Leading the Way Small to Medium Pharma

. . . those who worked in small to medium sized organisations had 27% greater levels of satisfaction.

This month sees the first of three articles in Pf to explore the world of the small to medium sized pharmaceutical company. We will be looking at the benefits, or otherwise, experienced by representatives working for these companies, as well as the commercial and financial implications. We will also investigate what it takes to work in the small to medium sized pharma sector. The Reality is Better than the Perception!

When it comes to working for a pharmaceutical company, does size really matter? Are the perceived benefits of working for a large company actually borne out by the day to day reality? To answer these questions, we turned to a recent Pf industry wide survey. In the 2003 Company Perception, Motivation and Satisfaction Survey, readers were asked to rate companies according to their desirability to work for (not including their own). The results for small to medium companies were interesting: Out of the Top 10 Most Desirable Organisations to Work For, as voted by 2000 readers of Pf, only two were from the small to medium sized sector. But, when asked how satisfied employees are with their employer, those who worked in small to edium sized organisations had 27% greater levels of satisfaction. In addition to this, Merck- a medium sized pharma company- was rated as one of the Financial Times 50 Best places to Work in the UK. This is particularly relevant, because the FTs results are based on employees’ views rather than external opinions. This would suggest that those individuals working for smaller companies find them highly desirable to work for – but that to the wider industry this is something of a well kept secret. This prompted us to do a little investigating into what it is that makes working for a smaller company so attractive once you are actually there. Of course the term ‘small to medium’ is rather a relative term. These companies are by no means ‘small fry’ in the world of business. Such companies include the likes of LEO, Merck, Napp, Schering Health Care, and Solvay, whose field forces number around 100 each, and whose turnovers can be as high as £72 million each. However, we suspected that there is probably a big difference in the working lives of those employed in this sector, as compared to those working for the bigger pharmaceutical companies. We asked sales professionals from Merck and Solvay for their opinions.

Stuart Ellison Smith, Business Manager at Merck, explains what it takes to succeed in this sector, and the type of people who thrive in it: “In this sector fieldforces tend to be smaller, so as a representative on territory you tend to be much more visible, and this only works for you if what you are doing on a day to day basis is impressive! In a large organisation, with ten of you on a territory you can ‘plod along’ if you choose to, but in a smaller company this is simply not an option. You need drive, an enthusiasm for responsibility, and to care genuinely about the business. This absolute reliance on representatives who have this self starting, responsible attitude, means that a lot of representatives find that they work their way up through the ranks of a small to medium sized company relatively quickly. This is because their efforts really stand out on territory, and their successes are easily identified and attributable. Of course there is a flip side to this, which is that if you prefer working as part of a large team, or to be measured on activity rather than sales, then this may not be the sector for you. The key to being a successful sales person in a small to medium sized pharmaceutical company is definitely to thrive on accountability and autonomy. This involves taking on a lot of personal responsibility, but the benefits are very real. The focus on the individual’s performance and success means that personalised career paths and individual recognition, are a very big part of the company culture.” Umbereen Mirza, a medical representative in Birmingham, left Solvay to work for a much larger pharmaceutical company, but returned to Solvay a few months ago. For her, the benefits of working for a smaller company are very clear. She told us: “Because I am the only rep on territory, whatever goes on, I am responsible for it! If I don’t go out to work – I don’t get any bonus! Its also really great not having to worry about having to stick to strict zones while on territory – I am free from the constant pressure of having to make sure I am not working the same area as other team members on any particular day. The main benefit of working for a smaller company though is the culture. You definitely feel more valued and not just a number. At Solvay head office everyone is known by their first names, which is very different to any head office I’ve been to before. Your efforts are also very readily recognised through the network of management and senior

“You definitely feel more valued and not just a number.”

management via emails, phone calls etc. It means that being noticed by those at the top is a much quicker process.” It would seem then, that the main differences in working for a small to medium sized pharmaceutical company, are the autonomy and accountability you are afforded, and also the culture of individuality you find yourself in. These are factors that influence every day of your working life. Do these benefits really outweigh those of having a heavyweight organisation behind you? In the next two editions of Pf we will be looking at these issues in greater detail.

Facing Up to the Challenges By Allan Mackintosh, Performance Coach/Head of Performance, Reivers Development More and more pharmaceutical companies are looking seriously at the skill of coaching as a method of developing and enhancing the performance of their staff and teams. The more enlightened organisations now insist that all line managers are competent in the skill of coaching whilst others are going even further and creating specialist ‘coach’ roles in order to support employees and teams within the organisation. There are, however, six major challenges that the internal Pharma company coach has to face and overcome before they can really excel in their coach role and thus bring tremendous benefits to themselves, the employees and the organisation itself.

IN THIS ARTICLE, Performance Coach, Allan Mackintosh, who was himself an internal pharmaceutical company coach for six years, outlines these six major challenges that the internal coach has to face, and ways that the coach can face these with confidence.

Challenge No.1 – Recruitment of Coaches

Correct recruitment is vital in any role if the organisation is to get the maximum for their employees and it is no different in relation to the recruitment of coaches. Great care has to be taken to recruit the right person in terms of their beliefs and their potential to take on the necessary skill set that is required for a competent coach. When I first became an internal company coach in the pharmaceutical industry, the recruitment was done internally with some people identified as potential coaches but the majority coming from a pool of ‘potentially redundant’ line managers who were in this position after a major company re-structure. The result was that certain individuals were ‘forced’ into a role in order to stay within the company. This was far from ideal and as a result a number of people did not take to the role and subsequently left the organisation. Others stayed in the role but really struggled to take on the role of the coach and actually behaved more like ‘trainers’. In order to avoid these challenges, organisations really have to take great care in the selection process of coaches in order that they get the right people with enough potential to become great coaches in the workplace. Shoddy recruitment only leads to great financial loss in the long run! Those employees wishing to become coaches should look at what they really believe about people and if they do not believe that everyone has the potential to become excellent in any role they undertake, then they might want to think twice about becoming a coach. If you do not believe in people then do not become a coach!

Challenge No.2 – Does the organisation really understand what a coach does?

It is vital that the coach role and what coaches do and can achieve, is fully understood by everyone in the organisation and not just a few ‘supporters’ of coaching. From the Board to the ‘shop floor’, everyone must know what coaching is, what coaches do, how coaching works, and what coaching can achieve. Otherwise, confusion reigns and chaos can ensue. In my own experience, in the early days, coaching was being promoted by the Chief Executive and a leading HR executive. Senior Management played along without really understanding what coaching was and what coaches were supposed to do. The coaches were expected to work with line managers in order to support them through the vast organisational change that was happening along with supporting and enabling them to develop their skills in leading their teams to success. On reflection, the role of the coach varied enormously throughout the organisation with coaches in some areas acting like ‘mini-managers’, others like ‘trainers’ and a few actually doing some coaching! In many respects, some coaches simply did the senior manager’s ‘bidding’. It is essential that everyone understands why coaching is being promoted, especially the line managers who may be supporting the coach. They have to agree objectives and methods of working so that there is consistency across the organisation. The coaches have to understand what they are supposed to be doing and they have to have the skill (and the courage) to stand up to senior management when, perhaps, the management wants them to operate in a way that perhaps is not actually the coach role. The objectives of the coaches must be consistent and clear, and where possible measures should be put in place in order that the success of the coaching interventions can be measured and communicated, in order to further the understanding within the organisation.

Challenge No.3 – Contracting the Role

Many of the challenges within the ‘understanding’ of the coach role arose due to the fact that the coaches never really learned how to ‘contract’ their role with their senior management, their peers and those people they ended up coaching. Contracting is simply a process whereby two people sit down and discuss expectations and agree a way forward. It is an opportunity to get to know the people you are working with, to understand their roles and to agree how best the two are going to work together. It is an opportunity for the coach to get know the person, to get them to fully understand the coach role, to More and more pharmaceutical companies are looking seriously at the skill of coaching as a method of developing and enhancing the performance of their staff and teams. The more enlightened organisations now insist that all line managers are competent in the skill of coaching whilst others are going even further and creating specialist ‘coach’ roles in order to support employees and teams within the organisation. There are, however, six major challenges that the internal Pharma company coach has to face and overcome before they can really excel in their coach role and thus bring tremendous benefits to themselves, the employees and the organisation itself. By Allan Mackintosh, Performance Coach/Head of Performance, Reivers Development PHARMACEUTICAL FIELD ISSUE 9 2004 13 learn what coaching can do for them, and how coaching can work for them. Only this way will be the managers and coachees gain a full understanding of the role, the skill and what it will mean for them. In the early days in my organisation, coaches ran straight into task and started attempting to coach individuals and teams without going through the contracting phase. As a result of a lack of understanding, there was confusion and in may cases mistrust. Many coaches were seen as the senior manager’s ‘little helper’ or ‘right hand man’ and as such huge barriers appeared between some coaches and the people they were supposed to be coaching. Contracting done effectively starts to build understanding, trust and respect. Coaches cannot survive without this! Contracting with senior management is a must and it is in this area that coaches have to be very wary. Many managers will expect the coach to divulge information gained from coaching sessions from employees. This can put the coach is a tight spot because as confidentiality is a pre-requisite in almost every coaching conversation and relationship, what happens if the coach lets something ‘slip’ to a senior manager? If this leaks back to the coachee then all trust with the coach will be lost. The coach must contract effectively with both senior management and the coachee and this is where the internal coach may have to be courageous and outline to the manager that there may be aspects of the coaching conversation that will not be fed back! Similarly the coach has to contract with the coachee what can and cannot be discussed with a senior manager.

Challenge No.4 – Learning the Skills

We were thrown into the ‘deep end’. Although we were given some initial theory training we became coaches without first learning the skills and as a result we ‘bumbled’ along using the managerial skills that we had been brought up with. The result was that the coachees saw very little difference in skills and behaviours. Coaches were still operating in a ‘tell’ fashion as opposed to an ‘ask’ one. We were actually put through an intensive two year programme and although some of it was very beneficial, there was some of the course which to this day, I wonder what the reasons were for it! We were all given a personal coach in order to support us through the programme and this, for me, was the turning point in my development and in many respects, my life. My coach was excellent – challenging yet supportive with the knowledge and experience that should go with a ‘training’ coach. Unfortunately, some of my coach colleagues had coaches allocated to them whose coaching skill allegedly left a lot to be desired. It is vital, in this respect, that ‘mentor’ coaches are chosen carefully and allocated appropriately. When creating a coach role, I would advise organisations to think carefully about how they are going to train their coaches. Training them from within an internal training department is very risky unless the coaching capability is extremely sound and respected. It may be better looking externally and choosing a training organisation which possesses a track record in training coaches and who have good quality coaches on their staff. Do not go for one or even two day training courses. All these do is highlight the skills needed – they do not build the actual skills necessary. A programme which includes theory, practice and follow up coaching is a necessity. Whilst doing this it is advisable to consider putting senior and middle management on such programmes because in the future, who is going to coach the coaches?

Challenge No.5 – How do you know the coaching is working?

One of the major challenges the coaching industry faces today is actually proving that coaching delivers what it promises. Many senior executives demand to see the link between coaching interventions and the ‘bottom line’ – results. This can sometimes be a challenge because even in the sporting arena, it is not the coach that gets the result it is the athlete or the team. How many people know who the coach is behind the top athletes in the world? Team coaches are probably better known due the exposure that they get from the media but very few individual sports’ champions’ coaches are widely known. Yet, these sportspeople would never consider attempting to do what they do without a coach! In business, internal coaches have to ensure that their interventions are proving to be a catalyst to success whether it is a team success or an individual one. Collecting feedback from coachees is one way, although the coach will have to ensure that the coachee sees the link between the coaches’ interventions and the individual’s success! Sometimes, the coaching can be so subtle that coachees do not realise that the coach has actually made the difference even though the coachee has actually carried out the successful action. Regular reports to senior management are a must. They must be kept informed, highlighting successes and challenges, and emphasising where the coaching intervention has brought success and why. Coaches really need to promote themselves and their actions so that senior management sit up and take notice. One of your greatest challenges in the early days as an internal coach was that, as a coach group, we did not stand up for ourselves and promote what we did, why we did it and the successes that were achieved.

Challenge No.6 – Keeping your Development going.

Within organisations there is a great need to deliver through action and as such ongoing development can take a ‘beat seat’ with the result that skills are rarely enhanced unless through the odd ‘refresher’ course. Coaches cannot afford to become ‘stale’. Although the coach may have gone through an intensive coaching programme over a period of time, it is important that not only do they look to keep the skill levels to an acceptable level they should really be looking to continually enhance them. Coaching is a skill that needs continual growth and there are more and more ways to coach effectively being discovered as research into the skill grows. Many internal managers and coaches can become insular in that they rarely network outside their organisation. Coaches, in particular should look to join network groups, coaching communities and the various institutes that are now accepting coaching as an essential business tool. Without continually growing your coaching knowledge and skill, the danger is that your skills may become ‘stale’ with the result that some of the learned coaching behaviours slip and before you know it, you are back acting as a manager or trainer!

In the UK it is estimated that work-related stress is responsible for six million days of sick leave a year, with stress being linked to many minor and major illnesses.

FOR MOST PEOPLE, work is a significant and meaningful feature of life with the majority of us spending around 25% of our adult lives working. While work can provide us with structure, purpose, satisfaction, self-esteem and spending power, the workplace can also be a setting of stress and worry

What is work-related stress? Everyone is under some pressure in the workplace. Some external pressures can be a positive factor, helping us to be more productive. Some people actually thrive under shortterm added pressure, and our bodies are designed to meet these short-term demands. Hormones including adrenaline are released to prepare us for a “fight or flight” response to demanding situations. However, excessive and prolonged stress can take its toll, producing a range of physical and emotional health problems which have come to be grouped as “work-related stress”. There is no single cause of work-related stress. While stress can be triggered by sudden, unexpected pressures, it is often the result of a combination of stressful factors which accumulate over time. Some people can become so used to the symptoms of excessive stress that it goes unnoticed to their detriment. Most work-related stress is related to management of work, relationships at work, organisational set-up and whether you feel you have power and control in your work. The experience of stress is different for every person. Some people are affected more than others, so what is stressful for one person may not be stressful for another. It can depend on your personality type and on how you have learned to respond to pressure. Typical triggers of stress include:

• lack of control over work
• excessive time pressures
• excessive or inflexible working hours
• too much or too little work or responsibility
• confusion about duties and responsibilities
• lack of job variety and interest
• inadequate training and possibilities for learning new skills
• poor work/life balance
• difficult relationships at work
• lack of support and lack of contact with colleagues
• organisational confusion, restructuring, job change
• uncertainty over job prospects

Symptoms of work-related stress Work-related stress can manifest itself as physical and emotional health problems, and as altered ways of behaving at work and at home.

Physical symptoms:

• increased susceptibility to colds and other infections
• headaches
• muscular tension
• backache and neckache
• excessive tiredness
• difficulty sleeping
• digestive problems
• raised heart rate
• increased sweating
• lower sex drive
• skin rashes
• blurred vision
• emotional and behavioural changes
• wanting to cry much of the time
• feeling that you can’t cope
• short temperedness at work and at home
• feeling that you’ve achieved nothing at the end of the day
• eating when you’re not hungry
• losing your appetite
• smoking and drinking to get you through the day
• inability to plan, concentrate and ontrol work
• getting less work done
• poor relationships with colleagues or clients
• loss of motivation and commitment

Self-help It is impossible to escape pressure at work altogether, so it is important to learn how to manage stress. There are a number of ways in which you can reduce the negative impact of stress, most of which involve taking a good look at how you function within your work setting and beyond.

Changes at work If work-related stress is affecting you, it is important to deal with the problem as soon as possible. One of the most important factors in reducing stress levels is managing time effectively. Prioritise tasks, delegate where necessary and take care not to take on more than you can handle. Completing one task before going on to the next will help you to feel more in control of work, while varying tasks will help to keep you interested. Make time to relax at work by stretching and breathing deeply. This will help you to keep focused and prevent tired muscles. Simply ensuring you get outside for a walk during your lunch break can be helpful. It is helpful to identify which situations stress you most. Practise how you could behave differently in tricky situations Perhaps you need to be more assertive (see BUPA factsheet titled Improving assertiveness), or you need to learn to “take a step back” in tricky situations. It can seem hard to confront the causes of workplace stress and to ask for help. But sometimes, support and advice from your line manager or human resources department is necessary to help you deal with difficulties at work, whether it is to clarify your job role and responsibilities, or to deal with workplace bullying. If you find talking about your concerns difficult, it may help to make notes to bring along to the work interview with you. Make these clear and specific. Try to remember that it is in everybody’s interest that the workplace is as stress-free as possible.

Lifestyle changes Regular activities outside work will help you to meet new people, take your mind away from work worries and remind you that there is more to life than the office. Bring a sense of fun into your life by starting a creative hobby such as painting, or a new form of physical activity such as dancing or swimming. There is increasing evidence that regular physical activity helps to reduce stress levels. It provides valuable “time out” and can trigger brain chemicals that improve mood. A brisk daily walk is ideal, but the main thing is to choose an activity that you enjoy. Learning to relax can improve sleep and relieve stress-related physical pains such and stomach pains and headaches. Your GP surgery or the local library will have details of adult education classes where you can learn helpful techniques. Libraries loan books, tapes or computer-based packages. Confiding in trusted friends or relatives is a useful way to articulate worries and negative feelings. It can give a fresh perspective and help to make stressful situations more manageable. Avoid unhelpful responses to stress such as increased alcohol intake, smoking, and high caffeine intake. These all increase stress levels. Regular meals and a balanced, high-fibre diet will provide sustained levels of energy to keep you on an even keel. At the end of the day, reflect on what you’ve achieved rather than worrying about future work. Don’t be too hard on yourself and remember to take each day as it comes.

Seeking further help Some people need to seek further help for work related stress, as they may be depressed or have an anxiety disorder which needs treatment. Anyone concerned that they need help should visit their GP for advice. If you are diagnosed with depression, you may be prescribed a course of antidepressants. Other treatments can include a talking therapy such as counselling. There are also courses for stress management and lots of self help resources. Some workplaces may provide a confidential counselling service or telephone helpline. Libraries, social services and local health centres will have details of local courses.

Conclusion Stress is an inevitable but complex companion to our working lives. Without challenges and pressures, work would lack sparkle, but we all have the capacity to be overwhelmed by work-related stress, and to experience its exhausting effects. The aim should be to manage stress by becoming aware of our individual ways of responding to it, and through making effective changes to our working lifestyle.

This article is the second part of the analysis of the Politics of Health, following on from last month. The alignment agendas can be summarised as Chronic Disease management (CDM-watch out for a DoH paper on this in September), health inequalities (do you have evidence to show your products work or work better in ethnic communities, the elderly?) and increased patient involvement in their health management. Other developments that may come to fruition if Labour get re-elected and should be tracked include:

• Devolved commissioning to GP practices
• Payment by results (PbR) - this is causing a lot of angst in the NHS at the moment, and may cause a lot of angst in the industry if launch strategies do not take account of its impact. It will shift the commissioner agenda to quality not cost, whilst making NHS Trusts highly cautious of initiating new drugs – particularly specialist hospital only drugs – unless they can show demonstrable quality/capacity improvements for their extra cost
• Regulation: the new Healthcare Commission has much more aggressive leadership under Prof Sir Ian Kennedy and will not put up with any more excuses/game-playing around delayed implementation of NICE guidance nor PCTs that demonstrate tokenistic behaviour with the patient participation agenda. The new HCC has already criticised 2 PCTs for poor patient involvement in the implementation of the CHD NSF agenda
• Choice will expand beyond choice of hospital and no doubt include patient choice in medicine taking - expect to see patients views listened to much more carefully by formulary/medicines management committees
• Diversity of supply: pilots by PCTs working with US Health Management Organisations, Kaiser and Evercare, to improve chronic disease management are in full flight.
• Pfizer are demonstrating the scope of diversity of supply with their CDM initiative in one of the large London PCTs
• PCT mergers to realise economies of scale - interesting this one, as some PCTs become as large as the HAs they originally replaced.

But you won’t have to wait until the next General Election to see some of the more traditional Labour behaviours emerge. The Health Select Committee has announced its intention to commence an inquiry into the pharmaceutical industry in September 2004. The inquiry will be far-reaching and will focus on:

• Drug innovation
• The conduct of medical research
• The provision of drug information and promotion
• Professional and patient education
• Regulatory review of drug safety and efficacy
• Product evaluation, including assessments of value for money

The Committee will be taking a very close look at the influence of the industry on organisations such as NICE as well as prescribers, professional and academic institutions. Those who support the conspirators view of the world suggest that this is a “parting present” to its Chairman and Wakefield MP, David Hinchcliffe, who has always kept a close eye on the behaviour of the pharmaceutical industry. Watch this space, the Health Select committee will leave few stones unturned and the media will have a field day if it digs up anything even slightly questionable. So what about the Tory plans for health? At the moment they are high on rhetoric and light on detail, wrapped up in a speech to the NHS Confederation on July 6th 2004, by the Shadow Health SoS, Andrew Lansley. Patient choice, medical staff free from bureaucracy and waiting lists a thing of the past was the rhetoric. Oliver Letwin, the Shadow Chancellor, has a real bee in his bonnet about the “Big government” and the growth of the civil service, pledging a further reduction in the size of the DoH and NHS quangos. GPs will be able to spend the £1.7bn savings that this generates on sending patients to any hospital-NHS or private. Now, where have I seen that policy before? “Plus ca change….” Sorry Oli, difficult to see where Labour’s policies stop and yours start. The most tangible detail in the Conservative’s pledge to “reform frontline public services” being plans to abolish SHAs, devolve their functions to PCTs, who in turn would devolve their commissioning (except emergency care) functions to GPs. So, under a Conservative administration, it could be re-arrange the deck-chairs time again, without any hard measures on improving health outcomes. Still maybe the long summer recess will have helped firm up this missing link in Conservative health policy. The big issues to watch have already been covered, so I will leave you with this parting thought, because after all a year is a long time in politics – Teflon melts at 609 degrees Fahrenheit, so long as Tony’s non-stick talents stay below this not even their decline in grass roots membership will get in the way of a 3rd Labour term. As to a 3rd Blair term? Maybe “Mandy’s” new European post is really just all about creating a President Tony?

References/Further Reading 1. Mori Opinion Poll; The Independent on Sunday. 1.8.04 2. The Daily Telegraph; 2.8.04 3. The NHS Improvement Plan: Putting People at the Heart of Public Services. June 2004 4. National standards, Local Action: Health and Social Care Planning Framework 2005-2008 5. New Statesman, 16 February 2004 6. The Healthcare Commission

Angela McFarlane

HealthGain Solutions is a contract services organisation which supplies specialist sales, nurse, pharmacist and PCT teams to the pharmaceutical industry and NHS. These specialist teams implement joint-working initiatives that help NHS Trusts, PCOs and their constituent GP practices realise their strategic targets. HealthGain Solutions are the only outsourced teams provider to have two team projects cited in the recently launched ABPI Framework for Joint Working between the Pharmaceutical Industry and the NHS”. www.healthgain.co.uk For more information contact HealthGain Solutions Telephone:  01635 277200  01635 277200 Email: headoffice@healthgain.co.uk www.healthgain.co.uk The copyright of this article is owned by HealthGain Solutions Ltd © HealthGain Solutions 2002