Pharmacy service improvement at CVS

Consumer Value Store (CVS) opened in Lowell, Massachusetts in 1963. The company was one of America’s largest retail drugstores and had 4,000 stores and revenue of $24.2 billion by 2002. Generally, a company that serves pharmacy service must emphasize customer’s satisfaction, customer’s safety, and process efficiency. The purpose of CVS is to satisfy consumer’s needs, guarantee the accuracy of filling prescription and the health of customers, and improve the existing pharmacy fulfillment process. Anything that hampers customer’s satisfaction and process efficiency will be the major problem for CVS. The Pharmacy Service Initiative (PSI) of CVS is to find any problems for the existing pharmacy fulfillment process, so that it helps the company to achieve its organizational goals especially including the increase of customer’s satisfaction and the improvement of process efficiency. Consequently, CVS should analyze the existing pharmacy fulfillment process, and then search any existing process problems. Any possible solutions, recommendations, and IT supports will be created after understanding those existing pharmacy fulfillment process problems. SUMMARY of THE EXISTING PHARMACY FULFILLMENT PROCESS at CVS

The existing pharmacy fulfillment process of CVS consists of five basic steps, including drop-off, data entry, production, quality assurance, and pick-up. Drop-off is a stage where customers leave their scripts as written by doctors in pharmacy (McAfee, 2006). A tech will ask the requested pickup time when customers drop off their scripts, and then the tech will put the script in a box that is separated different slots such as 2pm, 3pm, 4pm (McAfee, 2006). If customers want to obtain the prescription immediately, the tech will put the script in the slot of the current time. The peak time of drop-off window is before work, lunchtime, and after work. Data entry is a stage that a tech enters all required data from the script box into the pharmacy information system (McAfee, 2006). The pharmacy information system is an application that is connected to CVS’s central database of drug, prescription, customer, payment, and insurance information (McAfee, 2006). This stage includes two significant areas for checking drug utilization and customer’s insurance: drug utilization review and insurance check.

Drug utilization review (DUR) is to help check the script against all other prescriptions in the database for that patient and prevent any possibility for harmful drug-drug interactions (McAfee, 2006). If the DUR finds any potential problems, the system will stop to proceed until a pharmacist re-checks the prescription problems. Insurance check is that the pharmacy system performs an insurance check after the DUR. In the current society, there are numbers of different payment means to pay for the prescription fees, especially including third party such as employer, insurance companies, or government agencies (McAfee, 2006). Insurance check can understand customer’s insurance condition under which drugs they would pay for them. Production is a stage that drugs to fill the script are counted and verified by certified pharmacy technicians in the production area, so that customers can be ensured to acquire the correct drugs (McAfee, 2006).

Production normally takes place next to the drugs’ shelves. Quality assurance (QA) is a stage that a pharmacist makes sure each script that contains exactly the right drugs in the right quantities after the production stage (McAfee, 2006). This stage is one of the most important tasks for achieving one of the organizational goals that assure the quality of drug and patient’s health. Pickup is a stage that customers arrive to pick up their prescriptions from the pharmacy after the quality assurance stage. Each completed script is sealed in a bag and the bag is stored in the pickup area in alphabetical order. The technician must search for the right prescription for customers among the bags, verify customers’ identities, and take any required payments from customers (McAfee, 2006). The MAJOR PROBLEMS AT CVS’s PHARMACY FULFILLMENT PROCESS

According to the analysis of the pharmacy fulfillment process by PSI team, a number of major problems in the five basic steps should be concerned and emphasized by the company. The drop-off stage has a major problem for nobody watching in-store drop-off window. This problem will cause the decrease of customer’s satisfaction because customers cannot drop off their scripts and make the requested pickup time at that time and also waste customer’s valuable time. If no pharmacy staffs serve customers in any service time, the company will lose the trust from customers and will not achieve its organizational goals. The data entry stage has two major problems. The first problem is drug utilization review (DUR). As showed by PSI team for the pharmacy fulfillment process, DURs arise frequently and pharmacists must waste time to intervene. CVS’s central database of customer fails to update and understand customers’ newest condition, so that the issue of DUR triggers customer’s dissatisfaction and wastes a lot of time for pharmacists. The second problem in the data entry stage is no refill allowance.

Many customers may lose track of how many refills that were allowed and drop off an ineligible script (McAfee, 2006). Customers are not fully informed on the frequency to refill their scripts. “No refill allowed” script accounts for 6% of total scripts. This problematic process will contribute to the dissatisfaction of customer and waste time for customers and pharmacy workers. The technician will spend more time to call pharmacists for the refill allowance. At the production stage, the major problem is out of stock. The inventory is found to be lacking some important drugs that are prescribed for customers. This problem reduces customer’s satisfaction and trust because they cannot acquire the expected prescription at the pickup time. For considering CVS’s finance in the long term, the company will lose a lot of revenue from this problem and create unreliability for new and regular customers, so that customers will choose other pharmacies. The quality assurance stage is one of the most important tasks for drug accuracy and patient’s health.

According to CVS pharmacy fulfillment problems noticed by PSI team, prescription fills incorrectly sometimes. If patients are harmed by the incorrect prescriptions, CVS’s reputation and profit will be extremely reduced in a short run. The quality problem influences CVS’s organizational purposes including the escalation of customer’s satisfaction and the efficiency of pharmacy fulfillment process. At the pickup stage, there are two major problems that technician cannot find script and customers cannot acquire unauthorized refills. Generally, pharmaceutical corporations are required to focus on drug accuracy and customer’s health. If CVS’s technician cannot find script or give incorrect script for patients, it will deteriorate company’s reputation and lose customer’s trust. Customers will never obtain CVS’s pharmaceutical services due to the operational negligence. The second problem is unauthorized refills that mean scripts have not been paid for by insurance. This problem makes customer to walk away from the pickup window without medicine and creates a bad impression of CVS customer service (McAfee, 2006). Particularly, the busiest time is between 5pm and 7pm, the unauthorized refill problem brings down customer’s satisfaction and employee’s efficiency and performance. As a CVS’s technician said, “I hate the late afternoon shift, spend more time dealing with angry people, and cannot do anything to make things better for them”.

RECOMMENDATION
According to several major problems in the existing pharmacy fulfillment process, solutions must be created to increase CVS’s process efficiency and customer satisfaction. The first recommendation is to employ an assistant who serves drop-off point in the pharmacy permanently. Before customers drop off their scripts, They can inquire the assistant any problems such as refill allowance or insurance problems. This assistant can provide assistance for areas where are being empty in the busiest time between 5pm and 7pm and help customers to contact doctors for the problem of no refill allowed. This change will enhance customer’s satisfaction and make a good impression of pharmacy service. Moreover, the assistant helps customers who want to drop off scripts in the pharmacy, and then the assistant makes the pickup time with customers. When pharmacists decide what prescriptions patients should take, the assistant helps pharmacists to check drug inventory.

If drugs are out of stock, the assistant will inform or give a call to customers immediately. This can at least decrease customer’s dissatisfaction. Employing an assistant can escalate pharmacy efficiency and save time for customers and pharmacy workers. The second change is that customers are needed to fill the newest insurance condition when they come to get service in the pharmacy. When pharmacy staffs make sure that information customers provide is accurate, they will move to payment step. In the contrast, if customers’ information is inaccurate, it will be fixed and figured out. This change can solve unauthorized refill problem. Meanwhile, pharmacy staffs can contact with insurance companies and insurers for understanding customer’s insurance condition, so that pharmacy staffs can solve customer’s insurance problem such as “copayment” problems. This change also assists customers to understand their insurance condition, save customers’ and staffs’ valuable time, and what drugs will be free or how much they will probably pay for.

The third change is to establish database and communication platform that make more communication among local hospital doctors and in-store pharmacists. Drug utilization review process can be inspected by pharmacists and doctors, so that make sure any possibility for harmful drug-drug interactions. When in-store pharmacists suffer the confusion of drug utilization review, incorrect prescriptions, and no refill allowed, doctors can join in the problem discussion and provide assistance for in-store pharmacists. This system can share any pharmaceutical information with others, including doctors, pharmacists, patients, and medical school interns. The database and communication platform create medical research and enhance common sense for medical care. Furthermore, this recommendation can enhance CVS’s reputation and business value and lessen the huge number of calling to doctors.

The final change is to make different numbers on scripts that customers drop off, and then enter the number in customer’s data at the data entry stage. When pharmacy technicians cannot find scripts at the pickup point, they can use the number to find scripts by scanner. Then the display will show where scripts are, so that avoids any inconvenience and dissatisfaction for customers. This change can better find customers’ scripts and avoid incorrect scripts into customers’ prescription sealed bags. In conclusion, these four changes can better improve pharmacy work efficiency and customer satisfaction. Then, CVS’s organizational goals and performance will be achieved because of these four recommendations.

IT REQUIREMENTS for CHANGES
The changes of CVS’s existing pharmacy fulfillment process need a database and communication platform that are involved with sharing any medical information and communicating any stakeholders such as doctors, pharmacists, patients, and company management. Moreover, the IT system needs to be networked and updated with the newest information for insurance status before serve clients, the drug reaction status for clients, and a writing format for the doctors on scripts. The IT system must be designed to notice technician for drug inventory condition, so that customers will not waste their time to visit the pharmacy. The IT department should also ensure that all the stages and departments are connected, and all departments update
their information on a daily basis to reduce time wastage. This will ensure that all customers are satisfied, and the security of both the employees and customers is guaranteed. Furthermore, CVS should establish an IT system for emailing any current pharmacy news and reminder customer for refill time and insurance inquiry. Customers can ask any pharmaceutical questions by email online, and then certified doctors and pharmacists from CVS will make recommendations for them. CONCLUSION

CVS is facing some problems on pharmacy fulfillment process, so that it cannot achieve its organizational purposes including customer satisfaction and performance. Through analyzing major process problems by PSI team, CVS can make changes for improving pharmacy fulfillment process. Therefore, logical recommendations and IT supports must be created to solve the problems at the existing fulfillment process, including four changes and two IT systems. These changes and IT supports help CVS to achieve its organizational goals and performance. The old process should be replaced with the newly proposed changes in order to improve services with the help of information technology.

Reference

McAfee, A. F. (2006). Pharmacy Service Improvement at CVS (A). Harvard Business School,　9-606-015 REV: 20 Oct. 2006. 25 Jul. 2013.