You have been called in as a consultant to improve the pharmacy process at Lee Hospital which is
trying to reduce costs yet improve patient and medical services. A hospital pharmacy, a primary process,
uses two types of medications - fluids such as intravenous liquids and pharmaceuticals such as pills. The
pharmacy buys drugs in bulk and containers and bottles and dispenses them in smaller unit-dose
amounts based on doctor's orders. The hospital pharmacists are responsible for monitoring the supply
of all medicines used in the hospital and are in charge of purchasing, manufacturing, dispensing and
quality testing their medication stock along with help from pharmacy assistants and pharmacy
technicians. 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 range 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 .01 percent (1 in a 1,000) to 15 percent (15 in
100).The hospital pharmacy process at Lee 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 process 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. Baseline measures indicated
that only 10 percent of prescriptions require extensive verification (10 minutes), and the remaining 90
percent requiring one-third of a minute for verification and validation.
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. 97 percent of drugs are in the
pharmacy's shelves taking 1 minute for this step to be completed. However, 3% of the drugs are not
available and the pharmacist has to contact hospital's central supply. In this case, the average time for
to complete is 18 minutes, including transit time and inventory update at the central location.
Step 5 - Prepare the prescription, including the label, and attach the proper labels to the proper bottles.
Only a registered pharmacist can work this 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 conduct this step and it takes 0.8 minute.
Step 7 - Complete charges, write notes or comments if needed, and close the patient's pharmacy
record in the pharmacy computer system. The record is also sent to accounting for quality control and
auditing purposes. This step takes 1.5 minutes and may be done by a registered pharmacist but the law
does not require it.
Currently, pharmacists always perform steps 2 to 7 for each patient's prescription. 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.
As a consultant for the Lee Hospital, a report with your analysis of the pharmacy process by
considering the following questions:
1. What is the #1 competitive priority for this hospital pharmacy process?
2. What sustainability issues are there in a hospital pharmacy?
3. Draw the process flow chart with appropriate swimming lanes, including processing times for
each work activity.
4. Using the forecast value you developed in
of the assignment as the number of
prescriptions arriving between 8 a.m. and 9 a.m., a report with the estimated labor
utilization when six pharmacists and one technician are on duty doing all seven steps. (You do
not have the data to evaluate staffing levels by hour of the day for Monday.)
5. Clearly identify two additional process design, and discuss the advantages and disadvantages of
them. Include in the analysis the average number of prescriptions in the system and consider
how you will design the jobs for medical technicians and pharmacists.
6. Where's the bottlenecks in your process design? Explain.
7. Address the quality versus cost argument by considering whether it is preferable to have one
pharmacist handling a prescription from A to Z or can these tasks be assigned to different
8. What are your final recommendations?
9. Is there anything else that can be done to improve the pharmacy's efficiency?
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