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In resurveying and publishing Is There Still a Pharmacy Leadership Crisis? A Seven-Year Follow Up Assessment by Sara White and Sharon Murphy Enright (AJHP 2013;70;443-7) the comments were not included hence the sharing of them now since survey respondents were generous in taking the time to provide open text commentary around their concerns and leadership issues. The question posed was “In your opinion, what the key factors to ensuring health system leaders/managers for the future?”

Directors Leadership thrives on a passion for life-long learning, and that learning is best achieved when leaders learn together.  The creation of leadership forums and other community of learning formats creates the opportunity to build skills in vital areas to meet a changing environment.  Respondents noted in particular the need for solid grounding in financial strategy and tactics in a changing fiscal and reimbursement environment, skills associated with executive presence and political savvy in navigating within senior leadership circles, and communication and relationship building skills necessary to the growing integration of teams.

In terms of manpower related issues there were numerous comments relating to the leadership skills base of staff and recent graduates, beginning with concerns that they often lack a context for practice that would allow them to function at a higher level of independence and alignment with the realities of today’s healthcare systems.  Too often, a “shift-worker” mentality is common, and that many pharmacists are not prepared or motivated to deal effectively with physicians and nurses, or to do more to extend the pharmacists role in the patient care team.  Coupled with a “silo-mentality” that is all too prevalent, the small-l leadership capacity of most organizations is underdeveloped.  This concern was expressed broadly, encompassing the general pharmacy workforce, and more specifically to focus on clinical leadership capability and capacity.

 In relation to both of the previous issues, comments focused on entry-level (PharmD) as well as post-graduate education (residencies) and the need to infuse focused learning opportunities on leadership and operational integration.  “Schools are turning out very smart, well educated academics,” creating a mismatch with the expectations of real world skills that are needed.  This is a problem that crosses professions and which is receiving focused attention within medicine, nursing, law and other disciplines.  The comments were frequently linked with the growing need for focused master level training (eg MHA, MBA, MPH, etc) as a means to create both the broader contextual understanding necessary to an individual optimizing the value they bring to the organization, including a higher level of comfort with a rapidly changing environment, and to build the critical skills increasingly demanded by healthcare system executives and driven by the demands of the marketplace.  The best professional education does not provide this underpinning of skills that are increasingly expected of leaders in health systems.

 Many comments related to the positioning of the pharmacy enterprise within the larger organization, reinforcing the need for a broader context of understanding – up, down and laterally -- about pharmacy’s role and impact across the system.  Understanding the business of pharmacy is as vital as the professional knowledge associated with patient care, and this knowledge and applied understanding is critical for those in clinical roles.  The need for senior pharmacy leadership to be well represented and aligned within senior/executive leadership is vital, and to continue to urge that pharmacy be included within the senior leadership team.  Collaboration with ACHE was identified as an important consideration that should be a high priority for ASHP and the Foundation. 

 Organizational structure of the pharmacy enterprise was also a focus of attention by many respondents.  Noteworthy, the apparent increase in non-pharmacist MHA Directors of Pharmacy in situations were pharmacists are unwilling or unprepared for leadership was noted as a concern.  The impact of the flattening of organizations to eliminate or greatly reduce middle management positions, notably assistant director positions was explored both from the perspective of the loss of fertile training opportunity in the course of building senior leaders, and from the perspective of titling being an important factor in “wooing” young practitioners to leadership roles:  simply giving the work and experience in leadership issues and tasks is not always enough incentive to grow.

 Compensation issues were raised frequently and address a broad range of perspectives including leadership differential from staff salaries (negligible), as an incentive to “woo” staff and clinicians to formal (big L) leadership roles and in relation to the need for better qualitative and quantitative salary data (survey results) to address the various aspects of the issues internally within health systems to address compensation related issues.

 Related to the need for more accurate and expansive salary information, the entire issue of practice metrics was noted as an issue of concern and need.  Standardized measurement, in particular productivity metrics and metrics related to regulatory compliance were frequently mentioned.  Related resources (eg webinars, white papers, pilot programs, skills based resources) were featured as items that ASHP and the Foundation might offer to support this pharmacy leadership area of need. 

 Succession planning was noted by many director-level respondents as an area of need, particularly from a strategy and resources perspective.  While more organizations have taken steps toward some level of succession planning, that is an exception.  Linked to this topic of succession planning were frequent comments regarding the struggle to build and access effective coaching and mentoring initiatives, personally and organizationally, and targeting this area of potential resource development as a high priority for the ASHP and the Foundation.

 The need for transformational change, in particular related to both the pharmacy practice model initiative and to healthcare reform was a common discussion point.  While the recognition of the need for change and the will to change was apparent in the comments, the ideas and strategies for how to execute were not so apparent, in particular with relationship to engagement and ownership building among small-l leaders and staff, and in the essential transformative learning that will be necessary for pharmacy teams to execute on the will and ideas.  All the visions, directives and policy changes aside, the capabilities (individual) and capacity (team and organizational) will define the success or failure of these efforts.  Too often, the requisite skills are not in place and the resources are not available to build them.

 Finally, the pain point for small and rural hospitals and health systems was persistent and palpable across all groups of respondents.  The notion of having to be a “jack of all trades” in a highly specialty focused world, the concern of time and resources to access the requisite skills to continue to build practice capacity, and the sense of being outside the mainstream of the focus of attention for leadership development was noted repeatedly. 

What are your thoughts? In another post I will share the middle managers and pharmacy student's answers.