But I have, to start this off, a secret, maybe it's not a secret, to share with you, but I do not have a formal leadership title. I am not in a management position, I don't have any direct reports underneath me, I've never been in a job where I have. And I share that with you because I think I'm here speaking to you today because I'm still recognized as a leader within my profession and within my organization. And I've been intentional, though, to ensure that I am continuing to develop myself as a leader and develop new skills, even though I may not have a formal title. And so this quote really kind of hits home with me, thinking that everyone leads something. Everyone is in charge of something, even if it's just you. And again, I think that really harkens back to a lot of the discussion that we've had today and thinking about how we approach conversations with others, leading others and working within our teams. Because ultimately, we are in charge of ourselves and our own behaviors and decisions. Sergio said this, and maybe some different words earlier, too, that leadership is just having followers. Leadership is not a position or a stagnant role. And so John Maxwell, who is kind of the godfather of leadership, I would say, with all of his wisdom that he shared with us in many, many books, stated that leadership is influence, nothing more, nothing less. And so qualities of effective leaders are things like being able to influence and motivate others, having the ability to drive change, have that growth mindset in order to inspire others around you, whether that's your team that you are leading or your peers, to come together and achieve a common goal, and doing that with vision and empathy. And so that really starts with self-leadership and I think looking internally to grow and lead ourselves first. Leadership begins with knowing what those core values are that you possess and that are most important for you. And so if you can't list those three things like Sergio just shared with us, maybe that's something that you want to spend some time doing to think about what are those core values that you want to bring into your leadership role and those qualities and attitudes that really set you apart. Leadership doesn't typically start with a title. And I'm sure each of you in this room could share stories of how you maybe fell into your roles as well. And it was likely because you started with other leadership positions, but they just weren't titled as that. So your roles as mentors, coaches, course directors, or maybe program directors, committee chairs, task force chairs, leading subcommittees, being a teacher, a preceptor to your learners, all of those important roles take leadership skills and qualities. So many roles emphasize leadership through action and behaviors rather than relying on the title for power. And making a difference through influence, service, and integrity can be very powerful to move a common goal or mission forward and relying on hidden leadership. So even if you are in a position of title, I would encourage you to think about how leadership is occurring at all levels of your organization and within your team to know that you can't do it alone. Not anybody, not a CEO can't do it alone. They rely on everyone within that organization and below them to help move that mission forward. And it's incredibly important to recognize that leadership within an organization. As I read on this topic preparing for our discussion today, one thing stuck out to me that I thought was really helpful and impactful is thinking about not waiting for a title to lead. Because if you wait for a title to become a leader, it's too late. So some strategies. Lead yourself through self-awareness, discipline, and emotional intelligence. I feel like I can share with you that I think that these are some qualities that really stand out within team members that end up being recognized because they show that discipline and awareness of kind of their role, what they bring to the table, and understanding their strengths, the strengths of their peers, and how they can really use that to enhance the overall performance of the team. Also your attitude matters. Showing positivity, encouraging, praising others, thinking about that culture and how you're contributing to the culture that you're building is incredibly important. And focus on finding solutions rather than complaining about problems. And hopefully if you are in a management position, you can recognize that if you have reports coming to you with problems, that conversation usually goes a lot smoother if they're bringing solutions to the table rather than just coming to complain to you. And that's a much more productive kind of mindset within that conversation. Additionally, I think it's really impactful for you to think critically. We've talked about how leaders are usually recognized because they show the ability to problem solve and create solutions. And so ask questions about things that don't make sense to you. And don't be afraid to challenge that status quo and think about how you can make work life better or a process better and what those solutions are. I think it's really important to take initiative in that case and be proactive and then lead by serving others so that servant leadership to maintain integrity and vision. Now there's certainly some challenges when you think about being a leader though or being a leadership position or not being a leader but not being in a leadership position. There can be some difficult conversations that create tension. Especially if you are challenging someone in authority potentially. There can be frustration. And so recognizing that if you have a lot of high achievers, for instance, on your team, and they show great leadership, but they don't feel like they're getting the same recognition because they don't have that title, can start to make you feel like you're spinning your wheels a little bit and working really hard without getting anywhere. Another I think challenge that at least I've experienced is multi-hat syndrome where we have a lot of roles and responsibilities and I think leaders without titles especially experience that because you are spending a lot of time and effort leading that committee and ensuring that action items are moving forward and working with that group. But that doesn't mean all of your other roles and responsibilities don't stop. Patient care, your research, your other service obligations. And so to lead when you don't have administrative time tied to those title or tied to that leadership role can be very frustrating and challenging to manage. Another thing though I think to consider is silo thinking. And what I mean by this is that when you are leading without a title, you're not in that kind of titled position, administrative role, and not seeing the big picture. You're just seeing the one piece of the puzzle maybe that you are leading. And so I think that's also important where you can really rely on those managers ahead of you as well to ensure that you're also taking into consideration maybe other impacts of your decisions in that kind of other type of leadership role that you are currently in. And then sometimes ego and visibility can also get in the way because darn it, it really feels good when you can get that title or maybe a pay raise that you feel like you deserve from working so hard. And so this is where it comes back to thinking about why you want to be a leader. And I think really reflecting on are you doing this because you want the position and you want the title or are you doing this because you care? And so I always try and focus on, you know, what is the why behind why I'm saying yes to this so that hopefully I don't fall into the trap of feeling like I need that ego boost from getting that title. And then lastly, you know, we can't fool ourselves. With position titles comes influence. And so it can be frustrating if you don't feel like you have that voice or seat at the table because you don't have the title but you have important things to say. So I'd like to get us talking in our groups again with just two brief discussion scenarios. So the first is a faculty member at a college of pharmacy at a large university is faced with juggling multiple responsibilities including patient care, teaching, and research. Recently the university administration has appointed him to lead a task force aimed at developing new interprofessional education curricula which requires collaboration with faculty members from various health disciplines such as nursing, medicine, allied health. The faculty member is passionate about improving IPE but finds himself struggling to manage his existing responsibilities with patient care duties at the hospital requiring significant time, his teaching workload, preparing lectures and several courses, and working on multiple research projects with really looming deadlines. Without formal authority he finds it challenging to motivate and coordinate the diverse task force members each with their own busy schedules and differing priorities. So take a moment and consider and talk in your teams with what challenges and solutions do you think are present within this scenario. Alright, do we have any teams groups that would like to share any potential challenges or solutions for our scenario? I don't think it was very hard to figure out what the main problem is and that is our inability to say no For at multiple levels, right? We are enthusiastic about what we do. We love to help out. We are caring individuals Etc, etc. And that's learning to say no is extremely difficult. So we thought that Simply learning to figure out what his priorities are are like where he thinks his future wants to go and which one of the 37,000 things that they are doing he could try to eliminate consolidate and or reformulate Yeah, has anybody Heard or used the term non-promotable tasks it's been a new or recent one for me, but I've really thought a lot about it of What in my day-to-day that I that I do is a non-promotable task for my career And are those and really looking hard at those to think about are they things that I need to continue to spend on? Spend time on and do I was also at another talk or conference where that we had an activity where we wrote She the speaker looked at us in the room and said write down take five minutes and write down every every role and Responsibility that you currently have in your career and in your job And you can imagine all of us are like what? Um, but we did our best to write down all of the things and then she asked us to really look closely at that list And say now what on that list makes you say heck yes, like what do would you go back and say heck yes to I want to do that and Everything else on the list take it take a hard look at and think about you know What can you can you get rid of that? Is there a way for you to maybe move on from that that role or? Responsibility so that you can really devote and focus your time to those tasks that make you say yes So that was actually a really insightful activity as well to consider So yeah, obviously in this scenario plentiful or there's many challenges than competing for for time here What solutions do you think we could come up with in this situation other than just saying no? Wearing a no t-shirt having a no button Yeah, he's not really delegating anything to anyone Yeah, I think that's a great point And that's actually a strategy that I've taken in my position more so with the committee leadership of is there is there somebody? maybe an administrative assistant that can help me with sending that doodle poll to schedule the meetings and Put that on the calendar and send out the agendas And just again advocating yourself to ask for that help you never know until you you make the request another comment Definitely he's doing too much work what one person can do by himself With a good quality of work so one other way to for the solution for it is the administration higher up to him can delegate him to pick the people for any of the work which he thinks He can give Away to the other people so that the person who is giving away the work feel that he's involved he's involved in the nation making and he his value his recommendation has a value Because obviously there is a reason why he selected for so many jobs by the administration because he is good at it But obviously as one person can't do it They can ask him to delegate some of the work to the person of his choice and take his suggestion as a very strong feedback And I recognize that I'll say this from a position of tremendous privilege where I am in my career after 30 years, but I do think that people don't understand what are the things that have the highest value and impact, and they don't align that with their strengths. If you do fewer things, you take time to do it well, and you obsess on quality, you get away with a lot of stuff. And I think that that's also, I think, a common mistake that we all make as we come up, that we feel that if we say no to things, we're missing out or we're not going to do things. But if you know what your strength is and what your values are and where you can give the most impact for your department, for your group, and you focus on that, you will be much more successful, but also you'll be more satisfied. I also think that people don't always understand what really matters for promotion, what really matters for building. I mean, look at the notes that people write. People include a whole bunch of stuff that is there for building that has no impact on building, right? So understanding that promotion is your goal, okay, these are the two things that are most important, focus on that, right? And I think that doing fewer things is really the key, usually, but doing them with more intention. And we're all afraid that we're going to get into trouble, but if you're doing those things well, I can guarantee you you're not going to get into trouble. And I think that's kind of the leap that we have to do as we mature. Yeah. There's actually, there's a great book about just that and how to scale back, and I am blanking on the name, but if we put together that bibliography like we talked about, I will be happy to look that up and share that with you as well. And that's really the take-home point is that you can basically do more by doing less. So let's move to our second scenario, and then we'll wrap up. This is an associate professor at a college of medicine who was appointed to lead the Pharmacy and Therapeutics Committee. And the committee's role is obviously to evaluate and decide on whether new medications are added to the hospital formulary and includes a multidisciplinary group of professionals, including the director of pharmacy, who has superior rank and title compared to the newly appointed chair. During a P&T committee meeting, a disagreement arises between the chair and the director of pharmacy regarding the addition of a new high-cost medication. Cough, cough, this never happens. And so the chair feels that the medication should be added due to its potential to improve patient outcomes, but the director of pharmacy is concerned about the budget and the financial impact and questions whether benefits outweigh the risk or high costs. And she argues that the existing medications are sufficiently effective and more cost-efficient. So the chair is confident in his perspective and prioritizes patient care and the long-term benefit and sees long-term benefits from adding this medication, but also recognizes the validity of the director of pharmacy's financial concerns and the importance of maintaining a positive working relationship. So again, it kind of lays out challenges, maybe they're more obvious here. So maybe you can focus your time and your groups talking about what are potential solutions to help resolve this conflict on the committee. All right, I want to be respectful of everyone's time, and I see them setting up the bar in the back, so that's a good sign as we wrap up here. So I'll open it up. So what solutions do you think could help within this scenario and help this committee chair who's maybe having some issues challenging power? I also do the chair for the P&T committee in my institution. So sometime when these type of things come up, of course, we try to go into the cost analysis and all that. We try to find out where's the physician recommending it, and we try to go through the drug cost and all that. And if the conflict is still there, we try to go through the emergency approval, like it doesn't have to be a full formulary, and see how many times it is needed. And the good thing about us is we are a children's hospital next to the adult hospital, so sometimes if we really need it, it's just like a 10-minute drive, so we can always get it. So that's the safety window we have, and we can't wait and do that. So I think those are great solutions to consider, certainly preparing the evidence-based arguments and ensuring that we're looking at the data critically and trying to find common ground and highlighting what the potential benefits may be. And then trying to identify compromise, like you mentioned, whether it's completing an MUE or adding restrictions to the criteria or to the formulary addition, so that that helps to limit the cost and the concern that the director of pharmacy has within this kind of disagreement are really, I think, could be impactful solutions. What else? It's along the same lines, which is what's the evidence and what's the benefit. If the benefit's stopping vasopressor a couple hours shortly, and that's only evidence in the big scheme of things, it's not really a good benefit. But if the benefit, patient leave the ICU sooner, there is maybe hidden benefit. So it goes back to what the evidence is and what is the value of that evidence and what is the value of the benefit. So is it a huge value that there is something downstream effect that's important to consider or not? At the end, we're scientists, we need to practice based on evidence. Yeah. I think in this situation, too, remember, even though we're just highlighting a disagreement between two members, this is a full committee. And so as the chair, establishing your influence of also including others on the committee within the discussion and including their perspectives can also help develop solutions. So ensuring that you are utilizing the full power of the committee as well can be impactful. I thought since this is a leadership conference, first of all, this happens all the time. I'm sure we're all aware of this, where the system makes a decision, usually financially related for reasons that we're unclear of. And you find out, especially if you're in the trenches later and go, what the hell happened? I think from a leadership standpoint, they didn't even identify the problem. I didn't even know what the problem is. Someone's just dropping a concept of an anticoagulant. Was there like 30,000 bleeding things that happened? Did we run out of blood in the transfusion lab? I'm not really sure. And why I think this is important from a leadership standpoint is the concept of how do you bring things forward where you evolved your stakeholders, you build a consortium for an issue of which people have recognized as an issue is a far better approach. If I was the chair of this committee, I wouldn't even let that be presented because there wasn't even anything that was predominant to even make it, because now you just got everybody stirred up. And it really is unproductive across the board. So I think those are really important aspects. And there's lots of times that people that are under us who see a problem, and like you said, want to bring it forward, and how do you do that? And I will tell you, in some institutions, it's really hard to get information. I know we're data-driven, but transparency is big for me, and I rarely see it at most institutions, to be honest. No, I think that those are all great points, and I think certainly in this situation, you know, being the pharmacist on the team, we're the ones that always have to bear the bad news of, nope, sorry, you can't have that, right? That's not a fun job. We don't want to have to do that. And so being able to have a shared understanding, though, about why those decisions are made makes our job, all of our jobs, easier, but particularly when, you know, there's this instance where maybe somebody wants to use that medication, right, but we're saying no, and here are the reasons why, and here are some other options that are safe, effective, et cetera. We had another comment. Yes. It took a good 10 years into my career as an ICU physician to actually have an ICU pharmacist explain that there is a cap on the amount that CMS will pay per day for medications in an ICU, and that number is a little over $100. It put into perspective as a physician immediately why I couldn't have my IV Tylenol, why albumin makes my pharmacist go pale. I think you all should maybe lead with that maybe more often. Maybe you do at your facilities, and I just missed you all, but that was a huge piece of corollary information that I did not have. We have another comment. Aside from the medication aspect of this, yeah, I think the... Absolutely. And that was really why I chose this scenario was to share an example that that is real life of how that can create tension and struggle for those that are trying to lead with the best intentions without stepping on toes of people above them. And it can be very challenging and intimidating to have those conversations or to be in those meetings. And so I think managing disagreements respectfully, practicing the communication skills that we've talked about throughout all of today in these roles is very, very helpful and imperative to ensure that you don't feel like you don't belong even though maybe you are outranked or don't have that title. All right, well thank you very much. Just a few take-home points. Hopefully I've convinced you that leadership is not about one position or a title, but it's about influence and driving positive change. Begin by leading yourself with discipline and integrity and don't hesitate to challenge upwards when necessary. And to make your voice known, start leading now. Don't wait for a formal title because if you wait it will be too late. These are a few resources that I read to help me prepare for this talk. So the 360 Leader by John Maxwell and then Clay Scroggins' book How to Lead When You're Not in Charge. So these were really, really nice reads. Again, we can add them to our bibliography on this topic specifically of leading without a title. Thank you.

leadership

influence

self-awareness

emotional intelligence

self-leadership

communication

decision-making