Tuesday, January 05, 2010

The Customer Impact of Process Flow

A surprising (and painful) inflammation of my right shoulder last night around 3:00am prompted a highly-motivated trip to the Doctor's office this morning as soon as they opened.  Diagnosis was straightforward, and the clinic electronically transmitted my prescription to our local pharmacy of choice.  

Arriving at the pharmacy, still holding my right arm in pain, I checked in.  Yes, they said, my prescription had arrived already but they had a question about my insurance plan.  Indeed, I said, our company changed it at the first of the year, here is my new card.  They updated my information promptly, invited me to have a seat and went to work to fill the prescription. 

As I eased my aching body into a nearby chair, I realized I had a front-row seat on process flow.  The layout of the pharmacy let me see clearly eight pharmacists and technicians all working furiously.  There was activity everywhere; big bottles being pulled, filling smaller bottles, printing labels, stuffing sacks, stacking orders, three phone lines ringing.  I was impressed with how hard everyone was working on a Tuesday morning.  

Yet, with my process eye, I had concerns.  All the activity did not seem to have an obvious direction.  Two members of the team seemed to be stacking, re-stacking and then subsequently moving stacks of plastic baskets with partially filled prescriptions.  Several team members shouted to others.  Almost all members were interrupted a least a couple of times to go help another or respond to some other stimulus.  My ten-minute wait stretched to nearly thirty.  And the pace of activity of the eight team members never let up.  (Note to long-term readers; my perception of pain subsided as I analyzed process flow... who knows, maybe the geek factor is actually an analgesic.)

Finally, my order was ready.  The pharmacist took her time and reviewed carefully with me the timing of how I needed to take the medicine, even giving me a small calendar page with the specific instructions.  I asked a couple of questions, which she knowledgeably answered.  Nevertheless, in this moment where she was obviously speaking with a customer, one of her colleagues interrupted with a question as she spoke with me.  

I paid, eased back into my parka and drove home with an uneasiness unrelated to the continued pain in my shoulder.  In all that flurry of activity, did they actually get the proper medicine in the bottle?  Did they mistake-proof the process somehow?  How many hundreds of pills flowed in front of my eyes during that thirty-minute wait?  And did the correct ones get into the bottle now on the front seat next to me?  The best error checking I saw was the validation of my method of payment...did that system extend to the pills themselves?  My observations did not give me confidence it did.  

I realized I had one more check I could make at home.  I went to drugs.com and entered the markings on the pills themselves, figuring the imprint on the tablet was the closest possible identifier of the actual medicine.  To my relief, they matched, precisely, the prescription written out and handed me by the physician.  Only then, did I take the meds.  And, as promised, I had considerable relief within a couple of hours.

What do we take from this?  I've done business at this particular store for over 20 years.  I've always had good service there.  Yet observing that chaos gave me pause, such that I didn't trust them to fulfill the most basic element of a pharmacy's task.  

If I brought a customer into my shop, would she leave saying "Wow, do I have confidence in what they do?"  Or would she have an uneasiness, trying to figure out how to independently assess what we do? Would what we do and how we do it silently speak thunderously to the validity of our product?  

Got me thinking...hope it does you too.

Keep learning.  


Mark Welch said...

Interesting post, Joe. Since you've been doing business with them for about 20 years or so are you comfortable sharing what you observed with one of the pharmacists who is in a leadership role? It might open some doors, help them improve, and give you more confidence in the meds you're purchasing. I've read a number of accounts of Lean in pharmacies before and the huge difference it's made.

Bill Caputo said...

Another way to approach it is as a (professionally) interested customer. Instead of offering to help them improve, ask instead to understand. It's possible (even likely given the regulatory nature of the product) that some of the observed chaos is due to regulatory or other hard requirements that certain qualified people make certain decisions, double-check work, must be with a prescription from start to finish, etc. No offense to you or Mark, but assuming they need to improve, before understanding the requirements is a good way to be viewed as "one of those customers" instead of getting an inside view of things.

Brian Marick said...

May just be reiterating what Bill said: a lot of what could be perceived as chaos might be order you don't see. I'm sensitive to that because I've seen that reaction when executives walk into Agile team rooms. It looks *messy*. And, in fact, the room is in some ways organized to structure interruptions. For example, my experience when pair programming is that the conversations around me do not interfere with my work /but/ I am still attending to them enough that I can pop my head up when someone says something relevant to our task. Things like "maybe we should change the Framistat to..." might lead me to say, "Hey, we're changing the Framistat right now... What are you looking to do?"

Mark Welch said...

Bill & Brian,

I certainly agree with your comments - we've got to understand first the current state first. Perhaps I jumped ahead to the main objective, which would be offering to help them improve. I wouldn't think we'd just want to understand and then not offer to help them improve if we thought we could. There wouldn't be much point to observing, understanding, then not taking action, if welcomed.

I'd also be willing to bet than since Joe has been doing business with that pharmacy for 20 years that if it looks and smells like chaos, it probably is. Particularly the pharmacist being interrupted while she was directly helping him.

Anonymous said...

Seems like an accurate observation. I am currently and have been for 3 years, learning and testing flow experiments in a pharmacy.