Pharmacy has changed and will continue to change. This evolution has been fueled by advances in clinical practice, innovations in technology, and expansion of the technician role, enabling pharmacists to play an increasingly powerful role in patient care.
An important prerequisite for continued development and success of the profession is the establishment and maintenance of a high standard of excellence in individual practice. Seven essential elements, if adopted, will aid the profession in achieving this distinction. They include:
· Development of a leadership philosophy that focuses on others
· Effective management of oneself as well as others
· Embrace of change and support of progress
· Promotion of a professional image
· Continuous development of skills and knowledge
· Disciplined professional practice
· Effective communication
An expanded role
More than the practice of related healthcare professions, pharmacy practice has been evolving and continues to evolve. This progression has been led by a cadre of pharmacy leaders and academicians who envision an expanded role for pharmacists based on a need to use medications more effectively and responsibly.
Technology has played a significant role in this evolution, by improving the efficiency and quality of product- and clinically-oriented components of pharmacy practice.
In addition, the emergence of a more independent and regulated pharmacy technician role has allowed pharmacists to focus their efforts on providing clinical expertise, rather than dispensing medications.
How to break through?
Thomas Mann posed a question that is ageless but timely for our profession: “At bottom, there is but one problem, and this is its name: How does one break through? How does one get into the open? How does one burst the cocoon and become a butterfly?”1
Pharmacy is on the brink of breaking through. In slightly more than 50 years, our profession has transformed from one focused on product to one on the verge of a focus on direct patient care.
One prerequisite for pharmacy to “burst the cocoon” is a collective realization of individual practice excellence.
This framework for development of practice excellence comprises seven key principles. While it is not intended to be comprehensive or authoritative, it is intended to serve as a springboard for creation of a personalized plan. We believe that adoption of these or similar elements will support the profession’s transformation and simultaneously promote a uniform profession-wide culture.
1. Learn to lead capably, with others at the center. Be guided by a definition of leadership
Pharmacists must establish themselves as leaders, inside and outside the profession. To accomplish this goal, practitioners must first determine a definition of leadership. Ours is simple: leadership is “making things better.”2 Opportunities abound in pharmacy practice; leaders choose to open their eyes and see them when many cannot or choose not to do so. Leaders question, probe, and look beyond the obvious. They envision a better state. Leaders are in search of distinction. They influence, affect, and improve.
Leadership is not the exclusive domain of assigned leaders, who occupy formal leadership roles, such as CEO, president, or chair. Each of us can make things better, regardless of our titles.
Strong leaders focus on others. Leadership centered on others is founded in three elements: connection, gratitude, and responsiveness.3
Connection is the intangible but undeniable emotional or intellectual link or bond between people.
Gratitude is the display of thankfulness, appreciation, or approval.
Responsiveness is ready reaction to suggestions, concerns, or appeals.
Leaders who connect with others, respond to needs, and display genuine and constant gratitude will surpass their peers.
2. Learn to manage others and yourself effectively and efficiently
Unlike leadership, which according to M. McKinney is “difficult but not complex,” management is difficult and complex.4
Textbooks partition management into five main functions: planning, organizion, staffing, direction, and control. We split management using the “excellence equation.” The excellence equation divides excellence into two components: people and systems.
Examples of the people component include hiring, training, and motivation.
Examples of the systems component include automation, procedures, and processes.
Executing the people and systems components drives excellence.
Additional components of effective management are delegation and accountability. Delegation does not mean transferring one’s own work to others. It is the process of ensuring that the division of labor is clear — that all are aware of what to do, and when and how to do it — and that the “what to do” is done and done well. Once the division of labor is clear, all must be held accountable.
Accountability is responsibility with consequences. Without consequences, there may be responsibility, but no accountability.
The self-management challenge
Managing ourselves is often more difficult than managing others. When performance is lacking, we must accept accountability for our shortcomings and do so without excuses — our focus is on the processes of learning and improvement.
When problems with our colleagues arise, we must address concerns directly, using active, assertive communication. We should escalate issues when appropriate, but only after peer-to-peer feedback has occurred and failed to result in the needed change. We must avoid ignoring the situation or complaining to another, uninvolved party; such actions never result in resolution of the issue.
3. Develop and project an appropriately professional, positive, crafted image. Look the part; act the part
Maintaining a professional appearance is important, whether one is behind the counter, at the bedside, or in the clean room. How you dress is a telling sign of how you feel about your job.
Furthermore, the message communicated by appearance plays a fundamental role in establishing trust and confidence. Numerous studies have shown that patients and colleagues hold a more favorable impression of those who dress in a professional manner.5-7 We suggest that as a result of heightened confidence, collegial recognition, and a magnified self-esteem, professional dress can even enhance performance.
Appearance is only one component of image, albeit the most visually evident. In shaping the desired image, each practitioner must include other components, as well. These include demeanor, reliability, work ethic, communication skills, assertiveness, ambition, energy, productivity, individual achievement, and team play.
Projection of a positive attitude is a core component of crafting a positive image. Negativity, complaints, destructive criticism, and pessimism never help. Practitioners have a responsibility as team players to support the efforts of leaders. They should not make their leaders’ jobs harder by compelling them to counter negativity, complaints, destructive criticism, and pessimism.
It is useful to adopt a model that distinguishes between complaining and problem-solving. The differences are threefold: Whom do you tell? How do you relate? What is your role?
Complainers tell people who are not in a position to resolve the problem; they frame the issue in a negative manner; and they are unwilling to participate in the solution.
Problem-solvers tell people who are in a position to resolve the problem; they frame the issue in a positive, hopeful manner; and they are willing, even eager, to participate in the solution.
4. Embrace change and make progress
The history of pharmacy’s evolution is linked to academicians’ and practitioners’ dedication to progress and willingness to take risks.
All practitioners must see themselves as either good leaders who make change or good followers who support change. We must challenge the status quo. Just because “we’ve always done it that way” doesn’t make the practice right or relevant today. We should spend a portion of the day asking “why?” or “what if?”
Progress requires change, and change is often a struggle. The vision is rarely achieved immediately; in fact, interim instability often masks progress throughout a transition. All leaders and followers must have the resolve to persist and prevail — to refine, but not turn back.
5. Commit to continuous self-development
According to the Collins English Dictionary, lifelong learning is “the provision and use of both formal and informal learning opportunities throughout people’s lives in order to foster the continuous development and improvement of the knowledge and skills needed for employment and personal fulfillment.”8 One can argue that because of their intimate impact on the health and welfare of their patients, healthcare professionals have a heightened responsibility to sustain an intense practice of lifelong learning.
After close to double-digit years of education and incredible expense, pharmacists must reject the inclination to close the door on learning. Pharmacists must avoid participating only in “osmosis learning” at work and supplement their experience-based learning with a constant, diligent, purposeful pursuit of additional knowledge. The Completion of learning activities simply to earn continuing education credits is not worthwhile. Instead, pharmacists should pursue opportunities to develop knowledge and skills that relate directly to their current or desired practice.
6. Practice in a disciplined manner
Disciplined practice is a key modality with which to reduce the potential for error and resulting harm.
The first step in achievement of disciplined practice is to identify and describe the goal. The second is to outline the steps that are likely to achieve the goal. The third is for each participant to adhere to each step in pursuit of the goal.
Disciplined technicians and pharmacists define a goal: e.g., “prepare a medication that exactly matches the label,” or “review a prescription to determine appropriateness and safety.” Next, they define the steps that are likely to achieve the goal. Then they adhere to each step — meticulously, religiously, absolutely.
Undisciplined practice in pharmacy is seductive, because the undisciplined practice — for example, skipping a step — frequently produces the desired result, promoting the belief that the step is unnecessary, even frivolous. Eventually, a practitioner who has not been adhering to the practice teaches the deviation to a new staff member, who isn’t aware that that the approach is rooted in risk. Then, in a given situation, the arrows in the Swiss Cheese Model align and a patient is harmed either by the first practitioner, who is aware of the deviation, or by the second, who is naïve.
7. Learn to communicate effectively
Listening is one of the most important elements of effective communication. The first step to better listening is to stop talking. Listening and talking simultaneously is a multitasking challenge that few can accomplish.
Linda Eve Diamond has established 10 rules of listening.9 Among these are to give nonverbal clues, such as nodding and leaning toward the speaker, avoid being a verbal trespasser by interrupting or finishing sentences, and ask open questions by using “what” and “why.”
Another step in effective communication is mastery of business writing. The litmus test for a successful business communication is whether the message received equals the message intended. That parity is achieved primarily through clarity. A clear, concise communication ensures the singularity of the message received and the message intended. In achieving clarity, writers are best served by adhering to the standard principles, conventions, and rules. Use standard punctuation and grammar. Avoid exclamation points. Use active voice. Use short sentences and short paragraphs. Use simple words and phrases.
The bottom line
Each pharmacy practitioner has a responsibility to contribute to the continued evolution and advancement of our profession. One means of fulfilling that responsibility is to pursue individual practice excellence, which in aggregate supports that evolution and advancement. The seven practice elements outlined above support individual practice excellence. If these elements are applied individually and collectively, pharmacy is poised to continue its dramatic and noble transformation.
2. Summerfield MR. Leadership: a simple definition. Am J Health-Syst Pharm. 2014: 71:251-3.
3. Summerfield MR. Leadership: Three key employee-centered elements with case studies. Baltimore: Self-published. 2013.
5. Lill MM, Wilkinson TJ. Judging a book by its cover: descriptive survey of patients' preferences for doctors' appearance and mode of address. BMJ. 2005;331(7531):1524-1527.
6. Gjerdingen DK, Simpson DE, Titus SL. Patients' and physicians' attitudes regarding the physician's professional appearance. Arch Intern Med. 1987;147(7):1209-1212.
7. Gjerdingen DK, Simpson DE. Physicians' attitudes about their professional appearance. Fam Pract Res J. 1989;9(1):57-64.
8. Collins English Dictionary. Lifelong learning. http://www.collinsdictionary.com/dictionary/english/lifelong-learning. (accessed 2014 Feb 28).
9. Diamond LE, 1000 Advices, “10 rules of listening.” http://www.1000advices.com/guru/listening_10rules_led.html (accessed 2014 Feb 1).
Agnes Ann Feemster is assistant professor, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy. Contact her at [email protected]. Marc R. Summerfield is president of Summerfield Consulting, Bel Air, Md. Contact him at [email protected].