Leadership, advocacy and pharmacy – our future is bright

What a difference a few weeks can make! A few weeks ago, in this very space, I wrote a subjective opinion piece related to my perspectives on the drug shortages issue, particularly as it related to acetaminophen. This is an issue that is both professionally and personally distressing to me, and one that highlighted gaps and problems in our professional and health system structures that are both frustrating and difficult to understand. Little did I know that this article would strike such a chord with so many people. As someone who has very carefully and deliberately avoided social media channels, I’m not the easiest person to find online—yet found I was. I received many emails and messages. Clearly, raising questions about pharmacy advocacy is a topic of interest. Some people who contacted me expressed not just concern, but hostility and anger regarding the trajectory of our profession. Regrettably, in some cases the tone of this concern and anger bordered on alarming. While this is clearly a difficult time for many, devolving into uncivil language is something we as pharmacists and professionals must be very careful about. Learning to disagree without being disagreeable is an important skill for all of us. Learning what leaders do Some of the most interesting conversations I’ve had over the last week have been with leaders and advocates in our profession. What I’ve learned from them has been very important for me as a pharmacist and for helping me understand more about what it takes to be a leader at this time. Shakespeare wrote in Henry IV Part Two: “…heavy is the head that wears the crown,” alluding to the unique burdens and responsibilities carried by those who lead. In the context of drug shortages, pharmacy practice and health system challenges, these words resonate in ways he (and I) could never have imagined. My conversations with leaders and advocates have helped me understand how much work has been going on that many of us may not see or recognize in our day-to-day lives. The volume of work that leaders in pharmacy manage today is astonishing—beyond the emails and social media and meetings, leaders juggle tremendous workloads along with tremendous responsibilities. In such fast- paced environments, it is essential that they work in ways that are tactical, strategic and intentional, with a clear focus on priorities that go beyond individual interests or wants. What is particularly impressive to me is the unprecedented degree of collaboration and cooperation amongst different arms of the profession in tackling this specific issue of acetaminophen shortages: employer groups, professional associations, regulators, hospital pharmacy groups and community pharmacy groups have come together over the shortages issue in ways that help pharmacy as a profession speak with a cohesive and powerful voice like never before. This collaboration has resulted in development of a diverse and broad repository of resources for patients, pharmacists, other health care professionals, payors, governments, regulators and policy makers. The work is being done, the message doesn't always get out Of course, these individuals recognize and respect the reality that pharmacists have only so much time in a day and only so much bandwidth to read emails, link to websites and stay abreast of such a fast-changing professional environment. The resources they’ve developed and the guidance they offer may be lost amongst the numerous other demands for our attention. They recognize that finding new ways to reach different audiences (especially people like me who have shied away from new-fangled social media channels) is essential, and that rethinking the way leadership and advocacy is communicated within a complex and diverse profession like pharmacy is important. Perhaps most importantly, my conversations highlighted the commitment and dedication these individuals show not just for their profession but for the patients our profession serves. Their focus on solutions and practical approaches is essential: the bureaucratic and political complexity of advocacy work is astonishing and, as one leader put it, “patience and realizing this is a long game” is essential. To a person, the leaders and advocates I spoke with over this last week were dedicated pharmacists who saw their profession as an opportunity and a responsibility to act at the broadest levels possible—even if that means reading cranky articles like mine that raised questions about their success. So where does this leave us and our profession? Here's what I have learned: • Advocacy work is like an iceberg: those of us who are not directly involved only see the tip of what is a very deep process. • As a profession (and as citizens) we have a responsibility to remain civil and productive in our discussions. By all means it is important to raise questions, debate and discuss, but the tone of these conversations needs to remain objective and open-minded, and not devolve into unhelpful person-based criticisms. We should all be grateful that some members of our professions have elected to put themselves into leadership roles at a time when leadership has never been more professionally, or personally, difficult. • There is (and always will be) room for improvement. The level of collaboration and communication amongst our advocates at this time of drug shortages has been impressive. But finding ways to share this as broadly as possible with the rest of the profession continues to be a challenge given the multiple competing demands on everyone’s time and energy. And while productive and cooperative processes are the essential first step towards resolving issues, we also need better ways to highlight the successful outcomes and acknowledge the unavoidable limitations of leadership and advocacy without defaulting to the word “failure.” Finding ways to remain positive and productive despite the challenging circumstances facing our health system and our profession must be a priority. Conversation and communication will be central to that effort. Working together is our best option. Maintaining a civil and professional tone in our conversations and in our disagreements is essential if we are to continue to evolve as a profession to meet the ever-expanding needs of our patients. Zubin Austin BScPhm MBA MISc PhD FCAHS is a professor and Koffler Research Chair at the Leslie Dan Faculty of Pharmacy. His research focuses on the professional and personal development of the health workforce. He has published over 250 peer reviewed articles and four textbooks including the recently published Human Resource Management in Pharmacy, commissioned by the American Pharmacists Association.

Leadership, advocacy and pharmacy – our future is bright

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