Pediatric pharmacy leadership looks very different today than even five years ago.
As children’s hospitals navigate emerging therapies, persistent drug shortages, financial pressures, and increasingly complex care models, pharmacy executives are playing a larger role in organization-wide strategic planning and decision-making.
Today’s leaders are no longer focused solely on pharmacy operations. They’re partnering closely with clinical and operational leaders and helping drive innovation, manage risk, advocate for access, and lead cross-functional initiatives across the continuum of care.
To better understand how the role is evolving, the Children’s Hospital Association asked three children’s hospital pharmacy executives to share their perspectives on the challenges shaping the profession, the collaborative culture that sets pediatric health care apart, and the skills future leaders will need to succeed.
How has the scope of the role expanded, and what leadership skills have become most important?
Amy Gallagher, PharmD, RPh
Children’s Hospital of Philadelphia vice president of operations
Many pharmacy leaders now oversee broader operational, clinical, and support-service functions because the skills developed in pharmacy translate well to complex health care environments. The role increasingly requires enterprise thinking, change leadership, talent development, and the ability to align diverse teams around organizational priorities.
For me, the most important skill has been the ability to create a one-team approach that connects people, strategy, and execution while keeping patients and families at the center of our decisions.
Shabnam Gaskari, PharmD, RPh
Stanford Medicine Children’s Health vice president of clinical services & chief pharmacy officer
My own role has expanded beyond pharmacy to include areas such as clinical nutrition and laboratory services, while also leading and contributing to enterprise initiatives involving cell and gene therapy, technology, financial strategy, access, and care delivery.
As the scope grows, I’ve found the most important leadership skills are the ability to connect the dots across disciplines, build trust with people who bring very different expertise to the table, translate complexity into a clear strategy, and create alignment around a shared purpose.
Jeffrey Wagner, PharmD, RPh
Texas Children’s Hospital vice president of pharmacy, respiratory care & ECMO services
Pediatric pharmacy leaders are increasingly overseeing enterprise-wide operations to include medication supply chain and inventory visibility, retail and specialty pharmacy operations, infusion and home-care integration, medication prior authorization, and population health initiatives.
To successfully manage this expanded scope, leadership competencies like systems-level strategic thinking, cross-functional change management, advanced health informatics, and value-based financial stewardship are critical.
What makes pediatric pharmacy leadership distinct from pharmacy leadership in other health care settings?
Gallagher: Pediatric pharmacy leaders are often solving challenges for patient populations where there are limited precedents, limited data, and few commercial solutions. That creates a responsibility not only to care for our own patients but also to work together across children’s hospitals to advance the field.
One of the things I value most about pediatric health care is the willingness of leaders to share ideas, lessons learned, and innovative approaches. Through the Children’s Hospital Association and relationships with colleagues across the country, I’ve seen firsthand how collaboration accelerates innovation and improves care for children and families.
Equally important, our collective pediatric voice has become a powerful force in advocacy, helping bring attention to issues such as drug shortages, medication access, reimbursement challenges, and policies that directly impact children’s health.
Gaskari: Pediatric health care is unique. Our therapies are more specialized, and many of the challenges we face cannot be solved effectively by one children’s hospital alone. My experience with CHA has shown me the tremendous power of children’s hospitals learning and advocating together, from sharing solutions during shortages to collaborating on pharmacy strategy and leveraging our collective scale, and it has shaped my belief that some of our best innovations happen when we stop solving problems in isolation.
Wagner: The primary distinction in pediatric pharmacy leadership has been the necessity to overcome the unique and complex challenges in providing patient-specific medications to pediatric patients. For years, we have had to rely on internal systems and processes to compound and prepare more than 80% of the doses we dispense given that they are not commercially available unit dose medications. This is very resource-intensive and must be accomplished within an incredibly narrow margin for error, while prioritizing patient safety.
As such, we network and partner routinely to innovate, build solutions, and leverage available technologies to overcome the unique complexities of our environment. And now we are on the cutting edge of cell and gene therapy research and access.
How have emerging challenges elevated the role of pharmacy leaders within their organizations?
Gallagher: Emerging challenges have moved pharmacy leaders closer to the center of strategic decision-making.
Whether managing access to life-changing therapies, developing sustainable care models, or navigating unprecedented drug shortages, pharmacy leaders are often balancing clinical, operational, and financial considerations simultaneously. Success requires bringing together physicians, researchers, finance, supply chain, operations, and pharmacy teams to solve increasingly complex problems.
Gaskari: These challenges have brought pharmacy leaders into conversations from the bedside to the executive table.
In my organization, cell and gene therapies and other high-cost medications require pharmacy to lead and collaborate with clinicians, finance, managed care, research, operations, and executive leadership to determine how we safely deliver these therapies and how we make access sustainable for children who need them. Similar strategies have transitioned pharmacy from a cost center to a strategic partner in how the hospital takes on risk.
Drug shortages have reinforced a similar lesson: Pharmacy leaders need to anticipate risk, lead organizational strategy, and create solutions before a medication issue becomes a patient-care issue.
Wagner: These challenges and opportunities have placed pediatric pharmacy leaders at the forefront of institutional strategy, risk-mitigation, and clinical innovation. Pharmacy leaders have become indispensable in the mission of balancing access, outcomes, cost, experience, and equity within their enterprises.
What will define the next generation of children’s hospital pharmacy leaders?
Gallagher: They will need to lead through ambiguity, leverage data to guide decisions, and connect clinical excellence, operational performance, innovation, and financial stewardship.
Gaskari: The next generation of pediatric pharmacy leaders will need to think well beyond the patient’s medications, bringing together clinical expertise, business acumen, technology advancements including AI, payor strategy, and an enterprise mindset without losing sight of what is best and safest for the child and family.
Wagner: They will be defined by data-driven digital fluency, agility in adopting cutting-edge therapies and technology, strategic navigation of value-based care, and a collaborative mindset focused on ongoing advocacy for workforce well-being and health equity.
