Read the case study and then answer the questions that follow:Transforming a pharmacy together: the Charlete Maxeke Johannesburg Academichospital.Before $2015,$ the patient experience at the Charlotte Maxeke Johannesburg Academic Hospitalpharmacy went something like this: take the day off work to have your prescription filled; lineup at dawn before the pharmacy opens in hopes of beating the rush; once inside, wait up toseveral hours for your prescription to be filled; or worse, wait only to experience a false stockouta phenomenon in which medication appears out of stock but is in fact available inpharmacy storeroomsand go home empty$-$handed. Charlotte Maxeke JohannesburgAcademic Hospital is one of the largest central hospitals in South Africa, which sits in theprovince of Gauteng. The hospital pharmacy dispenses almost a quarter of a millionprescriptions each yearyet it had a reputation for poor service and facilities. For example,patients discharged from the hospital with prescriptionsa patient category known as to takeoutsspent on average six hours waiting for prescription medication to be delivered to theward after discharge. Every day, an average of $20$ percent of out$-$patients visiting the pharmacyexperienced false stock$-$outs.In September $2014,$ the Gauteng Department of Health began a province$-$wide project toprovide pharmacy customers with more professional and efficient visits. The departmentwanted to prove that it could offer better service wherever needed, and the troublesomesituation at the Charlotte Maxeke Academic Hospital pharmacy made it an excellent place tomake its case. With so much ground to cover, the leadership at Charlotte Maxeke AcademicHospital needed a step$-$by$-$step plan for the pharmacy transformation.The consultants began by working with managers to narrow their focus to improving thephysical environment, prescription$-$filling process, and stock management, the main factorbehind lengthy waiting times. To kick off the project, the consultants focused on making thephysical premises more welcoming and attractive to patients and staff. One Saturday,Department of Health officials, including a member of the executive council, the pharmacymanager and CEO of the hospital, infrastructure$-$department representatives, and theMBA$5926$MAY$/$JUNE $2024$ EXAMINATION$5$consultants, all pitched in for a day$-$long cleaning. The idea was to show staff how committedleadership 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 suppliedpharmacists with monogrammed lab coats. Patients and staff immediately appreciated the morecheerful and professional atmosphere. Then the consultants turned to improving the process ofprescription filling. A consulting team mapped the existing process and studied each step toidentify bottlenecks and areas of wasted activity. They then devised a streamlined approachusing three principles of lean production.The first was called first time right and aimed to stop invalid prescriptions from entering thefilling process. A senior pharmacist became the first point of contact for each patient. Thepharmacist would filter out patients whose prescriptions were invalid $($because they were notyet due for refills$)$ or could not be filled because of stock shortages. Second, they removed thebatch system, which meant prescriptions were no longer dispensed in batches of ten, but weremade available to be dispensed as soon as each one was ready. Finally, the team introduceda demand$-$pull system, which enabled staff actually to dispense these prescriptions to patientsin a timely fashion. The existing process began with taking in scripts as fast as possible, andthen filling them. The result was a huge buildup of filled scripts that were waiting to be labelledand dispensed to patients $($in other words, a push approach$).$ The team shifted the focus tothe end of the processdispensingand ensuring that there was sufficient staff to distributeprepared 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 wouldbegin retrieving medications from a second bin. The refill levels for a binhow manymedications to place insidewere calculated for each medication based on dispensingfrequency. The consultants also revised each staff members role in the process and adjustedthe layout of the pharmacy to make it more orderly. This included outfitting each workstationwith laminated posters that displayed the new process rules. They also designed managementtoolsfor example, a daily roster with role allocation and a performance dashboardthat thepharmacy manager was then responsible for implementing.MBA$5926$MAY$/$JUNE $2024$ EXAMINATION$6$Under the new system, pharmacy staff rotated between duties to ensure that there was nobuild$-$up of scripts. This required knowing how many people to assign to each stage of theprocess 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 andresolving bottlenecks quickly, with the senior pharmacist on the floor ultimately responsible formanaging the workflow.In conclusion, the teamwork and process review that was provided helped staff to work smartand not hard. Improving the working environment of staff, listening to their concerns andsupporting them through change management has definitely improved the quality of care andthe experience that the patients and communities received from the hospital.Read the questions in section A$,$ which apply to the case study.

Question $1[20]$To ensure that all processes in the Charlotte Maxeke Johannesburg Academic hospital werestreamlined, the consultants provided many useful methods to improve the situation of thehospital. Analyse the case study to justify the methods utilised.

Question $2[20]$Although the Lean Management System has helped healthcare facilities improve their bottom$-$line performance, many remain transitional and have not yet fully transformed into Leanorganisations. Justify with examples from the case study how the Total Quality Managementphilosophy could be applied to improve the quality and processes at Charlotte MaxekeJohannesburg Academic hospital.