Ascending the Levels of Leadership in Pharmacy Academia

Abstract

The influence of a leader depends on their position, the quality of their relationships with those they are striving to lead, what they have done for the organization, what they have done for their colleagues, and who they are and what they represent. Strong academic leaders who continually refine their leadership style can advance through the levels of leadership: position, permission, production, people development, and ultimately, personhood. To do so, one must build relationships, invest in others, and center activities on serving the needs of the people, the organization, and key partners. This necessitates approaching the situation with a strategic question: “How can administrators, faculty/staff, students, alumni, and site leadership work together in a way that encourages both individual and collective success?” In the end, we, as leaders, should strive to positively impact our profession, our organization, and the lives of those we have been entrusted to lead: ascending the levels of leadership helps us do just that.

INTRODUCTION

In his book Leadership 101, John Maxwell defines leadership as “influence – nothing more, nothing less.”¹ In alignment with this, the pharmacy literature most commonly defines a leader as one who “influences or motivates others, often in the achievement of a specific goal.”² A leader’s influence depends on their position (“position”), the quality of their relationships with those they are striving to lead (“permission”), what they have done for the organization (“production”), and what they have done for their people (“people development”). It is also influenced by who that person is and what they represent (“personhood”), which is the highest level of leadership and one that few achieve.¹ Maxwell’s levels of leadership seem to apply regardless of the leadership model, be it servant leadership or transformational leadership. So how does one ascend the levels of leadership? This commentary will answer this question by connecting Dr. Maxwell’s first four levels of leadership to the responsibilities of an academic administrator.

Position

Leadership level 1, which is positional leadership (eg, simply holding the title of department chair or dean), is the lowest level of leadership.¹ Authority is given to the individual at the time they are hired or appointed. At this level, people follow the leader because they must do so. This is a common starting point for many leaders, particularly upon entering a new organization. However, a leader’s influence, and consequentially the impact they can have, is limited at this level.

How does a leader advance beyond this initial point? First, the leader must learn about the organization and get to know the people they have been charged with leading. One of my mentors once told me a story about their dean. He said, “Do you know what Dean ____ did during his first year? He listened and learned. That’s it.” This is something new leaders, particularly those unfamiliar with an organization, should emulate because understanding the landscape helps leaders make informed decisions. Second, it requires the leader to perform their duties with excellence. No matter how equipped someone may be, there will be a learning curve to any new position. As McCall and Brazeau mentioned, “Leadership brings challenges (and opportunities) that you would have never expected to encounter and that were never discussed in various leadership programs.”³ A new leader needs to know when to ask for help and must be open to receiving constructive feedback that is intended to help them refine the skills needed to do their job well.

Permission

At leadership level 2, permission, people follow the leader because they want to, often because the leader has cultivated a relationship with that person.¹ Pharmacy academic leaders need to develop relationships not only with faculty, staff, and administrators, but also with external partners (eg, pharmacy directors, preceptors, alumni, donors, etc.). How does a leader go about building strong, trusting relationships? Theodore Roosevelt once said, “People don’t care how much you know until they know how much you care.” To get to level 2 requires putting others first, understanding the needs/wants of those you are leading, positioning them for their success, and investing time, a leader’s most precious resource, to help them reach their full potential.

As a new department chair, I took the initiative to meet with my faculty and staff individually for 30 to 60 minutes during the first month of my interim appointment. All told, I met with nearly 40 people, an investment of approximately 30 hours spread over four weeks. During these meetings, we discussed what was going well and not so well in the department, what they felt needed to change, and what strategic priorities should be the focus of our time and resources. This initiative proved insightful and helped me understand what changes to the organization needed to be made, what those in my department needed, and how I could position them to engage as opportunities arose. Reflecting on this, I believe having these conversations solidified my new role within the department, even though I had been a faculty member in that unit for more than a decade. I also believe it was instrumental in establishing strong relationships with those faculty and staff with whom I had worked with only peripherally as a faculty member as it showed my vulnerability and a willingness to listen and learn from them.

A leader’s influence can extend outside their organization as well. To encourage this, academic leaders need to understand the needs of their partners.⁴ As a new leader, I made a habit of visiting our key practice sites. One sentiment I heard repeatedly during these visits was, “People from your university come in, take what they want, and leave.” An approach that focuses on the needs of only one party is self-serving and will harm the relationship between the pharmacy school and the practice site. When a new leader encounters this situation, it can take years to reestablish trust (as I found). Because most schools rely heavily on practice sites and adjunct (unpaid) faculty to provide high-quality experiential education in a way that meets accreditation standards, it is vital to establish a win-win relationship with these partners. Academic leaders should seek to identify how faculty, staff, and students can help sites advance patient care initiatives at practice sites in exchange for the sites administering introductory and advanced pharmacy practice experiences and providing access to data for research purposes, which can help both entities strive towards meeting their vision, mission, and goals.

For example, as part of our school’s strategic plan, we created a clinical practice committee, the membership of which included faculty and leaders at key practice/experiential training sites. Together, we developed shared mission/vision statements, launched clinical programs intended to improve patient care and hospital-based metrics, and enhanced experiential education opportunities, and through these efforts advanced our outcomes-based and educational research programs. This initiative benefited both organizations, and helped our school realize strategic goals in clinical practice, education, and research/scholarship.

The COVID-19 pandemic presented an opportunity for leaders to strengthen relationships with faculty and staff by communicating understanding as to the challenges their colleagues were facing, permitting flexible work schedules to promote a new version of work-life balance and integration, and temporarily adjusting expectations.⁵ The pandemic also challenged relationships as it has continued for many months. While virtual communication was novel at the start of the pandemic, it quickly lost its luster. Information technology tools such as Zoom and Microsoft Teams saved us, but most would agree that virtual communication has its limitations in cultivating meaningful relationships. Pre-meeting interactions, social gatherings to celebrate individual and organization successes, hallway conversations, and water cooler chats have not occurred in two years. As we move into the “new normal,” where remote work has become more common, leaders will need to find new ways to build and maintain relationships or otherwise risk losing their effectiveness.

Production

At the third level of leadership, production, people follow a leader because of what they have done for the organization and/or the profession.¹ A strong leader understands that their role on the team is to encourage organizational success, be it through servant leadership or transformational leadership.⁶ At this stage, a leader is judged no longer by what they do, but by what their team does and their successes. In my opinion, setting a unit up for success begins with putting together the right team. In sports, the most successful teams rarely recruit only the best players. Instead, successful teams are typically composed of the right players placed in positions that best suit their skillset (ie, when coaches recruit, they set out to fill their roster with the top players at each position). There are certainly benefits to recruiting all-stars, but academic teams need to consist of faculty with diverse skillsets and interests. If a school’s mission includes teaching, research, practice, and service, the right team needs to include gifted educators who can train the next generation of pharmacists; talented researchers who can advance science and train the next generation of clinician, biomedical, pharmaceutical, and socio-administrative scientists; experienced clinicians who are passionate about providing patient care; and strong administrators who can lead the school in good times and in bad. Once the team is established, a leader needs to give the members the time and resources they need to succeed, let them go to work, and acknowledge their successes (eg, through dissemination of achievements and nomination for awards).

People Development

At the fourth level of leadership, People Development, faculty follow a leader because of what they have done for them. During a past faculty search, one of the candidate’s references made the statement, “I would follow Dr. __ anywhere.” How does a person reach a level of leadership where a colleague is willing to pick up and move for the opportunity to serve under their leadership? It is important to focus on developing people through mentoring, and in time, the relationship can grow into something deeper: a “professional friendship.” I have and continue to serve as a mentor to junior and mid-career faculty, both within and outside of my organization. As a mentor, I take great pride in seeing my mentees succeed, and I have grown into a more well-rounded academician through the process.

To facilitate this type of relationship, leaders must first and foremost care about the welfare of those they are leading, both personally and professionally. The leader must also identify faculty who possess the gifts and drive to excel in research, teaching, practice, and service, and allocate their efforts and invest resources in a way that positions these people for success. Third, leaders must identify those having an interest in administration and dedicate time and resources to mentor them as they learn leadership skills (eg, through engagement in leadership development programming, funding to engage in professional organizations, etc) and provide them opportunities to acquire administrative experience (eg, through immersion in leadership roles within the school). This positions the faculty member to advance their career while simultaneously growing the organization’s leadership pipeline.

Leading During Crises

Ascending the levels of leadership can help an individual prepare for both current crises and those that are to come. In one of his podcast series, John Maxwell discussed the topic of crisis leadership.^7,8 During this talk, Dr. Maxwell noted that a crisis moves us, reveals who the real leaders are, and tests a leader’s competence. What do crisis leaders do well? First, they move with an awareness of what is going on, they anticipate and trust their intuition, and they are flexible as things change. Much like a good coach who makes sound “halftime adjustments,” a leader in an academic organization during a crisis must be able to pivot quickly and learn from the situation. A crisis leader must also think creatively and maintain positive perspective, ie, “What good thing is going to come out of this?” Finally, they must show humility, putting others first.

In early 2020, one month after I assumed the role of department chair, our school faced an unprecedented challenge. The school was put on probationary accreditation status because of issues relating to experiential education at a time when practice sites were opting to decrease or pause both introductory and advanced pharmacy practice experiences because of the COVID-19 pandemic. The first external partner we approached for help said, “We are getting crushed right now.” I expected their response to end with, “We’d love to help but we just can’t.” Instead, the statement concluded with, “That does not really matter though. We want to… no, we need to help you because you make us stronger.” In the end, six healthcare partners stepped up, increasing the capacity of our inpatient APPE by nearly threefold. Our school was able to persevere because our leadership had focused on building trusting relationships over several years, had taken the initiative to listen to our key partners, and had invested faculty, staff, and monetary resources to help several partners advance their clinical practice initiatives. This helped our administrators ascend to the third level of leadership with those at these key practice sites, with the end-result being a stronger Doctor of Pharmacy program.

SUMMARY

Strong academic leaders who continually refine their leadership style can ascend the levels of leadership. John Maxwell has been quoted as saying, “Leadership is not about titles, positions or flowcharts. It is about one life influencing another.” Growing influence entails building trusting relationships, investing in others, and centering activities on serving the needs of the organization, those who make up the organization, and key partners, without whom the organization cannot flourish. In academia, this necessitates having the perspective of “How can administrators, faculty and staff, students, alumni, and site leadership work together in a way that encourages both individual and collective success?” This takes time, and most leaders will not advance through the levels of leadership with all members of an organization.

How influential are you? What do you need to do to grow your influence? I hope this commentary has compelled you to reflect on these questions. At the end of the day, we as leaders should strive to positively impact our profession, our organization, and the lives of those we have been entrusted to lead. Ascending the levels of leadership enables one to work toward these goals.