How to Lead as a Pharmacist

As pharmacists, we integrate many different skill sets: counseling, finance, business, communication, psychology, pharmacology, engineering — the list goes on and on! However, there is one skill that ranks number one and ties them all together. One skill that, if mastered and implemented correctly, will effectively enhance any other skill that you are looking to improve. That skill is leadership.

Let’s think about it: as a pharmacist, you are a part of a team. Your team works together in all that you do to deliver the best care possible to patients, fill prescriptions accurately, and work as a part of the health care system to minimize medication safety errors and cut back on unnecessary costs. To do this, you need to effectively lead your team of technicians, pharmacists, interns and other personnel because one fact rings true: you cannot do everything on your own!

How to effectively manage your team — not through dictatorial means, but by empowering them and aligning each team member with their inherent strengths and preferences is what will garner you trust, respect, and simply getting the job done effectively, and as a team.

Looking at the research and studies published by experts in the field, I present to you a way to warm your leadership skills and get social with your team: the SCARF model.

Let’s get basic here: do you remember back in recess when you were left out from a sports game, sleepover night, or special club meeting at the treehouse? It felt pretty crappy, right? You may have even cried. As it turns out, the feeling of being excluded elicits the same reaction in the brain as physical pain!

This comes back to one of the 3 basic psychological needs: relatedness. Researcher Matthew Lieberman hypothesizes this is the case because "being socially connected to caregivers is necessary for survival.” This highlights the findings in a study that paints this picture: social interaction is hardwired as a need in our brains.

Ok, now we have seen the impact that emotional pain can have on an individual, but how does this apply to the pharmacy workplace and being an effective leader? Keeping your pharmacy team engaged and feeling socially “in-tune” with coworkers can play a huge role in your performance — if they are in social pain, this will limit their commitment to the team initiatives and being an active participant of the roles required to deliver high performance.

So how does a leader prevent this from happening? Knowing each colleague will play a huge role, as you want to strive to align each individual’s talents with tasks to be completed. Looking at the above scenario, we want to avoid this by leading as pharmacists to create a cohesive team where we work together in an atmosphere that is “in sync,” delivering the best patient care and fulfilling our roles as a health care team as one unit.

“But my techs bicker!” “She will NEVER come around!” “He just doesn’t get along with anyone!” If this is the first reaction that comes to mind when thinking about your work environment, let me provide a reason as to why this negative behavior probably goes on: the threat response has been triggered.

If an employee feels threatened, they will not function at their optimal level of productivity. The key to being an effective leader is to ensure the opposite happens; that we enable the reward response. That is, each team member feels important, good about their efforts, their input is valued, and that they matter. How do we do this? Focus on 5 qualities that empower the reward response and shut off the threat response: Status, Certainty, Autonomy, Relatedness, and Fairness. SCARF!

Status

Being hooked on the Kardashians is not about being magnetized by their extreme intelligence — it’s about the level of status they have that is so alluring (no, for the record, I do not watch or follow them). How does this appeal of status translate into the pharmacy setting? If a coworker feels of lower status to someone else, this ignites the threat response, as evidenced by research from Hidehiko Takahashi et al in 2009. On the flipside, feeling that one is of high regard among their peers leads to feelings of being rewarded. Believe it or not, having a feeling of high status actually correlates with longevity and health, described in Michael Marmot’s book The Status Syndrome: How Social Standing Affects Our Health and Longevity.

One area to keep in mind is when you approach your team, give them feedback. Simply saying “performance review” can trigger the threat response, because it can be inherently interpreted as a challenge to their status. Another big trigger with this is saying, “Can I give you some advice?” This almost always is interpreted as a threat, because it innately says “I am superior, let me show you the right way.” Perhaps you have heard the adage sandwich your critiques in praise? This is why, and this is why it is effective! Giving people praise will strengthen the perception of high status, allowing them to become more receptive of the constructive criticism that you may be offering. We are only trying to help our team become better, but approaching it the wrong way will not be received well and won’t get either of us anywhere. Use this tip of approaching with praise and watch your team grow!

Certainty

We won’t always know how the day will pan out. Oftentimes, our “grand plan” never comes close to unraveling the way we plan! However, having some level of certainty can put our minds at ease, and instead of worrying we can put that energy into being productive. This rings so true in the world of pharmacy through setting clear expectations with our team right up front. Who is going to type in prescriptions? Ring up patients at the register? Place the weekly order? What’s for lunch?

Setting these roles and clearly communicating them to your team will ease their tension because at a basic level they are certain of what they will be doing. They are not certain on the specific unfolding of those roles- for example, if after ringing up a patient and handing them a receipt they give you a rebate card and say “do I use this now?”’- but knowing the roles gives them comfort. Being clear and communicating are the core ways you can foster a feeling of certainty with your team!

Autonomy

We have all had one of those bosses who takes the whole “creating certainty” a bit too far for our liking. Maybe even to the point of how many breaths you should take per minute, or what you should do in your free time. Think back to that time, how did it make you feel? Frustrated, angry, maybe even controlled? Not good is the basic emotion, and that’s because your feeling of autonomy has been threatened. Overreaching or micromanaging of employees can cause an unbearably stressful environment, and it doesn’t have to be that way! Yes, guidance and direction are of course paramount to success (see above factor), but allowing your team to feel they can complete assigned tasks using their own decisions without someone looking over their shoulder throughout the entire process keeps undue stress away, and provides a sense of empowerment. It’s not that you need to let everyone ‘run wild,’but the key factor to success here is that people FEEL like they have autonomy. There is a line between providing certainty and allowing autonomy, and having an open network of communication will prevent this from becoming problematic.

Relatedness

Feeling like you belong to a part of a team will make you more inclined to want to work to make that team better. If you don’t feel like you’re a “member," what incentive would you have to want to improve that group? This is a simple concept that has profound implications for work and colleague engagement in the pharmacy! If someone feels like they are a part of a group, they will have more trust and empathy for initiatives set in working toward a goal.

“But everyone is so different! How can I expect them all to get along?!” The ease at which this occurs can vary greatly from group to group. The ingredients that can overcome distancing among colleagues is time and repeated social interaction. This is related to the amount of oxytocin released by the brain in the presence of people we are comfortable with. Why does this matter, and where is the proof to back this up? A release of oxytocin defuses the threat response and allows bonding in a way that perceives group members as part of our group. Research using exogenous dosing of oxytocin by Michael Kosfeld demonstrated the impact this has on our interactions with other people by minimizing the threat response.

If we as pharmacists work to eliminate feelings of isolation and have everyone feel included as equal members of the team, we can form the ideal pharmacy environment that augments productivity and team effort.

Fairness

If one tech is 10 minutes late and you say nothing, but another tech is 10 minutes late and they get a scolding, how do you think that tech will feel? How do you think other techs will perceive that environment? Probably not fairly, and that could evoke feelings of being threatened, which as we now know thwarts productivity.

This impact has been represented through studies conducted by Lieberman and Tabibnia, where they found that people respond more favorably to be given $0.50 from $1 split between them and one other person, compared to receiving $8 out of $25 between another person. In the second scenario, they were given significantly more money, so why the angst? Even though it was more money, it was not perceived as fair, and that was where the focus resided. Apply the findings of this to your pharmacy, and you may be able to see the impact this can have on your team’s cohesiveness.

One key way to ensure an environment of fairness and equality among your team is through being transparent — communicating your plan, actions, and intentions to keep everyone on the same page will increase team engagement and encourage more productivity. Even when times get tough (this is pharmacy world), if this environment is well established, the “lows” won’t be as low had this comradery not been developed and engrained in your pharmacy culture.

Does the SCARF fit? One size fits all?

Being a pharmacist is a tremendous responsibility, as it carries with it the role of leadership. Each and every action you take will be analyzed by your team and you will in essence be leading by example. That can feel overwhelming, or empowering, depending on how you look at it: you have the power to make profound impacts to your pharmacy for improving teamwork and delivering the best patient care possible through working together as one unit!

The threat and reward responses are real, and unfortunately if both are present, the attention will always dominate on the threat because as we have seen through the research and discussion above, it is strong, urgent, and cannot be ignored. The ways to mitigate this and shift the power to the reward response all reside in following the concepts of the SCARF model. Through doing this, you will be able to become a more effective leader, in turn a better pharmacist, which will allow you to perform the ultimate task and primary objective: provide the best level of care possible to your patients. I highly recommend you adopt these concepts to your pharmacy, because your patients are worth it!

References

1. Cacioppo JT, Patrick W. Loneliness: Human Nature and the Need for Social Connection. W.W. Norton; 2008.

2. Eisenberger N, Lieberman M, Williams KD. Does Rejection Hurt? An fMRI Study of Social Exclusion. Science. 2003; 302(5643): 290—292.

3. Eisenberger N, Lieberman M. The Pains and Pleasures of Social Life. Science. 2009; 323: 890—891.

4. Marmot M. The Status Syndrome: How Social Standing Affects Our Health and Longevity. Times Books; 2004.

5. Rock D. Your Brain at Work: Strategies for Overcoming Distraction, Regaining Focus, and Working Smarter All Day Long. HarperBusiness,;2009.

6. Rock D, Schwartz J. The Neuroscience of Leadership. s+b, Summer; 2006.

7. Rock D. SCARF: A Brain-based Model for Collaborating with and Influencing Others. NeuroLeadership J. 2008; 1(1):44.