Pharmacy by Design – Reinventing the Dispensary

Recently, we published some work (Pharmacy by Design) carried out by some US design researchers that involved pharmacy design basic research.
The company, which is called Nurture by Steelcase, conducted research over a number of differing pharmacy settings and came up with a number of principles that held true for a pharmacy in all those settings.
Design is becoming more important as pharmacy undergoes a paradigm change at the beginning of a renewal cycle, and design help is important in preparing the right environment to accommodate new services and possibly a leaner inventory range.
As change processes take hold there will be new opportunities emerging and those pharmacists embracing change will derive enormous satisfaction as they begin to achieve objectives that even at the end of 2014 seemed out of reach.

Design Principle #1: Apply Lean principles throughout the pharmacy system

Filling prescriptions is task-intensive, which led us to consider what we know about improving processes in manufacturing.
Although pharmacy isn’t manufacturing work, Lean Strategies can be applied to minimise waste of time, waste of motion, and waste of storage space.
New roles like the “Water Spider” can be used to improve flow.
In manufacturing, “Water Spiders” are responsible for ensuring a steady stream of parts is supplied to the people assembling the final product.
They need to be skilled and knowledgeable to be able to anticipate the needs of the line to maintain standard work and keep the process moving.
In dispensary work, this role can be used to avoid batching of dispensing orders and eliminating bottlenecks.

A “Water Spider” is further explained:

A “Water Spider” position is a manufacturer’s term for a line management listing for someone who has the aptitude for what some may consider as a multi-tasking activity.
A “Water Spider” can visualise the assembly process as a whole and can intuitively work at a faster rate to create a final product assembly.

The position evolved in the Japanese car industry, and focused on preparing parts for manual assembly so that they were immediately accessible and properly oriented to make the work of assembly as easy as possible.
Initially, many managers were wary of applying this concept, because they perceived this work as “non-value added.”
However, when proper measurements were made, “Water Spiders” reduced actual assemblers from 10 assemblers to 6 + 1 water spider without any loss of production.
This equated to a net productivity increase of 30%.
Without water spiders, various assemblers had to do this work and did not have the aptitude, so the assembly line faltered.

Many companies made the mistake of putting beginners in that position, which led to picking errors, shortages, quality problems, and line stoppages.
Water Spiders are supposed to be experienced assemblers, familiar with the products and capable of carrying out all the assembly operations in the area they serve, which they actually do if required.
In the organisation, the Water Spider is a member of the assembly team, not the materials or logistics department, and is normally the leader of a team of 4 to 6 assemblers.

These “Water Spider” characteristics are strange and incomprehensible to some managers who simply lack vision.
They often disregard them, and this usually leads them to conclude that the “Water Spider” concept does not work for them.
But it is a concept that will help dispensaries to grow economically and efficiently.

(As a footnote, the actual insect the position is named after is a Water Strider (mizusumashi), not a Water Spider.
The water strider (also known as the pond skater) is a true bug that can run across the surface of water. It lives on ponds and slow-running streams. It rarely goes underwater. The underside of the body is covered with water-repellent hair.
Anatomy: Like all insects, th
Waterstrider_bwe water striders have a three-part body (head, thorax and abdomen), six jointed legs, and two antennae. It has a long, dark, narrow body. Some water striders have wings, others do not. Most water striders are over 0.2 inch (5 mm) long.
The Legs: The long, middle legs move this bug across the surface on the water like paddles. The long hind legs steer them and act as brakes. The short front legs are used to catch prey.
Diet and Predators: Water striders eat small insects that fall on the water’s surface and also larvae (immature insects). Water striders are very sensitive to motion and vibrations on the water’s surface. It uses this ability in order to locate prey. It pushes its mouth into its prey and sucks the insect dry. Water striders do not bite people. Predators of the water strider, like birds and fish, take advantage of the fact that water striders cannot detect motion above or below the water’s surface.

The Water Strider moves around quickly on the water surface; the water spider hides in the water and jumps out to grab prey, which has nothing to do with the function we are talking about.
“Water Spider” is a misnomer that has become standard usage.)

The parallels are easily recognised in the dispensing process.
Basic assembly occurs through dispensing assistants, but it is the dispensary technician that brings the final product together as a whole.
Because of their experience, the technician may double as the person who inputs data into the computer, centring their control within the process.
You would not put an inexperienced person in that role.

With dispensing volumes reaching record levels in 2013, some pharmacies decided to install automated dispensing equipment.
For some, this created new problems:
* a major refit was required in the dispensary area because of different work flows and the physical area occupied by the machine.
* whilst there was a small increase in productivity, it was insufficient to cover the high cost of a machine installation.

There is an alternative that pharmacy has not yet grasped and that is to adopt an assembly line process with a motorised dispensing bench.
This involves designing a bench with a conveyor belt installed along its full length that resembles a supermarket checkout conveyor system (but narrower), with the belt being driven by an electric motor.
Dispensing begins with prescription data being input, either electronically, by bar code or manually.
The paperwork, product information and labels are then inserted into a lightweight plastic security “pod” that ensures paperwork is kept secure.
The pod is then placed on the conveyor belt and transported to a “water spider” station located in the middle of the bench.
A trap device prevents the pod from moving past that position and there is a parking area sufficient to hold 4-6 pods.
All other pods are stored on the bench presumably awaiting some component for completion.
The “Water Spider” opens each pod and begins assembly.
In larger pharmacies there may be additional assembly assistants required at this central work station.
The “water spider” can double up as an assembly assistant as required.

Once a pod is completely assembled, it is transported to a second work station at the end of the dispensing bench. Here, a qualified pharmacist checks the entire prescription and makes any notes for patient counselling.
Each pod can have attached to it a read/write RFID tag that is re-usable.
A reader attached to each work station can be utilised to be a tracking device for each prescription. This information can be transmitted to an electronic screen that can be viewed by waiting patients, reducing the waiting time by patients.
The RFID tag can also be designed to hold complete details of the dispensed prescription which would allow a pharmacist to check from an organised reader screen, which can then become an additional check for input errors when original paperwork is checked against the screen.

Completed prescriptions then migrate to a secure indexed setting close to the pharmacist, and a counselling desk that may be an extension of the dispensary bench.
All items are left in the pod for handing over to a sales assistant to complete the process. They can be in a sealed clear plastic bag to facilitate the sales assistant if there are other items to be wrapped for the customer.
The desk is organised so that there is computer access to the dispensing system and an iPad-type system to organise knowledge products for pharmacist management and delivery to the patient.
The pharmacist at this work station should be the only pharmacist required for the dispensary and should occupy the line position of “pharmacist in charge”.
However, depending on volume, the position may need to be job shared by two pharmacists to ensure fatigue problems from repetitive work do not eventuate.
This position represents an opportunity to deliver a quality service for a patient and requires a quality pharmacist for the delivery.

A full colour printer may also be required.

i2P would suggest that an electric motor driven conveyor belt fitted to a dispensing bench would be a less disruptive system before progressing to a fully automated system (and less costly).

A motorised dispensing bench is a real productivity alternative to an automated dispensing machine.

The transition using this intermediate system would also be less disruptive for staff numbers as an automated system is installed, because productivity gains have been made in advance of the anticipated purchase and the supposed prescription volume increase to justify a machine purchase.
i2P is suggesting that pharmacies plan to gear up for high script volumes because of the ageing population.
Whatever measures adopted by government in terms of rationing health care through the PBS, pharmacies have to become more efficient and learn to manage using supermarket/assembly line processes.
The value-added component for dispensing will always remain with pharmacist-knowledge patient transfers, which is what patients will value.
During this knowledge transfer a pharmacist-patient relationship should be built, which should include a follow-up telephone system for any patient on a new drug or for any changes to a polypharmacy patient’s regimen.

This is the second article in a series that began with

Pharmacy by Design

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