In June 2012, I began working for a company that provides health care for extensive corporate facilities. They provide occupational health physicians and nurses, physical therapy, and pharmacy services. I am a pharmacist. The whole concept is referred to as a closed-door healthcare facility, or in my case, a closed-door pharmacy. Prescriptions and other health services were provided only to employees, immediate family, and retirees. I was filling prescriptions for the employees of a manufacturer of power drive trains and transmissions. It wasn’t long that I became the manager. Pharmacy budget, staffing, filling prescriptions, and the important…serve as liaison to the Human Resources Benefits Manager. I reported to a regional manager who came to visit once a quarter.
My thought had always been, what a brilliant business model! The client company saves thousands of dollars, if not millions, by having healthcare facilities on its corporate campus. My employer had locked in business. Again, operating your healthcare services as a closed-door endeavor for thousands of people is brilliant marketing. My thoughts on this activity concept must have been right; a leading retail operator bought them. I couldn’t help but wonder, what is going to happen now?
It was interesting that the retailer called the buyout a conversion. My company called it integration. I was told I was still to report to my current boss, but then I would also report to a district pharmacy supervisor of the retailer. It did not take long before storm clouds were brewing. My company was successful with their clients by developing special purchase agreements with vendors that were passed along to the client and ultimately to the employee. One great example was giving a blood glucose monitor for free to insulin-dependent diabetics, but this locked in business with the test strips, alcohol wipes, needles, and all of their insulin.
We were changing our computers, telephones, reporting software, and alarm system…everything to the retail chain’s system. One day, the supervisor and a training pharmacist oriented me to their new system. An elderly retiree came to the pharmacy with prescriptions for insulin and all the needed supplies. I gave him his free glucose monitor and taught him how to use it to assure accurate blood sugar readings. Immediately after the patient left, I was questioned and severely reprimanded for giving away a monitor. I attempted to explain the diabetes program to no avail. I was told that the retail chain is who I listen to now and whose directions and policies I follow.
For clarification, I questioned what transpired with my original employer’s management. I was reminded in a very supportive and encouraging way that I was still a pharmacist for them. The Vice-President and head of pharmacy services for the corporate health care provider was a knowledgeable and well-respected leader. At one time, he worked for the retailer. He shared with me the two successful organizations’ philosophies and business strategies. His company was successful because they were flexible and accommodating to their client’s needs. Meanwhile, the retail chain succeeded because of its consistent, rigid “rubber stamp” approach to all its “brick and mortar” facilities. In short, the companies were like oil and water, they did not mix. Alright, for those of you reading who are pharmacists and chemically astute, yes, you make an emulsion by mixing oil and water. But that requires a vast amount of shaking. Shaking here, was not going to happen. “But remember Brad, you are still a pharmacist for us,” was his friendly and supportive words. I was feeling conflicted, now a part of what was quickly developing into a no-win situation for me.
I remember first starting work in a retail pharmacy as a pharmacist intern. The hot Christmas toy for boys was the Stretch Armstrong doll. My vision was that I was a living one, being stretched in both ways.
The district leader for the retailer came to visit. He was the cheerleader type, extolling exuberant, positive energy, gregarious, and the lovable coach…most of the time. But he was also known for being a tyrant and could be brutal. He must have sensed my concerns about the new working arrangement and mode of operation. My latest method was called Matrix Management, he told me. I was given a chance to express my thoughts. I mentioned the pharmacy’s programs I was to subscribe to and my conversation with the vice-president of pharmacy services. Suddenly there was a shout, “be quiet!” “You now take orders from us; their business is unstable, unprofitable, and has no future!” he screamed. He then settled down, I had my “marching orders” from him. He said calmly, “many successful companies are now incorporating this into their business structure.”
Again, I am conflicted. I am part of matrix management, yet each side claims to be the autocrat. Do you remember your first chemical reaction when you were in elementary school? Do you know what happens when you mix vinegar and baking soda? It’s a bubble bomb. A large amount of carbon dioxide is produced from the reaction.
When one does not recognize or respect the value of the other, there is no collaboration, no attempts to understand each other’s business philosophies and to learn, and trouble only percolates.
This business plan, conversion, integration, new strategic implementation or whatever it was, was now captivating my attention. I did my research on matrix management. I know, pharmacists are not usually interested in business concepts or management leadership, right? I am far away, and I am not your typical pharmacist. My matrix management scenario was poorly crafted and executed. Matrix management is best suited for project management, not subjecting an employee to three leaders with opposing views. Matrix management is full of peril and frustration to the mid-level manager. I was becoming over-burdened with the diffusion of priorities, and there was a lack of clarity on tasks to be performed. I was also confused with competing agendas and emphasis, pulling me in different directions.
I was enduring all the disadvantages of matrix management, there were no advantages for me in this new consolidation. I was now dealing with pharmacy patrons unfamiliar with the new way of doing business. They were not happy. I was doing my best to communicate the concerns and issues. Neither side cared to do anything. The retail chain was firm in their stance, and the corporate provider was apathetic and, at best, placating. The original employer said to run the pharmacy “business as usual.” The benefits manager was concerned, yet somewhat powerless; she surely could not help, and I knew that. Matters were getting worse as the customers were getting increasingly frustrated. I was in a no-win situation. When this happens in your career, there is only one thing left to do…it is time to prepare for your departure. And that is what I began to do.
One evening at home, I received a phone call from an outsourced pharmacy management company. This company serves hospitals with pharmacy staff and services. I was invited to interview for a position as Director of Pharmacy at an acute care hospital.
Meanwhile, the situation grew worse at the pharmacy. One tech resigned and my supervisor chose not to replace her. My senior pharmacy technician was pregnant and would be on maternity leave soon. Customer count was decreasing; the prescription count was taking a downward spiral, and thus so were dollar sales. I was informed that the grand day had arrived for my pharmacy technician. She was pregnant no more, now the proud parent of a beautiful baby girl. I was not provided with a pharmacy technician to replace her. I was alone in the pharmacy. It was not a safe environment. As the old cliche goes, I was a sitting duck. I was granted some technician coverage from the retailer, but it was seldom. No lunch, no restroom breaks, and little opportunity to attend to administrative tasks. I was coming in hours before the pharmacy opened and often stayed late after the pharmacy was closed. Work was drudgery. There was little appreciation for my efforts. I wanted to leave. The beautiful musical, Annie, and the theme song “Tomorrow” would run through my mind. Indeed, I was looking forward to tomorrow.
I was tired from relaxing at home when my cell phone rang. The outsourcing company had extended me an attractive offer. I was excited—I was going back to the hospital pharmacy.
I submitted my resignation to my retail boss. He was frustrated, agitated, and even angered at my letter. My manager at the client provider was upset too. She let it slip, referencing my age, stating that she did not think I would ever leave; that I was not capable of finding work anywhere else. Bottom line, she thought she had me captive. I had not intended for my resignation to be an act of vindication, but timing-wise, it turned out that way. The only pharmacy technician for the pharmacy was now gone on maternity leave. I, the only pharmacist, would be gone in a few weeks.
Settling into my new role as the Director of Pharmacy was going exceptionally well. I reported to a manager at the outsource company and the hospital’s chief nursing officer (CNO). Shortly before I came on board, the hospital had become aligned with a hospital health system. I was told that it was only an affiliation, that it aided the hospital in purchase pricing, favorable contracts, and marketing strength. That sounds good, I thought. Healthcare was becoming more competitive and profitability was becoming increasingly difficult. This new bonding with the health care system made perfect sense.
I was attending meetings with my new employer. Attending several hospital committee meetings was a primary role of the Director of Pharmacy, and I enjoyed them. The Chief Pharmacy Executive for the health network came to meet me. He was exceedingly welcoming and supportive. I was made part of his team, attending network meetings and getting to know the other pharmacy directors from different hospitals. Feeling fulfillment, respect, and appreciation for my job was refreshing.
Attending my first hospital manager’s meeting, I learned that the hospital struggled financially. It was serious; losses were averaging a million dollars a month. Now, there was greater clarity regarding the affiliation with the network. The health system network was bailing them out for a few years. If the hospital didn’t “right the ship” on its own, the system would take it over totally.
The relationship I developed with the other pharmacy leaders in the network was growing positively. Discussions concerned my pharmacy’s contract pricing, drug costs, and the supplier’s agreement. My hospital’s contract pricing for drugs and supplies compared to others in the system was downright pitiful. Pharmacy leadership at the network said it was time to integrate my pharmacy with the network. Integrate. I was now respecting the direction from the network. They expected me to be compliant. My thoughts began reflecting on the previous job. Here I go again—another matrix management matter in the works. And I was right.
The outsource management team has remained silent about new developments. They may have been oblivious or in denial of what was developing. Then it occurred to me that they are arrogant. They are blind to the possibility that nothing adverse will happen to them. When it came to the hospital, the pharmacy department was the first to begin integration into the network’s operations. Other departments were soon to follow. There is that famous old quotation among sailors. “Red at night, sailor’s delight. Red in the morning, sailors take warning.” Let me say that it is dawn and the sky is red.
