There’s lots of talk about lack of leadership in our profession; lack of leadership in our dispensaries, in our associations, in our regulatory bodies.  What is it we are looking for as pharmacists and what can we do about the “lack of leadership” we are feeling?

Leadership in not an innate “born with” quality, nor is it automatically a term we apply to those in positions of power or authority.   It is quite obvious that a position of power does not denote leadership.  Leaders inspire, they create unity, direction, common purpose, a sense of belonging.  It is a fortunate situation if those in positions of power are also leaders, but this often is not the case. 

As pharmacists we do not have to lament our lack of leadership, we all have the potential to lead.  Leadership is a skill that can be developed within ourselves.  Where there is a lack of leadership, we can step up and develop these skills to work for the betterment of our pharmacies and our profession.

Leadership starts in the dispensary with our teams first.  In developing leadership skills, this is the perfect place to start.  You do not have to be in a management position to be a leader.

Simon Sinek talks about the top 3 qualities of great leaders:

1. Selflessness  Sometimes those new to a position of authority assume that in this position they should be served by those under them.  In fact, quite the opposite is true.  When you aspire to be a leader, you take on being responsible for those you lead.  A true leader will always work to bring out the best in people, to work with the individual talents and shortcomings of those they lead to help them be successful.  Indeed, great leaders put themselves last.  “You’re not a leader until you make it your job to look after others.”
2. Empathy  Those we endeavor to lead come to their jobs with their own personalities, behaviours and temperament.  A strong leader needs to work with a wide diversity of personalities.  I honestly had no idea until I was in the thick of it how much of “managing” is really “managing people”.  Sinek’s second point that great leaders show empathy is bang on.  Being kind to those we work with and lead, avoiding gossip and instead being empathetic to an individual is almost counter-cultural in some dispensaries.  Yet a strong leader can model this for those on the team and make it a priority to redirect negativity and reinforce kindness and patience. 
3. Grace under Fire  In a busy dispensary it is easy to place blame, to not assume the best intentions, to react rather than step back and take a breath.  Emanating grace under fire  is a key quality in any leader.  When everything around the team is chaotic, stressful, seeming to fall apart, the leader needs to be the essence of calm.  It is important the leader not get pulled into the mayhem and instead exert confidence and redirect the energy back to the common goal.  Providing support and direction in a reassuring manner is essential here. 

These qualities are by no means an exhaustive list, but they resonated with me as being qualities that all those looking for a leader would wish to see.  When looking for a leader, and not finding one, consider developing leadership skills yourself.  Leadership resources are easy to find.  There are many books, videos, podcasts, seminars, mentors and experts in the field to help develop such skills.  We all need strong leaders, and we need those around us to be willing to take the leap to be leaders themselves. 

A gentleman approached me just before I was about to step on stage at the last PXP Pharmacy Experience Pharmacie conference.  He shared with me an experience he had with his mother’s pharmacist.

His mother, a senior in her 80’s, needed a renewal of her ramipril so he went with her to the pharmacy to assist.  The pharmacist had a look at his mother’s file and said she would have to contact the doctor as there were no more refills. The gentleman, being in the know with the profession of pharmacy, advised her that this was not the case, the pharmacist indeed had the authority to extend the prescription if needed. The pharmacist insisted she must contact the doctor and refused to discuss it further.

While certainly there are times when referral to a physician is most appropriate rather than prescribing for continuity of care, what is highly disappointing in this case is that no assessment took place.  The pharmacist did not speak to the patient; no questions were asked, no discussion regarding her hypertension control, when her last appointment with her Dr. had been, does she home monitor, is she having any dizziness, etc.

I find this situation disappointing, but I also understand it is quite common.  As I’ve travelled across the country and had conversations with many pharmacists in community practice, management, academia and leadership positions, it seems a common trait for pharmacists to have difficulty making a clinical decision and taking responsibility for patient care.  The preference seems to be to defer decision making to another professional rather than take responsibility for the possible outcomes.   But what are the outcomes for the patient when our choice is to refuse care?  

Choosing not to provide care for a patient is a clinical decision in itself.  In this case, the outcome could be a gap in adherence or inappropriate accessing of emergency services or a walk-in clinic.   It is puzzling to me that many pharmacists seem to have a fear of causing harm by taking action, but do not feel a sense of responsibility towards the patient for the possible harm caused by inaction or delay of care. 

I have no doubt some will say that I must not have all the facts.  The pharmacist was likely under pressure, short of time, had many others waiting, etc.  We are all busy.  We all have patients waiting, phones ringing, billing issues and insane rules for paperwork.  Many of us, as we have heard, are feeling anxious, frustrated, worried, unsupported, jaded, disappointed and bitter.   But let’s look at this from the patient’s shoes.  A patient comes to a pharmacist requesting care, and the health professional turns her away; that’s the patient experience

Caring for the patient and taking responsibility for the decisions we make is a hallmark of being a health care professional.  If we want to be treated as professionals and not mere dispensers of drugs, we need to ensure we act like health professionals in every patient encounter.   Not taking action is not the solution to uncertainty and choosing not to care for a patient when it is within our competency and scope is a decision we are still responsible for.  There is simply no passing the buck or skirting the responsibility for care.  At some point it comes home to roost that if we are merely filling orders rather than caring for patients, we will continue on the path of being considered glorified technicians.

After speaking with this gentleman I stepped on stage and was heartened to see the engaged group of pharmacists who took the time out of their busy lives to attend an event meant to push pharmacy forward and make us all better professionals.  There was hope, not just fear,  brainstorming instead of stagnation, empathy replacing bitterness, and new energy in place of exhaustion.  We all face pressure, and pharmacy is in a tough place on many fronts;  I feel it every day when I walk into my dispensary.  But we must never forget to care for the patient, because without patients to serve there is no “pharmacist”.

I attended my 25^th pharmacy reunion this year and it seemed surreal to be celebrating 25 years of pharmacy practice.  Where has the time gone?? 

25 years doesn’t seem like so long ago, but the world has changed immensely in those years and it has caused me to think about whether we as pharmacists have kept up with the change.

When I graduated in 1994, there was no widely used public internet.  If we didn’t know something, we could not google it.  We had to look it up in a book, head to the library and search micro fiche, or call a drug company.  I had paper files for guideline updates and an overflowing paper copy of the CPS.  Information was not readily available nor easily accessed making it extremely valuable.  Consequently, pharmacists were valued for our ability to provide information to patients and colleagues regarding drug therapy.  Patients depended on us to give them information on their drugs, and physicians called us when they had a question.

Fast forward to today. We are now practicing in the information age.  Access to information is ubiquitous.  Being a source of information is no longer considered valuable as patients walk around with computers in their pockets and personalized drug information flows to them from many sources including third party insurance providers, APPs and websites.   Yet as pharmacists we have not really transformed pharmacy practice to keep up with what is valuable to today’s patients. 

Pharmacists are seen as providing a product plus information, because this is what patients experience when they walk through our doors.  The majority of Canadians interact with pharmacists when they are receiving a new medication; and we interact with them by providing information.  We call it counselling, but to the patient, it is information. 

Step into our patients’ shoes: how valuable are pharmacists to their quality of life?   What will keep patients coming into our pharmacies when they can receive their medications faster, cheaper and more conveniently by ordering them from their device and having it delivered to their door?  What will keep third party payers from requiring patients to only source prescriptions from these cheaper alternatives?

Pharmacists have an immense opportunity to demonstrate value to patients.  Study after study proves that we reduce health care costs and improve outcomes, but patients don’t seem to know this because they haven’t experienced it.  We practice reactively, responding to queries from patients or providing information when a product is dispensed.  What is needed is a shift to proactive engagement and assessment; an embracing of our role in chronic disease management.   Optimizing therapeutic outcomes and working with patients to improve drug therapy is what brings value.   

It takes proactive engagement because patients don’t know that they need us.  They don’t know if their blood pressure or blood glucose is at goal, that there are drug options that may optimize goals, have less side effects, are cheaper, or more convenient; that they could benefit from vascular risk reduction or that we can help them quit smoking.  I could go on and on about the immense opportunities for proactive intervention to improve a patient’s quality of life….but it takes a will to engage and renewed energy for patient care.  

The clock is ticking with innovative disruption rumbling in our near future.  We cannot allow negativity, financial pressures and government decisions to override the preservation of our profession, otherwise we may someday soon be hanging up our lab coats because it is too late.

I love my smart phone.  I can order dinner from my phone, I can schedule transportation from my phone, I book yoga classes and my kids haircuts from my phone, and I have already started doing my Christmas shopping, exclusively from my phone.

I know I am not alone here.  The dramatic rise in on-line commerce has risen at what could be seen as an alarming speed for industries that could be left behind.  The disruption felt in an increasing number of industries is not slowing down and pharmacy is starting to become one of those targets.

The trouble is that the perception of pharmacists is as providers of prescriptions. The value is in what the patient receives, which is a product.  Patients are always looking for the “what’s in it for me?”  If they can be offered speed and convenience (ie: order my prescriptions on my phone and have them delivered to my door) what’s stopping the vast and catastrophic wave of patients leaving their community pharmacies?
We cannot compete in speed, convenience, online platform, name recognition, familiarity with process or even price with monolithic companies such as Amazon.  When Amazon announced its purchase of Pillpack, the big three in the U.S (Walgreens, CVS and Rite-Aid) lost $11 billion dollars in value; the loss due to just the announcement.  What happens when Amazon actually starts filling prescription orders?

Will patients go for it?  Wall street analysts state 85% of insured Amazon Prime members are open to buying their drugs on the site.
The question we as pharmacists need to ask ourselves is, “Why should our patients come to our local pharmacies instead of ordering their prescriptions online?”

If our patients’ experience in our pharmacies is the provision of a product, then we will lose them.  If they interact with the pharmacist only when they receive a “new” prescription, and the pharmacist “counselling” entails giving them information and saying they can call them with any questions, again we will lose them.  Information is no longer a valuable commodity in the information age.  Our patients are walking around with Google in their pockets, and artificial intelligence today is just the tip of the oncoming iceberg.

As pharmacists we must demonstrate our value to patients through active engagement.  We cannot wait for patients to come to us with their questions.  It doesn’t matter how smart we are, or how many specialty certifications we have, or how many CEUs we attend if patients do not experience our care as actively impacting their quality of life.  Ultimately patients are asking, “What’s in it for me?”  With every interaction we can show patients the irreplaceable value of a face to face relationship with their pharmacist.  The value of the pharmacist is only realized when it is experienced.

If the ensuing disruption leads to pharmacists taking the lead in their own future and engaging patients to demonstrate the value of face to face care, then it will be a magnificent revolution.  If we do not embrace the disruption and choose to maintain the status quo, then we may very well end up with a lot of time on our hands to do our shopping from our phones.

A friend sent me a text the other day.  He went to his local pharmacy and was dispensed a drug he has never had before.  His text said, “Siri gave me better info than the pharmacist”

When I asked him to elaborate, he said the pharmacist never asked him anything about what he was taking the drug for, he simply read the directions off the label for him (which he could do himself) and mentioned a few possible side effects.  Ultimately, he felt the interaction was rushed and of no use to him.

I always find these situations rather embarrassing as a pharmacist, and they happen quite often.    Many of my friends and family across the country contact me for information regarding their health and their medications because they have had poor experiences and/or have no relationship with their local pharmacists.

Consider this typical pharmacy scenario.  A patient presents with a prescription for a repeat of their high blood pressure medication.  The technician at intake enters the prescription, sees nothing has changed and processes it.  On the back end, an assistant prepares the product, the pharmacist checks it and out it goes.  At the till the assistant asks, “Do you have any questions for the pharmacist today?”  The patient says no, thanks them and leaves.

This scenario happens over, and over again in our pharmacies every day.  For the majority of patients presenting to a pharmacy, they have minimal to no interaction with a pharmacist.

When do patients interact with a pharmacist?  Typically, when they get a new prescription.  What do patients usually receive in this interaction?  They are almost always provided with information, or what I call the “Top Five Points”.  What the drug is, how to take it, what side effects they could expect, when it might work and call if they have any questions.   Basically, patients see us as the providers of information. (Which I guess is marginally better than being seen as only a drug dispenser.)

The problem with this is that pharmacists simply spit out information that is easily found elsewhere.  This holds little value to patients.

Approximately 92 per cent of adults aged 18-39 now carry a computer in their pocket. Information is at our patients’ fingertips, it’s everywhere.  We are no longer the only source of drug information like we were 20 years ago.  People can look up the drugs on their prescription before they even get to you to fill it.  If our only interaction with a patient is to provide information (i.e. counselling), we will shortly be regarded as irrelevant.

If a patient takes a prescription to either your pharmacy or one of the four or five other pharmacies in your area and leaves with the exact same product and outcome, what is differentiating you from any other pharmacy?  This generation of young adults is favouring speed and convenience.  What’s more convenient than drive through, or a kiosk you can feed your Rx into and out comes a product, or an APP that will organize delivery of your drugs?  To the patient, there is no difference except increased convenience.  In both scenarios they do not have a meaningful interaction with a pharmacist.

In a time when pharmacists are pushing to advance forward on being reimbursed for services from third party payers and government, we must remember that these payers are ultimately patients too.  If they feel that a computer algorithm or robotic dispensing is cheaper and more convenient, and they have never seen the value of a pharmacist being involved in their care, then we may as well hang up our lab coats.

There are very few pharmacies that engage patients in shared decision making, chronic disease management and work to develop relationships with patients by following up with them on their drug therapy.  Yet, this is where pharmacists need to be.  This is what is irreplaceable.

Oh, but wait a second….  What about checking all those prescriptions?  We spend the majority of our time signing our name on the final check of prescriptions. Pharmacists are needed for that, right?  Nope. Registered technicians are much cheaper than pharmacists, so don’t count on being able to continue to sign your name for many hours a day and still be relevant.
“If we don’t like change, we will like irrelevance even less.” -General Eric Shinsek

I recently hired another registered pharmacy technician into my practice.  It didn’t take long before she became an essential part of the team, and with her amazing communication skills, she’s become sought after by our patients.  When I asked her why she left her previous job in a community pharmacy, she disclosed that it was because the pharmacists there did not allow her to practice to her full scope. She could not do final check on prescriptions, could not counsel on devices nor perform many other tasks she was licensed to take responsibility for.  When she gave her notice, the pharmacy manager told her she understood why she was leaving and supported her in pursuing a job where she could practice to her full scope.

This was stunning to me.  It was hard to believe that rather than change their practice, the pharmacy manager chose to let a valuable employee leave.

This certainly isn’t an isolated incident.   I’ve presented continuing education sessions to registered technicians and have heard very similar reports about pharmacists not allowing them to practice at the “top” of their license.  Meaning, they were not allowed to do final check on prescriptions or unit dose packaging, they were not allowed to counsel on devices and some not even allowed to count out narcotic medications.

This seems entirely contrary to the goals of pharmacists who typically state they do not have enough time for clinical work and engaging patients in expanded scope services.

Pharmacists cannot possibly evolve into providing expanded scope services without accepting registered technicians for the full professionals they have now become.

Working to the fullest potential of their license is empowering for any profession. Technicians and pharmacists alike tend to have more job satisfaction when they are doing what they are trained to do, and job satisfaction is key to a successful pharmacy team.

Here are three key areas where pharmacy technicians are often under-utilized:

• Final Check. There is no reason for pharmacists to do the final check on prescriptions.  The cognitive check and counseling of the patient can be done along with the initial assessment at intake.  Technicians carry their own malpractice insurance to take responsibility for the final sign off and dispense to the patient.  Pharmacists should also not be spending their time checking unit dose packaging or blister packs.  A cognitive assessment should be done by the pharmacist at regular intervals, such as quarterly, or when there is a change in therapy. This does not include having to check the final product or packaging.

• Identifying expanded scope and billable services. My technicians really shine in this area.  They are continually identifying patients requiring pharmacist services, including those requiring injections, medication reviews, follow up and prescribing services.  They triage patients, set up appointments, and market these services to patients.

• Teaching devices. Teaching a patient how to use a device such as an aerochamber or a blood glucose meter can be time consuming.  Utilizing the skills and expertise of registered technicians in device training is efficient but often underutilized in pharmacy practice.

Allowing all staff to work to their full potential, increases efficiency and job satisfaction as well as providing an excellence in patient care.