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Part Two: Big L vs Little L - Pharmacists’ Leadership Roles in the Past and Future

Adapted from 2011 Drake Pharmacy and Health Sciences Day Keynote Address

Every pharmacist is a leader, but does that mean every pharmacist has a title? No! The concept of Big L and Little L has been around for awhile but really became more commonplace in pharmacy discussions after Sara White’s report, “Will There Be a Health-Systems Pharmacy Leadership Crisis?”. When we talk about leadership as an obligation and that every pharmacist must be a leader, we are not saying that every pharmacist has to have a title depicting leadership (i.e. Director of Pharmacy, Pharmacist In Charge, Manager, etc). We recognize that both Big L and Little L leaders are crucial in moving things along.

Big L leaders are the “assigned” leaders that often have designated leader titles. These Big L leaders are obvious, traditional, in a position of authority, and the leader of the pack. Little L leaders aren’t quite as obvious. These are those who primarily influence without a title or official authority. Little L leaders accept responsibility. By nature of the profession, pharmacists accept responsibility and influence so all are Little L leaders by default. Many pharmacists must also step up and be Big L leaders, as well. Regardless of where you fall in the Big L / Little L categorization – remember it will take BOTH to evolve the profession.

In fact, leaders in pharmacy have already helped evolve their role in the past. Until 1969, the APHA code of ethics stated that, “The primary obligation of pharmacy is the service it can render to the public in safeguarding the preparation, compounding, and dispensing of drugs and the storage and handling of drugs and medical supplies. The pharmacist does not discuss the therapeutic effects or composition of a prescription with a patient. When such questions are asked, he suggests that the qualified practitioner [i.e., physician or dentist] is the proper person with whom such matters should be discussed.” So how did we come so far in only thirty-five years? It all comes down to the fact that every pharmacist is a leader and this leadership role has evolved the profession as we know it today.

Really, it is a no-brainer. As a pharmacist or other health care provider, you hold your patients’ outcomes as paramount. Regardless of what type of pharmacy practice you choose to pursue, you will find (and some of you might already be finding this on your rotations or in some of your part-time employment) that the responsibility of taking care of patients and optimizing their medication therapy is what keeps you on your toes, engaged in the day-to-day, and sometimes even up at night. Whether you are hoping to “influence” a patient to be compliant with their medications, “influence” another member of the healthcare team to make the right therapy decision, or “influence” a better practice process to ensure the safety of our patients and our colleagues, you are inherently influencers, or leaders, when you practice pharmacy.

As we look at the future, this role is becoming even more relevant as the public expects you to be a leader in:

  • Various aspects associated with health care reform
  • Implementing new technology that improves patient safety and efficiency
  • Control the rising costs of medication and the ability of our society to pay for it
  • Ensure that quality and safety are paramount to our providing quality care to our patients
  • Achieving provider status for pharmacists so pharmacists are recognized for the valuable service they provide to patients
  • Evolving the current practice model

ASHP and the ASHP Research and Education Foundation have developed this practice model and are currently in the midst of the Pharmacy Practice Model Initiative (PPMI). A PPMI summit was held in November, 2010, where thought leaders convened to discuss and identify a futuristic practice model for hospitals and health systems that supports the most effective use of pharmacists as direct patient care providers. Summits or conferences such as this have had a telling history in pharmacy. In 1985, the Hilton Head Conference really gave birth to the role of pharmacists in clinical practice. In 1993, the San Antonio Conference focused on the implementation of pharmaceutical care. These are commonplace and easily recognized aspects of practice now, but these conferences have a reputation for being the start of something big. In this instance, the PPMI will be the basis for developing a new practice model and, as students and soon-to-be new practitioners, YOU will be responsible for leading this evolution.

Now, I know, especially as students with exams, rotations, extracurricular activities, and student loans on your mind, it is not always that easy to focus on some of these broader, public expectations. So let’s briefly look at this from a “What’s in it for me?” perspective.

The first one – and this should get your attention - the pharmacy employment environment is changing. For many years we were in a shortage situation and it was not hard for pharmacists to find employment everywhere. That is no longer the case and every pharmacist needs to be able to display unique attributes that give one a competitive advantage. It really comes down to the difference between being an employed versus an unemployed pharmacist. Embracing leadership philosophies and skills can make you an attractive hire on many fronts.

Secondly, personal satisfaction and creating your own environment really go hand-in-hand. Nothing annoys me more to hear a pharmacist (or anyone else for that matter) whine about their current employment situation. My first thought is always quit being lazy and do something about it. Change your situation. Influencing change in your work environment can result in a better situation that gives you satisfaction and helps the organization. Don’t fall into the trap of the unhappy, complaining pharmacist who is only unhappy because he/she hasn’t made any effort to lead change in order to create a more positive situation. Being an influencer, or a leader, in pharmacy is important for yourself and your profession.

“The Pharmacy Leadership Field Guide,” a recently published book from ASHP, offers key points on leadership in the field of pharmacy.

Leadership is...

  • Being in charge of your career and having a plan
  • Being a Little L everyday leader and continuing to evolve pharmacy services as a change agent
  • Consistently supporting your patients to optimize their therapy even in difficult situations
  • Adapting your style to the situation and learning from your mistakes
  • Belonging and holding positions in professional organizations to advance the practice of pharmacy
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