Preamble:

This article is a reflection and insight into pharmacy leadership and management on the reservation as a real-life case study. It is the second of a series of articles. Fictitious names are used to preserve and respect the identity of the facility, and the people involved.

In this article, the focus is on preparing to get on-site, what skills and qualities are needed, and also the fit to take on the challenges of change management. This also applies to change management in any pharmacy setting, and can be a good tool for leaders who may share my philosophy “to make the world a better place” anywhere. It can also apply to rural and critical access hospitals where help is most needed.

The Checklist for the Challenge: Not your typical leadership lesson article

1. Understand what you’re getting into.
   • The time commitment can fluctuate as it’s a salaried position, but sometimes you may miss your flight home to see family and end up sleeping at the airport, which is associated with a physical toll. Sometimes, you may cancel a trip home to see family due to a “fire” at the facility which requires your leadership. I would have to drive 3.5 hours to the airport, catch the plane that’s usually delayed back to my home airport, and take another hour Uber or Lyft ride home to finally see my family after several weeks.
   • The physical environment and climate: may not be ideal, and your body has to adjust to a much higher atmosphere up to 6000+ feet elevation or extreme temperatures which can bring along illnesses or exacerbate chronic illnesses.
   • Mental health is probably the most challenging aspect in the first few months on site, moving from a big city to a town of 10,000 people with one grocery store, a few gas stations, and fast-food restaurants. Cooking will be at home after a long day as there’s nowhere to really eat out but at least it’s healthy. Also, adjusting to a different population where cultural competency and compassion are skills and traits you need to be equipped with already. One needs to possess the curiosity to learn and appreciate other cultures and be flexible and adaptable to new and unexpected circumstances while staying neutral at times from judgments as the focus is on the patient.
     
     Coming from a minority background, though raised in Australia, humility and a sense of gratitude is a must, passed down by my mother to help me succeed in this engagement. Adapting to isolation and, nowhere to go, nothing to do after hours is brutal at first. However, if you are on a mission, a reminder of the focus on the mission can help overcome isolation. Also, it’s a good time to take on further board certifications, as study time will keep you motivated. It is almost like a year in Sabbatical. Be upfront and clear with your family. Seek their support as they must share a similar philosophy or support you in your venture, knowing there’s an end.
     
     One key to success is maintaining your sanity and physical and mental health to demonstrate strong leadership characteristics as your staff mirrors your traits and emotions on any particular day.

2. Resilience: This trait is much needed in all aspects of being a leader on the reservation and as a leader engaged in change management overall. Some examples include:

   • While your goal is to educate the facility with more focus on pharmacy best practices and industry standards, the argument that will be made against you is “we don’t have to comply by that because we’re not regulated by the State Board of Pharmacy or certain bodies. It is important here to determination and have good negotiation strategies, tact, and a non-defensive compassionate mindset in presenting industry data and resources such as from the American Society of Health-Systems Pharmacist and your personal experiences to persuade every level up to and including the Chief Executive Officer and the Board. I had several opportunities to successfully convince the executive team and the Board while representing the Chief Operating Officer, as this person isn’t clinical nor has an in-depth knowledge of Pharmacy. The lesson is that you must prove yourself at first to be credible. Once they know you care and are subject matter experts in Pharmacy, they will listen.
   • Persistence is needed in not giving up when something fails the first or second time. This ranges from getting approval from all stakeholders and senior leaders to building out a much-needed home infusion program from the ground up without knowing all the answers at first, strategies to train your staff to encourage your native patients to keep their follow-up appointments in the pharmacy ambulatory clinic and being adherent with their medication regimens. A lot of readmissions are due to recurring problems and inability to get to their PCP, missing appointments, using the ER as urgent are. This could be a common problem among low socio-economic communities and minority communities anywhere in the country. Not only must you stay strong as a leader, but you must possess the ability to inspire your team to share the same philosophy as they are front line pharmacists and technicians who deal with patients face to face daily.

    

3. Patience, determination, and persistence to help people change from their deep-rooted ways: change management takes time and doesn’t happen overnight. It can be tough anywhere among your staff when you institute organizational changes, encourage patients to believe in Western medicine, or become more adherent. When results are not achieved with intense pushbacks, you can be very frustrated and start doubting yourself when it feels like everyone is against you. This is all normal, as human nature is to fear and resist change. I learned to trust my instincts more and more over the years, and they only fail when I don’t trust them. Count the small wins, wake up tomorrow, and find a refreshed new day to give it another attempt. 
   • Experiment with different strategies.
   • Listen in order to understand before seeking to be understood.
   • Find your allies who share common philosophies to change the world as more hands clap louder than one.
   • Start at the top to get support from your executive leaders.
   • Lead by example.
   • Ensure your direct reports (also leaders) share common values to cascade the change down the chain, communicate clearly while sharing the risks vs benefits and seek stakeholder investments at every level where possible.
   • Use clinical evidence in some instances and compromise at times when you may lose the battle but focus on winning the war.
     
     Over time, the ice will melt. I will share more examples of applying each of these in upcoming articles.

4. Priorities of the facility over your own at times: Plenty of articles discuss setting boundaries as a leader to avoid burnout, which isn’t wrong, but they are too general. I had a time limit set for my engagement and wanted to set a legacy after I left the facility. Thus, long hours, remote work, isolation, being away from family for long periods, including my two-year-old son, and being on call at odd night hours didn’t bother me as I had a bigger picture in mind. There is no gain without pain, and I wanted to set an example for my two-year-old son at the time that humanity comes before your own individual needs. The joy of putting your own needs first may not last long while the benefit you bring through the sacrifices can last a lifetime for some people.

In conclusion, this is not an exhaustive list, but some of the key highlights of being a change leader in any challenging setting beyond the reservation. Leadership and management are demanding and tough in themselves already, but change management is at a different level altogether. It is not recommended for new leaders as burnout can happen quickly, frustrations can skyrocket within the first few weeks on the job, mental health issues can soon set in, and one can become unmotivated and stop caring. However, it is a great position to be in as it’s a gift to lead, inspire, influence, be a role model, and leave a lifetime legacy for others to continue the path. 

The above-mentioned traits of a strong leader can be learned over time, but must be executed with commitment. Humility, life experience, and self-reflection can aid the continuous learning journey. A book or degree can help, but practice is the key to excellence. 

On an end note, my own experience and my mother’s upbringing gave me the strength to take on this challenge and be the person I am today. I am nowhere near perfect and still on my ever-lasting journey. This article in the series is dedicated to my mother, who taught me to give back to the world for all that I have and to do what I must to achieve that goal. Be on the lookout for my next article describing the start of my journey.