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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?”

 Middle Managers

 Many of the comments from Directors (blog published last week) were present in responses from Middle Managers and the summary was developed to reflect both categories.  Unique perspectives from the middle manager group offered some insights that were notable.

“Many of us are drawn to pharmacy practice because it is a job that can stay at work; leadership comes home with you.”  The concept of fear of leadership roles was clearly evident in many comments.  The inability to maintain the treasured work life balance, the idea of not having the requisite skills to be “comfortable” in the role, and the concept of “abandoning” the clinical connection were not uncommon responses.

Integration of health care delivery was a key focus, particularly in view of the exceptional leadership and relationship skills that are key to that success.  These were noted to be skills that are not inherent strengths of most pharmacists, nor are they developed in the educational process.  These are skills that must be taught early and often through every possible opportunity:  residencies, local and national continuing education programming and advanced education and training opportunities.  More, more often, more focused.

 Pushing new grads into Assistant/Associate Director positions just out of residency was a cause for concern by some.  With little or no experience and often with the lack of a coaching, mentoring relationship, this is not an optimal position for anyone in the equation.  Many of the comments reflected by Directors relate to this issue raised by middle managers. 

The academic path to pharmacy practice is long and costly.  The need to continually upgrade skills, the changing demands, led to a question: “ Just how many years should it take to ‘qualify’ to be a leader? “  In a changing work world, the mere professional credentials do not seem to be “enough,” with the escalating demand for business acumen, team and relationship skills, critical thinking and the ability to move nimbly from simple to complicated to complex tasks and even to survive in the occasional environment of chaos, not the domain that we are best trained to serve.

 The active promotion of leadership from student level through practice seniority was suggested.  These suggestions blended closely with the repeated suggestion of need for a pharmacy leadership support network – a stable learning community – that supports shared and mutual learning as we deal with a changing environment.  This should include the ability to envision a new future in a changing environment and to do that collectively, not in isolation, and to share new approaches to transformational change.

Access to leadership development resources and learning opportunities was a common theme.  Local development of resources for access, expansion of specialized leadership training – at every level of practice – for practice model transformative change, non-traditional residencies, unbundled Pharmacy Leadership Academy access for laser point access to needed skills, focused access to upgraded skills to build financial acumen – in many ways by many people described as “learning the basics without an MBA.”

 A unique suggestion that links to the general succession planning recommendations and the previous “access to leadership development resources” comments, suggested that there be a “recognized lead role at every level of pharmacy practice within an organization.  There should be limitation on the span of control any single leader can have, what they can presume to undertake themselves, with the advantage of more hands on work, more time with pharmacy staff, no leader – staff disconnect.”  Such an approach would surely build more young leader’s experience and confidence, and unburden existing leader’s heavy load. . . delegation on steroids with a formal plan.

Some attention was focused on “recruiting the right people to the profession in the first place,” providing a realistic and time sensitive view of the professional opportunity and the changing environment, with focus on the leadership opportunity and expectation that is fundamental to daily practice. 

 Some additional comments that were isolated but worthy of note:

• “Leaders will rise to the top naturally.” What’s all the fuss about?  Let it happen naturally, does not seem to be the tone and tenor of the majority of respondents.
• "Better pay,”  “better working conditions” and “less stress.”
• Generational differences were described to be either at the heart of the leadership problem, or not really a factor.

Pharmacy Students
Responses by students were largely – and not surprisingly – focused on development areas of need, including:

• General leadership skills
• Networking and social skills
• Team and relationship building, and nimbleness in working in teams
• Advanced professional analytic skills
• Communication
• Critical and creative thinking skills
• Public policy & health
• Experience . . . in everything
• Perspective
• Personal leadership skills including self-motivation, persistency, resilience, open-mindedness and joy in work
• Ethics and work ethic
• Understanding of the logic of the healthcare reimbursement system and models
• Time management
• Stress management
• Business acumen
• Social acumen including how to make small talk, tell stories, stay on the good side of people, build rapport, influence and persuade
• Teach me empathy (!), compassion for patients and families
• There were a lot of “don’t knows”, a few “maybe I should go to medical school” responses.

Overall the student notions of what they need to know, doesn’t differ all that much from what practitioners at every level articulated. The students were just more open and specific in expressing what they need.

 What are your thoughts?