Question

Customers drop off their prescriptions either in the drive-through counter or in the front counter of the pharmacy. Customers can request that their prescription be filled immediately. In this case, they have to wait between 15 minutes and one hour depending on the current workload. Most customers are not willing to wait that long, so they opt to nominate a pickup time at a later point during the day. Generally, customers drop their prescriptions in the morning before going to work (or at lunchtime) and they come back to pick up the drugs after work, typically between 5pm and 6pm.When dropping their prescription, a technician asks the customer for the pick-up time and puts the prescription in a box labelled with the hour preceding the pick-up time. For example, if the customer asks to have the prescription be ready at 5pm, the technician will drop it in the box with the label 4pm (there is one box for each hour of the day).

Every hour, one of the pharmacy technicians picks up the prescriptions due to be filled in the current hour. The technician then enters the details of each prescription (e.g. doctor details, patient details and medication details) into the pharmacy system. As soon as the details of a prescription are entered, the pharmacy system performs an automated check called Drug Utilization Review (DUR). This check is meant to determine if the prescription contains any drugs that may be incompatible with other drugs that had been dispensed to the same customer in the past, or drugs that may be inappropriate for the customer taking into account the customer data maintained in the system (e.g. age).

Any alarms raised during the automated DUR are reviewed by a pharmacist who performs a more thorough check. In some cases, the pharmacist even has to call the doctor who issued the prescription in order to confirm it.

After the DUR, the system performs an insurance check in order to determine whether the customer’s insurance policy will pay for part or for the whole cost of the drugs. In most cases, the output of this check is that the insurance company would pay for a certain percentage of the costs, while the customer has to pay for the remaining part (also called the co-payment). The rules for determining how much the insurance company will pay and how much the customer has to pay are very complicated. Every insurance company has different rules. In some cases, the insurance policy does not cover one or several drugs in a prescription, but the drug in question can be replaced by another drug that is covered by the insurance policy. When such cases are detected, the pharmacist generally calls the doctor and/or the patient to determine if it is possible to perform the drug replacement.

Once the prescription passes the insurance check, it is assigned to a technician who collects the drugs from the shelves and puts them in a bag with the prescription stapled to it. After the technician has filled a given prescription, the bag is passed to the pharmacist who double-checks that the prescription has been filled correctly. After this quality check, the pharmacist seals the bag and puts it in the pick-up area. When a customer arrives to pick up a prescription, a technician retrieves the prescription and asks the customer for payment in case the drugs in the prescription are not (fully) covered by the customer’s insurance.

The following issues have been identified for the process:

1. Sometimes, a prescription cannot be filled because one or more drugs in the prescription are not in stock. Customers only learn this when they come to pick up their prescription.

Answer 1

1. iThe itype iof iprocess

The iprocess idescribed iin ithe istudy iis iknown ias iorder ito icash iprocess. iAccording ito ivom iBrocke iand iSinnl i(2011), iorder-to-cash iprocess ithe iorder iis iimplemented iafter igetting ithe iorders ifrom ithe icustomers iand ithe icash iis ipaid ifully ior ipartially ito ithe ishopkeepers. iIn ithis icontext, ithe iorder iis igiven iby ithe icustomers iin iadvance iin imorning iand ithe iimplementation iof iorder iis idone iwithin i5 ip.m. iby ithe ipharmacist. iBetween ithat, iorder iis ichecked ithoroughly iin imultistage iprocess ifor iquality ienhancement. iThe ipayment iis imade ifully ior ipartially ito ithe imedicine ishops.

2. iThe iactors iin ithis iprocess

There iare itwo iactors iin ithis iprocess i– icustomers iand imedicine ishops.

3. iThe ivalue idelivered iby ithe iprocess ito ithe icustomers

The iprocess idescribed iin ithe icase istudy idelivers ivalue iof itime iand iprice ito ithe icustomers. iThe itime iis isaved idue ito iallowing icustomers ito ideposit itheir iprescriptions iin imorning iand ipharmacists ialso icheck iDUR iof ithe imedicine iwith irespect ito ipast idata iof ithe ipatient i(Zellner, i2011). iThis istep iensures ithat ipatients iwill inot ibe iaffected iby iany imeans idue ito iincorrect iprescription iprepared iby idoctors. iIt iprovides ivalue iof itime ias iwell ias ito iprice ias iit iis iuseful iin ichanging ithe idrugs iat ithe ivery ifirst imoment i(Storbacka iand iNenonen, i2012). i

4. iThe ipossible ioutcomes iof ithe iemployed iprocess

• i i i iThe ipossible ioutcome iof ithis iprocess iis ias ifollows:
• i i i iReduction iin icost iof ipurchase iof ithe ipatients
• i i i iDecrease iin iside ieffects iof imedicines
• i i i iTime isaving iof ithe icustomers
Cash isavings iof ithe icustomers idue ito iinsurance ichecking iby ithe ipharmacy ishop

5. iThe iperformance imeasures ican ibe itaken iin ithis icase

Customers ican imeasures ithis iprocess iin itheir iperspective iusing itwo ivariables i– itime isaving iand imoney isavings. i

6. iPotential iissues iand iessential iinformation ifor ianalyzing ithe iissue

The ipotential iissues imight ibe ipresent iin ithis icontext iare ias ifollows:
• i i i iSupplying iover idemanded imedicines iat i5 ipm
• i i i iUnavailability iof imedicines iin ipharmacy ishops
• i i i iChange iin iprescribed idrug
• i i i iCommunication iwith ithe icustomers iand idoctors

7. iThe ipossible ichanges ito icontrol ithe iissue

The ipossible ichanges iin icontrolling ithe iissues imight ibe ihelpful iin isupplying idrugs ito ithe icustomers. iThe ichange iin ithe iprocess iof iDUR ichecking iand iinsurance ichecking imust ibe iin isame iphase ias iif iany iincompatible iis iwatched iin iboth ithe icase ithen ipharmacists ineed ito icall ithe idoctor iand icustomers. iIf ipharmacists ihave ito icall itwo itimes ifor ia iprescription ithen iit iwill ibe ireally itime iconsuming iand icostly iactivity iin iview iof ithe ipharmacy. iTherefore, ito ireduce ithe icost iand isave itime iof ithe iprocess, iafter imaking ithe iboth ichecking, ipharmacists imust igo iforward ifor iresolving ithe iissues. iThis iwill ienable ithe ipharmacists ito ishadow ithe iunavailability iof imedicines iand ifurther, ithe irequired ichanges iin ithe iprescription iof ithe idrugs ican ibe idone iin ithis iway. iThe ichange iin ithe iprocess iwill ibe ihelping iin ireducing ithe ichances iof imiscommunication iwith ithe icustomers iregarding ithe ichange iin idrugs iand ialso imake ithe icommunication ieffective.

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