A leadership crisis in pharmacy

A lot has been said about leadership (or lack thereof) in pharmacy. We first wrote about this over 10 years ago,¹ suggesting steps for changing pharmacy practice and the need for strong leadership. Sadly, not much has changed since then, but at least the topic has resurfaced recently.^2,3

In their insightful paper published in the Journal in September 2018, Shizake et al.² said, “A profession without leaders from within that profession is simply not sustainable.” In their interviews with pharmacists, they found that the participants in their study identified a widespread leadership deficit and a current lack of leadership exemplars. Sadly, participants actually equated leadership with selfishness and self-interest.² Bachynsky and Tindall,³ in the November/December 2018 issue of CPJ, gave an important perspective on the history of leadership in pharmacy, as well as the decline of pharmacists’ professional independence, and outlined the need for “leadership from within.”

Why is this important? Leadership is necessary in order to be able to serve our communities with a full scope of pharmacy practice.⁴ To not act on this means we ignore the evidence for benefit of pharmacist care on patient outcomes, and we ignore that patients want this kind of care from their pharmacist.⁵ Let’s face it, pharmacy has a leadership crisis.

So, what specifically is leadership? There are many definitions, but rather than espouse a certain definition, let me list some principles and characteristics of good leadership:

• Vision: A good leader knows where we need to go (and goes there).

• Character: A good leader has a sense of duty, honesty, integrity, morality and ethics, all of which build trust, an essential element of leadership. A good leader is selfless and gives more than he or she receives. People follow character.

• Inspiration: Leaders inspire others to learn and to be better—to embrace the new vision.

• Exemplary: In the case of pharmacy practice, a good leader should also be an exemplary practitioner who deeply understands firsthand the issues in providing a full scope of patient care.

• Humility: Great leaders admit when they are wrong. They know when to ask for help. Leaders serve. It’s the opposite of ego.

• Decisiveness: Leaders consult, analyze problems and then make decisions (and stand by them).

• Communication: Leaders clearly articulate the vision to everyone. Communication includes both speaking and listening to others. Good leaders must be good communicators.

• Courage: Perhaps above all, leaders must demonstrate courage. The courage to do what is right, not necessarily what is popular. To take on barriers, to support those they lead.

It is also important to delineate what leadership is not:

• A title: For example, CEO, president, manager, board member. We often mistakenly equate leadership with titles. It’s not about “being the boss.”

• A manager: Leaders inspire a vision towards change—leaders lead people, while managers deal with processes and systems. The pharmacists interviewed by Shikaze et al.,² in discussing barriers to leadership, often confused management principles with leadership principles.

• Narcissistic: Leadership is not about you; quite the opposite, it’s about your followers. As General Norman Schwartzkopf said, “Love your troops.”⁶

• A vehicle for self-gain or self-interest (e.g., to enhance conditions for an individual or a corporation).

• A successful businessperson.

• About acquiring power.

Having said that, now look around at our “leaders” in pharmacy. Things could be better.

Why is this important for pharmacy? Lack of strong leadership prevents us from achieving our goals and our vision. In case it’s not clear, the vision I speak of is that which is central to the Journal, the Blueprint for Pharmacy and which we articulated 10 years ago: “We envision pharmacists engaged in patient-centred care, supported by high-quality research evidence of its efficacy, empowered in their work environment, continuously developing their professional skills, and recognized for their important contribution to patient care.”¹ In other words, a full scope of pharmacy practice.⁴

Lack of strong leadership causes disengagement of members, making change even more difficult. We have a societal responsibility to deliver care to our patients. We have strong evidence and the support of patients for a full scope of pharmacy practice,⁴ that is, prescribing, injections, laboratory testing and disease management, yet most of us are not doing these things. How will we get there? It’s leadership, man. We all have a role to play. We need to hold our leaders accountable to the principles above. And each one of us needs to step up and lead, from within.