By Annette M. Boyle

Tenley Poulin, PharmD, BCPS

Tenley Poulin, PharmD, BCPS

PHILADELPHIA — When outpatient pharmacy customer satisfaction scores plunged below 40% on a recent survey, pharmacists in Philadelphia responded with several quality-improvement initiatives and were rewarded with significantly improved ratings.

VA pharmacies use the Survey of Healthcare Experiences of Patients (SHEP) to measure customer satisfaction. Historically low rates at the Philadelphia VAMC outpatient clinic dropped further in a recent survey, reaching a nadir of 38.6%.

The center’s pharmacists decided that improvements had to be made to improve the experience of veterans picking up prescriptions.

“Before the initiatives were implemented, many veterans perceived the outpatient pharmacy service as poor for several reasons. Answers varied from ‘Why do you have three pharmacy windows available, but only one or two pharmacists working at a time?’ to ‘the wait time is too long,’” said Tenley Poulin, PharmD, BCPS, a postgraduate pharmacy practice resident at the Philadelphia VAMC at the time and now a clinical pharmacist at Christiana Care Hospital in Newark, NJ.

Over a two-week period, the pharmacy team administered a three-question survey that asked customers to rate their overall experience with the outpatient pharmacy service, their satisfaction with customer service and how they thought the customer service could be improved. The survey used a five-point scale with “5” being “excellent” for the overall experience question or “very satisfied” for the customer service question.

A total of 79 veterans participated in the initial survey, which was led by Poulin. Their answers served as the baseline for an analysis on the effectiveness of the quality improvement efforts, which was published in the American Journal of Health-System Pharmacists in September.1

The pharmacy team reviewed veterans’ survey responses to determine common themes, then developed initiatives with specific tasks, which were implemented over time. The team categorized initiatives as environmental, personnel, communicative or technological and prioritized them based on frequency of response.

“After the initiatives were implemented and the surveys were redistributed, many of the veterans recognized the improvements that were made,” Poulin told U.S. Medicine. “Some commented that the overall wait time had been decreased.”

The initiatives significantly improved ratings of both customer satisfaction and experience. Initially, 25% of veterans rated their customer service experience a “5.”After implementation of the quality improvement changes, that high level of satisfaction more than doubled to 56%. The percentage rating their overall experience as excellent rose from 20% to 36%. The follow up survey was completed by 25 veterans.

The authors noted that differences in the ratings “can be attributed to the fact that experience (Question 1) and customer service (Question 2) are not synonymous terms.”

“Based on the information that we collected, we found that perception plays a big part in how individuals view the customer service they are receiving. Having an equivalent number of pharmacists to open service windows plays a big part in patients’/customers’/veterans’ perception on how a business is operating,” Poulin noted.

Prior to the changes, the pharmacy had three counseling windows and just one pharmacist. The windows were labeled 1, 2 and 3, and the window that was staffed was No. 3. Following the initial survey, the team put up signs in the vacant windows noting that “This window is currently closed,” the authors explained. They also changed the window numbering so that regularly staffed window was No. 1. In addition, veterans’ comments and the staff’s own experiences reinforced the need to have two pharmacists during peak prescription pick-up hours.

Personnel received training in customer service in several formats. The team also undertook an education program with primary care providers and patients to correct misunderstandings about the prescription pick-up process and expected wait times. Healthcare providers received an email and a handout that explained the process and a pharmacist reviewed the process in person at a meeting with primary care providers.

The pharmacy also recruited volunteers, primarily retired veterans, who were trained and scheduled daily to help patients understand the process and facilitate the process for any who appeared to be waiting for extended times. The volunteers brought urgent complaints to the attention of pharmacists for immediate resolution and documented other comments to be addressed later.

Other improvements included a redesign that installed a glass partitions between an adjacent cafe and the pharmacy waiting room, relocation of the prescription pick-up line and a separate area for patient-education materials. The redesign had not been completed before the follow-up survey was done, but Poulin reports that it now looks much cleaner and more spacious.

The quality-improvement project allowed for real-time data collection and feedback, unlike national surveys that typically provide results with a three- to six-month lag. It also provided much larger samples of veterans (79 and 25) than the national SHEP survey (fewer than 10).

Overall, Poulin and her colleagues reported that the changes increased customer satisfaction and impressed Philadelphia VAMC leadership with the results obtained in a relatively short time period as well as ratings that were much higher than historical levels.

All the changes focused on making one point. As Poulin said, “Customer service is key! It is important to treat the veteran as though they are your only patient and give them the time and respect that you would expect if you were being served.”

1 Poulin TJ, Bain KT, Balderose BK. Quality-improvement initiatives focused on enhancing customer service in the outpatient pharmacy. Am J Health Syst Pharm. 2015 Sep 1;72(17 Suppl 2):S79-82. doi: 10.2146/ajhp150152. PubMed PMID: 26272897.