Leadership and Effective Succession Planning in Health-System Pharmacy Departments

Succession Planning as Part of the Strategic Plan

With the evolution of human resources in the hospital pharmacy setting in the 1980s, there was a focus on integrating institutional needs with employee needs.^1,2 The approach to effective management became more comprehensive and included motivating and training competent employees and ensuring human resources were sufficient to meet the needs of an institution's strategic plan. A pharmacy department's strategic plan is a long-term vision of how the department will achieve its goals and objectives through programs, services, and effective management of its employees. It is usually a formal plan, with a recommended projection of 5 to 7 years in the future. It can be drawn up and submitted similar to (or with) the department's formal business plan. A part of the strategic plan is succession planning, which focuses on ensuring key management roles will be filled through optimal recruitment and training of pharmacy employees.

Planning for successful management of employees requires a focus on preparation for successful leadership. A 2011 survey found that 75% of pharmacy directors would likely retire in the following decade. ³ This percentage is similar to the 80% reported in the original 2004 survey. Furthermore, recent reports show that Baby Boomers are not delaying retirement as previously thought; over half surveyed were either partially or fully retired by the age of 65. ⁴ It is no surprise that leadership succession planning is a topic of great interest within health-system pharmacy departments. The goals of the American Society of Health-System Pharmacists (ASHP) for leadership and management include the creation of management positions at all levels, with adequate training and mentorship for individuals in these roles so that a comprehensive vision is sustained across the institution's pharmacy department. ⁵ Additionally, the sixth objective of the ASHP Pharmacy Practice Model Initiative (PPMI) is to “determine the tools and resources needed to implement optimal pharmacy practice models in hospitals and health systems.” ⁶ A strategic plan and succession planning support this objective.

Leadership succession planning is crucial to the continuity of the comprehensive vision of the pharmacy department. Leadership development is arguably the main component of training and preparing pharmacists to assume managerial positions. A variety of pathways are available for pharmacists to develop leadership skills; most important may be on-the-job training and residencies. The doctor of pharmacy curriculum, professional organization involvement, leadership training programs, and more formal education are other options for pharmacists to develop leadership skills. The process of succession planning revolves around leadership development. A pharmacy department's succession planning process should be dynamic and evolving, with periodic assessments to determine how improvements can be made. Emphasis should be placed on succession planning, and it should be a marker for the success of pharmacy departments. This article will focus on pharmacy leadership development and steps to leadership succession planning. It will also provide the results of the 2012 University HealthSystem Consortium (UHC) Succession Planning Survey and case studies on succession planning.

Pharmacy Leadership Pathways

Historically, pharmacy leaders developed through on-the-job training, which still serves as a top leadership pathway. ⁷ In a recent survey of 205 health-system pharmacy leaders by Pollard and Clark, on-the-job training was the primary pathway contributing to leadership development of both residency- and nonresidency-trained pharmacy leaders. Other leadership pathways noted by survey respondents include mentoring, life experiences, and performing leadership roles in professional organizations. The authors concluded that mentorship, networking, and on-the-job training are imperative to creating an effective leader in pharmacy.

Another leadership pathway is built into the doctor of pharmacy curriculum. The curriculum has evolved to ensure that leadership opportunities are available to students throughout the 4 years of schooling. The Accreditation Council for Pharmacy Education (ACPE) has published guidelines for the doctor of pharmacy degree. ⁸ The guidelines state that admissions criteria for the doctor of pharmacy candidate should include a consideration of the candidates’ leadership qualities. ACPE also requires the formation of a student government or other committees in order to develop student leadership, professionalism, and communication. Professional student organizations provide opportunities to exercise leadership and teamwork through committees and student officer positions and through activities such as the American Pharmacists Association (APhA) patient care projects, National Community Pharmacist's Association (NCPA) business plan competition, and ASHP's Clinical Skills Competition. ⁹ Professional pharmacy fraternities offer seminars on leadership development and provide leadership opportunities through officer positions. Faculty, staff, and preceptors are responsible for committing to the strategic development of leadership skills and professionalism of the doctor of pharmacy candidates. One of the expected areas of competency of the doctor of pharmacy candidates is the social/behavioral/administrative pharmacy sciences, which includes an emphasis on leadership development within practice management. Colleges of pharmacy are also incorporating additional longitudinal leadership tracks or programs to further increase the focus on student leadership development.

ASHP supports ACPE standards and guidelines and has outlined goals for leadership development within the doctor of pharmacy curriculum, pharmacy internships, and residencies or residency equivalencies. ⁵ ASHP's position statement on developing leadership and management competencies encourages current leaders to seek out mentorship positions and foster practitioners to move into leadership roles. Emphasis is placed on the development of administrative, managerial, and leadership skills. Through their position statement, ASHP encourages colleges of pharmacy to enhance leadership training in their curricula and to create more combined-degree programs. ASHP would like the colleges to encourage students to attend leadership conferences, pursue residency programs, and gain experience in medication safety and medication management. These standards are echoed in the American Association of Colleges of Pharmacy (AACP) Argus Commission policy statements and recommendations. ⁹

For many students, it is a natural progression to move forward into a postgraduate year 1 (PGY1) residency program. The purpose of this year is to build upon skills and knowledge acquired during the doctor of pharmacy curriculum and allow first-hand experience in providing optimal direct patient care, managing medication-use systems, and enhancing leadership skills that are conducive to any practice setting. ¹⁰ ASHP mandates that all PGY1 programs provide some degree of management experience. ASHP is also the accrediting body for these programs, and it advocates for increasing the number of residency programs and the number of positions at each program. Its vision is that by 2020 the completion of an ASHP-accredited PGY1 will be a requirement for pharmacy graduates who wish to pursue direct patient care.

Leadership training programs are also available through professional organizations. ASHP has a distance-learning program called the Pharmacy Leadership Academy (PLA) that serves to enhance leadership skills at any level within a pharmacy department. ¹¹ An expert team runs 7 self-learning modules over the course of 6 weeks to allow for the completion of the program in 12 months. Some colleges and universities recognize PLA as a graduate-level program. ASHP has also created the Pharmacy Leadership Institute, which is a rigorous 6-day leadership conference for established pharmacy managers. ¹² The American College of Clinical Pharmacy (ACCP) offers a Leadership and Management Certificate Program, which aims to further develop these skills in pharmacists who are currently in leadership and management roles. ¹³ The program has a mentoring component and requires completion of 18 hours of core modules and 8 hours of elective modules.

Another pathway to gain leadership experience, albeit not necessarily pharmacy leadership experience, includes obtaining more formal education. ⁷ Pharmacists often obtain administrative graduate degrees, such as MBA, MHA, and MPH. These degrees are usually offered in both full-time (2 years) and part-time (4 years) programs. A greater number of colleges of pharmacy are offering dual or joint degrees. ¹⁴ During 2009 and 2010, 36 colleges offered dual PharmD/MBA programs, and 30 colleges offered dual PharmD/PhD programs. Overall, students have cited improved problem-solving and leadership skills as an advantage to these dual degrees. Also available are 1- and 2-year pharmacy practice management residencies, some of which are combined with a master's degree. Increasing numbers of PharmD students are beginning their pharmacy curriculum with prior degrees.

Evaluating and Harvesting the Talent Pool

UHC Survey

The succession planning process should be dynamic and evolving, with periodic formal evaluation of the effectiveness of the process to determine how improvements can be made. Leadership is an integral component to succession plans, and management should help individuals map out leadership pathways to help them achieve their short and longterm goals that align with the goals of the institution. Although it has been emphasized that formal succession plans containing objective employee assessment processes are a best practice, a majority of institutions do not have formal succession plans for their departments or individual employees. This was confirmed by a 2012 UHC survey of UHC-associated directors of pharmacy (DOPs).

The Succession Planning Survey that was e-mailed to DOPs at member UHC organizations aimed to identify formal and informal succession planning processes in place for DOPs, key positions, and pharmacy departments as a whole. A total of 36 directors responded, which was a 13% response rate. Sixtythree percent of the departments reported having formal (14%) or informal (49%) processes in place for key positions. Four respondents stated that their organizations have formal succession planning processes in place for the organization as a whole. Thirty-seven percent of respondents reported no succession plan.

Three of the 5 pharmacy departments with established formal processes for key positions have over 800 inpatient beds and are large health-systems. Most have formal succession processes for their director-level positions. Some list the process as emerging from the organization's formal plan as implemented by the executive suite. Others have conducted a department-wide review of the organizational chart and/or 360-degree evaluations with leadership and continuity planning.

Many organizations with informal processes in place for key positions listed all management positions or all direct reports as being included. One detailed response included informal plans for assistant directors of pharmacy positions (outpatient, ambulatory clinical, inpatient clinical and inpatient operations), the informatics coordinator, medication safety officer, P&T coordinator, and clinical specialists. Many DOPs mentioned that retaining general and specialty residents after they complete their residency is part of the informal plan. One director ensures that individuals being “groomed” alternate responsibilities every 2 years so they have the opportunity to manage the entire scope of the department. Common themes in the informal plans are promotion from within and acquisition of leadership experience.

Most DOPs have identified their successor internally; they often look to the assistant director as their replacement. Some DOPs will use their “higher-ups” to help them identify and groom potential successors. One DOP planned to recruit an entry-level manager with the goal of promoting him or her to assistant manager within 5 years and DOP within 10 years. Another DOP engaged an executive coach to work monthly with the individual identified to be the successor. Most respondents are trying to expand the scope of experience for all levels of managers.

When asked whether their pharmacy department supported “flexibility” within the structure in order to support succession planning, half of the respondents answered yes. Some alluded to their institutions taking a more neutral position on succession planning, with no measures to impede or promote it. Another stated that succession planning is a part of obtaining approval for new positions. Consistency in the ratio of employees to managers was listed as an impediment to succession planning by one director. Only one respondent elaborated on why the institution is not flexible, stating that financial issues are a higher priority and leadership does not allow for a flexible budget to support the proactive measures of succession planning. One larger system (comprised of 11 hospitals) stated that its size will allow it to be flexible in finding successors.

Respondents listed the following themes of successful succession planning:

Respondents listed the following barriers to successful succession planning:

Conclusion

The results of the UHC survey reveal that despite literature supporting use of succession plans to ensure a successful and goal-oriented future for pharmacy departments, many departments do not have them. Informal succession plans are more commonly in place for key positions than are formal plans. However, institutions that tend to have formal plans are larger health systems. Respondents consistently listed leadership, mentoring, and internal commitment as critical factors to successful succession planning.

Pharmacists have many pathways for gaining the leadership experience that is necessary for future career positions. A successful pharmacy department will have an evolving succession plan that systematically reviews all employees to identify their strengths and talent gaps. Succession plans are increasingly important for pharmacy departments, as many leaders in key positions are on the brink of retirement. By taking a proactive stance rather than a reactive stance through succession plans, organizations provide for a smooth transition when both controllable and uncontrollable factors contribute to changes in pharmacy services and a pharmacy department's organizational structure.

The case studies in the Appendix highlight the importance of succession planning and how the lack of a plan can result in negative consequences. They may be used as discussion tools during leadership training and at manager and staff meetings, as well as with residents and students when leadership topics are addressed.