C.Is leadership behavior influenced by internal or external forces? 14
D.Can people who have caused others harm be good leaders? 14
E.How do leaders gain credibility? 15
F.Who are your models of good leadership and why? 15
Strong leadership and leadership skills are a critical part of progress, achievement and growth for personal, team and organizational effectiveness. Core leadership values such as excellence, collaboration, self-respect, competency, creativity, wisdom, honesty and integrity resonate with me and guide the path I take in my current role as well as in the continuation of my leadership journey. I strive to keep these values as part of both my personal and professional life while continually reviewing and updating them in that journey. They form the foundation of my personal leadership development as well, both as an informal leader and as a member of a team.
I believe that while leadership is critical to the well-being and growth of both the individual and the team, it is not reserved strictly for those with formally assigned management or leadership positions. Strong leadership is also important from the ground level, from within teams and at the informal team leadership level. These skills also contribute positively to the interaction of team members, followers or supporters and the assigned leaders and further strengthen collaboration within and between both small and large teams.
Establishing core values is important, but they must be incorporated into behaviors and actions in all settings to truly have an impact on personal leadership philosophy. Modeling these values through behaviors brings them to life and gives them meaning within personal and team leadership settings. Strong leadership skills and needs may change over time and with the situation. They depend on group and organizational dynamics, but they are critical to effective team building and forward movement and allowing groups to recognize, accept and grow through periods of change. A strong ethical code, embodied in core values, is critical to the acceptance of a leader, particular in times of challenge, conflict, or significant change. Recognizing the importance and value of diversity and meeting the needs of each group member is also important for leaders. Strong effective leadership incorporates these skills into daily practice and reflection.
Personal Philosophy of Leadership
The research and development of a personal philosophy of leadership deeply intrigues me. My current role involves being a member of several working teams which interact with one another in many ways. I do not have an assigned leadership position at this time and do not wish to take on a formal role with typical management responsibilities. My interest is in building on the informal leadership role I have established as a Clinical Pharmacy IT Analyst and continue that personal growth. My passion is being able to use my knowledge about medications the medication use process and our Electronic Health Record (EHR) in a health care setting and research new options and functionality to improve our systems, keep our patients safe and make use of the data we collect using our EHR. Completion of the Masters of Medical Informatics program is a big part of meeting this goal and bringing the pieces together. I truly enjoy working with members of other disciplines to brainstorm options and I enjoy being a resource on the areas within my expertise while continually expanding and increasing the depth of that expertise. My desire is to improve my personal and team leadership skills and strengthen my leadership from the “ground level” as part of these and future teams.
Much of my literature review focused on pharmacy professional publications, particularly a series of short articles by a well-respected pharmacist mentor who has been extremely active in the American Society of Health System Pharmacists (ASHP), a volunteer pharmacy organization. Her focus is often helping to cultivate leadership skills at a personal level within the profession of pharmacy. My journey in leadership over the past few years, as well as my hope for future growth has taken me into areas peripheral to pharmacy, but always drawing on my knowledge of the medication use process and as a practicing pharmacist. Whatever my future roles hold for me, I will always be a pharmacist by profession and training, with a strong beliefs in the importance of leadership in this area.
This paper explores my philosophy of personal and team leadership and accountability, leading from an informal position, the promotions and progression of a professional group with leadership, the importance of commitment to core values, and the benefit of modeling behavior based and relationship focused theories such as Transitional Leadership Theory. These elements comprise the foundation of my leadership tenets: I can make a difference as an informal leader; I will contribute to the goals and advancement of the Pharmacy and Pharmacy IT profession; I will model my actions in both leadership and teammate roles based on core values and foster relationships based on a leader-follower relationship model.
III.Leadership Core Values
Positive, livable values form the foundation of leadership development and achievement. Some of the values that resonate with me include honesty, integrity, self-respect, collaboration, wisdom, trust, creativity, competency and excellence. These values are key to internal leadership as well as interactions with others. Defining and incorporation of these values into daily practice can be a part of the development of a personal leadership philosophy. “The genius of leadership lies in the manner in which leaders see and act on their own and their followers’ values and motivations.” (Drenkard, 2012, p. 148) This statement underlines the importance of building leadership on solid values and character.
Honesty, integrity and self-respect are particularly important to self-management and self-leadership. For me, being honest in self-leadership and personal growth means repeatedly assessing my performance based on input from team members and leaders and continually, objectively repeating this process and making any necessary changes. Holding integrity as a core value means making sure that every inward reflection and outward interaction as a leader or team member incorporates a comparison with established personal values. Based on that comparison, changes in direction may be determined. Honesty and integrity in this context contribute to the development of self-respect, which is important for sustained credibility, influence and growth in leadership.
These qualities contribute to the concept described by Sara White when she writes about managing yourself so others want to work with you (White, 2008, p. 922). The advice in this column discusses building an internal foundation that supports the development of leadership, teamwork and collaboration. Sara White has written and contributed to many articles for ASHP which is a professional volunteer organization that contributes to research for, and education of pharmacists and provides coaching and mentoring tools for pharmacists at all levels of leadership and team involvement. Sara was also a personal mentor to our former Director of Pharmacy. She traveled to our organization several times to speak to our pharmacists. These talks have continued to be a source of inspiration and foster the professional responsibility and personal and professional pride for contribution to excellent and safe patient care.
Introspection and reflection on personal ethics foster the development and growth of personal values. Badaracco describes ethical decisions as self-discovery that go a step further and which he calls defining moments that serve to refocus core values. While the following questions seem straight-forward, they can be provocative. They are “who am I?”, “who are we?” and “who is the company.” The author describes additional questions that can be used to develop answers to each of the first questions. To understand “who am I?” an individual can evaluate conflicting feelings which can define a natural tension between two valid perspectives. After doing this one can look further at which responsibilities and values are in conflict with the values that are important to me. The third consideration involves applying shrewdness and expediency to the scenario to develop a personal plan for what is right and important to the individual. The author describes this as coupling introspection with practical needs. (Badaracco, 1998, p. 95).
Collaboration, wisdom and trust contribute to positive team dynamics and abilities as a leader. Collaboration to me means that being willing and able to work with each teammate or leader related to team efforts or individual development. A strong leader is able to work with each team member in whichever way works best for that dyad. Wisdom comes from experience with technical or practical situations. Beyond the baseline skills, wisdom incorporates that knowledge with the practical application at skill-based and interpersonal levels. Trust involves establishing working relationships with each team member and leader to the point where each believes that the other shares a common interest and goal and will work as a team to reach those and is closely related to the collaboration mentioned previously.
Teams are critical to success in most organizations. The application of each of these values contributes to the cohesiveness and functionality of a team and increase the likelihood of success. Sara White describes the virtue of trust as follows. “When we trust people we can confide in them, believe them and have confidence in their honesty, reliability, integrity, strength and ability.” (White, 2012, p. 928) She also points out that trust must be earned by leaders and offers the following as guidance to those working toward earning trust from their teams. Remember trust is built over time. Take time to put yourself in the shoes of your team. Ask for feedback. Be transparent about decision making, particularly with unpopular decisions or programs. Don’t lie about bad news. Share information regularly. If you can’t answer a question, say so. Be up front if you don’t meet a commitment and hold yourself and others accountable. (White, 2012, p. 929) While this is aimed at those in formal leadership positions, it can also be applied at ground level, or to informal leaders or teammates.
The values of creativity, competency and excellence are a part of strong job knowledge and can be important to the development of confidence from subordinates or teammates. Creativity can be an important tool for finding new solutions to existing or emerging challenges as well as constantly evaluating current state. Being willing to think outside normal boundaries can lead to new ways to address problems. Additionally, involving all appropriate people in the problem solving can lead to additional solution options.
While extensive task knowledge is not necessary for all levels of leadership, it can be a part of the critical foundation for leadership in a non-assigned leader role. Competence in the subject and skill set being overseen increases the credibility of the leader with those being led. Expanding on this, if the leader is able to move beyond competence to excellence in the knowledge areas, particularly for highly skilled, complex or topics with patient safety implications, additional team credibility may be a result.
Northouse describes the Task Theory of leadership and the three types of tasks in that model – technical, human and conceptual. The model weights these three tasks differently based on the level of leadership. At top leadership levels the technical tasks take a smaller role while human and conceptual tasks take larger roles. In middle management roles the three types of tasks have similar importance. At lower levels of leadership, such as supervisory, the technical and human tasks outrank the conceptual tasks. The development of technical or application knowledge can be instrumental in demonstrating strong leadership at a staff or middle level (Northouse, 2010, p. 40).
A personal leadership philosophy incorporates a number of underlying assumptions that are important to the individual leader, and which may vary from those of other leaders. Assumptions for my personal philosophy development include the following. Leadership opportunities are open to all levels within an organization or team and informal or unassigned leadership from the middle can have a very positive impact on teams and outcomes. There is value to giving back professionally and contributing to the growth of the profession. My skill set and knowledge may change and expand over time, but the core professional skill set revolves around being a pharmacist. Recent efforts in the pharmacy community focus on expansion and clinical responsibility of pharmacists. Participating in key organization such as ASHP can contribute to the evolution of these and other pharmacy related initiatives.
Another assumption is that change is a constant variable and all leaders and teams must evolve with that change to succeed. Leaders must be open to that change and willing to re-look at established processes and preconceived approaches. Particularly in health care, regulations and expectations evolve quickly, without an approach allowing rapid assessment and change when needed, organizations will be challenged with meeting these changing requirement. Individual leaders may also experience this type of need for change in individual teams. I know my specific team has faced changes, and the ability to facilitate those changes is critical to the growth and sustainability of the leader. Anticipating, planning for, and adapting to change can also draw from the core values above. During change leaders must be creative, collaborative and supportive.
Because leadership is available and important at all levels, I can contribute and make a difference from an informal leadership position. I believe I have already done so, but there is greater opportunity, particularly given the journey of the Masters in Medical Informatics program. Transformational Leadership is one of numerous leadership theories and has been integrated into organizational approaches to leadership and systems improvement, including the Magnet nursing leadership approach (Wolf, 2012). This theory is defined by JM Burns as “a process whereby leaders and followers raise one another to higher levels of morality and motivation (Drenkard 2012, p. 148).” I have seen use of this type of principle in parts of our organization, although it is admittedly not universal. This approach appeals to me as it is based on the dynamics between leaders and followers and asserts that progress and growth is a result of these interactions and relationships. These benefits are reaped by the leader, followers, teams, the organization as a whole and customers, or in health care, the patients. I feel there is great potential in this model and to incorporation of it into an overall leadership plan.
Change in our culture and in our organizations, and particularly in health care is occurring constantly and at a rapid pace. Teams will not be able to use the same tools and knowledge to reach the same outcomes over time. Leaders and teams must constantly review current state, progress, and future needs in conjunction with changes in the environment. For my role this is largely concerned with the changes in medication use, healthcare, healthcare regulations and new directions and accountabilities. Many of the topics covered in the Masters of Medical Informatics program have provided increasingly complex tools and skills to make these adjustments and provide leadership to others.
Healthcare and leadership within healthcare is comprised of numerous groups, including various professions. In many cases nurses and physicians represent a majority of these leaders, along with partners with purely technical or a combination of clinical and technical experience. Pharmacists often constitute a much smaller number in these groups. Pharmacists have some unique skills to lead to healthcare and Healthcare Information Technology (HIT) teams. We are experts on medications and their interactions with the patient’s or community’s health and can partner with physicians, other providers, nurses and patients to optimize medication use within the IT structure, including Electronic Health Records (EHR's). Most pharmacists in the field of Pharmacy IT find themselves in these positions as part of an accidental pathway. Very few of us have formal IT training and have grown with support from our respective organizations and vendors. Along with our unique knowledge set related to medications, IT pharmacists can also help provide a bridge between the clinical and the technical and in many cases have long standing relationships in place with other clinicians. I have thoroughly enjoyed this process and its challenges and look forward to growing more over time and taking on more challenges.
Positive leadership is based in part on openness, honesty, fairness, transparency, equal opportunities and vision. My current manager is truly the best leader I have reported to during my twenty year tenure at my organization. For approximately the first seventeen years I reported solely to the Pharmacy department. As my role in IT grew, that portion of my job was transitioned under our Information Services department and I currently have dual reporting with eighty percent of my job assigned to Information Services and the remaining twenty percent to Pharmacy in an online, clinical pharmacist position. My IT manager has provided a contrast to the management I had become familiar with. She is open, shares as much information as she reasonably can, encourages each of us to participate, and tailors her interactions with each of us to guide us and focus on what we need to move on and succeed. She has been open during some challenging organizational times with reorganizations and restructure, easing some of our fears. She has also helped each of us see and appreciate where the organization is going in the immediate and more distant future. My manager’s style is exemplary, but is also consistent other leaders in the IS division. The contrast to the management styles in my other reporting relationship has made her style stand out even more. My organization is likely similar to many others, where individuals are promoted from within. In the past the organization has not done an outstanding job of providing these newly appointed leaders with the tools to acclimate to and expand in that new role. Recently better emphasis has been placed on providing this training. I have found new leaders to be better prepared, and I am more able to learn from their experiences.
Like many other health care organizations mine has had to undergo change relative to changes in reimbursement, regulation and incentives. Quite a number of positions were eliminated last summer throughout the organization, but the patients continued to need care and work and projects continued. The organization tried to maintain as much transparency as possible during this process. Then this spring it was announced that the organization was acquiring a fifth hospital with the anticipated closing in the fall. This has caused much uncertainty and concern with employees throughout the organization. My manager has worked very carefully with us to provide us with all of the information she has that is non-confidential and has involved each of us in information gathering and planning for pieces that affect us. She has also been very involved in the transition planning and represents our needs, abilities, ideas and concerns. She has successfully lobbied for additional help with consulting firms to assist with this new work. In a time of uncertainty this approach is appreciated and almost comforting. It is not uncommon for people from outside my department to ask if I have any updated information, as it has been recognized that my manager provides us with up-to-date, accurate information and involves us in the processes.
Poor leadership involves poor communication, lack of transparency, favoritism and closed door style. The members of the Pharmacy management team are good people and good pharmacists, but have not been able to provide the positive leadership I’ve been a part of within the past few years with Information Services. I didn’t realize how much information was not being shared until I received it through other channels. I believe information filtering was an attempt to spare department members extraneous distractions. However, this may be a somewhat outdated approach as most people now are used to and expect access to up-to-date information, particularly with the use of electronics. Much of this information is helpful to understand the happenings within our organization, our community and healthcare in general and has the potential to improve employee engagement. Recent organization and departmental changes were not disclosed within the department until after the rest of the organization was informed and in some meetings new organizational charts were distributed, only to be collected following the meeting. Despite a union presence, the creation and posting of new positions has not been viewed as equitable and has caused some to leave the organization. And finally there was a situation some time ago where a married manager was involved with a subordinate. Upper departmental management denied the situation and publicly punished several who came forward with concerns denying the relationship along with the special treatment that was happening. The manager in the relationship stepped down, but not before destroying a great deal of current and future trust with the whole of management. The former manager and subordinate are now married and both still work in the department. Their situation is a frequent reminder of poor management style and significant loss of trust.
B.Assumptions based on experiences
These contrasting experiences have illustrated that the organizational culture is not the only determinant of management style, particularly since both departments report up to the same Vice President and her style is much more aligned with the Information Services approach. I have watched my manager evolve from a staff position and informal leader roles, which supports that strong leadership can arise from an unassigned position and make a strong impact. I believe that strong personal leadership traits and relationships with subordinates are key to strong leadership and team growth.
V.Personal Leadership Beliefs
A.Purpose of leadership
Leadership improves individuals and teams and optimizes work and volunteer processes to contribute to excellence in outcomes. Leadership keeps employees engaged and motivated. It aligns organizational objectives with the skills of subordinates and partners with employees to achieve employee, team and organizational objectives. There are many leadership models, each with its own strengths and weaknesses. Many of the models have demonstrated benefit in either the provision of leadership training or on outcomes. One that appeals to me is the Transitional Leadership theory, particularly the close relationships between the leader and the follower. Transformational leadership is the process whereby a person engages with others and creates a connection that raises the level of motivation and morality in both the leader and the follower. (Northouse, 2010, p. 172)
Strong leadership is important to the effectiveness, performance and relationship of teams. Team performance is the “quality of decision making, the ability to implement decisions, the outcomes of team work in terms of problems solved and work completed, and finally the quality of institutional leadership provided by the team.” Team development is the cohesiveness of the team and the ability of group members to satisfy their own needs while working effectively with other team members. (Northouse, 2010, p. 252)
B.Who should decide who leads?
Determining who leads should be a collaborative endeavor between potential leaders, those already in leadership positions and those who will be led. Obviously, an employee needs to have a desire to become a leader, at any level. Theories such as Leader Member Exchange (LMX) indicate that the dyad-based partnership can increase the contribution of the employee and can be used for goal setting, mentoring, coaching and secession planning and can include pursuing leadership opportunities. Goffee and Jones describe four qualities that contribute to great leaders. These include selectively revealing their weaknesses, reliance on intuition to gauge the appropriate timing and course of their actions, managing others with “tough empathy” (defined as giving people what they need, not what they want) and capitalizing on their differences (Goffee, Jones, 2001, p. 154). These qualities may help evaluate those selected to lead. Existing leaders need to evaluate and contribute to the selection. In many cases those who will report to the leader can take part in the interview and be otherwise involved in the selection process. While broad involvement can complicate the process, it also increases cohesiveness of the team and better ensures that the leader will be a valuable part of it.
C.Is leadership behavior influenced by internal or external forces?
Leadership behavior is shaped by both internal and external factors. Leaders are affected by their experiences which can impact their leadership style and actions, but they can also be influenced or shaped by the environment in their organization and its resources, political and economic scenarios. Nearly anything experienced or the leader, or anything in their environment can impact decisions made in leadership development. For example, rules and hierarchies in an organization might have a negative connotation to a leader and may shape the approach that leaders takes on those subjects, or may influence changes they want to make in their surroundings. However, I believe that a leader has to possess and cultivate certain traits that make it more likely they will excel. The leader must make the decision to utilize or cultivate those traits to expand their leadership influence. I have made a conscious decision to take on leadership responsibilities from within my team while others on my team prefer to take a more passive follower role. I must also make the decision to apply for a formal leadership role if that becomes something I desire. The combination of my experiences, the skills and qualities I possess or have chosen to develop and specific decisions and commitments will all contribute to my style and success as a leader.
D.Can people who have caused others harm be good leaders?
Causing harm to others can cause permanent damage to leadership and trust. Whether trust can be regained depends in large part on how significant the harm was, whether the actions were intentional and if the person who caused the harm has learned from, or apologizes for the situation. Even if the harm was minimal and unintentional and lessons were learned, repair to relationships may take time and potentially not be possible. The effort needed to gain trust of followers after harm will be considerably more than without that event and will require the acceptance of the followers.
E.How do leaders gain credibility?
Practicing and modeling core values and encouraging others to do the same establishes respect. Demonstrating trust and reliability along with that respect contributes to credibility. Subordinates, as well as peers and superiors of a leader need to feel that the leader’s goals and actions are consistently genuine and in the best interest of the people and organization. Consistent follow through is important, as is the nurturing, support and directing of teams. If a leader does not consistently back up their talk with actions, credibility will be a challenge. Various leadership models emphasize different mechanism for improving leadership and relationships, which can range from using relational transparency, employing the dynamic in Transformational Leadership to improve individuals, leaders and teams or improving leadership skills through various models The path to credibility may be different for each leader and may take variable timelines depending on events along the way.
F.Who are your models of good leadership and why?
As described previously, I very much admire my current manager, her approach, her accomplishments and relationships. I have been around other leaders who take similar approaches and have learned a great deal from them as well. To me, good leaders must genuinely believe in the organization and the people they lead and work with or be actively involved in bringing about change that will support that belief. A good leader needs to be consistently governed by strong core values. The emphasis and priority placed on their core values do not always need to match the priority I place on mine, but they need to be universally accepted as “good values”. The leaders who inspire me are not necessarily in the highest levels of leadership. Some of the people I admire the most lead from a lower, more grassroots level, which inspires me to do the same.
Solid leadership is needed at every level of an organization and strong leadership at a staff or non-managerial level that aligns with formal leader goals can have a strong, positive impact on teams and the organization. White calls out that “managers administer, while leaders innovate, and managers ask how while leaders ask what and why. Managers focus on systems, while leaders focus on people.” She encourages pharmacists to strive to lead from a staff position with “leading from a staff of clinical position entails taking responsibility for and pursuing a vision, engaging and inspiring others, cultivating influence throughout an organization, and investing in the future by giving back.” (White, 2009, p. 2092) People in such roles need clear, strong personal leadership and direction as well as strong positive behaviors when working with teams and others.
One of my goals is to lead from an informal or middle position and assist the teams I am a part of to improve outcomes and protect patient safety. I have been working with my manager to define a new role under her as a formal mentor to members of my pharmacy team and expand my roles as a resource and liaison with other clinical teams, including pharmacy, nursing and physicians. I have been working hard on these roles, have learned a great deal and look forward to future experiences.
I have learned a great deal about Pharmacy IT and leadership through my experiences, and have more ahead. Much of what I have learned has been in an informal setting, but my experiences within the Masters of Medical Informatics program has contributed to my knowledge and growth. I feel very strongly about giving back and contributing to the body of knowledge of professional pharmacy organizations and have been participating in several committees within the ASHP and Health Information and Management Systems Society (HIMSS). While participating I have in turn learned a great deal from other organization members. Overall, I have learned and grown in my current informal leadership role as a member of several teams and will continue to learn and expand my skills, technically, clinically and as a leader.
Outstanding leadership is based on strong foundational values and ethics and leadership principles models which emphasize relationships between followers and leaders and how they motivate and elevate each other, such as Transformational Leadership theory. In an article on this theory Drenkard lists its qualities as individualized consideration, intellectual stimulation, charisma, inspirational motivation and idealized influence.” (Drenkard, 2012, p. 148). These qualities can be aligned with the core values of honesty, integrity, self-respect, collaboration, wisdom, trust, creativity, competency and excellence honesty, integrity, self-respect, collaboration, wisdom, trust, creativity, competency and excellence.
Each of these concepts contributes to the basic approach and doctrine I have and continue to follow in my leadership journey. I can and do make a difference as an informal leader within the teams I work with. I can use my leadership skills and experiences to contribute to the growth and influence of the profession of pharmacy and IT pharmacy. I can make a difference by ensuring I fall back on the core values that resonate with me and that I can grow as a leader by working within team and leader-follower relationships.
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