Burnout is increasing among the Australian pharmacy profession and strong leadership is essential to maintaining a healthy workforce, argue these pharmacist researchers
By Therése Kairuz, Richard Jane, Jack Papworth and Andrew Walker
Leadership may be described as a style, trait, ability or skill yet leadership can include all of these – and then some! Whatever the description, leadership is real; people know when they experience good leadership and they can discern when leadership is poor.
Leadership has many interpretations. To some people, it involves monitoring things closely, delegating tasks, being proficient at managing time and managing people. To others, leadership means being innovative and willing to take risks while also being prepared to take responsibility for the consequences of those risks.
And sometimes leadership simply means being the boss.
Leadership is about people and the essence of leadership is about inspiring people to be self-motivated. Leadership is affected by our impression on others and how other impress upon us, and an essential component is self-leadership.
‘Me’ and ‘I’ are of paramount importance to each and every person and the human instinct to promote survival of ‘me’ is unbelievably strong, driving acts of heroism, survival and sheer resilience. The first step in leadership is self-leadership – being true to self and being prepared to uphold one’s values; it is the key pillar that enables leadership of others.
Integrated with self-preservation is respect, for oneself and for others. Respectful leaders are respected leaders.
The pharmacy profession highlighted the importance of self-leadership by incorporating it into the 2016 National Competency Standards Framework for Pharmacists.1 Competency Standards describe the skills, attitudes, values and beliefs needed to “consistently perform a specific task of function to the desired standard”, enabling effective practice.1
Published in 1994 as Competency Standards for Entry Level Pharmacists and revised in 2010 as the National Competency Framework for Pharmacists, the most recent version (2016) requires pharmacists to “show leadership”. In the 2016 version, Leadership and Management reflected the most changes in competency domains and reflects the need for, and importance of, leadership and management (Fig 1).
Leadership and management are not the same, but they are inter-related. A good leader should demonstrate good management skills, although a good manager may not necessarily be a good leader. However, leadership can be learnt.
Learning the art and skills of leadership requires a different teaching approach to learning than the approaches to gain knowledge about evidence-based medicines, for example, and can be challenging for those responsible for educating future pharmacists.
Before one can “[influence] the behavior of others towards” one needs to know one’s own strengths and weaknesses, understand and display self-awareness, and be able to self-regulate and self-motivate.1
Consideration of these important behaviours associated with leadership gave rise to the broad question: How is leadership, including clinical leadership, developed within the profession of pharmacy?
Searching the literature about pharmacy leadership
To answer this question, a review of literature was conducted in 2019 between March and April, using MEDLINE and EMBASE databases with ‘clinical leadership’, ‘pharm*’, ‘develop*’ and ‘pharm*+lead*’ as search terms. The process followed a systematised approach and focussed on articles published from 2010. Results were uploaded to ‘Covidence’, a literature screening application with built-in features that enables a team to screen and rate articles.
Titles of the search results (n=178) were screened and 93 were rejected as not relevant (Fig 2). The remaining abstracts (n=85) were reviewed and 47 were excluded due to: insufficient information about leadership development, including education/training; lack of robust discussion and the importance of leadership; and/or lack of evidence of clinical leadership that improved patient outcomes.
Full text articles (n=38) were reviewed for relevance and quality assessment was conducted using the built-in feature in Covidence. Nineteen articles were excluded as they did not include educational aspects about leadership development, and the remaining articles were critically reviewed.
Pharmacy leadership: findings from literature
The majority of studies about leadership in pharmacy originated in America (n=15) followed by Canada (n=2), Turkey (n=1), and the Netherlands (n=1) (Fig 3); there were no studies from Australia. Most articles (n=16) had been published from 2013 to 2020, with three published in 2021.
Just under half (47%; n=9) of the articles related to pharmacy students or interns/residents and leadership education/development,2-10 four articles related to leadership in the profession11-14 and three reported on clinical leadership.15-17 Two articles focussed on emotional intelligence, including amongst students2;18 and one concentrated on self-leadership.19 This review was limited to research databases and did not include ‘grey’ literature.
Discussing leadership development in contemporary practice
That there were no studies about pharmacy leadership arising from Australia was surprising, as the profession is proactive in conducting clinical trials and reporting clinical findings. It was anticipated that leadership development among pharmacy students/interns (residents) would dominate the literature, as it is expected that academics (faculty) will publish their work.
Examples from studies involving student development included descriptions of development in relation to emotional intelligence2 and the application of the seven action logics to gain control of one’s own behaviour.3 One study extended to the use of photovoice methodology in which a camera placed in participants’ hands is used to help them in the process of documenting, reflecting, and communicating issues during activities.7
Recently, Kairuz et al. described a learning experience that was launched from Newcastle in Australia in which an experiential learning approach was used to provide opportunities for pharmacy and medical students from different countries to experience leadership development, including ‘norming and storming’ within a team environment, during the 2020 pandemic.20
In our review we identified only one study that focused on emotional intelligence. According to Goleman, emotional intelligence is more important than intelligence quotient (IQ),21 and learning how to handle anger, manage conflicts, develop empathy, and control impulses are essential skills that can be learnt.
In addition to social skills associated with emotional intelligence, empathy is advantageous in leadership. However, it must be acknowledged that not all people in positions of authority are empathic.
In his book Taming Toxic People, Australian author David Gillespie aptly describes people who are intent on reaching career goals with little or no consideration for those who may inadvertently stand between them and their aspirations.22 This book is recommended for anyone who aspires to creating a healthy workplace environment and is especially relevant for those who are responsible for the wellbeing of other employees.
It was expected that articles which describe clinical leadership would be identified in this review. Clinical pharmacy, including the functions of accredited pharmacists in performing medication reviews, provides rewarding career pathways for many pharmacists including in Australia.
Australian pharmacists are also known for stepping up and providing services and medicines during challenging times including natural disasters such as bush fires, droughts, floods and the pandemic,23 despite the actions placing their health, at risk.24
Not surprisingly, stress levels have increased since the emergence of the pandemic in 2020 and while pharmacists may recognise signs and symptoms of mental ill health in patients, it is easy to overlook the signs in oneself.25
Burnout, defined as “chronic workplace stress that has not been successfully managed”, is now included in the International Classification of Diseases (ICD-11) although it has not (yet) been described as a medical condition in the Diagnostic and Statistical Manual of Mental Disorders (DSM V).
Symptoms of burnout include energy depletion, mental ‘distancing’ from one’s job or negativism, and reduced professional efficacy.26
Burnout is increasing among the Australian pharmacy profession27 and strong leadership will be essential to maintain a healthy workforce and sustain the delivery of medicines to people in Australia.
Pharmacy leadership will also have to guide early career pharmacists, as described by Lambert,28 and address some of the frustrations of pharmacy students as outlined by Paola.29 It is timely to take stock of the most valuable asset of any organisation – its people.
In conclusion, our review illustrates that there a gap in the literature regarding pharmacy leadership studies emerging from Australia.
Therése Kairuz is Associate Professor, School of Biomedical Sciences and Pharmacy, University of Newcastle. Richard Jane, Jack Papworth, Andrew Walker are pharmacy students for the BPharm(Hons) at the University of Newcastle.
Readers can contact the corresponding author at Therese.Kairuz@newcastle.edu.au for more information.
The authors thank Luke Kelly (BPharm, FPSA) and business leader Tracy Nickloes (MBA) for their guidance.
- 2016 National Competency Standards Framework for Pharmacists. Accessed 03.06.21. Available from: https://www.psa.org.au/wp-content/uploads/2018/06/National-Competency-Standards-Framework-for-Pharmacists-in-Australia-2016-PDF-2mb.pdf
- Smith MJ, Wilson J, George DL, Laster K, et al. Emotional intelligence scores among three cohorts of pharmacy students before and after completing the University of Oklahoma College of Pharmacy’s Leadership Degree Option Program. Curr Pharm Teach Learn. 2018 Jul;10(7):911-917. doi: 10.1016/j.cptl.2018.04.001
- Philip A, Desai A, Nguyen PA, Birney P, et al. Evaluating pharmacy leader development through the seven action logics. Am J Health Syst Pharm 2016; 15;73(2):82-5. doi: 10.2146/ajhp150162
- Panther SG, Allen RA, Brantner K, Jefferson CG, et al. Addressing Unmet Patient Care Needs Through Curricular Development of Student Pharmacist Leadership and Entrepreneurial Skills. Am J Pharm Educ. 2019; 83(5): 6764. doi: 10.5688/ajpe6764
- Feller TT, Doucett WR, Witry MJ. Assessing Opportunities for Student Pharmacist Leadership Development at Schools of Pharmacy in the United States. Am J Pharm Educ. 2016; 25;80(5):79. doi: 10.5688/ajpe80579
- Frederick KD, Desselle SP, Gatwood JD, Hohmeier KC. The intersection of pharmacy leadership and management with clinical skills: Education plays a key role. Curr Pharm Teach Learn. 2021; 13(3):198-202. doi: 10.1016/j.cptl.2020.10.003
- Wilson JE, Smith MJ, Lambert TL, George DL, Bulkley C. A novel use of photovoice methodology in a leadership APPE and pharmacy leadership elective. Curr Pharm Teach Learn. 2017; 9(6):1042-1054. doi: 10.1016/j.cptl.2017.07.018
- Fristorm ED, Hager DR, Rough S. Integrating health-system pharmacy leadership into the school of pharmacy curriculum: A professional imperative. Am J Health Syst Pharm. 2021; 18;78(7):633-635. doi: 10.1093/ajhp/zxab002.
- Hill JD, Fenn EN. The future of pharmacy leadership: investing in students and new practitioners. Am J Health Syst Pharm. 2019; 76(23): 1904–1906. https://doi.org/10.1093/ajhp/zxz224
- Hohmeier KC, Borja-Hart N, Cooper M, Kirby, J, Fisher C. Training and retaining community pharmacy leaders: Career pathways after completing a PGY1 community pharmacy residency affiliated with a large supermarket chain. J Am Pharm Assoc. a2003; b 2017;57(1):82-85. doi: 10.1016/j.japh.2016.08.013
- Haumschild RJ, Weber RJ. Life in a fishbowl: accountability and integrity in pharmacy leadership. Hosp Pharm. 2014; 49(7): 671–676. doi: 1310/hpj4907-671
- Shay B, Weber RJ. Assuming a Pharmacy Organization Leadership Position: A Guide for Pharmacy Leaders. Hosp Pharm. 2015; 50(11):1051-6. doi: 10.1310/hpj5011-1051
- White SJ, Enright SM. Is there still a pharmacy leadership crisis? A seven-year follow-up assessment. Am J Health Syst Pharm. 2013;70(5):443-7.doi: 10.2146/ajhp120258
- Jones AM, Deloney SP, Clark, JS. Survey of Health-System Pharmacy Leadership Pathways: A 10-Year Revisit. J Pharm Pract. 2021; 5;897190020986094.doi: 10.1177/0897190020986094
- Mebel ER, Ortega M, Massey LR, Martin K et al. Recommendations for smooth career transitions in pharmacy leadership. Hosp Pharm. 2013; 48(6): 520–525. doi: 1310/hpj4806-520
- . Bachynsky JA, Tindall WN. It’s time for more pharmacy leadership from within. Can Pharm J. 2018; 151(6): 388–394. doi: 1177/1715163518803875
- Zed PJ. Pharmacy Leadership during the COVID-19 Pandemic. Can J Hosp Pharm. 2020; 73(3): 173–174.
- Hall CM, Enright SM, White, SJ, Allen SJ. A quantitative study of the emotional intelligence of participants in the ASHP Foundation’s Pharmacy Leadership Academy. Am J Health Syst Pharm. 2015; 1;72(21):1890-5. doi: 10.2146/ajhp140812.
- Van Dorssen-boog P, De Jong J, Veld M, van Vuuren T. Self leadership among healthcare workers: a mediator for the effects of Job autonomy on work Engagement and health. Psychol; 16 July 2020 https://doi.org/10.3389/fpsyg.2020.01420
- Kairuz T, Piggott C, Kelly L, Dibben P, Nickloes T. In the footsteps of leaders. AJP E-Mag 06.05.21. https://ajp.com.au/columns/in-the-footsteps-of-leaders/
- O’Neil J. Emotional Intelligence. A conversation with Daniel Goleman. Educational Leadership. 1996; 54(1):6-11.
- Gillespie D. Taming Toxic People. MacMillan. Australia. ISBN: 9781760555047
- Pandemic Australian Journal of Pharmacy. 2020; 101 (1194):18-21
- Hoey J, Stanley W. Aggression ramps up in pharmacies as fear increases. Australian Pharmacist. 2020; 39(4):77-79.
- Doyle J. Stress test. Australian Journal of Pharmacy 2020; 101(1201):62-66.
- Burnout an “occupational phenomenon”: International Classification of Diseases. Cited 03.06.21. Available from: https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases
- Johnston K, O’Reilly CL, Scholz B, Georgousopoulou EN, Mitchell I. Int J Clin Pharm.2021; Apr 13 : 1–10 Doi: 1007/s11096-021-01268-5
- Lambert J. ECPs-leaders of future pharmacy. Australian Pharmacist. 2019; 38(10):24-27.
- Paola, S. A bright future. Australian Journal of Pharmacy. 2019; 99(1177):24-32