Q&A with Parata Industrial Engineer Brian Cristobal
At Parata, we have frequent conversations with pharmacies about leveraging technology to increase safety and efficiency and improve patient care and satisfaction.
Pharmacies are always looking for ways to do more with less. Sometimes, it comes down not just to technology, but to examining and improving the day-to-day processes in your pharmacy.
That’s why Parata Industrial Engineer Brian Cristobal recently presented a webinar called Boost Your Efficiency: A Lean Approach to Pharmacy Operations.
In the discussion, Brian shared how you can apply 100 years of manufacturing teachings to your pharmacy’s processes to maximize your operational efficiency, minimize waste, and deliver a higher-value experience that will delight your customers.
We had a lively discussion after the webinar. Here’s the Q&A with Brian.
Q: What is the most common waste you see?
The most common waste I see in pharmacies is motion — people walking back and forth to get things they need. Unfortunately, this can also be one of the more challenging wastes to correct, as it may require some substantial changes.
Let’s look at why so many pharmacies have waste in motion.
It often comes down to perceived limitations of your physical space. When things in the pharmacy change, we don’t always redesign the layout. Instead, we just put things where they can physically fit.
Say you need another printer. Even though the person sending the print job and the person needing the paper are on the right side of the pharmacy, there’s more space on the left side of the pharmacy — so you put the printer on the left side, where there’s room.
Another common one is finding space for an additional workstation: “There’s some room on the back counter we’re not using. Let’s put another data entry station there.”
Things like this happen all the time. Putting new things where they fit seems like the path of least resistance, but it can really limit your pharmacy’s efficiency.
To fix it, look critically at the way people move through your pharmacy. You may have to physically move some fixtures or equipment around. You may have to ask someone to give up their favorite spot. You may even get the best results by sacrificing the efficiency of one person to get better flow for the other three people. Don’t be afraid to tweak your layout and workflow.
Q: My pharmacy is running smoothly. Why should I examine my processes?
It’s great news if you feel your pharmacy is operating efficiently. There are likely things you’re doing very well. I encourage you to keep an open mind and take a fresh look at entire processes in your pharmacy. There is always room for improvement. The very nature of the work in a pharmacy creates opportunities for waste — movement, idle time, etc.
One thing to try is shifting your focus; instead of examining the individual steps involved in completing a process, such as filling a prescription, look at what happens between each step. What happens after data entry, but before the order is actually filled? Often those in-between phases are where you’ll find waste that can slip by unnoticed unless you’re looking for it.
It also helps to ask your team members. What challenges or opportunities for improvement do they see in their daily processes? They usually have suggestions to offer. You can make it a game or a challenge: how lean can we get?
Q: What’s the low-hanging fruit — an easy but impactful change?
Organize your workspace.
This also falls under the umbrella of motion. An unorganized workspace leads to searching for tools you need and moving to retrieve those tools. These are commons wastes, and they’re easy ones to address.
This is your goal: “A place for everything and everything in its place.”
In Lean, we call this the 5Ss.
- Sort: Get rid of anything that shouldn’t be there.
- Set: Create a designated place for everything that should be there. If something is missing, you should be able to look and tell right away.You may find something is missing or sorted incorrectly when you have to constantly retrieve it from somewhere else. That’s fine. Set a place for it where it belongs.
- Shine: Clean everything.
- Standardize: Put controls in place to keep your workspace organized — checklists, shadow boards, schedules, etc.
- Sustain: Create the expectation of a clean, organized workspace. This isn’t a one-time fix. It’s something to constantly monitor and continue. Let your team take pride in it.
Q: What’s the first step in finding the waste?
Watch the operation.
This is not a project for a conference room or an office. You need to be on the pharmacy floor, observing what’s actually happening. Otherwise, you may talk about how you think things are happening or how they’re supposed to be happening, but that might not be reality.
Pick a resource and watch what it’s doing. Follow an order from the time the patient walks in the door, through the process as it currently is, and until they walk out.
Write down everything as you see it. Don’t worry about whether it’s a waste while you’re observing. Later you can map it out, decide if it’s a waste, and make a plan to address it.
For help identifying all eight types of waste in your pharmacy, download our handy worksheet. It contains more than 20 pharmacy-specific examples of wastes, questions to help you identify other opportunities for improvement, and space to take notes while you’re observing your pharmacy.
Q: What do I do after identifying a waste?
Once you identify a waste in your pharmacy, you’ll need a plan to improve it. There’s a wide variety of tools and frameworks you can use to help.
The tools below, listed in a general order of simplest to more involved, may be particularly useful in tackling wastes in your pharmacy.
5S is a workplace organization method from Japan. It’s extremely simple, but it can have a big impact. Translated into English, the 5Ss are: Sort, Set, Shine, Standardize, Sustain. That last S is important; to get the most out of the 5S framework, treat this as a mindset to build into your company culture.
Use this simple technique to get to the root of a problem quickly. When you encounter a problem, ask “why” at least five times, until you reach the underlying source. The 5 Whys is best suited for simple or moderately difficult problems — nothing too complex.
Process Flow Charts
Flow charts are simple diagrams that map out the steps of a process in sequential order. Creating a flow chart can help you understand how a process is currently being done, analyze the process for improvement, and document and communicate how a process should be done. This makes for a good interactive exercise that gets your whole team involved and invested in the project.
Value Stream Mapping
This pencil-and-paper tool helps you visualize the flow of material and information required to produce a product, like a completed prescription, or a service, like delivery to a patient’s home.
How is value stream mapping different from process mapping? Value stream mapping takes the analysis one step further by determining whether processes are value-added or non-value-added.
A value-added process either physically changes the product or is a process the customer is willing to pay for. A non-value-added process does not change the product and the customer is not willing to pay for it. Non-value-added processes are often considered waste.
DMAIC is your go-to method for tackling complex or high-risk problems. It’s an acronym for a structured, five-step process: Define, Measure, Analyze, Improve, and Control.
DMAIC is a data-driven, customer-focused framework to help you discover best practices. Its structure discourages teams from skipping crucial steps, increasing the likelihood of a successful project.
I recommend doing some additional reading before you apply the DMAIC framework to a challenging problem, but this is often the process that will give you the most guidance.
For more details about any one of these tools, use the links to additional resources at the bottom of this post.
Q: That sounds like a lot of work. Is it worth it?
Short answer: it depends.
Sometimes you’ll uncover a big inefficiency that can be minimized with a simple tweak. In these situations, I would make the change for an easy win.
Other times, even a substantial effort would only incrementally reduce the waste. It’s perfectly acceptable to evaluate a process and say, “We’re ok where we are. Let’s leave this as is for now.”
If you encounter a complex challenge that seems difficult to address, remember that you’ve already taken the first and most important step: you recognized the waste and identified the opportunity for improvement. That’s huge.
While there are many tools available to address the problem with a standardized process, that isn’t always necessary. These methods aren’t anything revolutionary — you can go a long way by discussing the situation with your team and applying a little common sense.
The Lean approach to minimizing waste is iterative and ongoing. You can do a little at a time and eventually reap big benefits from paying close attention to the small details.
Q: Where can I turn if I get stuck?
In addition to our pharmacy automation solutions, Parata provides consulting services to help pharmacies improve their operational efficiency. Our consulting team has been behind the counter of hundreds of pharmacies. We’re happy to help you identify and address your biggest operational challenges.
If you’re interested in working with me or another member of the Parata Consulting team, contact us at firstname.lastname@example.org.
- Five S (5S) Tutorial
- A Practical Approach to the Successful Practice of 5S
- 5 Whys: Getting to the Root of a Problem Quickly
- Determine the Root Cause: 5 Whys
- What is a Process Flow Chart?
- Flow Charts: Understanding and Communicating how a Process Works
- Creating a Value Stream Map
- To DMAIC or Not to DMAIC?
- Six Sigma DMAIC Roadmap
As an industrial engineer on the Parata Consulting team, Brian Cristobal has been behind the counter of more than 200 pharmacies. With experience in diverse pharmacy settings — from independent pharmacies to national chains to the Department of Defense — Brian offers a unique perspective on efficiency in the pharmacy. Brian holds a B.S. in Industrial and Systems Engineering from North Carolina State University and a Lean Six Sigma Greenbelt certification with an emphasis in health care.