Leading Change: The Pharmacy Team By Jess Coppla, Healthcare MBA, 2018

Simmons University, Boston, MA

Introduction Kim could not believe how Joe had just talked at an elderly customer. Joe had been rude and abrupt with someone who was clearly confused about his medications. As an employee of Poplar's Drug Store chain, Joe, a pharmacy technician, had been trained in how to approach and interact with customers, but he was not exhibiting the behavior taught in those classes. In her first shift since she had rejoined the pharmacy team at Poplar's Chelsea location, Kim noted other problems among team members: poor communication, high stress levels, inability to balance operational tasks with taking care of customers, a lack of teamwork, and so on. The pharmacist who was on duty, clearly flustered by the backlog of work, was so busy filling prescriptions that he was unaware of Joe's interaction with the customer. After turning to walk away from the counter, another technician bumped directly into Joe, dropping her basket of prescription labels and bottles of medication all over the floor. Obviously upset by what had just transpired, Joe announced to no one in particular that he was taking a bathroom break and stormed out of the pharmacy. No one beside Kim even seemed to notice.

Kim had worked on the Chelsea pharmacy team, the group responsible for prescriptions and over-the-counter medications, for four of the last five years: in fact, she had worked there since her sophomore year in high school. During that time, she knew that the pharmacy team had consistently received low marks in customer service. This dismayed her greatly, because she felt like everyone on the team shared the same goal: helping customers be healthy.

The team members assisting the pharmacist(s) were called "pharmacy technicians." The normal size of the team at the Chelsea store was four plus the lead pharmacy technician. The senior pharmacist on duty was ultimately responsible for the performance of the team, but day-to-day leadership was delegated to the senior technician. Since her return from the nearby Elmwood store, Kim had ideas about how to make things better at Chelsea. A little over a year ago, Kim had transferred to Poplar's nearby Elmwood location where she was promoted, trained, and learned how to become an effective senior technician. Now Kim was back at Chelsea as the senior technician and she was hoping to make changes in how team members approached their work.

Kim envisioned a pharmacy where customers left feeling happy and employees loved coming to work, where a cohesive team delivered a great experience that was reflected in their monthly scorecards. Within hours of her return, however, she observed that nothing had changed in Chelsea since her departure. In fact, if Joe's recent encounter with the elderly customer was any indication, things had gotten worse.

Kim asked herself, how and where should I begin to make changes? What structural changes do I need to make? Or, should I begin with the team's culture, and if so, how? How do I work with the senior pharmacist and staff pharmacists to inspire a shared vision? What about the managers and staff that serviced the other parts of the Chelsea Poplar Drug Store who were responsible for all the other types of products and services the store offered its clients (e.g., over-the-counter drugs, perfume, skin and hair care products, greeting cards, 145 food products, electronic products, etc.)? Did they need to become involved in her change initiative or should she just focus on her team? What changes do we need to make with how we service and treat our customers, Kim asked herself. How will I be received by my team, given that I've just returned? As the second in command after the pharmacist on duty, she knew she needed to talk to Joe and address the situation. A pang of anxiety came over her. For the first time since she embarked on her mission over a year ago, Kim felt nervous. It was at that moment she thought to herself, "What have I gotten myself into?"

Background Poplar's Drug Store had grown its footprint significantly since Kim was hired. Once a small, regional player in Illinois, Poplar's ownership turned its attention to becoming a nationally recognized pharmacy ten years ago. Of particular note were the two very large-scale acquisitions over the past five years, adding more than 1,000 locations and expanding its presence to several more states. Due to acquisitions, Poplar's sales levels had increased dramatically, though profitability had lagged because of integrating, logistics, and rebranding initiatives with the acquisitions. Though there were some 1,000 sq. ft. outlets that were strictly pharmacies, many of the stores were 12,000 to 15,000 sq. ft. in size and Chelsea was one of these. In addition to medically related offerings, the larger stores provided customers with a wide range of beauty care products; household items, such as paper products and cleaning supplies, and food items, including milk, a limited range of meats, fresh fruits, and vegetables.

As it became more of a household name, however, Poplar struggled to hold on to the local vibe and reputation for good customer service it once held. In an effort to standardize business across the fleet of pharmacies, Poplar's management introduced a series of trainings all employees were required to take as well as a monthly scorecard with key performance metrics (KPM) by which each store's performance would be measured. Metrics fell into two categories: one focused on customer satisfaction and the other on financial health. Customer satisfaction scores were generated from feedback surveys customers completed by filling out an e-survey or by calling a number provided on the bottom of their receipt. Customers completing a survey were given a coupon for a 10% discount on regular priced products. (See Appendix A for an example scorecard.)

Problems at the Chelsea store Within the very busy, chaotic Chelsea pharmacy, days could get very stressful for Kim and her teammates. Every shift had its own unique challenges and time constraints, but many problems were predictable, too: customers needing prescriptions or over-the-counter, non-prescription medical products that were not in stock; staff not showing up to work; or, so many tasks and responsibilities that staff simply did not have the bandwidth to take care of all the orders and daily tasks within standard operating hours. There were often piles of prescriptions left unfinished from the day before, resulting in long lines of frustrated customers. Despite their dissatisfaction with the Chelsea store, Poplar's was the only conveniently located pharmacy in the community. Kim felt that more customers surely would have left if there were other options. She wondered if improving customer service had been overlooked in the past since the store continued to meet its sales expectations. Considered a "needs improvement" store mainly for its poor performance in customer service, Chelsea's KPM scores had been consistently running in the high 60s when Kim decided to take steps to address the problems. (See example Chelsea scorecard in Appendix B.)

Kim's career aspirations Although she was 21 years old at the time, juggling a full-time job as a pharmacy technician at Poplar while completing her full, final year of college, Kim yearned to be a leader and to make a difference. She was a fixer, and she wanted to 146 inspire change at her pharmacy for the sake of the patients and the staff alike. Correcting long-standing performance issues and the underlying behaviors that caused them would not be easy, yet Kim felt it was right to try. To do so, she devised a multi-phase career plan that involved leaving the Chelsea store for a short period. Kim was not in a position of power and felt she needed to move into a respected role in order to make changes. Approximately a year ago, she shared her proposed plan with both her senior pharmacist, Will, and with the chain's regional manager. She told them she wanted to become a lead pharmacy technician so that she could play a leadership role and help bring about positive changes. This role functioned as a supervisor within the pharmacy, an intermediary between the pharmacy technicians and the pharmacists and the store manager. The store's current senior technician had notified them that she would be taking a long-term maternity leave in six months.

Will, the senior pharmacist, the store manager, and the regional manager all agreed that Kim was ready to take on more responsibilities. However, they worried that she lacked the experience needed to lead the Chelsea team out of its current state and felt it would be better for her to learn the role by first transferring to another store that was already doing well. That way, she could assist in overseeing a functional team that had no history with her as a friend or co-worker. Kim liked the idea of having a safe place to learn the role and was eager to demonstrate that she was up for the challenge. The regional manager identified a store in Elmwood, a community 30 miles away where she could take on the developmental role of assistant senior pharmacy technician. He did so with the support of the store managers at both pharmacies and the new store's senior technician.

Learning how to lead change While working in the Poplar Drug Store in Elmwood, Kim realized that the recipe for success is hard to bake into a standardized scorecard that thousands of stores spread out across the country are expected to follow. The one-size-fits-all approach drove business, but not necessarily culture. The threshold score to "meet expectations" was 77 points out of a possible 100, with up to 50 points earned through customer ratings and the other 50 from sales. In some stores, this created conflict among Poplar's employees who felt at times they did not have ample time to help each customer as quantity of interactions seemed to be valued just as much, if not more, than the quality of them. With the current scorecard structure, stores could somewhat mask issues with customer service if the sales volume was there, which had been the case in Chelsea. Though sales levels accounted for only 50% of a store's score, it was Kim's impression that financial performance played a significantly greater role in determining how stores were assessed, including managerial bonuses. Why else would Chelsea's lower scores have been tolerated for so long by upper level management at Poplar's?

The Elmwood store was a high performer before and during Kim's time there, scoring in the low 90s and earning the designation of "outstanding performer." At first Kim found this ironic since Elmwood was a busier pharmacy with a less tenured staff than Chelsea. She quickly learned that there were key differences between the two pharmacy teams, accounting for their scorecard disparity. Part of what made Elmwood so successful was that everyone on the team knew how to do every task. This alleviated pressure on individuals and created a team environment where the staff knew they could rely on one another to get things done. Additional team-building activities, such as weekly competitions to see who could get the best customer comment or sign up the most customers for flu shots, created a fun atmosphere in Elmwood. The senior pharmacist and the senior pharmacy technician encouraged Kim to have weekly check-ins with each of her technicians as well as take part in team meetings, hiring interviews, and the quarterly performance review process. Kim knew she'd need to bring these practices to Chelsea. Her experience in Elmwood confirmed what she already knew. Scorecards and trainings do not teach passion, empathy, positivity, or trustleaders do.

147 The leaders in the Elmwood store, both in the pharmacy and the general merchandise section, shared Kim's vision about how great Poplar could be for its customers. They emulated the passion they wished to see in their teams and led by example. They worked in harmony, offering associates from either section to help the other. Every employee in the store was trained to assist any customer, and coached on the importance of teamwork and great customer service. This was all done in addition to the standard training all Poplar employees were required to complete, and the Elmwood team lived out these principles every day. Elmwood even had an unofficial, motivational slogan that Kim found rather clever: "Who puts the U in PopYOUlar?" When an employee was recognized by a customer for a job well done or reached a goal or milestone, their picture was displayed on a bulletin board dubbed The PopYOUlar Wall of Fame. The caption on the board read, "Great job, and thank you! Poplar wouldn't be PopYOUlar without you!" Kim loved this approach and recognized how happy it made the team at Elmwood. She spoke with the senior pharmacist and store manager to learn more about it. They believed that passion must start at the topif the team doesn't observe genuine enthusiasm in their leader, the shared goals become less important to them and they will pursue their jobs with less fervor. They encouraged Kim to be self-aware and think about how she could show her passion in her work to inspire others.

Over the course of six months, Kim learned the ins-and-outs of the lead pharmacy technician's position, becoming exceptionally proficient in the tasks required for the role. Kim's leadership skills had grown greatly through this experience, training, and the mentorship she had received at Elmwood. She earned a spot on the Wall of Fame for her efforts. Kim felt she was ready to return to Chelsea as lead pharmacy technician and her regional manager and Chelsea's senior pharmacist agreed. Her return to Chelsea was accompanied by challenging performance goals. She was given six months to help Chelsea boost its monthly scores from "needs improvement" to "meets expectations." Kim knew that was a tall order, but she was excited by the challenge. It was both the best thing for her career within Poplar (she had agreed to continue with Poplar following college graduation in three months), and her beloved Chelsea community.

Now What? Kim could see Joe walking toward the pharmacy while she was finishing up a transaction with a regular customer. She thanked Mr. Braxton for coming in, took a deep breath, and met Joe at the door.

"Hey Joe, I saw what happened a few minutes ago. Can you tell me a little more about it?" she asked.

"That guy hates this place. He said it was his third time coming in to pick up his prescriptions, which we told him we'd have ready yesterday afternoon. Then he had questions about his medication that I couldn't answer, and was upset when I told him the pharmacist could help him after he was done with his calls. I had to get back to my inventory tasks because unless I order the medications we don't have, we'll get another bad score in 'Item in Stock.' He was yelling at me. I tried to stay calm, but it's hard to excuse yourself when someone won't leave. I had to get away from him."

"That sounds frustrating for both of you," Kim said. She then asked a question to which she felt she already knew the answer. "Who else on the team helps with the inventory?"

"That's a good one, Kim. No one else here is trained in inventory. There's no time for me to teach someone, and there's no one else that wants to learn. It's all on me and without help, it's really hard to get things done."

Kim could hear the exasperation in Joe's voice. She offered, "Why don't I help you with the inventory tasks today, Joe?"

"Really?" Joe's frown eased a bit. "You know Kim, everyone around here is shocked you'd leave as great a store as Elmwood to come back here. I don't think we'll ever be as good as them."

Kim smiled at Joe, although she wondered to herself if he was right. She completed the inventory work before leaving for the night. As she walked out, she considered the magnitude of the work ahead. The clock was ticking on her master plan. She asked herself, "Now what?"

148 Appendix A Example of Monthly Scorecard at Poplar Drug Poplar KPM Rating - Example

KPM

Target

Customer Satisfaction

(Scale 1-5)

Greeted Immediately

5

Friendly and Attentive

5

Professional

5

Received Clear Instructions

5

Offered Help

5

Item in Stock

5

Cleanliness

5

Timeliness

5

Would Recommend to Others

5

Total Satisfaction With Visit

5

Financial Health

(Scale 1-25)

Over-the-Counter Sales

25

Prescription Sales

25

Overall Monthly Score

100

Rating

Outstanding Performer

Rating Scales

<77

Needs Improvement

77-83

Meets Expectations

84-90

Exceeds Expectations

>90

Outstanding Performer

149 Appendix B Recent Scorecard at the Chelsea Store Poplar KPM Rating - July 2016

KPM

Current Score

Target

Customer Satisfaction

(Scale 1-5)

Greeted Immediately

2

5

Friendly and Attentive

3

5

Professional

3

5

KPM

Current Score

Target

Received Clear Instructions

4

5

Offered Help

2

5

Item in Stock

1

5

Cleanliness

2

5

Timeliness

2

5

Would Recommend to Others

2

5

Total Satisfaction With Visit

3

5

Financial Health

(Scale 1-25)

Over-the-Counter Sales

22

25

Prescription Sales

20

25

Overall Monthly Score

66

100

Rating

Needs Improvement

Rating Scales

<77

Needs Improvement

77-83

Meets Expectations

84-90

Exceeds Expectations

>90

Outstanding Performer

Leading Change: The Pharmacy Change Case Study located at the end of Chapter 4 in the eText. Discuss the following:

1. What would you do if you were Kim?
2. What specific controls could Kim implement at Poplar Chelsea's location to monitor the change. Consider the following:
   1. Controls when Planning Change
   2. Controls in Early Stages of Change
   3. Controls in Middle Stages of Change
   4. Controls at Late Stages of Change
   5. Controls after the Change (to ensure institutionalization)