A Vision of Pharmacy's Future Roles, Responsibilities, and Manpower Needs in the United States

This paper was prepared by the 1997-1999 ACCP Clinical Practice Affairs Subcommittee A: Michael S. Maddux, PharmD, FCCP, Chair; Betty J. Dong, PharmD; William A. Miller, PharmD, FCCP; Kent M. Nelson, PharmD, BCPS; Marsha A. Raebel, PharmD, FCCP, BCPS; Cynthia L. Raehl, PharmD; and William E. Smith, PharmD, PhD

Pharmacotherapy. 2000;20(8) 

In This Article

Providing Necessary Leadership and Management for the Future

...one gets the feeling that everything has already been said, and I can well imagine a pharmacist back in 1776, or even Galen before that, arguing about the need for change in pharmacy. We constantly seem to be wandering in the wilderness seeking our true identity.
William Kinnard, 1976 [74]

Let's dedicate ourselves to remaking this occupation of ours into a profession that gives people what they want and need. This is not an agenda that we can assign to someone else. Each of us must take personal responsibility for making this happen.
Zellmer, 1996 [9]

As we noted earlier in this paper, pharmacy has suffered from a fractionated vision of the profession due to the conflicting perspectives of different practitioner groups. Although a unified vision for all segments of the profession likely will occur with time, the changes in pharmaceutical education and in the health care and pharmaceutical industries are focusing pharmacists' efforts on utilizing their advanced pharmacologic knowledge to improve patient outcomes. The implementation of entry-level Pharm.D. programs has provided an opportunity to increase the consistency of pharmacists' abilities, regardless of their practice setting. The expansion of pharmacists' outpatient roles to include collaboration with other health care professionals in disease state management is an effort to improve patient outcomes and to control spiraling pharmaceutical and health care costs. The increased use of automation and the emphasis on the value of the pharmacist's unique knowledge and skills are other factors that may result in expansion of pharmacists' roles. The future health care environment may hold many opportunities for pharmacists if the leadership and management of the profession can respond quickly to focus the profession's efforts on improving patients' drug therapy outcomes.

The role of future pharmacy leaders will be to establish an innovative working environment by projecting a unifying vision for the profession and providing mentoring to pharmacy managers and staff. Pharmacy leaders must emphasize the responsibilities of the pharmacist to ensure the safe use of drugs by demonstrating a commitment to serving the drug-related needs of patients and other health care professionals.[75] Pharmacy leaders can provide direction to all health professions in improving drug-related outcomes. If future pharmacy leaders can embrace the objectives of health care reform (i.e., improved patient outcomes at an affordable cost to the patient and society) and proactively direct pharmacists' efforts to improve the medication use system, the profession will be well-positioned to adapt to future challenges.[76] Pharmacy does not require visionary "giants." In fact, future challenges will require that pharmacy leaders capitalize on the diversity of the pharmacy profession and accept responsibility for developing leaders from within its organizations. Pharmacy should attempt to foster an organi-zational and professional culture characterized by collaboration, teamwork, and empowerment.[77]

Accomplishing the necessary transformation in professional philosophy and roles will require that pharmacy's leadership engage in eight critical processes. First, pharmacy leaders must establish a sense of urgency to identify and seize major opportunities for the profession. Second, leaders must form a coalition to lead the change. Third, they must create a vision and develop strategies to achieve it. Fourth, they must communicate the vision and use examples from early coalitions that engage other pharmacists in achieving the vision. Next, they need to empower others to act on the vision by removing obstacles, encouraging risk-taking and nontraditional ideas, and changing systems that undermine the vision. Sixth, pharmacy leaders must plan for and create visible short-term accomplishments, and then recognize and reward pharmacists who are involved in achieving these initial outcomes. Seventh, leaders will need to consolidate improvements and produce more change by utilizing their increased credibility in the system. Even small improvements that occur with change will encourage pharmacists to follow leaders who want to make a difference. Sustaining the process by hiring, promoting, and developing pharmacists who can implement the vision will also be important. Finally, effective new behaviors must be institutionalized and promoted. It is important that pharmacists realize that new behaviors can be instrumental in achieving success.[78]

Future pharmacy management training must be experience-based, rather than conceptual or global.[79] Due to the rapid pace of change in health care, pharmacy managers must act with both speed and effectiveness. The profession cannot afford untapped resources. All pharmacists must become agents of change.[79] A single pharmacy manager in a complex department is wholly inadequate to implement all of the changes necessary. Although the manager must be in charge (e.g., providing guidance for multiple initiatives), he or she also must exhibit trust, encourage new ideas, and delegate responsibilities to achieve the vision.[75] Frequent, sincere reinforcement and recognition will encourage excellent performance. Pharmacy managers must develop collaborative teams to achieve optimal outcomes.[79]

A team's performance is a function of team member abilities and motivations.[80] Pharmacy managers can create a stimulating work environment by providing good clinical practice opportunities, productive pharmacist relationships with physicians and nurses, competitive compensation and benefits, and professional opportunities, such as teaching students or residents and attending professional meetings.[80] Managers should attempt to hire personnel who share the vision of the department's leaders. Although a pharmacy manager can provide support for the team's activities, team members must sometimes stretch their capacity in order to achieve extraordinary results.[75]

Pharmacy managers who have assembled a high-performing pharmacy team with clear goals can work with the team to produce data that justify current and future pharmacist roles. By working with leaders in the department and organization, effective pharmacy managers develop an understanding of the information that key decision-makers need to approve future projects. Managers who communicate effectively with all team members can focus their energies toward achieving the identified goals.

Whereas pharmacists are among America's most trusted professionals due to their ability to develop effective relationships with their patients, pharmacists have not routinely displayed the leadership abilities necessary to establish effective interprofessional relationships and assume positions as full-fledged members of the health care team. Although not all pharmacists will find themselves in formal leadership positions, they should possess leadership skills. Pharmacists of the future must effectively demonstrate their value in reducing drug-related morbidity and mortality, and in improving drug-related patient outcomes. This will require leadership abilities that may not have been well-honed in most traditional, noninter-disciplinary pharmacy practice environments. Hence, future pharmacists will require increased mentoring to develop the leadership and management skills necessary to successfully demonstrate pharmacists' value in the interdisciplinary health care environment. Able pharmacy leaders and managers increasingly will become responsible for assembling pharmacist teams and providing them with the necessary direction to achieve these goals.


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