In 2004, the ASHP Scholar-in-Residence program focused on pharmacy leadership, with the objective of quantitatively assessing the current and future pharmacy leadership situations and developing recommendations to avoid a future leadership crisis.1 At that point in time, 80% of directors and 77% of middle managers who responded to the survey anticipated leaving their jobs in the next decade. Only 30% of current practitioners and 62% of pharmacy students at that time indicated that they would seek a leadership position sometime during their career.
White’s1 benchmark survey drove a seminal change in thinking about professional leadership, stimulated the development of multiple programs and services, and refocused educational emphasis and policy considerations from purely clinical to include leadership.2 The recommendations embodied in that report led to the development of the ASHP Research and Education Foundation’s Center for Health-System Pharmacy Leadership, a focal point for the development of programs and services targeted to address the leadership crisis.3 In recognition of and response to these forces, the ASHP Board of Directors adopted the ASHP Statement on Leadership as a Professional Obligation in 2011, further emphasizing the responsibility and accountability of each professional to accept this personal development challenge as a critical part of the professional role.4
Our world has changed since the time of that survey’s publication. The economic recession delayed some planned retirements and changed the leadership demands within health care systems.5 Health care reform introduces new uncertainties, change, and leadership expectations. The pharmacy work-force shortage has evolved to become, if not a surplus of pharmacists, surely a mismatch of demand and supply in the context of existing skill sets.6,7 Simply stated, it is time to reexamine the current and future pharmacy leadership situations.
In September 2011, an online survey was launched to determine the current state and future trends of pharmacy leadership as well as the attitudes of pharmacists and pharmacy students. The survey questions included those posed in 2004, as well as additional questions to assess the effectiveness of leadership activities implemented since the publication of the 2004 survey data. While we could not ensure that the same individuals who responded to the previous survey were included, e-mails containing a link to the survey were sent to 11,212 ASHP-member pharmacists, 10,774 ASHP Student Forum members, and 515 individuals identified as employer prospects from CareerPharm. The survey was launched September 7, 2011, and closed October 3, 2011, with one reminder e-mail sent to nonresponders.
Of the 22,501 individuals to whom surveys were sent, 2,631 (11.7%) responded; 245 surveys were undeliverable. Of the 2,092 pharmacists who responded, 535 were directors, 483 were middle managers, and 1,074 were current practitioners, compared with 517, 489, and 290, respectively, in 2004. Of the 10,774 students to whom surveys were sent, 481 (4%) responded (105 undeliverable surveys), compared with 776 student respondents (15%) in 2004. Of the 515 employers to whom surveys were sent, 58 (23%) responded (15 unde-liverable surveys), compared with 55 (16%) in 2004.
This article describes key observations made based on the findings of the 2011 survey and provides recommendations to stimulate discussion and continued efforts in promoting the development of pharmacy leaders. Due to differences in the survey samples, statistical tests were not conducted. Complete survey results (eTables 1–9) are available with the full text of this article at www.ajhp.org.
Observations.Demographics. The demographics of respondents changed very little between survey periods with a few exceptions. Fewer (67%, from 83% in 2004) current practitioners indicated that a hospital was their primary work setting (Table 1). The percentage of practitioners in their position for less than 5 years increased from 45% to 67%, as did the percentage of directors who had been working in their position for 16 or more years (from 32% to 39%). The percentages of female directors and current practitioners also increased (from 27% to 40% and from 36% to 63%, respectively), yet the number of female pharmacy student responses decreased (from 79% in 2004 to 70% in 2011). It appears that residencies have become more available and better utilized since the 2004 survey, as more middle managers (from 45% to 55%) and current practitioners (from 43% to 55%) indicated the completion of one and more pharmacy students (from 66% to 77%) indicated that they planned to complete one. The survey also found that the percentage of current practitioners who have at least one child has decreased from 2004 (from 52% to 36%).
Job satisfaction. Respondents’ satisfaction with their current position and potential turnover has demonstrated some positive changes. Within the next 10 years, 75% of directors and 74% of middle managers do not anticipate remaining in their current positions, compared with 80% and 77%, respectively, in 2004. When asked, “If you were starting over, would you pursue health-system management,” 38% of directors selected “definitely would,” compared with 27% in 2004. The percentage of directors who were very satisfied with their positions increased from 31% in 2004 to 44% in 2011, while the percentages decreased for middle managers (from 32% to 19%) and current practitioners (from 31% to 22%).
Directors were most satisfied with the ability to influence the decisions that affect pharmacy, the sense of accomplishment they felt from doing their job, the amount of freedom they have to do their job, and interdepartmental relationships. The top 4 job characteristics that satisfied middle managers included making an impact and improving services, solving problems, helping people grow and develop, and being involved with organizational issues (e.g., patient safety). All 24 factors rated by directors increased in satisfaction; the 12 rated by middle managers were rated very similarly compared with the 2004 survey.
Pharmacy students highly valued the same job attributes as in 2004, including the ability to apply their knowledge, advance and grow professionally, balance work with personal life, and solve problems at the individual patient level.
Mentors. Mentors and the desire for work–life balance revealed some trends. Since 2004, more middle managers (from 37% to 46%) and current practitioners (from 31% to 53%) have embraced the use and value of career mentors. More current practitioners (from 16% to 23%) and pharmacy students (from 17% to 24%) were career focused than seven years ago.
Leadership pipeline. The leadership pipeline demonstrated an increase in current practitioners (from 30% to 45%) and pharmacy students (from 62% to 63%) who intend to seek a leadership position during their career. New questions were included in this survey, asking directors about succession planning for their own position. Their responses reflected that slightly over half still do not have a succession plan for their position. Forty-eight percent indicated that there was someone they considered qualified and would recommend to do their job, compared with 44% in 2004, with 71% in 2011 believing that the person would be somewhat or very likely to accept the position.
A higher percentage of employers (from 3% in 2004 to 17% in 2011) had the ability to fill vacant leadership positions within two months, and 37% of employers reported that filling a leadership position was more difficult than it was three years ago (from 57% in 2004). The top three reasons for this difficulty included a lack of practitioners with leadership experience (74% versus 55% in 2004), the belief that these positions are tougher or more stressful than in the past (63% versus 35% in 2004), and a lack of interest among current practitioners (58% versus 50% in 2004).
Since 2004, new leadership programs have been developed, including the Pharmacy Leadership Academy,8 Pharmacy Leadership Institute,9 “leadership conversations” videos,10 and Leadership Resource Center,11 as well as the ongoing ASHP leadership conference.12 Participants indicated that the conference provided them with new insights, a broadened perspective, and a network of colleagues in similar positions. These survey data revealed that the awareness or use of these programs was higher by directors and middle managers than by current practitioners.
Discussion and recommendations. Interestingly, even though a lot has changed since the 2004 survey, such as the country’s economic situation and a new health care reform law,13 these two data sets are remarkably similar.
These data suggest that while the pharmacy leadership crisis has been somewhat mitigated, work is still needed to avoid a pharmacy leadership crisis in the next 10 years. The recommendations that follow are offered to stimulate discussion and continued work in the pharmacy leadership arena.
Recommendation 1: Continue and enhance the current leadership development and training programs for emerging, aspiring, and current leaders. Since many of these programs have been operational for several years, it is time to (1) comprehensively survey participants and faculty, (2) review, assess, and reevaluate resources to fine-tune program effectiveness, and (3) capitalize on the gains and advantages each program offers. Applicable newer technology (e.g., podcasts, YouTube videos, MP3 downloads) should be evaluated and integrated to improve and expand the learning experience.
Recommendation 2: Design, implement, and conduct leadership development and training opportunities for all pharmacists to ensure leadership as a professional obligation. A concerted new effort in both schools of pharmacy and residency programs should be undertaken to ensure that all pharmacists have basic leadership skills and the commitment to continue to innovate pharmacy services on behalf of patients. Specific curricular programs should be designed and offered for all current pharmacists. Most importantly, the transformational organizational change currently in demand requires a learning culture (i.e., learning together) and transformative learning opportunities for every individual to achieve results. ASHP and the ASHP Research and Education Foundation should support this learning culture by providing opportunities for development for individual practitioners, collaborative teams, and departments seeking to meet the challenges.
Recommendation 3: Support and assist current formal leaders. Once leaders are provided basic skills-development opportunities, it is imperative that they have a leadership community and programs to draw on when faced with the inevitable new problems and challenges, such as how to maximize social media. An efficient way to connect those who have or are gaining leadership experience with specific situations so that others may benefit from the lessons learned is needed, perhaps in an “on-demand” mode. State and national acknowledgement or recognition programs for excellence in pharmacy leadership could ensure the retention of superior leaders. An annual “leadership think tank” should be investigated.
Recommendation 4: Provide an efficient way for current leaders to stay abreast of new and emerging trends that will affect them. Since there are many demands in leadership positions, the available time to look ahead and plan is minimal. Concise and ongoing assessments of current and future trends should be developed and provided by the ASHP Leadership Center.
Recommendation 5: Reevaluate the need for a comprehensive metrics-based evaluation of critical pharmacy measures that reflect the contemporary “business of pharmacy” and support the qualitative and quantitative evaluation of contemporary pharmacy services in an increasingly hostile fiscal environment.
Recommendation 6: Whatever assessment or program development is undertaken, the plan should be developed from an integrated and curricular perspective and not as individual initiatives for improvement. A comprehensive plan that offers an umbrella of resources that are responsive to current and emerging demands and fluid in response to change will be the weapon of choice in responding to the leadership challenges we face.
Conclusion. Despite the programs, inroads, and advances, there is still the potential for a health-system pharmacy leadership crisis in the next 10 years. However, we have developed an infrastructure of learning and development that will serve us well in anchoring further development. While the efforts of the ASHP Leadership Center are paying off, new programs and initiatives are needed.
The assistance of Colleen Bush is acknowledged.
Supplementary material is available with the full text of this article at www.ajhp.org.
The authors have declared no potential conflicts of interest.
- Copyright © 2013 by the American Society of Health-System Pharmacists, Inc. All rights reserved.