The Science of Change

Leaders today must understand and apply the knowledge of behavioral psychology to manage organizational change successfully

The industry’s response to the evolving customer landscape is to shift their business model from sales to outcomes, from products to services, and from bottom line-orientation to patient-focus. Amid ongoing controversy over the cost of prescription drugs, an issue that has caused particular outrage in the United States and become a talking point in the presidential campaign, the pressure is on the industry to show more tangible commitment to behavior change beyond mere rhetoric.

To become more outcomes-focused, service-oriented and patient-centric, pharma members need to improve the ways in which they interact with stakeholders and how they behave within the confines of their organization. There is a critical need at this time to understand better this complex process, especially in terms of which approaches lead to successful changes and which actions fail to achieve the desired results.

Behavioral change explained

Influencing and maintaining behavior change is notoriously difficult. There is more to changing a person’s behavior than simply instructing them to act differently; behavior is deeply ingrained, the sum of a person’s values, attitudes, emotions, beliefs, and habits.

“To effectively implement smooth change processes, pharma organizations need clarity of purpose and specifics about desired outcomes,” says Mike Rea, CEO of IDEA Pharma.

Pharma grasps that incentives drive behavior, but the connection of the unintended consequences of new incentives with corporate goals is poorly understood.

Importantly, leaders must ask the right questions. What behavior needs to change and why? Is the person ready to change? What does the desired behavior look like? A deeper knowledge of the science behind organizational behavior change can benefit tremendously, not only in improving colleague behaviors but in “understanding of the behaviors of value chain stakeholders – patients, physicians, pharmacists and payers – and which factors influence their decision-making,” says Rea.

Academics use the transtheoretical model to break behavior change into five key stages. They are:

  • Pre-contemplation. The person is unaware of the problem and possibly does not know about the benefits and consequences of behavior change. There is resistance or lack of intention to take the desired action.
  • Contemplation. The individual is aware of the problem, has identified the desired behavior, and is considering making the change. However, there is still hesitation or the tendency to procrastinate.
  • Preparation. In this stage, the person intends to change behavior, develops an action plan, and takes a few preliminary actions.
  • Action.The person follows the action plan, practices the desired behavior, and is successful at making specific and observable change.
  • Maintenance. The individual works to sustain the desired behavior and, in the process, gains confidence about the change. At this stage, relapsing to old organizational behaviors is possible and so the person needs to prepare for and work at relapse prevention.

Facilitating change

The next step is to understand what components need to be in place to facilitate behavioral change. Dean Heath, co-author of Switch: How to Change Things When Change is Hard, outlines three components:

Motivation through incentives

Compensation schemes, review criteria, reward systems and public recognition, and other incentives can be tailored to promote the desired behavior. However, incentives can be difficult to use effectively; it they are removed, people can revert to old behaviors, or professionals can take it as an insult that they would need to be incentivized to do their jobs well.

Incentives don’t always have only the desired effect, says IDEA Pharma’s Rea. “Pharma grasps that incentives drive behavior, but the connection of the unintended consequences of new incentives with corporate goals is poorly understood. For example, the drive towards teams being nicer to each other in many cases has reduced the organizations’ competitiveness or capacity for innovation, if we go at the speed of the slowest team member.”

Direction through training

How do people go about change? Changing behavior involves new skills and a mastery of the desired behavior. Information, technical guidance and training are vital ingredients.

“Listening has been an underdeveloped skill for most of pharma’s history but we need to move from one-way communication with stakeholders to two-way engagement'', says Rea.

Customer-facing team members need sincerity and the ability to understand evolving customer needs. They must possess the adaptive skills to actively listen, handle objections, educate objectively, and work collaboratively with others. Furthermore, training in the knowledge of compliance and application of that knowledge is needed.

Creating the right environment

Successful behavior change needs an environment that makes it easy to constantly perform the desired behavior. “There are some good people doing good work, but we find that it is on an individual basis rather than a company approach to dealing with it,” says Katie Rishi, Co-Founder and Managing Director of the creative healthcare communications agency COUCH. “The changes leaders want to see need to be fully integrated into the company ethos. A cohesive approach across the company is needed.”

While many compliance violations are linked to sales representatives, their behavior is picked up from the values and attitudes of their organizations. Where such violations are associated with mismanagement and a profit-driven attitude among leaders, this can create ambivalence and a drive to act unethically. Consequently, targeting behavior change at the lower levels of the organization requires re-alignment of top-level behavior and overall organizational culture.

“I see a lot of top-down messaging, including those relating to patient centricity, that rarely connect to behavior change because they are so vague,” says Rea. “Having the CEO frequently say such messages does not necessarily lead to behavior change, because it could mean anything, and therefore nothing. Leaders like Andrew Witty [of GlaxoSmithKline] have been a lot more specific in what they mean (and don’t mean), and that has produced tangible change.”

For an in-depth examination of GSK’s pioneering decision to adopt an ‘ethical’ approach to its commercial model, see ‘GSK’s new ‘ethical ‘customer approach: is it delivering?’

Sustaining behavior change

Some experts in behavior change have added a sixth stage – Termination – where the old behavior is completely replaced and the temptation to fall back into old habits no longer has any power. 1

Blame is still a large part of the culture, and for as long as the need to avoid blame is the predominant behavior, it will be difficult to override that and produce real innovation.

Moving from Maintenance to Termination, however, often takes years and constant effort, says Rishi because behavior change does not happen overnight.

While innovation has increasingly become a source of competitive advantage for pharma companies– causing many organizational changes to promote it – failure in innovation can result in blame and create a culture of risk-aversion.

“Pharma often talks of being comfortable with failure,” says Rea. “However, in many cases, blame is still a large part of the culture, and for as long as the need to avoid blame is the predominant behavior, it will be difficult to override that and produce real innovation.” A move towards life-long learning and greater confidence in uncertainty is needed, he adds.

Companies must also be specific about who needs to change. “Many approaches aim to change individuals, but that misses the point of leveraging the specific roles that individuals play in the collective,” says Rea. “They may not need to change their behavior, but have the company find a way to harness their differences.”

While Rea and Rishi agree that pharma has a long way to go in terms of adopting the science of behavior change, there is plenty of expert help out there. “Getting proper support from experts is important to make behavior change a priority and commit to a long-term plan rather than opt for a quick fix,” says Rishi. However, for Rea the answers should lie within. “Achieving the shift may well require insights from outside, but it is unlikely that this is beyond the capabilities of enlightened leadership.”


Sources: 1. COUCH (2016). Influencing Behavior Change: It’s Time for Personalisation. Retrieved from http://special.wearecouch.com/hubfs/White_Papers/Behaviour_Change_Whitep...

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