Culture: The Missing Piece

When I graduated with my pharmacy degree all those many years ago, I came out trained to be a pharmacist.  Nowhere in my education was I taught how to be a leader.  Yet many pharmacists are thrust into the position of pharmacy manager or leader of the dispensary team and many more choose leadership as owners of their own practice.  When I started out as owner/manager six years ago I had no idea how to manage “people”, yet I soon discovered that productivity in the dispensary is at its highest when pharmacy teams work as a cohesive unit. I also quickly learned that being a leader is tough because it means managing a group of people, each with their own personality, history, experience, skills and challenges. 

Most often as managers/owners we focus on strategic planning, goals, getting “stuff” done, and sometimes cannot understand why our plans are not well implemented, why execution is lagging and negativity abounds.  Most often this is due to not understanding the power of culture.  Group culture is one of the most powerful forces on the planet, yet it is difficult to define.  We can sense when a strong group culture is present in successful businesses, championship teams, or philanthropic causes, and we sense when it is absent or toxic.  According to a Harvard study of over 200 companies, a strong culture increases net income 765% over 10 years. 

What is culture?  It is the tacit social order of an organization: It shapes attitudes and behaviors in wide-ranging and durable ways. Culture defines what is encouraged, discouraged, accepted, or rejected within a group.

Why is a strong common team culture important?  Because it correlates with levels of employee engagement and customer orientation; and both employee engagement and customer orientation correlate with productivity and profitability in business. 

If a team or business culture is properly aligned with staff’s values, drives, and needs, culture can unleash tremendous amounts of energy toward a shared purpose and foster a business’s capacity to thrive.  Cohesive culture allows creativity to flourish. Problem solving is innovative, identification of inefficiencies comes from the ground level as all team members strive to achieve common goals.  Leaving team or business culture to form on its own can confound strategic goals and lead to poor performance and dissatisfaction in employees which ultimately leads to unhappy patients/customers.  A pharmacy team culture that has been left to form on its own tends to be negative and staff’s internal dialogue can look something like this:


“That customer is difficult, I’m just going to put my head down and hope the other staff will take that prescription.”
“Why am I working so hard? He’s over there being so slow.”
“I don’t understand this. I’ll just leave it for the next shift.”
“I wonder if Pharmacy X is a better place to work?”

“I’m just going to use the washroom- but really I’m going to check my phone.”

Culture is not tangible, so how does it work?  We tend to think about it as a fixed trait, like DNA, some groups just have it and some don’t.   This however is not the case.  Team culture can be shaped and managed.  The first and most important step leaders can take to maximize the value of team culture and minimize its risks is examine and understand their business’s culture and assess its intended and unintended effects.  What is the implicit social order, the values, leadership style and team dynamics?  Once the culture is understood, leaders can work on shaping and changing team culture to align with the goals and strategies of the organization.  Successful change requires leaders themselves to align with the culture they wish to espouse.  Organizational conversation must underscore the change and so must organizational design.  As employees start to recognize that their leaders are talking about different business outcomes—for example patient care or innovation instead of revenue or quotas—they will begin to behave differently themselves, creating a positive feedback loop and ultimately meet and exceed the organizations goals. 

 “Leading with culture may be among the few sources of sustainable competitive advantage left to companies today.”  Harvard Business Review 

Resources:

  1. Start with Why: How Great Leaders Inspire Everyone to Take Action by Simon Sinek
  2. The Culture Code: The secrets of Highly Successful Groups  by Daniel Coyle
  3. The Culture Factor  Harvard Business Review.  HBR.org 
  4. Leader’s Eat Last: Why some teams pull together and others don’t.  by Simon Sinek.  Penguin 2014
  5. Corporate Culture and Performance  by James Heskett and Dr. John Kotter. Harvard Business School.

Where’s the Passion?

My oldest son entered his first year of university this year and it has been amazing to witness his excitement and passion for learning and the drive to achieve his goals.  It has me looking back at my own university days, over 20 years ago, and the ensuing years that have past.  What did I expect from working so hard to be a “pharmacist” all those years ago and where am I now?

I remember what it was like sitting in a lecture hall, in classes I enjoyed (admittedly medicinal chemistry may perhaps be excluded here!)  While it was incredibly hard work, I loved it!  I loved learning the newest drug studies and guidelines for disease management. I also remember those early years of pharmacy practice, fresh out of school, being so excited to get into the real world and apply my skills caring for patients.  Even 25 years ago we were talking about “Pharmaceutical Care” and “expanded scope of practice”.

It didn’t take long however before discouragement set in and I felt stuck in a rut of checking endless prescriptions.  I spent over ten years of my professional career mostly just “doing my job”, and I will admit, slowly drifting into apathy.  I did my job accurately, but I was not passionate about it. I also did the minimum amount of CEUs every year, never remembering the learning or applying it to practice.  One year I even had the College respond to my continuing education submission with the comment that it seemed “ lacking in thought ”  and rather “hastily put together”,  and they were right!  I wasn’t engaged, I had no passion for the practice or for continued learning.

I often complained I didn’t have the time to look after patients properly, however, when I did have time I did not extend myself to proactively engage patients.  I eventually asked myself the tough question:  If I was given the perfect circumstances, all the time I needed, the ideal practice setting…would I be able to do the job I wanted to?  Could I take responsibility for patients medication management, solve drug therapy problems, engage patients proactively rather than waiting to be asked questions?  I wasn’t sure.  I was so rusty from the many years of the prescription checking tread mill that I was hesitant and frankly afraid to step out of the role of just technically checking prescriptions.

I share this rather embarrassing segment of my career as I feel many pharmacists are stuck in their practices.  When I read comments on blogs and have discussions with colleagues at conferences, I hear the resounding theme that pharmacists, even just a few years out of school, have lost their passion for pharmacy practice.  There are numerous outside factors that contribute to this including corporate decisions, government cutbacks, drastic cuts in drug pricing, third party pressures, etc.  But I think we as a profession also need to acknowledge our own contributions to this state of the profession.  Apathy abounded even in the “good” years, in the years where pharmacists were being offered starting bonuses, had shift overlap and high wages.  It’s been decades of pharmacists not stepping into their role, merely talking about how important we are rather than demonstrating it in our pharmacies.

So now we face a time of crisis where artificial intelligence and automation can take over pharmacists role, and the drive towards cheaper, faster and more convenient drug access will radically disrupt traditional community pharmacy.

I don’t claim to have all the answers, or really any at all.  I continue to write and speak and engage colleagues because I’m just not ready to give up.  I’m not ready to retire my white coat and send my patients to the “Amazons” of the world.  Despite it being rather vulnerable to put myself out there in discussing pharmacy practice on a national platform, the dialogue is essential.

Where am I now?  In the ensuing years since that wake-up call I radically changed my practice, and eventually hired on support staff and pharmacists who have the same vision and passion and are willing to practice in an environment I am proud to have created.  Have I encouraged my son to pursue pharmacy as a career?  I will admit that in his earlier years I did, but as he got older and Engineering more suited his interest I was relieved.  I don’t know where pharmacy is headed, it isn’t looking good, but giving up for me is not an option.  I still need to find passion in my work, a reason to get out of bed in the morning, and that reason is the patients in our care and the development of my incredible team that looks after them.