Curbside Consult with Dr. Jayne 3/31/14

I wrote earlier this month about our hospital nickel and diming staff who wanted an actual paper card to confirm their life support certification. There was an outpouring of reader correspondence about hospital policies that are designed to cut costs but that seem to have backfired.

Many of us are pinching pennies to buy larger more powerful servers because we’ve outgrown our current ones faster than anticipated or are juggling implementation budgets to ensure providers get the go-live support they need. With that focus, we tend to forget how much our organizations spend on day-to-day operational costs. We’re not the only ones who have to keep an eye on the bottom line. One reader knows acutely just how deep the budget slashing has gone.

Dr. Jayne, I enjoyed your column about penny wise and pound foolish. Our hospital replaced a fairly decent paper towel with a very cheap brown one. These towels don’t absorb much, so you end up using five times the paper towels that you did with the previous rolls. Our department runs out of paper towels frequently and I have to run down to housekeeping to pick up more rolls. As it happens, housekeeping has trouble keeping paper towels in stock (maybe because the whole hospital is using the cheaper rolls much faster – go figure).

Many times I am unable to pick up paper towels the first time I run down to the supply department. When I pointed out the inefficiency of the paper towel situation (particularly with the FTEs spent running around trying to keep them in stock) in a cost savings committee meeting, the environmental services rep said, “You wouldn’t believe how cheap they are.” Hello? Did anybody hear me? It’s been a couple of years. We still have the same blasted paper towels. And let’s not forget – it takes FOREVER to dry your hands, but they want to encourage hand washing.

We’ve had a similar situation in the office building where our ambulatory EHR office is located. To save money, instead of having housekeeping staff check the bathrooms multiple times each day, they only service ours once a day. We don’t have rolled towels but those old-school folded ones. In order to keep the towels from running out, the housekeepers cram as many towels as possible into the dispensers. They’re packed so tightly that if you try to pull a single towel, it rips, so there are constantly scraps of paper on the floor.

The only way to get towels out is to hook them on the end and pull a big stack of them out. This leads to dozens of towels being dumped in the trash. Another tactic is for the housekeepers to leave a stack of towels on top of the dispenser, which leads to either all of them falling into the trash (or on the floor) or being ruined when someone drips wet hands on the stack. Ditto with leaving a pile of spare towels on the sink.

Additionally, because after-hours housekeeping is more expensive than having it done on the day shift, our floor is now serviced during the noon hour when lots of people are trying to get in and out. Some housekeepers will work around the staff’s needs, but a few of them barricade the door. In the best-case scenario, our staff wastes a little bit of time going to another floor. In the worst-case scenario they stand around and wait for the housekeeper to finish.

I’m pretty sure the productivity cost from either scenario would cover the shift differential so our facilities could be serviced before or after office hours. Either way the staff is left with the feeling that saving money is more important than their needs, which isn’t exactly a morale builder.

Another reader recently relocated and finally landed a position with a health system after a lot of looking. It was more of an entry-level position than he had when he worked for a large vendor. He expressed concern at the waste he’s seeing from a personnel standpoint:

I’ve worked with hospitals, but never for one directly. I didn’t want to miss out on ICD-10 and Meaningful Use 2 and there aren’t many vendors out here. I was blown away by the size of the IT department. There are more manager-types than doers. Everyone is a consultant and no one gives a hoot. There is a ton of turnover and no accountability. The consultants are riding out the sunset of their careers and take it out on the energetic ones. The SMEs have skills that no one wants and the six tiers of management exist solely to waste time and overcomplicate things. People vanish for hours a day and the place is empty by 3:15. What do I do now that I’ve taken a job and am surrounded by such inefficiency and waste when I really wanted to DO something?

Unfortunately, I don’t have good advice for him other than encouraging him to stick with it long enough to either move up or find something better in his new home town. I’ve worked with a handful of analysts that think it’s OK to arrive at the office late, Facebook all day (pausing only for a long lunch), and duck out early. I suspect that with that many layers of management they may not have a handle on what’s going on right under their noses.

With all the regulatory events on the horizon, though, most organizations have more work to go around than anyone can handle. Our analysts work their tails off, and if they have a spare moment of time, they’re looking ahead trying to anticipate ways that they can make processes more efficient or help our users. They’re a self-policing team and if there was a slacker in their midst, they’d make his life miserable. Unfortunately if the entire team has those tendencies, it’s much trickier.

Have any advice for this reader? Any other great stories of cost cutting that saves dimes at the expense of dollars? Email me.

Email Dr. Jayne.