Question

Case Study :

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 labeled 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.

1. What type of process is the above one: order-to-cash, procure-to-pay or issue-to-resolution?

2. Who are the actors in this process? Who is/are the customer(s)?

3. What are the tasks of this process?

4. What value does the process deliver to its customer(s)?

5. What are the possible outcomes of this process?

6. Taking the perspective of the customer, what performance measures can be attached to this process?

7. What potential issues do you foresee this process might have? What information would you need to collect in order to analyze these issues?

8. What possible changes do you think could be made to this process in order to address the above issues?

Answer 1

1. What type of process is the above one: order-to-cash, procure-to-pay or issue-to-resolution? Issue-to-resolution since it involves a series of steps wherein there is inventory check, certifying whether the prescribed drug is suitable for the patient(customer), communicating with doctor, checking insurance policy of individual customers, suggesting and confirming regarding substitute with doctor and patient, quality check. Thus, the process is detailed and aimed at providing best Medicine to the patient.

2. Who are the actors in this process? Who is/are the customer(s)? The actors of the process are the pharmacist and the staff at the pharmacy. While, patients are the customers.

3. What are the tasks of this process? - the tasks involve taking order, prescription and time of delivery from patient, checking stock, confirming it's suitability with customer past health record, discussing with doctor if required, checking insurance coverage of the patient, asking doctor and patient regarding substitute drug suitability as insurance policy and patient suitability.insurance check, physically collecting the drugs in a bag and sealing the bag with prescription stapled, quality check performed by pharmacist, handing over to customer and receiving payment in case the customer is not fully covered by insurance.

4. What value does the process deliver to its customer(s)?

The pharmacist not only confirms whether the prescribed drug is suitable for the patient but also confirms with the doctor regarding use of drug replacement to avail insurance coverage. Thus, the pharmacy exhibits a proactive role in catering customer's said as well as unsaid demands.

5. What are the possible outcomes of this process? - customer satisfaction, ensuring secured payment cycle I.e. ensuring the pharmacy receives payment, customer loyalty.

6. Taking the perspective of the customer, what performance measures can be attached to this process? - time to execute the order from prescription submission to payment receipt. This will be the total process time, as it will determine the customer wait time.

7. What potential issues do you foresee this process might have? What information would you need to collect in order to analyze these issues? - wait time is considerably longer. Also, due to this the customers opt to drop prescription in the morning or afternoon and collect it in the evening after work. Thus, they need to visit the pharmacy twice. Also, the entire process is human dependent, thus, there is scope for manual errors.

8. What possible changes do you think co uld be made to this process in order to address the above issues?

The confirmation of suitability of the drug can be done by the doctor. Also, checking for replacement drug in case of insurance policy coverage can be a proactive action. Payment cycle needs to be streamlined. If the entire process is made error free and perfect, quality check may be eventually eliminated. Also, the checking and verification with system must be software oriented.