By Annette M. Boyle

A soldier selects the appropriate option on the queuing system in the McDonald Army Health Center Pharmacy at Joint Base Langley-Eustis, VA, earlier this year. Air Force photo/Staff Sgt. Teresa J. Cleveland

JOINT BASE LANGLEY-EUSTIS, VA — The pharmacy team at McDonald Army Health Center (MCAHC) on Joint Base Langley-Eustis in Virginia had a common problem—longer than desired wait times for patients to pick up prescriptions. Their solution was anything but typical: They reduced operating hours by an hour in the afternoon and cut wait times by more than 50%.

While counterintuitive, the resolution relied on solid analysis. The team used a queuing system recently installed in the pharmacy to study prescription demand and wait times.

“One of the things we learned from the new system was we were having large amounts of patients come in at lunchtime and we wouldn’t be able to take care of that patient flow until one or two hours down the line,” according to Adam Resnick, MCAHC pharmacy chief.

The lunch back up became much easier to understand once the team looked at the data. “On average, 22% of our patients were being serviced between 1200 and 1400,” said Heather D. Guntherberg, PharmD, MCAHC supervisory clinical pharmacist. They also found that mornings were much busier than afternoons.

To shift resources to earlier in the day, the pharmacy now shuts its windows at 5 p.m. rather than 6 p.m.. “By closing an hour earlier, we’re able to rearrange our shifts so we’ve got all of our windows open at the same time and we’re able to help patients by decreasing their wait time,” Resnick said.

Jessica Pruitt, McDonald Army Health Center lead pharmacist, discusses a prescription with a patient at Joint Base Langley-Eustis, VA, earlier this year. Air Force photo/Staff Sgt. Teresa J. Cleveland

With more staff available during peak hours, “the average wait time was reduced from 15 minutes to six minutes” for patients enrolled at McDonald Army Health Center, Guntherberg told U.S. Medicine. “For patients not enrolled to McDonald Army Health Center, the wait time decreased on average from 29 minutes to 15 minutes.” Put another way, the percentage of prescriptions processed within 30 minutes increased from 76% to 98%.

Those most likely to have longer wait times are patients who bring in handwritten prescriptions, said Jessica Pruitt, MCAHC lead pharmacist. Prescriptions that are called in are often waiting at the refill pharmacy in the Post Exchange when patients arrive.

Electronic prescriptions allow the pharmacy to quickly address any questions they may have with the prescriber while the patient is in transit from their doctor’s office. With hard-copy prescriptions, patients may have to wait for a pharmacist to decipher sometimes-challenging handwriting, resolve any questions and then fill the prescription, she noted.

The pharmacy also uses a kiosk system that speeds check-in and processing, as long as patients use it correctly. “With the new system, you scan your ID card, so in the back we can actually see who is in the lobby—we have their information so we can go into the system before they even arrive to the window, and in a lot of cases their medications are already ready before we actually call them,” Pruitt explained.

Delays can occur when beneficiaries scan the ID of the sponsor or the person picking up the prescription rather than patient. To match the prescription, parents or guardians need to put in the child’s ID, not their own, she noted.

Changes Get Kudos

Patients have definitely appreciated the change. “We have had numerous compliments on the increase in efficiency as well as customer service. I personally have had several of my clinic patients comment to me during their appointments that their overall experiences have been wonderful. Most often they are happiest about the decrease in wait times,” Guntherberg said.

As expected, given the lower number of patients who came to the pharmacy in the late afternoon, “we have had very minimal negative feedback secondary to reducing the hours of operation in the main pharmacy.” The hours at other three pharmacy locations on the base remain unchanged. The base’s seven outpatient pharmacists prepare 30,000 prescriptions each month across the four pharmacies.

The pharmacists appreciate the change in hours at least as much as the patients. “There has been a definite positive shift in our staff’s morale, which has translated to an increase in patient care satisfaction,” said Guntherberg. “Taking care of our staff is the pharmacy leadership’s first priority. This was a win-win for us. It benefits both our staff and our patients.”

For other pharmacy teams who might consider making similar changes, Guntherberg has some advice. “Prior to making any major changes within your services, I would recommend implementing the use of an established performance improvement management plan. Our quality management leadership endorses FOCUS-PDCA.”

The FOCUS-PDCA acronym summarizes a process improvement model first developed by the Hospital Corporation of America:

  • Find a process to improve.
  • Organize an effort to work on improvement.
  • Clarify current knowledge of the process.
  • Understand process variation and capability.
  • Select a strategy for continued improvement.

Then,

Guntherberg recommends the model because it provides a framework for the continual improvement of processes. She also noted that education and management of expectations are also critical for successful implementation of significant changes.