Goodbye, and good luck (I fear you're going to need it)

George Harrison's first album after The Beatles broke up was called "All Things Must Pass", and that has become the case with this blog.

After 10 years working for Can't Value Sanity I am no longer with the company. Several months ago I made the move out of their grasp, and haven't been this satisfied at work in YEARS. Just being out of the world of CVS's own particular brand of corporate bullshit has had such a calming effect it's almost too good to believe. On those occasions when I have stressful moments at my new job I just take a moment to remember how much it would suck to be back at CVS and I am instantly appreciative of where I am.

That being said there's no real point in continuing to post since I am out of the day-to-day grind of having to constantly work short-staffed while having to deal with more and more corporate bullshit and ridiculous requirements that have absolutely NOTHING to do with healthcare. I couldn't look my district manager in the eye one more time while he tried to tell me that all the phone calls begging people to refill their prescriptions were about compliance and helping people stay healthy. It was about sales building, plain and simple. You don't think for a second that some VP sitting in the ivory tower gives 2 fucks about whether your grandma takes her lisinopril, or that your metformin is 7 days overdue and that might cause you problems with your blood sugar. He cares about 2 more refills that he can bill to your insurance company (which is probably managed by Caremark, thereby creating a tidy little double-dip). 

I knew a pharmacist who moved from the stores to the world of corporate CVS where she works with a group that makes decisions on how things should operate at store level. She was amazed at how completely out of touch these people were with what goes on in the trenches. The people she works with are either not pharmacists, or have been off the bench for so long they have absolutely no clue how the real world of pharmacy works. Next time a new procedure comes down from on high and you look at it and think how completely ridiculous it is, just remember that it was developed by a group who have either never worked in a retail pharmacy, or haven't done it since computers were introduced.

One thing that happened recently that shocked me was the decision to cease the sale of tobacco products as of October 2014. One side of me thinks "it's about time." I don't know how you can pretend to be a member of the healthcare community and turn around and sell tobacco products. Of course, it is a legal product and I hate to see the slow erosion of personal freedom in this country. The most amazing thing is they have acknowledged that the company will lose some $2 billion in sales and are giving that up voluntarily. So we all know what that means, your tech budgets are about to be cut back by another 10 or 15% to make up for the cash loss. SOMEONE has to pay Larry Merlo's bonus, so why not place it on the backs of the overworked and underappreciated worker bees? In 2011 he got a 33% raise, and in 2012 it was up 51% from THAT number. Stay tuned for his 2013 numbers to come out sometime in March. But don't worry, if you are really really really good at what you do (and you don't already earn their allowable max) you can hope to get a 2% raise. Practically golfing at the same country club as old Larry before you know it!!

I wish all of you who are still laboring for the ivory tower crowd the best of luck. I'd like to say I hope it will get better, but I know that's just not going to happen. Here's hoping you get the experience and confidence so that you can someday go to work for an employer who respects you and values your knowledge. It won't be CVS, that much is obvious. Hopefully you are able to get out before someone in your store makes some fatal mistake due to being grossly understaffed and overworked so that it doesn't follow you around for your whole career.

So for the last time, goodbye, good luck, and BITE ME, CVS!!!!!!!!

CVS's newest clusterf*ck: WeCARE

So by this point the entire company has been converted to the newest brainchild of the CVS Ivory Tower boys-WeCARE. The motto was something along the lines of "Helping us work more efficiently. So we can care more", or some such bullshit. This is somehow meant to convince us that because of this new workflow we will have all sorts of extra time to actually take care of customers. This philosophy, while certainly an ideal, is also completely unattainable from this new workflow. It has meant more pressure on the techs and the pharmacists to reach more time-related goals, all the while doing it with fewer hours budgeted. Let's not even talk about the fact that since the program rolled out the system has crashed at least half a dozen times, leading to countless hours company-wide where we were unable to service ANYONE IN ANY MANNER, Tell me how this helps us "care more."

The situation as I see it is that the workflow in a pharmacy is a little like transferring liquid from one gallon bottle into another gallon bottle by using a funnel. The problem was the receiving bottle (representing the customers) wasn't filling up fast enough from the feed bottle (representing the prescribers) because the capacity of the funnel (representing the pharmacies) was limited, Now logic would tell you that if you want to eliminate the slowdown you would increase the capacity of the funnel (put more personnel in the pharmacy). However, the fucking geniuses at corporate have reasoned that the way you improve the flow is to pour the liquid faster out of the feed bottle. Anyone who has ever tried this method realizes soon enough what happens when you do that--you spill shit all over the table.

Now add to this fabulous formula the fact that they have actually REDUCED the capacity of the funnel. Technician hours have been cut across the board by 10%, no doubt due to the notion that the new workflow is SOOOOO much more efficient that they don't need as much help. Where they came up with the conclusion that the system works better is a mystery to us all. One thing we know is it didn't come from the system developers' vast experience working in the stores. They are in the Ivory Tower and they have absolutely no fucking clue as to what it's like in the stores. All they know is that they spent millions of dollars developing and implementing this program and they have to find some kind of cost savings to justify it, so they cut labor hours to pay for it.

Once again what's going to happen is that everything will just slide along as is until there's some tragic event that comes from the fact that the new system puts more pressure on the stores to perform more work faster with less personnel. When people start dying because of the added pressures that the system puts in the stores then they might take a look at it. More likely is the real possibility that they will do whatever they need to to blame in-store personnel. They will never look at their own house to discover if perhaps things could have been done differently, In the past the operating philosophy has been to try to deflect blame. I remember a few years ago there was a death related to a mis-dispense and the company released a statement the press in a question and answer format. When they got to the question of "Does CVS time their pharmacists?" the answer was classic dance-around-the-truth bullshit where they tried to give the impression that pharmacists aren't timed or measured on their time. Anyone who knows the stores knows that nothing could be further from the truth. The whole bonus system for pharmacists is based on speed, not accuracy. The new workflow brings this into sharp focus.

More work being done faster by fewer people--a corporate manager's wet dream. A recipe for disaster in a pharmacy, however.

Changing the corporate culture? I don't think so!

Dear CVS-

So you thought you needed a culture change? Good for you for having such self-awareness. So you thought the best way was to hire Senn Delaney at a cost of tens or hundreds of thousands of dollars to cheerlead and do their corporate motivation bullshit? So much for your self-awareness.

To put it bluntly, fuck you and fuck Senn Delaney and all their fucking "accountability ladders," and their fucking "mood elevators," and their motivational-poster-style catch phrases ("Be Here Now"?). You want to elevate my mood? How about giving your employees a raise that's not an insult. I just got my annual report in the mail. CVS Caremark had an increase in sales of  nearly $12 billion last year compared to 2010. According to The Motley Fool investing website CVS is in prime position to take over RiteAid due to CVS having $700 million in free cash. Then you're going to tell me you can only afford a 1% raise? You've already raised expectations for your retail-level managers so high that there's no way they're going to bonus, so you're saving millions in that area too.

Want to elevate my mood? How about properly staffing your stores so we actually have time- between calling customers to tell them their meds are ready to calling customers if they'd like us to have their meds ready, to calling to see if they'd like us to get their doctors to refill those meds that they haven't refilled in 6 months to having to beg customers to "give us all 5s" on your bullshit Triple S surveys- to actually do patient care. We spend more time doing sales building in the guise of patient care that we do actually giving patient care. If you're going to insist that we pester these people relentlessly to refill their scripts you could at least give us the man-hours to make the fucking phone calls. And while you're at it how about putting pharmacy managers in place who actually know how to manage. Simply having a brand new pharmacist's license and the inability to say "no" to the district manager does not qualify someone to run a fucking pharmacy!

The whole problem with this current approach to corporate culture change is that culture change has to start from the top down, not from the bottom up. It's a bit like a psychiatrist treating a severely mentally ill patient by making sure his shoes are shined. Once again the powers that  be in the Ivory Tower are going to put even more responsibility on the stores to improve on things over which the stores have little control (anyone seen the new Stores Own Sales?) and then getting all the managers to buy in by bringing on the Senn Delaneys of the world to "empower" them. It's a bunch of bullshit rah-rah that is intended to convince weak-minded managers that they are all able to impact their metrics.

So spare me the shit about how the stores are the ones who control everything, and if we fail it's because we weren't good enough. If the culture isn't going to change at upper corporate level then all the fancy little plaques with all the little catch phrases aren't going to mean shit. The company has more money than ever before, and the stores are getting shit upon more than ever. Wonder what Senn Delaney has to say about that.

Prescription errors: Who is really to blame?

The recent dispensing error at a New Jersey CVS once again raises the awareness of everyone who works in a pharmacy. Fortunately, it appears at least initially that there was no serious harm brought by the error. This is a good thing, especially since it involves children. It does raise the question (as errors always do) of who is to blame?

Make no mistake, the error is ultimately the responsibility of those who filled and subsequently verified the prescriptions, namely the techs and the pharmacists. The alarming fact is that this was not isolated, it affected as many as 50 families, so this was an error that happened over and over again. I fully believe that when the facts come out we're going to find out this was a case of a script filling robot that was loaded with the incorrect med. The fact that the pills look very similar made it easier to overlook, and I'm guessing that on some level verifying pharmacists probably don't take quite the hard look at scripts that they know were dispensed by robot. It doesn't excuse it, but it might explain it.

While the techs and pharmacists in the store are ultimately responsible, however, there are many factors at play here and it should not be ignored that the corporate culture and indeed customer expectations are complicit to a certain degree with creating an atmosphere where errors are more likely to occur. Corporate culture pushes for more sales, more sales, more sales and safety and customer care are an afterthought. Increasing sales targets and shrinking hourly budgets force pharmacies to do more with less, and safety is the first thing to suffer. Fewer technician hours, coupled with pharmacists who regularly work 10 or 12 hour shifts without so much as a meal break are a formula for disaster and corporate just turns a blind eye. Unless someone dies as a result of an error (and even then I'm not 100% sure) they are not going to re-examine their policies and practices. Hell, these people will look you straight in the eye and tell you that they don't time their pharmacists, to which I call a hearty BULLSHIT!

This mindset has now translated into customer expectations about turnaround time that put added strain on pharmacy staffs. The "fastfood" mentality that was fostered by companies like CVS, Walgreen's, and the like has lead to the expectation that pharmacy should be instant, like ordering a Big Mac. No one thinks twice about walking in at 5pm on a Monday and insisting on waiting for a refill on the blood pressure medication that they've been taking everyday for 8 years and are suddenly out of. If you don't turn it around in 15 minutes you might get a bad SSS score and we know how corporate hates that. And God help you if you tell one of these refill waiters that it will be longer than 15 minutes, or suggest that they could have called in the script in advance, because they'll be on the phone to the corporate snitch line to complain. Oh, did I mention that you also show up on a report that shows that the pharmacist failed to fill that waiter in 15 minutes? So much for not timing pharmacists, right?

Bottom line is that there are multiple pressures being put on pharmacies to perform to higher and higher levels, all the while performing their jobs perfectly. Those pressures are going to be ignored when heads finally roll, and rest assured there are people who will lose their jobs over these errors. The problem is it will all be people in the store, with a blind eye being turned to the architects of the corporate business model that helped to lead to the errors becoming more likely to happen.

(Hey, if you like what I have to say spread the word. I'd love to get a loyal following in the blogosphere. And don't forget to bookmark the page. Thanks!)

Newsflash!! Obsession with Triple S Causes Brain Damage

OK, so I know I've written about Triple S before, and what utter bullshit it is, and wondered aloud why CVS' upper management team (AKA:The Ivory Tower Boys) put such stock in its questionable subjective results, but I just went through an incident that shows in a nutshell what happens when the ITB's obsession filters down to field management.

Anyone who works in a store knows what the first week of the year brings: insurance issues. Probably 25% of the scripts you process require new insurance cards, which make more work for us at store level because we have to call the customers to tell them we need their new insurance cards, then explain to half of them that we need to see the card instead of them reading random numbers over the phone. Then when they come in to pick up their scripts you have to enter the new insurance (which hopefully works and doesn't require an additional call to the insurance company) and then the pharmacist has to go through the entire verification process all over again, all while the customer is staring holes through you wondering what's taking so long. Add to that this year in that Monday was considered a holiday by most doctors, so all the rest of our work was condensed into fewer days. Oh, and let's not forget that now that Walgreen's doesn't contract with Express Scripts we are having to do dozens of transfers on a daily basis and those are also supposed to be our priority because as we all know CVS only wants to take care of NEW customers. They don't really care once you're in the stable. Just try getting a customer's name off the refill reminder call list and tell me that CVS gives a shit about existing customers.

So here I am, working on the first Thursday of the year (which was coincidentally the day we got our warehouse delivery) and doing it short-staffed because, of course, it was a holiday week so my pharmacy supervisor shorted us hours in our budget due to projected lower volume. Don't forget that although our volume may be lower we have way more work due to the aforementioned insurance issues and Walgreen's transfers. So at 5 PM when  everyone is coming in to pick up their scripts and we have the insurance edits lining up like planes queueing up at the airport my district supervisor calls to (get this) TELL THE PHARMACY MANAGER TO PRINT DOWN THE TRIPLE S SCORES BECAUSE THEY NEED TO TALK ABOUT WHAT A BAD NUMBER WE HAD!!!! What kind of a fucking moron is this guy????? Even if our Triple S had totally tanked could you use the brain that God presumably gave you and call at a less busy time? By the way, our overall number was down by a whopping 3 points, meaning we missed our overall yearly target by 1 WHOLE POINT!! OH NO, WE"RE NOT AN 'EXCELLENT STORE' ANYMORE (whatever that means).

Look, I understand that this whole pressure for Triple S is a downward pressure from the ass-hats in the Tower, but that pressure seems to cause brain damage in the people on whom it is applied. At the root of the whole issue is that you have people who have been out of the stores (or in pharmacist-speak "off the bench") for so long they forget what it's like. Yeah, they cruise the stores once in a while and observe for a few minutes, or maybe even an hour or two and they think that qualifies them as having their fingers on the pulse, but that simply isn't true. I can deal with almost anything for 5 or 10 minutes. Try it when you're in hour number 8 of a 10 or 11 hour shift day after day and tell me it's the same thing!

And maybe, just maybe, our Triple S scores could be improved if we weren't having to stop in the middle of the busiest time of day during the busiest week of the year to run a report and take a call from the pharmacy supervisor telling us how much we suck. Oh and by the way, haven't seen the final figures for 2011, but the first 3 quarters of the year saw 'same store sales' increase for every quarter over the previous year. I'm guessing this trend to continue through the end of the year, meaning our sales are increasing although our hourly budgets are shrinking. Yeah, we suck. The survey may say one thing but peoples' pocketbooks say something else entirely.

The customer is always right (yeah, sure)

In this installment I have decided to look at another side of the joys of retail pharmacy--dealing with the great unwashed masses. Although this is not meant to be a complete list of observations or complaints I bet everyone reads this and says "yeah, no kidding."

Dear customer,

-If you approach me with an overly friendly approach and make a point of calling me by name like I'm your best friend I'm going to be immediately suspicious of that narcotic prescription that you're handing me. In spite of what you think, you are not putting me at ease, you are putting me on the defensive.

-When you come to the drive-thru window on your cell phone, apologize to me, NOT to the person to whom you are talking. You're being rude to me, not to them. You pulled up to MY drive-thru while in the middle of your conversation. And by the way, I quit smoking a long time ago. I'd prefer that you not share your cigarette with me while I'm waiting on your lazy ass. And if you're coming to the drive-thru to pick up your blood pressure meds or your cholesterol meds, or you weigh more than 250 pounds do yourself a favor and walk into the store. A little exercise goes a long way.

-If you take your medication every day and have done so for a long time, why in the world do you wait until you take the last pill to try to refill it? With no refills left? On a Friday? Before a long weekend? Did it surprise you that you were actually going to need your diabetes medicine before you left for your weekend away to visit the in-laws?

-If your insurance doesn't want to pay for your prescription, for whatever reason, please don't call your doctor and tell them that we refused to fill your prescription, or that we wouldn't sell it to you. That's not what we said. If you want to pay out of your own pocket feel free. If you don't want to pay $150 for that newest, latest, greatest brand name only medication then maybe you should ask your doctor why he/she prescribed that one in the first place. Bet it has nothing to do with that "consultant" gig they were offered by the big pharmaceutical company that manufactures it.

-And speaking of insurance, let me explain how this works. You get a new insurance plan. You bring your new  card into the pharmacy. We put the information into our computer. We bill your insurance. Everyone goes home happy. Let's be clear about this-your insurance information doesn't magically transmit from your insurance company's computers into ours, we have to actually type it in. And no, we can't access Walgreen's or Rite Aid and look it up there. They get a little sensitive about proprietary info being accessible by their competitors.

-Why do you bring in a prescription dated 3 months ago and tell me you need it as soon as possible? Is 3 months as soon as possible? If it's not for you, why should it be for me? I'm sure sometime in the last 90 days you knew you were coming into the store, why didn't you bring in your colonoscopy prep script in to fill instead of waiting until the morning before your procedure? I'll just tell the mother of the sick 2 year old that the antibiotic that they need is going to be a few more minutes because I was just filling the script that you've had hanging on the front of your refrigerator so long the paper's starting to yellow.

-If you've handed me a prescription that you need to be filled, and I'm concentrating on reading the doctor's handwriting, making sure I've selected the right patient out of our database, making sure I selected the right medication and strength, making sure I can read and properly type the directions, choosing the correct prescriber and making sure your insurance information goes through (maybe while also fielding a phone call) please don't be offended if I don't do it all with a big smile on my face. Sometimes it's not at the top of my mind to smile you to death like I'm trying to sell you a used car. If a smile is more important to you than competence when it comes to your medication perhaps you should re-evaluate your priorities.

-When you bring me a prescription that you're dropping off for someone else and I ask you for the date of birth don't ask, "Mine or theirs?" I hate to break this to you but even if you're the nicest person in the world I really don't give a shit when your birthday is unless the script is for YOU. I'm not asking so I know when to mail you a fucking birthday card. Use your brain!

-If you need a prescription refilled please have at least a slight clue as to what the medication is. If you have the script number that's excellent; if you have the name of the medication that will also work well; if you don't know either of those things at least have a clue as to what it's treating (blood pressure, cholesterol, male pattern baldness, whatever) and I can probably figure it out. Don't say to me, "It's a little white pill, I take it once a day." Do you have any idea how many "little white pills" we carry? Why is knowing what your medication is more important to me than it is to you? Have a clue as to what medication you take and why you take it. It might just save your life.

-When you come to the register to pick up your prescription and you have 12 things from the front store to pay for it's OK to start writing out your check while I'm ringing your merchandise. Nothing pisses off all the customers in line behind you more than when you wait for the total before you actually pull your checkbook out of your pocket or purse and start the tedious job of writing out a check. On a related note none of us want to stand there while you search through your change purse or pocket for the exact change, like you think you're doing me a favor. Trust me, I can count your change back to you way faster than you can dig into the inside pockets of your pocketbook and slowly dig out the exact change ONE PENNY AT A TIME!! That will also not win you any new friends.

I'm sure as soon as I post this I'll come up with a bunch more but I figured this was a pretty good list. If you think of any that I left out don't hesitate to post your own contribution to the list.

Employee Engagement, and other myths

Q: What's the difference between Bigfoot, The Loch Ness Monster and CVS's commitment to its employees' job satisfaction?
A: There's actually a chance that the first two exist.

I bring this up because it's that time of the year again, time for the CVS Employment Engagement Survey. You know, it's that list of about 20 questions that all employees are encouraged to anonymously answer so that CVS can take in what their employees have to say about the company and alter their policies and procedures accordingly.

OK, OK, I almost got through that entire description without actually laughing out loud. There are only three things that are wrong with the description of the Survey; 1) employees aren't so much encouraged as they are required to participate (more on that later); 2) it's only somewhat anonymous, and; 3) after 3 years of taking this ludicrous survey not one thing has improved.

I'll start with the last thing first, but first a little background on the EES. Let's start with the basic presentation of the EES to the employees. Store and field management is quick and persistent to drive home the point that the EES should only reflect how the employee feels about his or her store. You're not supposed to think about the district, the region, the area or the company as a whole. I remember the district manager actually sending an email to the store manager when they were trying to schedule a store meeting so they could discuss the results of the EES a few years ago. This nitwit actually wrote that if any of the employees started talking about issues outside of the store the store manager was to steer the conversation back to store level. Translation: the residents of the Ivory Tower don't give a fuck what you think about the job they do. I've said many times that I don't have any significant problems with store management, my frustration lies with the upper levels and their decision making and policies.

After all the money, time and energy the BIG changes are an occasional pizza party and "free soft drink and snack day." Evidently this is the big idea that they hit upon to help improve morale. At one time they were going to let us wear jeans one day a month, but then the regional manager saw it in one store and decided it didn't look professional so it got squashed after only a couple months. I guess only dress slacks are really worthy to be worn with those high end polo shirts, eh? Meanwhile there's absolutely no means for people at store level to communicate directly with those above. You have to "go through channels" and if your district manager is anything like mine then you're better off talking to a mop. So once again the frustrations with things like the warehouse, the store support center (a misnomer if ever there was one), IT issues, policy and procedure, etc. are ignored.

Then there's the issue of anonymity. While it may (or may not) be true that it's considered an anonymous survey the store management still knows if everyone in the store has completed it. They receive a report that tells how many employees haven't yet completed the survey, then they go around asking people if they've completed it because (wait for it...) the store managers get shit from the district manager if they have employees who don't complete the survey. This leads to the third point, that it's not REALLY voluntary.

Because the store managers are held responsible for their staff's participation they will absolutely harass any employee who is honest and admits that they haven't taken the survey. In my store we actually had the store manager tell an employee that she couldn't leave for the day until she took the survey! When I heard that my reaction was ARE YOU FUCKING KIDDING ME? You want to know how the employees feel about their jobs so you're going to hold them against their will until they participate. It's kind of like the poster I once saw that said, "THE BEATINGS WILL CONTINUE UNTIL MORALE IMPROVES." I know the employee really can't be held after their shift is over but in this job market some folks may be hesitant to cross the manager, even when the manager is so blatantly wrong. I just hope the manager isn't surprised when their survey results show a high level of job dissatisfaction.

Bottom line is that once again it is CVS doing something because it gives the perception that they actually give a shit and that they are "proactive". Must be something that Wall Street likes, since the only thing the Ivory Tower team really cares about is the bottom line. If pretending that you actually view your employees as human beings helps drive up the stock price I guess they must consider it money well spent.