ASQ - Team and Workplace Excellence Forum

Online Edition - November 2001


Issue Highlight — Actions That Might Matter
- In Actions That Might Matter, Peter Block challenges us to rethink our well-intended and often automatic urge during difficult times to just "Do Something!" Think instead, he asks, about authentic change, shifting consciousness, relationships, and reconciliation.

The Drugs Are in the Mail
Caremark Uses Teaming, Career-Pathing, and Cross Training To Guarantee Satisfied Customers

Phyllis Dale receives her blood pressure medicine on the first of each month. While mail order and mail fulfillment of prescriptions are a relatively recent development in pharmaceutical care, Phyllis is grateful that she has that option. What Phyllis doesn’t realize is that a cross-functional team made certain that her prescription arrived on time and correctly. And it is quite likely that Caremark fulfilled her prescription.

  Caremark Rx, Inc. (formerly MedPartners Inc.), a Delaware Corporation, is one of the largest pharmaceutical services companies in the United States. The company’s operations are conducted through Caremark Inc., which provides pharmacy benefit management services and therapeutic pharmaceutical services. These services are sold separately and together to assist corporations, insurance companies, unions, government employee groups and managed care organizations throughout the United States in delivering prescription drugs to their members in a cost-effective manner

  In 2000, Caremark provided these services to more than 1,200 health plan sponsors, including some of America’s leading corporations, managed care organizations, insurance companies, government agencies, and unions. More than 20 million plan participants will receive over 70 million prescriptions through Caremark’s retail, mail service, and specialized home delivery options.

  Caremark’s Florida offices decided to move to a team environment last year, according to Lynn Rose, training manager for Caremark Pharmaceutical Group, Weston, Florida, with 500 employees on site. While corporate-wide the company had benchmarked many companies’ team environments, including Motorola, the switch to a team environment in its mail-order processing area presented some unique challenges.

  “Previously, we were very individualized in our job responsibilities,” recalls Rose. “We had shippers, clerks, pharmacists, and technicians each handling their own area of responsibility. If someone called in sick, work would slow down or stop. So we quickly saw the value of cross-training. The natural environment for that seemed to be in the establishment of teams.”

Implementation: One Team at a Time
However, Caremark did not suddenly institute teams across the facility. Instead, they carefully selected upbeat and positive individuals through supervisors and managers who would comprise the first teams. These first teams would then serve as internal cheerleaders for the establishment of other teams across the facility.

  An individual could be assigned to a dispensing team consisting of a pharmacist, technician, shipper, and clerk or an order processing team consisting of several pharmacists, a technician, a shipper, and a clerk. The team structure consisted of a team leader who was always a pharmacist. The team leader’s responsibility was to keep the workflow going and move people to other areas. In addition, the team leader promoted the team goals and tracked team processes. Because of the governmental regulation of the industry, the team leader had to be a pharmacist who could actually sign off on orders. All of the individuals on the team had to be cross-trained in other areas.

  “Of course the biggest challenge was managing the change,” recalls Rose. “We were asking individuals to work with new people and learn new skills which is outside many people’s comfort zone. We also needed to work on getting everyone team focused.”

Dealing with Change: A Slice of Cheese at a Time
Caremark met this challenge by embracing the concepts of Who Moved My Cheese? Change can be a blessing or a curse, depending on your perspective. The message of Who Moved My Cheese? is that all can come to see it as a blessing, if they understand the nature of cheese and the role it plays in their lives. Who Moved My Cheese? is a parable that takes place in a maze. Four beings live in that maze: Sniff and Scurry are mice — nonanalytical and nonjudgmental, they just want cheese and are willing to do whatever it takes to get it. Hem and Haw are “little people,” mouse-size humans who have an entirely different relationship with cheese. It’s not just sustenance to them; it’s their self-image. Their lives and belief systems are built around the cheese they’ve found. Most of us reading the story will see the cheese as something related to our livelihoods — our jobs, our career paths, the industries we work in — although it can stand for anything, from health to relationships. The point of the story is that we have to be alert to changes in the cheese, and be prepared to go running off in search of new sources of cheese when the cheese we have runs out.

  “We distributed the book to all our managers and supervisors. From there we trained all employees in a mini-workshop around the video,” recalls Tom Meyer, former senior organizational development specialist for Caremark and current chair of the ESL (English as a second language) and Foreign Language program at Miami Dade Community College. “It was critical that we carried out this training before we moved to the team environment. Pharmacists often had the biggest hurdle to embrace the change. They generally did not view the works of others as important, a sort of status and image scenario. After the training, as we moved to the team environment, the pharmacists began to view their co-workers as equal team members who just mastered a different process.”

  “I think people begin to realize that things change as in Who Moved My Cheese?” Meyer explains, “They always have changed and always will change. And while there’s no single way to deal with change, the consequence of pretending change won’t happen is always the same: The cheese runs out.”

Training Coaches and Those Being Coached
In addition all leaders were given coaching training. “Because of the recursive nature of the process, we realized we must keep training,” says Rose. “We do monthly mini-camps where we retrain our coaches. Every employee at Caremark has a coach and because we are set up for double-loop learning we revisit this training and see how we can improve it. We are also planning to have all employees participate in the coaching training. We want people who are being coached to understand their role as well as those providing the coaching.”

  Coinciding with the move to the team environment, Caremark also reviewed its career-pathing environment. “What we found,” says Rose, “is that many pharmacists really did not want to go into management. So how could we help them? We are approaching this situation by offering CEUs with cross-training into other areas of the company. For our technicians the challenge was a little easier. We are able to offer them classes to receive their certification. Florida is one state where they do not need to be certified but it is a career enhancement. We provide technicians who want the program with exam materials and pay for them to take the classes and exam. We cross-train our clerks and line staff for higher-level jobs. Even our management team is involved. Every manager must take a certain number of hours each year; for example, they might take a course in financials for nonfinancial managers.”

Training in an Academic Environment
Tom Meyer found the experience invaluable. Now in his role of chair of a 25-professor community college department, the value of cross-training and career pathing is also apparent. “I suddenly realized that even in the academic environment cross-training is essential. College professors are educated and have a sort of status just as pharmacists do. Given the events of September 11, I now have some individuals called up for reserve duty. With ESL education, students are taught in components of reading, writing, or speaking. Many professors only choose to teach one component. Given our current staffing situation, this can create gaps. So now I am encouraging professors to teach one other component class and we are moving to a teaming environment where a group of teachers will teach the same students in a block of time.”

  The advantage of cross-training, teaming, and career pathing transcends all industries and job classifications. Whether it is in a mailroom dispensing prescriptions or a community college teaching immigrants a new language, better service, better results can occur when people work together.

  The result — people like Phyllis Dale get the prescriptions and products they need in a timely fashion through the mail.

November 2001 News for a Change Homepage

 In This Issue...
Global Quality from Johnsonville, WI, to Durban, South Africa, with Jennifer James
The Drugs Are
in the Mail

Virtually Amazing
Why Can’t We All Just Get Along
What Did You Just Say?

Peter Block Column
Views for a Change
Brief Cases

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