The HMO Pharmacy Crisis
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John Dover had just completed an intensive course, “Statistical Thinking for Continuous
Improvement,” that was offered to all employees of a large health maintenance organization
(HMO). There was no time to celebrate, however. Dover worked as a pharmacy assistant in the
HMO’s pharmacy and he was under a lot of pressure, because his manager, Juan de Pacotilla,
was about to be fired. Pacotilla’s dismissal appeared imminent because of numerous complaints
and even a few lawsuits over inaccurate prescriptions. Pacotilla now was asking Dover for his
assistance in trying to resolve the problem.
“John, I really need your help,” said Pacotilla. “If I can’t show some major improvement or at
least a solid plan by next month, I’m history.”
“I’ll be glad to help,” replied Dover, “but what can I do? I’m just a pharmacy assistant.”
“Your job title isn’t important. I think you’re just the person who can get this done,” said
Pacotilla. “I realize that I’ve been too far removed from day–to-day operations in the pharmacy,
“To be honest, I’m really disappointed with that guy. He has spent two weeks trying to come up
with a new modeling approach to predict weekly inaccurate prescriptions. I tried to explain to
him that I don’t want to predict the mistakes; I want to eliminate them. I don’t think I got
through, however, because he said we need a month of additional data to verify the model before
he can apply a new method he just read about in a journal to identify ‘change points in the time
can see something I can’t. I realize it’s a long shot, but I was hoping you could use this as the
project you need to officially complete the course.”
“I used to feel the same way about statistics, too,” replied Dover. “But the statistical thinking
course was interesting because it didn’t focus on crunching numbers. I have some ideas about
how we can approach making improvements in prescription accuracy. I think it would be a great
project. But we might not be able to solve this problem ourselves. As you know, there is a lot of
“It sounds like there’s no hope,” said Pacotilla.
“I wouldn’t say that at all,” replied Dover. “It’s just that there might be no quick fix we can do
by ourselves in the pharmacy. Let me explain what I’m thinking about doing and how I would