CONTINUING EDUCATION

Published through an educational grant from WYETH-AYERST LABORATORIES
TRENDS IN PHARMACY AND PHARMACEUTICAL CARE

An ongoing CE program of The University of Mississippi School of Pharmacy and DRUG TOPICS

The University of Mississippi School of Pharmacy is approved by the American Council on Pharmaceutical Education as a provider of continuing pharmaceutical education. Accredited in every state requiring CE. ACPE # 032-999-02-019-H04

This lesson is no longer valid for CE credit after 9/30/04.

CREDIT:

This lesson provides two hours of CE credit and requires a passing grade of 70%.

OBJECTIVES:

Upon completion of this article, the pharmacist should be able to:

• Relate why leadership skills are important to pharmacists
• Describe the characteristics of good leaders
• Identify the commandments for successful leadership
• Discuss the styles of leadership and the factors affecting leadership style
• Explain the ingredients for good leadership and suggest ways to improve leadership

GOAL:

To increase the pharmacist's awareness and understanding of the components of leadership and how to apply this knowledge to improve his organization's efficiency

Effective leadership:
The pharmacist's role and responsibility

By Dewey D. Garner, R.Ph., Ph.D. Chair and Professor Department of Pharmacy Administration The University of Mississippi

There they go. I must follow after them, for I am their leader.

—Anonymous

What is leadership?

Leadership is defined in various ways; however, all of the definitions have common elements. In one of the most comprehensive definitions of leadership, Gary A. Yukl, in his book entitled: Leadership in Organizations, 4th ed., defines leadership as the process wherein an individual member of a group or organization influences the interpretation of events, "the choice of objectives and strategies, the organization of work activities, the motivation of people to achieve the objectives, the maintenance of cooperative relationships, the development of skills and confidence by members, and the enlistment of support and cooperation from people outside the group or organization." This single definition includes individuals, groups, organizations, objectives/strategies, influence, and acceptance. In simplest terms, leadership is the ability to decide what is to be done and then to get others to want to do it. The purpose of leadership is to accomplish the mission. It involves putting people, things, time, and effort together to accomplish a group goal.

Leadership vs. nonleadership

Leadership facilitates the accomplishment of the work and develops the employee; nonleadership accomplishes the work at the expense of the employee. A leader inspires the employee to do his/her best to accomplish the tasks at hand; a nonleader drives or pushes the employee along. A leader assumes the obligations and consequences of the role; a nonleader will pass blame to others. A leader serves while leading. He shows the employee how to do the job. A leader has the skill to awaken emotional as well as rational powers of the followers. A nonleader instills fear in the followers by threats and coercion. A leader knows that positive influence comes from dedication, and not knowledge alone. A comparison of leadership and nonleadership can be seen in Table 1.

Importance of pharmacist leadership

Effective leadership is essential if we as a profession are to provide high-quality patient service and deliver the concept of pharmaceutical care we embrace. We are literally undergoing a revolution in the delivery of health care, and leaders are needed in such difficult times. Recall the Swedish proverb: In calm water every ship has a good captain. We are treading in turbulent waters today, and we need inspiring, competent leaders. Leadership affects how the work is done, how well the organization or system performs, and whether the objectives are achieved.

Organizational leadership

How do we contribute to the leadership process in our organizations? Or can we?

Some argue, "Leaders are born, not made." Others propose that all leaders possess certain personality traits. Based upon their experience and reading of the leadership literature, a group of pharmacists offered these responses:

• "Potential leaders are born, but it takes a combination of genetics, experience, training, and fate to make them leaders."

• "There are individuals who are born leaders and possess certain traits, however, many researchers have concluded that individuals can learn and practice certain technical skills that make them good leaders. Effective communication, empathy, authority, and social skills can be taught and combined with an individual's personality to make him/her an effective leader."

"One's environment plays a crucial role in leader development. For example, a leader must learn what type(s) of leadership styles should be utilized in specific situations. One setting may require an autocratic style, while another may need a form of group decision-making. A leader is not born with this skill."

"People are born to become leaders. As they go through life, they acquire the knowledge and refine their personality traits, which allows them to recognize their leadership potential."

These findings suggest that while a leader may be born with specific leadership traits in physical characteristics, personality, and ability, these traits may also be learned or fine-tuned through practice and by interacting with one's environment.

To effectively contribute to the leadership process, the leader must have influence with the members of his organization. John French and Bertram Raven in their book, The Bases of Social Power, offered a fivefold framework of influence (power).

1. Coercive power, which relies on fear and is based on the expectation of the subordinate that punishment is given for not agreeing with the superior's actions and beliefs

2. Reward power, which sees that rewards are granted for compliance with the superior's actions and wishes

3. Legitimate power, which is derived from the supervisor's position in the organization

4. Expert power, which stems from the individual's possessing some special skill, knowledge, or expertise

5. Referent power, which is based on identification of a follower with a leader who is admired and held in high esteem by the follower.

This framework supplies distinction among the possible power bases and is helpful in knowing from where the power arises and something of its nature.

To effectively contribute to the leadership process in our organizations, we must have interaction with the members of the organization. The leader is related to the employees in some way, and the employees likewise are related to the leader. How much interaction should occur for good leadership to exist depends upon what is to be accomplished, the behavior of the people involved, the knowledge and ideas that each employee can contribute toward solving a problem, and the permissiveness of the general environment. For routine matters, little interaction is necessary. If the issue requires new ideas, is constantly changing, and seriously affects the leader and many employees, the need for interaction is critical.

Characteristics of good leaders

Dr. Curt Reimann, director of the Malcolm Baldrige National Quality Award, has summarized the characteristics of excellent leadership as follows. They are:

• Visible, committed, and knowledgeable. Leaders promote the emphasis on quality and know the details and how well the organization is doing.

• A missionary zeal.- The leaders are trying to effect as much change as possible. Identify one core value of your organization and drive it through the system.

• Aggressive targets. Leaders go beyond incremental improvements and look at the possibility of making large gains, getting the whole workforce thinking about different processes, not just improving processes.

• Strong driver. In health care, leaders clearly define patient satisfaction and quality improvement objectives.

• Communication values. Leaders provide written policy guidelines and other documented statements for clear and consistent communications.

• Customer contact. Leaders are accessible to patients.

Successful leadership

There are a few commandments for successful leadership which summarize some important features for today's successful leaders. Think about these things:

• Leaders must have direction and desire. In the simplest terms, a leader is one who knows where he/she wants to go; then gets up and goes.

• Leaders must realize that they do not have all of the answers. Success is dependent upon communication with others. Successful leaders do not make all decisions alone. The most successful leaders realize that none of us is as smart as all of us.

• Leaders should set the example. If the leader chooses to gossip or betray a confidence, then he/she should not be surprised when others do likewise.

• Success is dependent upon one's ability to work with everyone. Be careful with the label "problem worker," because the problem may be originating with you.

• There is strength in admission of error. If you are mistaken, admit it.

• Remember that there is plenty of room in the spotlight. All employees deserve respect and praise when their jobs are completed to the best of their ability. Successful leaders shine the spotlight on others. A good leader takes a little less than his/her share of credit. There is truth in the adage, "There is no limit as to what you can do if you do not care who receives the credit."

• The leader sees leadership as responsibility rather than as rank and privilege. When things go wrong—and they always do—leaders do not blame others. Napoleon said: "There are no bad soldiers, only bad officers." A good leader takes a little larger share of the blame.

• Effective leadership does not depend on charisma. Leadership is often mundane, unromantic, and boring. Its essence is performance.

• While communicating, it is best to remember that we were made with one mouth and two ears. Successful leaders listen twice as often as they speak. Successful leaders try to make followers comfortable in challenging them.

• Leaders set the tone. There is a saying in the Yukon: The speed of the leader is the speed of the pack. And there is only one thing all great leaders have in common—their uniqueness.

• To be an effective leader, one must earn trust. Otherwise, there will be no followers. It is not necessary to like a leader to trust him/her. Nor is it necessary always to agree with him/her. Trust is the conviction that the leader means what he says. It is a belief in something very old-fashioned: integrity. Effective leadership is not based on being clever but on being consistent and fair.

• Great leaders know human relation skills. Great leaders get extraordinary things done by inspiring and motivating others toward a common purpose.

Perhaps the legendary coach of the Alabama Crimson Tide expressed it best:

"I'm just a plow hand from Arkansas, but I have learned how to hold a team together; how to lift some men up; how to calm down others; until finally they've got one heartbeat together—a team. There's just three things I'd ever say: If anything goes bad, I did it. If anything goes semi-good, then we did it. If anything goes real good, then you did it. That's all it takes to get people to win football games for you."

Leadership: Whose responsibility?

Leadership is the responsibility of management. The job of the manager is to lead, to help people in the organization do their tasks better. In hiring people, management takes responsibility for their success or failure.

Edward Deming, leader of the quality movement effort in America, stated that it is the responsibility of management to discover the barriers that prevent workers from taking pride in what they do. The workers know exactly what these barriers are: an emphasis on the numbers, not quality; turning out the product quickly rather than properly (how many prescriptions can you produce in an hour?); turning a deaf ear to their suggestions; too much time spent on correcting errors. The system is responsible for 85% of the problems, and employees are responsible for 15%, and management is responsible for the process. It is management's job to institute leadership.

"Lead, follow, or get out of the way." —Anonymous

Styles of leadership

Identifying our style of leadership is not an easy task. The styles of leadership are illustrated in Figure 1. They are arrayed as a continuum ranging from autocratic to laissez-faire. The extremes are often referred to as "autocratic" and democratic, respectively. Autocratic leadership tends to be work-centered. It is a powerful approach in which the leader closely supervises to ensure that the designated work is performed. The formal organization structure is respected at all times. Orders and directives are given, but frequently an explanation for them is not given. The autocratic leader uses commands generally supported by sanctions, of which discipline is among the most important. The effectiveness of an autocratic leader depends upon his power to reward or punish. An autocratic style of leadership may be appropriate in an operating room because work activity must be performed precisely and immediately, perhaps under crisis conditions. If subordinates are skilled professionals, the leader may readily seek their opinions and use a consultative approach. If the work is routine, clerical, and must have a specific sequence flow, then the leader may be more consultative.

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A participative leader takes the position that his followers want to do their best and that he can lead best by supporting their efforts. To this end, the leader creates a work environment that promotes the desire by each follower to perform to the best of his ability, cooperate with others, and develop his own skills and abilities.

A democratic leader encourages followers to participate concerning decisions to be made. While this style of leadership does have democratic aspects, it implies rule neither by the majority nor by vote.

Laissez-faire leadership is the direct opposite of autocratic leadership. The leader gives complete freedom in determining activity to his followers. The leader does not participate, or if he does, very little. The laissez-faire leader submits various data and materials, either voluntarily or by request to the followers, but he takes no part in work discussions. He communicates essentially when he is communicated to, making very infrequent comments on the activities of his followers unless questioned. Laissez-faire groups tend to develop informal leaders, and they frequently form a group whether formally designated or not. Which is correct?

Leadership is complex, and no one style of leadership is correct for all situations. Figure 1 shows alternative ways for leaders to approach decision-making, dependent on how much participation they want from followers. The more modern approach to leadership is the recognition that the appropriate pattern of leader behavior is contingent upon the situation. Leaders should examine themselves, the costs, and the benefits of the leader authority style they use. The perceptive leader can determine when and how to change leadership behavioral style to fit the followers, the time, and the place.

Success is largely a function of the leader's ability to develop a winning combination of leadership styles. Many leaders consider participative or democratic styles to be superior to autocratic styles in terms of their contribution to productivity and follower satisfaction in the delivery of healthcare services.

Factors affecting leadership style include:

• The importance of the results

• The nature of the work

• The characteristics of the workers

• The personal characteristics of the leader

In most cases, the importance of the results is defined in monetary terms. The cost of possible error should be taken into consideration whenever selecting the leadership style. Under the nature of the work, participative leadership is possible only if there is adequate time to seek the opinion of others. It must be used with sincerity and must be legitimate. The workers must have the skill and expertise in the matter under discussion and be willing to participate. Personality traits such as age, self-confidence, resourcefulness, and dependence greatly influence the leadership style.

Contingency theories of leadership

By the early 1960s, it had been determined that styles of leadership such as autocratic or democratic behavior could not fully explain leadership effectiveness, and it was found that behavior that was appropriate in one circumstance produced failure in others. Researchers began incorporating situational factors, or contingencies, into leadership models. Fred Fiedler was the first to undertake a comprehensive attempt to incorporate situational variables directly into a leadership theory. Complex theories typically have ample room for criticism, and Fiedler's is no exception; however, most research supports his model. His model has considerable utility in management practice, especially in suggesting to managers the importance of systematically assessing their position power, leader-follower relations, and task structures in relationship to their leadership styles and, in turn, how this affects their effectiveness as leaders.

Fiedler's research focused on specifying situations in which certain leader styles would be particularly effective. The phrase contingency theory refers to Fiedler's hypothesis that effective leadership is contingent on whether the elements in a particular leadership situation fit the style of the leader. He sought to identify leader styles that fit particular situations and that could be used to improve leader effectiveness by changing leader styles to fit situations, selecting leaders whose styles fit particular situations, moving leaders in organizations to situations that fit their styles, or changing situations to better fit leader styles. Fiedler was interested in whether a leader was more task- or relations-motivated.

The task-motivated leader is more concerned about task success and task-related problems. Such leaders are motivated primarily by achieving task objectives and are not motivated to establish good relationships with followers unless the work is going well and there are no serious task-related problems. In contrast, the relations-motivated leader is more concerned with good leader-follower relations; is motivated to have close interpersonal relationships; and will act in a considerate, supportive manner when relationships need to be improved. For such leaders, the achievement of task objectives is important only if the primary affiliation motive is adequately satisfied by good personal relationships with followers.

Later, Paul Hershey and Kenneth Blanchard developed a leadership model to explain effective leadership as interplay among the leader's relationship behavior. This is defined as:

• The extent to which leaders maintain personal relationships with followers through open communication and by exhibiting supportive behaviors and actions toward them

• The leader's task behavior, which is the extent to which leaders organize and define roles of followers and guide and direct them

• The followers' readiness level, which Hershey and Blanchard define as readiness to perform a task or function or to pursue an objective

This model focuses on followers as the key situational variable—specifically their readiness to perform. The central premise is that the most effective leadership style is determined by the readiness level of the people whom the leader is attempting to influence. This model is widely used by managers because it is intuitively appealing. The model also provides a useful reminder to leaders that it is important to treat followers as individuals, with real differences among them.

Leaders vs. bosses?

What is the difference between leaders and bosses?

Theodore Roosevelt said, "People ask the difference between a leader and a boss. The leader leads and the boss drives." Harry Selfridge, developer of one of the largest department stores in London, stated: "The boss drives the people; the leader coaches them. The boss depends upon authority; the leader, on goodwill. The boss says, 'I'; the leader, 'We.' The boss fixes the blame for the breakdown; the leader fixes the breakdown. The boss knows how it is done; the leader shows how. The boss says, 'Go'; the leader, 'Let's go!'" Which do you think is more effective? Being a leader or being the boss?

What is good leadership

The ingredients that are predictive of a good leader are as follows:

• A great personal clarity of mission, a belief in one's own ability to lead, and a devotion to the people and the organization one is serving. What are the needs of your patients, for example? What do you have a passion to deliver? Your mission is where the two shall meet. It is important that your people agree on the mission and on the governing values that will get you there.

• Predictability. People want to know where they stand with you, so be consistent.

• Enthusiasm. If you sincerely like an idea, the way an individual did a job, reflect this to others in words and manner. The personal atmosphere you create determines whether people will have the welcome mat out for you or give you the busy signal.

• Self-denial. A willingness to forgo self-indulgences (like blowing your top); the ability to absorb the headaches the job entails.

• High character. Be honest with yourself and with others. To quote Abraham Lincoln, "No man has a good enough memory to lie." A leader must be willing to face unpleasant situations with courage, be able to take criticism for his/her own mistakes, and be sincere and dependable.

• Interest in the individual's welfare. People want a leader they can trust in time of need, a person to whom they can go when they need advice about personal matters.

• Job competence. A person who knows the requirements of the job he/she supervises will be a more effective leader.

• Energy. Leadership at any level means rising early and working late. It leaves little time for escape from problems. Good health and good nerves make this job easier.

• Equality in treatment of others. People insist on a leader's having a sense of fair play. They want to feel they are being given assignments entirely upon their merits and that the leader will not play favorites. Not only is favoritism a sign of weak character, it can also wreck an organization.

• Good judgment and common sense. A good leader needs the wisdom to look into the future and plan for it. These additional ingredients make for the best leaders.

Supervisor's guide to leadership

Shoot for personal excellence. Tell your workers to do their best. Create an environment that releases the capacity of your people, making them proud to do their best. Debrief major mistakes and major successes, covering the mistakes in private.

Get participation. Leadership grows in a culture that nourishes it. Ideas flow and enthusiasm builds when everyone is in on the act. Find a challenging goal, and get everyone involved in achieving it. Encourage constructive discussions on departmental problems, seek ideas, and provide greater authority and responsibility in important matters whenever possible.

Balance criticism by giving credit for good work. Notice when people do things right, and recognize these contributions.

Pay attention to the individual. Cooperation starts with the individual. Make each member of your work team conscious of his/her individual responsibilities to the success of the group. This is the way to build a competitive employee team.

Give recognition. Be quick to credit a job well done. Show people you accept and value them. Treat people as individuals. Express a pride in their accomplishments. Credit is one of the few things you can give away and still keep.

Be confident of your subordinates. If employees understand that you trust them to do the job right, while being available to help when they have problems, they will perform satisfactorily. Leadership is inspiring confidence in others.

Don't avoid decisions. While good leaders obtain advice when they must solve a problem, they also know that the final decision is up to them.

Develop good communications. Effective communication goes up and down the organization. Employees want to hear their supervisor's ideas and plans. They are interested in all matters that affect their jobs. Stay in contact with your people. Consult with them. Listen to their suggestions. Provide them with wanted information.

Improving leadership

The following suggestions are offered as ways to maximize leadership:

• Be technically and tactically proficient.

• Know yourself, and seek self-improvement.

• Know your people and look out for their welfare.

• Keep your people informed.

• Set the example. Be what you ask your people to be. Do what you ask your people to do.

• Ensure that the task is understood, supervised, and accomplished.

• Train your people as a team.

• Make sound and timely decisions.

• Develop a sense of responsibility in your subordinates.

• Employ your command in accordance with its capabilities.

• Seek responsibility, and take responsibility for your actions.

Additional considerations

It is appropriate to mention some additional considerations of leadership that may help one understand it more fully. These were presented by George Terry in his book, Principles of Management.

First, some irritations are almost always present in the leader-follower relationship. This is simply human nature. Many people are not well organized or self-motivated. They accept others to get them to do what they know should but will not be done unless leadership is present. The leader can be liked or disliked, but he must have the respect of his followers. They may not be overcome with affection for him, but they are glad to have the leader they have because they are getting somewhere.

Leadership requires followers. Leaders are created as the result of either formal or informal actions. Whatever the reason, to be effective the leader must retain and develop the continued acceptance and the confidence of the group members.

Time influences leadership. For example, most leaders are influenced somewhat by the time in which they live, as revealed by the opportunities which either exist or can be created during their active work life. We are all conditioned to a greater or less degree by the times in which we live. Furthermore, a time of emergency seems to bring about a greater emphasis on leadership. A good example of this is the September 11th tragedy in New York City and the embracement of Mayor Rudolph Giuliani as leader.

Finally, a leader operates in the light of publicity; people know his achievements or failures. When the leader is successful, many will emulate his achievements, but a few will envy his accomplishments. There are always a few who delight in clamoring denial of a leader's achievements. However, the successful leader is not deterred from his appointed goal by these minority cries. He continues to lead and remain a leader.

Conclusion

Your profession and your organization depend upon the quality of its leadership. Remember, good people will not stay forever in an organization lacking quality leadership. They will leave. Leadership is about action. Leaders get up and go. You will discover that every organization is perfectly aligned to get the result it is getting. Leadership is required to get the organization to its next level. What an opportunity and what a responsibility! It is all up to you. If you have vision plus ability and willingness to lead your profession and organization, then, to paraphrase William Faulkner, "Your organization will not merely endure, it will prevail."

References are available upon request.

TEST QUESTIONS

Write your answers on the answer form below (photocopies of the answer form are acceptable) or on a separate sheet of paper. Mark the most appropriate answer.

1. Leadership is defined in various ways; however, all of the definitions have common:

a. Elements
b. Objectives
c. Goals
d. Processes

2. What is the purpose of leadership?

a. To make money
b. To become famous
c. To accomplish the mission
d. To feel important

3. Who summarized the characteristics of excellent leadership as being visible, having aggressive targets and missionary zeal, being strong drivers, and having communication values, and customer contact?

a. Richard Nixon
b. Curt Reimann
c. William Apple
d. Peter Drucker

4. A truly successful leader is one who:

a. Has all of the answers
b. Does not have all of the answers
c. Is an excellent follower
d. Is smarter than everyone else

5. Successful leaders are those who:

a. Take less of the credit
b. Take more of the credit
c. Blame others for their mistakes
d. Never admit their mistakes

6. What is the one thing all great leaders have in common?

a. They are great followers.
b. They are charismatic.
c. They are highly intelligent.
d. They are unique.

7. Effective leadership is based upon:

a. Being consistent and fair
b. Being right
c. Being wise
d. Being in power

8. Leadership is the responsibility of:

a. The followers
b. The employees
c. Management
d. No one

9. Employees are responsible for what percentage of the problems that occur in an organization?

a. 15%
b. 40%
c. 75%
d. 90%

10. Which style of leadership allows the greatest freedom for followers?

a. Autocratic
b. Consultative
c. Democratic
d. Laissez-faire

11. Many leaders consider which style of leadership to be superior in terms of their contribution to productivity in the delivery of healthcare services?

a. Autocratic
b. Consultative
c. Participative or democratic
d. Laissez-faire

12. What is the difference between a leader and a boss?

a. A leader drives, and a boss leads.
b. A boss drives, and a leader leads.
c. A boss says "we," and a leader says "I."
d. A boss fixes the breakdown; a leader fixes the blame for the breakdown.

13. The point where the needs of your patients and your passion to deliver meet defines your:

a. Tactics
b. Objectives
c. Strategy
d. Mission

14. Which one of the following is not an ingredient for good leadership?

a. Good judgment and common sense
b. Enthusiasm
c. High character
d. Inconsistency

15. Favoritism is a sign of weak:

a. Character
b. Criticism
c. Structure
d. Management

16. Self-denial is:

a. The ability to absorb the headaches the job entails
b. A belief in your own ability to lead
c. A willingness to face unpleasant situations with courage
d. The wisdom to look into the future and plan for it

17. Balancing criticism by giving credit for good work means:

a. Debriefing major mistakes in private
b. Catching people doing the right things and recognizing these contributions
c. Listening to your people's suggestions
d. Inspiring confidence in others

18. A good leader:

a. Does not avoid decisions
b. Does not listen to suggestions
c. Does not give individual recognition
d. Does not communicate with followers

19. What is not a good suggestion to improve leadership?

a. Keep your people informed.
b. Make sound and timely decisions.
c. Let your people set the example.
d. Train your people as a team.

20. Your profession and your organization depend upon the quality of their:

a. Leadership
b. Finances
c. Influence
d. Environment

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