/publications/issue/2009/2009-03/2009-03-10053

Editor's Note: Change, Compromise, and Making Progress

Author: James C. McAllister III, MS, FASHP


Mr. McAllister is a health-systems consultant based in Chapel Hill, North Carolina.


Regardless of your political leanings, I know you wish only the best for our new president, Barack Obama, and his administration. I heartily agree that we need to establish improving our economy as our top priority, but our president and the government have a myriad of challenges that demand attention, including a health care system that is a major contributor to our economic woes. I am not old enough to have personally experienced the Great Depression, but I did grow up in a large single-income family that worked together to avoid waste, watched our pennies, and, as children, used our creativity to have fun without spending money.

It is almost comical to think about our lifestyles today. We need a cellular phone that manages e-mail, takes pictures and video, gives us driving directions, and performs a score of other functions that fall just short of doing our work or changing the baby. A summer vacation over a long weekend at the beach was a real treat, whereas a $5000 week at Disney World is average for many families today. Similarly, health care providers, including pharmacists, have come to form unrealistic expectations based on the false assumption that resources are limitless.

President Obama used ?a time for change? as his theme for the election, with promises for changes in the ways government does its business and expectations for citizens to change as well. Albert Einstein once said, ?We can?t solve problems by using the same kind of thinking we used when we created them.? I suggest that this mentality applies not only to our country?s woes, but to reforming health care.

As we plan pharmacy department budgets for fiscal year 2009-2010, we need to remember the state of the economy and plan accordingly. As a director of pharmacy, I never submitted a budget in which I did not request additional staff. My staff and I could readily identify how we could improve medication use processes with additional staff. The drug budget was planned based on the most recent drug utilization patterns, adding the cost of inflation and anticipated new drugs to be used. Given the current situation, we should submit a reduced (or neutral) budget compared with last year, even without a mandate from hospital leadership.

In terms of planning for the future, it is time for some gut-wrenching, totally objective, creative strategic planning. Although each of us should assume such an approach, a profession-wide, consensus-based approach will hasten adoption. Unit-dose systems were created in the 1970s before computerization, bar coding, automation, and role expansion for pharmacists, technicians, and other providers. Intravenous admixture services have become increasingly more complex and errorprone, but evolution has been driven by technological progress directed at ?automating? systems and processes originally designed 3 or more decades ago. Pharmacy patient-focused services, including rounds and teaching students and residents, have often been designed in ways that segregate staff who provide such services. Over this same time, health-system pharmacists have realized that the most significant waste occurs with the use of drugs.

As a part of a multidisciplinary strategic planning process, we need to consider planning and rebuilding basic pharmacy services without regard to how it is currently done, asking ?why do we do it this way?? incessantly. Whenever possible, human resources should be redeployed to accomplish our goals. I am not advocating ?doing more with less,? but rather focusing our efforts on our priorities to improve quality and reducing cost while optimizing therapeutic outcomes, which should result in abandoning activities that have less significant impact on our goals.

As widespread change to improve our country becomes our national mantra, I strongly suggest that the profession of pharmacy leads health care reform rather than follows. What do you think?