Gaurava Agarwal, MD: Too often, we reserve the label of leader for someone with a fancy title before their name.

Logan Pause: But great leaders are everywhere in our midst.

Gaurava Agarwal, MD: I'm Gaurav Agarwal, MD , but everyone calls me G.

Logan Pause: And I'm Logan Pause.

Gaurava Agarwal, MD: On Anatomy of an Everyday Leader, we believe that everyone has the potential to be a great leader on a healthcare team.

Logan Pause: To find out what it takes and what it means to lead in healthcare, we talk to people from around Northwestern Medicine who are doing just that.

Gaurava Agarwal, MD: Whether you've just started your career in healthcare or are a seasoned professional, have a leadership role, or hope to take one on someday, this podcast is for you.

Logan Pause: Join us as we peel back the layers of leadership to ultimately make healthcare better.

Logan Pause, PharmD (Host 1): A common theme that has come up on this show is leaders who think beyond healthcare. Matt Dandino is one of those leaders. In his role as program director of Ambulatory Pharmacy at Northwestern Memorial Hospital, he fuses a strong clinical background with forward-thinking business acumen. Welcome to the show, Matt.

Matthew Dandino, PharmD: Thank you.

Gaurava Agarwal, MD (Host 2 ): It's great to have you. I'd love for us to just open up with our audience, getting to know a little bit about you and your role here at Northwestern Medicine.

Matthew Dandino, PharmD: Sure. Currently, I oversee the business aspects of our specialty pharmacy and infusion service lines. And so, what that looks at is not only making sure that we're financially sound, but that we're being innovative in the quality of care that we're bringing, you know, and making sure that at the end of the day, what we are providing to the patients is top-level care.

Gaurava Agarwal, MD : Part of my objective with this is to highlight pharmacists, what they do for a system. Can you just tell us a little bit about — for those folks who have a mental model of pharmacists at Walgreens as the only mental model they have, can you talk a little bit about what a pharmacist does in a healthcare system and just how critical and important they are to our workforce?

Matthew Dandino, PharmD: Sure. In the healthcare system, pharmacists have a wide variety of roles. I think if you look at, you know, the floors here within the academic medical center, you'll find them deeply ingrained in rounding models. You know, not only on the medical side, but also the pharmacy side. And so, a lot of times on the inpatient floors, you know, the pharmacists are reviewing recommendations while we're rounding, and then also, coming back to the team with any adjustments to orders or drug interactions, whatnot.

I will say too, the one thing that pharmacists are very good at is we know all the formulations of particular medications. And when it comes to compounding or making what's needed for a patient, especially when we talk about intravenous therapy, we are your best resource to have there as well, right?

Then, when we pivot to the ambulatory side, most ambulatory clinics at this point in time now have a pharmacist embedded in them. And so, it's not only reviewing therapies that are occurring on a day-to-day basis, but also educating patients, making sure that those patients feel comfortable about the therapies that they're receiving. And then, when they go home too as well, what to expect and, if something happens, you know what to do. I think too, as well, depending on the state that you're in, there are many different collaborative practice agreements that exist out there to ensure that pharmacists are another layer to reach our patients, you know, from the front lines.

At the end of the day too, the pharmacist is always in the community. If we think about even retail, they're always accessible. And that's one of the things when you hear a survey of what people think about pharmacists, it's always one of the most accessible healthcare providers out there.

Matthew Dandino, PharmD: Thank you for that. Tell us a little bit about your journey to Northwestern Medicine, your professional journey, how did you get into pharmacy.

Matthew Dandino, PharmD: Sure. Well, I did not see myself as a pharmacist. I saw myself as a dentist. My grandfather was a dentist, and I thought that I would pursue a similar career path. And while I was doing some clinical shadow work, doing pre-dental work, I witnessed a drug interaction take place and I found myself deeply interested in why the drug interaction took place with a patient.

And so, I think that was one of the pivotal points in my journey that told me, you know, maybe there's something here. And I was much more interested in the chemistry behind why certain interactions were occurring, and really how to mitigate those interactions, but keep pursuing, you know, the type of care that patients need.

And so once you're in certain health science degree pursuits, it's easy to pivot at times, right? And so, moving into the pharmacy realm was actually quite easy. And after I got my pharmD, I knew I wanted to pursue some form of clinical pharmacy, but I also always had an interest in business. And so, doing a first-year residency that was heavily focused in clinical pharmacy, making sure that I had a solid clinical foundation to move on, allowed me to pursue a second-year pharmacy residency and health system pharmacy administration. And what that does is it builds on the foundation of knowing the clinical pieces and then layering in a business acumen to it as well to ensure that you're set up as a pharmacy leader to move forward in the management level.

Once I finished my residency, my second-year residency, I moved into what was at that time a new coordinator role where we merged not only understanding pharmacy operations, but also supply chain dynamics together. And then, the COVID pandemic hit, you know, there was a lot of uncertainty. And during that time of uncertainty, I joined Northwestern Medicine in 2020 as a coordinator here, and helped build out our 340B program, And then, as different opportunities became available, I moved into a pharmacy manager role over inventory on the inpatient side, and then most recently have moved into a program director, overseeing the ambulatory pharmacy business portfolio pretty much.

Gaurava Agarwal, MD : Let's double click on a couple of those things. You know, obviously, you mentioned a few different ideas. And I guess the first thing is it sounds like even as early as your second year of residency, you foresaw yourself as a leader and wanting to have the skills to become a pharmacy leader. What was it about being a leader that, you know, sort of drew you and made you feel like, "Hey, I'm somebody who's going to be a leader or wants to be a leader"?

Matthew Dandino, PharmD: Yeah, I think for me, personally, I had the background of seeing great leaders out there and how they interacted with peers. And I saw individuals who, at that point in time, you know, were moving their departments forward. And I thought, "Well, that's a catalyst to moving the profession forward." And so, I knew I wanted to pursue a similar fashion of professional work. What I didn't know at that time was how much I would want to break the glass ceiling and go beyond just pharmacy and think of myself as a healthcare leader versus just a pharmacy leader.

I think that as you get comfortable in certain disciplines, you see how the skillset translates over to other departments very well. And there's much synergy gained between working in different departments. And so, I can tell you a lot of the things that I do now are financially intertwined, right?

Matthew Dandino, PharmD: Can you get a little bit more specific in what about those leaders and those mentors that you had? What drew you to them? What did you feel like made them effective?

Matthew Dandino, PharmD: When I think about the mentors, the skillset that I see in all of those who are still mentors to this day to me, they're all deeply grounded individuals that have substantial rapport from entry-level positions through senior leadership. And I think that piece of humility is one of the most valuable skillsets you can learn.

There are also those that have what I would call referent power. And through business school, the concept of power is something that I would teach a course on — I'm so obsessed with it — and learning all the different intricacies of power and how it affects organizational leadership. And what I learned from diving into the concept of power is that referent power is truly the type of power that I, as a leader, want to be known for. Because that means that you have a sense of admiration and peers trust you based on the work that you've done and where you meet them in the middle.

And I think that that's something that not a lot of leaders have. And when I look at all of my mentors and those who have, you know, helped me get to where I am, they have never wavered on that principle of making sure that, as you assume higher level roles, those who you work with — doesn't matter the position or whatnot — they respect you. Because at the end of the day, that makes you that much more effective at executing and getting to where you need to be. And so, I think I would challenge a lot of folks to just consider that concept. There's certain types of power that you'll see all over, but there's many that are not exhibited by all leaders.

Matthew Dandino, PharmD: Where did that drive come from to pursue and want to break this glass ceiling that you've mentioned?

Matthew Dandino, PharmD: So for me, the drive has come from seeing the various disciplines within health systems and underrepresentation of pharmacy at certain tables when, besides labor, drug spend should probably be your second-highest expense if you're looking at overall expense of a health system. And so, being able to have a seat at those conversations and earning your way there, certainly, it's come with failures at time, right? You're going to meet skeptics and those that have criticism of what you're trying to do. But at the end of the day, I think what we see now is that folks who have, I'll just say, skillsets in different areas of healthcare. When you have leaders that are more than just one-dimensional, I think it greatly expands the quality of work and your ability to execute in general. And so, I think for me that's really where the glass ceiling concept has come from, is that I started in pharmacy. And then, I also picked up an education in business administration. And I see how both of those pair very well to be a successful leader. And to be a successful leader, that means at times I may have to go outside my home base of pharmacy, but that doesn't mean that I'm completely abandoning pharmacy because I've also moved into a different direction.

Gaurava Agarwal, MD : Your story is interesting in how you found yourself on this podcast. Initially, you were nominated by someone above you. And that's generally not how we accept people, to be honest with you, because there's a lot of people that manage up very effectively. But the folks above them don't realize the wake that they're leaving behind them.

And so, that initial nomination was great. But then, we had to go check from the people you lead and say, "Hey, you know what? Is he the real deal?" And what they said in terms of — and obviously, they didn't use this term — but your referent power that they felt you did really, really well, was you connected purpose and meaning to what could be tasks that sound very minutiae sort of financially. But you actually make the connect the dots around why this thing actually matters to you. Can you talk a little bit about what they may have been referring to or what strategies you use to try to help bring meaning and purpose to something that may seem otherwise sort of irrelevant to a clinician?

Matthew Dandino, PharmD: Yeah. Let's pick apart all the work that goes into actually getting a medication to arrive correctly to be used for a patient, right? And so, there's several complexities within that process itself. And I'm one of those who likes to draw out processes and map it out to where we can anticipate as a team and learn where failures may occur. And if they do, can we pinpoint exactly in the process where the failure occurred?

And so, you know, I think when you're talking about getting into what could be considered minutiae, a lot of times it's in many of these complex workflows that, from a 50,000-foot level, it seems like a simple task. Once we break it apart, we see all the complexities that are layered into just complete simple tasks. And I say that because, you know, when we think about medications coming in the door, there's thousands of them coming in the door daily. So to have a process that can be replicated and doesn't include flaws, you know, that's a feat in and of itself. And so, when you look at tasks like that and you build out workflows, it would be very easy for myself to say, "This is the workflow I, as the leader, designed. Let's implement this because I'm the leader," right? But that's not what I do. I sit down with my team and I say, "This is the mapping that I have created. Please pick this apart. Rip it to shreds." I want to know all the intricacies that go on that I may not even be privy to that could insert flaws into what I have designed.

And so, what I think that peers are bringing to you is that even these simple tasks, there's purpose and meaningful discussion behind why they're structured a particular way. And you know, if you look at things such as engagement, I'll say I'm very proud of my engagement scores because I've built them around meeting my employees where they are and taking their input and valuing it worth gold and refining our processes to make us all better.

Matthew Dandino, PharmD: Matt, as a leader, how do you manage the balance or the tension between getting feedback or input from your team, and then also being a leader that's accountable to decisions, right? And sometimes, you need to make decisions or I would assume that you need to make decisions that at times may go against what some of your team members, or your direct reports say should be done. So, how do you balance that tension?

Matthew Dandino, PharmD: Yeah. So whenever there's tension, I try to look at what are higher level officials trying to accomplish? And then, what's creating the tension between my staff and this accomplishment, right? And so, at times, I think when tension occurs, it can be from processes not being refined. But it can also mean that there could be a misunderstanding as well to higher level officials of what's truly going on.

And so, the word tension is a good word. Because what it does is it tells me that I need to do a better job at articulating what staff reporting to me are doing, but also making sure that staff understand what expectations are from higher level officials. And so, I'll tell you, I find myself in the middle of this tension a lot of times, because certain responsibilities that my team has, those responsibilities are very complex. And so, to get some processes to go correct, there's not glamorous duties behind it, right? It's very tedious work. But at the end of the day, how this shows up in financials greatly affects the organization.

And so, when I hear things like headwinds coming and whatnot, typically to counteract headwinds, for me, that means that my operations are going to get more complex. But knowing that I already work in a complex world, how do I alleviate that tension that I think you're getting to, Logan, and that really has to come down to synergy and refinement of what we're doing, you know, on the front line. If we're not continually refining our process and our product that we're producing to keep our teams afloat, then I think that tension will always be there.

Gaurava Agarwal, MD : I've had some friends who are trained clinically in whatever field, and then they go back and get the MBA, and they say, "Hey, You know what? There was a lot of interesting mental models that I learned from this field just because, you know, generally most of us have been in that science world and that clinical world. If you had to pick one sort of leadership framework or concept that you learned in MBA school, what might that be?

Matthew Dandino, PharmD: Oh, that's a good one. Let's talk about surveys and the importance of surveys. But how do we actually utilize surveys. And so, I would say coming from business school and learning how to develop a survey, there's many pitfalls to developing a survey, but you can also get some great improvement technique and concepts out of a survey, right? And so when I think of organizations that are used as case studies that have these surveys, they not only ask, we'll say, vague questions, but then they dial into specifically what was behind that vague question that you saw, right?

And so, I'll give you a real-world example. I just recently interacted with a company where I said that the engagement was not a positive engagement. Instantly, it said, on the next page, "We realized that your engagement was not positive. Could you articulate a bit more what happened?" Once I put those exact words in there, I got a direct phone call from that company to go through this. I can tell you that was about two to three weeks ago. I just called that company a few days ago, the exact feedback I gave was changed in their phone tree already.

So, I say that because these type of case studies come out of business school. And when I translate that over to what I do now, I'm going to dive right into the engagement survey where I will tell my staff right away the most important piece of that survey you can fill out are the comments. The more words you give me, the better because it's more that I will act on.

And so, you know, I try to keep this type of mindset of customer service always in the back of my mind. Even though I'm the leader of a team, those type of surveys are some of the most important information that I can gather. Now, I will say, I think surveys give you just one point in time and that you need to be in tune with your team at all times, right?

And so, there's a lot that we can learn. And I think that gaining trust from individuals to actually fill things out, like surveys completely, and to just understand that these will never be punitive, you know, that's one of the pieces that has translated over that I try to always keep in the back of my mind, as I am, you know, now working in my present role.

Gaurava Agarwal, MD : You know, it goes back to this issue of input, right? It is that input is the secret sauce of having people be engaged with you. And if I'm asking for your input on these surveys, I'm asking sincerely because I plan on doing something about them, and I'm going to make sure you can see that I did something about them.

Matthew Dandino, PharmD: I'm also hearing along with input, G, I'm also hearing consistency. Matt, you used — and I just kind of jotted a note here, you said continuing to refine the process, right? And so, I just hear, and the language that you're using both in terms of getting input, I imagine that if you were to only get input for your team twice a year, that would be a very different result or outcome in relationships than a consistent refinement. And so, I'd love to even hear you comment on how do you think about refinement in growth with just your own leadership? What does growth look like for you in consistent refinement as a leader?

Matthew Dandino, PharmD: Yeah. So, my true north motto, and I always say this, is: Don't strive for perfection because you'll never achieve it. And I love to hear how people interpret that because it tells me right away the direction that a leader is thinking I'm heading. And so, if you say that he said, "Oh, don't strive for perfection, you'll never achieve it. He's a negative person. That means he can't get a well-finished product out the door," I always say false. That means that I am in a state of continual refinement that means that I know that what I deliver today, tomorrow I can refine and make it better. And that's how I become a better leader through a true north motto like that. And ever since I've interviewed for residencies, that's always been the mantra that I've lived by. So, how I keep refining my leadership, it's taking advantage of opportunities that are out there for me to grow outside of my present comfort zone.

And so when I do that, that starts enhancing skill sets that, one, I may not know I even had. It may start nurturing new areas that I may find I actually like and just add to my skillset. But also, two, it may identify an area that is a true difficulty for me. And if that area is difficult, well, then let's tackle it head on. I think I'm one of those leaders who I understand what my strengths are and I understand what my weaknesses are. But at the same time, if you can learn how to work with your weaknesses, I think that makes you an even stronger leader,

Matthew Dandino, PharmD: It's really good. Really good.

Gaurava Agarwal, MD : It's a funny thing you asked that, Logan. Because, you know, I recently had to go look for an old PowerPoint I had made for a talk. And I remember thinking, "Man, this is an awesome talk," five years ago. I was like, "I killed it. This is a great deck." And I was looking at it recently. I was like, "My gosh, it's like amateur hour. How did I even get a job after I presented this slide five years ago?" And now, I'm just sort of chuckling because, you know, right now I'm like, "Hey, I got a nice little deck here. Good talk." But I imagine five years from now, I'd be like, "What was that slop you put together?"

And so, this issue of constantly growing is real. And there are these little objective moments where you can feel it and see how you've changed and then how you've grown if you're doing it right. Matt, this is called Anatomy of an Everyday Leader. Obviously, you're an actual title of leader at this point. But it sounded like to me, your initial big break was one where you didn't ask permission. It sounds like you sort of saw this problem and you said, "Hey I want to sort of be involved with the solution and sort of created something that didn't exist before." Can you talk a little bit about that? Because I think the audience that isn't titled right now as a leader is looking to say, "How can I get some more responsibility? How can I create a path that isn't there yet?" I think they may benefit from your story.

Matthew Dandino, PharmD: Absolutely. So for me, I think the most important thing that has aided in my journey and that I would encourage anyone to do is know the direction that you want to grow in, seek out opportunity or even put yourself on a project or even a minor deliverable that can start granting you experience in a new area that's ultimately in the direction that you want to grow?

I can tell you, for me, the opportunities that have come along, it has been my intuition and curiosity that has earned me, whether it's a seat at the table or participation in a project, it's by putting yourself out there that people take notice and by going above and beyond. And so, I think that, you know, when you're willing to put yourself out there, especially in an area that isn't your comfort zone, people notice that. And it takes a particular level of curiosity and willingness to make yourself feel uncomfortable, right? No one likes the feeling of failure. And so, putting yourself out there in an area that may be uncomfortable, it can lead to failure, but it can lead to great success.

And so, I think when we look at the success that's achieved when you do this, it's not only that you've accomplished something, it's that you've likely now interacted with many folks that you would've never interacted with before. And you're now on their radar as a participant, and someone that they know to go to for future things. And now, if I look at what comes in on a day-to-day of requests and whatnot, it has been by me putting myself out there and developing rapport, that now I'm looked to as a trusted colleague to help solve these issues.

Matthew Dandino, PharmD: That's great, Matt. You've got such an infectious presence. Just hearing you talk about growth, hearing you talk about curiosity, hearing you talk about refinement, I think is inspiring. I'd love to ask a question of how do you handle setback or failure or perceived failure? Is there any examples throughout your professional career that have been defining moments that maybe at the time was a setback or you felt like you failed, but looking back, it was an opportunity to grow?

Matthew Dandino, PharmD: Yeah, I'll give you the pinnacle failure of my career. And it was during my interviewing for first-year residencies. I had thought that I knew exactly where I wanted to go because I was chasing something that wasn't really what I thought it was. And as I was interviewing for certain programs, I realized — I realize now — that if you go back a decade ago, I was talking about a future and a position where I hope to get to that didn't exist. And when I mentioned it to certain leaders, I was sort of written off, and they didn't understand.

And I think that now I look back, and I see that it was a very conventional way of thinking at that point in time. And I was trending more futuristic with what I wanted to do. And so, when I didn't get to, you know, where I wanted to my first go-around, I realized when I was selected for the program that I was, it was because my core-defining principles that I was looking for were actually shining through and got me to where I was. And that level of mentorship and finding true leaders was exactly going to put me where I needed to be.

And so, I would tell folks that you think you can have this whole career path drawn up and you want to go to this place, that interview went super well and maybe, you know, an interview somewhere else didn't go well, never judge your feelings coming out of things in a particular direction, because you may never know how the other individuals felt. And I can tell you that it was night and day difference between how I felt coming out of one and the other. But I ended up exactly where I was supposed to be, and I am forever grateful that I ended up where I was because I would never have the mentors now that I have.

And if I think about especially my second year of residency and all of the pharmacy leaders that I worked with, all of them now are at executive levels of health systems or at an executive level and some other, you know, healthcare company at this point in time. And so, when you're able to put together mentors that have risen to those ranks, I think it tells me that my team had the right folks on it the entire time. I just had to trust the process. And it sounds so cliche to say that. But when people truly believe in you and you can sense a connection that's beyond whether you're intelligent or not, those are the folks that you want to stay in a lifelong mentor-mentee type of relationship.

Gaurava Agarwal, MD : Thank you very much. It's been a real pleasure to learn about pharmacy and, as you said, being a trusted clinician to our patients. Thanks, Matt.

Matthew Dandino, PharmD: Yep, absolutely. Thank you both.

Gaurava Agarwal, MD : Take care.

Matthew Dandino, PharmD: Thanks, Matt.

Outro: Thank you for listening to Anatomy of an Everyday Leader. Subscribe to the show wherever you get your podcasts so you don't miss an episode.