Question

Tutorial 11

Topic

Business process redesign

Questions

(Re-)read Exercise 1.6 about the pharmacy on page 30 of the textbook, Foundations of Business Process Management 2nd Edition.

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.
2. Oftentimes, when customers arrive to pick up the drugs, they find out that they have to pay more than what they expected because their insurance policy does not cover the drugs in the prescription, or because the insurance company covers only a small percentage of the cost of the drugs.
3. In a very small number of cases, the prescription cannot be filled because there is a potentially dangerous interaction between one of the drugs in the prescription and other drugs that the customer has been given in the past. Customers only find out about this issue when they come to pick up the prescription.
4. Some prescriptions can be filled multiple times. This is called a “refill”. Each prescription explicitly states whether a refill is allowed and if so how many refills are allowed. Sometimes, a prescription cannot be filled because the number of allowed refills has been reached. The pharmacist then tries to call the doctor who issued the prescription to check if the doctor would allow an additional refill. Sometimes, however, the doctor is unreachable or the doctor does not authorize the refill. The prescription is then left unfilled and customers will only find out when they arrive to pick-up the prescription.
5. Oftentimes, especially during peak time, customers have to wait for more than 10 min to pick up their prescription due to queues. Customers find this annoying because they find that having to come twice to the pharmacy (once for drop-off and once for pick-up) should allow the pharmacy ample time to avoid such queues at pick-up.
6. Sometimes, the customer arrives at the scheduled time, but the prescription is not yet filled due to delays in the prescription fulfilment process.

For each of these issues:

1. Discuss and explain what redesign and other improvements might be able to be made in regard to the issue for the pharmacy process. As a starting point, try considering the eight process redesign heuristics that were covered in the lecture: Parallelism, Case-based work, Activity elimination, Empower, Case assignment, Triage, Flexible assignment, and Centralization. However, do not limit yourself to these heuristics, as there are many more that could be considered (for a formal list, see Appendix A in the textbook, but you are more than welcome to propose improvements of your own that may or may not match up with the heuristics).
2. Consider how the redesign and other improvements you have proposed will affect process in terms of the Devil’s Quadrangle, and in particular in regard to the other issues identified.

Answer 1

1.   Discuss and explain what redesign and other improvements might be able to be made in regard to the issue for the pharmacy process.

Taking into consideration the point of view of the customers, the following performance measures can be further attached to the process:

·     Insurance checking before Drug Utilization Review (DUR):

The insurance checking should be done before the DUR so that in case, a drug is not available or the DUR shows an incompatible case then the pharmacy can suggest proper on time replacement.

·     Production/ Inventory:

Information must be circulated to the customers if the drugs is not available in the pharmacy so that they can take necessary suitable actions in good time.

·     Data Entry:

Technician only check the prescription just an hour before the pickup time. So in case of increased workload, the technician might not be able to address the all the processes and inform customers that the drugs is unavailable. This can lead to inefficiency and customer dissatisfaction.

2.    Consider how the redesign and other improvements you have proposed will affect process in terms of the Devil's Quadrangle, and in particular in regard to the other issues identified.

The potential issues that can be foreseen in the process include but are not limited to:

·     Drop Off:

If there is not any technician available to receive or recollect the prescription, then it might be a problem for the customers to schedule the pickup time. To keep a check on this, either at least one technician must be present or a self-drop-box can be installed.

·     Data Entry:

Checking out the prescription just one hour before the pickup time is insufficient to handle every process and complete the order.

·     Poor communication channel with customers:

There isn't any proper way to inform the customers about drug's shortage. The insurance checking is done while customer is not available. So, in case if the amount of bill is too high and the insurance company doesn't cover it completely or partially, then there is no way to apprise the customer whether they want to pursue the purchase or quit it.

·     Service Issue:

Time spent on waiting for the doctors or the technicians can be tiring.