assigning an employee to be responsible for inputting prescriptions and describing when that changes based on volume of fills. A larger staff may need more specific procedural guidelines, such as what greeting to use when answering the phone, which Galdo said is similar to what’s found in manuals at national chain pharmacies.
“It’s like a cookbook,” Galdo said. “That way everybody knows what’s in their scope of practice.”
Once you create and implement your standard operating procedures, and make them available for employees to reference, Galdo suggests reviewing them once a year, or when you hire a new employee.
Thinking that your workflow can’t get any better is another big mistake pharmacy owners and managers make. Without improvement, operations grow tired and stale.
Once you do make the effort to institute change, it’s equally important, Galdo said, to practice what you preach.
“If I’m the owner, or I’m the manager and I’m trying to tell my workers that we need to change, I can’t force that on them. It needs to be something that I believe in as well, and that I’m willing to adopt, too,” Galdo said.
Once you’ve created and implemented your standard operating procedures, it’s important to follow them carefully. Galdo said the best way to give the new workflow procedures legitimacy is to lead by example.
“If you always make exceptions to what you’ve established, then you really haven’t established anything,” he said.
Take a hard look at your workflow and don’t be afraid to mix it up—even if that means going against the norm.
For example, Galdo said to consider having a pharmacist do the inputting, instead of a technician.
“When I work at a pharmacy that has a pharmacist doing the inputting and dispensing drugs, I absolutely love it,” Galdo said. “He knows why the patients are on what therapy. He knows what they’ve tried in the past. He knows who to counsel and how to counsel them—it’s a very efficient system.”
Also worth considering is how to incorporate clinical services into your workflow.
One option for integrating clinical services is to have technicians complete patient-intake for medication therapy management (MTM). The technician records the patient’s symptoms, gets his medication list and reviews his medical records. Then, the pharmacist completes the visit.
“That’s very similar to how physicians practice in the clinic setting,” Galdo said. “You have a nurse who checks your blood pressure and talks to you about your medication, and then the physician comes and talks to you.”
If you want to improve your workflow, Galdo advises thinking about what outcome you want to achieve and how workflow can help. Then, work toward that outcome by monitoring and tracking your outputs to see what adjustments you need to make to meet your goal.
For example, your goal could be to get each prescription from drop off to dispensing in seven minutes. To reach that goal, track how quickly you can dispense a prescription, and then identify barriers preventing you from reaching your goal time for every fill.
“You set an idea of, ‘This is what I want to do; this is my goal,’ and then you fix it,” Galdo said.
Tracking is key, no matter the goal. Every pharmacy should look at eliminating waste in order to improve workflow, Galdo said, and one way to do that is to increase efficiency by measuring—and monitoring—your cost of dispensing.
Measure your cost of dispensing by dividing all of your expenses by the number of prescriptions filled in a given period of time. “That tells you how much money you’re spending to get one drug out the door,” Galdo said.
Then, use that number to improve your workflow by eliminating waste wherever possible.
“I worked in a pharmacy that was co-located as long-term care and retail. Long-term care probably generated about the same amount of money as the retail, but retail had eight pharmacists and long-term care had two,” Galdo said. “We could have saved money on the retail side by putting some of those pharmacists in the long-term care side. We would’ve been able to dispense those drugs faster, which would have cut down our expenses.”
Galdo also advises pharmacy owners to make changes gradually, so they can pinpoint which operational tactics are working—and which aren’t.
“You don’t want to do a thousand things at once,” he said. “You want to do one thing at a time, and look at the impact of that one thing.”
To a large degree, workflow is having the right drug at the right time for the right patient. Galdo said effective inventory management not only improves workflow, but prevents unnecessary costs, too.
Many unnecessary costs come from ordering too much and having to pay to return the drugs to the wholesaler.
“I was talking to a pharmacist recently and their pharmacy paid $10,000 to return overstock to their wholesaler in the last fiscal year,” he said. “That $10,000 is an expense, and if you cut that expense out, then it’s all net income.”
One workflow strategy to prevent the problem of over-ordering is the appointment-based model, which helps patients stay adherent to their medications by synchronizing their refills to a single day each month, and it allows the pharmacist to know what to order and when.
“If you know you need to order this expensive Sovaldi® or this expensive Tobi® or Atripla®, you get it and have it in stock to dispense it that day or the next day, as opposed to leaving all these random baskets hidden throughout the pharmacy because they all have partial fills,” Galdo said.
Adopting the appointment-based model, is also a prime example of using workflow to meet a larger goal.
Pharmacists today know the importance of Star Ratings, quality measures set by the Centers for Medicare & Medicaid Services (CMS), and meeting the metrics defined by them.
“The appointment-based model is a great example of changing workflow to both meet Star Ratings’ metrics and to improve your business,” Galdo said. “You’ve changed workflow in the fact that you’re planning ahead on what medications you’re filling and when. And, you’re improving adherence because you’re pre-selecting patients to sync all of their medications and having them come in and talk to you.”
“We shouldn’t approach Star Ratings as something that’s burdensome,” Galdo said. “We need to approach it as something that can be built into our workflow and how we practice, so that what we do is quality—we’re not just striving to achieve a metric.”
PBA Health is dedicated to helping independent pharmacies reach their full potential on the buy side of their business. The company is an independently owned pharmacy services organization based in Kansas City, Mo., that serves independent pharmacies with group purchasing services, expert contract negotiations, distribution services, and more.
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