Leadership and Managerial Development Needs of Pharmacy Leaders in Canadian Health Care Systems: Results from a National Questionnaire

Abstract

Background

The scope of pharmacy practice in Canada is expanding, as are the responsibilities of health care-systems pharmacy leaders. However, there is limited knowledge of the training pathways used by current pharmacy leaders and the leadership and managerial skills they value most.

Objectives

To identify key leadership skills valued by Canadian pharmacy leaders and to determine the development pathways for these skills.

Methods

An electronic survey on leadership and management competencies was distributed in spring 2024 to health care–systems pharmacy leaders across Canada. Descriptive statistics, one-way analysis of variance, and linear regression were used to assess the associations between the self-reported skill deficit and sociodemographic and employment-related factors in the quantitative data.

Results

A total of 141 pharmacy leaders answered some or all of the survey questions. Respondents were predominantly midcareer leaders in academic hospitals with up to 10 years’ experience, many of whom had prior clinical leadership training. Respondents expressed confidence in their clinical or operational management skills and identified finance and budgeting, human resource management, and leadership as areas requiring further development. Every mean 1-point increase in the skill deficit was associated with a 2-point decrease in job satisfaction score (95% confidence interval −3.4 to −0.90, p < 0.001).

Conclusions

These findings suggest the need for further leadership and management training programs. It is recommended that a national pharmacy leadership and management competency framework be developed, along with leadership certification programs offering hands-on learning opportunities.

INTRODUCTION

Pharmacist and pharmacy technician leaders play an increasingly complex yet vital role within modern health care systems.¹ The presence of formally trained pharmacy leaders is associated with improved patient care, enhanced medication safety, and greater pharmacy productivity.² Strong leadership is essential, as pharmacy leaders in today’s Canadian health care systems face growing challenges, including drug shortages, rising pharmaceutical costs, workforce shortages, and high rates of pharmacist burnout. ^2–4 Leadership development is therefore urgently needed to prepare the next generation of pharmacy leaders.⁵

A major barrier to advancing pharmacy leadership development in Canada is the lack of consensus among pharmacy organizations regarding key leadership competencies. ⁶ Leadership was recently added as an entry-to-practice competency within the 2024 professional competencies of the National Association of Pharmacy Regulatory Authorities. ⁷ However, the absence of a standardized leadership framework across Canadian pharmacy organizations limits the ability to design consistent training and development opportunities for current and future pharmacy leaders.

Leadership and management are different but complementary skill sets in pharmacy. Management seeks to produce order and consistency, whereas leadership seeks to produce change by innovating, setting future directions, and motivating others.⁸ Pharmacy leaders in the roles of directors or operations managers often draw on both sets of competencies.⁹ Entry-level leadership positions, however, support clinical practice quality, advancement, and innovation.¹⁰

These distinct competencies need to be considered when designing pharmacy leadership development programs. A survey of US health care–systems pharmacy leaders conducted in 2019 ranked interpersonal and managerial (human resource, finance, and budget management) skills as the most valuable leadership competencies.⁹ Similarly, a survey of Canadian health care–systems pharmacy leaders conducted in the year 2000¹¹ and a survey of Canadian and US health-system pharmacy leaders conducted over the period 2000 to 2002¹² identified interpersonal and communication skills as important leadership competencies, while financial analysis and implementation of marketing programs were ranked among the top self-identified weaknesses. ¹¹ However, given significant changes in the pharmacist’s scope of practice and health care trends over the past 2 decades,^9,13 it is uncertain whether similar results would be observed today.

In the 2000 survey by Axworthy and MacKinnon,¹¹ most pharmacy leaders reported developing leadership and managerial skills through non-formal learning methods such as on-the-job training. Formal learning—defined by Johnson and Majewska¹⁴ as structured, credentialled learning delivered by an educational institution or recognized organization—was less common. Only 37.6% of leaders reported having completed formal learning after their Bachelor of Science in Pharmacy degree, including residency training or a graduate-level program (Master of Business Administration [MBA], Master of Health Administration [MHA], etc.).¹¹ It is unknown whether these trends have changed in the past 20 years.

In a survey of US pharmacy leaders published in 2022, Jones and others⁹ found that a postgraduate year 1 (PGY1) pharmacy practice residency was the most common leadership training pathway for health care–systems pharmacists (38%), followed by graduate-level programs (24.8%) and on-the-job training (21.5%). Most graduate programs had a general focus (e.g., MBA, MHA, Master of Public Administration), with few participants reporting completion of pharmacy-specific leadership programs. We hypothesized that similar training patterns would be observed among Canadian pharmacists, given that no pharmacy-focused graduate-level leadership programs existed in Canada at the time of this study.

The current study aimed to identify the leadership and managerial competencies most valued by Canadian health care–systems pharmacy leaders and to characterize the pathways through which current leaders have developed these competencies.

METHODS

This survey was part of a larger mixed-methods study exploring Canadian hospital pharmacy leadership pathways and learning needs. The focus group results are published in a companion paper.¹⁵

Survey Development and Dissemination

An electronic questionnaire was developed and distributed, using LimeSurvey software (LimeSurvey GmbH; http://www.limesurvey.org), to licensed health care–systems pharmacists across Canada from May 13 to June 14, 2024. The LimeSurvey software allows researchers to record unique site visitors, participation rate, view rate, and completion rate.

With convenience sampling in mind, we used multiple approaches to reach potential participants. A link to the questionnaire was sent to potential respondents through the e-newsletter of the Canadian Society of Healthcare-Systems Pharmacy (CSHP). Moreover, 3 of the coauthors (H.N., M.L., N.J.M.) circulated the email invitation within their leadership networks. Even though the CSHP membership and leadership networks included both pharmacists and non-pharmacists, the invitation email specified pharmacy leaders and managers as the eligible respondents. Periodic reminders were sent to potential respondents through the same channels. Participation in the survey was voluntary, with no compensation provided to respondents. At the beginning of the questionnaire, participants were asked to provide informed consent and were offered the choice to leave the survey at any time. The Horizon Health Network’s Institutional Review Board reviewed and approved the protocol (application no. 101982).

The questionnaire comprised a mix of previously validated questions with no-response options, adopted from Axworthy and MacKinnon¹¹ and Jones and others,⁹ as well as new items created by the study authors (the questionnaire is available upon request to the corresponding author). It included questions on demographic characteristics, education, past and current employment, job satisfaction, and 32 leadership competencies (Supplement 1A, available from https://doi.org/10.4212/cjhp.3836). The competency questions were based on the LEADS in a Caring Environment capabilities framework¹⁶ and the 2018 American Society of Health-System Pharmacists (ASHP) postgraduate year 2 (PGY2) pharmacy administration and leadership residency competencies.¹⁷ Job satisfaction was measured using a validated pharmacist job satisfaction tool originally developed by Barnett and Kimberlin.¹⁸ The response structure for the 4 questions on job satisfaction was based on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree). The competency questions were divided into 5 domains: clinical and operational management (5 items); quality, safety, and process improvement (3 items); finance and budgeting (5 items); human resource management (9 items); and leadership (10 items) (Appendix 1).

The respondents were asked to rate the importance of the competencies in their current position (henceforth “importance”) and their current confidence level with the competencies (henceforth “confidence”) using a 5-point Likert scale (1 = very low, 5 = very high). We based our leadership questions on these 2 models (i.e., importance and confidence) as Canadian pharmacy leadership competencies were not defined at the time of the study. The questionnaire was pilot tested by 4 independent hospital pharmacists in leadership positions who did not subsequently participate in data collection.

Data and Measures

We analyzed data from all respondents to avoid any response bias. No approach was adopted to adjust for the sample’s non-representativeness. The original response categories for the selected variables are shown in Table 1. To avoid over-compartmentalization of the data for these variables during the bivariable and multivariable analyses, we modified and merged levels for a few categorical variables (see Supplement 1B, available from https://doi.org/10.4212/cjhp.3836). For example, we considered respondents’ socioeconomic information such as age (recorded in years), sex (male or female), ethnicity (white or non-white), education (only clinical leadership training, only formal leadership training, or both), and region of residence (Atlantic, Prairies, etc.). “Formal education pathway” was defined as a structured, credentialled learning program that followed an established curriculum and was delivered by an educational institution or recognized organization.¹⁴ We also included current and past employment-related information in the context of leadership skills. These variables contained information on the respondent’s current leadership position (director, manager, team leader, or other), the number of employees currently reporting directly to the respondent, the duration of the current pharmacy leadership position (up to 10 years or more than 10 years), the place of work (teaching hospital or other), and job before first leadership position (staff/clinical pharmacist or non-staff/non-clinical pharmacist). The responses to the job satisfaction questions were transformed into numeric values, and each respondent’s total job satisfaction score was calculated (minimum 4, maximum 20). Similarly, responses to the competency questions were converted into numeric scores ranging from 1 to 5.

TABLE 1.

Characteristics of Respondents to the Canadian Pharmacist Leadership Questionnaire, 2024

Characteristic	No. (%) of Respondentsa,b
Age (years)
Mean ± SD	43.2 ± 8.6
Data missing	44
Sex
Female	76 (76.8)
Male	23 (23.2)
Data missing	42
Ethnicity
Aboriginal	0 (0.0)
Asian	12 (12.1)
Black or African American	1 (1.0)
Hispanic or Latino	0 (0.0)
White	84 (84.8)
Biracial or multiracial	2 (2.0)
Prefer not to say	0 (0.0)
Data missing	42
No. of employees directly reporting at current leadership position
Mean ± SD	21.2 ± 23.8
Data missing	43
Duration of pharmacy leadership position (years)
< 1	9 (8.9)
1–10	59 (58.4)
11–20	21 (20.8)
> 20	12 (11.9)
Data missing	40
Place of work
Ambulatory care centre	4 (4.0)
Community health centre	1 (1.0)
Community hospital	35 (34.7)
Regional or provincial health authority	6 (5.9)
Teaching hospital	53 (52.5)
Other	2 (2.0)
Data missing	40
Current leadership position
Director of Pharmacy	19 (18.6)
Pharmacy Manager	47 (46.1)
Pharmacy Clinical Practice Leader or Clinical Resource Pharmacist	15 (14.7)
Other (supervisor, clinical coordinator, and unspecified roles)	21 (20.6)
Data missing	39
Job before first leadership position
Staff or clinical pharmacist	77 (77.0)
Non-staff or non-clinical pharmacist (e.g. drug information pharmacist, drug use pharmacist, residency coordinator, clinical practice leader, and unspecified)	23 (23.0)
Data missing	41
Education
Master’s degree (e.g., MBA, MHA, MPA, or MPH)	7 (7.0)
More than one degree (Master’s level or pharmacy-related)	36 (36.0)
Other (incomplete master’s program, pharmacy technician diploma, undergraduate degree)	31 (31.0)
Pharmacy Practice Residency, year 1 (PGY1)	19 (19.0)
PharmD for Working Professionals (e.g., bridging program)	4 (4.0)
Postbaccalaureate PharmD	3 (3.0)
Data missing	41
Satisfaction score for current job
Mean ± SD	15.1 ± 3.3
Data missing	47
Province or territory
Alberta	12 (11.9)
British Columbia	7 (6.9)
Manitoba	9 (8.9)
New Brunswick	13 (12.9)
Newfoundland and Labrador	7 (6.9)
Northwest Territories	0 (0.0)
Nova Scotia	13 (12.9)
Nunavut	0 (0.0)
Ontario	17 (16.8)
Prince Edward Island	2 (2.0)
Quebec	8 (7.9)
Saskatchewan	12 (11.9)
Yukon	1 (1.0)
Data missing	40

MBA = Master of Business Administration, MHA = Master of Health Administration, MPA = Master of Public Administration, MPH = Master of Public Health, SD = standard deviation.

^aExcept where indicated otherwise.

^bColumn percentages are shown for categorical variables with exclusion of missing values. For each demographic variable, “Data missing” denotes the number who did not respond.

Statistical Analysis

We first conducted a descriptive analysis to understand the respondents’ characteristics. Then, we conducted a separate analysis of the importance and confidence sections, calculating the mean and standard deviation (SD) for each competency. Based on the mean scores, we ranked the 32 competencies. To pinpoint the skill deficit between leadership skills required and those possessed by respondents, we calculated, for each competency, the difference in mean scores between importance and confidence. We then performed a one-way analysis of variance (ANOVA) to check the association between the mean skill deficit across all competencies and each sociodemographic and employment-related variable. Following this, a multivariable linear regression analysis was performed to test our hypothesis that the job satisfaction score (the primary predictor variable) was inversely related to skill deficits (response variable) after controlling for sociodemographic and employment-related variables. The detailed results of both the ANOVA and regression analyses are available upon request to the corresponding author. Missing values for any of the variables included in the model were ignored for the analysis.

For all statistical tests, significance was based on p values less than 0.05. All data manipulations, analysis, and visualizations were performed in R statistical software¹⁹ using the dplyr,²⁰ ggplot2,²¹ ggridges,²² and gtsummary²³ packages. For reporting the results, we followed the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) ²⁴ guidelines.

Data Availability

The data supporting the findings of this study are available from the corresponding author upon reasonable request.

RESULTS

General Demographic Characteristics

A total of 141 Canadian hospital pharmacy leaders responded to the survey, of whom 82 answered all questions. Table 1 outlines participants’ demographic characteristics. The mean age was 43.2 years, about 77% were female, and about 85% were white. Participants directly supervised a mean of 21 employees, with just a third having over 10 years of experience. More than half were employed in teaching hospitals, and almost half served as pharmacy managers. Just over a third (36.0%) of respondents reported having pursued more than one educational pathway for leadership development, whereas only 19.0% relied solely on a pharmacy practice residency. The mean job satisfaction score was high (mean 15.1, SD 3.3). Most of the respondents were from 5 provinces: Ontario (16.8%), New Brunswick (12.9%), Nova Scotia (12.9%), Alberta (11.9%), and Saskatchewan (11.9%).

Importance of Competencies

Table 2 shows the most and least important competencies, ranked according to their mean importance scores. Certain of the human resource management competencies (n = 2) and leadership competencies (n = 6) were perceived to be most important for the respondents’ current positions, and the mean score for each of these competencies fell above the neutral score of 3 on the 5-point Likert scale. Competencies in the domains of budgeting (n = 4), quality, safety, and process improvement (n = 1), and clinical and operational management (n = 1) were perceived as the least important. Except for one competency, mean scores for these competencies were above the neutral. The rankings across leadership positions showed a distinct pattern, with pharmacy directors rating almost all competencies with high importance. In contrast, pharmacy managers and clinical practice leaders ranked competencies from the leadership domain as having higher importance than those from the finance and budgeting and the quality, safety, and process improvement domains.

TABLE 2.

Most and Least Important Leadership and Managerial Competencies^a

Competency	Score (Mean ± SD)	Rank
Most important
Leadership: Show integrity in professional relationships and actions	4.8 ± 0.5	1
Leadership: Communicate effectively when speaking or in writing	4.8 ± 0.4	2
Leadership: Use effective conflict management skills to resolve disputes	4.7 ± 0.5	3
HR: Facilitate environments of collaboration and cooperation to achieve results	4.6 ± 0.5	4
HR: Support and challenge others to achieve professional and personal goals	4.6 ± 0.6	5
Leadership: Demonstrate sensitivity to the perspective of the patient, caregiver, or health care colleague in all communications	4.6 ± 0.7	6
Leadership: Actively seek opportunities and challenges for personal learning, character building, and growth	4.5 ± 0.7	7
Leadership: Inspire vision by identifying, establishing, and communicating clear and meaningful expectations and outcomes	4.5 ± 0.7	7
Least important
HR: Understand labour and contract management principles	3.8 ± 1.1	23
F&B: Monitor and manage operating and capital budgets	3.7 ± 1.3	24
Quality: Apply methods for measuring and improving internal and external customer satisfaction with pharmacy services	3.7 ± 1.1	25
Clinical/operational: Design a plan and manage the daily safe and effective use of technology and automated systems	3.6 ± 1.2	26
F&B: Utilize productivity measurement in operational decision-making	3.6 ± 1.0	27
F&B: Construct reports and recommend plans to improve outcomes based on conclusions drawn from analysis of financial and clinical outcomes data	3.5 ± 1.1	28
F&B: Understand the process of negotiating contracts with vendors	2.9 ± 1.4	29

F&B = finance and budgeting, HR = human resource management.

^aAs reported by respondents using a 5-point Likert scale, where 1 = very low importance and 5 = very high importance.

Current Confidence in Possessing Competencies

Table 3 shows the most and least important competencies, ranked according to their mean confidence scores. The competencies for which respondents felt the most confidence fell in the domains of leadership (n = 4), human resource management (n = 4), and clinical and operational management (n = 1). The competencies for which respondents felt the least confidence fell in the domains of finance and budgeting (n = 5), human resource management (n = 1), and clinical and operational management (n = 1). The mean scores for the competencies with the most and least confidence fell above and below the neutral score of 3, respectively. The disaggregated ranking analysis across leadership positions showed a similar trend as described for the importance of competencies.

TABLE 3.

Leadership and Managerial Competencies with Which Respondents Were Most and Least Confident^a

Competency	Score (Mean ± SD)	Rank
Most confident
Leadership: Show integrity in professional relationships and actions	4.5 ± 0.7	1
Leadership: Communicate effectively when speaking or in writing	4.3 ± 0.7	2
Clinical/operational: Identify patient care service opportunities	4.1 ± 0.8	3
Leadership: Actively seek opportunities and challenges for personal learning, character building, and growth	4.0 ± 0.9	4
Leadership: Demonstrate sensitivity to the perspective of the patient, caregiver, or health care colleague in all communications	4.0 ± 1.0	4
HR: Support and challenge others to achieve professional and personal goals	3.9 ± 0.8	5
HR: Observe employee performance and provide timely and objective feedback	3.9 ± 0.9	6
HR: Facilitate environments of collaboration and cooperation to achieve results	3.9 ± 0.8	6
HR: Conduct recruitment and hiring activities	3.8 ± 1.2	7
Least confident
F&B: Develop strategies to ensure access to medication and implement cost reduction strategies	3.0 ± 1.2	22
Clinical/operational: Design a plan and manage the daily safe and effective use of technology and automated systems	3.0 ± 1.3	23
HR: Understand how to design and implement plans for maximizing employee engagement and enhancing employee satisfaction and retention	3.0 ± 1.0	24
F&B: Monitor and manage operating and capital budgets	2.7 ± 1.3	25
F&B: Utilize productivity measurement in operational decision-making	2.6 ± 1.2	26
F&B: Construct reports and recommend plans to improve outcomes based on conclusions drawn from analysis of financial and clinical outcomes data	2.6 ± 1.2	27
F&B: Understand the process of negotiating contracts with vendors	2.0 ± 1.2	28

F&B = finance and budgeting, HR = human resource management.

^aAs reported by respondents using a 5-point Likert scale, where 1 = very low confidence and 5 = very high confidence.

Skill Deficits: Differences between Perceived Importance of and Confidence in Competencies

Table 4 shows the 10 competencies with the largest differences in mean scores between importance and confidence, which we refer to as skill deficits. The competencies “Use effective conflict management skills to resolve disputes” and “Navigate sociopolitical environments” had the largest skill deficit, as expressed by the difference in mean scores (1.2 points). For example, respondents rated the competency “Use effective conflict management skills to resolve disputes” as important (ranked third, with a mean score of 4.7), but the mean confidence level for this competency was low (mean score 3.5). Competencies within the domains of leadership (n = 5), finance and budgeting (n = 4), and human resource management (n = 1) appeared in this list. Appendix 2 shows, for each competency, the skill deficit in mean scores for perceived importance and confidence. This figure confirms the divergence between importance and confidence for the competencies with the largest skill deficits (Table 4).

TABLE 4.

Top 10 Leadership and Managerial Competencies with the Largest Differences Between Perceived Importance and Confidence

Competency	Differencea
Leadership: Use effective conflict management skills to resolve disputes	1.2
Leadership: Navigate sociopolitical environments	1.2
HR: Understand how to design and implement plans for maximizing employee engagement and enhancing employee satisfaction and retention	1.1
F&B: Monitor and manage operating and capital budgets	1.0
Leadership: Inspire vision by identifying, establishing, and communicating clear and meaningful expectations and outcomes	1.0
Leadership: Use effective techniques to motivate staff to achieve the pharmacy’s mission	1.0
F&B: Construct reports and recommend plans to improve outcomes based on conclusions drawn from analysis of financial and clinical outcomes data	1.0
F&B: Develop strategies to ensure access to medication and implement cost reduction strategies	0.9
F&B: Utilize productivity measurement in operational decision-making	0.9
Leadership: Scan the environment for ideas, best practices, and emerging trends that will shape the health care system	0.9

F&B = finance and budgeting, HR = human resource management.

^aDifference between mean importance and mean confidence, based on respondents’ reporting with a 5-point Likert scale, where 1 = very low importance/confidence and 5 = very high importance/confidence.

Association Between Current Job Satisfaction and Differences Between Perceived Importance and Confidence in Competencies

The one-way ANOVA to check bivariate associations between total mean skill deficit and sociodemographic variables revealed statistically significant associations with respondents’ age, sex, duration of pharmacy leadership position, and job satisfaction score (p < 0.05 for all). Linear regression showed that a 1-point increase in the mean skill deficit was associated with a 2-point decrease in job satisfaction score (95% CI −3.4 to −0.90, p < 0.001), which suggests that lower confidence in leadership competencies was associated with lower job satisfaction.

DISCUSSION

In this study, we examined the leadership and managerial development needs of Canadian health care–systems pharmacy leaders. The respondents were primarily midcareer women working in academic hospitals, most of whom had no more than 10 years of leadership experience. Using multiple pathways for leadership development was common, with involvement in professional organizations (volunteerism), on-the-job training, and mentorship contributing most to competency development. Leaders reported high confidence in clinical and operational management, but skill deficits in finance and budgeting, human resource management, and leadership. In general, lower self-confidence in leadership and managerial competencies was correlated with lower job satisfaction; however, this effect was less pronounced among those with formal leadership training.

Our results suggest that Canadian pharmacy leaders need further development of managerial competencies, particularly in budgeting, financial analysis, and human resource management. Notably, large skill deficits existed in the domain of finance and budgeting, where perceived importance far exceeded self-assessed confidence for several competencies. Similar findings were reported in 2002 by Axworthy and MacKinnon.¹¹ Although leadership training has been better integrated into undergraduate pharmacy programs since then, the focus remains minimal. ^7,25 Although not all pharmacists will pursue formal leadership roles, these competencies remain relevant for all pharmacists across most practice settings and are valued by current leaders. Our findings suggest that further professional development opportunities are needed to address skill deficits among pharmacy leaders, particularly in the areas of financial management and human resources.

Pharmacy leaders also placed high importance on competencies related to employee engagement, such as designing and implementing strategies to enhance staff satisfaction. However, consistent with the findings of Axworthy and MacKinnon,¹¹ as well as Faris and others,¹² pharmacy leaders continue to report low self-confidence in this area. A recent global qualitative content analysis²⁶ further supports team engagement as an important leadership competency. Employee engagement has been linked to improved patient safety,²⁷ reduced turnover, higher productivity, and greater employee well-being.²⁸ Given the predicted shortage of pharmacy professionals in Canada,⁵ developing employee engagement competencies is increasingly important.

Leadership training pathways for Canadian pharmacy leaders have changed over the past 2 decades. In the early 2000s, most leaders held only a bachelor’s degree, with 34% having pursued postbaccalaureate education.¹¹ In contrast, all leaders in our study had completed some form of postbaccalaureate education, most commonly more than one degree (36.0%), a pharmacy residency (19.0%), or a single master’s degree (7.0%). Skill deficits remained in the domains of finance and budgeting, human resource management, and leadership, suggesting that current academic pathways may not fully address the competencies required in today’s health care systems.

An interesting finding of our study was that respondents perceived non-formal learning—such as life experience, involvement in professional organizations, on-the-job training, and mentorship—as more influential in their leadership skill development than formal education. Similar results were reported by Jones and others,⁹ who found that on-the-job training and life experience contributed most to leadership development among US pharmacists. Experiential learning approaches can have more impact than formal education where they provide hands-on exposure to real-world scenarios, which aligns with findings of Schindel and others,²⁹ who noted that pharmacists prefer practical, skill-based learning over didactic approaches.

At the time of this study (2024), few pharmacy-specific leadership programs existed in Canada. While MBA and MHA programs provide strong foundations, they do not address pharmacy-specific leadership challenges. Similarly, the Canadian College of Health Leaders offers a LEADS-based, hands-on exposure program that leads to a Certified Health Executive (CHE) designation,³⁰ but it lacks a pharmacy-specific focus and formal training components. Pharmacy residencies (specifically PGY1) include an experiential pharmacy leadership rotation; however, the rotation is often only 1 to 3 weeks long,³¹ with the remainder of the 12-month program focused on clinical pharmacy practice.^29,31 The ASHP Pharmacy Leadership Academy (PLA) remains a well-established option, but uptake among Canadian pharmacists is low. The program’s cost may be a barrier, with 2025 tuition listed as US$7400.³² The CSHP Research and Education Foundation currently offers one Can$5000 PLA scholarship annually. Expanding the number of scholarships could improve PLA accessibility and foster leadership capacity among Canadian pharmacists.

Since this study was conducted, 2 Canadian universities^33,34 have introduced postgraduate leadership programs tailored to pharmacy. The University of Toronto now offers a 24-month Master of Pharmacy degree³⁴ that allows pharmacists to focus on 1 of 3 streams, including leadership. The University of British Columbia has also launched an 11-month Pharmacy Leadership diploma³³ that aligns with the LEADS framework¹⁶ and incorporates coaching, mentorship, and real-time application of knowledge in the workplace. This approach is consistent with contemporary leader-development theory³⁵ and the experiential learning methods valued by our study respondents.

Professional organizations also have an important role in leadership and managerial development. A 2024 CSHP member survey identified health care leadership as the education area of highest interest for additional credentialling. ³⁶ Canada does not currently recognize such specialized certifications; however, pharmacists have indicated that they would welcome the availability of these programs.³⁷ Other initiatives, such as PGY2 leadership residencies³⁸ or a supervisory skills course,^39,40 could be considered by professional organizations and integrated into current training offerings. Given the importance of mentorship reported in our study, structured mentorship programs led by organizations such as CSHP would further strengthen leadership development.

We recommend that pharmacy organizations collaborate to establish a national consensus on core leadership and managerial competencies. The LEADS framework provides a strong foundation.¹⁶ Our study findings may also be used to provide insight into which competencies Canadian pharmacy leaders value most and where further development is needed. A contemporary pharmacy leadership framework should also incorporate competencies in digital health, artificial intelligence, automation, telehealth, and cybersecurity— areas that are increasingly relevant to pharmacy practice⁴¹ but are beyond the scope of this study.

Strengths and Limitations

This study had several strengths. First, the 32 competencies were adapted from current ASHP and LEADS frameworks, ensuring relevance to contemporary pharmacy practice. Second, the study questionnaire was built on prior work, providing continuity in assessment. Respondents to our survey included not only former pharmacists but also former pharmacy technicians who are emerging as leaders in operations management roles.

The limitations included a small, convenience-based sample and potential under-representation of Canadian pharmacy leaders, especially from Quebec, given that a French-language version of the questionnaire was not available. Moreover, we would like to highlight the debate over the use of parametric tests to analyze Likert-scale data. As Sullivan and Artino have demonstrated,⁴² we preferred parametric tests over non-parametric tests because they yield more unbiased results, despite the relatively small, nationally unrepresentative sample size in our study. We suggest that readers interpret our results with these caveats in mind. The third notable limitation was our reliance on self-reported data and the possibility of recall bias among respondents. Lastly, selection bias is also possible, as those with strong opinions or experiences may have been more likely to participate. Such bias is also plausible in our multivariable analysis, as cases with missing values were omitted in the complete-case analysis. As a result, the findings should be interpreted with caution.

CONCLUSION

Canadian health care–systems pharmacy leaders primarily develop leadership and management competencies through on-the-job training, life experience, and mentorship. All leaders who responded to our survey reported some type of formal postbaccalaureate training, with pharmacy residencies and master’s degrees being most common. Although the pharmacy leaders reported confidence in clinical and operational management, skill deficits persisted in the areas of finance and budgeting, human resource management, and leadership. Lower confidence in these areas was associated with reduced job satisfaction, suggesting that skill deficits may negatively affect pharmacists’ fulfillment in leadership roles. We recommend that pharmacy professional organizations collaborate to develop a national pharmacy leadership and management competency framework, establish a national mentorship program, and create pharmacy-specific leadership certification pathways that offer experiential learning. These initiatives will help prepare the next generation of pharmacy leaders for the evolving challenges of the Canadian health care system.

APPENDIX 1. Comparison of competency rankings across leadership positions. A: Importance of each competency. B: Confidence in each competency

APPENDIX 2. Responses on Likert-type scale concerning the importance of and confidence in specified competencies. Competency abbreviations are defined in the table on next page

Definitions of abbreviations and details of competencies

Abbreviation	Competency Description
ptcareserveop Identify	patient care service opportunities
medusepolicyimprove	Participate in the development and coordination of medication-use policy improvement initiatives
pharmcompliance	Participate in assuring pharmacy compliance with internal and external compliance requirements, including legal, regulatory, safety, and accreditation requirements
meddistribution	Understand and evaluate the medication distribution process
autsys	Design a plan and manage the daily safe and effective use of technology and automated systems
custsat	Apply methods for measuring and improving internal and external customer satisfaction with pharmacy services
ptsafety	Lead a root cause analysis, gap analysis, or other safety assessments based on a significant patient safety event
qltyimprove	Develop or revise the pharmacy’s quality improvement plan or policy
opertndecmake	Utilize productivity measurement in operational decision-making
budget	Monitor and manage operating and capital budgets
costreductn	Develop strategies to ensure access to medication and implement cost reduction strategies
contract	Understand the process of negotiating contracts with vendors
dataanlysis	Construct reports and recommend plans to improve outcomes based on conclusions drawn from analysis of financial and clinical outcomes data
staffrequire	Determine and recommend the staff requirements that match an area of the department’s scope of services
recruitnhire	Conduct recruitment and hiring activities
emplyfdbk	Observe employee performance and provide timely and objective feedback
teambuildng	Effectively employ team-building techniques
achvcoop	Facilitate environments of collaboration and cooperation to achieve results
profnpersngoals	Support and challenge others to achieve professional and personal goals
emplyapprsl	Compose and deliver an employee’s performance appraisal
emplyretentn	Understand how to design and implement plans for maximizing employee engagement and enhancing employee satisfaction and retention
mgmtprincple	Understand labour and contract management principles
prsnlearng	Actively seek opportunities and challenges for personal learning, character building, and growth
mtvtstaff	Use effective techniques to motivate staff to achieve the pharmacy’s mission
inspirevision	Inspire vision by identifying, establishing, and communicating clear and meaningful expectations and outcomes
sensitive	Demonstrate sensitivity to the perspective of the patient, caregiver, or health care colleague in all communications
integrity	Show integrity in professional relationships and actions
effctvcomm	Communicate effectively when speaking or in writing
effctvconflictmgmt	Use effective conflict management skills to resolve disputes
nvgtsociopoltclenv	Navigate socio-political environments
advncpharmprof	Design and implement a quality improvement or research project on a topic related to advancing the pharmacy profession
envscan	Scan the environment for ideas, best practices, and emerging trends that will shape the health care system

Funding Statement

This study was funded by the Dalhousie Pharmacy Endowment Fund.