Here we are, just starting a new month and there is so much to do before the end of the year. So much. There are holidays to schedule around, events and celebrations to plan, budgets to write and defend, flu shots order and give, and still more. There’s a lot going on.
As soon as October hits, the holidays come fast and furious. First there is Columbus Day/Indigenous Peoples Day in October, then the holiday everybody seems to be celebrating, Halloween. November’s scheduler must deal with Veterans Day and Thanksgiving, and take respond to the requests to be off the day after Thanksgiving. In December the Eves often see as many time-off requests as the actual holidays, but because Christmas and New Year’s Day fall on Saturdays in 2021, this year's work calendar must consider observed Christmas, actual Christmas and observed and actual New Year’s. A variety of religious and cultural observances and professional meetings add to the disruption of a near normal workflow over the final 13 weeks of each year.
Beyond the holidays, there are other fall anomalies that arise to thwart the otherwise competent manager. Say goodbye to the personnel cushion available all summer in the persons of pharmacy students to help with projects, seamlessly cover lunches, and generally lend a hand. Meanwhile, some full-time employees, beneficiaries of the company education benefit, may be joining those departing students making it necessary to work around their class schedule.
The Fall season often also brings budget season. Managers get their first look at the newly adopted budgets for an October 1 fiscal year start - budgets that bear little resemblance to the proposals presented to the finance experts months earlier. Those with budget years coinciding with the calendar year typically have proposals due in October and plans for defending the proposed numbers shortly thereafter.
Back in the patient care arena, flu vaccines are being received, distributed, and administered, and soon the cold and flu season will be responsible for increased patient loads to community, hospital, and extended care pharmacies. With luck, those patients won’t develop pneumonia adding to the pandemic induced critical care burden most facilities can expect to continue through at least the fall.
But it is not all doom, gloom, and endless days of overtime. We already have a tool in our arsenal to deal with the quirks of autumn in healthcare – Failure More Analysis. Yes, that same bit of design magic we’ve been using for years to avert medication administration catastrophes can save you from going into the final quarter of the year dreading the worst scenarios by planning for the worst scenarios.
Pharmacists were early adoptees of failure mode analysis, planning for failure in drug delivery systems and medication administration so they can avoid catastrophic consequences of unanticipated breakdowns. Failure mode analysis works because anything that can go wrong has been anticipated and remedies placed in practice before the error has the opportunity to be committed. Yet few if any pharmacies consider failure mode when dealing with routine pharmacy operations.
Even if you can’t anticipate the worst-case disasters in your operation, you can plan for disappointment and frustration. Consider scheduling. Routinely I would always schedule my hospital pharmacy team assuming as close to a full FTE less than approved and available. This allowed me to respond to unexpected absences by redeploying team members already on site to the shorted position. With a full staff on hand, rotating pharmacists through clinical services kept them engaged with more direct patient care services or with department projects. When not covering unanticipated absences among their ranks, technicians had more time for cleaning, outdate checking, med cart maintenance, or the constant search for items in short supply.
Among the many inspirational sayings about leading your team, a most telling one is Ben Franklin’s adage, “By failing to prepare, you are preparing to fail.” No team can succeed without a plan to succeed and the time to plan is when you know difficulties lie ahead. The only way you can see the difficulties ahead are to look ahead. Perhaps a plan to fail should be included in the overall operations design. Adopting Failure Mode Analysis gives the manager the opportunity to deal with those difficulties before they arise. This decreases management frustration. That does not go unnoticed by the team and as frustration decreases, staff satisfaction increases. It doesn’t take long for the manager’s manager to note the pharmacy’s operating efficiency and personnel harmony, and that is never a bad thing.
The only failure that cannot be address by failure mode analyses is the failure to plan for failure. We’ve all been told we learn from our failures. Nobody has ever advocated to plan for failure. Until now. Part of the plan for success is to anticipate difficulties that result in the failure to perform. It is the wise manager who goes beyond anticipating the difficulties and approaches them with a plan already prepared to address them. Even a Hobbit knows recognizing risk is the first step to avoiding disaster and tells us, “It does not do to leave a live dragon out of your calculations, if you live near one.” ( J.R.R. Tolkien) Now take the second step. Plan to take that risk and fail and you will improve your chance to succeed.