CT: Keith, IE isn't necessarily new to pharmacy. What's the take for pharmacists who may feel as if they've gone this route before?

Overfield: Well, Robin made a really good point that IE isn't just time and motion and direct observation studies. In fact, these probably aren't going to be very useful in most pharmacies. Where you'll find real value is when you start to think along the lines of humanizing the IE approach, and seeing how it can help you understand the human capital that makes pharmacies run. We need to see it as a set of methods that can support change management by helping you understand what you can do to empower your staff and get the most out of your technology.

CT: So what will pharmacists who want to use IE methods being doing?

Overfield: In my experience, when you look at all the activities, beginning when a prescription is received and ending with the pick-up transaction, there are probably 15 activities that will cover 99% of the activities that happen behind the counter, and these tend to be common to most pharmacies. How you accomplish these activities can vary, but what you need to do doesn't.

So the interesting part comes when you then ask: "What are the problems I'm trying to address?" The answers here depend on what you want to achieve, and having a clear idea of what that is. Once you've defined your problems, the next question is how do you quantify it? You will need to find out what the key metrics are for understanding how your pharmacy is performing.

The challenge is that when you are observing your business from inside your operation, it can be tough to see the forest for the trees. For example, in the CE, Robin asked how many pharmacists agreed that refills take much less time than new prescriptions. Most did.

In fact, an IE-based evaluation reveals that while some time is saved with refills because you don't have to enter the script into the system and engage with the customer at the counter, there's not that much difference in time required because most of the other steps are the same, whether it's a refill or a new script.  

CT: So the conventional wisdom isn't right in this case. Are there other good examples?

Overfield: Sure. Another example that illustrates this point is will call. Many pharmacies have identified will call as a major pain point in their operations. While that may be true, will call represents just 4 percent of total pharmacy work, and less than 20 percent of customer service time. So an investment to improve the efficiency of will call will have only a marginal impact on customer service.

Of course, the pressure of locating a prescription for a waiting customer can skew your perception. An objective look at your processes can help you clarify priorities and make investments in areas of your workflow that will yield the greatest return against your goals.

CT: OK, so benchmarking is very important. What are some resources for doing this?

Overfield: The first place most will look is the NCPA Cardinal Digest, which will tell you how the top-performing pharmacies are doing in terms of metrics such as labor dollars/rx, how many rx/total hours staffed, and a lot of good measures of operational efficiency against which you can benchmark against.

Then you've got to step outside your operation, and take an objective look at how your processes work and the time it is really taking to perform various functions.

CT: Keith, incidentally, the American Society of Consultant Pharmacists has just published the results of an operational benchmarking survey for long-term care pharmacies, which is available from ASCP's Web site at www.ascp.com/business. So then, once you've reviewed the studies, how do you put this into action?

Overfield: This is when your vendors can come into play. They can help you deploy solutions that will expedite progress toward the goals you've identified.

What's critical is that you are armed with your own metrics for evaluating technology and understanding the potential of a given solution to help achieve your goals.   In short, you'll be able to evaluate which technology investments will deliver the biggest bang for your buck.

CT: It certainly is ideal to be able to have a plan for your pharmacy that's based on solid research. But to make the effort and investment worthwhile, you really need to be ready to make changes in how your pharmacy operates day-to-day. That's usually easier said than done, right?

Overfield: Change management, it's not free, it's not easy. There's a statistic out there that says that 70% of management teams that have deployed change management processes say that they haven't gotten the value out of it they expected. There are huge rewards for change management, but it's a tough task to succeed at.

CT: Exactly. So offer busy pharmacists out there some advice.

Overfield: You need to ask yourself some hard questions. For example, how do you know you are open to change? Are you very clear about what you are trying to achieve? And then it comes down to having a specific business plan that is designed to take advantage of the changes you make. If you have a goal of freeing up a certain amount of time, know what tasks you'll assign that time to and who will do them. If you are looking for growth, then you have to have a plan and benchmark against which to measure growth and determine your return on your efforts. You'll want to be able to benchmark internally so that you can see in a year, say, how your investment has affected a few key metrics.

CT: There's a lot of work here, but really a lot of opportunity for pharmacists as well.

Overfield: Yes. And to be fair this whole process of change management isn't something that most pharmacists necessarily have any training in. It's not likely to have been a major component of their pharmacy education, if it's part at all. So if you can find the resources to educate yourself about creating change and identify the people who can help you do it, then you will distinguish yourselves from your competition by better managing the change you are making.