Customer orientation is a fact of life in many industries—except pharma. In a consumer environment that demands this orientation, pharma can turn this problem around by understanding who their customers are at every level, and giving them what they want and need.
In 1960, Theodore Levitt wrote an article in the Harvard Business Review called “marketing myopia” that changed the way businesses think. He pointed out that every industry going through hard times had once been a growth industry, and that the hard times were often a result of, or at least exacerbated by, the tendency of successful industries to become too inwardly focused. He proposed a new concept to battle this tendency and called it “customer orientation.” Since then, just about every major company in the world has publicly stated that it is customer oriented, as opposed to being focused on its products, or its stock price, or whatever.
The degree to which this is true is an entirely different matter. Some companies really, truly are fairly customer focused. Some industries lend themselves to customer orientation, particularly in the service sector. Some industries tend to be much more product oriented, despite Levitt’s entreaty.
And then there’s pharma.
I know you’ll disagree with such a contentious, blanket statement, but I’m going to be provocative and maintain that of all the large international industries I can think of, at least, the pharmaceutical industry is probably the least customer-oriented. For those of you who, like me, began their careers in other fields, I bet you know what I mean.
To a degree, this is understandable: pharma makes scientific products for scientific customers, right? Drugs are extremely complex and they are marketed to clinicians on the basis of their clinical attributes. It’s all very dry and rational and there’s little room for such fuzzy notions as customer value and the like. But even if this was the case in the past (and I don’t think it entirely was), it’s certainly no longer the case today, particularly as the definition of “customer” gets expanded far beyond what it used to be. In fact, as the meaning of customer expands, pharma finds itself farther and farther away from true customer orientation.
What is customer orientation?
According to Levitt’s original article: “Management must think of itself not as producing products but as providing customer-creating value satisfactions. It must push this idea (and everything it means and requires) into every nook and cranny of the organization.” If you really think that your pharma company does this, congratulations, but I’ve never seen one that comes anywhere near as close as some of the financial services companies I’ve worked for, or the travel companies, or the… but I digress.
If pharma would like to become more customer oriented—which would be a very good idea as the old model for success goes through such radical changes—then the first step is going to be to understand exactly who the customers are and what exactly they want and need. It used to be simple: the customers were prescribers. They were the ones who decided which drugs got used for which patients. They were the ones to talk to. Of course, this isn’t customer orientation. They were talked to, not engaged: pharma went around talking about its products with them and only addressed the question of prescriber needs because that’s what was written in step two of the sales technique—but at least everyone knew who the customers were.
Even then, however, the story didn’t end there. And this definition of a customer is incomplete. One easy way to consider the interplay between the pharmaceutical industry and its varied customers is through the “5P” framework: pharmaceuticals, prescribers, providers, payers and patients.
How do the 5Ps all fit together?
To a large degree, it depends on the country, but let’s try to imagine a typical situation through the eyes of the one inevitable end customer, the “P” that everyone can agree on—the patient.
One such patient: Bill.
Bill is nearing 60 and has just learned that he has type 2 diabetes. Or rather, almost has diabetes. It wasn’t clear to him. His GP says that his blood sugar was too high and he is prescribed an oral medication. His GP also suggests he lose some weight. Bill is confused. He’s not even sure if he has diabetes or not. He had a few questions he hadn’t dared to ask his doctor, and many more that came to him afterward. He goes to the pharmacy to fill his prescription and asks some of those questions to the pharmacist, who takes time to inform him about his treatment and suggests that he look at a patient support site for diabetes, which he does as soon as he gets home. Armed with information he gets from the web, Bill talks to his family and to some of his closer friends, but they tell him different things—some reassuring, some frightening. He hears about an interesting medication that can help him lose weight as well, but he discovers that his health plan won’t cover it. Also, Bill often forgets to take his medication, and he’s not sure what to do when he forgets. For example, he usually takes his medication in the morning, but what if he forgets until he gets home from work? Should he take it then, even though he’ll take it again when he wakes up? He’s not sure who to ask. And then, after all, he feels fine. Is all this medication necessary? What if he just loses weight, like he was asked? What if he just changes his diet? Some of the things he’s seen on the web say that would be enough!
So who’s involved, here?
First of all, remember that while it is indeed the prescriber who has decided which medicine (if any) to prescribe for Bill, this decision is typically dependent on which medication is covered by whatever health plan he has. Furthermore, remember that outside of an institution, the prescriber’s influence pretty much stops with his or her pen. The prescriber doesn’t decide whether Bill takes his medication or not. That’s entirely up to Bill. With adherence levels under 60% for oral diabetes treatments, there’s a very good chance that Bill isn’t going to be taking his medication properly, if at all. Who influences that?
The first answer is the pharmacist. The industry dramatically underestimates the importance of pharmacists in patient adherence. While the role of pharmacists differs from country to country, in many cases they provide crucial information to patients, information that goes a long way in determining the patient’s initial attitude towards adherence, particularly if Bill has a renewable prescription in a country that doesn’t allow postal delivery of drugs. If that’s the case, Bill is going to be seeing his pharmacist more often than he sees his doctor. And when he does go back to his doctor, he may often spend more time talking to the practical nurse about the actual administration of his drugs. The nurse may be more in tune with the day-to-day issues Bill faces with his treatment than his doctor. And, of course, these are the only instances during which Bill comes into contact with the healthcare industry. He’s going to get a lot more information from friends, family and sources on the internet. Some of that information will be useful, some will be harmful, but don’t forget, in the end, it’s Bill who decides what he does with his life, and these are the sources of information that will influence those decisions.
Of course, Bill’s decisions determine the result of the pharmaceutical company’s costly efforts to convince his prescriber to write a prescription for their drug. Congratulations, your sales force helped to get the scrip from Bill’s doctor, but what do you, as a company, do to influence what happens after that?
Over the past few years you’ve undoubtedly been paying more attention to payers, making sure that Bill is allowed to receive your drug at an affordable level, but are you doing anything at all with pharmacists to help them provide the right information to Bill so that he follows his treatment properly? Are you doing everything you can to help Bill find the right information on the web? Remember that your own website plays a tiny role in Bill’s information-gathering efforts: sites like PatientsLikeMe, patient group sites, or general medical information sites are far more important to Bill.
And back to nurses…so many pharmaceutical companies only consider nurses to the degree that they influence prescription decisions, when they often play a greater role than prescribers do when it comes to adherence. In a hospital setting, their influence on adherence is often substantially greater than that of prescribers.
The 5P framework is a good review of all the stakeholders in the pharma world, but the framework is easier to consider—more visceral—when examined through the patient journey. Gaining a prescription is one thing, but getting the most value out of it—whether financially or from the perspective of health benefits—is a different matter involving different people. It is in the interest of the pharmaceutical industry to do all it can to look past the prescription decision to the roles of all the stakeholders.
Exactly how to do that is a broad topic, and a lot of good examples exist. But the first, crucial step, is to identify exactly who your customers are, through Bill’s eyes. If you want to be truly customer oriented, there’s no better way than to look at the world through the eyes of the customer.