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Case Study: Face To Face
Nicky Muscillo
Pharmacist Nicky Muscillo asks, is this our call to action and to regain our central role as healthcare providers?

“It is not just about doing a script as quickly as possible. Offering a commodity at the cheapest price possible does not necessarily present the best value to your customer. And, if the pharmacy down the road puts in a dispensing robot or improves their dispensary workflow, where is your advantage then? For us, the key driver was what you do with the extra time for which you have that customer in front of you.”

 
NICKY MUSCILLO

PHARMACIST NICKY MUSCILLO ASKS, IS THIS OUR CALL TO ACTION AND TO REGAIN OUR CENTRAL ROLE AS HEALTHCARE PROVIDERS?

In retail pharmacy, there is always a new challenge, a new threat to our viability, new services to offer the community and increasing customer expectations. There is never, it seems, a time when we are not forced to look at how we do things. There always seems to be something looming on the horizon. While this is what keeps our profession continually driving to make a difference and provide the community with a valued and professional customer experience,

how can you best prepare for this? Let me share with you our greatest challenge… And the preparation and work we’ve undertaken to turn that into an opportunity.

OUR STORY

First, a little background. I have been a pharmacist for over 20 years, and almost 10 of them have been as an owner of Terry White Chemists (TWC) Coorparoo. Located in a shopping centre strip on a main road, we find ourselves in adestination medical precinct nestled amongst three doctors’ surgeries, three dental practices, podiatrists, physiotherapists, eye specialists, anX-ray centre, pathology, dieticians, psychologists and chiropractors. Each of these bring a diverse range of customers and conditions through our doors.

As a pharmacy, we provide a range of professional services, among them, a sleep apnoea clinic, compounding services, maternal health and baby clinic, naturopath services, health checks, NDSS and hearing screenings in addition to medication packaging, a delivery service, weight management and now an immunisation service.

We are open from 7am to 11pm, 365 days a year. That is 112 hours per week and 16 hours a day, including Christmas Day: and we have been servicing the local community in this way – as an extended hours pharmacy – for over 50 years.

These extended hours and diverse services, though, bring their own unique set of challenges. Among them, rostering and managing multiple peak trading periods – think the late morning prescription rush, after school and after work – and on top of these, the even more challenging – and less predictable – peaks. This busy time could be after a popular show on TV has just finished or it stopped raining … Very hard to predict and roster for!

A while ago, these challenges seemed to be on the rise: our rush times were becoming busier and more variable, severely impacting on our script waiting times. Still we wanted to give each customer the service and counselling they required without feeling pressured to hurry the interaction. We desperately needed to reduce the congestion around the dispensary and schedules counters during these busy times, it was off-putting for our customers as they assumed that asthere were a lot of people in the pharmacy that there would be an extended wait for their prescription and it created a degree of stress for the team.

“There is always a better way” – this is one of the core values of Terry White Chemists. It was during these peak times that we realised more than ever this had to be true: but how could we make our dispensary more efficient? How could we decrease our script waiting time? And, just as importantly, how could we increase our time with our customers?

The answer? We prepared the way for automation.

White Retail Group, our head office, took the initiative to introduce a dispensing robot to Coorparoo – and several other pharmacies in the group – that would also benefit from improving the efficiency of the dispensary.

“VERY RARELY ARE TRANSITIONS EASY, BUT SOLID AND COMPREHENSIVE PREPARATION IS THE KEY TO MAKING IT AS EASY AS POSSIBLE. WE TURNED TO THOSE WHO HAD ‘BEEN THERE, DONE THAT’ IN THE HOPE WE COULD LEARN FROM THEIR EXPERIENCE.”

ENSURING SUCCESS, SEEKING EXPERIENCE

Very rarely are transitions easy, but solid and comprehensive preparation is the key to making it as easy as possible. We turned to those who had ‘been there, done that’ in the hope we could learn from their experience. We were lucky enough to get the insights of one of our group, Tanya, a managing partner of TWC Coffs Harbour. Her pharmacy had a dispensing robot installed several years ago and she visitedour pharmacy to share her experience. For the first 12 months, the gains they made in efficiency were purely in the time they gained. Interestingly, it was only when they changed their workflow and moved to the direct dispense model that they began to experience the full benefits of the initiative.

To have someone talk through their experiences and give you insight into how they handled different scenarios is invaluable. Tanya spoke to all the members of the dispensary team and gave them a positive picture that what we were trying to do was achievable and worked well.

Two weeks after installation, we had our meeting with Tanya. We took the learnings from this and started to incorporate themstraight away. Everyone on the team was on the same page and involved in the process.

It’s also important to take away the ‘what ifs’ to reassure those on your team that you are prepared … For anything! There were many discussions with the team and the professional services pharmacists from Terry White Management. These gave them the confidence to handle different scenarios as flow charts were developed and displayed in the dispensary, team member roles and examples of scripts that team members could use with customers in different situations were also developed.

What happens when a customer presents a pile of prescriptions, when there are three people waiting to put in a prescription, if there is only one pharmacist on duty?

Having a plan to effectively handle each of these scenarios gave the team confidence that by sticking to the new workflow, our customers would be well looked after.

“It’s not going to work when there is only one pharmacist on duty and we are busy…”

Early in our implementation phase, I had this conversation with one of our night-time pharmacists on their first shift working in the new work flow model and with the dispensing robot. I was working back that night as we werestill finishing off our dispensary re-fit, I re-enforced with this pharmacist all we had discussed during our preparation phase and asked him to stick to our new workflow processes while I went out to grab some dinner. On my return I asked him how he had gone. His response was fine and ran smoothly but we were not that busy. I checked our dispensing statistics for the last hour and – although he struggled to believe it – he’d dispensed much higher than his usual average number of prescriptions per hour, all from the direct dispense terminal without feeling pressured.

“I always believed we offered a highly professional and valuable service to our customers. What I now know is that by increasing these valuable interactions with our pharmacists – with a larger focus on health solutions and aligning the associated products and services – we see positive outcomes for our customers and, ultimately, our sustainability.”

HOW IT WORKED – PREPARATION IN PRACTICE

Don’t underestimate the importance of leadership and direction. For us, it was a more literal interpretation than most: the only way for the direct model to work consistently was to have the main pharmacist on the direct dispense terminals – they became known as the ‘director’ pharmacist. When there was more than one pharmacist on duty one would be allocated the director role and the other pharmacist would be the coordinator pharmacist. This made sure there was no interruption to the direct dispense flow and ensured that all customers (in-store, calling back, packing patients, compounding customers) were looked after efficiently and effectively.

Continuing the tradition of turning to the experts, our pharmacy group decided to partner with Willach (Pharmacy Solutions) for our automation solution. Their focus, from the beginning, was to design a solution to meet the individual needs of our business and to support where we saw the future to be in terms of how wewanted to dispense and interact with our customers. The aim was to get a result that ensured a seamlessly integrated pharmacy: it was never about simply replacing some shelving with a robot.

The team of pharmacists and professional spatial designers at Willach had a firm understanding of what we were trying to achieve and, from the outset, were there to help us tailor the unique solution to our pharmacy. This was a real advantage to us.

On top of this, Glenn Guilfoyle from The Next Level (B2B sales consultancy) analysed our work flow, observing our customer interactions when they presented prescriptions and also at the schedules counter. Some of the analysis included: average duration of script customer lifecycle, customer retention score, customer engagement during lifecycle, customer engagement effectiveness and script processing efficiency. All important factors in getting to know our customers – and their needs – a whole lot better.

The results of the analysis provided us with an objective, scientific and rigorous scorecard to show the degree of customer engagement, value adding and script processing efficiency, framed against associated business metrics.

THE CATALYST FOR CHANGE

But let’s backtrack a little. Before the installation of the dispensing robot, our pharmacy dispensing process followed a more traditional model: scripts in counter attended by a pharmacy assistant who would input the administrative personal data. The customer, after lodging theirscript, was given a buzzer so they could wander around the pharmacy while the pharmacists and technicians in the dispensary could process and assemble the prescriptions. If a pharmacist was available, they would give out the prescription, otherwise a pharmacy assistant would hand out the medication at the patient medication advice counter or the schedules counter.

Did it make sense that for a prescription to be completed it may have been handled by three different people?

Was this really the most efficient way to process a prescription?

Was this what our customers really wanted? What our pharmacists wanted?

Sure, this process worked well for a long time, we believed that as long as a prescription was taking less than 10 minutes to be prepared, customers were being looked after and this was how it was supposed to work. Right? Or was there a better way?

While it might not always be the answer, for our pharmacy, it certainly lifted our customer engagement and satisfaction. A key component of the success of this dispensary reform was the change in the dispensary design: we eliminated the scripts in counter and replaced it with the ‘Direct Dispense’ terminal.

I always believed we offered a highly professional and valuable service to our customers. What I now know is that by increasing these valuable interactions with our pharmacists – with a larger focus on health solutions and aligning the associated products and services – we see positive outcomes for our customersand, ultimately, our sustainability.

Through our direct dispense engagement model we now regularly have interactions such as this one: a gentleman presented a prescription for metformin on his way to work. While dispensing his prescription and discussing his medication, I was able to pick up that he should have been on the extended release form and updated his blood glucose monitor. He purchased his NDSS testing strips and I spoke to him about a Diabetes Medscheck, normally he would have dropped off the script and come back after work to pick it up and we would have lost this opportunity to be a true healthcare professional.

COMMUNICATING CHANGE: THE PEOPLE WHO MAKE IT HAPPEN

Mechanics aside, working with the right people to get the right plan foryour pharmacy is critical. As mentioned above, the dispensary layout was a crucial component: it not only facilitated a complete change to our workflow, but brought us closer to our customers. The decision was not just to put in a machine to increase our efficiency and speed up the dispensing process, but a huge opportunity to change the way we engage with our customers. Four direct dispense terminals were installed, giving customers direct access to the pharmacist as they were dispensing their script.

As this change was customer-centric, it was crucial to communicate and involve our customers in the process– to prepare them for change.We shared our vision through our dispensary newsletter, in which we let our customers know – in advance–that we were changing the way we did things. At the end of the day, it isalways about the customer and their experience that drives us to make changes and encourage them to return to our pharmacy. To get buy-in from our customers, we ran a competition to name the machine: this created a lot of interest and when seven different customers came up with the name ‘Spencer’ we knew that that was what we had to call our dispensing robot.

When it all came to fruition, we felt it was important to put the dispensary robot on display, Customers like the theatre of the dispensing machine, they like to see it working. Initially, customers were in awe of the machine, couldn’t believe it was so quick. They’d come in with a script for an antibiotic, and it was in their hand before they knew it – sometimes they didn’t even notice the machine working as they were listening to what you were saying!

“It was crucial to communicate and involve our customers in the process – to prepare them for change.”

NICKY MUSCILLO

Everything we needed to dispense – approximately 80% of our prescriptions – was accessible to the pharmacist from the direct dispense bench. There was no stepping away from the customer anymore. We were on show. In the first couple of weeks, we had a conversation with each customer about the robot, why we got it, how efficient it was and how it enabled us to spend more time talking to them. We got used to the new processes, ordering, filling and making any adjustments. It was also a good time to work through what we needed to do in different scenariosas there are never only prescriptions to dispense, there is compounding, medschecks, checking packs, talking to doctors, taking customer phone enquiries and customers wanting to speak to the pharmacist at thesame time.

Our team, too, were always kept informed throughout the process, they were shown the plans and we let them know the reason why we were making changes.

It was important to get across to both the team and customers from the outset that our reason for change was not to replace or reduce any team members but to improve our efficiency and increase our customer contact.

OPPORTUNITIES FOUND

The success of these changes came down to communication and consistency in the crucial stage of preparation: the same messages were given to our customers and team and this was critical in enabling the change. The commitment of the owners and managers in facilitating this process and leading by example ensured the team adapted quickly to this new workflow. Comprehensive training was completed two weeks before installation. It was really important that the team were confident that they could handle any problems if they occurred and this training offered a reassurance that it would operate smoothly over all of our 112 opening hours. Also, that backup support was there if and when it was needed.

I needed to make sure also that the systems and processes we were putting in place would work across all hours of trading. This meant they needed to be robust enough to cope with those peak periods. For us it meant they had to pass the Saturday night test!

But it is not just about doing a script as quickly as possible. Offering a commodity at the cheapest price possible does not necessarily present the best value to your customer. And, if the pharmacy down the road puts in a dispensing robot or improves their dispensary workflow, where is your advantage then?

For us, the key driver was what you do with the extra time for which you have that customer in front of you. They have made the choice to stay with you as you dispense their script, this time must be used effectively.

With e-scripts removing a lot of the administrative processing of our prescriptions, we can go straight into the risk management (checking allergies, contraindications, dosing instructions and storage) and the most valuable counselling component of dispensing. As this is done during the dispensing process the customer is fully engaged, the pharmacist has full access to their dispensing history, can check compliance, can follow up on other medications and make notes in their file. It is a different dynamic as opposed to doing all this after the processing is complete and a customer is called up to collect their prescription. The customer is much more receptive to answering any questions and listening to your advice. It is also in a more private setting.

MAKING IT WORK FOR YOUR PHARMACY

I believe we have successfully implemented our changes in workflow and lifted our level of engagement with our pharmacy prescription customers. This, though, is only the first step in moving towards the future of our pharmacy business. The next step is making sure that the value of this engagement is maximised and carried across into different areas of the pharmacy and professional services.

Looking at our resources, we hope to replicate this level of engagement at the schedules counter and in our professional products aisles such as therapeutic skin care, first aid and wound care, stomach and bowel, smoking cessation, heart health, diabetes and asthma care.

Automation was an important part of our dispensary work flow solution because we had the space and dispensing script volume to make it work. It may not be the solution for your pharmacy but a good hard look at your current dispensing practice is probably worthwhile. Ask yourself, is there an opportunity to increase your customer engagement? Are you maximising the time the pharmacist is able to spend with the customer? Are you utilising a pharmacy technician for all the administration and processing duties to free up your pharmacist?

Our pharmacy assistants are highly trained and invaluable assets to our business but it is continually being shown that it is the pharmacist interaction that leads to the highest solution and advice satisfaction with our customers.

Our customers, if given the choice, always have and always will want to speak to the pharmacist about their medication or health concern. We need to make this easier and happen more as this is what makes going to a pharmacy a unique experience; you do not get access to a health professional without an appointment anywhere else!

Throughout this change process I was fortunate to be able to utilise the support of Rhonda White and the team at head office, the team at Willach, Glenn from The Next Level and the learnings from Tanya Maloney and her TWC Coffs Harbour experience. I would like to thank my managers, team and partners for their willingness to get out of our comfort zone and make a change to positively impact our customer engagement and navigate our way through this challenging time.