By Annette M. Boyle

At Ireland Army Health Clinic at Fort Knox, KY, a pharmacist counsels a patient as part of a new service-oriented model being pilot there and at three other sites. Photo courtesy of the Army

HINESVILLE, GA—Four Army pharmacy sites have taken the lead in shifting the patient experience from a transactional paradigm to a service-oriented model the Army hopes to replicate across all facilities.

Each center—Winn Army Community Hospital at Fort Stewart, GA; Munson Army Health Center, Fort Leavenworth, KS; Ireland Army Health Clinic at Fort Knox, KY; and William Beaumont Army Medical Center, Fort Bliss, TX—has followed a slightly different path but achieved similar, largely positive results.

Changes in the healthcare landscape have largely driven the new approach. “Our patients expect safe, high-quality care, and the organizations we serve expect us to be accountable for the outcomes of our patients,” said Ryan C. Costantino, PharmD, deputy chief of pharmacy at Winn Army Hospital. “It’s no longer good enough to simply dispense a medication to a patient. In order to improve patient loyalty and prevent negative outcomes, we have had to be proactive in detecting and preventing errors as well as building our relationship with patients so they trust us in the delivery of their care.”

At Winn, the safety aspects of prescription dispensing has been enhanced by the Parata and ScriptPro Systems, which help ensure each patient receives the right medication every time, he said. The robotic systems standardize and automate much of the traditional counting, matching and verification process.

The adoption of standardized processes has also helped improve the human interactions in the pharmacy. “Previously, your experience at a pharmacy would depend on which staff member was assisting you. Now, every patient should have the same experience,” Costantino told U.S. Medicine.

Training for all staff emphasized a six-step process that includes greeting patients, verifying their identity, inquiring about allergies, asking if they have any issues with their medications and determining whether any medications are new for the patient. In addition, “we strive to perform a show-and-tell for all new medications, placing specific emphasis on medications that are difficult to use, like inhalers or injectable diabetes medications,” he noted.

So far, patient response has been very positive, with satisfaction scorers rising 10 points despite increased wait times caused by renovations. “You would think our satisfaction scores would trend down; however, we have found that patients rarely remember their exact wait time or experience, but they always remember how you make them feel. If we can continue the emphasis on making the patient feel welcomed, valued and that we care about their health, I have no doubt these measures will continue to improve,” Costantino said.

To continue on the path of greater customer focus and increased efficiency, the pharmacists at Winn are evaluating the appointment-based model, a patient care service designed to improve patients’ adherence to medications and increase pharmacy efficiency by synchronizing refills for chronic medicines and confirming the patient receives the correct medications each month, he added.

Improving Patient Safety

Medical Department Activity Maj. Justin C. Nevins, chief of the department of pharmacy for Munson Army Health Center, receives the Soldier Bust Award from LTG. (R) Robert Arter for outstanding service on Jan. 12, 2017. MAHC pharmacy is currently ranked first in the Joint Outpatient Experience Survey for customer satisfaction. Photo by Tracy McClung

At the Ireland Health Clinic at Fort Knox, pharmacists see the new process as a natural outgrowth of their position, as they are “the premier source of drug information and play a vital role in providing quality patient education,” said Alisa Fisher, PharmD, officer-in-charge of Outpatient Pharmacy.

She noted that the pharmacists “perform a brief medication reconciliation as well as an allergy check at the beginning of each patient interaction to screen for crucial changes in the patient’s drug regimen.” The demonstration and discussion of any new medications ensure patients have a “full understanding of why, how and what to look out for when taking their medications,” she told U.S. Medicine.

The extra time spent with each patient “cultivates improved patient understanding and, on many occasions, has enabled the pharmacy staff to catch drug interactions or inappropriate therapies that may have been previously overlooked,” Fisher said. It has also resulted in the Fort Knox facility being ranked among the top pharmacies across the DoD, she added.

The Munson Army Health Center staff at Fort Leavenworth needed to do more than tweak its performance. In 2015, the pharmacy ranked last in MEDCOM with an Army Provider Level Satisfaction Survey (APLSS) score of 42%, said Justin Nevins, chief of the Munson Department of Pharmacy. To turn around its performance, the pharmacy team focused on reducing patient wait times, while increasing customer satisfaction and maintaining safety. As a result, wait times dropped from an average of over one hour in May 2015 to a December 2016 wait of less than 10 minutes. The increased speed and customer attention lifted its APLSS scores in 18 months to 91%. Today, Munson ranks first in customer satisfaction in MEDCOM, according to Nevins.

Munson quickly implemented a number of changes to transform its performance and patient perception. “The outpatient pharmacy underwent a major reorganization that included the installation of efficient shelving and maximized the use of robot automation. Sorting medication stock at filling stations reduced the number of physical steps taken by employees and decreased time taken to fill a medication by over 50%,” Nevins told U.S. Medicine.

The pharmacy also utilized the queuing logic in QFlow, which allowed it to offer one-hour drop-off and next day drop-off services. Like Winn, Munson turned to pharmacy robots to label, fill, sort and store high-volume medications with 100% accuracy. Purchasing unit of use packages and storing those units at filling stations also reduced processing times, Nevins noted.

Throughout the change process, pharmacy leadership monitored error rates, which did not increase, and solicited customer feedback through a weekly survey form. Patient feedback guided prompt adjustments in practice and process to efficiently address patient concerns, Nevins said.

Providing World-Class Customer Service

The Department of Pharmacy at William Beaumont Army Medical Center recognized that, if it wanted to provide the world-class customer service it has as its stated goal, it needed to do things differently at the customer-service window.

The changes “began with the creation of a robust customer service incentive program geared toward recognizing and rewarding staff members and pharmacy sections for providing patients with exceptional customer service,” said Jaleh Ghalandarysafavi, PharmD, assistant chief of the Beaumont Department of Pharmacy.

Pharmacy staff was measured on four pillars of service: asking about allergies, probing for any adverse drug reactions, counseling for new medications and demonstrating use of new medicines. Other metrics used in the program included patient volume, prescription volume, transaction time, idle time, comments and patient satisfaction scores. The program recognized both the individual and section with the highest scores.

As a result of the program, customer service scores rose 5% in three months, and the ratio of positive survey comments to negative ones improved from 2:1 to 4:1, Ghalandarysafavi told U.S. Medicine.