Addressing the pharmacy leadership crisis in Canada: A call to action for a unified approach

The problem

Although pharmacy leadership in Canada has been a topic of discussion for decades,^1,2 many are of the opinion that it is currently in crisis. In an editorial in CPJ from 2019, Tsuyuki stated that “a profession without leaders from within that profession is simply not sustainable.” ² Presently, there is sparse detail and no apparent consensus among pharmacy organizations in Canada as to what qualities a pharmacy leader should possess. Without strong leadership to share a unified vision for the profession, it is difficult to capitalize on opportunities within the health care system to move forward. ³

What is leadership?

When we hear the word leadership, we may be inclined to picture people sitting at their desks, in offices far removed from the frontline work, making decisions that affect the day-to-day operations of those who work for them. This more closely aligns with the definition of a manager. In contrast to this, “a leader is someone who can create an idea or vision and motivate others to share and act on that vision.” ³ Leadership is important at all levels within an organization, making it a vitally important skill for everyone to learn. ⁴

How is leadership currently defined in pharmacy practice?

A quick analysis of this leadership crisis, through an economic lens, may lead one to postulate that there is an issue either with the supply of pharmacy leaders or with demand for pharmacists to fill those leadership roles. There appears to be a high demand for pharmacy leaders in Canada; therefore, the leadership crisis must stem from an issue with supply. ⁵ Either pharmacists early on in their careers feel ill equipped to take on leadership roles or there is little incentive for them to do so. A survey conducted by Musing et al. ⁶ found that one of the barriers pharmacists face when considering leadership roles is a lack of confidence in leadership abilities. Making leadership opportunities more enticing is an incredibly complex issue, requiring universal coordination across various employers, and is beyond the scope of this commentary. To address concerns about pharmacists who may feel ill equipped to assume leadership roles, it is critical to evaluate the educational framework of leadership skills in the Canadian pharmacy curricula.

The National Association of Pharmacy Regulatory Authorities (NAPRA) establishes the competency requirements for practising pharmacists in Canada.^7,8 The Canadian Council for Accreditation of Pharmacy Programs (CCAPP) designs the standard to ensure programs meet the requirements. ⁹ The Association of Faculties of Pharmacy of Canada (AFPC) takes those requirements and creates a roadmap for Canadian pharmacy schools to use to meet the standard. ¹⁰

The NAPRA model standards of practice and NAPRA competencies for Canadian pharmacists at entry to practice do not currently include leadership as a core competency.^7,8 The model standards of practice briefly discuss management-type activities like the appropriate use of resources and the management of staff and pharmacy workflow. ⁷ The NAPRA competencies for Canadian pharmacists at entry to practice do include competencies relating to leadership, but rather than being emphasized in a dedicated leadership section, they’re scattered throughout many different competencies. Examples include time management, critical analysis and problem solving, conflict management and continuous quality improvement. ⁸ Although some subsections mention characteristics relating to leadership qualities, there are no clearly defined competencies focused specifically on leadership, such as developing a vision, communicating strategy and inspiring progress.

AFPC educational outcomes organize key competencies into 7 categories, one of which is the leader-manager competency. ¹⁰ AFPC states that “as leaders and managers, pharmacy graduates engage with others to optimize the safety, effectiveness and efficiency of health care and contribute to a vision of a high-quality health care system.” ¹⁰ The 4 key competencies within the leader-manager (LM) section comprise the following: LM1, contribute to optimizing health care delivery and pharmacy services; LM2, contribute to the stewardship of resources in health care systems; LM3, demonstrate leadership skills; and LM4, demonstrate management skills. ¹⁰ One may argue that LM1 and LM2 belong as enabling competencies of LM3, as they directly relate to leadership skills. This emphasizes the importance of separating the leadership from the management competencies as that will allow each to become more clearly defined.

ASHP PGY1 competencies and the Canadian Pharmacy Residency Board (CPRB) competencies contain a more clearly defined leadership section compared with the entry-to-practice competencies listed above, which one may expect given that residency provides an additional year of training and aims to build on competencies that have already been achieved through an entry-to-practice pharmacy degree.^11,12 The CPRB leadership section states that a pharmacy resident “shall demonstrate an understanding of the difference between management and leadership” and then goes on to discuss important leadership traits such as self-awareness, effective communication and showing pride and commitment to the profession. ¹²

Looking at entry-to-practice competencies among other health care professions, such as medicine and nursing, we find that leadership is differentiated as a key competency within each. The Royal College of Physicians and Surgeons and the Canadian Council of Registered Nurse Regulators entry-to-practice competencies highlight that leadership is important in each profession and that key characteristics of leadership that every physician or nurse should possess include contributing to a culture of patient safety, engaging in the stewardship of health care resources, time management and demonstrating self-awareness, to name a few.^13,14

Creating a unified approach

The time for a unified approach to pharmacy leadership from within the profession is now and it affects all of us. It is the responsibility of every pharmacist and pharmacy organization in Canada to see the profession advance in a direction that allows us to optimally care for our patients. Qualified pharmacy leaders contribute to better patient care, improved medication safety and enhanced pharmacy productivity, all of which lead to better medication use within health systems. ³

Summary

Not every pharmacist needs to be a manager, but every pharmacist needs to be a leader. A manager may be able to get a pharmacy team through day-to-day operations in the short term, but a leader creates a vision and guides the team to achieve long-term success. To begin to address the pharmacy leadership crisis, the following steps can be taken:

1. Form a consensus among pharmacy organizations regarding what competencies a pharmacy leader should ideally possess.

2. Develop or adopt a leadership framework that can be applied to the profession and used as a guide for leadership education and development.

3. Differentiate leader and manager competencies, providing each with due emphasis and allowing leadership to become more clearly defined.

Call to action

To begin to address the leadership crisis facing the pharmacy profession in Canada today, a few steps can be taken. First, pharmacy organizations must come together to form a consensus on what competencies a pharmacy leader should ideally possess. Based on J.P. Kotter’s theory for creating effective change, if we fail to create a guiding coalition, we cannot expect change to become sustainable. ¹⁵ Next, we will need to develop or adopt a leadership framework and apply it to the profession. One such framework is LEADS (Lead self, Engage others, Achieve results, Develop coalitions, Systems transformation), developed by the Canadian College of Health Leaders. ¹⁶ This framework has been adopted by other health care professions and may provide an excellent pillar for future leadership efforts in the profession of pharmacy. Finally, we will need to assess the lack of leadership competencies in entry-to-practice pharmacy curricula in Canada. Separation of the leader from the manager competency is a critical step in moving forward.

Conclusion

Although not all pharmacists will find themselves in a management role, every single pharmacist will need to embrace the opportunity to be a leader within the health care system or on a health care team. How well they perform will greatly depend on the foundational leadership skills gained through formal didactic education. Leadership is an important skill for all pharmacists, regardless of practice setting; whether a pharmacist holds a formal leadership title or is a member of a patient care team, leadership skills are imperative to the work that he or she performs. Bachynsky and Tindall ¹⁷ wrote, “Every pharmacist has an opportunity to lead from within even if it’s done by leading one patient at a time.”