Can you guys elaborate? Or may be give a couple of examples?
Yes, you will be pressured to increase profits/keep costs down....but this is made impossible because of the politics involved. OK, lets say you have 1 physician who insists on expensive drug A, even though slightly cheaper drug B works as well and every other hospital physician is happy using slightly cheaper drug B. But this 1 physician brings in a lot of patients and is head of the P & T committee. So, you speak out about how drug B is more cost effective than Drug A, so the 1 physician is upset, and the other physicians really don't care one way or the other (not enough to defend you at any rate), so of course, the physician gets his way, and Drug A is added to the formulary. But that's not enough for the upset physician. The upset physician goes to the CEO and goes on and on about how you aren't a team player and how he won't admit his patients to a hospital where they don't get the best of care. The CEO promises him he will "keep an eye on you." So now the CEO sees you as threatening hospital business. Now because Drug A is so overpriced, you pharmacy drug budget is out of whack, so now in the CEO's eyes, not only are you unprofessional in making a valued physician upset, but you can't even keep to a basic budget. So now the CEO is triply "keeping his eye on you." Now you as a relatively intelligent pharmacist, pick up on the frozen cold vibes emanating from the CEO and the hospital's favored physician at you....you realize you have 3 choices, wait to get fired, voluntarily step down, or leave and get a different job.
This is one example. I'm bored, so I'll give you another. Let's say there is 1 floor where nurses have a secret stash (OK, we all know its not just 1 floor, in reality it is all the nursing floors.) There are different ways nurses get the extra drugs to keep in their secret stash, which they use to give (in their minds) "stat" drugs without having to wait to get the order verified by a pharmacist. So, you find out about their secret stash & you do the right thing and confiscate their secret stash. Now nursing is mad at you. The nurses start to complain to their manager about everything they can dream up. They complain about how they were forced to keep the secret stash because pharmacy wouldn't verify orders fast enough, they complain about having to keep a secret stash, because they don't want to open up the crash cart because pharmacy takes to long to replenish it, they complain that they have to keep their secret stash because pharmacy won't make and deliver their "stat" IV's quick enough. Never mind if none of this is true, you and your pharmacy department are vastly outnumbered by the nurses. The nurse manager takes the complaints to the CEO, the CEO is sick of hearing of these complaints s/he also realizes that its just you against say 1000 nurses, so s/he sees the easiest way to make the nurses happy, is to get rid of you. You start getting the cold vibes, and quickly realize your 3 choices.
OK, so lets say you realize their secret stash makes them happy, so you decided to ignore it and let them keep it. Maybe you'll even unofficially give them a couple of KCL vials to keep in their stash, that will really make them happy. Nurses are happy, all is good. Until JCHO shows up, finds their stash and cites you for major violations. Now the CEO is mad at you, the hospital can't afford to lose their JCHO certification, nursing claims that you told them it was good to have a secret stash and that you had full knowledge of it and everything they had in it. The CEO sees you as vastly incompetent and wants you gone. You get the cold vibes, and realize you now have only 2 choices, get fired, or quickly find a different job.
I could give you a ton more examples. This is the life of a hospital manager/director. The politics of keeping all these different groups happy, when these groups want opposing things from you.
I'm not sure why you keep bringing up CII counts, this is a manager responsibility, but a pretty small part of their job compared to the rest of it. Personally, I think being a retail pharmacy manager is slightly easier than being a hospital manager/director, but neither job is easy, which is why most pharmacists are content to be staff.