It is midday in Retail Zombieland, and the hordes relentlessly flock to our counter.

Amidst all this, a doctor calls into the pharmacy, wanting to prescribe Augmentin for a patient.

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“My patient usually fills across the street, but I want to call it in here; I can’t get through to anyone on the phone.”

I express sympathy for my fellow PharmD and also for the sick patient experiencing the delay.

More scripts for us, though. I reassure the physician that I will fill the prescription with all the quickness humanly possible.

I just need a claim reversal from the other pharmacy.

Luckily, I only endure 15 minutes of hold music on the prescriber line before the pharmacist answers.

He apologizes, transfers the antibiotic, and informs me he has “99+ problems” in his queue.

“Ninety nine plus?” I ask, perplexed. This phrase highly intrigues me because I know exactly what he means.

He doesn’t have 99+ problems; he only has one.

Bottlenecks in Workflow Equal Staffing Problems

In most corporate pharmacies, we work with highly efficient computer systems that prioritize our tasks by importance and urgency.

If we are late (even by a second) the dashboard lets us know. Usually by turning a color that displeases the eyes.

In order to avoid burning our retinas, we play the priority game. What’s coming up next, and how can we beat the time.

It’s fun, and metrics keep us honest with our productivity.

However, there are times when we get behind and can’t keep up with production and tasks.

The first scenario happens due to normal circumstances: the pharmacy experiences more than usual foot traffic and influx of prescriptions.

Payroll forecasting algorithms are powerful, but they also have limits. Technician hours never seem like enough.

Workflow backs up for a couple hours, and the team experiences some short term stress until it reaches steady state again.

The second scenario happens when the pharmacy leader on duty fails to lead his or her business: the pharmacy experiences any sort of disruption, and a bottleneck is created.

This ranges from onboarding a new trainee, customer complaints, regulatory inspections, or computer system changes and outages. Operations slow down, clog up, but do not recover in a few hours.

Nor does it after a few days. Constant, unchecked disruption causes 99+ overdue prescriptions to happen.

Overdue Prescriptions Aren’t the Problem

While late prescriptions can create customer dissatisfaction, focusing only on workflow will actually hinder you from fixing the real problem.

Similar to sinking in quicksand: the more you flail and flounder, the faster you sink.

The real problem starts from inaccurate triage of the prescriptions and tasks in workflow.

Simply put, when pharmacy teams treat all prescriptions and tasks as equally important and urgent, it feels like a never-ending black hole.

Ten overdue prescriptions can compound after a few phone calls, new waiters, drive-thru drop offs, and an insurance rejection.

All of a sudden, the cycle repeats, and now your team is paralyzed because there are 10 times as many tasks in front of them.

But not all of them are truly important; most are only urgent with the perception of importance.

Whoever is allowed to label the tasks is the one who ultimately dictates the pace of work.

Many times, the patient does so. But in reality, this is our job.

Imagine patients who seek medical attention from the hospital. Imagine if it was first-come, first-serve.

Or worse, what if the patient gets to decide which condition is the most important to treat?

With all the complexities of delivering safe and effective healthcare, it’s up to the practitioners to triage, or assign priority, to problems and tasks.

The added challenge of running a retail healthcare business like pharmacy is how to set the right expectations with the patient while doing so.

Therefore, the workflow is not the problem; the system is not the problem; the patients aren’t the problem.

It’s the leadership of the pharmacy team.

Think Short-Term and Long-Term

The first step in getting out of the quicksand requires you quit playing victim. Take off the goggles, look around, and promote awareness.

As the pharmacy leader, your job code requires you to manage operations and workflow. And right now, you’re sinking and need to react quickly.

You can only do this by communicating directly with your team. The first sign of a bottleneck needs to be addressed immediately to everyone it impacts: your technicians and your patients.

Getting slammed and backed up is normal. But if the patient is unaware, their expectations will beat you down.

If the technicians don’t understand the impact, their lack of urgency will be your ultimate demise.

After spreading awareness, the second step deals with root cause analysis.

Why is the bottleneck happening? Where is it happening? What patterns can you uncover? If workflow has stopped, is it due to normal fluctuation in foot traffic? Is a technician not pulling their own weight at their workstation?

Is the pharmacist constantly being pulled away to fix problems and unable to verify? Ask yourself, “Why?” Then, continue to ask yourself the same question 4 more times.

Five Why’s will help you get closer to the root of the real problem. Ninety nine plus problems can all be traced back to one or two root causes.

Lastly, the third step requires assessment of resources, both intangible and tangible.

Resources are finite, and our jobs as business owners require us to think long-term when tapping into budgets. Payroll budget, staffing availability, and strategic allocation will solve most problems.

Are you over or under payroll? Does your script count and foot traffic warrant a flex in hours? What personnel can be shifted or added to workflow?

How severe is the problem to the longevity of your team and business? Think long-term and assess whether you need to borrow resources now and pay back later.

Managing and Developing Your Team

At the end of the day, you can only re-allocate and strategize so much.

Overspending never solves any problems in the long run because we are responsible to run profitable businesses. And human resources are our most expensive assets.

Therefore, good pharmacy leaders realize how important developing our talent is.

The very best Corporate PharmD’s not only strategize, solve problems, and optimize resources, but they also invest in developing people to proactively defend against disruption to workflow and operations.

Technicians that understand how to triage, set proper expectations, and communicate with one another are invaluable.

They are able to catch and solve problems early before they become bottlenecks and require pharmacist intervention.

Verbal de-escalation, insurance adjudication, and multi-tasking are all important skills that they are responsible for demonstrating.

The Corporate PharmD takes time out of her day to invest and impart this knowledge and inspiration to the team.

In doing so, the pharmacy stays resilient and adaptable in the face of adversity. They stand tall, unwavering before the onslaught of post-holiday Mondays and rush hour.

They laugh at workflow disruption because the dashboard does not control them.

The ninety nine plus problems become one manageable problem, one that doesn’t even require the pharmacist to lift a finger.

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Business Tips from The Corporate PharmD

  • As the leader on duty, assume complete responsibility for workflow and operations
  • Teach your team how to triage and set the proper expectations for delivering safe and effective healthcare
  • Conduct root cause analysis, assess all available resources, and strategize before executing solutions
  • Balance short term business needs and long-term implications when making decisions

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