Process Map
The analysis of the difficulties HMO’s pharmacy experiences is based on the step by step analysis of the processes that take place in the company. The analysis enables identification of the sources of errors that lead to the inaccurate prescriptions. The process flow diagram is presented in Figure 1.
Figure 1. HMO’s pharmacy process flow diagram (by Hopper, 2012).
HMO’s Pharmacy Key Problems
The analysis is performed by stages.
1. Receive a prescription. The source of inaccuracy here is the wrong prescription. Here, two cases are possible. The customer provides with the wrong prescription or the technician takes the wrong prescription (an old prescription from another customer that accidentally appears at hands). Although this is the improbable case, it should be considered.
2. Translate prescription. The technician reads the prescription in a wrong way due to scrawled handwriting. The other case, the technician translate the prescription in a wrong way, namely reads the wrong drug name, conformable with the correct one. This may happen due to inadvertence or lack of technician qualification (weak knowledge of the drug names).
3. Enter information into the computer system. If the error appeared in the previous stage, then the wrong name is entered. In case the prescription was properly translated, the wrong drug name can be entered. As in previous case, the source of error is inadvertence or lack of technician qualification. The error can also take place if the database malfunctions and outputs the wrong result.
4. Filling the prescription. Basing on the information from stage (3), the technician fills the prescription (packs the order). In cases the mistakes were at the previous stages, the customer receives the wrong drug. The technician might put the wrong drug into the order or mix up with the other order due to inattention.
5. Providing the patient with the consultation. If there was a mistake on any of the previous stages, the wrong instructions are provided. It is also possible, that the technician provides the wrong instructions with the properly filled prescription due to poor qualification. The customer may also misunderstand the instructions, since the technician’s instructions have not been enough detailed or clear.
HMO’s Pharmacy SIPOC Analysis
The HMO’s pharmacy SIPOC analysis is illustrated in Figure 2.
Figure 2. SIPOC analysis of the HMO’s pharmacy.
HMO’s Pharmacy Root Causes of the Problems
The main root causes of the problems that HMO’s pharmacy experiences might appear in any stages presented by SIPOC diagram. Some of the causes intercross in different stages of SIPOC diagram. The most probable sources of error are:
- doctors – handwriting issue;
- prescription and translation the prescription (input and process sections) – wrong translation or mixed prescription.
- data base with drugs (input and process sections) – error at entering the prescription, malfunction of the database.
- filling the order – wrong drugs put in the order;
- passing to the customer – wrong order passed (if two orders processed at the same time);
- consultation on the application – wrong or improper instructions on drug application;
- customers – customer provided with the wrong prescription or misunderstood the instructions.
Common cause variation is present in any process, and the appearance of it is subject to probability. Typically, it causes insignificant influence on the process. The special-cause variation is unpredictable and appears as a new characteristic of the system (Balestracci & Barlow, 1996).
The common causes:
- issues with handwriting and improper translation due to handwriting; the doctor’s scrawl handwriting is typical, and the pharmacists learned to read it, and therefore the case of the wrong translation subject to random variability;
- error at entering prescription;
- improper consultation on the application.
The specific error causes are those that appear unpredictably and in some degree sound weird and impossible. These are random wrong translation, mixed prescriptions, malfunction of the database, putting the wrong drugs into the order, giving the wrong order to the customer, wrong instruction provided, and the wrong prescription provided by the customer.
Tools and Data to Correct HMO’s Pharmacy Problem
The manager has to analyze cases with the wrong prescription and determine the reasons for the wrong prescriptions. To perform this, all cases have to be gathered and categorized. The categories are formed according to the root causes of the problem. Table 1 presents the example of the categorizing table.
Categorizing the Wrong Prescriptions by Root Causes
In case there is a significant number of cases (about a hundred), the frequency distribution can be build (Kobayashi & Pillai, 2012), and this can show the most frequent cause of the improper prescription. Basing on the example presented in Table 1, translation due to improper interpretation is the most frequent. Therefore, the statistical frequency is the tool to recognize the reason for faults in drugs prescription.
Solution to HMO’s Pharmacy Problem and Strategy to Assess Success
Generally, all cases are caused by technicians’ inattention or lack of qualification and some uncontrolled faults. The uncontrolled factors appear irrespective of the management and personnel efforts. The other cases can be corrected. The managers can organize series of trainings for personnel to read and interpret doctors’ writing, and training for the drugs names, as well as training for attention development. Irrespective of the reasons, the trainings for technicians’ skills improvement is a useful tool to improve the situation at HMO’s pharmacy.
After the trainings, the managers have to calculate cases with the wrong prescriptions. In a month, or any other period, the managers have to compare the number of inaccurate prescriptions and compare to pre-training period. This should be done with the application of the statistical tests. Namely, this should be the paired-sample t-test (Kobayashi & Pillai, 2012). It will allow testing if the difference between the pre- and after training periods differ significantly and if the training was successful.
Therefore, the process flow diagram and SIPOC analysis allows determining the difficulties that HMO’s Pharmacy faces. The detailed analysis provides with an opportunity to determine the reasons of the improper prescription.
References
Balestracci, D., & Barlow, J. L. (1996). Quality improvement: Practical applications for medical group practice. Englewood, Colo: Center for Research in Ambulatory Health Care Administration.
Hopper, T. (2012). Mosby's pharmacy technician: Principles and practice. St. Louis, Mo: Elsevier Saunders.
Kobayashi, K., & Pillai, K. S. (2012). A handbook of applied statistics in pharmacology. Boca Raton, Florida: CRC Press/Taylor Francis Group.
