A NIH parable at a fixed cost – the health care blog

By Gregroy Hopson

The family restaurant in T-Maître Pierre was an institution of Louisiana. The kind of place where generations gathered on smoking mountains of boiled crayfish, spicy corn and seasoned potatoes. A place where Louisiana Blues and Zydeco by Clifton Cenier played in the background and the server wore white starchy shirts with brightly colored butterfly knots. The walls were plastered with wilted photos of smiling people. No one knew who they were anymore, but they felt like family.

Pierre Thibodeaux, the founder, made sure that each client was treated as if they were indeed the family. It was therefore a little ironic that when he died, he had no heirs.

During the week, the restaurant was acquired by the developer of several million dollars Ob Nocious, who addressed journalists under a banner that was read:

Make the crayfish incredible
“They call these little lobsters.

To supervise the transformation, Nocious called on Otto in Maladore, a consultant known for directing companies of a billion dollars and by doing mathematics in mind (where he also did all his research).

Maladore spent thirty minutes walking on the property, looking at this, pressing it and going back things while shaking your head. It did not take long to publish his report to the press:

• Excess work: “Wait the staff, the goalkeeper, the dishwasher?” None of them are cooking we waste money on them. Eliminate all these positions. “
• Menu simplification: “The boiled crayfish exceeds everything. Eliminate everything else. Eliminate the menu itself. The menus are nothing more than administrative bloating. ”
• Decor: “We will have the best of everything. These photos are faded and were of low quality when they were new. Remove them. “
• IT modernization: “I found an IBM 5150 which still directs their books.
• Fixed costs: “This place is a hemorrhage due to indirect costs. Forty percent of income on facilities and administration? It’s crazy. Ten percent are more than enough for a place like this! But we are much more generous and much more compassionate than people grant us up to 15%! “

The changes occurred quickly overnight.

The next day, when customers presented themselves, they found no music. No servers. No atmosphere. Just folding chairs, an old battered card table and fluorescent lights that are flickering (they were told that the reshaping would be done later). The walls were naked except for a sign that was read:

The crayfish of T-Master Pierre

Read carefully !!!!!!

1. Go to the rear parking and connect.
   You will receive a ten -minute time slot to boil.
2. You will receive:
   A. Living crayfish
   Born, non -rumin
   c. Potatoes (with high quality dirt: pH between 6 and 6.5)
3. Boiling pot preheated to 212 ° F.
   Do not add or remove the water !!!!!!
4. The spice levels are predefined.
5. Additional towels: $ 0.25 each
6. Incorrect elimination of corn shells: 10% surcharge
7. The fact of not eliminating crayfish in time leads to the confiscation of meals.
   No exception, no refund !!!!!

A middle -aged man in a hats of Ragin ‘Cajuns read the instructions aloud. Then he looked around the solemn appearance customers who were waiting online behind him. The place was quiet except for a few muffled noises from the kitchen. He removed his cap, looked towards the sky, a break and martbered:

“But that’s not good.” (Man, This is no good.)

At the end of the week, two of the three chefs were tired of renting pots and pots and arguing on the rights of burners. They moved to California, where a Chinese restaurant offered a fully equipped kitchen and covered with indirect costs. In a few weeks, they had introduced the crayfish of Admiral Pierre, featuring crayfish imported from Chinese-descendants of the Louisiana crayfish who accidentally introduced in the 1930s.

Back in Louisiana, the rain went stronger and the only remaining chief held in the ankle in a puddle, rumbling a customer full of water to have thirty seconds late by putting his crayfish in the pot.

Morality

This is what happens when foreigners impose arbitrary cost ceilings in the name of “efficiency”.

The Pierre Pierre has not failed because of bad crayfish. He failed because he lost the infrastructure that made the meal possible, burners, pliers and people. The chef, once celebrated for his recipes and skills, is now in the rain, helpless to cook without the tools on which he depended. The recipes remain, but customers must now have trouble filling the gaps themselves, leaving behind the joy and ease of a shared meal.

NIH facilities and the administrative ceiling (F&A) is no different. It reduces the financing of the essential elements which allow the search to prosper: laboratory space, equipment, compliance staff and humans who know how to maintain complex machines such as autoclaves. Researchers, formerly empowered by infrastructure and expertise, must watch their innovations take down while benefactors rush to reconstruct what is missing.

At T-Maître Pierre, you are blocked in the rain, fighting to understand how to boil the crayfish correctly. And when you ask for help, the chief answers:

“I am the uniq who stays, worse that’s all I have.”
(I am the only one to stay and that’s all there is.)

Under the 15% ceiling of the NIH, your research institution tries to finance an autoclave by tearing its sofa to find any change that could have fallen from the visitors. And even this dry source in the increase in Paypal and Venmo has no currency.

Gregory Hopson works at a distance from Baton Rouge, in Louisiana, as a developer of Business Intelligence for Emory Healthcare in Atlanta, GA.