Savannah is a pharmacy manager at community pharmacy practice in a rural geographic location which also happens to be the very same location where she was an intern several years ago. After graduating from pharmacy school and moving away to the city, she has returned to her hometown as the pharmacy manager of her former location. Savannah wanted to return home as a staff pharmacist but found that her former manager was retiring and this seemed like a really good opportunity. While she enjoyed being back to see familiar faces and even working with nearly all the same staff as previously, it was a bittersweet reunion as Ray, the previous pharmacy manager, had long since “checked out” of his role leaving behind quite the struggling operation.
Patient complaints and declining prescription count have plagued this pharmacy for the past 18 months, and she was welcomed to what seemed like an endless amount of things to do in her new role. Additionally, the pharmacy was disheveled and cluttered which made it hard to work efficiently and nearly caused a misfill error within her first week. However, she was absolutely determined to bring the shine, luster, and amazing patient care back to this community pharmacy favorite so she started right away with cleaning and organizing the pharmacy to bring some order to the chaos.
Shortly after, Savannah had to take a week off to finish moving into her new home from the city and came back to a pharmacy that had nearly unwound itself back to where it was just a short time ago. Frustrated and tired, Savannah was finding herself working longer days and even coming in on her days off to try to keep the pharmacy running. She needed to make some changes if she was ever going to enjoy her pharmacy career and begin bringing excellent patient care back to her hometown pharmacy.
Savannah knew that her constant rescuing of the pharmacy wasn’t sustainable and she had a team to support her and the pharmacy’s mission. She sat down one Saturday morning at her house and decided to put some thought and organization to her process. She had some data from this past week’s workflow then grabbed a blank sheet of paper and wrote down four large items at the top: Delegation, Goals, Priorities, and Workflow.
If you were Savannah, what would you write down on your sheet of paper and how would you begin to build your plan? Share and discuss!
| Hours Worked | Employee | Data Entry | Time (seconds) | Fill | Time (seconds) | Pick-Up |
| 38 | Aaron | 120 | 37 | 357 | 14 | 537 |
| 38 | Jose | 47 | 117 | 122 | 31 | 78 |
| 22 | Katerina | 65 | 42 | 445 | 21 | 4 |
| 40 | Martin | 200 | 32 | 502 | 11 | 487 |
| 36 | Paula | 187 | 57 | 214 | 17 | 767 |
| 40 | Samuel (RPH) | 156 | 44 | 14 | 15 | 4 |
| 40 | Savannah (RXM) | 14 | 32 | 7 | 13 | 7 |
| Total: | 789 | 52 | 1661 | 17 | 1884 |
22 Comments
Shannon Pukl · October 3, 2021 at 11:41 am
The long-term plan for the team cannot be to have Savannah to come to the rescue. That isn’t sustainable. Savannah should begin with establishing the goals portion of her bucketed list. It is hard to delegate, prioritize, and arrange workflow if you don’t know where you are headed.
Savannah needs to establish what she wants to accomplish first and by when making some specific goals with timelines to share with the team. She should then have individual team meetings to discuss and provide specific feedback to help move the team toward these goals.
Beyond communicating goals, Savannah can then set the priorities of what matters helping the team identify the most important and urgent items to be done.
As part of her one-on-one meetings, she also needs to evaluate and discuss objective performance metrics of the individual employees. Using a workflow model can help assess skill vs. will, execution and improvement. Additional training might be the next step or perhaps the individual just needed to know members will be accountable for their results.
For the star players, Savannah can leverage their skills delegating specific tasks or training to get the total team on board.
Savannah has got quite the road ahead of her!
Erin Houdek · January 14, 2023 at 12:06 am
Prioritizing the goals prior to speaking with the team is essential. Going over a list of goals – which in this case, may be a rather large list considering the current state of the pharmacy – may be overwhelming and almost demotivate the team. By having a solid plan and including the what-why during the discussion, the team has a better chance of understanding Savannah’s thought process and supporting her. This is a time for her to essentially prove herself and gain their trust as their manager. Starting off with a smaller goal (not necessarily easily reached but that requires some extra effort to obtain) and achieve this goal can help to build their trust and her credibly with them, making them more motivated to support her with such a large undertaking.
It may also be important to go over the generalized workflow of the pharmacy during those one-on-one meetings. It is not uncommon in a high-volume pharmacy for team members to fall into individualized jobs and never stray, thus promoting an unawareness of what other team members do every day. It is crucial that all team members understand the overall workflow within a pharmacy, all of the moving parts, and how they all come together to achieve the common goal. It may even spark interest in further training and development!
Stephanie Matesic · January 29, 2023 at 11:57 pm
Savannah definitely cannot be the hero and save the pharmacy all on her own. I think delegating tasks to others will be extremely important. Something like cleaning and organizing can easily be done by another employee, and Savannah can use her time to complete more important tasks. I agree that one-on-one meetings are necessary. I think it will be important for her to establish and make her expectations of each employee known as well as allow employees to let her know what they expect out of her as their manager and to provide any feedback they have for what has not been going well for the pharmacy.
Jeffrey Tran · July 10, 2023 at 10:07 pm
I like your approach of having the one-on-one meetings as that is something I implemented when first starting my management role. I think that would be a good starting point to re-establish those connections/relationships with staff and also evaluating their performance and realigning the goals of the pharmacy. I agree with using the “star players” to delegate specific tasks, and I do this too, but would recommend only doing it for short term (to get the pharmacy back on track) as others may view this as favoritism. They definitely can help out with re-training of staff to try and get everyone to the same level. A good tool to consider would be a training matrix/Harvey Ball.
Samantha · December 16, 2021 at 6:25 pm
Savannah has to start with setting goals for her team. I have found that the initial goal setting process is a good group activity, especially in a group that may already have reached a group consensus that their needs are not being met and they cannot find a way within the group to make the situation better.
If I were Savannah I would have a group meeting with her team to set baseline goals of how to she wants to run operations and what the group sees as an ideal workplace. This will bring her team together from the start with an agreed upon list and she can also gauge what are some areas that may need addressed on a one-on-one basis based on the reactions of the group to each goal she tries to set. While setting goals she should also set up parameters for how she will address the department if these goals are not reached by their deadlines.
Once the goals are set she can talk priorities with the group. I think its important to involve the group as much as possible when making decisions that will impact everyone with the caveat that the manager does have the final say. They can decide what changes need addressed immediately and what are more “annoyances” that can be addressed once the pharmacy is running more smoothly. Outside of the group setting I think some of the top priorities should include efficiency as evidenced by the data given in the table. I think getting everyone comfortable with each station within the pharmacy workflow and setting a baseline expectation of productivity with each employee should be addressed early on in private meetings.
Once goals and priorities are set, Savannah can start delegating operational tasks to her high performers. When the employees that need to work on meeting minimum expectations meet those goals, they can also be delegated some bigger stretch projects to make everyone feel that they are being included and that they are expanding their KSAs.
As for workflow, I think to get the pharmacy set up for success Savannah should put employees in their strongest roles until minimum competencies are met across the board. As employees start to show competency, they should be put into a rotation to various roles in the workflow.
Kamal Althobaiti · May 11, 2022 at 2:25 pm
Savannah is in a tough situation. The good thing about this case is that Savanah knows the place and is familiar with the clients. I assumed that she had gained a rich experience in the city. Although it is challenging, she can bring the pharmacy back to track and she sounds like the perfect manager to run the place. If I were Savanah, I would start meeting with individuals and seeking feedback. Something I would like to know more about is clients’ complaints and as meetings go along, more issues and feedback will come to the surface. Meeting with employees will effectively inspire and motivate them in the workplace.
On the other hand, Savannah must start setting and determining priorities. This will help the pharmacy; thus, a sustainable operation is expected. She also may need to set a team meeting to discuss the goals and objectives, so everyone can engage, as this isn’t completed by the manager only.
A significant point worth mentioning is that Savannah must be careful and needs to avoid poor prioritization. She also needs to engage her team and use it as a source rather than only delegating.
Heather Lindell · May 18, 2022 at 9:17 pm
It is great Savannah came in ready to make a change and is “determined to bring the shine, luster, and amazing patient care back.” Although from her first experience, it seems she needs to take a deep breath, slow down, and accept the challenge as a work in process. It will not happen overnight and if she thinks it will she may become disenchanted. Here she can engage change management strategies and well as many people management techniques. Keeping Goodhart’s law in mind, she can examine data that is useful and contextually sound to help her. Not all hard data is going to be useful. I would likely perform several observation analyses to observe culture, workflow, interactions, and emergent data I may have overlooked without a purposeful qualitative approach. Next, I would probably engage document analysis. Meaning, I would pull the mission/vision/values statements to determine if we are working towards a purpose of if it needs to be updated (or even created!). I would also pull other documents that may be useful (e.g., client feedback, etc.). Before I engage interviews I would likely want to have a team meeting where I would share my expectations. Those would be my expectations of the team, what they can expect from me, and what are my deal breakers (e.g., stealing drugs). Hopefully Savannah has learned about the focus funnel (eliminate, automate, delegate, concentrate, and procrastinate). She can definitely use this in combination with the Eisenhower matrix to come up with a good game plan for prioritizing tasks identified, and after learning more about each of her team member’s KSAs she can delegate effectively. She can circle back around to assure the established what-why link and the change approach matches the mission of the pharmacy.
Paul Carnes · March 30, 2023 at 3:00 pm
I think your idea to do observations of the current state of the pharmacy is a good one. Just realize that it should only be done as a means for you to learn things that are good that are happening. I find in my experience that when I walk around the pharmacy, everything happens the way it’s supposed to because people are “being good” while the boss is around. Other methods need to be employed to find ways to improve.
Erin Houdek · January 13, 2023 at 11:59 pm
Savannah has the right idea with getting this information together and developing a plan. She seems to have quickly learned that being the rescuer day in and day out is not sustainable and also will not motivate her team to take ownership and pride in their positions and the pharmacy. The first thing Savannah needs to do is develop her short term and long term goals. These goals need to align her pharmacy’s mission and vision, as well as keep patient care as a top priority. It is a delicate balance between obtaining optimal patient care and creating/sustaining a motivated, enthusiastic team.
Once these goals are established, Savannah needs to review her data for her technicians and pharmacist. It may also be beneficial to briefly meet with each team member to discuss strengths, opportunities, and comfort levels with specific tasks. There may be certain factors contributing to the data that Savannah can only discover by talking with her team, rather than only looking at the numbers. All of this information can then allow her to determine if she needs to work additional training into her plans. Some of the technicians may be achieving low metrics in certain areas as a result of a lack of training and/or comfort.
Delegation can the next item to review. Savannah can delegate specific tasks to those who have shown success in those areas. Once the pharmacy is in better shape, she can then look to switching technicians on tasks to improve skill levels (ex: removing the best data entry technician to assist with a stretch assignment and allow another technician to gain experience and knowledge with data entry). The stretch assignment could even be to train the technician moving into the data entry position! If a team member does not appear to be producing much within the metrics listed above, she may utilize that team member to assist in maintaining the cleanliness and organization of the pharmacy. Regardless of the task, Savannah needs to make sure she has a solid what-why explanation for each situation.
Regarding priorities, Savannah needs to have her goals set before she can prioritize. Looking at patient care results, potential for script errors, cleanliness, training, etc. all need to be prioritized based on what she wants and/or needs to accomplish first. It would be helpful for her to utilize the Eisenhower Matrix and the Vaden’s Focus Funnel.
Deborah Miskie · March 17, 2023 at 9:45 pm
Setting the pharmacy Mission and Vision do create the path to the goal. Meeting with each individual to discuss any issues, evaluation of possible lack of training or standards, and progress will be very important to keep the team on task, and communication with the staff open. I also liked the possibility of the stretch assignments or peer training to add motivation and skills.
Stephanie Matesic · January 29, 2023 at 11:51 pm
Savannah needs to develop a plan to get the pharmacy back up and running. Patient safety is first and foremost, so she needs to prioritize organization and cleaning so no more mistakes nearly happen or actually happen. This is a task she could delegate to another employee. It takes no professional license or clinical knowledge to clean and organize, so instead of using the valuable time of a pharmacist, she could delegate that task to a technician or a store clerk, if the pharmacy employs any. She also needs to develop goals for where she wants the pharmacy to be both short term and long term. I would recommend she set goals revolving around patient satisfaction and prescription count. She should have a meeting and discuss the goals with her fellow pharmacists and technicians so everyone has input and is on the same page. Savannah should also set goals for the staff for their data entry, fill, and pick up. This would assure everyone is held to a standard and knows what her expectations are. Savannah also needs to determine what should be high priority and low priority. Everything cannot be done at once, so she needs to decide what is most important to the business and the patients and make those top priorities. Workflow also needs to be established so employees know what their roles are and how the workdays will go. She should look at everyone’s data and numbers to determine strengths and weaknesses to best suit business needs.
Dina Norris · April 11, 2023 at 8:03 pm
I really like your idea for developing short and long-term goals focusing on patient satisfaction can be very helpful for the overall experience in the pharmacy and can help to improve word of mouth in terms of new customers coming to pharmacy. I also think goal-setting as a team will help to improve the morale of the pharmacists and potentially can help them to be more engaged for the pharmacy as a whole.
Ashley Martin · July 17, 2023 at 1:24 am
Savannah as a new manager definitely has a lot on her plate. She seems to be taking on a lot of tasks, similar to Brooklyn in our first case. I agree that delegation is a must for Savannah as she is only one person and cannot do everything herself and runs the risk of burning out or making a mistake that could be harmful to patient safety. She has already identified that the current disorientation of the pharmacy is creating a potential risk to safety. As you stated this is a great place to get another staff member involved and take ownership of this task. I believe that if she were to set goals for data entry, fill and pickup it is important to keep in mind what each staff member’s strengths are. and customize them accordingly. While one person may be fast at data entry, they may be slower at product dispensing. Playingto each members strengths will allow the team to run more efficiently and achieve goals quicker.
Deborah Miskie · March 17, 2023 at 9:38 pm
Savannah is right that cleanliness and organization are very important to good workflow. The Expectancy Theory -Expectancy, Instrumentality, and Valence- would be a good place to start to set the goals, showing the staff what is expected, why it is worth it, and the value for each staff person. She could use the What-Why link to start the conversation with staff, going back to the Mission, goals, and services of the pharmacy. Having standardized processes for safety (Hygiene), and consistency defines the workflow progress, and provides motivation for the staff (Two-Factor Theory). Looking at the staff data, though data is not everything, shows there may be a better roll-fit for some of the technicians according to their knowledge, skills, and abilities. Reviewing the technicians skills, shifts, and task assignments to create a better workflow would be helpful. This would create a better team effort to regain the excellent customer service and patient care for the pharmacy, and the rewards that these bring to the job.
Paul Carnes · March 29, 2023 at 12:59 pm
Savannah is correct that this workload distribution is unsustainable. She can not continue to be the superhero. She needs to maximize her staffing to help her improve her chances of success. Based on the workload distribution shown, it seems that she has some staff members who are underperforming. Jose, in particular, seems to work more slowly than the others and has less output in order entry and filling than other technicians. This may be due to other duties that Jose is performing. So Savannah needs to determine if the workflow around the pharmacy is equitable. If Jose is spending less time, whether it’s personal request or by assignment, doing order entry and filling, it makes sense that the output would be lower. So, overall workload needs to be evaluated amongst all of the technicians to ensure equity. Once equity is established the output should be reevaluated. If it is still disproportionate, then perhaps retraining needs to occur to ensure that all of the technicians are “at the same level” so that there is a reasonable expectation that the output would be similar. But sometimes deidentifying the data and presenting it to the employees is enough to “light a fire” under the lower performing individuals since they know that the boss is watching. Unfortunately, in the end, there may have to be some hard decisions made about staffing as the only way to improve the performance may be to replace the employee.
Healthcare Leadership Certificate · March 30, 2023 at 12:15 am
Great thoughts around balancing workflow, Paul! What other recommendations would you give Savannah on delegation to help her stop “being the hero”?
Paul Carnes · March 30, 2023 at 3:18 pm
It’s important for her to remember that she can delegate the authority but not the responsibility. She maintains the responsibility for all of the duties that she may delegate but she needs to trust her employees (and her training of those employees) enough to allow them to carry out those duties. Showing them that she trusts them with delegation will help her relationship with them and help them to trust her as well.
Carol Campbell · September 18, 2023 at 6:57 pm
I like the idea of deidentifying the data and presenting it to the employees. Most likely the previous manager did not look at the data since he had long “checked out”. This may help to motivate the staff or it may not. Time will only tell and documentation of these discussions will help Savannah in the end if she needs to make some tough decisions.
Dina Norris · April 11, 2023 at 7:59 pm
I think that one of the first steps that needs to happen is that Savannah needs to develop a Vision for her pharmacy and staff as well as Mission Statement. This could help determine the functions of her position that she will take direct responsibility for. In addition this can help her delegate some of the responsibility to others in her workgroup. I also think it is very important for Savannah to really focus on self-care and making sure she is able to balance work-life appropriately to avoid burnout. I also think it is important to spend some time on competency and training to help avoid potential medication errors. The training can also be provided to make sure that the pharmacy technicians are practicing to the top of their license and will also help to assure that the pharmacists can be more productive. Savannah can also ask the staff pharmacists if they have any functions they would be interested in learning more about and this can increase their satisfaction with work and also some relief for Savannah.
Jeffrey Tran · July 10, 2023 at 9:56 pm
Savannah cannot continue with her current plan as it is clearly not sustainable. The best thing for her to do would be to “reset” and start over from the top. Clearly defining the mission and vision for the pharmacy (if possible) or if it is already defined, then using this as an opportunity to realign/remind themselves of the mission and vision. From there, she should start to set her short term and long term goals for the pharmacy and staff. The table included looks like metrics, but a few of them don’t have units of measurement. I would use that as an opportunity to review and evaluate staff on their current performance and let them know of what the future expectations are. She should then look at her priorities within the established goals, possibly using Vaden’s Focus Funnel.
Ashley Martin · July 17, 2023 at 1:09 am
Goals: Savannah should begin by brainstorming what her own goals and objectives are for the pharmacy and her team. She should then have a brainstorming session with the staff to come up with what they think the goals of the pharmacy should be. Having the team contribute to the goals of the pharmacy will give them ownership and buy-in for their efforts. She needs to keep in mind that goals should be challenging but not so difficult to reach that they are unobtainable.
Priorities: Savannah needs to write down a list of priorities and then use the Eisenhower matrix to determine what is in quadrant 1 of both urgent and important so she knows what should be taken care of first. She can then determine what falls into the other quadrants to know when she should take care of them. It is likely that some of the priorities and goals will line-up such as; patient safety, error reduction and increasing script count, which can help her with prioritizing.
Delegation: Savannah needs to begin delegating daily and weekly tasks to the staff members including duties such as cleaning and organizing shelves, restocking daily supplies, ordering supplies, etc. This will allow her to focus on tasks that must be completed by her and cannot be done by other staff.
Workflow: Savannah needs to work on evaluating the numbers each week in order to place staff members into their strongest areas. This will help with workflow improvement. It appears, based off of the numbers she has, that some of the staff may need to do further training to become more efficient. One way to determine if further training is needed is observation and meeting with staff to determine what they believe their strengths and weaknesses are. From there she can decide what area each employee should be assigned to until the pharmacy is on more stable ground. For example, Jose entered the least number of prescriptions, filled the lowest number of prescriptions and did not sell very many prescriptions during his 38 hours. By determining if there is a need for further training, and providing it if needed, she will be able to drive up his productivity and help the team balance the workload.
Carol Campbell · September 18, 2023 at 6:49 pm
The workload definitely shows that there are some areas to be worked on. I would first meet with all the staff and ask each of them to give you both positive and negative feedback. I would asks them for ideas on what could be done better. Maybe schedule some clean-up time with all hands on deck to get the pharmacy organized and decluttered. Once the meeting and clean-up are complete, I would then look at the delegation of duties, what are our goals, how do we prioritize them and how to manage our workflow. It needs to be a team effort and Savannah will need to make sure she is delegating so that she is not living at the pharmacy. It may be tough but she does have a good staff most likely not being used to their full potential. Healthcare is always changing, I know Savannah worked there as an intern and wants to bring it back like it used to be but maybe she should strive to make it better than it used to be. New blood new ideas.