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Transformational Presence


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In this episode of Truth in Transformation, host Paul Abramowitz, ASHP CEO, talks with ASHP President Tom Johnson about transformational presence — the concept of self-awareness and observing what is going on around you. The ASHP leaders share ways pharmacy practitioners can use transformational presence to embrace change to advance the profession.


Tom JohnsonThomas J. Johnson is Assistant Vice President of Hospital Pharmacy at Avera Health, in Sioux Falls, S.D. He has consistently championed advancing optimal patient outcomes through the progressive use of pharmacy staff within healthcare teams.

Tom earned his Pharm.D. from North Dakota State University (NDSU) and completed an ASHP-accredited residency at St. Alexius Medical Center/NDSU in Bismarck, N.D. He has served in multiple roles over his professional career including clinical practice, academia, research, and leadership.

Tom has served ASHP in multiple roles including Treasurer (2016–2019); Board of Directors (2011–2014); Council on Education and Workforce Development; Council on Therapeutics; Committee on Nominations; Task Force on Organizational Structure; Practitioner Recognition Committee; and as a state delegate for many years. Tom is a Past President of the South Dakota Society of Health-System Pharmacists (SDSHP) and 2005 SDSHP Pharmacist of the Year. Currently Tom serves as ASHP President.

ASHP CEO Paul W. AbramowitzPaul W. Abramowitz is the Chief Executive Officer of the American Society of Health-System Pharmacists (ASHP).

Prior to joining ASHP in September 2011, Dr. Abramowitz worked in hospitals and health-systems for 34 years. He served as Associate Hospital Director for Professional Services and Chief Pharmacy Officer at the University of Iowa Hospitals and Clinics, and Professor at the University of Iowa College of Pharmacy. He also held prior positions as Director of Pharmacy and Associate Professor at the Medical College of Virginia and the University of Minnesota.

Abramowitz received a Bachelors Degree in Chemistry and Biology from Indiana University, a Bachelors Degree in Pharmacy from the University of Toledo, a Pharm.D. from the University of Michigan, and completed his residency at the University of Michigan Medical Center

In addition to serving as Treasurer of ASHP from 2007-10 and as ASHP President in 1993-94, he chaired the Boards of: the ASHP Research and Education Foundation, the Iowa Board of Pharmacy, and the Iowa Statewide Poison Control Center.

Dr. Abramowitz has actively combined practice, teaching, and research throughout his career. He has lectured and published extensively focusing on: the effect that pharmacists have on improving outcomes of care and reducing costs; developing new care models; reducing adverse drug events; and expanding comprehensive medication management to the ambulatory setting.

He was a recipient of the John W. Webb Lecture Award in 2000 and the Harvey A.K. Whitney Lecture Award in 2009, health-system pharmacy’s highest honor. In 1990, he received the Distinguished Alumni Award from the University of Toledo College of Pharmacy, in 2010, the Alumni Distinguished Lifetime Achievement Award from the University of Michigan College of Pharmacy, and in 2013 the Honorary Degree of Doctor of Science from the University of Toledo. In 2015, he was recognized as one of Washington’s Trending Association Leaders by Bisnow.

Currently, Dr. Abramowitz serves on the Boards of the American Nurses Foundation, the Pharmacy Technician Certification Board and the GTMRx Institute. He also is a member of the National Steering Committee for Patient Safety of the Institute for Healthcare Improvement and a Professor-Emeritus at the University of Iowa.

The information presented during the podcast reflects solely the opinions of the presenter. The information and materials are not, and are not intended as, a comprehensive source of drug information on this topic. The contents of the podcast have not been reviewed by ASHP, and should neither be interpreted as the official policies of ASHP, nor an endorsement of any product(s), nor should they be considered as a substitute for the professional judgment of the pharmacist or physician.

Speaker 1 (00:02): Welcome to the Truth in Transformation podcast series, where ASHP president Tom Johnson shares insights from his 2020 inaugural address about personal and professional transformation.

Paul Abramowitz (00:15): I'm your host, Paul Abramowitz, ASHP CEO, and with me today is our president, Tom Johnson. Tom, last time we had a great conversation about self-evaluation and how to stand in your truth. Today, we'll be talking about the concept of transforming our pharmacy presence. What does that mean to you, Tom?

Tom Johnson: Well, it's a term that comes from a book that I cite in the inaugural address by Alan Seale called Transformational Presence. He uses a quote from Teddy Roosevelt, who would say, “Do what you can with what you have, where you are.” If you know anything about Teddy Roosevelt, that's exactly where he would start. He actually would write in his diary, take action, and start. So he would always start a quote with “Do.”

But Alan Seale asks us to think about how we might reverse that quote just a little bit. He would say, well, first identify who you are. Ask where you are and identify that first. Then think about what you have available. Then what you need to do will reveal itself.

So that's what we are talking about in terms of presence, being self-aware, and being in that space. That's what we were talking about before in a previous podcast. So I applied that to pharmacy by saying, “Well, if the profession, if I, as an individual, need to change, then how do I be the person that I need to be?” Or “How do we need to be the people or the profession we need to be, to understand how to move forward?” So that's pharmacy presence to me.

Paul Abramowitz (02:05): Now for many of us, change tends to be a very difficult thing. Whether we're talking about as pharmacists in our professional lives or in our personal lives, I've needed to be a change agent in almost every organization that I've worked in. However, even in practicing that myself, whenever I've had someone I've worked for, come to me and say, “Paul, I think we ought to be doing something differently,” or “Why don't we try doing this instead of that?” I feel myself somewhat immediately kind of tensing up a little bit and feeling like I'm getting resistance.

I have to tell myself, “Whoa, wait a minute, listen to that, understand where this individual is coming from and think about it.” So I guess what I'm saying is it seems to be a natural tendency for us to sometimes resist change. So Tom, why do you think changes are so difficult?

Tom Johnson (03:25): Well, you know, there are all kinds of quotes about change. Albert Einstein has been credited with saying that no problem can be solved by the consciousness that created it. I think what that just tells us is that if you came up with this absolutely perfect plan and somebody says, “You know, maybe we could do this a little differently,” it's human nature that we tend to push back on it a little bit.
I remembered a summer meeting at ASHP, maybe 15 or 20 years ago. I went to a presentation on the seven dynamics of change, and they walked through and they ask you to go through some very minor changes that were really no big deal.

Tom Johnson (04:15): But everybody in the audience did the same thing. Nobody looked around and asked for help. They all went through it by themselves. You could tell by the body language they were thinking, “How am I going to do this?” Those are things that cause us stress when somebody asks you to do something differently, even if we're working on a process that's not very efficient. We’re comfortable with that process. “Why would I change this when I don't see the need?”

So I think you're exactly right, Paul, and I do the same thing. Somebody comes to me and says, “You know, really, you should do that differently.” Yeah, but I have all these reasons why this is perfect. So I'm not sure what I would do it any differently. So that's a great point.

Paul Abramowitz (05:07): Yeah. Well, we need to practice what we preach. Right?

Tom Johnson (05:13): Do, as I say, not as I do, right? Yeah.

Paul Abramowitz (05:15): What are some of the ways Tom, which pharmacy professionals can learn how to be present so that they can become the person or the professional or the leader that they need to be to achieve the outcomes that they desire?

Tom Johnson (05:32): Well, sticking with our theme, from the inaugural and what we've been talking about in these first couple of podcasts, I think you start with true self-awareness. I read something the other day, and I don't remember exactly where. I'll probably get this statistic wrong, but 85%, maybe it was 80% of people claim to be self-aware yet when validated against what's truly going on, maybe 15% are self-aware. That’s why self-awareness is so hard. Did you read the people in the room the right way? Did you ask people if that was really what was going to happen?

So I think that that's one of the challenges that we have to think about— being honest with yourself as the place to start. The other part is when somebody asks us to do something different or if we identify something we need to change in the profession or in ourselves. We’ll start figuring out why did somebody ask me to do this differently? Why am I asking myself to do something differently? Why do I feel like I'm not in a role that I should be in? Or, why am I not advancing? To me that's about figuring out your own self-assessment and then finding a way that you can best contribute.

So identify your talents—there books like StrengthsFinder and personality analysis type things that can help you become more self-aware. Then ultimately just stay positive. Stay positive in who you are, be confident in your own skin, and understand that you're not perfect. You're not going to be.  I think that's a great place to get started as a pharmacy professional and as an individual.

Paul Abramowitz (07:16): Well, let's switch gears just a little bit, Tom. I know you're a history buff. I might say, particularly North Dakota history is your specialty area. You even included a quote from Teddy Roosevelt in your Inaugural Address. How did that quote go?

Tom Johnson (07:34): Well, I mentioned it earlier, and it is “Do what you can, with what you have, where you are.” Teddy was a man of action. I have read just about every book there is on Teddy Roosevelt. His goal was to take action. And speaking of North Dakota, he had bought into a cattle ranch operation in the Badlands of North Dakota after some personal tragedy in his life. His first wife and his mother died on the same day when he was a young man, after that, he needed time for personal reflection.

Tom Johnson (08:24): He went to the Badlands of North Dakota where I went to school at North Dakota State. Becoming the person you need to be brings us back to transformational presence. You have to understand who you are. You have to understand where you are. You have to understand what you have and then you can move yourself forward.

Paul Abramowitz (09:14): So how does that apply to pharmacy professionals?

Tom Johnson (09:18): This conversation around transformational presence tells us to stop waiting for perfect. Teddy Roosevelt starts with “Do.” He takes a “fire, ready, aim” approach. I guess that works okay for some situations, but I think most pharmacists would probably feel more comfortable with “ready, aim, fire,” as opposed to “fire ready aim,” which would be the original version of that quote.

So I think pharmacists like to plan, understand, set a course, and then take action. But sometimes we get stuck and I think that happens to everyone and not just pharmacists or pharmacy professionals. I think sometimes the perfectionist in us wants us to be perfect before we act. We want to have all of the possible scenarios in line before we act and it's just not possible. It's just not possible in a lot of situations. So what that tells us is to act, but of course we need to plan appropriately and have a sequence for what we need to do.

Paul Abramowitz (10:21): Well, we've just passed the midpoint of 2020 and I think it's fair to say that it's been not only a very significant year, but also a very challenging year. So along with things that we normally have to contend with, we've been dealing with and trying to mitigate the COVID-19 pandemic. Simultaneously we've been trying to address in a major way racial injustice, equity, and inclusion in the United States. Now we've also seen significant continuing transformation within our profession. Can you talk with us more about that transformation, Tom, and the positiveness of that transformation?

Tom Johnson (11:10): I sure can. From an observation standpoint and from living in this environment, people across healthcare have really been challenged with coming up with a new way. I have seen a lot of things happen within our own health system and even across all of healthcare that we've been talking about doing, or that, you know, we should, we should really investigate this or we've started down a path. And all of a sudden we were just doing it. We didn't have any choice. When you see different challenges like that, where you're forced to come up with a new plan, it allows you to get to a different place a lot faster. Now, I don't think I would pick this process for how to do this. I wish it were easier to just move ourselves along instead of getting slapped in the face by a major crises or multiple crises, even.

Tom Johnson (11:57): So I think those have been some of the things, but specifically from pharmacy, I think our role has become even more public related to drug acquisition and supply chain and medications, our clinical roles, and how we've been able to work with our nursing colleagues and our physician colleagues and everybody else across the healthcare team to optimize therapies, our broader role as societal leaders, and having conversations that I would argue are more in the middle.

It's amazing to me at times how we find a way to have debates about the polar opposites when it's really not about the polar opposite we need debate. It's more in the middle. It's okay to have those opinions, but we need to find ways to really create solutions that are much more in the middle. I recently read a book called The Dichotomy of Leadership written by a couple of Navy seals, Jocko Willink and Leif Babin. The entire book is based on the idea that you can't be too far to one end or one extreme to be an effective leader.

Tom Johnson (13:03): You have to be more in the middle. You have to understand that you can go too far with any concept. That’s a great one for us to remember and think about. Our profession has tried to help keep everybody in the middle. As everybody was running after the next drug that was going to be the miracle cure for COVID, I kept hearing our professional organizations, particularly ASHP, providing data and literature and understanding what was out there.

We kept asking for safety and we kept asking for continued evidence. Instead of just giving everyone a particular drug, I kept hearing our profession call for additional research, not flat out saying no, but at the same time, let's put this in the right context. So to me, that's what's really strengthened the profession and created opportunities going forward.

Paul Abramowitz (14:00): So where do you think we go from here, Tom?

Tom Johnson: Well, I think we go forward because it's the only thing we can do.

We can't go back and wish things had come out differently. We can't go back and think, “Gee, we wish we should've done it this way, or we should've done it that way.”

We have to be in the conversation. We can't wait for other people to tell us how pharmacists or pharmacy services are going to be involved. We need to be in the fray, as Teddy Roosevelt would describe if you've read his Man in the Arena speech. I think it's one of the better speeches that you’ll ever find, which is really about the importance of citizenship and being an effective citizen. That's a great place to get started with this conversation as well.

Tom Johnson (14:44): So not only does the profession need to do that, but the profession is each of us as individuals coming together collectively to bring forward solutions. Individuals have to have a plan of how they're going to continue to move forward, how they're going to set up their next six months to a year to five years and really have a plan.

If those individual ideas can be furthered and collected by ASHP and other professional organizations, then absolutely that's what we need to do because really ASHP is all of us. It's not some entity somewhere that does things for us. It's all of us as members.

I really believe that. That's a great way to move ourselves forward.

Paul Abramowitz: Well, that sounds like a great place to leave it for today. Thank you very much, Tom, for sharing your thoughts and insights about transformational presence. I’d like to encourage everyone, if you haven't already, to please read Tom’s Inaugural Address. You can find it on our website, Join us next time when we discuss how transformation can create new opportunities for the pharmacy profession.

Speaker 1 (15:57): Thanks for joining us for Truth in Transformation. Be sure to visit to discover more great episodes, access show notes, and download the episode transcript. If you love the episode and want to hear more, be sure to subscribe, rate or leave a review. Join us next time for more Truth in Transformation from ASHP President Tom Johnson.