Leadership in the time of crisis: another missed opportunity

Since the start of the COVID-19 pandemic in March 2020, community pharmacy has emerged as both a focal point of primary care and a hotbed of discontent. At a time when community pharmacists have been needed like never before, these same community pharmacists have experienced occupational stress and burnout in unprecedented ways. It has truly been the worst of times and the best of times to be a pharmacist. Undeniably, the events of the pandemic have been—to say the least—impossible to plan for or predict. The Oxford dictionary defines a crisis as “a time of intense difficulty, trouble or danger” and a “time when a difficult or important decision must be made.” A further definition includes “the turning point of a disease, when an important change takes place, indicating either recovery or death.” While the pandemic grinds onwards beyond 30 months, the sense of urgency surrounding those strange dark days of March 2020 have receded for many of us—but the consequences and knock-on effects persist now and into the future. Prior to the pandemic, there were innumerable “issues” facing the pharmacy profession: staffing, remuneration, expansion of scope of practice, workload, and occupational stress and burnout. A critical issue facing the profession at that time included drug chain supply problems and medication shortages. Learning to manage these shortages has become a subspecialty area for community and hospital pharmacists alike. The global shutdown during the pandemic—and the subsequent rearrangements of supply chains due to geopolitical tensions that have evolved since that time—have turned the concept of “just in time” inventory management into a catastrophe. Currently, one of the most pressing issues facing the profession, and the general public, is the well-publicized shortage of acetaminophen liquid formulations across Canada and other parts of North America. This too is one of the knock-on effects of the pandemic and its impact on production, procurement, and supply chains. Recent media coverage of this issue has highlighted the very real and traumatizing effects of this shortage for parents and families. Stories of anguished fathers and mothers looking for relief for their infants and babies are heartbreaking. Some media have also highlighted the “moral distress” faced by many pharmacists who must bear silent witness to their patients’ suffering and are seemingly trapped with few viable alternatives to suggest. Yes, in some places, compounding pharmacies can help; yes, an airlift of new supplies is on its way to rescue us; yes, tablet splitters and careful measurement, and sprinkling on applesauce may in some cases be a least-worst alternative. Yet again, pharmacists have been let down by leadership It is striking that during this time, professional leadership by pharmacy has been strangely absent. All pharmacists know of the literally heroic efforts of our colleagues in community practice who are helping patients as best as they can, absorbing their anxiety and anger in unsustainable ways, and being as creative in problem solving as possible under the circumstances. While individual pharmacists have—yet again—done unbelievably hard work in helping their patients, the pharmacy profession has—yet again—let them down. Everyday, across Canada, pharmacists are having to reinvent the wheel on their own, jerry-rig their own solutions and alternatives, and endure the same fear-based intense anger foisted upon them by an overwhelmed public. The acetaminophen shortage should have been a golden opportunity for the pharmacy profession to collectively demonstrate its leadership in solving problems, not simply in placating terrified parents. Our profession did not mobilize early enough and quickly enough to develop viable work-arounds that were evidence-based, safe, and effective alternatives…leaving individual pharmacists to figure this out on their own with increasingly distraught parents. Our profession did not act early enough on trends and data that signposted a pending problem, nor did we advocate vigorously enough to find alternative supply chains: media pressure on government officials and physician advocacy ultimately were the drivers of the recent “airlift” of emergency supplies. The acetaminophen shortage has highlighted again a leadership crisis within pharmacy. The heroic, stoic, and irreplaceable work of individual community pharmacists continues to be an inspiration and a lifeline for patients and communities. This is not, however, sustainable. The profession needs leadership to support it, so that the moral distress and burden of practice does not crush our already depleted workforce. This crisis should have been an opportunity for pharmacy—collectively—to actually lead public discussion, anticipate medical need, and vocally advocate for the best interests of Canadians…and yet these roles ended up being filled by other professions and groups, while individual pharmacists struggled in the trenches to do the best they possibly could for patients. A crisis such as this points to the need for leadership in the profession as a whole. The profession can learn so much from the individual front-line pharmacists who so selflessly support their patients while—at the highest levels where real change is possible—inertia seems to predominate. Pharmacies have data about supply, demand, sales, and shortages: leadership is needed to coordinate this data at the national level to identify and act quickly on trends. The severity of the “tainted water” catastrophe in Walkerton Ontario in 2000 was partially mitigated because sharp-eyed pharmacists noted unusual patterns of sale for over-the-counter anti-diarrheal products and alerted public health officials: as a profession, we should be at the point of maturity where our job is not to simply “alert” others any longer but actually act, solve problems, and lead implementation of solutions to reduce bureaucratic delay and to signal to the public the central role of pharmacy in primary care. As a profession, let us learn from this experience so that the next time around, pharmacy provides leadership worthy of our education, expertise, and role as primary care providers. 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 in the time of crisis: another missed opportunity

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