Walking the Talk – A Top-Down Approach to Embedding Patient Centricity
Dustin Seale, Partner and Managing Director, EMEA at Senn Delaney, shared 22 years of culture-changing expertise with eyeforpharma.
Pharma organizations working towards becoming more patient-centric – an endeavor eyeforpharma’s Whitepaper Patient-Centered Culture by Design discusses in detail – will need their entire top teams to be aligned around the new strategy. Purposeful leadership plays a critical role in effective cultural change, which will further require the business to be aware of the outcomes they expect and be in agreement as to what they are going to measure. As an example, Partner and Managing Director, EMEA at Senn Delaney, Dustin Seale refers to the European pharma company, UCB, which has changed its organizational structure from a focus on geographical profit and loss to global patient units. Seale recommends that companies determine the culture and mindset that will enable patient centricity. “The way leaders think and act is mirrored by the organization. If their behavior isn’t consistent with the behavior they want to see, they are unlikely to achieve that behavior in their organization,” he says.
Seale’s observation of the industry is that most business organization models are built around serving the organization, not the patients or customers. There is a need to reshape the organizational model from one that many companies have become accustomed to into one that represents their core beliefs. He cites the example of CVS Health, the largest pharmacy chain in the US. When working with CVS Health on culture shaping, the company defined its stated purpose of bringing health to the communities it served. However, its multi-billion-dollar tobacco business unit didn’t fit with this purpose – so CVS Health stopped selling tobacco products in October, 2014. Rather than experiencing a fall in revenue, the result was that consumers moved their business from competitors of CVS Health in support of its renewed purpose.
Why leading culture change from the top is important
The most successful and effective culture changes take place when the CEO and entire top team are leading the transformation. Seale’s firm, Senn Delaney had previously worked with Yum! Brands (which operates Taco Bell, Pizza Hut, KFC, and Wing Street worldwide), whose sales at that time were declining. David Novak, then CEO and now Executive Chairman of Yum! Brands, declared, ‘The change is with us’ – signaling to everyone in his organization that the top team needed to change. Yum! Brands has since become the fastest growing quick service restaurant group in the world.
Regarding executive accessibility, Seale refers to GSK House in London, where a “high street” runs through the middle of the building. The executives’ offices have clear windows so everyone working in the building can see what they are doing, adding to the transparency that is becoming a fundamental component of patient-centric pharma companies.
These experts have a hard time listening to non-experts (the patients). Experts need to be willing and agile enough to change, and to learn from non-experts in order to be patient-centric.
In the past, Seale observed that hospitals tended to regard patients and their families as a source of annoyance. Since reimbursements are linked to Hospital Consumer Assessment of Healthcare Providers and Systems scores, administrators, nurses and doctors need to collaborate to deliver a superior experience. This involves leaders knowing the team that is serving and fostering a culture of collaboration, communication, and respect for one another. Staff members need to be attentive and emotionally present when they are with patients in order to adequately listen and understand their needs.
Pharma is an expert model, which according to Seale, is good because you need deep expertise. However, he also points out that, “These experts have a hard time listening to non-experts (the patients). Experts need to be willing and agile enough to change, and to learn from non-experts in order to be patient-centric.”
When employing leaders, while consideration must be given to background, CV, and experience, Seale believes it is important that the applicant’s mindset fits a patient-centric culture. There are tools and methods available that aid in assessing cultural fitness and competencies, but Seale highlights that the least expensive option is developing people from within the company.
Changing the collective culture by creating genuine, individual change
Leadership need to experience what Seale calls the “aha moment”, where they recognize the need for cultural change and a stronger resolve to focus on the patient. But he implores that every person in the organization needs to have the experience for themselves so that it goes beyond company dictate. Employees must see how patient centricity works through their own eyes and how their individual behaviors contribute to it. “You change culture one person at a time as a culture is made up of people,” he explains.
Seale also provides the four pillars of change that must be achieved before a new strategic and organizational model can be created. These are: purposeful leadership; a willingness to personally change; an ability to quickly engage everyone in the organization, and finally, to build the reinforcing systems to support the first three pillars.
Seale provides an example of a telecommunications company with whom his culture-shaping team worked. The team worked on giving everyone in the organization a similar experience to, as he puts it, “unfreeze” their old behaviors and thinking to help them become more agile and collaborative. Consumer regard for the telecom company is now positive for the first time in a decade, so the strategy obviously worked. He explains, “The reason it was successful is because it was not condescending or mechanistic. Creating an experience each person will connect with personally works because they are learning from the ‘inside out’ instead of from the ‘outside in.’”
It is also about creating individual motivation among employees. Instead of the carrot-and-stick type approach, genuine individual change involves inspiring people to do things differently and eliciting their personal initiative. Giving people experiences will help them find a fulfilling role in the company, such as was the case with GSK, where patients around the world can share how a drug they used changed their lives, thereby inspiring those who produce those drugs. Seale also believes that essential to motivation is removing any feelings of insecurity and fear among employees, “If a mistake is made, people should be allowed to learn and fix it without punishment,” he suggests.
Building pace, momentum and engagement across the whole organization
Seale emphasizes that often there are large time lags between departments in implementing change, which implies a loss of momentum. “Some of the most exciting starters in shaping culture haven’t retained their success due to a lack of pace engaging people across the company in the culture shift,” he says. Change has to happen with momentum and mass, so everyone is on board and aligned in demonstrating the values that are the foundation of the culture shift.
Ownership of culture change is also critical in driving a company towards patient centricity. The consultants employed to effect the change should empower staff to carry on alone, as culture transformation is never truly finished, but must be a continual focus. Seale recalls one large UK engineering firm he previously worked with that was successful at claiming ownership over the culture shift and experienced global business reach in the aftermath. After their consultation work was done, it was routine for Seale and his team to revisit the company to check on the status of the culture change they had set out to do. He considers the revisit to the UK engineering firm as one of the best moments of his entire career. Upon entering their manufacturing sites, he recounts how a young lady who didn’t know who they were took them in, sat everyone down and explained how culture shaping happens and how they play a part in it – starting with the four pillars – and it was all done in the context of their plant. “They explained how they had saved several million pounds in scrap by thinking and doing things differently. The key drivers they mentioned were ownership and accountability, applied day in and day out,” he recalls.
Essentialism – less but better
In line with the theory of essentialism, espoused by the management consultant Greg McKeown, patient centricity requires pharma to focus on tailored drugs, with companies now realizing that they need to concentrate on particular areas. “With the GSK Novartis swap, vaccines have been moved into GSK, and oncology into the Novartis world. Instead of trying to be an expert in everything, it is better to develop deep solutions for narrow disease areas,” says Seale. This is at the heart of essentialism; rather than trying to do everything and doing it poorly, there is a move towards doing less but doing it better.
There is a need to understand the entire ecosystem and thus go beyond merely wanting to sell a drug to a doctor or system. Acknowledging how the big picture works reveals that patient/doctor collaboration is essential to patient-centricity, specifically to putting the patient first in order to achieve positive health outcomes. In addition, with governments imposing tighter controls on medicines, pharma companies must prove efficacy more effectively in order to contain costs and retain contracts.
Common barriers to changing organizational culture
In Seale’s opinion, the three most important barriers and solutions to creating organizational change are:
1. When the shadow of leadership isn’t consistent with the message.
Solution: The top team needs to walk the talk.
2. When inspiration doesn’t link to day-to-day activities.
Solution: Make sure that the company culture is ingrained in how people do their jobs.
3. When people who are not a reflection of the culture you want are promoted.
Solution: You need to promote on values and capabilities to drive culture change.
Many barriers can be overcome by learning from outside the industry. Companies dealing in consumer goods, for example, spend a lot of time understanding the end users, so pharma companies could learn how consumer goods companies listen to customers and make the effort to ensure they become repeat customers.
Turning the pyramid on its head and putting the patient at the top, so everyone helps serve the next level that serves the patient.
Seale advises that learning from the well-performing telecommunications companies could be useful in relation to connecting with the consumer as people interact with their products through a number of different mediums. “Manufacturing also has experience in creating a safety and quality compliant culture that is customer-centric,” he explains.
Historically, pharma is a hierarchical, careful, slow-moving industry. Seale suggests, using the cliché of a pyramidal company, “Turning the pyramid on its head and putting the patient at the top, so everyone helps serve the next level that serves the patient.”
If I were a Chief Executive of a pharma company, I would ask myself whether I woke up every morning thinking about how I could make patients feel better. If the answer is ‘no,’ perhaps you are in the wrong job.
A key way to assess whether barriers have been overcome is to measure whether the intended change has been successful. Traditionally, companies measure financial results more frequently, sometimes daily, weekly, monthly, and quarterly, while people and culture measures are accomplished only every one or two years. To measure the effectiveness of patient-centric cultural shift, pharma companies need to conduct people and culture measures more frequently to avoid losing touch with patients and weakening the momentum of change. Seale adds, “There are KPIs in terms of business output. For pharma, these would be in terms of the drug and efficacy around the patient, feedback from physicians and systems, patient results, and patient experience with that particular pharma company. KPIs should be devised to be viable and easy to measure.” He adds that the financial aspect is not to be discounted. Reimbursements must be measured as well to determine whether the business is actually making money.
Walking the talk
As reflected in the Senn Delaney whitepaper, ‘Walking the talk in patient-centric pharma,’ Seale believes that a framework for approaching a change to patient-centricity requires that leadership demonstrate the change they want to see in others, that everyone in the organization should be engaged and inspired, that change should happen quickly and robustly, and that KPIs for various aspects are very clear. The sharing of inspirational experience is also important in shaping culture change, as are the support structures of coaching and mentoring to drive patient-centricity, and the constant measuring of results.
When it comes to integrity of purpose, Seale states, “If I were a Chief Executive of a pharma company, I would ask myself whether I woke up every morning thinking about how I could make patients feel better. If the answer is ‘no,’ perhaps you are in the wrong job.”
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