Talking behind each others back, leaving the “hard” baskets/patients for someone else, being annoyed by co-workers, being grumpy or negative with others.  These are all things that tear down a dispensary team.  One of the root causes for this kind of behaviour is the tolerance of a culture that allows this type of behaviour.  But how do we tackle it?  How do we foster a more positive culture that builds up the team instead of tearing it down? 

One critical piece is positive feedback.  This may seem counter intuitive when it seems that taking a heavy hand and “correcting” these behaviours seems to be what’s called for, but no amount of punishment or strong arming will prevent negativity and back biting to seep into the dispensary. 

Why does positive feedback work?   When we do not understand our value as an individual and as a member of the team, we will unconsciously find ways to feel important by either seeking attention and needing to be “right”, or by criticizing or talking negatively about others to over inflate our own sense of importance.  Both of these will tear down your team.   The less people understand how their hard work contributes to the team and to shared goals, the less engaged they are and more prone to frustration, failure and negativity.

Leaders need to sit down regularly with team members and lay out for them what their real contributions to the team are.  What their unique gifts and talents bring to the team and how they are essential to the team and organization thriving. 

Why don’t we provide positive feedback regularly?  Several reasons can be at work here.

• We assume people know their strengths and how they contribute
• Fear that if we tell people how important they are, they will “take their foot off the gas” and slow down production. 
• Fear that if we focus on the positives then the negatives will be seen as “okay”
• Fear of being vulnerable in discussing and sharing at this level
• Not devoting time as a leader to recognizing the talents and contributions of team members.

I have learned through experience that each of these are false assumptions

Some of my most happy and productive team members, who I would think need no affirmation at all, are usually the most in doubt of their essential contribution to the team and what their unique talents are. 

I’ve also learned that focusing on the positive does NOT slow down production and efficiency.  As a matter of fact, it does the opposite.  Team members feel a renewed sense of enthusiasm and purpose and cooperation when their contributions are pointed out to them and they feel they are essential to the team and the business.  (All team members have essential contributions, even our most challenging ones, and all of them need to be recognized in this way.)

When we focus on the positives with our team it does not discount the work on the “negatives”  As a matter of fact, acknowledging the contributions and unique skills of a team member builds trust and vulnerability, two essential qualities in personal and team growth.  In the posture of trust it is then easy to bring up and discuss issues that each team member needs to work on.  Everyone has areas that require growth including the leader.  When trust is cultivated and maintained, then the vulnerability it takes to have these discussions and do this work flows naturally on both sides. 

The fear of sharing at a deeper level with team members is real.  Not everyone is comfortable with being vulnerable.  My advice is two part.  First, do your own work.  Confront your fears with having deeper levels of conversation and work through it.  Secondly, take baby steps into it with your team members.  Start out with sharing a little about yourself and your reasons for meeting with them, and focus on just one or two things that are obvious and easy to discuss. 

Lastly is time.  It is so hard to just take the time for something that is so important but easy to let slide.  When steeped in “management” duties, it is very easy to forget the critical importance of leadership.  But taking the time for developing your leadership skills, reflecting on each of your staffs development and your relationship to them as a leader, makes management so much easier.  Taking that “Ten Minute Check In” is the difference between just plugging along as a team or thriving as a team.   Take the time for it and for your own development as a leader.

I have often been asked the questions about my own leadership journey.  How did I develop skills, how do I create high performance teams, where did I start and what am I doing now? 

Firstly, I want to share what I think real leadership is so we have a common understanding of what we are talking about. 

Leadership is not about title, position or power.  It is also not the same as management.  Managers do a job and many of them never transition to be leaders.  Leaders take responsibility for those who do the job.  They “take care of” those they lead.  This is not a soft, idealistic, airy sort of concept.  It is doing the hard work of recognizing the potential of those you lead, developing their talents, as well as working with their limitations to continually encourage growth.  It is about creating trust within the team, not avoiding difficult situations, continually bringing the team together.  It is about setting the environment and developing the culture where growth can happen and creativity flourishes; where team members feel they are essential to the team, contributing to a higher purpose and feel free to express frustrations as well as ideas and solutions. 

There are many ways pharmacists can learn leadership skills.

Mentorship

Observation of others

Education

Experience

Trial and error

When I started out as a manager, not yet understanding what leadership really was, I went purely by trial and error. ( To be clear, this is not the recommended route!)  I was a manager, and started to realize that I wasn’t doing a super great job with my staff.  I was falling prey to negativity, stress, and lack of clarity.  It took me awhile to realize that what I needed to focus on was my own development so I could create the culture I needed to cultivate a strong team.  Mentorship would’ve been invaluable when I started out, but I didn’t have anyone I knew in pharmacy that was a role model for this.  So after a lot of trial and error, failures and small wins, I started educating myself on leadership and teams and started applying some of my learning.  I asked for regular feedback from trusted team members, realizing with much humility, that I had a lot to learn.

One of my biggest lessons in the last few years is that leadership is a lifestyle.  It is not a destination.  Even when you have achieved your goals, even when the team is built and it is performing well, positivity is high and team members are thriving, it is not over.  Circumstances always change and develop and shake up the equilibrium.  COVID is a great example of this.  Incorporating new team members is another example and perhaps one of the most challenging to an already high functioning team. 

If this is all so hard, why bother? Why not just continue as we are?  Well, the answer seems to be pretty clear in many blogs and posts and comments and discussions in dispensaries around the country.  Pharmacists and dispensary staff are not happy.  They tolerate their jobs.  Disillusionment begins almost immediately after graduation for new pharmacists. The purpose of the leadership lifestyle is to create and maintain teams who trust each other, take care of each other and value each other and the organization in which they work.  Who doesn’t want that?  Who doesn’t want to feel they are cared for, looked after, that their work has meaning and they enjoy being part of the team?  That is your job as a leader.  It is no small feat but one so valuable it changes lives. 

Below are some resources to kick start your learning as a leader.  Enjoy the journey!

Brown, Brené, Dare to lead: Brave work. Tough conversations. Whole hearts.New York : Random House, 2018.  

Sinek, Simon. LEADERS EAT LAST: Why Some Teams Pull Together and Others Don’t. New York: PORTFOLIO/PENGUIN,

Covey, Stephen M. R.,, Rebecca R. Merrill, and Stephen R. Covey. The Speed of Trust: The One Thing That Changes Everything. Unabridged. [United States]: AB Publishing, 2017  

Harvard Business Review: Leadership Resources  https://hbr.org/topic/leadership

I spent some time recently talking to new pharmacy grads.  Just starting out in their careers, we spoke about expectations and current situations.  These enthusiastic new pharmacists all expressed to me the fear of falling into apathy.  They see the dispensary environments around them, the seasoned pharmacists as well as the pharmacists who were just new grads but a few years ago, all seemingly disillusioned with the profession. 

New grads are often burdened with the “hope for change’.  They have been told “You’re the hope for the future of the profession.  We’re counting on you!”  But once out in practice environments, they have no tools and no support for being such an agent for change.  It is an impossible expectation we have set upon their newly professional shoulders. 

We cannot expect new grads to change the system when they are entering into a culture that does not support practice change and moving forward. 

We keep saying ”You’re the next generation of leaders!”  But wait….we’re the leaders right now…we’re in control!  What are WE doing?  We set the environment, we set up the practices, we are the “leaders” of our teams. 

Pharmacists today often complain of the lack of leadership in our profession. This is not a surprise since our training is in how to be a pharmacist. No one ever teaches us how to be a leader.   Leadership is a skill like any other skill, it can be learned, but there is no training for pharmacists in this area, no system of mentorship to become a leader.

Leadership is also not the same as the functional position of manager.  We all know this. 

Managers in pharmacies come from pharmacists who are excelling as staff pharmacists. 

When we’re a staff pharmacist our only job is to work hard and learn how to do our job really really well.  When we do our job really well, then we may become a manager, being responsible for the people who used to do our job.  The reason managers often micro manage their employees is because they actually know how to do their staff’s jobs, better than the staff themselves, at least at the beginning.  But a transition in the manager has to happen.  They need to transition from being a manager to to being a leader.  Some managers transition quickly, some transition slowly, some unfortunately never transition.   The transformation is going from somebody who knows how to DO the job to someone who knows how to look after the PEOPLE who are responsible for doing the job. 

Leadership is a learnable skill that you can practice.  Like any skill, if you incorporate learning and you practice it regularly, you will become stronger at it.   Simon Sinek compares being a leader to being a parent, in that it comes at great personal sacrifice.  As a leader you are not IN charge, but responsible for those IN your charge.   This is tough.  It’s teaching and mentoring, it’s encouraging others to “try again”. It’s being the calm in the storm, it’s working through your own negativity or struggles so it does not impact your team.  It’s discovering and working with both the gifts and talents of each team member as well as accepting and working with their limitations.  It’s taking the overwhelming pressures on yourself so that it dampens the impact on your team. 

At the end of the day, a great leader is not responsible for the job, they are responsible for the people who are responsible for the job.  Leaders are not even responsible for the results.  They are responsible for the people who are responsible for the results.  I probably sound like a broken record on this, but it is just that crucial for leaders to understand that they need to take care of those they are charged with leading.  Understanding this one concept allows leaders a complete change in perspective as to what their job really is.  And with this understanding, to embrace the learning and personal growth that needs to go along with it.  Leadership is a continual growth journey, it is not a destination.   It is up to us to be the leaders and the agents of change.  We need to embrace this and create the environments where our new grads can thrive. 

Many pharmacists feel stuck.  Constrained by jobs they didn’t envision when they finished their degree and donned their white coat.  Of course we have standards and regulations that guide our practice, but it is the pressure and constraints from employers that often is the tipping point for the stress most pharmacists feel.  Many pharmacists have described their situation as being boxed in.  Pressure coming at them from all sides, and being unable to move.

I was listening to Dan Pink the other day, and something he said resonated with me in regards to this. 

“I really think that we have given short shrift to the concept of small wins, both in terms of personal development and organizational performance. We want big, audacious goals, we want moon shots, we want giant transformations—and that’s cool sometimes. Sometimes that’s the approach. But most times, the more practical, realistic, and ultimately effective way is to go for a small win.”

What does this mean for pharmacists who are feeling stuck?  Pharmacists who are disillusioned with what once was a passion and now is merely a job to endure.  Not everyone can seek out greener pastures, finding a pharmacy more in line with how they want to practice, or even leaving to start their own practice.  The market for pharmacists right now is pretty dismal in many parts of the country. 

Frustration mounts when we ask ourselves, “How do I escape this?”  But as Dan Pink goes on to say, “To my mind, you’re asking the wrong question. The question you should be asking is, “Can I do one small thing tomorrow to make things a little bit better?” And the answer is almost always yes.” 

Look at what are true constraints in the pharmacy, versus what are actually perceived barriers that can be moved. True constraints are the walls of your box, things you do not have the power to change.  But many times there are things that we perceive as being a wall but are actually moveable, we actually have some control over them. 

Take a look at your practice within that box and see where the possibilities are.  There are always possibilities.  What can you change to improve your practice, to increase the engagement you have with patients, to extend the knowledge and skills you have developed in order to improve the quality of life of your patients?  What small change can you make to bring your personal practice more in line with what you want it to be?  To, in the end, find your profession more satisfying and rewarding?

This does involve knowing what you want your practice to be, and sometimes we are so deep into the frustration and disappointment that we don’t know what that is.  This may be the first step for some.  Examining why you do what you do.

Pharmacists have a certain amount of autonomy in how they do their job.  They can indeed innovate inside the box.  Change small things in order to come closer to what they want their practice to be.  Making small steps slowly in order to advance.  Only you can examen the walls of your own box and determine what small wins you can reach for. 

Some examples from when I was stuck in my own box: choosing engagement with a patient rather than signing off on a prescription and having an assistant give it out.   Choosing to spend the extra minute extending empathy to someone who is suffering. Offering to call and follow up with a patient who is anxious about starting a new therapy.  Offering proactive information on prevention of disease to ward off long term complications for a patient.  Spending a minute discussing drug options that may be less risky than their current therapy.  When I started examining the walls of my own box, I knew that I could not change everything.  But I could create small wins in my day that brought me closer to being the pharmacist I wanted to be. 

http://www.dailygood.org/story/1856/dan-pink-on-the-science-of-staying-motivated-heleo-editors/

Credit given to George Couros and Katie Novak whose book  title inspired my thinking on this post.

It took a few years as a manager and leader of a dispensary team to understand the importance of checking in with my staff.  Unfortunately, when I went to pharmacy school, leadership training was not included, so over the years I’ve just had to “figure stuff out” and learn as I go.  My goal has always been to lead a high performance team, producing work that each team member can be proud of and generally have everyone, including myself, enjoy coming into work every day. 

I am asked quite often how I created and maintain the team that I have.  To be honest, it isn’t easy.  It takes a lot more hard work and continual skill development on my part than I ever realized.   There are many pieces that have contributed to this building and maintaining, but one of the key ones has been the “ten minute check-in”. 

The ten minute check in is a completely separate entity from a performance review or goal setting.   It took quite a few years for me to understand how something so simple was so critical to the functioning of the team.   

Here are a few things I’ve learned about this valuable tool which I encourage team leaders to implement for the health and growth of their team.

1. The ten minute check-in has to be scheduled.  If I merely have the intention to do it, but do not deliberately schedule time for it, the check-ins never happen.  Staff need to know that they have a time and space with me and that this will come around on a regular basis
2. This time is about them.  This check-in time is not the forum for me to bring up problems or things to work on, it is time given solely to the team member in front of me.  My job is to listen.
3.  It’s not always about the job.  Sometimes a team member is having difficulty or struggling in areas outside of work.  It is important to keep an open mind and hear what is shared as all aspects of a person’s life affects their ability to be a healthy contributing member of the team

When check-ins become the norm, team members become more and more comfortable coming to you with issues and concerns.  This often means that they will also ask for a check in when they need it, which can be critical in addressing issues that are time sensitive. 

Regular one -on- ones are preventative medicine for our teams.  This dedicated time can not only solve problems but prevent issues from creeping into the team, which could cause negativity, hard feelings or discontent.  Growth and development of each member also occurs as they feel they have a safe space to bring up concerns or struggles they may be having.   As leader of a group of dedicated and hardworking staff, I owe it to them to be deliberate and consistent with the time I give to them.  It’s an investment of time that continues to pay off for the entire team.

The term “team” is not often used in pharmacy circles when describing dispensaries and staff, yet our dispensaries are typically made up of a small to medium sized group that works closely together day after day, needs to be able to communicate and cooperate efficiently and work with a common purpose and goals.  This is pretty much the definition of a team, and how effectively the team works together will be reflected in how happy staff are in their positions,  how productive the team will be and the level of care provided to people walking through the door. 

Pharmacy practice requires high functioning teams which are efficient, cohesive, focused and high performing.  Productivity is at its highest when teams perform as a cohesive unit.  Yet not a lot of attention is paid to how our dispensary teams are functioning and whether or not improvements could be made which would increase job satisfaction, employee retention and improve patient care.  With so much riding on the outcome, it doesn’t make sense to leave successful team member interaction to chance.

Google’s five year study on highly productive teams, Project Aristotle, found that psychological safety was “far and away the most important of the five dynamics that set successful teams apart.”  What does this mean?  In a team with high psychological safety, teammates feel safe to take risks around their team members. They feel confident that no one on the team will embarrass or criticize anyone else for admitting a mistake, asking a question, or offering a new idea.

Harvard Business School professor Amy Edmondson in her book “Teaming”, states that psychological safety is “a taken-for-granted belief about how others will respond when you ask a question, seek feedback, admit a mistake, or propose a possibly wacky idea.”

A few common scenarios in pharmacy can demonstrate what a lack of psychological safety looks like:

• When a mistake is made, team members look for blame rather than supporting those involved and looking for ways to improve and prevent future incidents.    
• When there’s a challenging clinical decision to be made, pharmacists hesitate to ask each other for their opinion because they’re afraid to look like they don’t know the “correct” answer.  In reality, checking in with a colleague for “what would you do in this situation” is an immeasurable tool for professional growth.
• When a staff member is not present and others discuss or critique them, or a scenario they were involved in, rather than addressing the issue with the person involved with positive intention and empathy. 

Maintaining psychological safety in a team requires a strong leader who will pick up on any tensions or situations in which vulnerability and safety is being damaged, and then be confident enough to address the situation and bring the team back into alignment.  Skills in interpersonal management,  healthy conflict resolution, strong self-awareness and emotional intelligence, and empathy are essential. 

Normalizing certain behaviours in a team is also critical, such as apologizing and backing that up with behaviour change, expectations on how we treat each other and communicate with one another, assuming positive intentions, demonstrating respect and maintaining accountability. 

It is important not to mistake safety for comfort.  Psychological safety does not mean a cozy situation in which people are close friends and there are no pressures or problems.   Often times maintaining psychological safety in a team is not comfortable.  For example, instead of ignoring gossip, bringing it to light and addressing the issue is not typically comfortable, but it is crucial in order to resolve the hard feelings and division gossip can cause.  The end result is a stronger team who understands they can come to their leader with issues and have them addressed with equanimity. 

Edmondson, Amy C. Teaming: How Organizations Learn, Innovate, and Compete in the Knowledge Economy. Jossey-Bass, 2012.
Brown, Brené, Dare to lead: Brave work. Tough conversations. Whole hearts.New York : Random House, 2018.

“Field of Dreams” is one of my favorite movies.  If you haven’t seen it, it is about the vision of the main character to build a baseball field in the middle of his corn field with the belief that players from the past, including Shoeless Joe Jackson, would return to play.  Many characters in the movie think the main character, Kevin Costner, is crazy but he builds the ball diamond and of course, the players return and spectators from all over come to his field, in the end saving his farm from bankruptcy.   

What is interesting when applying this to pharmacy practice, is that there are so many pharmacists out there who are unhappy with their profession and how they are practicing, many of them managers and even owners, but change seems insurmountable and frightening because this is just how we’ve always done things, and simply imagining doing things differently seems impossible, even crazy.

When I started my pharmacy practice 8 years ago (after 17 years of being a staff pharmacist) I had a somewhat foggy vision of what I wanted it to be.  I was mostly unhappy with the care I was providing to patients due to systemic and cultural factors in the pharmacies where I worked, and knew that things could be different.  Over the years since then I have developed a practice I am proud of, a fluid one, as we grow and adapt all the time, continually striving to improve, but where the goal is a practice my team and I are proud of. 

When I travel across the country discussing practice change and patient focused care I sometimes hear, “Well Carlene, easy for you, you have your own practice.”  Yes, I certainly do, and all the sleepless nights and uncertainty that came with that responsibility.  As a matter of fact, my first day open, eight years ago, I had a pharmacy owner from a neighbouring town stop in and tell me it was a “terrible time” to start a pharmacy because of the immense government cutbacks we were facing.  He had a point.  It WAS a terrible time, and not much has changed. Challenges just keep coming pharmacy’s way year after year. 

But what was the alternative?  I wasn’t going to retire in my 40’s, so it was either continue to practice in a professionally unsatisfying manner, or take a risk and work towards what I hoped would be a rewarding second half of my career.

Now I know many pharmacists are stuck with little power to change their situation, and obviously not every unhappy pharmacist can open their own pharmacy, but every pharmacy in the country is managed by a pharmacist, and these managers and/or owners shape the practice they are managing.

If we truly want change it starts with us, in the trenches, creating a culture centered on patients and demonstrating pharmacists as essential by optimizing drug therapy and solving drug related problems, thus improving patients’ quality of life.

It is truly sad that so many of our students enter practice with high hopes and in a few short years are disillusioned because they must conform to the culture in the pharmacy which they are employed, generally being at the end of an assembly line doing mostly technical work.

It takes vision and a strong team leader to shift practice and shape culture, but ultimately pharmacists and technicians who find their work meaningful are happier.  When staff are happy it filters down to how they interact with patients.  Patients are drawn to this type of care when they experience the value of engagement with their pharmacist.  I’ve seen it in my own practice and in others across the country when pharmacists put their energy into shaping practice this way. 

Change is possible.  There are amazing pharmacists out there who would love to be part of a forward thinking, patient centered practice, and so many patients falling through the cracks who truly need pharmacist care.  If you build it they will come, and the professional satisfaction from looking after patients in the way we were trained to will make all the difference, and perhaps it’ll “save the farm”.

Just prior to COVID, I had the pleasure of presenting a session to pharmacists both in Vancouver and Toronto at PharmacyU where I posed to each group a question.  “Why do you do what you do?  Why are you a pharmacist?  Why did you go into the profession and why are you still here?”  I stated that indeed many of their colleagues have left the profession altogether, and many more are so disheartened you would never find them at a pharmacy conference. 

This question was a risky move on my part.  To be honest, I wasn’t sure at the start of the session whether I would even include the question.  I could’ve gotten all kinds of responses that perhaps I was not prepared to hear.  But I decided to risk it and gave the groups of pharmacists five minutes to discuss the question with the colleagues at their tables.  I then walked around to the tables to collect their responses and share them with the group. 

As I went around the room, in both Toronto and Vancouver, table after table resonated with a very similar theme.  In many varying ways, participants expressed that what got them excited about their work and why they continued to do what they do, is the difference they make in the lives of their patients.  In both rooms, at opposite ends of the country, pharmacists spoke poignantly about the patients they serve, the hopes they had entering into the profession, and the patients that keep them there.

The question of why we do what we do and what gets us out of bed in the morning is not my schtick.  I borrowed this from Simon Sinek, and if you haven’t seen his TED talk on this subject it is well worth the watch.  The reason I adapted the question for our own profession is that it is so easy to forget why it is we are pharmacists in the first place.  We are bogged down with negativity and the continual hammering at us from all directions chipping away at our professional identity.  It is vital as health care professionals to take back that identity and own it.

Leaders therefore need to first examine their own “why”, and if they don’t know it, it is exceedingly valuable to spend some time discerning what it is that gets them out of bed in the morning and into their pharmacies.    

As leaders and managers in our pharmacies, it is also essential to remind our team why it is we do what we do.   As the leader you must be able to clearly articulate the why to your team.  If we can’t articulate the why then how do we expect our team to know WHY to come to work?  WHY give their best?  WHY go above and beyond to provide exceptional care?

When people come to work with a higher sense of purpose they find it easier to weather storms; hard times, times of increased stress, difficulties and conflicts. People with a strong sense of “why “ are less prone to give up after tough times or failures because they understand the higher purpose.  It also results in a team that will provide exceptional care to patients, not because they have to, but because they WANT to. 

Much has been written and discussed about the pharmacist experience through the COVID-19 pandemic. Our colleges and associations have had to pivot and adapt and step up to provide us guidance. Individual pharmacists, managers and companies have had to rush to develop new policies and guidelines to aid front line dispensary staff in providing service and staying safe.

I’m not going to add to the all the wonderful writing and teaching and learning that has come about since Covid hit our world.

Really, I only wish to share my own experience with looking after my patients.  When I am in a tough spot as a professional, when I find it hard to get up day after day and face the imposed changes of this unprecedented time, I find that I need to refocus on why I am there, and for me it always comes back to my patients and my team.

There are things that I just simply miss about the way I always practiced my profession and have been forced to change.

I miss being able to lean into the conversation with a patient, using my body language to convey empathy.

I miss my patients seeing my smile of welcome when they come in, my face now hidden behind a mask and a barrier.

I miss being able to give a patient a hug when they are diagnosed with a life changing condition or have lost a loved one.  Yes, I have hugged patients.

I miss analyzing patient interactions with how best to connect with patients rather than how best to distance in order to keep the patient, myself and my staff safe.

The constant re-evaluation of whether we are doing enough to protect our staff and whether we are providing the best care possible to our patients can be exhausting.  The constant change of protocol and daily briefings and updates allow for no escape from the focus on COVID.

However, I do remind myself that pharmacists across the world are facing unparalleled issues; some have lost patients to COVID and some have had to battle the virus themselves.  Much suffering and turmoil have spread across the globe, keeping pace with the virus that has forever changed us all. 

My small reflection and limited experience is perhaps sentimental, but maybe one day, if our “new normal” is but a memory, I will reread this and remember what it is about my everyday practice that I can be thankful for.