Abstract
Objective. To understand and identify developmental opportunities by exploring students’ evolving views of leadership, including the emergence of leadership and self-identification, among students considered to be leaders and those considered to be followers.
Methods. An exploratory qualitative study using semi-structured interviews was conducted, investigating developmental differences among leaders and followers. Fourteen students/residents were selected to participate in interviews. Student responses were analyzed using qualitative thematic analysis.
Results. In discissions, four themes surfaced: motivations for exploring and engaging in leadership, perceptions of ideal leaders and followers, the value of coalition building, and a leader’s role in sustainability. Leader respondents indicated that a potential barrier to helping others develop was their difficulty in delegation. Further, stress on leaders may contribute to a self-serving perspective on their responsibilities to help others develop.
Conclusion. In comparison to their leader counterparts, followers may require a more individualized approach to their development and may become more deeply attached to their responsibilities, giving them a greater desire to promote sustainability in an organization or endeavor. Schools of pharmacy should be poised to support faculty, advisors, mentors, and student leaders with the tools to identify and develop active followers who may not seek out traditional leadership experiences.
INTRODUCTION
An essential element of professionalism is leadership. 1, 2 Some even maintain that pharmacists have an obligation to shape the future of the profession, regardless of their position or title. 3 As such, the Accreditation Council for Pharmacy Education (ACPE) has established key standards and guidelines related to leadership, and the Center for Advancement of Pharmacy Education (CAPE) has established educational outcomes that require Doctor of Pharmacy (PharmD) programs to foster ambitious leaders. 4, 5 Although guiding principles have been created for developing leadership in students, including approaches that recognize leadership as a relational process, 6 efforts to understand relational leadership are limited.
Relational leadership can be seen in the connections that form within a team, group, or organization with goals for social change. 7 Such connections provide a process for influence based on context rather than on the contributors or their formal roles. 7 Despite this, leadership is most often studied through a leader-centric lens, restricted to those holding positions of power or certain skill sets, omitting the process of mutual influence. 8 A more relational view recognizes that leadership is generated among people acting together in meaningful ways. 9 Thus, understanding “followers” provides a more comprehensive view on leadership.
The typical conceptualization of “followership” often limits the perceived importance of followers to leaders and leadership development efforts. Lay definitions provide negative, unfocused, and, at times, subservient connotations. Leadership, on the other hand, has higher visibility and perceived importance. Stereotypical (but widely held) leader-centric views, may overattribute the leader’s role and power; therefore, the leader may be rewarded or blamed inappropriately for group efforts. 10 Whether leadership is a learned behavior or the expression of inherent abilities of an individual, leadership is a process sustained and recognized only if followership emerges. 11
Detailed conversations on followership are absent from the pharmacy literature despite several mentions in health services research regarding its importance for achieving positive work-life balance, health care quality, and patient safety. 12, 13 Followers determine how leaders emerge, the potential for social change, and group dynamics. 14 This has implications for the persistence of practice advancement efforts. When followers lack confidence in their leader, they may reject the leader and the roles prescribed by their leader. 15 Thus, greater consideration should be placed on the progression of leadership development efforts, fostering relationality in leadership, and the unique role of followership development. This study aims to understand and identify developmental opportunities by examining students’ evolving views of leadership, including the emergence of leadership and self-identification, among leaders and followers.
METHODS
To encourage participants to speak freely, in-depth, semi-structured interviews were conducted to identify potential developmental differences between leaders and followers. The leadership identity development (LID) model (Table 1) was used to construct the interview guide, as it focuses on students’ experiences, relationship building to accomplish change, and potential developmental milestones. 16, 17 Questions were designed to probe respondents’ developmental influences, personal development strategies, and changing views on leadership and followership. Peer review of the interview guide was completed by the research team as well as by two pharmacy-trained students in a research-intensive graduate program to ensure that questions were clear, neutral, singular, and opened-ended. Interviews were structured to move from fundamental to more reflective responses. Participants’ responses guided the use of probing questions during the interview, and flexibility in the protocol allowed for interviewers to immediately follow up on emerging ideas. The research protocol was submitted to the University of Mississippi Institutional Review Board and was granted exempt status.
Stages of the Leadership Identity Development (LID) Model
Eligible participants included students and residents currently enrolled in the final year of an early-entry undergraduate program, in the professional pharmacy program, or in the associated residency program at a public, research-intensive institution in the southeastern United States. Participants were recruited by email using Qualtrics (Qualtrics International Inc) to elicit willingness to participate, to provide study objectives, and to collect pertinent demography. Inclusion criteria for the “leader” participants included formal extracurricular leadership experience to ensure some exposure to leadership. To accommodate the timeline and feasibility of the study, recruitment was stopped when a sample spanning the current educational path of the pharmacist was achieved, from prepharmacy to resident status.
Snowball sampling was used to identify follower participants during the leader interviews. Leader/follower relationships were identified through participants describing the leader or follower, allowing each other to assume a leadership role when appropriate, appropriately deferring to the other’s experience, or resisting/negotiating influence to achieve an outcome. 10 In addition to obtaining verbal permission to contact individuals, confidentiality was requested of leader participants to ensure that subjects selected for the follower sample were not primed (made aware of their “follower” status) without first receiving clarity in terminology by the research team.
Leader/follower pairs were independently interviewed by a pharmacist enrolled in a research-intensive doctoral program using the most convenient modality for the participants, and interviews lasted 60 to 90 minutes on average. To ensure clarity in operationalizing the terms followers and followership, participants were provided established definitions from the literature for review and given opportunities for questions. Interviewees were encouraged to think out loud on the topics to allow the interviewer to validate and document that the participant understood the terminology. The interviewer also encouraged both leader and follower participants to provide examples of when they may have exhibited or experienced followership. In addition, participants were asked to rank and discuss several established followership traits and abilities.
Every effort was made to maintain equity in the protocol between the leader and follower interviews. Transcriptions were edited to remove nonsense words, identifying information, and to add participant emotion or tone in the margins. All transcriptions and audio recordings were password protected and available only to the research team. Data analysis occurred alongside data collection as a means to support study direction and emerging ideas. A line-by-line coding approach was used to provide an initial understanding of information gathered and to suggest areas for clarification or adaptation in the interview guide. In particular, care was taken to provide clearer opportunities for discussion about participants’ perceptions on the role of titled versus nontitled leadership opportunities in their development as well as on the role that other individuals play in the success of their leadership experiences. Through this process, patterns in established codes began to coalesce. Once interviews were complete, a second set of transcript reviews were performed to identify potential overlap in the codes and aid in theme generation. Content analysis was performed by two independent reviewers to discover recurring themes within transcripts. A third independent reviewer assisted to resolve any thematic disagreements. Upon a complete review of the data and synthesis of themes, verbatims were collated in support.
Multiple measures of validation were used to ensure the trustworthiness of the findings and minimize personal bias. Following each interview, handwritten notes were transcribed for each participant and placed in a reflective journal throughout the study period. These written reflections helped the study team identify themes early and determine when modifications to the interview guide were needed. Respondent validation was used to ensure clarity in messages (two participants declined follow-up due to scheduling concerns). Transcripts and emerging themes were confirmed by participants for factual accuracy; they were given the opportunity to provide additions or edits.
RESULTS
In total, 14 participants (from seven leader/follower pairs) that expressed willingness to participate and met eligibility requirements were offered an interview in this exploratory study. Ten participants (71%) were female, 10 (71%) self-identified as a leader among their peers, and 9 (64%) had formal leadership on at least a state level. In addition, four participants (29%) were enrolled in their first or second year of a postgraduate pharmacy residency program, four (29%) were in their third or fourth year of the professional (PharmD) program (P3 or P4), four (29%) were in their first or second year of the professional program (P1 or P2), and two (14%) were in their final year of prepharmacy education and intended to enter the professional program.
Four themes surfaced in discussions: motivations for exploration and engagement in leadership, perceptions of ideal leaders and followers, the value of coalition building, and a leader’s role in sustainability. Of note, follow-up interviews were completed with 12 of 14 participants within seven to 14 days of the original interviews, and these interviews addressed transcript accuracy, preliminary themes, including more contentious themes such as leader delegation during times of stress. No meaningful changes were made to content based on these conversations.
The first theme suggests that leaders and followers have differences in their motivations for exploring leadership. Most leader participants (85%) cited that their primary driver for exploring leadership was career aspirations, including resume-building opportunities and perceived obligations for involvement. A leader and professional student admitted, “I would be lying if I didn’t say that the major reason I got involved is because of residency. You need a great CV. Even though I enjoy what I do, I’m still mostly involved to learn from the experiences and have a shot at a residency” (Participant 1). Another leader and resident stated, “at this point in my involvement, I really think I have been granted some opportunities to make a difference. But, initially…I don’t know…I think I got involved because it seemed like something that we were supposed to do…” (Participant 8).
Most follower participants (86%) mentioned that their primary drivers for exploring leadership were related to passions, strengths, or opportunities for unique contribution to a meaningful cause. While followers seemed to have less exposure to traditional leadership in pharmacy, they seemed to find a more personalized direction for involvement. A follower and resident affirmed, “I am passionate about preventative medicine. As a student, I made sure to get involved with the organization that would provide me with the most valuable opportunities to hone those skills” (Participant 2). In addition, a follower and professional student stated that a colleague “had a role she felt I would be uniquely be good at based on my past experiences with graphic design. I wouldn’t have even known it was available, but I’m glad she brought it to my attention” (Participant 9).
A second theme was about perceptions of the ideal leader or follower. Leader participants (71%) suggested that it is important for a leader to work with others, and it is the ultimate responsibility of the leader to get things done. A leader and professional student admitted, “while it is important for me to make sure that members are involved with what we are working on, I am the individual ultimately responsible if things succeed or fail. Honestly, at this point…, I’m still working on me and am not sure how effective I can be helping others to be the best they can be” (Participant 1). Most leader respondents (86%) cited experiencing pressure to achieve success in their leadership role and having difficulties in trusting and delegating even after years of experience. A leader and resident stated, “I thought I would be better at this by now, but I’m not. I still try to do everything myself and I know better. I think when you spend so long doing things yourself, you begin to get used to it” (Participant 8).
Followers (57%) emphasized that the ideal leader assists others in their personal development (provides followers opportunities to be purposefully involved) and highlighted that the responsibility of accomplishing a mission is on all members of a group. A professional student who served as an appointed committee chair for a student organization shared how her unique experience could be leveraged. She said, “though I don’t hold an office, it’s really important that I help others on my committee to be the best they can be. Maybe I can reach others in a way that [an executive member] cannot as we have worked closely together to move the ball forward” (Participant 3). A follower and professional student stated, “a leader needs to elicit feedback from their followers. This is important as without all of our contributions, a particular project or initiative cannot be the best it can be. Most leaders think it’s all on them and forget we’re all to blame.”
Both groups (86%) provided overwhelmingly similar perspectives on the ideal follower, highlighting the importance of followers that take initiative, with the majority citing passive followership in their past experiences. Even after doing the exercises to define the term follower, 79% of all participants still held a generally negative connotation toward the concept of followers, despite confirming their positive contribution to leadership. A follower and preprofessional student described opportunities to lead that do not involve a title. She stated, “I would consider myself a follower, but that doesn’t mean I don’t find ways to be a leader, just on my terms. I feel a good follower takes initiative, especially when I can do the job to the best of my ability” (Participant 4). A leader and professional student concurred, stating, “it would be great if my classmates were more actively involved or took more initiatives, but the majority of them don’t. I could imagine how much impact we could make if more followers were active” (Participant 11). A leader and resident recalled, “it’s amazing how the stress of school really made me rely on others less, probably to the detriment of the project and myself, because I didn’t encourage people to be a better follower” (Participant 5).
The third theme suggests that leaders require the assistance of others and work toward community building. Despite leader and follower respondents both understanding the value of community, there were some differences in the reasons for building community. Most leader respondents (71%) saw community building as a way to manage their responsibilities, avoid failure, and manage the stress of trying to achieve a work-life balance. A leader and professional student recognized that “while I am a leader by my office, it’s comforting to know sometimes I get to lead and sometimes I get others to lead things. I strategically try to get underclassmen involved as much as possible not only to help them out, but to ensure that we [senior students] can study for a test we have coming up” (Participant 11). A leader and preprofessional student stated that followers are relied on “when the stress of being in a leadership position becomes too much or you need to catch up on things” (Participant 12). Of note, only one leader participant in the preprofessional or professional program spoke to the value of community building to stimulate growth, potential impact, or to make change. A leader and professional student stated, “our student organizations do a lot that is always more work than reward. Making sure everyone is encouraged to bring their best to the table is the only way it all works” (Participant 6).
Most follower respondents (86%) valued leadership as a means to capitalize on the strengths of the group and to strengthen the buy-in to a cause. A follower and resident highlighted that “while followers may not be interested in everything, if you find what makes them tick, they can be a powerful advocate” (Participant 13). A follower and second- year student recalled, “some of my best leadership experiences are when I have worked with teams where no one really leads…agreeing on allowing people to do what they do best” (Participant 9). A follower and professional student discussing her own development stated, “I’m trying to learn from that experience, realizing someone who leads on one project may not be the best to lead on the next. I think we could do more if the responsibility wasn’t just on the presidents or officers” (Participant 3).
The final theme illuminated a difference between leaders and followers regarding a leader’s role in the sustainability of an organization or initiative. While most respondents (79%) cited difficulties in delegating and developing others, leader respondents suggested that leaders in pharmacy will always be available to sustain efforts. Fewer leader participants displayed urgency regarding the development of future leaders, their followers, or even their replacements in their current leadership roles than follower participants (21% vs 86%, respectively). A leader and professional student reflected, “I really am not sure if I am qualified to cultivate other leaders. To be completely honest, there’s always someone behind you ready to do the work or build their resume. Also, as an officer it’s hard enough to juggle the work you have, let alone preparing others to do the same” (Participant 7). A leader and preprofessional student stated, “To be honest, I haven’t thought much about what I am going to do when my term is over. Luckily, there are plenty of people that can pick up the torch for me when I am gone” (Participant 14). A leader and resident remembered, “As a student leader, my major focus was survival. Yes, I challenged my fellow executives to identify whom would be our replacements, but frankly, pharmacy students are such over achievers there was always someone willing…especially with the pressures of residencies” (Participant 8).
In contrast, most follower respondents (86%) showed a strong sense of responsibility to develop the next generation of leaders. A follower and professional student stated, “I worked very hard to get our [name] program to the level it is today. I swear I am going to grieve when I have to pass it on to someone else, but at least I know I have left a mark on the community getting it to where it is today. I cannot tell you how important it will be to make sure it is in the right hands when my time is over” (Participant 3). A follower and professional student stated, “while I never thought I would be good at it, many underclassmen have thanked me for what I do and seem to have been helped by me. I think it’s important that I make sure that when I leave the school of pharmacy, that the things I have started don’t fall by the wayside.” (Participant 9). A follower and resident said, “I try to tell my students all the time, it’s important to leave a legacy and that we all can leave a mark in what we do.” (Participant 2).
DISCUSSION
An active and engaged followership provides opportunities for mutual influence within the leader-follower relationship. Effective followership not only shapes leader behavior but also supports group performance, as followers are responsible partners in change. To the best of our knowledge, a follower-centric approach to identify developmental opportunities and to understand evolving views of leadership among student pharmacists and residents had not been examined. Our efforts suggest that developmental differences exist in leaders’ and followers’ motivations for exploring leadership opportunities, evaluations of the need for coalition building, and urgency in ensuring sustainability; these differences warrant additional exploration.
While leaders and followers are exposed to leadership opportunities in similar ways, motivations to take on leadership responsibilities may differ. Leader participants highlighted that their primary drivers for exploring leadership opportunities were career aspirations and expectations, confirming previous efforts that identified motivating factors of formal leadership to include networking, belief in the organization’s mission, ability to affect change, and legacy. 18 Follower participants held strong convictions for seeking targeted opportunities for unique contribution based on their passions/skills sets. Our finding suggests that followership development may require a more tailored approach by advisors, mentors, and student services personnel to encourage and increase exposure to nontraditional leadership opportunities. Work should be done to better understand the developmental needs of followers to ensure prolonged engagement and highlight unique opportunities for their potential contribution(s).
An active followership supports job satisfaction, engagement, and measures of organizational performance in health care settings. 19 While leader and follower participants stated that they value the development of a more active followership, they may not be equipped to take on the responsibility of developing followers. Most leaders cited a general lack of delegation skills and a general fear of failure as contributing to their not seeking help when needed from classmates or fellow officers on organizational and service efforts, thus taking the burden on themselves to ensure successful completion. Leader participants who conveyed confidence in delegation suggested that seeking help provides a personal relief from the pressures of balancing academic and extracurricular responsibilities, while followers confident in delegation found community as a means to obtain the best long-term product from a team. Follower participants more consistently expressed a greater depth of identity development (LID model stage “generativity”), where their responsibilities guide their influence on others, such that they do not require positional power to support delegation. This suggests that in times of constraint, the development of an active followership may be a crucial step for the leader, and the overall mission, to succeed. Self-serving perspectives of some leader participants seemed immature in approach, as their actions lacked the identification of leadership as a shared group process (stage “leadership differentiated”); additional development is needed as we continue to strive for the development of effective, servant leaders for pharmacy. Student leaders should be able to attend to the development of others, motivating them to accomplish more than is usually expected. 20
In addition, marked differences between leaders and followers were evident in the of level of urgency in achieving sustainability of professional and organizational initiatives. While follower participants indicated it is important to develop and prepare individuals to take on organizational efforts, even though this involves significant time, effort, and contribution, leader participants suggested that, because of the nature of the inherent goals and personalities of student pharmacists, leaders will always be available. Follower participants described a more personal connection to their work, which may contribute to their general desire to ensure buy-in and promote the development of individuals they work closely with. Disparities between groups on sustainability is concerning; this should be considered in future scholarship. Student affairs professionals, mentors, and advisors should consider that exceptional leaders may not be overtly identified by traditional recruitment efforts. An increased focus on relational leadership may provide an effective approach to achieve sustainable professional and organizational goals through valuing individual contributions toward community efforts. 20 Several limitations of this study are worth considering. First, recruitment used “positional” leadership as a means to identify leader respondents. While this increased study feasibility, the concept of leadership is far more complex than position alone. Some who practice leadership may have been overlooked by this method. An additional assessment during recruitment may have been warranted to better understand the leadership behaviors of potential participants. Second, the sampling method of followers may have not identified or may have even inflated the concept of an ideal follower. Despite providing well-established definitions of followership to participants, student leaders may have not had adequate exposure to the concept to make appropriate recommendations or felt compelled to recruit participants. Third, follower respondents were not told that they had been identified as followers in the interview process. This may have limited the reliability of response validation of follower-specific perceptions of the ideal follower or their developmental challenges. Next, the generalizability of the study needs to be put in perspective, as this was completed at single, public research-intensive institution. While the sample was at the lower end of the range of sample sizes employed in thematic analyses, this was deemed appropriate because of the exploratory nature of this research. 21 To enhance value from the limited sample, significant reflection and time was taken to support the depth and duration of each interview, to support the richness of data obtained, and to form a robust understanding of perspectives. Finally, while participants were encouraged to be candid in their conversations, social desirability biases may have resulted in overreporting of pro-leadership behaviors. The primary author had served as a graduate assistant, a student organization advisor, and had given lectures to many of the participants on traditional leadership and management topics. This could have limited participants’ willingness to be open and honest in the interview process, despite every effort in developing the environment to do so.
CONCLUSION
Several differences between leaders and followers were identified, specifically on their reasons for exploring leadership opportunities, motivations for coalition building, and urgency in ensuring sustainability in leadership efforts. Thoughtful delegation was identified as a key element of developing a more active followership, with student leaders being less equipped and unwilling to delegate in the face of pressures for success. Followers may require a more individualized approach to their development and may achieve deeper attachments with their responsibilities, giving them a greater desire to promote sustainability than their leader counterparts. Schools of pharmacy should be poised to improve the development of student leaders’ team-building skills and to support faculty, advisors, mentors, and student leaders with the tools they need to identify and develop active followers who may not seek out traditional leadership experiences.
- Received April 14, 2021.
- Accepted October 15, 2021.
- © 2022 American Association of Colleges of Pharmacy
REFERENCES
In this issue
Jump to section
Similar AJPE Articles
Cited By...
- No citing articles found.