Studies have shown that many pharmacists working in HMOs encounter various problems that lead to poor qualities in health care. Research studies have shown that pharmaceutical professions face six issues in their area of duty. The six types of issues include prescription error, prescribing faults, dispensing errors, transcription error, across setting and administration errors (Shade, Hoerl, Hare, Emerling, & Britz, 1997) . Further studies reveal that of all these six irregularities, the most irregularity in healthcare is a dispensing error. A dispensing error is defined as a discrepancy between a prescription given by the doctor and the medication that the pharmacist delivers to an individual patient or distributes to the patients in the ward. Similarly, it is possible to include three other categories to the list of dispensing areas. This is done because all qualities of medication should be under the care o the pharmacist. This is to mean that the pharmacist should be responsible for ensuring that all the dispensed medication meets the right compounding, combination, quality, and prescribed amount.
The added list would include categories such as failure to detect manufacturing error before releasing drugs and provide patient counseling with the aim of preventing errors in administration, and the failure to detect and rectify any prescription errors before dispensation. These errors can be shown using a model that pharmacists use in dispensing as shown below:
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Clerk hands it to pharmacist
Patients start using wrong medication and get sick from the prescription
The doctor handwrites the prescription, which the patient takes to pharmacy
Pharmacist read and gives wrong medication
Patient gives prescription to clerk pharmacist
Clerk receives wrong medication
Clerk gives medication to patient
Clerk pharmacist misreads prescription and stamps it
Using the supplier, input, process steps, outcome, and Customer (SIPOC)model to analyze the HMO business process, one realizes that the causes in dispensing irregularities can be traced using root cause analysis methods. On the same note, it is possible to find the causes of dispensing errors by using surveys to inquire about the errors from the participating pharmacists. Of all the two, research has revealed that the root cause analysis is more beneficial and gives closer results because it measures the experiences of the pharmacist with dispensing and other problems they encounter while working. However, the survey method is largely based on the perception and opinions of pharmacists but not on real life experiences.
The SIPOC model revealed that most errors encountered by pharmacist originated from factors such as poor handwriting from doctors used in the prescription, look-alike, and sound-alike in prescriptions, disruption when dispensing, understaffing, fatigue of health providers and time constraints (Shade, Hoerl, Hare, Emerling, & Britz, 1997) . The model further states some of the leading root causes of errors in medication include poor handwriting from doctors make it impossible for pharmacists to dispense the right medication. When health providers become fatigued, they usually tend to give the wrong prescriptions. On the other hand, medication who the same name look and sound alike also lead to the pharmacist dispensing the wrong medication to the patients.
These main root causes can further be categorized as common causes of errors in HMO business process. They are common nature because it is common to hear healthcare professionals complaining of being understaffed hence having to work longer hours serving a large number of patients. On the other hand, many doctors have poor handwritings that are barely legible, and it is possible for pharmacists to dispense the wrong medication because of poor transcription of the poorly written medicine. Similarly, it is possible for fatigued healthcare providers to prescribe the wrong medication, which is then dispensed by the pharmacists.
In researching dispensing errors in HMO business process, the most effective tools to use include the list of patients that have suffered from health issues based on poor dispensing errors. In this case, the researcher should look at factors such s wrong expired medication, medication of low quality and poor compounding, errors in prescription, and over or under dosage. Similarly, the researcher needs to include the prescription sheets used by the pharmacists during the dispensation process. The prescription sheets will make it possible for the researcher to find out whether the error occurred due to poor handwriting from the health provider or if it occurs due to look/sound-alike medication. The researcher also needs to gather where possible the final medication given to the patient hence leading to the medical malpractice. This tool will help the researcher to discern the type of cause problem that led to poor dispensation process. It will also be vital to talk to the pharmacist and find out how often he or she gets distracted during dispensation procedures to qualify it as a cause of errors in the dispensation.
One solution to dispensing errors in HMO business process is to ensure that all pharmacists are educated and aware of statistical thinking strategies to help deal with such issues. That is pharmaceutical institutions needs to ensure that they train pharmacists on statistical thinking compounded with the ability to apply SIPOC model to recognize or detect any errors in prescriptions and correct them before dispensing the medication (Carey & Lloyd, 1995) . Similarly, one strategy to measure the success of the need to use statistical thinking is to measure the number of reported prescription errors after a given duration. For example, the health leaders can decide to evaluate the number of reported of health malpractices by the patient that relate to dispensing errors in a period of six months or more. A higher number of such reports will indicate failure of the strategy while a reduced number of such cases will indicate a successful application of the strategy.
References
Carey, R., & Lloyd, R. (1995). Measuring Quality Improvement in Healthcare: A Guide to Statistical Process Control Applications. Milwaukee: ASQ Quality Press.
Shade, J., Hoerl, R., Hare, L., Emerling, D., & Britz, G. (1997). How to Teach Others to Apply Statistical Thinking. Chicago: Quality Progress.
