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. 2016 Sep 25;80(7):113. doi: 10.5688/ajpe807113

The Role of Servant Leadership and Transformational Leadership in Academic Pharmacy

George P Allen a, W Mark Moore b, Lynette R Moser c,✉, Kathryn K Neill d, Usha Sambamoorthi e, Hershey S Bell f
PMCID: PMC5066916  PMID: 27756921

Abstract

A variety of changes are facing leaders in academic pharmacy. Servant and transformational leadership have attributes that provide guidance and inspiration through these changes. Servant leadership focuses on supporting and developing the individuals within an institution, while transformational leadership focuses on inspiring followers to work towards a common goal. This article discusses these leadership styles and how they may both be ideal for leaders in academic pharmacy.

Keywords: servant leadership, transformational leadership, leadership

INTRODUCTION

Academic pharmacy is immersed in a sea of constant change. Internal influences like interprofessional education or enhanced learning environments, and external influences such as new accreditation requirements, expanding scope of practice, and availability of research funding are driving change.1-5 Effective leadership is necessary to guide students, faculty members, and staff. Leaders are facing the challenge of continually aligning goals for the success of the institution with each employee’s personal ideals, particularly in matters relating to promotion and tenure.6 Servant and transformational leadership, which have existed since the 1970s, both claim to successfully navigate change.7,8 We explore these two leadership styles to evaluate which is better suited for the academic pharmacy environment.

METHODS

The original debate topic of a preferred style of leadership in academic pharmacy was discussed and developed in September 2014. Five team members conducted a literature review to identify references. Keywords included leadership style, servant leader, transformational leader, servant leadership, service leadership, and transformational leadership. The literature search was completed in December 2014. Resources searched were PubMed, Google Scholar, EBSCO, and the Harvard Business Review. References of selected articles were used to identify additional resources, and authors’ collections of books were searched. More than 50 sources of information were used in the development of the point and counterpoint discussions. The discussion question was refined over several weeks to determine the final point and counterpoint arguments that were presented in a debate format in February 2015 at the American Association of Colleges of Pharmacy (AACP) Interim Meeting in Austin, TX.

POINT: SERVANT LEADERSHIP IS PREFERRED TO TRANSFORMATIONAL LEADERSHIP IN ACADEMIC PHARMACY

Greenleaf describes the servant leader as one who “begins with the natural feeling that one wants to serve, to serve first. Then conscious choice brings one to aspire to lead.”9 Servant leadership can be a philosophy, a set of leadership practices, and a set of leadership qualities (Table 1). Since 1995, authors have defined and refined the characteristics of a servant leader.7 Although Russell and Stone distinguished at least 20 attributes of servant leadership, Spears summarized 10 characteristics of servant leaders as: listening, empathy, healing, awareness, persuasion, conceptualization, foresight, stewardship, commitment to the growth of people, and building community.10,11 While the theory of servant leadership resembles other leadership theories, none of the other theories encompass all the characteristics of a servant leader.7 A servant leader shares power, puts the needs of others first, helps individuals develop and optimize performance, is willing to learn from others, and forsakes personal advancement and rewards. Servant leaders concentrate on performance planning, day-to-day coaching, and helping people achieve. They provide vision, and their team understands their expectations and desired outcomes. The ultimate responsibility of the servant leader is the enduring investment of the leader’s life in the lives of those who follow.12 As the ancient Chinese philosopher Laozi said “A leader is best when people barely know he exists; when his work is done, his aim fulfilled, they will say: we did it ourselves.”13

Table 1.

Comparative Attributes of Servant Leaders and Transformational Leaders

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Common features of academic institutions are academic freedom, scholarship, lifelong learning, shared governance, and teaching,14 which align perfectly with servant leadership. First, individuals choose to serve in academia to practice “academic freedom.”15 Along with scholarship and lifelong learning, academic freedom is critical to the creation of new knowledge and innovation. The servant leader’s commitment to individual growth cultivates an environment of academic freedom and provides tools for effective scholarship. In academic pharmacy, these values underpin the mission of improving public health. Innovative products from academic research demonstrate a positive impact on global health and safety and provide evidence that innovation and improved health are distinctly linked.16

Shared governance is expected and widely practiced in academic pharmacy.3 Leaders who seek power do not truly develop others, and power must be shared to succeed.17 However, servant leadership makes shared governance feasible and less formidable. In a turbulent organizational landscape, employers utilize shared governance as they rely on employees to be creative, autonomous problem solvers. A servant leader builds teams, listens, heals, persuades and empowers followers until a consensus is reached. A servant leader ensures successful shared governance by building effective teams. Indeed, servant leadership promotes team effectiveness.18 For example, using the servant leadership questionnaire, the team effectiveness scale, and structural equation modeling, servant leadership was positively associated with the effectiveness of the team.18,19

Servant leadership promotes learning-focused classrooms.20 According to Spear, servant leadership is adopted in undergraduate and graduate courses to support systems thinking and community building.21 Based on the narratives of students’ reflective journals, interviews, and unsolicited comments, the hallmark characteristics of the servant leader (ie, listening, empathy, healing, persuasion, awareness, foresight, commitment to the growth of individuals, conceptualization, stewardship, focus on building community) optimize the learner-focused classroom.20 Using 18 characteristics of a servant leader and a convenience sample, Drury found a high correlation between effectiveness of professors and servant leadership.22 Moreover, student-focused principles of servant leadership “provide a starting point for the development of a ‘new’ paradigm of teaching.”23

In addition to upholding the key features of the academic enterprise, servant leadership produces results. For example, servant leadership and job satisfaction have a strong relationship for faculty and nonfaculty members.24 Studies also suggest increased organizational commitment under servant leadership, with productivity increasing by as much as 50%.25,26

The servant leadership model is not without its critics. Some critics posit that servant leaders may fall short when compared to transformational leaders when business environments are extremely competitive, experience rapid change, require risk taking, and involve a careful balance of organizational and individual goals. However, in 2011 servant leadership was practiced by half of the top-10 companies ranked by Forbes Magazine: SAS (1), Wegmans Food Market (3), Zappos.com (6), Nugget Market (8) and Recreational Equipment Incorporated (9).27 The size of the company was not a factor as the servant leader organizations ranged in size from 1200 to 167 000. 27 In 2014, one-third of the top 35 companies practiced servant leadership, most of which are household names: Marriott, FedEx, Southwest Airlines, AFLAC, Starbucks, Men’s Wearhouse, Nestle, ServiceMaster, UPS, GE.28 Thus, servant leadership produces results in numerous industries in ever-changing environments.

The core tenet of servant leadership is the desire to serve. While all leaders serve, the real question is who they serve. Exemplary leaders serve others.12 Nancy Ortberg, renowned author and religious leader, claimed, “Serving means that when a person leaves my sphere of influence, he or she will be a better person and leader because of the time spent with me.”17 However, the emphasis on serving encompasses more than employees and their development; servant leaders make the needs of consumers, employees, and communities their top priority.12,29 The concepts of servant leadership expand to relationships between parents and children, educators and students, and service personnel and customers. In each of these relationships, the needs of others should be the focus of the organization. Servant leadership addresses the responsibilities and relationships between parents and children, educators and students, employees and customers, investors and shareholders. It entails placing the needs of others at the forefront of every organization, institution, business, agency, department and group.29 Therefore, one may expand the view of a servant leader from that of one individual to an entire organization. Tom Peters, author and inspirational-management expert, states that “Organizations exist to serve…Period. Leaders live to serve…Period.”30

Critics question the success of servant leadership in higher education, health care, and the education of health care professionals. These areas are targets of scrutiny, defined outcomes, increasing regulation, and tight funding streams. Numerous institutions of higher learning include servant leadership in their programs, even some that educate and train health care professionals.20,22,23,27,29,31-36 Several universities offer servant leadership educational programming including some degree programs.37 Additionally, servant leadership practices are used in the classroom in the form of servant teaching, which focuses on student-centered learning.20,22,23,33,34 The pharmacy programs at Palm Beach Atlantic University, Concordia University, and Cedarville University incorporate servant leadership into their culture and mission and strive to produce servant leaders for the pharmacy profession.

Servant leadership should be considered a prominent model for health care. Servant leadership emphasizes trust and empowerment in interprofessional relationships including relationships with patients and the community.38,39 With major challenges affecting the health care system, servant leadership may inspire necessary change so that all health care stakeholders concentrate on serving the patient, team, and community.38-40 Engaging stakeholders to serve others creates sustainability by providing an enhanced value proposition that improves the quality of care and reduces costs.38

Academic pharmacy calls for servant leadership because it thrives on shared governance and development of individuals. In addition, academic pharmacy is now being re-engineered and restructured. The profession has moved from a product orientation to a patient focus. Clinical training requirements have greatly expanded. Providing high-quality and safe medical care with continuous quality improvement is expected. Service to the patient requires academic pharmacists to be servant leaders with empathy, kindness, healing, and persuasion.

COUNTERPOINT: TRANSFORMATIONAL LEADERSHIP IS PREFERRED TO SERVANT LEADERSHIP IN ACADEMIC PHARMACY

The transformational leadership model was conceived in part by James MacGregor Burns in 1978 and Bernard Bass in 1985.41 A major distinction between transformational leadership and servant leadership is the focus of the leader (Table 1). Whereas a servant leader focuses on his or her followers, a transformational leader primary focuses on the organization and collective goals, and organizational growth and development is a priority.42 Despite this focus on the organization, the needs of followers are not ignored. Indeed, a transformational leader empowers and inspires followers to share a collective organizational vision, and encourages behaviors such as intellectualism, innovation, creativity, and risk-taking, and the development and success of followers is an important outcome.43 A transformational leader serves as a role model, mobilizes commitment, and uses motivation, encouragement, inspiration, and charismatic influence to develop followers and the organization.43,44

Transformational leadership consists of four key behavioral components.8 The first is charismatic leadership or idealized influence. A transformational leader places an emphasis on the needs of others, serves as an inspirational role model, instills pride and optimism, and emphasizes commitment, alignment around a shared purpose, high ethical and moral standards, and respect and trust.41,43,45,46 As a result, such leaders are admired, respected, trusted, and viewed as a role model by their followers.41,45 The second behavioral component is inspirational motivation. The leader articulates an organizational vision, demonstrates a sincere and passionate commitment to that vision and related goals, and clearly communicates expectations.41 The leader is enthusiastic, optimistic, motivational, and inspirational.43 Idealized influence and inspirational motivation foster alignment around shared goals within an environment of high ethical and moral standards that supports and strengthens shared governance within an academic community. The third behavioral component is intellectual stimulation. A transformational leader encourages creativity, innovation, risk-taking, and a willingness to abandon inefficient systems, and followers are stimulated to question assumptions, approach issues in novel ways, and creatively solve problems.8,43 Academic freedom, lifelong learning, and scholarship flourish within an environment that encourages intellectual stimulation. The fourth behavioral component is individualized consideration. A transformational leader evaluates and considers the distinct needs of each individual follower, creates a supportive environment that is focused on followers’ achievement and growth, and uses coaching, mentoring, creation of new development opportunities, and continuous feedback to empower followers and help them achieve their potential.8,41,46 Principles such as motivational interviewing and counseling impact followers’ interactions with students and patients within an academic health care environment.

A transformational leader uses the four behaviors to motivate followers. Motivation is dependent on followers aligning with the vision, mission, and collective goals of the organization.47 The transformational leader is able to unite and align followers around collective goals that promote a collaborative approach to problem solving and resource management. To achieve this, followers must trust, admire, and respect their leader, and be motivated to perform beyond expectations. Together, these factors will drive the success of the organization.48

Transformational leadership is associated with increases in employee satisfaction, commitment to the organization, effort, retention, organizational citizenship, and overall performance.49 The link between transformational leadership and these outcomes occurs in varied work environments.49 Transformational leaders are more proactive, more able to motivate followers, and more capable of developing organizational goals that interest followers, and, as a result, the followers of transformational leaders display greater commitment to and alignment with the organization, work harder, and are more cohesive.50 Transformational leaders possess high emotional intelligence, and, as a result, their effectiveness is rated highly by their followers.51 The impact of transformational leadership occurs in part through the related effects in establishing trust and value congruence among followers.52

Thus, the transformational leadership model encompasses many positive leadership attributes. The behavioral components of idealized influence, inspirational motivation, intellectual stimulation, and individualized consideration are ideal for academic pharmacy. However, the dynamic environment in education and health care is the most compelling argument for transformational leadership. Evidence that highlights this dynamic environment include standards from the Accreditation Council for Pharmacy Education, an endorsed Pharmacists’ Patient Care Process released by the Joint Commission of Pharmacy Practitioners in 2014, an updated blueprint for the National Association of Boards of Pharmacy (effective November 2015), revisions to the Center for the Advancement of Pharmacy Education (CAPE) Educational Outcomes in 2013, and the establishment of Core Competencies for Interprofessional Collaborative Practice in 2011.3,4,53-55 More widely established scope of practice and payment models for clinicians are demanded within health care reform strategies, and greater collaboration in research is required in translational science models, personalized medicine, and funding processes that recognize submissions by teams of scientists that differ from historical funding mechanisms.56 Leadership in innovative educational and service models is not only encouraged, but required, within pharmacy’s guiding principles and accreditation standards. Transformational leadership is best suited to organizations that exist within a constantly changing environment. A transformational leader creates an organizational culture in which the mission, vision, and values of the organization are being constantly assessed, and adaption to change and flexibility is encouraged.8 Transformational leadership is the appropriate model for “organizations facing intense external pressure where revolutionary change is a necessity for survival.”43 The transformational leader can change, adapt, and take risks. At the same time, the influence of such a leader and the empowerment of followers leads to faith in decisions and commitment to the organization, even in the midst of change. The advantages of transformational leadership are most apparent in the early (birth and initial growth) and late (decline) stages of the life cycle of an organization, when adaptation is particularly needed.43 Academic pharmacy depends on adaptation, and thus a transformational leader is best suited to lead within academic pharmacy.

Critiques of the transformational leadership model propose that a transformational leader’s focus on the organization may lead to an environment in which the leader devotes excessive time to evaluating performance and protecting hierarchies within the organization, thus “weeding out” underperforming employees who fail to contribute to the efficiency of the organization, rather than creating sustainable growth. However, a transformational leader focuses on the growth and development of individual followers, resulting in followers who succeed. In addition, followers of a transformational leader, because of their increased organizational commitment, will be motivated to outperform expectations.

The most important characteristic of a transformational leader arguably is charisma. But what if a leader lacks charisma? Current descriptions of the transformational leadership model prefer the term “idealized influence,” which results from the use of intellectual stimulation, inspirational motivation, and individual consideration.57 Leaders who employ these behaviors and develop emotional bonds with followers are then perceived as charismatic.57

The potential for “moral shortcomings” in a transformational leader is also proposed.42 A transformational leader may choose to adopt unethical behaviors or behave immorally. However, a transformational leader is devoted to the collective good, empowerment of followers, and to a culture of shared values and goals, and thus immoral behavior would not be acceptable. In a seminal work describing the transformational leadership model, Burns stated, “[transformational] leadership occurs when one or more persons engage with others in such a way that leaders and followers raise one another to higher levels of motivation and morality.”58

Ultimately, both servant and transformational leadership styles value human resources and support followers’ individual development. However, academic pharmacy, in which challenges from students, community stakeholders, and the health care system arise constantly, represents the type of dynamic environment for which transformational leadership is an ideal fit. Transformational leadership values risk taking, innovation, and intellectualism. It strives to change the status quo, is best suited for changing environments facing incredible external pressures, and creates an “empowered, dynamic organizational culture.”43

Leaders from a variety of backgrounds demonstrate transformational leadership through dynamic change. Franklin Roosevelt led the country through a time of turmoil and uncertainty following the Great Depression by establishing his New Deal. Henry Kaiser was a founder of medical transformation on a population level with the initiation of the Kaiser Foundation and Kaiser Permanente. Andrew Carnegie’s philanthropic legacy heralded new opportunities for the arts and future leaders. Henry Ford created a corporate model in the transportation industry that survives more than 100 years later. Bill Gates revolutionized the electronic age through his work with Microsoft, and he and his wife Melinda, set an example for philanthropic models of educational transformation through their foundation. Walt Disney revolutionized the entertainment industry and engaged members of families from the youngest to the oldest with adventures that resonate regardless of time or vantage through movies and theme parks.

As outlined above, academic pharmacy is experiencing unprecedented pressures to adjust to rapid changes in education, research, and the health care environment. Risk-taking attitudes and behaviors required to successfully navigate a rapidly changing environment are key elements of transformational leaders, who are better suited to navigate individual and organizational decisions when change is required. Additionally, transformational leaders within a service-oriented industry typically demonstrate highly effective emotional intelligence. Leaders with more emotional intelligence are rated as more effective by followers and shape better climates of service.51 This enhances the leader’s ability to mediate between an organization’s goals and those of the individual. Such leaders anticipate reactions employees may exhibit, and therefore, are ready to adapt and incorporate components that address emotional reaction. This ability allows a transformational leader to change inefficient financial, educational, or human resources systems in a more aggressive manner than followers in a servant leadership model would tolerate. Communication skills that target conflict resolution and recognize employees’ needs are essential to transformational leaders.51 Ultimately, no organization can be successful without a committed team. By focusing on the success of the “we” and not the “I,” transformational leaders unite their followers in a shared vision for the organization and empower their workers to achieve team goals. Thus, this strategy is best suited to academic pharmacy.

CONCLUSION

Determining the most appropriate leadership model for academic pharmacy is open to debate. The skill set required of servant and transformational leaders is different. A servant leader is one who leads from behind by supporting the development of individuals in the organization while a transformational leader provides a common goal and vision and develops individuals to meet those goals. Servant leadership would be congruent with developing faculty members, encouraging scholarship and innovation in teaching, and building toward producing pharmacists who develop empathy with patients and motivates patients to develop healthy lifestyle choices. The transformational leader is uniquely qualified to move an organization during a time of high external pressures. The transformational leader emphasizes intellectual stimulation, innovation, and creativity in a way that can effectively develop faculty members to be successful in the competitive promotion and tenure process. Leaders in academic pharmacy must evaluate which leadership model fits the needs of their environment as well as their individual skill set.

ACKNOWLEDGMENTS

We would like to acknowledge the American Association of Colleges of Pharmacy for providing the Academic Leadership Fellows Program and giving us the opportunity to participate in the Fellow Debates at the 2015 AACP Interim Meeting.

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