Tutorial 7

Questions
Case Study:
Customers drop off their prescriptions either in the drive-through counter or in the front counter of the
pharmacy. Customers can request that their prescription be filled immediately. In this case, they have
to wait between 15 minutes and one hour depending on the current workload. Most customers are not
willing to wait that long, so they opt to nominate a pickup time at a later point during the day.
Generally, customers drop their prescriptions in the morning before going to work (or at lunchtime) and
they come back to pick up the drugs after work, typically between 5pm and 6pm.When dropping their
prescription, a technician asks the customer for the pick-up time and puts the prescription in a box
labelled with the hour preceding the pick-up time. For example, if the customer asks to have the
prescription be ready at 5pm, the technician will drop it in the box with the label 4pm (there is one box
for each hour of the day).
Every hour, one of the pharmacy technicians picks up the prescriptions due to be filled in the current
hour. The technician then enters the details of each prescription (e.g. doctor details, patient details and
medication details) into the pharmacy system. As soon as the details of a prescription are entered, the
pharmacy system performs an automated check called Drug Utilization Review (DUR). This check is
meant to determine if the prescription contains any drugs that may be incompatible with other drugs
that had been dispensed to the same customer in the past, or drugs that may be inappropriate for the
customer taking into account the customer data maintained in the system (e.g. age).
Any alarms raised during the automated DUR are reviewed by a pharmacist who performs a more
thorough check. In some cases, the pharmacist even has to call the doctor who issued the prescription
in order to confirm it.
After the DUR, the system performs an insurance check in order to determine whether the customer’s
insurance policy will pay for part or for the whole cost of the drugs. In most cases, the output of this
check is that the insurance company would pay for a certain percentage of the costs, while the
customer has to pay for the remaining part (also called the co-payment). The rules for determining
how much the insurance company will pay and how much the customer has to pay are very
complicated. Every insurance company has different rules. In some cases, the insurance policy does
not cover one or several drugs in a prescription, but the drug in question can be replaced by another
drug that is covered by the insurance policy. When such cases are detected, the pharmacist generally
calls the doctor and/or the patient to determine if it is possible to perform the drug replacement.
Once the prescription passes the insurance check, it is assigned to a technician who collects the drugs
from the shelves and puts them in a bag with the prescription stapled to it. After the technician has
filled a given prescription, the bag is passed to the pharmacist who double-checks that the prescription
has been filled correctly. After this quality check, the pharmacist seals the bag and puts it in the pick-
up area. When a customer arrives to pick up a prescription, a technician retrieves the prescription and
asks the customer for payment in case the drugs in the prescription are not (fully) covered by the
customer’s insurance.

The following is taken from Exercise 6.8, 6.10, and 6.16 of Foundations of Business Process
Management 2nd Edition.

1. Considering this process, identify the steps in this process and classify them into VA, BVA, and NVA.
 ANSWER:
PROCESS ACTOR CLASSIFICATION

VA BVA NVA

Drop the Prescription Customer

Fill the Prescription Technician

Automated Prescription System/Pharmacists

check (DUR)

Review the prescription Pharmacists

check

Request for Insurance Insurance company

policy

Perform drug replacement pharmacists

Collect the drugs Technician

Perform Quality check Technician

Making drug ready for pharmacists

pickup

Retrieving prescriptions Technician

Making Leftover Payments Customer

(IF ANY)

2. Considering this process, what types of waste can you identify in this process?

ANSWER: MOVE: (Unnecessary Transportation): Dropping Prescriptions-Technician sends them to

pharmacists-Pharmacists again send back to technician-Technician puts for picking up-Customer
picks up prescriptions.
Hold: (Waiting): Insurance Checks approval, Replacements of drugs approval (If any), and Drug
utilization Review.
and OVER-DO: (Defects), (over processing): No drugs found suitable and looking for any
replacements, Insurance company not paying for drugs and reviewing again and again by
pharmacists, doctors and technician and prescription delays due to no availability of drugs or Drug
replacements not approved by doctors.

3. The following issue has been identified for the process:

 Sometimes, the customer arrives at the scheduled time, but the prescription is not yet filled
due to delays in the prescription fulfillment process.
Analyse the possible causes of this issues using a cause-effect diagram or why-why diagram.
ANSWER:

Insurance
Pharmacy Check
System Review for Payment
of drugs by insurance
company
Wrong Details
System
entered
processing slow Insurance company
delays in estimating the
Alarms raised by costs of drugs.
DUR

Problem: Delays in Prescription

Fulfillment Process.

Prescriptions are
Doctor not wrongly filled
reached to Drug Pharmacists may not
confirm Replacements review the prescription
not approved on time.

Prescription Quality
Review Checks