Question

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

Answer 1

Answer:-

TQM is a concept for a client focused organization that involves all employees in continual improvement. Here are the 7 principles of TQM taken into account to address the issues of Charlete Maxeke Johannesburg Academic Hospital.

Integrated framework:

Though an organization may comprise of many diverse functional specialties often organized into vertically organized departments, it is the normal procedures interconnecting these capacities that are the focal point of TQM.

Consequently, an integrated framework interfaces business improvement components in an attempt to continually improve and surpass the expectations of clients, staffs, and other individuals in the hospital.

Strategic and systematic approach:

A major part of the management of quality is the strategic and systematic approach to achieving an organization's vision, crucial, goals. Here, the approach needs to have a quality assistance as a major segment.

Fact-based dynamic:

TQM necessitates that an organization continually gather data on activities of staffs in request to improve accuracy in dynamic.

Communications:

When there is a change management, as well as part of day-to-day operation, successful communications plays a major part in maintaining morale and in motivating staffs at all levels.

Client focused:

The client here are the patients who determines the degree of quality. In request to improve the quality, training of employees, integrating quality into the structure procedure, or upgrading the working framework ought to be taken into consideration.

Worker involvement:

All staffs includes the top management must participate in working toward shared objectives. Superior workplace integrates continuous improvement endeavors with normal routine operations.

Procedure focused:

Handling the patients and delivering The better assistance is the major aim of hospital. The procedure should be defined and aligned as such and the same should be observed on regular basis to find the deviation.

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