Instruction for Student Pharmacists on Leading Change

Academics are eager to graduate pharmacists prepared to provide medication therapy management (MTM) to patients. In response, curricula are being carefully constructed to develop students' patient care skills. In addition, in order to sustain environments where MTM services can flourish, MTM practice management is increasingly receiving attention in curricula. However, despite the attention to patient care and practice management skills, a critical skill set is still missing. The new graduate's ultimate success will be determined by their ability to influence change.

Pharmacies and health care systems will need to transform to accommodate an MTM model of practice. As MTM services develop and expand, there may be needs related to patient recruitment, collaborative practice agreements, documentation systems, dispensing release time, billing procedures, or additional space. In order to address these needs, new graduates will be planning and advocating for new policies and procedures, along with alterations and modifications to “the way things have been done.” New graduates may need to facilitate a paradigm shift or a cultural transformation within a pharmacy or health care system. The new graduate will undoubtedly encounter frustrations, resistance, and roadblocks, which can lead to decreased professional satisfaction and disengagement.

To arm against these challenges, colleges and schools of pharmacy must create learning opportunities that provide all students with a basic understanding of leadership, organizational change, and the leader's role in change. In addition, colleges and schools must demonstrate to students that leadership does not just come from positional leaders within a hierarchy of authority. Students must hear grassroots success stories from recent graduates who created change as non-positional, non-titled leaders.

More specifically, new graduates require a particular knowledge and skill set. First, in the minds of students, leadership needs to become tangible and concrete. Study of the 5 practices of a leader makes leadership less ethereal.¹ As a foundation, students should learn that leaders model the way, inspire a shared vision, challenge the process, enable others to act, and encourage the heart. The 5 practices are describable, learnable, and measurable. Inventories like the Student Leadership Practices Inventory can be used to assist students in leadership development.

Second, the ability to recognize and identify the change process is vital. It can be difficult to thrive in the upheaval and anxiety that often accompanies change within an organization. Objectivity and perspective is needed to weather the storm. Kotter provides a coherent model of the organizational change process, which includes the concepts of creating urgency, visioning, guiding coalitions, communicating for buy-in and quick wins.² Once studied, this model offers students a roadmap to avoiding the pitfalls and steering toward best practices, as a pharmacy navigates change.

Third, new graduates need to understand the role of the leader in the change process. Successful leaders employ identifiable and learnable strategies to guide an organization through change. The leader must “get on the balcony,” think politically, and control the pressure. There must be just enough tension to motivate the organization forward, but not so much that chaos reigns. Heifetz and Linsky outline strategies and tactics that are essential for leaders of change.³

Most importantly, student pharmacists must be convinced that change cannot just be left to those with positional authority. Pharmacists can not just wait until an appropriate practice is created for them by someone with power. Creating MTM practices is not solely a management function; grassroots leadership is needed.⁴

Although academic pharmacy has made great strides in preparing new graduates to provide patient care and manage MTM practices, opportunities for students to develop skills in leading change must also be incorporated into curricula. A new graduate's success, and ultimately the transformation of our profession, is contingent on the ability of non-positional leaders to influence change.