Hospital Pharmacist
Vol 11 No 8 p325-328
September 2004

How can pharmacists become better managers?

By Ian Harrison, MBA, FRPharmS

All hospital pharmacists are managers to some extent. Each will undertake some form of self-management such as professional and personal development. Many will have responsibility for support staff. Senior pharmacists will also be involved in more strategic level management of clinical services, departments and trusts. There is therefore a benefit to all pharmacists and the organisations they work for if they become better managers.

This article sets out the skills needed to manage well at all levels and some of the concepts involved. It also gives information about some appropriate courses and training programmes.

Management for all

The “top six” skills required by employers, according to a 1997 study by the Association of Graduate Recruiters and Institute for Employment Studies, are:

· Motivation and enthusiasm
· Interpersonal skills and team working
· Flexibility and adaptability
· Good oral communication
· Initiative and proactivity
· Problem solving, planning and organisation

These skills (some of which are perhaps better described as attributes) match well to those needed by junior pharmacists. They are also generally reflected in the “core dimensions” from the “knowledge and skills framework” (see Panel 1, below).¹ They will therefore be needed in order to progress through “gateways” under the “Agenda for change” process.

At a more strategic level, leadership is a key skill. A commonly heard cliché is: “Managers do things right; leaders do the right thing.” The originator of that phrase, Warren Bennis, believes that the key competencies are “visioning” and then effectively communicating that vision. He also stresses the benefits of personal effectiveness, positioning and self-learning.²

Various leadership and management issues that need to be tackled are set out in the Department of Health’s “A vision for pharmacy in the new NHS”. These include:

· Re-engineering services to make optimal use of skills at different professional, technical and assistant levels

· Developing strategic intent, in order to take forward initiatives such as health promotion, supplementary prescribing and making better use of information technology

· Developing effective clinical leadership (consultant pharmacists) in a clinical governance context

· Achieving better decision making on effective medicines use across health communities

· Integrating pharmacists as stakeholders within the NHS (including developing inter-professional relationships and an understanding with non-pharmacy commissioners/managers)

· Identifying the key elements of a wider-ranging pharmacy service to the community and sharing of “best practice”

Being in control

One key aspect of better management applicable to all pharmacists is that of taking as much personal control as possible. When people feel they have personal control they are likely to function better and suffer less stress. For example, in one study carried out by researchers at Yale University in the US, two rats from the same litter were put into cages that contained a lever. The cages were subjected to a mild but unpleasant flow of electricity. One rat could turn off the current to both cages by pressing the lever, but the lever in the other rat’s cage was not connected. The rat with the power to stop the current endured no measurable adverse effects but the cortisone level of the other rat did not return to normal even when there was no current and progressive sickness resulted.

According to the “fried egg model” of Rosemary Stewart, the way to achieve personal control is to push back the demands on time (represented by the yolk) and push out the constraining boundaries of a job (represented by the outer rim of the fried egg) thereby allowing choices (represented by the egg white) to grow.³

Professional development

In common with any other profession that wants to “stay alive”, pharmacy is embracing the concept of “lifelong learning”. In every new job (or as a job evolves) the relevance of skills already possessed needs to be analysed, with poorly developed skills being identified and honed.

To help in doing this, some training bodies (eg, workforce development confederations) run non-formal introductory management modules. These help pharmacists analyse and clarify their own career goals. They often use a simple psychological tool (based on the work of Carl Jung, a psychiatrist working in the 1930s) to help people understand their learning and behavioural style, as well as those of their colleagues. Knowing what style of learning a person has can help him or her decide which of the various methods would suit them best. These include:

· Undergoing secondment or rotation to a role where relevant skills are improved by “osmosis” from the example and direction of others

· Undertaking supplementary informal study, preferably using relevant problem-based learning (eg, from case studies)

· Participating in workshop-style training organised by the employer or a professional tutor (such as that offered by organisations such as the Centre for Pharmacy Postgraduate Education)

· Enrolling in a formal postgraduate qualification

Having a formal mentor might also help professional development. The main roles of a mentor are set out in Panel 2. The emphasis of mentoring should be enabling and facilitating development.⁴ The person who is in the best position to do this will change and so it is likely that an individual will have a number of mentors over the length of a career. Someone who is not a person’s line manager should be chosen as mentor.

It should be remembered that in a less formal sense, most pharmacists already have a mentor or role model. These include passive mentors, such as those who are admired but have not been met and occasional mentors, such as lecturers and those who have helped with issues like career guidance.Peers, within or outside work, also act as informal mentors.

Another useful exercises is to complete a “360 degree” questionnaire. The “360 degree” concept involves getting the opinions of others, including line managers and those working for you, on the same questions so you can compare their perceptions with your own.

Formal qualifications

It has generally been accepted that an aid to promotion is the possession of relevant formal qualifications. For the clinical pharmacist there are clinical diplomas and masters degrees and DPharm courses. Parallel management qualifications such as the MBAs (master of business administration), various certificates and diplomas and short courses exist.

When deciding which course to take a main consideration (particularly for management training) is whether to learn in a unidisciplinary (pharmacy) environment or undertake a more multidisciplinary course. A multidisciplinary course gives the opportunity to see the “bigger picture” and builds awareness and confidence to network beyond a pharmacy department. A unidisciplinary course can give more “real life” examples from pharmacy and introduce participants to a network of colleagues who can be helpful in their careers and who might be able to act as a mentor.

MBAs An interesting book has been written about the contents and benefits of the “gold standard” MBA offered by Harvard University in the US.⁵ It sets out the key concepts of the course as being:

· Business policy
· Organisation behaviour
· Marketing
· Finance
· Operations management
· Human resource management
· Control
· Managerial economics
· Management communication
· International business

It highlights the benefits of the problem analysis approaches used, such as questions on real case histories and of working in a team that is structured to include a student from a financial background.

This model for learning has been emulated by many UK business schools. Many offer fortnightly or modular attendance. The most popular example being the Open University (OU) with its strong emphasis on distance learning. Dave Miller, the chief pharmacist at Sunderland Royal Hospital, has acted as an OU course tutor. The City University (London) Healthcare MBA is also an attractive option but is lighter on the “hard management” (ie, finance) than traditional MBAs.

Certificates and diplomas Public health diplomas have been fairly popular with pharmacists. Other options include an evidence-based health care masters programme, such as that run by the University of Oxford. The first year takes you to certificate level, while the second year is project-based, often using qualitative surveys. These can be an ideal way of tackling and implementing key organisational changes. Non-pharmacy organisations offering management courses include the Institute of Health Management (certificate and associateship) and the Chartered Institute of Management (diploma in management practice via diplomas or masters courses).

National development scheme for senior pharmacists The overall aim of the national development scheme for senior pharmacists is to introduce participants to management topics and to present these in a form in which they can readily be applied in the work place.

Each course (which is run in Durham by Bill Gould and Alan Hall, director of pharmacy at the James Cook University Hospital, Middlesborough) comprises two residential weeks separated by six months during which the participants undertake a work-related project. This enables them to put into practice topics considered during the first week. The content evolves to meet the continuing professional development needs of the participants. These, in turn, reflect the changing environment in the hospital pharmaceutical service. The participants on each course consider, at the end of the first week, what they wish to cover in the second week.

The importance of networking is acknowledged. The scheme is aimed primarily at hospital pharmacists of grade E and above although applications from grade D pharmacists are considered if their responsibilities warrant this.

Short courses and books A number of pharmacy organisations (see Panel 3) offer short courses or otherwise cover management issues in an introductory way. These give an ideal opportunity to reflect on whether it is appropriate to study these topics in greater depth. Similarly, the main text book on hospital pharmacy includes introductory information on:⁶

· Pharmacy management
· Business planning
· Preparing a business case
· Budget management
· Benchmarking
· Staff management

Funding Several pharmaceutical companies have supported hospital management training (including project and change management) in recent years. WDCs generally exclude unidisciplinary courses for pharmacists and few are currently willing to enter partnership agreements with external non-NHS agencies.

Conclusion

Management issues are relevant to all pharmacists, whether their focus is more on self-management or on making strategic decisions on behalf of clinical services, departments and trusts.

By taking charge of our management training we learn more about ourselves and others, prevent “burn out” and, together with the techniques we acquire, benefit our career and the hospital we work for.

References

1. Cattell R. The Knowledge and Skills Framework, Healthcare Pharmacy 2004; Aug: 16–17 (PDF 100K)
2. Bennis WG and Nanus B. Leaders: the strategy for taking charge. New York: Harper and Row; 1985.
3. Stewart R. The reality of management. San Diego: Elsevier Science and Technology Books; 1999.
4. Bellingham C. Who needs a mentor? Pharmaceutical Journal 2003;270:694 (PDF 40K)
5. Kelly HM. What they really teach you at Harvard Business School. New York: Warner Books; 1986 .
6. Stephens M. Hospital Pharmacy. London: Pharmaceutical Press; 2003.