Before 2015 the patient experience at the pharmacy at the Charlotte Maxeke Johannesburg Academic Hospital was something like the following: you take a day’s leave to fetch your prescribed medicine and stand in a queue at dawn in the hope of beating the rush. Once inside, you wait for hours for your prescription to be made up or, worse, encounter a “false stock-out” – when available medication seems be out of stock – and have to go home empty-handed.
Charlotte Maxeke Johannesburg Academic in the province of Gauteng is one of the largest central hospitals in South Africa. Although the hospital pharmacy dispenses almost a quarter of a million prescriptions per year, it had a bad reputation of poor service and facilities. For example, patients discharged from the hospital with a prescription – a patient category known as “take-outs” – waited on average six hours for their prescribed medication to be delivered to their ward. Every day about 20 percent of out-patients encountered false stock-outs at the pharmacy.
In September 2014 the Gauteng Department of Health began a province-wide project to provide pharmacy customers with a more professional service. The troublesome pharmacy at the Charlotte Maxeke Academic Hospital was an excellent place to start.
With so much ground to cover, the leadership at Charlotte Maxeke needed a step-by-step plan for improving the pharmacy’s service delivery and appointed consultants.
The consultants began by improving the physical environment, dispensing process, and stock management, the main cause of lengthy waiting times. First, the physical premises had to be made more welcoming and attractive to patients and staff. One Saturday morning, Department of Health officials, including a member of the executive council, the pharmacy manager, the CEO of the hospital, representatives of the Infrastructure Department, along with the consultants, pitched up for a day-long cleaning. The idea was to show staff that management committed themselves to turning around the pharmacy. These volunteers painted and decorated walls; added amenities such as 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 dispensing prescriptions. 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 is called “first time right” and aimed to stop invalid prescriptions from entering the dispensing process. A senior pharmacist was appointed as patients’ first point of contact. The pharmacist has to filter out patients whose prescriptions are invalid (because they are not due for refills) or could not be dispensed because of stock shortages. Second, they did away with the batch system so that prescriptions were no longer dispensed in batches of ten, but as soon as they were ready. Finally, the team introduced a “demand-pull” system, which enabled staff to dispense prescriptions in a timely fashion. The existing process began with taking in prescriptions as fast as possible and dispensing them. The result was a build-up of medication waiting to be labelled and dispensed (in other words, a “push” approach). The team improved the end of the process – the dispensing – by ensuring sufficient staff to dispense medication and thus “pulling” prescriptions through the process.
The consultants also addressed false stock-outs, another important cause of long waiting times, by implementing a two-bin system on the pharmacy shelves with pre-defined refill levels. When one bin of medication is empty, pharmacists get medication from a second bin. The refill levels of a bin – how many medications to place inside – are calculated for each medication based on its dispensing
frequency. Each staff member’s role in the process was revised and the layout of the pharmacy was adjusted to make it more orderly. This included laminated posters displaying the new process at each workstation. Management tools such as a daily roster with role allocation and a performance dashboard, were designed for the pharmacy manager.
According to the new system, pharmacy staff rotates between duties to avoid a build-up of scripts. This required knowing how many people need to be assigned to each stage of the process and rotating staff when someone is absent or taking lunch, or when there is a backlog. The team of consultants, who initially oversaw shifts, coached the pharmacy staff to identify and resolve bottlenecks quickly. Ultimately, the senior pharmacist is responsible for managing the workflow.
In conclusion, teamwork and the process review helped staff to work smarter, not harder. Improving the working environment of staff, listening to their concerns, and supporting them through change management have definitely improved the quality of care and the service that patients get at the hospital pharmacy.

To streamline the processes at the pharmacy of the Charlotte Maxeke Johannesburg Academic Hospital, the consultants have suggested several useful methods. Identify these methods and discuss their suitability in addressing concerns raised in the case.

Answer rating: 100% (QA)

The methods suggested by the consultants to streamline the processes at the pharmacy of the Charlotte Maxeke Johannesburg Academic Hospital are as fol... View the full answer