Consider the following process at a pharmacy.
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.
Exercise 6.9 Write an issue register for the pharmacy prescription fulfillment process
Described above . Analyze at least the following issues:
• Sometimes, a prescription cannot be filled because one or more drugs in the prescription
are not in stock. The customer only learns this when they come to pick
up their prescription.
• Oftentimes, when the customer arrives 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.
• 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. The customer only
finds out about this issue when they arrive to pick up the prescription.
• Some prescriptions can be filled multiple times. This is call a “refill”. Every 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 the customer only finds it out
when they arrive to pick-up the prescription.
• Oftentimes, especially during peak time, customers have to wait for more than 10
minutes 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
• Sometimes, the customer arrives at the scheduled time, but the prescription is not
yet filled due to delays in the prescription fulfillment process.
When making assumptions to analyze these issues, you may choose to equate
“oftentimes” with “20%of prescriptions”, “sometimes” with “5%of prescriptions”
and “very small number of cases” with “1%of prescriptions”. You may also assume
that the entire chain of pharmacies consists of 200 pharmacies that serve 4 million
prescriptions a year and that the annual revenue of the pharmacy chain attributable
to prescriptions is € 200 million. You may also assume that every time a customer
is dissatisfied when picking up a prescription, the probability that this customer will
210 6 Qualitative Process Analysis
not come back after this experience is 20 %. You may also assume that on average
a customer requires five prescriptions per year.
Taking the issue register as a basis, apply Pareto Analysis to determine a subset of
issues that should be addressed to reduce the customer churn due to dissatisfaction
by at least 70 %. Customer churn is the number of customers who stop consuming
services offered by a company at a given point in time. In this context, this means
the number of customers who stop coming to the pharmacy due to a bad customer