FEATURE
BRIAN SMITH
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FEATURE
W
ith 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 crossfunctional 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
Pharmaceutical Marketing Europe July/August 2010
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.
“Individuals put in less
effort when they know the
blame for failure will be
shared”
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
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29
FEATURE
BRIAN SMITH
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.
“Despite claims of mutual
respect and teamwork…
some departments consider
themselves superior”
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,
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“Sub-group
commitment
weakens
commitment
to the
business
unit”
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 hardwired 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 buyin; 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 (www.
pragmedic.com), a specialist strategy consultancy.
Pharmaceutical Marketing Europe July/August 2010