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

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

Regardless of your political leanings,I know you wish only thebest for our new president,Barack Obama, and his administration.I heartily agree that we need toestablish improving our economy asour top priority, but our president andthe government have a myriad of challengesthat demand attention, includinga health care system that is a majorcontributor to our economic woes. Iam not old enough to have personallyexperienced the Great Depression, butI did grow up in a large single-incomefamily that worked together to avoidwaste, watched our pennies, and, aschildren, used our creativity to havefun without spending money.

It is almost comical to think aboutour lifestyles today. We need a cellularphone that manages e-mail, takespictures and video, gives us drivingdirections, and performs a score ofother functions that fall just short ofdoing our work or changing the baby.A summer vacation over a long weekendat the beach was a real treat,whereas a $5000 week at Disney Worldis average for many families today.Similarly, health care providers, includingpharmacists, have come to formunrealistic expectations based on thefalse assumption that resources arelimitless.

President Obama used ?a time forchange? as his theme for the election,with promises for changes in theways government does its businessand expectations for citizens to changeas well. Albert Einstein once said, ?Wecan?t solve problems by using the samekind of thinking we used when wecreated them.? I suggest that this mentalityapplies not only to our country?swoes, but to reforming health care.

As we plan pharmacy departmentbudgets for fiscal year 2009-2010, weneed to remember the state of theeconomy and plan accordingly. As adirector of pharmacy, I never submitteda budget in which I did not requestadditional staff. My staff and I couldreadily identify how we could improvemedication use processes with additionalstaff. The drug budget wasplanned based on the most recent drugutilization patterns, adding the cost ofinflation and anticipated new drugs tobe used. Given the current situation,we should submit a reduced (or neutral)budget compared with last year,even without a mandate from hospitalleadership.

In terms of planning for the future, itis time for some gut-wrenching, totallyobjective, creative strategic planning.Although each of us should assumesuch an approach, a profession-wide,consensus-based approach will hastenadoption. Unit-dose systems werecreated in the 1970s before computerization,bar coding, automation, androle expansion for pharmacists, technicians,and other providers. Intravenousadmixture services have become increasinglymore complex and errorprone,but evolution has been drivenby technological progress directed at?automating? systems and processesoriginally designed 3 or more decadesago. Pharmacy patient-focused services,including rounds and teachingstudents and residents, have often beendesigned in ways that segregate staffwho provide such services. Over thissame time, health-system pharmacistshave realized that the most significantwaste occurs with the use of drugs.

As a part of a multidisciplinary strategicplanning process, we need toconsider planning and rebuilding basicpharmacy services without regard tohow it is currently done, asking ?whydo we do it this way?? incessantly.Whenever possible, human resourcesshould be redeployed to accomplishour goals. I am not advocating ?doingmore with less,? but rather focusingour efforts on our priorities to improvequality and reducing cost while optimizingtherapeutic outcomes, which shouldresult in abandoning activities that haveless significant impact on our goals.

As widespread change to improveour country becomes our nationalmantra, I strongly suggest that the professionof pharmacy leads health carereform rather than follows. What doyou think?