COVID-19 continues to pressure the American healthcare sector in unprecedented ways. Pandemic-related challenges extend to every aspect of health system operations, including the pharmacy. Many hospital and health system leaders are considering how their pharmacies may change as a result. They are considering – what will my pharmacy look like in 5 to 10 years as a result of the pandemic?
Becker's Hospital Review recently spoke with Michael McCarrell, Chief Operating Officer for CPS about the current state of pharmacy operations and what the future may hold after the pandemic abates.
Q: Many of the hospital and health system leaders you collaborate with are consumed with navigating COVID-related challenges. These are preventing them from operating their pharmacies efficiently. Can you elaborate?
Michael McCarrell: Hospitals are more efficient when the moving pieces of their organization are understood — that's the key to optimizing operations. When a hospital experiences optimal flow, patients are scheduled efficiently and teams have clear visibility into the procedures being performed. COVID-19 has added a significant variability to healthcare processes. Patient census levels, as well as the level and type of patient care being delivered, are not reliable. That introduces significant inefficiency inside pharmacy operations.
In addition, the entire health system landscape is experiencing staffing challenges. This places pressure on all ancillary areas, including the pharmacy. Since patient census has been high for months, there's been no break for healthcare workers. We're seeing pharmacy resignations due to the work required to provide the proper level of care. The stress is high, the hours are long, and the number of new people entering the pharmacy field is limited. All of these factors apply additional pressure to pharmacy operational quality.
The supply chain is the other COVID-related challenge that is reducing operational efficiency for health system pharmacies. Over the last 10 years, the healthcare industry has streamlined its supply chain significantly. The pandemic, however, has introduced supply shortages that have destroyed many of these efficiencies. On top of that, the shortage of drivers and delivery people means that delivery times are unpredictable.
Q: You mentioned your partners, in many cases, are challenged to find sufficient, properly qualified staff to meet their workforce needs. Is this a temporary problem or is it a symptom of something larger happening in the market?
MM: I think COVID-19 has accelerated a pre-existing problem. For several years, there has been decreasing participation in key healthcare positions. Although there isn't necessarily a shortage of registered pharmacists in the market, there is a shortage of effectively trained pharmacists who are prepared to provide high-quality care in acute care environments. COVID-19 will create long-term effects in terms of not only the quantity of the workforce, but also the quality. Healthcare administrators and leaders are under a lot of pressure to really look at operations overall and consider how they need to adjust.
Key questions include:
The current situation is one where employees experience mounting stress on their shoulders and at the end of each workday, they walk away completely exhausted.
Q: What steps might hospital and health system leaders take to address their pharmacy-related challenges?
MM: I think we need to take a short-term and a long-term look at the situation. From a short-term perspective, hospitals and health systems must improve their technology utilization. With telehealth, COVID-19 accelerated utilization of telemedicine by five- to tenfold. Within the pharmacy, technology is crucial for enhancing telepharmacy, order processing and other clinical initiatives designed to optimize staff.
From a long-term point of view, we need to examine the work we're doing on the inpatient and outpatient side. According to American Hospital Association projections, over the next five to ten years, outpatient volume will grow by 30 percent, homecare will increase by 35 percent and inpatient care will decrease by 15 percent. Organizations must consider what they need to do operationally to adjust the pharmacy and accommodate this new landscape. We're ready at CPS with technology solutions that we can bring to the table, as well as best practices related to optimizing staff and supporting patient care.
Q: How do you believe inpatient pharmacies will be different five years from now than they are today? Are the changes brought on by COVID-19 here to stay?
MM: I believe the pandemic-related changes are here to stay. As unfortunate and challenging as COVID-19 has been, it has also driven change. Looking ahead, we are learning how to work smarter and how to be more dynamic. However, the staffing issues are here to stay. Utilization of technology needs to accelerate. To do that, you need to gain acceptance across the majority, and I think we're making good progress there. From the inpatient side, it will be extremely important for pharmacies to have efficiencies in place that support high-quality, fast transactions. We can do that through telepharmacy services and then deploy pharmacists to the hospital floor to support patient care. With the ongoing nursing shortage, pharmacists at many health systems have seen their level of responsibility grow. Deploying pharmacists to the floor to support physicians and nurses with clinical care is the future of pharmacy on the inpatient side.
Q: How can hospital leaders benefit by getting out in front of these changes?
MM: Early preparation is essential for long-term performance. Healthcare leaders must accept the current state of the market and recognize that today's challenges aren't going away. Staffing challenges are here to stay. I firmly believe that the supply chain will take years to return to prior levels of efficiency.
We must utilize technology, data, and remote services more effectively to capture the same level of quality that we've traditionally produced inside hospitals and translate that into outpatient and home care environments. Although inpatient care is a necessary component of healthcare, care is moving to the outpatient arena. We are beginning that adaptation now, and COVID-19 is serving as a springboard for making the changes needed to prepare for the future.