Reference no: EM132497045 , Length: word count:6000

Problem 1

Read the case study below and answer the questions that follow.

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.

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.

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

Problem 2

Total Quality Manaagement (TQM) is perhaps the most significant of the new ideas which have swept across the operations management scene over the last few years . There are two reasons for this: first the ideas of TQM have great perspective attraction for many people - most of us want tp achieve "high quality" and secondly, a TOM approach to improvement can sometimes result in dramatic increases in operational effectiveness.

Choose an organisation that you are familiar with and answer the questions that follow.

2.1 Analyse the manner in which quality is measured in an organisation of your choice.

2.2 Evaluate the estimated costs of poor quality in your organisation. You can use the principles from theory to derive a cost of quality.

Problem 3

Legal claims against the Gauteng Health Department "have soared". According to the latest Annual Report, which was tabled in the Gauteng legislature last Friday, claims have climbed from "R8.9-billion to R13.1-billion from April 1, 2014 to March 31, 2015".
The total amount comprises:
- Medico-legal claims went "from R6.566-billion to R10.1-billion"'
- Civil claims "went up from R855-million to R1.502-billion; and
- Claims "from the premature termination of contracts remain at R1.508-billion".

The civil claims figure includes "R1.263-billion owing to the National Health Laboratory Service (NHLS)" which "is listed as a contingent liability as the investigation into NHLS billing irregularities is still ongoing, and it may be offset by a possible NHLS debt to the department of R1.6-billion. "It is important to note that the enormous R10.1-billion medico-legal claim arising from alleged medical negligence is a maximum potential liability that is unlikely to be ordered by the courts." "Some of the claims may be frivolous or not stand up to scrutiny. Nevertheless, the huge jump in the past year is of great concern. "The department has been paying on average about R200-million every year for medical negligence in terms of court settlements."

3.1 Construct a fish bone diagram to analyse the problems listed in the above extract.
3.2 Critically analyse the determinants of service quality that the Gauteng Health Department could use to solve these problems.