As the nations’ leading pharmacy benefit manager for the hospice community, Enclara Pharmacia handles millions of prescriptions, phone calls and digital interactions each year. The overwhelming majority are uneventful: medications are delivered on time, phone inquiries are handled efficiently, and technology works as expected. However, when it comes to meeting the needs of hospice patients and the busy nurses who facilitate their care, the goal needs to be perfection. That’s where Enclara’s quality improvement (QI) team comes in.
The Enclara QI team monitors performance across several areas of the company to identify potential areas for improvement. For Associate Director of Clinical Quality, Franci Laska, it’s a labor of love. “I have a passion for organizational change and for me that starts with data,” Laska said. “When you start to analyze customer interactions at the macro level, you start seeing trends that point to opportunities to either correct systemic problems or replicate success.”
The QI team tracks performance across multiple parts of the enterprise, including pharmacy fulfillment, customer service and the digital tools used to profile and dispense medications. Cases created through customer questions or feedback are one important indicator, as are issues caught internally before they have a chance to impact hospice staff or patients. However, the team also takes a more proactive approach by auditing calls, deliveries and other interactions to uncover trends that might otherwise never draw anyone’s attention.
Sometimes, identifying areas of opportunity simply means asking the right questions. When going over cases with the Enclara systems integration and informatics team, Laska noticed that some took a day or two to resolve while others were resolved quickly. When she started to look into why that might be, it turned out that there was an email address used for group messages that routinely created duplicate cases.
“My team was regularly deleting these duplicates and they all considered it just a part of their normal process,” Senior Manager of Systems Integration, Tradd Dantzler said. “You always have some risk of duplicates but it’s usually just a handful. However, this one specific issue had been happening so long nobody even brought it up. Once we became aware of it, we were able to fix the problem. It was a small thing, but it allowed us to be more accurate in our reporting and improve our productivity.”
While internal efficiencies are always a priority, the primary targets for quality improvement are metrics that directly impact nurses and patients. For example, the QI team works closely with Enclara’s internal trainers to improve the quality of customer service calls. One tool they use is live coaching, in which trainers and supervisors listen in on calls and provide immediate feedback to the customer service representative following the call.
“It could be constructive criticism but it could also just be ‘wow, that was amazing’ so they’re getting real-time advice on how to improve or reinforcement of the kind of activities we want to see,” Laska said. “Our gold standard is calls that are both empathetic and efficient. We want the nurses who call to feel respected, get the information they need and be able to return to their work as quickly as possible.”
The concept of positive reinforcement is central to the mission of Enclara’s entire QI program. It’s not about simply correcting problems; it’s about replicating success. By regularly auditing large numbers of interactions, the team frequently uncovers informal best practices that one department (or even just one staff member) has developed that should be adopted more widely.
“We are really the ones looking behind the scenes to identify what is working and drive change throughout the company,” Laska said. “Everything we do is about enhancing the voice of the customer and helping them provide the best possible patient care.”