Minimizing Workflow Interruptions

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Wouldn’t it be nice to have all day to perform the tasks one sets out to do during their work day and not be interrupted by anyone at anytime? Can you imagine how much work you could get done? Can you imagine the stress reduction? Well, those sorts of conditions are rarely if ever applicable for anyone’s job. In fact, so-called ‘interruptions’ are a large part of pharmacists’ jobs and  involve a considerable amount of their communication activities. However, workflow and job descriptions can be designed to minimize the impact of these disruptions and even leverage them to promote higher quality of work and minimize their deleterious impact on work llfe.

Reddy et al examined the interruptions that occur for pharmacists in the community setting.1 One of the many interesting aspects of the study is that for study participants (interviewees), the researchers did not define what an interruption was, so as to avoid the Hawthorne effect. Instead, the researchers informed participants merely that the study was to investigate how pharmacy personnel work and communicate with one another. For the purposes of coding and analysis, the researchers defined an interruption as a break in the task of a pharmacist while the pharmacist is engaged in any activity related to dispensing medications, such as order transcription, pill counting, filling, labeling, verification, and counseling. The study found an average of 7-13 interruptions per hour across 6 different pharmacies. They characterized the interruptions across 5 domains: (1) Patients (43%, walking up to the counter, calling in refills); (2) Technicians (25%, interrupting a pharmacist due to a task required that they are unauthorized to complete, having difficulty with a prior authorization, or talking with the pharmacist about a non-work matter); (3) Self-initiated (17%, calling a prescriber's office to seek needed information, initiating a non-work conversation, pausing in anticipation of an interruption); (4) Technology (8%, phone ringing, attending to DUR alerts on the computer, store loudspeaker announcements); and (5) Second pharmacist (5%, having question about dosage or similar question and leaving a shift that requires handoff of information to current/upcoming shift of employees). All of these might sound like, and indeed are part of the pharmacist’s job, per se, but they come as interruptions to workflow, requiring of the pharmacist that they divert their attention away from a current task, onto a different one, then back to the task they were initially working on; and this demands cognitive load and can lead to errors and to burnout. The researchers note workflow redesign factors modeled after the Systems Engineering for the Improvement of Patient Safety SEIPS) model, along with the need to educate patients on the complexity of processing prescriptions, improved technology for notification of patients regarding the status of their prescriptions in addition to better call management systems for triage, provision of an interface to aid decisions for interruptions based upon a cost-benefit assessment of the potential interruption, system modification to reduce error alerts, training technicians to differentiate between urgent and non-urgent needs for interruption, and various spacing improvements, including even color-coded zones to indicate certain areas where interruptions are basically impermissible.

Pharmacy managers do not have to simply live with interruptions. They are and will likely remain for quite some time to be a consistent and persistent part of the job. But certain changes can be made to operations that minimize these interruptions, reduce errors, and facilitate greater quality of work life.  

Additional information about Operations Management can be found in Pharmacy Management: Essentials for All Practice Settings, 5e. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to Pharmacy Management: Essentials for All Practice Settings, 5e. If your institution does not provide access, ask your medical librarian about subscribing.

1Reddy A, Ebebe E, Rivera JA. Interruptions in community pharmacies: Frequency, sources and mitigation strategies. Res Social Adm Pharm. 2019;15(10):1243-1250.

Shane Desselle

Professor of Social and Behavioral Pharmacy, Touro University California


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5 months ago

Have you worked in places that differ in how interruptions are handled? What’s the outcome for how these differences in the way that interruptions are handled?