Musings on poor resource management in healthcare

I’ve recently had the displeasure of running up against some significantly poor resource management that has had a negative impact on my ability do my job, and it got me thinking about what kind of overall impact poor resource management has on healthcare. I’ve held a full time position as a pharmacist in four hospitals and worked either part time or per diem in two others. That’s a total of six separate facilities in five different cities, so I’m going to assume that I have a fair sampling. No two facilities were the same, but they all suffered from the inability to manage resources, i.e. people, hardware, software, reference material, etc.

I’m sure running a hospital doesn’t come cheap, but I believe you have to create a balance that gives you not only the ability to move forward, but also creates an environment that allows one to perform at a high level.  The problem I see in healthcare is a general lack of foresight when it comes to moving forward.  For example, you can’t purchase a new piece of automation hardware for the pharmacy and expect it to run itself forever at no cost for maintenance, optimization and upgrades. But that’s how we, i.e. healthcare, view things. While I’m general speaking about things related to pharmacy because that’s what I know, the basic principles can be applied to almost anything.

In my opinion there are some general truisms when it comes to making decisions about moving forward in a healthcare system:

1. If you don’t have the manpower to do something right, don’t do it. Period. I don’t like doing anything half-assed. Do a no “BS” assessment of the situation and make the call. If you’re willing to dedicated the resources to the project to make it a success, then move forward, but if you can’t then postpone. It’s that simple. Leadership gets paid to make the tough decisions, so make them. It’s better to have fewer system performing perfectly, than have many system running poorly.
2. You can’t plan for every contingency. If you believe you can then you and I need to talk because you have super powers. With that said, you can make general provisions for additional resources, i.e. plan for additional costs and manpower if or when they become necessary. In the thirteen years that I’ve been a pharmacist I have yet to witness a hospital project come in on time or under budget. Shouldn’t there be a lesson in there somewhere?
3. Education is important. You cannot implement a new piece of hardware or software and expect everyone to instantly know how to use it. There is no magic switch when it comes to learning something new. I can’t tell you how many times I’ve been taught how to use a piece of hospital equipment only to find out later that the person teaching me how to use it didn’t have a clue about the real functionality of the system. You can’t replace formal education. Companies like Talyst, Siemens and Pyxis all offer formalized training sessions several times a year. Every year I ask to send some of my technicians to get additional training on our systems and every year I get shot down. We are slowing losing the expertise we have for our systems secondary to attrition and memory loss. The only way to ensure that we have the knowhow is to continue to develop the staff. I give you a 100% guarantee that there are things we don’t know about our systems or that we could be doing better. To believe otherwise is foolish. Period.
4. It takes resources to manage other resources. If you decide to implement new automation or technology in your facility realize that you will need not only manpower to manage it, but financial resources as well. Things break, upgrades are necessary and general maintenance is required. It’s a simple principle that eludes most executives in healthcare. I’m sure they put gas in their car, change the oil or have it washed on occasion. Well, it’s no different for million dollar equipment. Technology that doesn’t work is useless. Period.
5. You need the right tools to do your job. This one is a real pet peeve of mine, and causes me to rant for hours so I won’t go into details here. Suffice it to say that new technology requires new tools, and those tools shouldn’t be optional.

That’s pretty much it. I feel that we’re headed for a big fall in healthcare as we continue to take on projects that we simple don’t have the resources to tackle. “Do more with less” is the new battle cry in healthcare. Unfortunately, I have a feeling Custer said something like that at Little Bighorn just before he was slaughtered.