The interview begins—and you have already reviewed the candidate’s resume’. They meet all the qualifications, and even have some excellent references. You hire the candidate, and around six months to one year later after their up and down performance you and the employee decide that it’s best to part ways.
So what happened? The interview went well…check. The references seemed to be great…check. Yet, once the candidate got the job — they had a fatal flaw that was impossible to overcome.
They just didn’t seem to care.
They didn’t care about the customers, didn’t care about their daily performance, didn’t even seem to care about their evaluations… Which ultimately meant that the product they were serving up to your loyal base was average at best. They had just enough good days to make you think maybe it would work out, interspersed with enough bad days to make you shake your head.
It’s pretty weird when you think about it. And naturally, you have to feel a bit disappointed. Typically, I’ll even replay their interview over in my mind; trying to figure out what I missed during my evaluation. Going through this process forces the manager to ask themselves what checkboxes are the most important to be checked before making a commitment to offer the candidate a position.
A few days ago, a colleague reminded me of her words on the hiring process prior to me taking on a management position. She’s held multiple management positions. And she said, “when you hire someone, find a person with good customer service…if the person has good customer service, you can typically work around some of their deficiencies…”
I would add to her statement — that the job candidate’s deficiencies can even be remedied with appropriate teaching and training. So, then the manager must ask themselves, “am I a good enough teacher/trainer to remedy the candidate’s deficiency or do I currently have someone on staff that can be an appropriate educator/mentor for the job candidate?”
I don’t know of any degrees/diplomas to my knowledge that are being conferred by colleges and universities in the field/study of CARING @ WORK. Thus, what questions could be asked to determine if a candidate meets your standards? I guess… you could simply just ask the magical question, “do you care… or will you care? But, unfortunately you will most likely just get a canned answer.
So I suggest going through what-if scenarios with your candidate using a diagram for what you consider to be right and wrong answers for each of your scenarios. This I believe is the best method for gaining a little more insight into determining if a candidate truly possesses the traits required to serve your customer base.
Management can be difficult. As you have read from my previous posts the most important resource of any business is its employees. If a manager is unable to effectively communicate and utilize their employees, he or she will not be managing for very long.
Leverage is a principle often utilized to discuss financial debt in the world of business. Financial institutions and businesses can utilize debt to take on more risks in the hopes of increasing revenue and profit margin. In that same respect the employee and manager utilize forms of “workplace leverage” to ensure status and influence within the organization. Both the manager and employee use various levers to elicit a response.
The manager’s “work place levers”
- Hire versus Fire to influence employee behavior and decisions
- Praise versus Write Ups to influence employee behavior and decisions
- The power to increase salary and dole out bonuses to influence employee behavior and decisions
- Positive evaluation versus Negative Evaluations of employees to influence employee behavior and decisions
- Internal politics with ownership and co-workers to maintain status and position while influencing employee behavior and decisions
The employee’s “work place levers”
- Underutilization versus over-utilization of sick and paid days off to effect management behavior
- Gifts and Praise of management/co-workers to effect management behavior
- Positive versus Negative Evaluations of management/co-workers to effect management behavior and decisions
- Habitually early to work versus habitually tardy to work to effect management behavior and decisions
- Internal politics with ownership and co-workers to maintain status and position to effect management behavior and decisions
I won’t delve to deep into the details of how these actions can be utilized by both the manager and employee; but briefly review each point. Consider the names and or faces of the people that you can associate with each variable. In short, both the manager and employee utilize forms of leverage to elicit responses.
As I’ve mentioned previously, people are as important as financial capital in maintaining a functional organization. For those in management; please take the time to consider these 10 key points to ensure a functional work environment.
- Be upfront and honest about the role each person plays in maintaining a functional business.
- Value the opinion of every member of the team, and actively demonstrate this by listening to their opinions and actively considering these opinions when creating changes within the organization.
- Even in times of disagreement; work diligently to maintain a level of respect for that person
- Focus on the value created for the shareholders when trying to create a unified vision between management and employee.
- Focus on the quality of the product created for the consumption of your customer when trying to create a unified vision between management and employee.
- At a minimum evaluate employees biannually; when evaluating always have a third person involved to witness. This reduces the possibility of arguments and misunderstandings.
- Be respectful of the goals your employees have; most likely they do not want to be employees for life. And that is fine. Work with them on creating a 1 year, 5 year, and 10 year plan so that they don’t feel stuck in a rut.
- Create rubrics to grade yourself and employees; this shows thoughtfulness and reduces bias when grading employees on their abilities.
- During reviews, offer each employee a time to have a moment of reflection. Ask them, “do you have an issue with management, a co-worker, or the organization that needs to be resolved?”
- Practice being able to discipline without bias; this practice helps maintain uniformity in the organization, and builds a level of trust for the employee in relation to management.
You will never be able to keep people completely happy. And following this plan will not eliminate every employee’s discontent. I still implore each manager to have a plan, and stick with that plan during both the good and bad times. Work with diligence to ensure the employees you manage have enough space to consider their place and role in the organization.
We work and work till we are tired. The days and months will pass us by, and before we realize it our most important employees are desiring to leave the organization and often we don’t even see it coming.
Please review my 10 key points; by reviewing these points I hope that you’re able to improve employee satisfaction. It is important that managers ensure that an employee’s concerns are heard. There should be open lines of communication in all phases of hierarchy; ownership–>management—>employee. Communication is paramount to ensuring business success.
A company can quickly collapse under the duress of organizational stress. To prevent this collapse managers must pride themselves on using “workplace levers” in an appropriate manner to maintain balanced scales of power in these “workplace courtrooms” that house office politics in every business and industry.
My Operations Management (OM) Professor in B-school had one question for our final exam.
Explain if this course will or will not be relevant in your chosen profession or career path?
I revisited my short summary a few days ago and considered the role of the Pharmacist in relation to the current healthcare model. How can Pharmacists help create efficiency when we see inefficiency? How can individual Pharmacists help bring order to a process and fill in the gaps when we see an opportunity to help?
I believe the Pharmacist can fill in the “gaps” and find an opportunity to serve in new ways. This will further our value to the healthcare team. Dispensing medications correctly should always be the foundation of our Profession, yet there are more bricks to be put in place to create the final framework in our bid to be seen as “healthcare providers”. With the broad knowledge base that Pharmacists have in their toolbox, there is an opportunity to be more than “retail or clinical.”
December 4th 2015 at 9:53PM I submitted the following.
Sam Blakemore, PharmD
Personal Operations Management
I have been a practicing Pharmacist for three years. In that time period, Walgreens purchased Alliance Boots, CVS Caremark purchased Target’s in store pharmacies, and most recently Walgreens made another large investment in agreeing to purchase Rite Aid Pharmacies.
The number of patients that the healthcare system takes care of will continue to rise due to more people having access to healthcare with the implementation of the Affordable Care Act. Yet, the reimbursements for these services has become more competitive due to increased demand for better pricing by federal and state funded programs.
The Affordable Care Act has made mergers the new norm. Hospitals, Pharmacies, and Home Health Care Agencies have decided that the key to survival is to become as “lean” as possible. In becoming “lean”, the merged companies streamline operations by initiating new workflow processes, retire outdated facilities, and layoff under-performing workers in the hopes of increasing productivity and profits.
Mergers within the pharmaceutical industry are creating shifts in the supply chain. This will impact the drug companies, wholesalers, and retail pharmacies both independent and chain. In the article Drug Partnership Could Trigger Major Supply-Chain Changes, the author states the following:
For now, drug manufacturers mostly use wholesalers like AmerisourceBergen to ship their product to pharmacies. But if manufacturers are squeezed too much by the arrangement, some could opt to bypass wholesalers altogether and peddle their drugs straight to the drug stores…1
Pharmacy mergers have increased for the purpose of survival in a market with a reimbursement structure that changes by the day. In the article, Reassessing the pharmacy supply chain for a healthier bottom line, the author states the following:
The unpredictable and shrinking reimbursement landscape requires these organizations to reassess expenses and processes –especially within the supply chain—across all facilities and departments to determine cost-effective operational strategies.2
Forecasting reimbursement and cost of drugs in pharmacy is key to success. As an example, Rite Aid Pharmacies earnings per share decreased due to a cut in Medicare reimbursement rates.
Rising generic drug prices are hurting drug store operators as insurers and pharmacy benefit managers have been slow in raising reimbursement rates for those drugs…reimbursement rates for Medicare Part D drug plans, which cover prescription drugs for senior citizens and the disabled, are falling due to growing competition to win these contracts.3
Appropriately forecasting revenues and expenses, using lean/six sigma principles to eliminate drug errors, and having a firm grasp of inventory management are the big three principles I will remember from this course. Having a firm grip on these concepts can be the difference between thriving and failure in this market. It is imperative that a pharmacist have a firm grasp of operations management to thrive in this market and differentiate one’s self against other pharmacists they’re competing against for a job.
I want my patients to have a good experience. I want them to receive the right drug, at the right dose, at the right time, and for the right price. With that in mind, this quote grabbed my attention when I first read it.
“With the country focused on controlling the escalating costs of healthcare, every entity in the healthcare system is under increased pressure to lower costs—while at the same time not jeopardizing the quality of care that patients receive.”4
It is my opinion that schools of medicine, nursing, pharmacy, public health and so forth should require or offer as an elective an operations management course. This course has challenged me to reconsider how I manage employees and myself. This operations management course offered me the information, vocabulary, and resources that I’ll be able to draw from in a healthcare environment that is rapidly undergoing change due both to increased competition and decreased net margins.
1.) Martin, Timothy W. Drug Partnership Could Trigger Major Supply-Chain Changes. 22 March 2013. http://www.wsj.com/articles/SB10001424127887324373204578374801163395308. Accessed 23 Nov. 2015.
2.) Piotrowski, Cary. Reassessing the pharmacy supply chain for a healthier bottom line. 17 July 2015. http://www.beckershospitalreview.com/finance/reassessing-the-pharmacy-supply-chain-for-a-healthier-bottom-line.html, Accessed 18 Nov.
3.) Ramakrishnan, Sruthi. Rite Aid cuts full year forecasts citing reimbursements. 17 Sept. 2015. http://www.reuters.com/article/2015/09/17/us-rite-aid-results-idUSKCN0RH1I920150917#BMoHOwRPdPZFJMVo.97. Accessed 18 Nov. 2015.
4.) Pharmacy Inventory Project: Improving Inventory Management at Genesis Healthcare System Pharmacies. 19 Nov. 2014. http://fisher.osu.edu/supplements/10/14252/white_paper_genesis_2014_2.pdf. Assessed 18 Nov. 2015.
It’s not always about how much money a business makes; oftentimes its more important to understand how much money the business can save.
I asked a Pharmacist the following question:
“Who is probably the most famous and richest industrial engineer? Your hint… he grew up in Mobile, AL?”
He paused and thought about it for a few moments…
Then he said, “I’m not sure…who?”
I said, “look at your smartphone… Tim Cook ring a bell…”
Tim Cook…iPhone…ring a bell…”HAHA.” I know…I know…so funny, not really. Our discussion began when he asked me about my experiences in B-school (business graduate school). I discussed various points in my journey as a manager, and how I sought some answers to my many managerial questions. B-school helped fill some of those gaps.
Quantitative Analysis for Managers I explained was an interesting but difficult course. I really had to work hard to put all the concepts together. It was business math on steroids. A taste of algebra with a pinch of calculus and a dollop of excel spreadsheet. One week we were discussing linear programming models; the next week we were discussing transportation models.
I felt like I could study all week for the tests, and still not feel good about my prospects of passing. The Professor would allow us to have a formula cheat sheet, but that was of little value. The course took time and was intense. The tests were tough. He ended up curving our final grades that semester.
It was tedious work. It took time to wrap your mind around some of the concepts; but studying those concepts gave me satisfaction. My mind was being pushed and thats what I wanted as a student. It made me appreciate the skill and art it takes to make complex business processes less complex. I began trying to understand the formulas behind business principles. I enjoy learning about a Professor’s educational background. It always explains why some concepts just feel so natural to the teacher/lecturer. Turns out our Professor that semester was an expert in the field of industrial engineering. I had heard about civil engineering, chemical engineering, electrical engineering, etc.. But I had never heard of industrial engineering.
Pharmacist in general have an appreciation for math and science. So I decided to show my Pharmacist “buddy” an old video on linear programming that the Professor had uploaded on the web. The Pharmacist became “giddy” with anticipation on how to setup the correct mathematical equation to reach an appropriate business decision based on profitability.
We then lightly touched on transportation models…
I said, “driving a 18-wheeler seems simple enough…but then imagine all the routes and paths those trucks can take to get to their destination.”
He said, “yea…that’s right…isn’t that why some mail couriers only take right hand turns? That’s why they have people doing that research…think of all the money they save on gas, and all the time they save by making routes more efficient…”
I said, “you know where most of these principles fall under? Industrial engineering…”
Industrial engineers bring science to our everyday lives by engineering efficiency; they use math to bring order to a process. Pharmacists practice the same methods with medications. We ensure patient safety by being the medication experts of the healthcare team. We bring order and create efficiency in the dispensing and consumption of medications.
So what’s stopping Pharmacists from reaching our full potential as the “industrial engineers” of drug management? Gaining status as “healthcare providers” will go a long way in creating a structure for the reimbursement of our services. But until that “provider status” reaches all 50 states; what can our Profession do to show the “system” our value?
Currently the market is focused on volume to magnify shrinking profit margins. However, the market will gradually shift to a focus on reducing costs. In part because rising costs will lead to skyrocketing debt in our current healthcare model. The market is at risk of collapse due in part to rising medication costs. While we can’t control how Pharma prices new drug regimens.. Pharmacists can be on the front lines of change by initiating the following principles:
- Limit “defects”–use “lean” principles to ensure patient safety and accurate dispensing of medications with appropriate operations management principles
- Improve discharge planning—ensure patients receive the appropriate medications upon discharge.
- Improve access—ensure that upon discharge from hospitals or clinics; patients have access in the community to the appropriate medications from local pharmacies, mail-orders, and patient assistance programs.
- Engage in dialogue with prescribers—regarding the prior authorization process, formulary additions and deletions, an analysis on patterns seen at the pharmacy in the local community.
- Build an alliance—with social workers, churches, community organizers so that when patients need help the Pharmacist can give guidance.
- Data mine–effectively gather data about medication usage and prescriber patters; then turn data into usable information to enhance quality of care.
- Reduce expense—have an active engagement in knowing the costs of medications, and the copay tiers of pharmacy benefit managers. Have an active discussion with patient’s and their families regarding their ability to manage these expenses.
There are more PharmD’s graduating with dual degrees; Pubic Health, Business, and Law. There are more PharmD’s entering pharmacy school having already obtained a bachelors degree. The “Millenial PharmD” has the potential to step outside the box to meet the changing demands of the market.
My version of the Pharmacist Industry Engineer (PIE) does not epitomize the traditional meaning of Pharmaceutical Industrial Engineering in that traditionally the framework of the definition was focused on manufacturing for “Big Pharma”. I simply seek to use this term to reframe how we are defined as agents of change in the current marketplace.
A PIE as defined by me—both optimizes and individualizes pharmaceutical care, creates new processes to improve pharmacy access, improves operations to ensure patient safety, and builds communication channels with both prescribers and patients to reduce waste and expense for the individual and healthcare system.
Efficiency. Accuracy. Reduced Defects. Reduced Costs.
I’m a visual person.
In the pharmacy, visual cues help me make quick decisions regarding prescription status. As a student at a “chain pharmacy” I would put prescriptions in blue buckets or red buckets. Blue buckets for folks picking up their prescriptions in one to two hours, and red buckets for folks picking up in 30 minutes or less.
Throughout pharmacy school it was blue bucket versus red bucket. It’s a pretty efficient model. So efficient I took the practice up at the independent pharmacy that I manage. These buckets can easily be purchased online.
Then I went to business school and started studying operations management. I started to gain an appreciation for the blue bucket/red bucket workflow process. It was an effective method of ensuring customer satisfaction. It gave the Pharmacist visual cues as to what order prescriptions needed to be filled. Lastly, it helped maintain organization, thus decreasing “defects“. With the buckets you can simply drop the prescription in the bucket with the drug. Thus, things matched up when it was time to enter the order and fill the prescription.
I began reading articles on how other Pharmacist maintained organization. I read an article by a man that discussed how he used multiple colors of buckets. When I read the article, I felt like a pharmacy nerd when I read the article and became giddy. For me I had only known blue bucket and red bucket. How could I incorporate more buckets? I know I know…sounds lame!
I began writing up a method and came up with the following:
DROP OFF —> DATA ENTRY—>FILL PRESCRIPTION–>VERIFY PRESCRIPTION–>PICKUP PRESCRIPTION
BUCKET COLORS (Pharmacy Tech/Pharmacist organize accordingly)
BLUE- prescription to be picked up in 1 to 2 hours
RED– prescription to be picked up in 15 to 45 minutes
GREEN– prescription medication is high dollar; pickup likely next day
YELLOW-prescription has an issue ( order needs clarification, call pharmacy benefit plan, etc.)
BLACK– prescription to be compounded
WHY we WORKFLOW
Workflow improves patient safety. Please keep with the workflow to better serve our patients.
This is what works for me as the manager of a pharmacy. The buckets allow me to remain efficient and organized. Both Technicians and Pharmacist can be on the same page with a simple color cue.
I know some people will think this is entirely too much! I would completely understand if you felt that way. It’s an idea…consider it and think of ways that you can tailor it to fit your own practice. I use this technique for pharmacy, however this same technique could possibly be used in the operations of other business models.
Is your business predicated on “volume” to maintain appropriate profit margins? Colored buckets are a cheap investment and can potentially increase your worker’s efficiency. Increased efficiency will increase worker output. Maintaining appropriate output very well could be the difference in business success or failure.