Fox and Hedgehog Leadership in a Crisis: A Pharmacy Story (Seamless Care Pharmacy, Toronto, 4/1)

Marwah Younis Damani, RPh. PharmD, Managing Director, Seamless Care Pharmacy, Scarborough, Ontario. Medical Director, Community Living Toronto

Getting from Sharing Space to Social Distance

By March 2, 2020, Canadians were well aware of the escalating impacts of a novel virus around the world. Yet, while COVID-19 was receiving a lot of air time and the newscasters were calling for stricter measures around infection control, I was at a large pharmacy industry conference at a hotel airport in Toronto, where attendees were sharing laughs and personal space, oblivious to the realities that were already threatening the community.

As a leader of a specialized community pharmacy in Ontario, I realized early that we were in a time of history where we will be affected by something big, yet it did not become clear how big until weeks later. Despite the lack of initial guidance from our industry and our government on how to best move forward, I felt it was imperative to redefine our go-forward strategy given the environment we find ourselves in and the urgency of the situation.

Normally, our pharmacy emphasizes extensive direct contact with clients as part of our services, both in our facilities and theirs. By contrast, the goals of our revised strategy are to maximize staff protection by creating a drive-thru model and minimizing client contact, while updating the operational model as we adapt the business. While this may seem like a small change, the revision was wrenching for our clients and for our staff.

The key question in redefining and executing the new strategy was what style of leaders we needed to act effectively. Nate Silver’s book, The Signal and the Noise [1], draws on an idea by the Greek poet Archilochus that “a fox knows many things, but a hedgehog one important thing”, to describe two types of leaders. Fox-type leaders gather a lot of information, while hedgehogs tend to focus on a few points of information. In many cases, foxes are most effective, because they assess many options. When you need to move quickly, however, we need hedgehogs, preferably in combination with foxes.

Foxes, Hedgehogs, and Dual Leadership

The fox: If you need to be right before you move, you will never win

Foxes need to know all the details and they need to be sure of their next move before they make the move. This delay in action can jeopardize the greater goal in a crisis. In responding to the COVID-19 pandemic, the details were important, but time was of the essence. If we had relied only on fox leadership, we would still be waiting for action.

The hedgehog: React quickly, stop chains of transmission

In times of crisis, you need leadership that is laser focused on one goal, decisive, and action oriented. A hedgehog leader filters out the noise and makes hard decisions quickly. The hedgehog leader doesn’t think too much about all the details of how we’re going to do it, just that we need to do it and we need to do it now.

We needed both foxes and hedgehog leadership

Yet relying only on hedgehog leadership creates a risk of quickly going down the wrong path. In our pharmacy, we needed engagement by both types of leaders. Foxes gathered as much pertinent information as possible and presented the information. The hedgehog then made the calls and created urgency around the change.

Quite simply, both types of personalities were crucial. Without careful attention by the foxes, useful information would not be communicated, and the plan would not have been executed effectively. But without a hedgehog, this process would have inevitably taken weeks, not days, and would have rendered it too little, too late. Our team took on the dual fox and hedgehog challenge.

How Our Pharmacy Moved Quickly While Finding a Fox and Hedgehog Balance

The goal of my specialty pharmacy was to rise from this international disaster as a leader in the sector and to survive with minimal damages. “Be fast, have no regrets, be the first mover”. We heard about the “drive-thru” pharmacy model from different regions of the U.S. and we were warned about pharmacy closures due to lack of staffing. While there was no initial guidance from our college on what to do next, we decided to follow what the world was doing and start reducing direct contact of staff in the pharmacies with patients, who had the risk of being infected and, in turn, infecting our staff.

Data gatherers and providers

It’s important to engage with the stakeholders who will be implementing your decisions for change. We presented our ideas and the information we gathered to our staff. They brought to our attention relevant barriers and challenges that we did not consider before and we worked through those challenges as a team.

Some ideas we decided would not be accommodated. Staff were advocating to allow clients who walked rather than drove to the pharmacy to wait inside the building. We decided that they would still have to wait outside. The hedgehog leader stressed that, while flexibility is usually the key to a successful business, in a crisis situation, strict adherence to the rules was necessary to protect all parties involved.  The foxes were then instrumental in communicating the message about the importance of the rules to get understanding and support from our staff, clients, and the community at large.

Decision makers

Sometimes we simply could not come to a consensus. When that happened, the hedgehog stepped in and redirected people to focus on the bigger goal and made the hard decisions. Some choices met resistance because they risked affecting the pharmacy’s immediate financial top and bottom line, but would ensure that we meet the main outcome.

Hence, in addition to information from the foxes, decisiveness by the hedgehog was critical. In this time of crisis, many stakeholders need more direction than usual as fear and uncertainty renders many paralyzed in the face of decisions. While empowerment and collaboration are the basis of the leadership in our pharmacy team, in this crisis, strong direction was key to mitigating the risks imposed by time.  Indeed, we over indexed on the presence of the management team for the first week to ensure effective implementation of the strategy.

It was a call to arms. We are healthcare practitioners and we are essential frontline workers. We met with the pharmacists, pharmacy assistants, and drivers to share our vision and strategy. Their fox-type insights were invaluable, but their hesitation was ever present, along with fear, anger, and stress. In those moments it was important to rally the troops towards our singular goal, our calling to be a leader in protecting the community. It was clear that we had to start by protecting ourselves if we wanted to achieve that outcome.

Mutual respect

In acting quickly and thoughtfully, we respected both types of leadership. The hedgehog commended the stakeholders for their bravery, acknowledging the sacrifices they were making. The foxes kept the hedgehog informed and addressed the stakeholders’ concerns, which provided them with a sense of comfort.

When there was a lack of consensus or when the information or direction was challenged, the foxes were unsure of how to move forward. The hedgehog, on the other hand, was committed to the goal, focused on alignments and misalignments, ready to make the hard decisions. This sometimes meant sacrificing short term individual comforts for the greater good. With the mutual respect, though, the foxes understood the need to act.

Skin in The Game Creates Wins

A hedgehog must be aware of the inevitable risks. Since this is a crisis, initial losses are likely. One must be willing to show how short-term losses may be worth the long-term gains. Some clients were rightfully upset, and some may go to a different pharmacy. The fear in our team was that revenue will be lost in the efforts to conserve our manpower.

But our decisiveness is a win for both the community and our business. We are showcasing to the community that we are leaders in action and in protecting them. We sent out communications that we can supply any patient’s medications from any pharmacy that is unable to deliver or keep their doors open. Patients who are concerned about the handling costs of a new 30-day limit for dispensed chronic medications were reassured that even if the government does not waive future copays, we will.

In turn, this has allowed us to increase our catchment area for deliveries, which will provide us with more customers and a wider reach. As of late March, we had experienced a record increase in our prescription sales. This has been challenging to implement as, initially, our broader base of deliveries was not fully organized and required multiple trips a day. Nonetheless, we have been able to refine our procedures to make the growth more scalable.

What have we taken away from the story so far? By combining fox and hedgehog leadership, we are reacting to the crisis, protecting our clients, staff, and community, while sustaining our business.

 

References

[1] Nate Silver, 2012. The Signal and the Noise: Why So Many Predictions Fail – but Some Don’t. Penguin.