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The coronavirus pandemic has put strain on many sectors of the United States economy. Perhaps the hardest hit is the healthcare industry, where medical and administrative staff have continued to go above and beyond the call of duty to care for patients amidst increased risk of infection, a high rate of COVID deaths, and escalating political tension over mask and vaccine mandates.  

According to a Kaufman Hall study that drew data from 900 hospitals across the country, hospitals’ operating margin fell by 46.1% from 2020 to 2021, not taking into account federal aid. 

Declining budgets have put additional pressure on hospital staff, who are already overworked and overstressed in many cases. According to a 2021 survey conducted by Health Facilities Management with the American Society for Health Care Engineering (ASHE) and the Association for the Health Care Environment (AHE), managers have often had to pick up additional positions in emergency management, patient surges and environmental services, in order to keep everything running. 

The drive to consolidate positions comes at a time when health professionals are running ragged. Survey responders report real difficulties in managing their time, particularly when it comes to keeping plates spinning and managing staff across multiple departments. There are only so many hours in a day, and when a manager holds multiple positions, it’s difficult to balance priorities—and resources are often scarce. Burnout is a common result.  

The immediate effects of these challenges can be actively disastrous. A manager handling multiple roles can be forced to make decisions outside of their expertise, capabilities, or comfort zone. Managers who don’t know much about specific fields may appoint less qualified workers—and there are steep learning curves when it comes to dealing safely with medical gas, electrical systems and complex and expensive equipment.

These can be life-or-death decisions: an HVAC system leaking refrigerant gas—which is poisonous—can choke someone to death in minutes, while improperly-managed electrical systems can burn and kill. When un- or poorly-trained facility managers are hired, it often effectively means that nobody is managing risks, in part because they don’t know them. 

Despite these challenges, the bundling of positions is unlikely to go away. Around 26% of survey respondents have over 25 years on the job and will likely retire in coming years, leaving a swath of openings. As it stands, health facilities are already seeing high staff turnover and are finding it difficult to fill any vacancies. That’s in part due to a lack of significant pay increases to go with increased responsibility, and what one respondent calls the  “constant, never-ending drumbeat to do more with less.” 

In the future, it seems, consolidation of departments isn’t likely to go anywhere. And it may well end up becoming the norm, leaving health care officials managing some serious risks.