designing pharmacy services

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DESIGNING Pharmacy Services David Holdford, RPh, MS, PhD Professor, School of Pharmacy Virginia Commonwealth University Building Quality into the Design

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Page 1: Designing pharmacy services

DESIGNINGPharmacy Services

David Holdford, RPh, MS, PhDProfessor, School of PharmacyVirginia Commonwealth University

Building Quality into the Design

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Slides to Accompany Chapter 9 of “Marketing for Pharmacists”

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Learning ObjectivesCompare and contrast the production line approach and the empowerment approach to designing and managing pharmacy services

Explain the concept of service scripts and their value in providing excellent pharmacy services

List the steps involved in service recovery

Describe tools for visualizing pharmacy services

Discuss the purpose and components of a service blueprint

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Every system is perfectly designed to get the results it gets

― Donald Berwick

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Service design is increasingly important in personalizing care and conveying value and excellence to customers.

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Organizations can be divided into four categories according to the quality of services they provide

These categories indicate the importance they place on service

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1. “Available for service”

Services are necessary evils

Services are not important to business strategy

Service employees are an expense

The message from management -- “Don’t screw up!”

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2. “Journeyman”

Services should only meet that of competitors, but not necessarily meet customer needs

Services only need to be minimally competitive

Over time, these organizations resemble competitors

Employees are an expense, not an asset

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3. Distinctive competence

Service focused on customer needs

Service is integral part of strategy

Resources are committed to providing excellent service

Employees are considered assets because they generate revenue and value

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4. World-class service

Not only excellent but innovative

Set the standard for all others

Employees treated as assets and are a source of innovations

Employee performance standards are very demanding

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Two broad approaches occur in the design & management of service

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Production Line Approach

Empowerment Approach

Pharmacy

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A powerful illustration of an empowered employee

Ronald Ruiz has driven a New York City bus for 11 years. In that time, Ruiz, 58, has become one of the most beloved drivers in the Bronx, counting more than 100 regulars among his many passengers. But Ruiz, a single father with two daughters, says that one passenger, a woman from two years ago, sticks in his mind.

http://www.npr.org/templates/story/story.php?storyId=4755286

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Did Ronald Ruiz do the easy thing in serving this customer?

Did he take ownership & responsibility for serving her?

Did he likely break company policy?

If you were his boss, what would you say to him?

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Benefits & Costs of EmpowermentBenefits Costs

Better capacity to respond to the unique needs of customersMore individualized serviceBetter ability to quickly resolve problemsGreater sense of employee ownership about their jobsGreater employee acceptance of responsibility for service and outcomesLower turnover, absenteeism, presence of trade unionsMore employee warmth and enthusiasm in customer interactionsPositive customer word of mouth recommendations and loyalty

Slower servicePotentially higher labor costsEmployees cannot be easily interchangedLess easy to replace employees with part-timersTechnology is less able to replace empowered employees, because their output is less standardized (for technology to be used, standardization of tasks is necessary)Greater need for flexible and competent leadershipEmployers have to be willing to accept that empowered employees will sometimes make bad decisions

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The Better Approach Depends on:

Basic business strategy (e.g., low price versus personalized service)

Nature of transaction (e.g., dispensing a refill versus providing MTM)

Needs of patients (e.g., minor infection versus multiple chronic decisions)

Types of employees & managers working in a business

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INDUSTRIALIZED INTIMACYBlend technology with empowered workers to achieve a high level of contact, communication, & coordination with customers

Collecting data on customers and making it available at a touch to service workers can build a high level of customer intimacy

Easy access to information about patient therapy, service preferences, insurance coverage, & best practices

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PLANNING FOR SERVICE PERFORMANCE

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QUALITY OF PHARMACY SERVICES CAN BE ENHANCED THROUGH BETTER PLANNING AND DESIGN

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Service Scripts

They are a script describing a service performance in a written list of actions

Similar to a script from a play or movie

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INDIAN HEALTH SERVICE COUNSELING GUIDELINES – 3 PRIME QUESTIONS

1. What ___________________________?

2. How____________________________?

3. What ___________________________?

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SERVICE RECOVERY

Scripted response to a poor service experience

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Apologize Offer a Remedy

Fix the Problem Immediately

Consider Compensation

SERVICE RECOVERY STEPS

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Customer Journey Maps1. Identify everyone involved in the service experience

2. From the patient's viewpoint, list all of the steps that need to be completed to receive the service.

3. List all of the points of contact between the patient and specific employees

4. List the services that are provided in the pharmacy and a visible to the patient

5. List all of the support services provided to the frontline employees and the backstage people providing them

6. Now map the elements on the outline using a formal structure like flow charts, diagrams, or service blueprints

7. Identify moments of truth from the map

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VISUALIZING PHARMACIST SERVICES

Flowcharts

Supply Chain Diagrams

Tech ReceivesRx from Patient

PharmacistReviews Rx

Patient Goes toAnother Pharmacy

Drug in inventory?

Tech Fills Rx

PharmacistChecks Rx

PharmacistDispenses Rx

With Counseling

Patient Needs Counseling?

Tech Dispenses Rx Without Counseling

Patient LeavesPharmacy

No

Yes

Yes

No

Pharmaceutical Manufacturer Wholesaler Pharmacy Patient

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Give History-Medical-Medication-Smoking

Diagnostic Tests-Fagerstrom Test-BP/Pulse

Receive Instruction-NRT/ “Cold Turkey-Lifestyle/EnvironmentModifications

-Alternatives to Smoking-Personalized SmokingCessation Plan

Arrive atPharmacy

Greeted byPharmacyPersonnel

RecordHistory

AdministerDiagnostic Tests

Instruct Patient-NRT/ “Cold Turkey-Lifestyle/EnvironmentModifications

-Alternatives to Smoking-Personalized SmokingCessation Plan

Make Follow-upAppointment

Within One Week

Make Follow-upAppointment

Within One Week

SOAPNote

Check ForDrug Interactions

With Smoking Cessation

SelectTherapy

Stage theSmoker

PhysicianConsultation

InsuranceClaim Form

MDReferral

Line of Visibility

Line of Interaction

Line of Internal Interaction

Service Blueprints

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Service Blueprint for Appointment Based Medication Synchronization Program in a Community Pharmacy

Physical Evidence or Communication Channel

Line of CommunicationCustomer Actions

Line of InteractionOnstage Contact People

Front-line Service Personnel Actions (Onstage)

LinLine of VisibilityBackstage People

Behind-the-Scenes Personnel Actions (Backstage)

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Service Blueprint for Appointment Based Medication Synchronization Program in a Community Pharmacy

Physical Evidence or Communication Channel

Experience with basic dispensing process & other

services

Website POS signage and conversations with

techs & pharmacists

Word-of-mouth from customers &

health care professionals

Phone calls Social media

Line of CommunicationCustomer Actions Patient learns

details of ABM Program

Patient signs ABM contract

Patient brings new &/or refill

prescriptions to pharmacy to

choose synch date

Patient appointment

where adherence plan is established

Patient receives monthly call prior to picking up the

meds

Patient receives meds & discusses

any issues with adherence or

therapy

Line of InteractionOnstage Contact People Pharmacist, tech Pharmacist, tech Pharmacist, tech Pharmacist, tech Reminder phone

call peoplePharmacist, tech

Front-line Service Personnel Actions (Onstage)

Identifies & informs potential

candidates

Completes contract

Receives and counts meds,

identifies synch dates

Counts meds, co-creates adherence

plan (e.g., motivational

interview)

Makes call, resolves any issues

Medication picked up or delivered,

difficulties or issues solicited

LinLine of VisibilityBackstage People IT people,

marketingPhysician, insurance

company, business office

IT people Insurance company, business

office

Physician, IT people

Remote filling people, business

office

Behind-the-Scenes Personnel Actions (Backstage)

Website design & maintenance, Promotional messaging

Coordinating ABM with physician treatment plan and pharmacy benefits plan

Sets up and manages synch

system

Insurance company and

business office coordinate

financing and compensation

Physician communicates with pharmacy

about changes, IT maintains

automated call system

Meds filled and delivered to

patient's preferred location

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SummaryDesign can make the difference between

poor and excellent services

Production line & empowerment approaches both can be useful frameworks for providing pharmaceutical services

Service scripts and visualization can help improve the design of pharmacist services

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SEE ‘MARKETING FOR

PHARMACISTS FOR

MORE DETAILS

D HOLDFORD