Innovator: The power of a workflow revolution

“Healthcare isn’t just filling a prescription; it’s being that trusted person in the community that patients can call on.” That’s how Chris Juozaitis, pharmacist/owner of Howe Sound Pharmacy describes the purpose that drives him and his staff. In fact, Juozaitis and his pharmacists don’t fill any prescriptions—and haven’t in the many years since he completely redesigned his pharmacy’s workflow to allow pharmacists to do what they should do: work directly with patients to ensure they optimize their use of medications. When you’ve owned a pharmacy in a small coastal community like Gibson’s in southwestern B.C. for the last 35 years, it’s not uncommon to see patients you knew as babies now coming in with health questions for their own children. Knowing, for example, that Mrs. Smith lost her husband last summer and has more anxiety now also comes with the privilege of knowing your community, says Juozaitis. This emphasis on pharmacist/patient relationships is at the core of pharmacy services at Howe Sound Pharmacy, which Juozaitis has co-owned since 1988 with various partners. It’s also what prompted him to revamp the pharmacy’s physical design and workflow so that patients have as much pharmacist contact as possible. The strategy has not only improved clinical care, but it has also increased profitability and staff satisfaction. Despite the fact Howe Sound Pharmacy has the highest dispensing fees in an area with eight other pharmacies, new patients continue to transfer their prescriptions there. And when fully staffed, the pharmacy bills more than $10,000 per month in clinical services. Juozaitis tells us how he’s optimized pharmacy workflow to enhance patient care in a community setting, and why it’s a strategy he’s hoping more and more pharmacies will adopt in the near future. How exactly is the pharmacy set up? We have four intake stations, so right off the bat, patients deal with a pharmacist when filling a new prescription or refill. This gives the pharmacist time to assess the patients’ needs and provide counselling. Pharmacists will provide medication management, identify and address drug therapy issues and counsel on OTC or herbal products as needed. We spend anywhere from two to 10 minutes with a patient depending on what they require. Then the technical parts of filling the prescription are passed onto the assistants and registered technicians. The real innovation is that the pharmacist is at the start of the process instead of at the end. The extra time pharmacists spend with patients also helps generate fees for cognitive services, which the province pays for. When the medical building originally beside us decided to move, we were able to move with them—from a tiny, old building in a strip mall to the 4,500 square-foot space we’re in now. How do customers react to this concept? The first time they come, people will say they’ve never been in a pharmacy like this—I get those comments weekly. They don’t expect to get a chance to spend time with the pharmacist, but then they really appreciate it. With medication management comes better compliance too, as we are helping ensure patients are getting their refills and taking their medications properly. We also fill a lot of emergency prescriptions for patients who can’t see their doctors, so there’s that continuity of care. How did you come up with this concept? Back in 2011, the government was looking for opportunities for pharmacists to do more clinical services and was offering payment for medication management services. We were already spending extra time with patients anyway so jumped at the chance to be part of that initial pilot. We moved into our new space and realized we needed to create an environment that allowed for better contact with patients. When we realized this really was a better way to practise and that this model could work in any size pharmacy, we decided to open up a consulting business in 2016 called AdhereRX. One of the first customers we had was Sobeys Safeway and they completely revamped the way they practise. Even though their store footprint may be the same, they are much more focused on having enough technical staff in the background to allow pharmacists to spend more quality time with patients. I also want to stress that this kind of model can work in any size pharmacy and you don’t have to have intake stations. When we started it was a hole in the wall and a counselling area that was the size of a closet, but you can find workarounds for most issues. How many currently on staff at Howe Sound? We would typically have between 19-22 people on staff, but we lost some people during the pandemic as they didn’t want to work on the frontlines and we haven’t fully recovered yet. We now have four pharmacists (three full-time and one part-time), three registered pharmacy technicians, plus pharmacy assistants and front staff. I often have other pharmacists reaching out to me too to ask about what we do. And no one balks at your higher dispensing fees? No, I always tell new patients we are more expensive ($14, compared to $10 at pharmacies in the area), but it’s the patient experience that sets us apart, and they’re willing to pay for it. I wish my colleagues would recognize that their time is valuable and they’re worth it. You will not lose patients if you provide better care. Have you adjusted your practice model over the years? We added an automated vial dispensing machine in 2019 (called a Parata System) to offset the loss of some staff. The robot, while expensive, has made us all more efficient in our jobs and allowed us to fill more prescriptions. The key is in looking at how automation can do the technical work to allow you to spend more time with patients. Having the technical parts of a prescription filled by automation and skilled assistants and techs at a much-reduced rate (compared to pharmacists) just makes perfect sense. It’s not about replacing long-term staff per se, but if your pharmacy is growing, adding a piece of automation can be a good thing. What’s next for you, Chris? I’ve been in pharmacy for more than 40 years so it’s time to start winding down. Eventually I’d like to go down to three days a week. But that said, I still want to share my knowledge and will continue to talk to pharmacists who are reticent about changing things around. I really love going into pharmacies and helping make changes that make a positive difference in patient care and in pharmacy workflow. Rosalind Stefanac is a Toronto writer specializing in pharmacy and retail journalism.

Innovator: The power of a workflow revolution

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