Problem: Patient stuck at pharmacy window because pharmacy staff has a question for provider and cannot dispense medication until question answered.

Process Mapping & Observations: No standard procedure existed for the pharmacy staff member to follow to solve this problem.  Each time the problem occurred, the pharmacy staff member would try whatever made sense at the time: eg, call the medical assistant, call the provider on office phone, use the overhead announcement system to page the provider, leave the pharmacy window and walk around the clinic looking for the provider.

Types of Wastes Identified in Observations: complexity, corrections, inventory, waiting time, searching time, transportation.

Proposed Solution: Pharmacy staff member pages the provider on her or his personal cell phone or pager through the Group Health paging system.

Results: Proposed solution tested for one week, during which time the consensus opinion in the clinic was that the new procedure was at least a 50% improvement on the previous procedure and became formally adopted by clinic.

Lessons Learned: 1) many providers not carrying pagers or cell phones; 2) many providers did not have the appropriate pager or cell phone registered with the Group Health paging operator; 3) if the provider did not respond to the page in 8-10 minutes, the pharmacy staff member would have to use judgment as to next best step.