A nnapolis Hospital is trying to reduce costs, yet it aims to improve the patient count and medical services. The hospital pharmacy, which is considered a primary process, uses two types of medications—fluids, such as intravenous liquids, and pharmaceuticals, such as pills. The pharmacy purchases drugs in bulk containers and bottles and dispenses them in smaller unit-dose amounts based on doctor’s orders. The objective of the pharmacy is to “get the right drug in the right amount to the right patient at the right time.” The consequences of errors in this process ranged from no visible effects on patient health to allergic reactions, or in the extreme case, to death of the patient. National studies on hospital pharmacies found error rates ranging from one error per thousand (an error rate of 0.001) to 15 errors per hundred (an error rate of 0.15) prescriptions. The hospital pharmacy process at Annapolis Hospital includes seven major steps:

Step 1 Receive the doctor’s patient medication order via a written prescription, over the telephone, or through the hospital Internet system. This step averages 0.5 minutes per prescription and could be done by the medical technician or a legally registered pharmacist.

Step 2 Verify and validate the order through whatever means necessary. For example, if the handwriting was not legible, the doctor must be contacted to verify the medical prescription. Only a registered pharmacist can do this step, which takes from one-third of a minute to 10 minutes depending on the nature of the prescription and checking out potential problems. Since only 10 percent of prescriptions require extensive verification, the weighted average time for this step is 1.3 minutes

[0.9 3 (1/3 minute) + 0.1 X (10 minutes)].

Step 3 Determine if duplicate prescriptions exist, and check the patient’s allergic reaction history and current medications. This work activity averages 1.4 minutes using the hospital pharmacy’s computer system. Only a registered pharmacist can perform this step.

Step 4 Establish that the drug(s) are in stock, have not expired, and are available in the requested form and quantity. Only a registered pharmacist can perform this step, and it takes one minute.

Step 5 Prepare the prescription, including the label, and attach the proper labels to the proper bottles. Only a registered pharmacist can do this work activity, and it averages 3.2 minutes.

Step 6 Store the prescription in the proper place for pickup and delivery to the patient. Only a registered pharmacist can do this step, and it takes 0.8 minute.

Step 7 Prepare all charges, write notes or comments if needed, and close the patient’s pharmacy record in the pharmacy computer system. This step takes 1.5 minutes and may be done by a registered pharmacist but the law does not require it. Currently, the pharmacist always performs steps 2 to 7 for each patient’s prescription and sometimes step 1. Two medical technicians are on duty at all times to receive the prescriptions, answer the telephone, receive supplies and stock shelves, deliver prescriptions through the service window, and interact with nurses and doctors as they visit the pharmacy service window. You have been called in as a consultant to improve the process and begin by considering the following questions.

Case Questions for Discussion:

1.Draw a process flowchart including processing times and capacities at each step, and total time per prescription.

2.As a baseline measure for one time period, what is the labor utilization if 30 prescriptions arrive between 8 a.m. and 9 a.m. on Monday, and four or five pharmacists are on duty doing all seven steps?

(You do not have the data to evaluate staffing levels by hour of the day for Monday.)

3.Clearly identify two other ways to group and divide the work among the medical technicians and pharmacists, compute labor utilizations, and discuss the advantages and disadvantages of each job and process design option.

4.What are your final recommendations?