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    At her latest Advanced Sales Training course, Monique has been given very clear messages. Things need to change! She has been with this pharmaceutical company for almost five years during which she has worked as a medical representative in a specialist niche market where the company had leading market share. One of the reasons for the advanced course is the rapid change in the competitive forces in that market. New entrants from companies of significantly greater critical mass have seriously destabilized the old dominant position of Monique’s firm. The ‘old ways’ of doing things need to be replaced with ‘new ways’. This
    According to USFDA, a combination product is one composed of any combination of a drug and device; biological product and device; drug and biological product
    is a clear message.

    In a series of modules and sessions spread over an intensive week, Monique has been told that they all now need to change and adapt to the new competitive environment. Today we need - Monique’s notes said - a different attitude. Complacency is gone; a sense of urgency is required, big time! We need a ‘will to achieve’, ‘will to surprise’ and ‘will to succeed’. What is now needed more than anything else - Monique’s notes continued - is an ‘esprit conqu?rant”, as the French affiliate says, a ‘spirit of conquest’ coupled with more confidence in dealing with the customers, which for this Sales Force mean
    ; or drug, device, and biological product and fixed dose combination would include two or more combinations of drug.

    Examples of combination products may in
    mainly physicians and pharmacists. Also, more than ever, one of the company’s old values, ‘entrepreneurship’, is required and needs to be revived. Entrepreneurial spirit is key, particularly at local district level where they have now been given more flexibility in the use of resources. In this ‘new mindset’, conviction and confidence ‘should be seen’ - Monique had highlighted it on her notepad.

    The main theme in the second week of the Advance Sales Training course was ‘culture’. Monique’s bundle of notes grew bigger and bigger. There was more group work this time. A consolidated output of many hours of work with coll
    lude drug-coated devices, drugs packaged with delivery devices in medical kits, and drugs and devices packaged separately but intended to be used together.

    eagues, some of them more experienced than her, pointed to very clear directions. Monique’s accurate notes read: we need to create a solid ‘winning culture’, where dynamism, creativity, optimism and confidence in the future are in everybody’s mindset. We need to project a new image, living the values of the company: integrity, excellence and customer-centric mentality. This new mindset of self-belief, ‘conquering spirit‘ customer effectiveness and entrepreneurship - Monique wrote down - is the key to the new culture, the only way to face the significant new challenges.

    Monique was very excited. She said the course was e
    here is enormous increase in the number of combination products entering the market in the recent years. Combination products have proven advantages but fixe
    cellent and that it lifted everybody’s spirits, which had, quite frankly, been a bit down after having been confronted with the new hard realities. A couple of weeks later, her district manager held a regular meeting with his small group of sales representative specialists. This was a routine meeting but an important one because a new electronic Territory Management System (TMS) had been recently introduced and they were all trying to make the most of the new tool on their personal laptops. HQ had just released the new benchmarking and market data as well. There were new updated lists of ‘A’ and ‘B’ doctors, and quite
    d dose combinations are still in the process of convincing regulatory authority on their advantages over the single ingredient formulations.

    Combination pro
    a lot of new information on local hospitals, where many of the sales visits take place.

    During the meeting, Monique and her colleagues looked at sales targets, individually and as a district, ‘call rates’, efficiency ratios, completion of input/feedback into the TMS and some competitive benchmarking data. They all had clear goals to improve rates of customer visits by 15% for the current six month period and to cover 95% of assigned hospital pharmacists. Overall, Monique’s district was achieving 85% of sales targets so far and, seeing what was happening in other districts, it wasn’t bad at all!

    The missing connecti
    ucts have become life saving products for the pharmaceutical companies who doesn’t have many innovative molecules in their product pipeline and have been inc
    n
    The meeting ended and Monique drove back home, stopping for an extra visit to the local hospital. She had promised to bring some scientific papers on new drugs to the head pharmacist and she thought she would do that. In the waiting room of the hospital pharmacy, she had a sudden revelation, thanks to the peace and quiet of the place and to the unexpected delay in the pharmacist’s availability. What was the connection between the two-week Advanced Sales Training and this morning’s District meeting?

    She struggled for a bit until her mind reassured her (the mind is wonderful at comforting us). “It’s all ther
    easingly used in the product life cycle management. Even the companies having product patents are trying to extend their product life cycle through the combi
    e,” she thought, “in the background, in the mindset”, as the sales trainer had insisted. ‘Change your mindsets’ seemed to be the unofficial summary of that training! The waiting continued; apologies were given. Monique secretly welcomed the delay because it was rare that she could ‘stop and think’, as she liked to put it. But restless ‘revelations’ seemed to come in waves, like a psychological migraine. “What is the mindset? What kind of mindset do I have? Where is the mindset?” She found it silly at first, but all sorts of other questions started to bombard her, all about the same mindset-thing. And ba
    nation products and maximize the revenues. But the companies involved in this practice are overlooking that they are burdening the patients both economically
    k to “Where is the connection?”

    She had her old training notes in her laptop. She went through all of them quickly: esprit conqu?rant, will to succeed, confidence, conviction… She then opened the TMS by mistake: sales targets, call rates and class ‘A’ physicians were all there in front of her. “Where is the connection? Where is the connection?”

    Monique’s anxiety was put to rest by the sudden appearance of the hospital pharmacist who went on and on about the ridiculously long and boring management committee meeting she had just attended.

    Monique is not unique as a sales force representative of the company
    and physically. They need to rightly judge the benefits of the combination products and they have to even look at the risks involved when combining the produ
    . Not too junior, not too senior, she has been around long enough to get through recurrent training programs, most of them around product knowledge and some on selling skills. But this Advanced Course was a bit different because it focused on a series of qualities that were required for success. Like her colleagues, Monique thought highly of the course. It all seemed to make sense but she kept trying to understand ‘the connection’ (as she put it) between the training and its language and the operational targets in front of her. On reflection, Monique thought that ‘the connection’ would have been provided by the District
    ts. Some of the combination products were well accepted by physicians while others suffered. Companies involved in development of combination products are fi
    anager, but the reality is that they spent the time on ‘numbers’, sales targets, sales planning and review of the benchmarking data.

    If you work in sales, you may perhaps relate to the above scenario! If you don’t, please bear with me because the problems described are universal and embedded in the majority of ‘change programs’, whether formal or informal. There are two fundamental, and if I may say so colossal, flaws in this very real life scenario:


    • Monique is quite right that she has not been given ‘the connections’. First of all, her performance-related compensation and incentives are mainly focused on sa
    ding difficulty in defining their combination products and facing various challenges from selecting a combination to marketing it.

    Following aspects would a
    les targets and call rates, so these are the themes that occupy the reviews with her district manager. None of the new list of qualities in her notepad has been connected with rewards, although there is some talk about linking ‘will to succeed’, ‘entrepreneurial spirit’ and ‘projecting the values’ next year.

  • The advanced training course contains a rich, comprehensive, beautifully-crafted, inspiring, energizing and skillfully organized framework of close-to-useless non-operational concepts. Mindset, attitude, complacency, healthy restlessness, ‘will to achieve’, ‘will to surprise’, ‘will to succeed’, ‘esprit con
  • dd to the challenges in developing combination products:

    Which markets to tap where the combination products can do fairly well?
    Which combination prod
    u?rant’, confidence, entrepreneurial spirit, conviction, ‘winning culture’, dynamism, creativity, optimism ‘project a new image’, ‘living the values’, integrity, excellence, customer-centric mentality, self-belief, and customer effectiveness may have come from a company-wide, undoubtedly expensive ‘research on behaviors’, but they all share the same problem: a negligible predictive value in behavioral terms.

    To put it more bluntly, the word ‘behaviors’ appears in Monique’s training binder, but there are no behaviors in it. The rich list above contains none. It is impossible to know, to extrapolate or infer f
    cts are meaningful and rational?
    Which therapeutic categories to select?
    Which Combinations can address unmet needs of the patients?
    Do combin
    rom the list what it is that a medical representative has to do or not do, do differently, stop doing, do more or do less of, so that the famous ‘new mindset’ shows. People don’t have a mindset in the same way as they have a car, a pair of eyes or pneumonia. Monique can’t find ‘her mindset’ but she has no trouble in finding her call/frequency rate data, the benchmarking numbers in her spreadsheets and any other day-to-day ‘hard indicator’ of performance. And inevitably, she is going to focus on what she can find.

    Monique hasn’t been given any ‘translation’ of the comprehensive quality-based framework into her real life.
    tions increase the patient compliance?
    What would be the developing cost?
    How to tackle the risks encountered during combination product developmen
    There is a gulf between ‘all these things there in the background’ (‘the new mindset’) and what she perhaps has to do differently. Not all is lost from that training, though. In the absence of that behavioral bridge, Monique would probably unconsciously apply the energy and excitement of the course to her relationship with the customer. She was, after all, very excited and enjoyed it thoroughly. And that ‘application’ may result in a more-of-the-same-otherwise-more-energized way of doing things. If she is successful in the new competitive conditions, she will probably be told that ‘the new mindset works’, even if nobod
    t?

    As combination products don't fit into the traditional categories of drugs, medical devices, or biological products, the USFDA is in the process of devel
    y in the District would have ever seen such a mindset. If collectively they do well, they will probably be told that the new culture is paying off, even if nobody has ever described in behavioral terms what the new culture should be.

    Concepts into behaviors
    Contrary to what you may have thought I would say, the lack of connection between the list of new qualities in the binder (which they now call ‘new behaviors’ in a serious case of mistaken identity) and the performance management system is a blessing. It is better to have no connection than to have one based on non-operational concepts. Like many companie
    ping new procedures for reviewing their safety, efficacy and quality.

    Professional from academic institutions, pharmaceutical industries, health care indust
    I know, Monique’s sales operations management system falls short of a behavioral-based framework, although, like many companies I know, they say they have one. The process of translating concepts into behaviors is not necessarily complex but it needs to be done professionally. Concepts such as ‘will to succeed’ or entrepreneurial mindset’ need to be operationalized and the only way to do it is through a true behavioral framework.

    The district manager needs to know what is expected of Monique in the way she does things that would qualify for the label ‘good mindset’ since no complex neurosurgery in Monique’s brain will
    y and representatives from various regulatory agencies are working out to design the regulatory requirements for manufacture and sale of combination products
    ever find that mindset. Perhaps, once a simple set of behaviors is in place – what to do, what not to do, whether they are flexible or non-negotiable, in situations such as A, B and C – then ‘the connections’ have been established (and therefore the loop with the performance management system can be closed). Once this operational level is clarified, the label automatically becomes less relevant. Whether you still call it ‘entrepreneurial mindset’ or if I prefer to call it ‘winning attitude’, it is not going to change the fact that Monique will know what to do and her district manager will know what to look for, measure a
    .

    As there is an increasing trend of the combination products companies manufacturing such products should be able to tackle the problems involved in the de
    d reward. So now we are in business.

    This real life example from a sales management perspective should not provide any comfort to colleagues in R&D where they think that (a) either they don’t need this stuff or (b) they have a very well crafted performance management system, obviously based on hitting milestones and filing applications. Some R&D organizations are beginning to suspect that there is more life beyond hitting the milestone and that they have a similar problem when trying to define things such as their ‘culture of innovation’, ‘creative environment’ or ‘drug hunting mentality’. My experience with R&D is that
    elopment. They need to be wiser in analyzing the market trends and the regulatory requirements.

    Companies that provide selfless information through particip
    they are, on the whole, in worse shape behavior-wise than many sales operations organizations.

    P.S. Monique did very well that year. She managed to get to the top of the sales target ranking at district level and won the rep-of-the-year President’s award. Following a long-standing sales management tradition of withdrawing the best sales reps from the field, she has been promoted to a new position in a new sales force effectiveness unit where she will be in charge of training programs and, in particular, the roll-out of a new corporate one entitled ‘Leadership excellence’. Please join me in wishing Monique every success


    tion in industry events and feedback to regulatory authorities would be able to face the challenges and will be successful in developing combination products

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