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Reap the rewards

Clever teamwork and shared values are vital to the success of market access plans

Some carrots hanging from a poleWith impressive speed, market access has become the foundation of most pharmaceutical go-to-market strategies. However, without implementation, strategy is just a fantasy and new research we have conducted reveals that many market access plans fail to become reality. More surprisingly, this situation seems to be caused by some of the management practices that are meant to ensure implementation.

Though the basics of how firms achieve market access may seem obvious, they are worth clarifying, as they help us to understand where things can go wrong. In essence, firms marshal a wide range of knowledge to develop a sophisticated clinical-economic value proposition. They then work with customers' complex decision making units to gain acceptance, endorsement and uptake.

This approach means that market access activity, much more than most other components of commercial strategy, depends on three essential factors. First, market access is a cross-functional pursuit requiring effective coordination between medical, marketing, health economics and other departments. Second, there must be ongoing communication between the firm and the customer organisation; selling is simply not enough. Finally, the most differentiating and value-creating aspect is discretionary activity; that is, those soft, intangible things like sharing information and building relationships that cannot be measured easily and only happen in committed, motivated teams.

Of course, market access strategy is not alone in needing teamwork and driven individuals, but its cross-functional, multi-disciplinary nature makes it especially susceptible to infighting between departments and among self-serving or demotivated people. Awareness of this susceptibility led to our decision to study market access strategy implementation and what it is that makes some firms better at it than others.

This investigation found a complex, interwoven set of organisational behaviours. However, the key points can be summarised in six lessons which, interestingly, contradict typical management practice.

Hard metrics
The first, and perhaps most fundamental, difference between firms that succeed and those that do not concerns metrics. Typical management practice focuses on hard metrics, such as dates and quantities that can be measured unequivocally. The problem with this approach is that human beings focus on the target, which isn't always the same as a goal. For example, in one case involving big pharma, the team consistently delivered the target, which was a report that specified the customer's requirements in order to grant market access. However, it failed to delve beneath the customer's superficial responses or gain real insight into how the customer would make the access decision.

By contrast, the few firms that do unravel customers' complex, ambiguous thought processes set their teams less measurable, but more descriptive, goals. These could involve gaining understanding of not just what the customers say, but finding out about who they are, how they say what they say and how much they follow their own rules. In other words, being too wedded to hard measures leads, paradoxically, to worse market access outcomes.

The second, and equally contradictory, finding that emerged is that some aspects of teamwork can be counter-productive. In many firms, decisions about how to achieve market access are made by teams and a huge emphasis is placed on 'buy-in' and ensuring everyone agrees. However, this approach forgets that collaborative decision-making (which, in any case, is not well supported by research) tends to blur decision rights and accountability. In other worlds, because everyone is partly responsible, no one feels fully accountable. As motivation theories predict, individuals put in less effort when they know the blame for failure will be shared.

Responsibility
By contrast, teams that gather everyone's opinions, but then let the appropriate person take responsibility for key decisions, engender more motivated individual effort. This is especially true for those intangible, discretionary activities that seem to create most of the value when implementing market access strategy. In other words, in placing so much emphasis on getting buy-in, management practice often reduces the motivation of key individual implementers.

The third example is the way in which we try to generate commitment to the strategy. Although this varies in detail, most firms try to focus the dedication of their key players with a combination of sticks and carrots: attractive rewards and worrisome sanctions. But this ignores the fact that commitment takes three forms. It can be affective (the individual shares values with the company), normative (the individual feels pressured into complying) and continuance (the employee cannot afford to leave).

Only affective commitment leads to proactive behaviour that creates value; the others encourage rule following and over cautiousness. In effective companies, therefore, there is more emphasis on shared values and common goals and less on financial rewards and implied threats of punishment. In other words, the complex nature of market access strategy does not fit well with the sort of mechanistic ways of leading that might be copied from sales management techniques, for example. Instead, successful market access follows when the team shares, and aligns behind, the same set of principles outlining what is important and what is not.

Imbalance
The fourth, common, restricting management habit is the idea of internal customers. This is often used in the context of one department (eg marketing) being 'supplied' by another (eg health economics). This has the effect of setting up asymmetric dependencies between departments in the firm. For example, the success of the health economics department is judged by how well it supplies marketing, but not the other way round. Such imbalanced support undermines cross-functional working as it encourages one side of a cross-departmental relationship to undervalue another.

This is difficult to overcome in the traditional pharmaceutical firm, but clever companies work to minimise the internal customer idea and find ways of emphasising the way each department depends on another. For instance, they build mutual arrangements into departmental goals for supplying, and receiving, information, resources and help between divisions. In other words, the idea of a set of one-way internal customer chains is replaced with a more interwoven set of mutual relationships, which encourages, rather than discourages, cross-functional working.

On the same theme, but more subtly expressed, is the fifth key difference. In addition to asymmetry of dependence is asymmetry of status. Despite claims of mutual respect and teamwork, the reality is that some departments consider themselves superior to others in the sociological hierarchy of the firm. Further, this perceived status ranking is tacitly agreed across the company. The exact order varies between firms, but medical affairs and brand management are often perceived as 'above' functions like business intelligence or health economics.

As a result, 'lesser' departments indulge in what organisational psychologists refer to as "social competition" and take subtle, implicit steps to undermine their rivals and reduce their perceived status.

The hidden nature of this cross-functional conflict makes it hard to manage, but smart leaders usually employ 'dynamic symbolism'. This involves highly visible acts designed to even out the perceived status rankings within the firm, such as public praise by senior management, appointment to key executive teams and special reward systems. In other words, the implied class system that is often allowed to exist between departments obstructs the sort of cooperation that is essential to market access, so more thoughtful leaders take steps to weaken that culture and replace it with a more egalitarian one.

The sixth, final, lesson to emerge from our research is perhaps the most counter-intuitive of all: the fact that team spirit is often a bad thing. To be clear, commitment to a group is powerful and important, but only if it is to the right group and not to a sub-group. Often, even when working in matrix-structured brand teams, functional leaders, such as marketing, finance or sales directors, encourage a primary loyalty to a profession-based sub-group.

This appeal to tribal loyalties is made all the more compelling by our apparently hard-wired evolutionary instincts to belong to a group and to think in terms of 'them and us'. Unsurprisingly, this sub-group commitment weakens commitment to the business unit as a whole and creates the basis for inter-functional conflict. In companies that avoid such infighting, top management discourages functional leaders from promoting such clan loyalty and instead supports a higher level of team spirit focused on the business unit as a whole.

Break habits
Like all good research, these findings make clear to hindsight what was invisible to foresight. Making market access happen needs cross-functional working and committed individuals doing more than is asked of them. To achieve that, however, some embedded habits must be broken: measure less and assess more; value accountability above buy-in; place shared values above fear; balance dependencies and status and displace functional allegiances with higher loyalties.

None of this is easy, of course, and the value of mastering such market access implementation skills lies in the fact that most of your competitors will not be able to do it. But, you must master these skills of organisational behaviour management, because market access will only become more crucial to commercial success, not less.

The Author
Dr Brian D Smith is a Visiting Research Fellow at the Open University Business School and runs Pragmedic - a specialist strategy consultancy.

To comment on this article, email pme@pmlive.com

11th August 2010

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