- Email: [email protected]
Executive Challenge
WintedHiver 1990
FORUM
D6fi administratif
Executive Challenge
SCENARIO
SCENARIO
As Administratorof a 200-bed community general hospital, you are approached by the hospital pharmacist who expresses concern over the second quarter financial statementfor his department. Actual drug costs for this fiscal period are over budget by approximately 30 percent. The pharmacist is both defensive and resentful about being held accountable for expenditures he considers beyond his control. The pharmacist explains what he believes are the reasons for this overexpenditure.In a concerted effort to expand the medical staff of the hospital, privileges have recently been granted to three additional members in family medicine. The pharmacist states that each of these physicians has a personal preference for treating their patients with antibiotic products not contained in the hospital’s approved formulary. He further explains that these drugs are three times more expensive than similar drugs in the hospital formulary. All drugs in the hospital formulary are reviewed and approved by the Medical Advisory Committee. Policies relating to the use of non-formularyproducts allow the pharmacist to order such products on a patient specific basis upon receipt of written orders from a member of the medical staff. To resolve this problem, your best approach would be to: a) Require all requests for drug products not contained in the hospital formulary be approved by the Administrator b) Meet with the physicians concerned and explain the fiscal restraints facing the institution and advise them of the cost implications of their practice patterns. c) Request the Medical Advisory Committee to establish more formal mechanisms for review of drug products contained in the formulary, together with a process for approval of non-formularyproducts. d) Request the pharmacist to complete a cost analysis comparing these drug products for presentation by you at the next medical staff meeting. e) Advise the pharmacist to substitute drugs in the formulary for those ordered by physicians.
Vous btes administrateur d’un hapital general de 200 lits et vous recevez la visite du pharmacien de l’hapital, qui vous fait part de son inquietude h propos des comptes himestriels de son service. Les coilts rhls des mtdicaments pour cette periode depassent les affectation budgetaires d’environ 30%.Le pharmacien est sur la defensive et se montre init6 d’Ctre tenu pour responsable de depenses qu’il considhre comme Ctant de son contrble. Le pharmacien vous expose ce qui lui semble btre les raisons de ce surplus de depenses. Dans un effort concert6 pour accroitre le personnel m6dical de l’hapital, des privilhges ont rkemment 6t6 accord6s h trois autres mUecins de famille. Selon le pharmacien, chacun de ces mCdecins pr6ere traiter ses malades avec des antibiotiques qui ne font pas partie de la liste de m6dicaments approuvee par l’h6pital. I1 explique en outre que ces m6dicaments coiltent quatre fois plus cher que les produits similaires qui figurent dans la liste de l’hiipital. Tous les m6dicaments de la liste de l’h8pital sont soumis au Comit6 m6dical consultatif qui les appouve. Les directives relatives A l’emploi de produits ne figurant pas dans cette liste autorisent le pharmacien h commander ces produits pour des cas particuliers,sur rkeption d’une demande krite d’un membre du corps medical. La meilleur fagon de resoudre ce problhme serait: a) D’exiger que toutes les demandes de medicaments,qui ne font pas partie de la liste de l’hbpital, soient approuv&s par l’administrateur. b) Rencontrer les medecins concern&, leur exposer les restrictions budgetaires auxquelles 1’Ctablissementdoit faire face, et les informer des implications financihres de leurs mCthodes thkrapeutiques. c) Demander au Comitk m6dical consultatif d’6tablir des mkanismes plus pdcis pour reviser la liste de medicamentset le processus d’approbation des produits non inclus dans cette liste. d) Demander au pharmacien de prCparer un tableau comparatif des couts de ces m&licaments, que vous presenterez vous-mCme A la prochaine reunion du Conseil des m6decins.
Answers: page 20
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Reponses : page 20
e) Dire au pharmacien de remplacer les medicaments de la
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FORUM
D6fi administratif
Executive Challenge
SCENARIO
SCENARIO
As Administratorof a 200-bed community general hospital, you are approached by the hospital pharmacist who expresses concern over the second quarter financial statementfor his department. Actual drug costs for this fiscal period are over budget by approximately 30 percent. The pharmacist is both defensive and resentful about being held accountable for expenditures he considers beyond his control. The pharmacist explains what he believes are the reasons for this overexpenditure.In a concerted effort to expand the medical staff of the hospital, privileges have recently been granted to three additional members in family medicine. The pharmacist states that each of these physicians has a personal preference for treating their patients with antibiotic products not contained in the hospital’s approved formulary. He further explains that these drugs are three times more expensive than similar drugs in the hospital formulary. All drugs in the hospital formulary are reviewed and approved by the Medical Advisory Committee. Policies relating to the use of non-formularyproducts allow the pharmacist to order such products on a patient specific basis upon receipt of written orders from a member of the medical staff. To resolve this problem, your best approach would be to: a) Require all requests for drug products not contained in the hospital formulary be approved by the Administrator b) Meet with the physicians concerned and explain the fiscal restraints facing the institution and advise them of the cost implications of their practice patterns. c) Request the Medical Advisory Committee to establish more formal mechanisms for review of drug products contained in the formulary, together with a process for approval of non-formularyproducts. d) Request the pharmacist to complete a cost analysis comparing these drug products for presentation by you at the next medical staff meeting. e) Advise the pharmacist to substitute drugs in the formulary for those ordered by physicians.
Vous btes administrateur d’un hapital general de 200 lits et vous recevez la visite du pharmacien de l’hapital, qui vous fait part de son inquietude h propos des comptes himestriels de son service. Les coilts rhls des mtdicaments pour cette periode depassent les affectation budgetaires d’environ 30%.Le pharmacien est sur la defensive et se montre init6 d’Ctre tenu pour responsable de depenses qu’il considhre comme Ctant de son contrble. Le pharmacien vous expose ce qui lui semble btre les raisons de ce surplus de depenses. Dans un effort concert6 pour accroitre le personnel m6dical de l’hapital, des privilhges ont rkemment 6t6 accord6s h trois autres mUecins de famille. Selon le pharmacien, chacun de ces mCdecins pr6ere traiter ses malades avec des antibiotiques qui ne font pas partie de la liste de m6dicaments approuvee par l’h6pital. I1 explique en outre que ces m6dicaments coiltent quatre fois plus cher que les produits similaires qui figurent dans la liste de l’hiipital. Tous les m6dicaments de la liste de l’h8pital sont soumis au Comit6 m6dical consultatif qui les appouve. Les directives relatives A l’emploi de produits ne figurant pas dans cette liste autorisent le pharmacien h commander ces produits pour des cas particuliers,sur rkeption d’une demande krite d’un membre du corps medical. La meilleur fagon de resoudre ce problhme serait: a) D’exiger que toutes les demandes de medicaments,qui ne font pas partie de la liste de l’hbpital, soient approuv&s par l’administrateur. b) Rencontrer les medecins concern&, leur exposer les restrictions budgetaires auxquelles 1’Ctablissementdoit faire face, et les informer des implications financihres de leurs mCthodes thkrapeutiques. c) Demander au Comitk m6dical consultatif d’6tablir des mkanismes plus pdcis pour reviser la liste de medicamentset le processus d’approbation des produits non inclus dans cette liste. d) Demander au pharmacien de prCparer un tableau comparatif des couts de ces m&licaments, que vous presenterez vous-mCme A la prochaine reunion du Conseil des m6decins.
Answers: page 20
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Reponses : page 20
e) Dire au pharmacien de remplacer les medicaments de la
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