Transforming a pharmacy together: the Charlotte Maxeke Johannesburg Academic hospital.

Before 2015, the patient experience at the Charlotte Maxeke Johannesburg Academic Hospital pharmacy went something like this: take the day off work to have your prescription filled; line up at dawn before the pharmacy opens in hopes of beating the rush; once inside, wait up to several hours for your prescription to be filled; or worse, wait only to experience a “false stock out”—a phenomenon in which a medication appears out of stock but is in fact available in pharmacy storerooms—and go home empty-handed.

Charlotte Maxeke Johannesburg Academic is one of the largest central hospitals in South Africa, which sits in the province of Gauteng. The hospital pharmacy dispenses almost a quarter of a million prescriptions each year—yet it had a reputation for poor service and facilities. For example, patients discharged from the hospital with prescriptions—a patient category known as “to take outs”—spent on average six hours waiting for prescription medication to be delivered to the ward after discharge. Every day, an average of 20 percent of out-patients visiting the pharmacy experienced false stock-outs.

In September 2014, the Gauteng Department of Health began a province-wide project to provide pharmacy customers with more professional and efficient visits. The department wanted to prove that it could offer better service wherever needed, and the troublesome situation at the Charlotte Maxeke pharmacy made it an excellent place to make its case.

With so much ground to cover, the leadership at Charlotte Maxeke needed a step-by-step plan for the pharmacy transformation.  

The consultants began by working with managers to narrow their focus to improving the physical environment, prescription-filling process, and stock management, the main factor behind lengthy waiting times. To kick off the project, the consultants focused on making the physical premises more welcoming and attractive to patients and staff. One Saturday, Department of Health officials, including a member of the executive council, the pharmacy manager and CEO of the hospital, infrastructure-department representatives, and the consultants, all pitched in for a day-long cleaning. The idea was to show staff how committed leadership was to turning around the pharmacy. The volunteers painted and decorated walls; added amenities like water coolers, TVs, and coffee machines in the waiting room; and supplied pharmacists with monogrammed lab coats. Patients and staff immediately appreciated the more cheerful and professional atmosphere.

Then the consultants turned to improving the process of prescription filling. A consulting team mapped the existing process and studied each step to identify bottlenecks and areas of wasted activity. They then devised a streamlined approach using three principles of lean production.

The first was called “first time right” and aimed to stop invalid prescriptions from entering the filling process. A senior pharmacist became the first point of contact for each patient. The pharmacist would filter out patients whose prescriptions were invalid (because they were not yet due for refills) or could not be filled because of stock shortages. Second, they removed the batch system, which meant prescriptions were no longer dispensed in batches of ten, but were made available to be dispensed as soon as each one was ready. Finally, the team introduced a “demand-pull” system, which enabled staff actually to dispense these prescriptions to patients in a timely fashion. The existing process began with taking in scripts as fast as possible, and then filling them. The result was a huge buildup of filled scripts that were waiting to be labelled and dispensed to patients (in other words, a “push” approach). The team shifted the focus to the end of the process—dispensing—and ensuring that there was sufficient staff to distribute prepared scripts, thus “pulling” prescriptions through the process more efficiently.

Relatedly, the team addressed false stock-outs, another important factor behind long wait times. These were resolved by implementing a two-bin system on the pharmacy shelves with pre-defined refill levels. Essentially, when one bin of medications was empty, pharmacists would begin retrieving medications from a second bin. The refill levels for a bin—how many medications to place inside—were calculated for each medication based on dispensing frequency. The consultants also revised each staff member’s role in the process and adjusted the layout of the pharmacy to make it more orderly. This included outfitting each workstation with laminated posters that displayed the new process rules. They also designed management tools—for example, a daily roster with role allocation and a performance dashboard—that the pharmacy manager was then responsible for implementing.

Under the new system, pharmacy staff rotated between duties to ensure that there was no build-up of scripts. This required knowing how many people to assign to each stage of the process and shifting staff when someone was absent, at lunch, or when there was a backlog. The team initially oversaw these shifts, but then coached the pharmacy staff on identifying and resolving bottlenecks quickly, with the senior pharmacist on the floor ultimately responsible for managing the workflow.

In conclusion, the teamwork and process review that was provided helped staff to work smart and not hard. Improving the working environment of staff, listening to their concerns and supporting them through change management has definitely improved the quality of care and the experience that the patients and communities received from the hospital.

QUESTION 1           [60]

1.1 To ensure that all processes in the Charlete Maxeke Johannesburg Academic hospital were streamlined, the consultants provided many useful methods to improve the situation of the hospital. Analyse the case study to justify the methods utilised. (5 x 6marks =30)

1.2 Provide a critical account of how the total quality management (TQM) concept could have been used in the case study? (30)

Business ethics

Define code of ethics and code of conduct, and discuss the difference between the two.

Explain the pros and cons of corporate whistle blowing with examples?

(Answer should have a minimum of 300 words)

Explain the ways in which managers would perform their Fiduciary Responsibility in order to govern ethical practices?

(Answer should have a minimum of 300 words)

1. A large producer of household products purchases a glyceride used in one of its deodorant soaps from outside of the company at a cost of $1.5 per pound. It uses the glyceride at a fairly steady rate of 40 pounds per month, and the company uses a 23 percent annual interest rate to compute holding costs. The chemical can be purchased from a supplier who charges a delivery fee that varies on the ordering quantity as follows:

Assume that the cost of order processing is $150. What is the optimal order quantity and the corresponding annual total cost?

Business ethics

Establishing systems to monitor and enforce ethical standards is an important component of ethics program. Discuss four distinct methods to monitor and enforce ethical standards.

Refer to the gasoline sales time series data in the given table.

1. Compute four-week and five-week moving averages for the time series. If required, round your answers to two decimal places.
   

   Week	Sales	4 Period Moving Average	5 Period Moving Average
   1	17
   2	20
   3	18
   4	22
   5	19
   6	15
   7	21
   8	19
   9	21
   10	19
   11	15
   12	23

2. Compute the MSE for the four-week and five-week moving average forecasts. If required, round your intermediate calculations to four decimal places and round your final answers to three decimal places.
   
   MSE for four-week moving average =
   
   MSE for five-week moving average =
   
3. What appears to be the best number of weeks of past data (three, four, or five) to use in the moving average computation? Recall that MSE for the three-week moving average is 10.519.
   
   

business

1. The person obligated to pay for a secured interest is known as a:

H. Secured party

I. Creditor

J. Lender

K. Debtor

True or False:

2. A secured party and an unsecured party have equal rights to a Debtor’s collateral that is secured by the secured party.

3. A secured party cannot breach the peace when repossessing secured collateral.

4. A secured transaction is a transaction in which the payment of a debt is guaranteed by property owned by a debtor.

The management of Brinkley Corporation is interested in using simulation to estimate the profit per unit for a new product. The selling price for the product will be $50 per unit. Probability distributions for the purchase cost, the labor cost, and the transportation cost are estimated as follows:

1. Compute profit per unit for the base-case, worst-case, and best-case.
   
   Profit per unit for the base-case: $  
   
   Profit per unit for the worst-case: $  
   
   Profit per unit for the best-case: $  
   
2. Construct a simulation model to estimate the mean profit per unit. If required, round your answer to the nearest cent.
   
   Mean profit per unit = $  
   
3. Why is the simulation approach to risk analysis preferable to generating a variety of what-if scenarios?
   
   The input in the box below will not be graded, but may be reviewed and considered by your instructor.
   
   
   
4. Management believes the project may not be sustainable if the profit per unit is less than $9. Use simulation to estimate the probability the profit per unit will be less than $9. If required, round your answer to one decimal place.
   
   %

Guiding principles to bring about a shift in employee morale and enhance productivity

Specify the promotion objectives for the market-leading company in any industry of your own choice in the state of North Carolina.

Identify the target audience for the market-leading company in any industry of your own choice.

1. You will play the role of a paralegal in a software development company. You have been given the task of recommending the type of license agreement that should be used for your company’s new software product line. Consider all types of license agreements in making the recommendation. The software delivery method should also be considered.

Asiacentric Communication Ethics and Competence

Asia is diverse and dynamic. It is a region of cultural complexity, continuity, and change, although the term signifies a certain geographical location in the world, designates a common historical and political struggle against Western imperialism and colonialism, and implies shared religious-philosophical foundations and cultural heritage (Miike, 2003a). Asian nations are plural societies. They “have a dominant community and a number of minority communities divided on the basis of language, religion, caste, and ethnicity living together under a single polity” (Goonasekera, 2003, p. 368). Chen and Starosta (2003) vividly depict such a place of remarkable variety and vitality:

Indonesia is largely Muslim, yet it contains a large Hindu enclave in Bali. Indians were also imported to parts of Malaysia, and Buddhism, started in India, [but] can hardly be found there now, except [as] a political reaction to casteism. Instead, it has taken root in China, Sri Lanka, and elsewhere. Shintoism thrives in Japan, but maybe nowhere else. Asia has some massive cities, but 80% of some Asian countries are rural. India and China have 800 language varieties or dialects. (p. 1)

Obviously, therefore, all Asian communicators do not subscribe to the above-discussed five propositions. These propositions do not necessarily reflect the way Asians actually communicate in real-life situations.

Nevertheless, they serve as theoretical lenses from which to see an Asian version of humanity and to view Asian thought and action. They are designed to provide much food for thought in rethinking the nature and ideal of human communication in Asia and beyond from an alternative vantage point.

For example, the advent of the global village and the crisis of the human condition have made it compelling to ruminate on communication ethics and competence in intercultural contexts (Chen, 2005; Miike, 2009b; Tehranian, 2007). There have been extensive discussions on Eurocentric biases in the definitions and components of these key concepts (e.g., Chen & Starosta, 2008; Ishii, 2009; Shuter, 2003; Xiao & Chen, 2009). We can reexamine current conceptualizations of communication ethics and competence from the five Asiacentric propositions. They suggest that an ethical communicator can (1) remind herself or himself and others of interrelatedness and inter- dependence through communication, (2) discipline and cultivate herself or himself without being overly self-centered through communication, (3) develop her or his altruistic sensitivity to the sufferings of others, (4) feel her or his obligation to remember the debts that she or he has received and to try to return them in one way or another, and (5) speak up for greater harmony and morality.

Just like many proponents of Asian values who are often misunderstood by Western conservative intellectuals (Mahbubani, 2002), I am not asserting that these Asiacentric viewpoints on humans communicating are superior to Eurocentric ones, but I am protesting that they are not inferior to them. They are rooted in the Asian worldview and yet may be sharable along with those rooted in, say, the African worldview toward what Tu (2006, 2007) calls “a dialogical civilization” or what Sitaram (1998) calls “a higher humanity.” In Sitaram’s (1998) view, such a truly human civilization “is not an extension of any one culture; rather it would be the essence of all cultures of the entire humanity” (p. 13). Hence, there is room for Asiacentric, as well as Afrocentric and other non-Western, contributions. As Asante (1993) avers, there is also “space for Eurocentricity in a multicultural enterprise so long as it does not parade as universal. No one wants to banish the Eurocentric view. It is a valid view of reality where it does not force its way” (p. 188).

Summarize, with examples, the five Asiacentric communication propositions and compare them with the propositions based on the Eurocentric worldview.??

You’ve Got Mail…and You’re Fired! The Case of RadioShack No one likes to receive bad news, and few like to give it. In what is heralded as one of the biggest human resources blunders of 2006, one company found a way around the discomfort of firing someone face-to-face. A total of 400 employees at the Fort Worth, Texas, headquarters of RadioShack Corporation (NYSE: RSH) got the ultimate e-mail message early one Tuesday morning. The message simply said, “The work force reduction notification is currently in progress. Unfortunately, your position is one that has been eliminated.” Company officials argued that using electronic notification was faster and allowed more privacy than breaking the news in person, and additionally, those employees who were laid off received generous severance packages. Organizational consultant Ken Siegel disagrees, proclaiming, “The bottom line is this: To almost everyone who observes or reads this, it represents a stupefying new low in the annals of management practice.” It’s unclear what, if any, the longterm effect will be for RadioShack. It isn’t just RadioShack that finds it challenging to deal with letting employees go. Terminating employees can be a painful job for many managers. The communication that takes place requires careful preparation and substantial levels of skill. BusinessWeek ethics columnist Bruce Weinstein suggests MAN 1163_2 (April 4 th, 2020) © 2020 LAMBTON COLLEGE IN TORONTO that anyone who is involved with communicating with downsized employees has an ethical responsibility to do it correctly, which includes doing it in person, doing it privately, giving the person your full attention, being honest but sensitive, and not rushing the person. Some organizations outsource the job of letting someone go to “terminators” who handle this difficult task for them. In fact, Up in the Air, the 2009 movie starring George Clooney that was nominated for six Oscars, chronicles changes at a workforce reduction firm and highlights many of these issues. Downsizing has been referred to using many euphemisms (language that softens the sound of the word) for termination. Here are just a few ways to say you’re about to lose your job without saying you’ve been fired: • Career alternative enhancement program • Career-change opportunity • Dehiring staff • Derecruiting resources • Downsizing employment • Employee reduction activities • Implementing a skills mix adjustment • Negative employee retention • Optimizing outplacement potential • Rectification of a workforce imbalance • Redundancy elimination • Right-sizing employment • Vocation relocation policy Regardless of how it’s done or what it’s called, is downsizing effective for organizations? Jeffrey Pfeffer, a faculty member at Stanford and best-selling author, argues no: “Contrary to popular belief, companies that announce layoffs do not enjoy higher stock prices than peers—either immediately or over time. A study of 141 layoff announcements between 1979 and 1997 found negative stock returns to companies announcing layoffs, with larger and permanent layoffs leading to greater negative effects. An examination of 1,445 downsizing announcements between 1990 and 1998 also reported that downsizing had a negative effect on stock-market returns, and the negative effects were larger the greater the extent of the downsizing. Yet another MAN 1163_2 (April 4 th, 2020) © 2020 LAMBTON COLLEGE IN TORONTO study comparing 300 layoff announcements in the United States and 73 in Japan found that in both countries, there were negative abnormal shareholder returns following the announcement.” He further notes that evidence doesn’t support the idea that layoffs increase individual company productivity either: “A study of productivity changes between 1977 and 1987 in more than 140,000 U.S. companies using Census of Manufacturers data found that companies that enjoyed the greatest increases in productivity were just as likely to have added workers as they were to have downsized.” Please Answer the Following 5 Questions: 1. What communication barriers did RadioShack likely experience as a result of terminating employees via the communication method used? 2. What do you think RadioShack’s underlying motivation was in using this form of communication? 3. What suggestions for the future would you give RadioShack when faced with the need to dismiss a large number of employees? 4. How has technology enhanced our ability to communicate effectively? In what ways has it hindered our ability to communicate effectively? 5. What ethical challenges and concerns do you think individuals involved in downsizing have?