George’s Corner: January/February 2014 

Making sure work flows instead of stumbles can make huge differences in your day. Every pharmacy needs workflow analysis on at least an annual basis. There are some easy things you can do if you take a few minutes to do them. 

My favorite involves a ladder and a clipboard. Get a 5- or 6-foot ladder that you can sit on top of. Grab a clipboard and a pad of paper and pencil. Set the ladder up in a corner of your pharmacy where you can sit up there and see what is really going on. The ladder is important, because you will get an overall view of your operation while not being involved in it (because you are on the ladder). 

Stay on the ladder for at least 20 minutes. Make notes. Don’t try to remember — you will forget some important things. Let your staff know that you are not looking for faults in what they do, just faults in the system (or lack of) that is being used. Focus on how things flow in your pharmacy — from the point of receiving a task through to its completion. 

Things to Look For 

Are the telephones where they are handy for those who use them? Are telephone wires being ducked under, wiping the counter, tangled up all the time? How can that be fixed? Do the telephones get answered promptly? 

Are they handy? It’s bad if someone has to take a few steps or turn around to toss a scrap of paper. Having several small baskets at strategic points and that get emptied often is much better than one big one that you have to make a careful aim for every time you have a scrap. 

Is stuff getting piled up at some locations? Figure out how to spread things out and keep them organized so that you can rapidly find things that need immediate attention. 

Fast movers:
I have seen pharmacies that have only four or five fast movers separated from the rest of the stock and some that have decided that half of the stock are fast movers. There should probably be about 15 to 20 that can be reached without moving more than a step or two (or turning around). 

Counter depth:
Deep counters are better, especially if you put a shelf or two at the back of the counter where you can easily reach (without turning) things you need often, like fast movers, Rx pads, and note paper. And keep other things in reach below those shelves. 

Empty vials:
Are the most-often-used ones right there where you can get them without even looking, much less opening and shutting a drawer? 

Waiting pieces of paper or other waiting things:
Do you have a system for keeping them in order? Does everybody use it? Any one person should be able to leave his or her station, and the others should be able to find things when that long-awaited phone call comes in. 

Paper clips and clothespins:
I still like to use clothespins to hold pieces of paper together. Color-coded clothespins are even better — bright red for STAT stuff, dull green for wait-till-tomorrow stuff. Get plenty of them. You don’t want to run out and make a busy day even worse. Paperclips are cheaper. If you do use them, set up big magnets to toss them to. That’s more fun. 

Are you still on the ladder? Good. Take those notes down and implement the easy changes first. The harder ones are usually the most disturbing to people (including yourself) who have been doing it the old, bad way for years. 

Remember that the objectives are: 

• Make it easier. 
• Make it faster. 
• Reduce congestion. 
• Reduce wandering around. 
• Make it all more accurate.

I once saw a very busy pharmacy where just about everybody was sitting down and staying seated. The only people walking around were stock clerks who pulled stock, shelved stock, emptied wastebaskets, and filled vial bins. Every now and then there would be a volleyball-type rotation to a different station to keep things interesting. Work flowed. 

I discovered the ladder method many years ago when I took over a pharmacy that did not have good workflow. I knew there were problems but I could not identify them, much less fix them, while being in the midst of them. I got a ladder out of the back room, climbed up on it, and was surprised by what I saw. The simplest thing involved wastebaskets. There were two. Each was about three feet from the primary workstation. My workflow was being interrupted by deciding which wastebasket to use, wadding up the paper to the right density, taking careful aim, tossing, and picking up the missed tosses. I removed a drawer that was right below the workstation, put a box in the empty space beneath the drawer slot, and began tossing scraps into the vacant drawer slot. It made my day. 

Are you still on the ladder? Good. Take those notes down and implement the easy changes first. The harder ones are usually the most disturbing to people (including yourself) who have been doing it the old, bad way for years. 

I did other things as well. The point is that the easiest and most satisfying may not be seen until you climb on the ladder. Do it. You will be amazed by what you see. 

Do you and your staff spend too much time looking for things? Put them in order. Integrate them alphabetically, by the biggest name on the label. Do not put the gabapentin where the Neurontin used to be. Put it with the other drugs that start with G. If local laws allow, integrate the controlled drugs with all the others. Stocking shelves and pulling stock should be easy enough so that a part-time high school student can do it. Test all job applicants for their alphabetizing skills and make sure they know that 1 gm is bigger than 500 mg and therefore goes to the right of the 500 mg bottle. I have been in pharmacies where I concluded that some long-time staff did not know that hydrochlorothiazide comes before hydrocortisone. Or that James came before Jones. 

A note on track and trace. Thank goodness that it is now a federal issue, not a state issue. It really needs an international solution. Counterfeiting really needs an international solution. Keep an eye on the fed’s track and trace proposals. They very well may mess with your workflow. The feds need to understand the importance of workflow and not cause problems with it. 

I am sure this issue of ComputerTalk will have more sophisticated solutions to workflow problems. 

Try the ladder first. CT 

George Pennebaker, Pharm.D., is a consultant and past president of the California Pharmacists Association. The author can be reached at; 916/501-6541; and PO Box 25, Esparto, CA 95627.