The FISH! Management theory is taking America by storm, but is it valuable for business in the UK or self-explanatory hyperbole? Steve Ainsworth reports.

Back in 1929 an academic book entitled The Sexual Life of Savages in North-Western Melanesia by Polish anthropologist Bronisław Malinowski became an unexpected best seller.

To study mankind in a state of nature Malinowski had visited the Trobriand Islands in the Solomon Sea. There he discovered the curious cultural practices which would eventually titillate readers back in Europe.

In 1998, to study workers in a natural environment, John Christensen from Minnesota, current Chief Executive Officer (or ‘Playground Director’ as he prefers) of ChartHouse Learning visited Seattle’s world-renowned Pike Place Fish Market.

Christensen was overawed by how involved and happy the workers in the fish market were, particularly given the mundane and repetitive nature of their jobs.

Those who worked there seemed totally committed to their customers, tossing fish to one another in response to customer orders. They often involved customers in their banter, creating a remarkably cheerful and animated environment for both workers and customers alike.

Inspired by what he had seen Christensen went away and made a film, then wrote a book, about what he had discovered – the Holy Grail of management – a workplace utopia in which everyone was motivated, content and competent.

His system is called the FISH! Philosophy (complete with exclamation mark).

School of thought

Christensen noted that not only were the workers in Seattle making routine work fun for themselves and their customers, but they also were selling tons of fish. He constructed his FISH! Philosophy around four key concepts:

1. Choose your attitude – take a positive approach, feel valued and able to accomplish goals.
2. Be there – attend to work in body, spirit and mind.
3. Play – people may think play is the opposite of work, but by engaging in workplace fun and laughter, work becomes more enjoyable, less of a chore and more productive.
4. Make their day – encouragement, praise, freedom of practice, responsibility (with appropriately added accountability) and appreciation leads to positive responses and a happy and fulfilled workforce.

The resulting FISH! film was translated into 17 languages, and spawned a series of spin-off book titles, including Fish! A Remarkable Way to Boost Morale and Improve Results, which has been translated into 34 languages. Many companies and organisations have paid to introduce the FISH! Philosophy to their workplaces.

Could the FISH! Philosophy help your company ensure that work becomes a form of daily reward in itself rather than just the pay it earns?

Giving business a sole

Training and case-study material (which also demonstrates the diverse range of business types embracing the FISH! Philosophy) is available from ChartHouse.

In order to practice the FISH Philosophy, managers have to have to learn to:

• increase energy and morale in the workplace

• use the four principles of the FISH philosophy to manage change and stress in the workplace – offering ‘power without paralysis’

• be a creative and innovative team-builder by connecting with their team members (employees) at their level

• use the FISH Philosophy to improve trust and develop integrity in the workplace and business

• reduce staff turnover as a result of a heightened moral

• encourage communication of their new-found enthusiasm to service users through positive interaction.

What does this mean in practice? One British retail company advises its managers to use the following ways of applying Christensen’s fishy philosophy:

1. Choose your attitude – encourage team members to think positively before arriving at work – perhaps arrange a pre-shop opening breakfast with team pep talk.
2. Be there – ask staff members to act on something immediate – perhaps a stock update or managers special re-price – don’t leave something for tomorrow that could be completed today.
3. Play – instigate a game during opening hours – each member of staff to move a piece on a draughts board each time they make a sale and award a small token for ‘taking a piece’.
4. Make their day – do something nice during the day – compliment a team member within earshot of a customer.

One method of recognition is the FISH! Card, given by employees to each other when they have demonstrated one of the FISH! concepts. Employees who have earned three FISH! cards are presented with ‘Pete the Perch’ a small stuffed toy fish of varying colours. Many US companies reportedly present these tokens at staff meetings, throwing them – just as the employees at Pike Place are said to fling real fish – to their colleagues who have earned them.

A load of pollocks?

Is this the greatest advance in management theory since Maslow’s ‘Hierarchy of Needs’? Or just a pile of hyperbolic Yankee fish paste?

In fact, this is hardly rocket science. It is self evident that a happy workplace is a lot better than a miserable one – and that managers set the tone. Similarly, any manager who isn’t already aware that praise and appreciation help keep up morale shouldn’t be in the job in the first place.

What really sets the FISH! Philosophy apart, however, is its clever marketing, and its packaging around that famous fish market. Yet is even that all that it seems? The Trobriand Islands have been satirised as being infested by hordes of sexually-eager young anthropologists, the islanders delighting in spinning ever more colourful cultural yarns for their gullible guests.

Could the Seattle fishmongers have taken John Christensen for a similar ride?

A video clip of the Pike Place Fish Market posted on Youtube claims Christensen spent only a very short time there. According to one fishmonger who is asked about the FISH! Philosophy: “Nah. We don’t do that – it was just made up by some guy from Minnesota. We just ‘showed up’ for the guy over the three days he was here.”

But the less cynical may be more impressed by ChartHouse Learning’s own words: “We’re not afraid to use words like ‘love’ and ‘soul’ and ‘spirit’, because those are an essential part of our humanity. FISH! is a wisdom that everyone can embrace. It is an invitation that enables people to care about each other and their commitments. FISH! is an ongoing journey. It is not a fad.”

But, whether fatuous fad or fundamental philosophy, FISH! is likely to be heading your way.

For more information:

FISH! Philosophy – www.charthouse.com

Video: Pikes Place Hates Fish Philosophy?

www.youtube.com/watch?v=_Oga_DBOP1Y&NR=1/

Steve Ainsworth is a well-known writer specialising in the history of medicine, the NHS and Primary Care. Steve qualified as a member of both the Institute of Chartered Secretaries and Administrators and of the Institute of Healthcare Management. In addition to his other activities he has been a Lay Chairman of Independent Review Panels dealing with complaints about the NHS, a Lay Panel Member for the Healthcare Commission and is a Lay Reviewer for the Royal College of Surgeons.

Mike Sobanja, Chief Executive, NHS Alliance and Andy Etheridge, Commercial Director, Cegedim Dendrite, outline the challenges facing pharma in adapting to the recommendations of QIPP, the expected rationalisation of PCTs and the predicted emergence of GP consortia led Practice Based Commissioning.

Can pharmaceutical companies find any positive opportunities in a cash strapped NHS that is going to be torn between slash and burn tactics and the objectives of Quality, Innovation, Productivity and Prevention (QIPP) to meet challenging financial targets in 2010?

Political uncertainty notwithstanding, the NHS looks set for serious change in the coming years as senior managers wrestle the budgeting challenges that must be imposed in response to the global economic problems.

At a most basic, organisational level, there is little doubt that the number of Primary Care Trusts (PCT) will be cut over the next few years in a bid to reduce administrative costs and achieve greater consistency in policy making. The current number of 31 trusts in London looks set to be consolidated to eight, whilst smaller PCTs are also likely to disappear. Realistically, the number of PCTs is likely to reduce by up to one third.

There is also going to be a stronger divergence in health policy between England and the rest of the United Kingdom; with Wales and Scotland, in particular, following very different political agendas. While PCT consolidation has already occurred in Northern Ireland, where four Trusts have been replaced by one single body, policies for commissioning will be very different nationally, with politicians in Wales and Scotland extremely against any type of market exposure within the NHS.

In England, by contrast, if the Conservative Party gains power, it is likely to follow through on its pledge to make Practice Based Commissioning a reality. This will place budgetary control in the hands of increasingly powerful GP consortia, a move that will have very real implications for the pharmaceutical industry.

But this shift will also raise questions about the long term future of Strategic Health Authorities (SHA). With budgetary control shifted to the GP, the PCT will be left with the role of ensuring sound performance management and enforcing accountability. This will be a clear duplication of role with SHAs, a duplication that is unlikely to be tolerated in what must become an administratively leaner health service.

Understanding QIPP

But for pharma companies, changes in the NHS will have far greater implications than the need to identify a new set of Key Opinion Leaders (KOLs). Politicians of every party are increasingly committed to a quality agenda and David Nicholson is taking personal responsibility in ensuring every PCT is defining its new budgetary planning with the recommendations of Quality, Innovation, Productivity and Prevention (QIPP) in mind.

For NHS senior management, QIPP is seen as the only way of achieving the real term budgetary cuts that must be put in place for the next few years, without drastically compromising the quality of patient care. No politician wants a repeat of the 1980s style of slash and burn, which saw beds, appointments and staff numbers radically reduced.

There will undoubtedly be another wave of pressure on spending, including pharma spending, across the NHS and pressure to increase the use of generics even further. But for pharma companies, QIPP represents a shift away from traditional prescribing decision making and must have a profound impact on the way medicines are presented to the NHS. Critically, companies will have to express the value propositions for each drug in line with the QIPP agenda; the messaging must include information about a drug’s ability to improve productivity by, for example, preventing hospital admissions and enabling patients to more effectively manage their conditions in the community.

Consistent messaging

In some ways, the huge emphasis on the QIPP recommendations is beneficial for pharma; organisations can focus on this one, critical challenge, as opposed to managing the multiple challenges and objectives that have characterised the NHS in the past.

But pharma will also have to deal with a far wider range of customers within the NHS and greater market fragmentation, especially if the Conservative Party policy of pushing budgets away from PCTs and towards clinical groups is adopted. Each PCT will have its own QIPP interpretation and implementation policies. Pharma companies will have to understand a far wider range of customers, assess their interpretation of QIPP and align the messaging accordingly.

Furthermore, the move to QIPP based messaging will be a challenge for many companies. Realistically, how many products can be described as having a real quality, efficiency and productivity outcome?

Speed of response

The pharmaceutical industry has been notoriously slow to respond to changes in the NHS. And although companies now admit that the traditional rep role has been dramatically changed by the shift towards a more team-focused approach, where key account management is the new aim, it has taken the industry 15 years to recognise the need for a new model.

Companies cannot wait another 15 years before adapting and introducing the skills that will be needed in this marketplace. Successful pharma operations now require individuals with competencies that include analytics, the ability to identify alignment opportunities, negotiating skills and partnership skills. These are very different from the traditional competencies and will require investment and training.

Organisations must also address the challenges posed by very different national NHS strategies. With pressures on cost and resources within each pharma company, the objective is to create national, even global marketing strategies but deliver them in a way that can be implemented successfully at a local level. In the politically fragmented UK marketplace, this will be achieved by creating the right competencies across the work force, but also restructuring around regional units and the reorganisation of company departments within these regional set ups.

Conclusion

The pressures posed by the NHS in 2010 and onwards will undoubtedly place even greater challenges on pharma companies, companies that are already struggling in an extremely tough global marketplace. Consolidation will continue, whilst many international companies are likely to retrench their UK operations.

But while NHS structural change and market fragmentation will be key issues to address, if pharma companies fail to express their value propositions in a way that reflects the QIPP agenda, the chances for success and market growth will be minimised.

Whoever wins the General Election in May, NHS policy over the next five years will be dominated by severe funding restrictions. Thoreya Swage discusses what this means for the NHS’s commercial partners and suppliers.

The message of the recent Government policy statement NHS 2010–2015: from good to great. Preventative, people-centred, productive was clear. In twelve years of economic growth, the NHS has experienced an increase in funding to put it on a par with other nations around the globe. It currently has a workforce of 1.4 million. Waiting times have been dramatically reduced. Patient satisfaction with the services is high, and the Next Stage Review has placed quality and innovation on the NHS agenda.

Hard times are coming, however, with a target of £15–20 billion (some say more) ‘efficiency’ savings to be made over the next three years from April 2011. This funding cutback is made in the context of higher patient expectations, an ageing population, changes in the nature of disease, and advancements in health IT and treatments.

The vision the DH has developed to meet this challenge focuses on maintaining and improving coalface services, restructuring care so that more people are treated closer to home, greater use of information-based technologies and ensuring that services are sustainable in terms of their impact on the environment and society. These changes are to be led by clinicians who will promote best practice, looking at services along whole pathways of care and not just within their own institutions.

Positive steps

The NHS is expected to make these savings by improving the quality of services as identified by the SHAs in the Next Stage Review and through the use of NICE-approved drugs, technologies and vaccines. There is a new emphasis on the need to act early through health promotion and preventative activity, focusing on younger people to encourage the development of healthy behaviours. Priorities indentified include risk assessment (e.g. NHS Health Checks) and advice on the safe use of medicines by high street pharmacists and earlier, prompt diagnosis – for example, a maximum of two weeks from GP referral to being seen by a specialist for suspected cancer, brain scans within one hour of admission for stroke patients and local primary angioplasty services for heart attack.

With the priority to identify conditions upstream, this will mean that PCTs need to be prepared to commission the extra care that will be needed to treat the previously unmet need – this will include more prescribing.

In systemic terms, the payment mechanisms are being linked more closely to the quality of care through the implementation of CQUINs (commissioning for quality and innovation), fines for poor-quality service (e.g. high rates of deep vein thrombosis, pressure ulcers or wrong site surgery) and a shift to the community (e.g. more chemotherapy and renal dialysis closer to patients’ homes).

Patients, particularly those with long term conditions, will be given greater power to choose their own health care through the use of personal health budgets currently being piloted.

Commissioners are required to be more robust in their contracting relationships with the NHS. If current services are underperforming, commissioners are to give the provider at least two opportunities to improve through contract management and benchmarking (which should include feedback on patient experience). A service review will be undertaken to generate a service improvement plan, assessed through contract monitoring. If no improvement occurs, then commissioners can go ‘within months not years’ to other potential providers tendering for services. Further details on this ‘NHS First’ approach will be published shortly.

Clinical knowledge is moving ever more to the centre of the commissioning process with practice–based commissioning consortia having devolved rather than indicative budgets and the document opens the way for Foundation Trusts to extend their provision of services by running primary care.

An uncertain relationship

All of this indicates subtle changes in the relationship between the NHS and the independent sector, with some mixed messages. It appears that the Government wants the NHS to look to its own services first before going elsewhere. Yet the door is kept open with the statement that the NHS will be looking to work with the independent sector, particularly if new services or new service models need to be developed to meet future need or to offer more choice for patients. The document offers to remove barriers to participation in the development of services, such as improved access to information systems and better staff mobility between the public and private sectors (through the use of a ‘staff passport’ that preserves the terms and conditions of NHS employment).

The major question not adequately answered is how improving quality can make savings. SHAs, in response to the Next Stage Review, developed their own action plans for improving quality in their regions. These plans were published prior to the economic downturn. They have been asked to revise their strategies since then – but not all have been forthcoming with new plans.

However, not all is bleak. A fair proportion of the second chapter is devoted to a detailing a number of ‘accelerated improvements in quality’ in five major areas of care, including cancer, cardiac conditions, stroke, maternity care and patient experience, together with greater emphasis on the management of long term conditions such as diabetes, chronic obstructive pulmonary disease and dementia. Some initiatives include ‘supporting adherence to drug therapy’ for COPD, ‘optimal medication’ for heart failure, tighter glucose control in diabetes and reducing the use of anti-psychotics for people with dementia to a third of the current level. Across all conditions the main themes are stopping the use of drugs that are not effective and increasing the prescribing of generic rather than branded drugs.

Tucked away near the end of the document mention is made of incentives being developed to recognise and reward good practice in partnership working between the NHS and industry to deliver productivity as well as preventative healthcare.

Independent intervention

The document keeps quiet about the future of the Independent Sector Treatment Centre (ISTC) contracts, some of the first wave of which are due to finish in the first six months of this year. These centres have played a major role in reducing waiting times for common surgical procedures such as hip and knee replacements, and in driving up innovation and quality – but at a cost. As part of their contracts, the income of ISTCs has been guaranteed regardless of the actual number of procedures undertaken. That arrangement is no longer sustainable.

The responsibility for renewal of these contracts has now been devolved to the PCTs, who lack the procurement capability to undertake the necessary commercial discussions. This has resulted in great uncertainty for the companies running these centres, with some facing tender processes to rent the buildings they are using from the NHS, short-term extensions of three to six months and a change in their payment terms from block contracts to payment at tariff through patient choice.

With PCTs focused on making savings, it would be easy for them to turn their backs on the ISTCs since the latter are not a quick fix – and their relationship with NHS organisations has sometimes been problematic. This would be regrettable, however, given the strides in innovation made by the ISTCs and the continuing need of the NHS to concentrate on promoting best practice.

Into the blue

In their draft health manifesto, the Conservatives have acknowledged the need to make savings – taking the usual route of cutting NHS bureaucracy and scrapping formal targets. They have promised to create an independent NHS board, free of political control, to allocate resources across the country. This will include targeting funds for public health where they are needed.

As with the current government, the issue of patient choice is high on the Tory agenda – with the independent sector playing a role in offering alternative provision of healthcare. GPs will be given further commissioning clout through holding budgets to commission care on behalf of their patients. It is possible that innovative practices and practice-based commissioning groups may look to the independent sector for new forms of treatment. However, that may be difficult with stretched resources.

The road ahead

Though the chilly financial climate has caused the NHS to look in on itself in order to make savings and improve productivity and quality over the next five years, there are still opportunities for the pharma industry to support and be part of that process.

The emphasis on clinical staff taking the lead in achieving change, together with the requirement for clinical teams to be in charge of their own budgets, will make discussion on the use of appropriate medication to improve care easier. When a provider is going through a service review and agreeing a service improvement plan, the industry can help by demonstrating how performance can be improved through the effective use medication to streamline a care pathway, particularly if that results in a reduction in unnecessary hospital admissions, e.g. improving compliance.

The move to advice and better use of medication by pharmacists, real decision-making power to patients and practice-based consortia through actual budgets and the development of new providers with Foundation Trusts expanding their services out into the community, opens a wide range of opportunities to engage with different customers.

The message for industry to hang onto is the will to drive innovation, despite the gloomy economic background. This innovation ranges from evidence-based interventions to new services and service models.

We can be sure that NHS policy change will grind to a halt once the election date is announced, and decisions will be difficult to pursue over the next few months. It is also certain that the independent sector will have a part to play in providing NHS healthcare in the future – the question is, to what extent and how?

Dr Thoreya Swage has several years’ experience in the NHS, both as a clinician (psychiatry) and as a senior manager, including Executive Director for a Health Authority, in various NHS organisations covering acute and primary care. She has expertise in commissioning health services, most recently working with the independent sector as part of the Independent Sector Treatment Programme at the DH. She is currently working for a number of NHS organisations, including DH agencies, to develop a more commercial approach to the commissioning of healthcare.

Are you on track to meet your targets for the first quarter of 2010? Maybe you need to set yourself a bigger goal. Motivational speaker Dave Hyner explains.

The early part of a new year is the perfect time to be setting goals, both personal and professional. What do you want to achieve? Although losing weight, getting healthier and spending more time with friends and family are all popular resolutions, ‘exceed my sales targets’ should also feature among many Pf reader’s goals for 2010.

As the weeks progress, how far have you come? Have you made the impact you were hoping to make? It is not uncommon to start the year full of enthusiasm, but lose all motivation amidst the cold and dark of the winter months.

Could it be that you are not setting the right targets? It’s time to refresh those good intentions with a whole new approach.

Aspiring to mediocrity

The common mantra when setting any goal, like a sales target, is to come up with something ‘realistic’ and ‘achievable’. Conventional wisdom suggests this is better, because it means the goals are easier to hit. It also says the alternative – setting a massive, amazing goal – can be demoralising when people realise it’s out of their reach.

In reality, while that may be true for some, it just sets the majority of people up for mediocrity – at best. How could anyone be truly inspired and motivated by something that is within their reach? And don’t be fooled into thinking realistic, achievable targets can’t be equally demoralising. The lack of inspiration can be just as de-motivating – imagine how it would feel to set a realistic goal and then not achieve it!

So if realistic goals can be demoralising, is there really any point in setting them? Pharmaceutical sales is no different. In fact, the need for a massive goal in such a pressurised, competitive environment could not be greater.

The rewards of a successful sales career within the pharmaceutical sales industry can be huge, but this means there are more people willing to aim for them – and to do what they have to to get there. But there is a way to be number one, without being completely ruthless. I base this assertion on years of speaking to top achievers, from various fields including sport, business and academia. They all have one thing in common – they set themselves a massive goal and refused to give up until they reach it. And then they set themselves another one.

Case studies: leading by example

One example is sales professional Geoff Cox, who had set up a networking group called Network2Connect. He implemented our goal-setting technique – despite being sceptical about it – and transformed his fledgling business into an international company, with a global reach through the website (www.network2connect.com). He’d quadrupled his business in one year alone.

As a young man, Poundland founder Steve Smith was told to get a job and a haircut or leave home. He set up a market stall selling items for £1, to the ridicule of friends and fellow traders. He experienced more ridicule when he opened the first Poundland store in Burton-upon-Trent in 1990 – they said costs would be too high and the prices would give the goods a poor image. Today Poundland has over 70 stores around the country, employs over 2800 people and has turnover of more than £160 million.

Sport is a field where goal-setting has a major role to play. The late Emlyn Hughes OBE is a fine example of this. As a child, he set himself the goal of playing football for England. However, he was considered too small to play football, so he lied about his age to get into teams of older players, which made him stronger than those in his own age group. It also made him a fierce tackler, and earned him the nickname ‘Crazy Horse’. His determination and drive took him into the Liverpool and England sides of the late 1970s and early 1980s, becoming captain of both and the most successful English footballer of all time before his retirement in 1981. By that time he had played for England 62 times and won 14 trophies, despite being ‘too small’ to play football.

Yet another example is author Andy Cope, who is now a best-selling children’s writer after applying the Massive Goals Principle. He was a college lecturer, with the dream of writing a children’s book about his pet dog, Lara. His first novel ‘Spy Dog’ was published in 2005, and this has since developed into a hugely successful series of books, beating JK Rowling to win the Red House Children’s Book Award in 2006. Andy is now an author, trainer, accomplished professional speaker and positive psychologist.

While these are truly remarkable individuals, there is no reason why we can’t all emulate their success.

Five steps to success

1. The first thing is to decide what the goal is. What does it look like? How will it feel to get there? Some people choose an expensive sports car, or a mansion, or an exotic holiday. Others choose security for their family, or a better work-life balance. The important thing is to make it specific, tangible, and quantifiable. If you need help with this, think about people you admire – particularly those who have succeeded in pharmaceutical sales. How did they get to the top? Can you take anything from their experience and apply it to your own goal-setting? What about Asa Candler, the man who brought Coca-Cola to a global audience, who started out as a pharmaceutical salesman and manufacturer? Or perhaps there is someone a bit closer to home?

2. Secondly, think about the process. The best approach with a massive goal is to break it down into bite-size chunks. Once the building blocks have been created, commit to doing something each month to help you hit the ultimate target.

3. You must hold yourself accountable to your commitments. Without accountability your massive goal will soon fall by the wayside. This is why the mini-goals have to be measurable. But they don’t necessarily have to be connected to sales – it could be something as simple as contacting former clients and prospects, or reading a book from an industry expert. In other words, they can be related to the personal developments which will help you reach your ultimate goal, or generate more leads.

4. Develop some landmarks to achieve along the way. This makes it easier to gauge progress and prove the goal is becoming closer.

5. And bring in some fun, incentives or rewards to help you. The journey may become difficult at times, but a reward, such as a gift for yourself, or a city break to somewhere you’ve always wanted to visit, will help to focus the mind and keep you on the path.

Follow these five steps and I guarantee you will hit the heights – it really is that simple! Just be clear on what you want to achieve and what you need to do to get there. This is the only way you will become the number one pharmaceutical salesperson in your company or therapy area. If you continue to set achievable goals you will only ever get to mid-table, and you’ll never reach your full potential.

Let’s make 2010 your most successful year ever!

Dave Hyner is a Staffordshire-based motivational speaker, and Managing Director of Stretch Development. He has travelled the world to deliver keynote addresses on his research into top achievers in sport, business and academia.

A wide range of case studies and testimonials, along with a video of David in action, are available at the Stretch Development website: www.stretchdevelopment.com.

360 feedback is a development tool that is gaining popularity. But should it be reserved for the benefit of management? Pf’s Diana Spencer discusses the benefits of this feedback process and the concerns that surround it.

360 Feedback, sometimes referred to as 360 degree feedback, provides information on an individual’s work performance from a number of different sources. These can include the line manager, direct reports, colleagues, peers and even customers. Each person will fill out an anonymous questionnaire about the person’s performance, usually giving responses on a scale of one to five, and sometimes with the opportunity to add further free-text comments. A report is then formed from the varied responses and it is this that is presented to the individual, so that the anonymity of the respondents is maintained. Sometimes companies will employ a specialised company to provide the questionnaire and report-generating services online, which can also add to the security of the process. Although 360 feedback is becoming a common way of seeking feedback on an individual within the pharma sales industry, most companies only use this process for management and senior-level staff members. But what is the value of this professional development tool? And could other members of staff benefit from it? This article will discuss these questions.

The value of 360

As a performance management tool, 360 feedback is growing in popularity. This could be partly due to the changing structure of how we work, which means that managers often have multiple lines of reporting and there is much more team-based working. It is generally considered a feedback tool that provides, quite literally, a more ‘rounded’ view of an individual’s performance, and is especially useful in cases where the direct manager. It also minimises the risk that a person’s assessment could be affected by any personal preference or dislike on the part of their manager. The value of 360 feedback also lies in providing a challenge to a person’s idea of how they are perceived by others in their professional life and can motivate a lasting and genuine change of approach and improvement of performance.360 feedback can also be repeated further down the line to see if the individual has improved on their weaker areas. Susan Glenn from training company The Portland Partnership gave her top tips for successful feedback. She explained that good feedback has to be:

• Candid and honest: this kind of feedback is essential and although it can be painful, is your best bet for helping the person change.
• Specific and actionable: the more behaviorally-based the feedback is, rather than character-based, the more able the recipient will be to implement what you suggest.
• Based on more than one person's view: this can be tricky – on one hand, if multiple people share a perception, it is likely to be more valid and credible. At the same time, you don't want the person to whom you're giving feedback to feel ganged up on.
• Framed positively and constructively: avoid being unduly critical - people are more likely to hear and act on feedback if you use a ‘carrot’ rather than a ‘stick’ in describing to them the potential benefits of doing something better or differently.
• Summarised and integrated into key themes: it is helpful to point out trends and links between feedback in order to give the person a big picture view and then also provide more detailed feedback in that larger context.

“I started off with a healthy degree of cynicism,” Mel Redfern, Director of Financial Control at AAH Pharmaceuticals, explained to Personnel Today following the implementation of 360 feedback at his company, “but by the time I got to the feedback stage, I was a convert. In a one-to-one appraisal, there is a much higher chance of conflict and the message won’t always be accepted. But it is more likely to be taken on board if it comes from several different avenues.”

Just for management?

It is understandable that companies are using this method of feedback for their senior level members of staff, with high levels of responsibility and management duties, as it is important to ensure these individuals are pulling their weight. However, many would argue that all employees within an organisation would benefit from 360 feedback. The role of the field sales representative or key account manager is perhaps one that seems most suited to this tool. These members of the sales force are often on the road all day with limited contact with their line manager, and will have closer working relationships with NHS customers than anyone in a different type of role. Field visits with a manager, the traditional assessment method, can also be fabricated to some extent. For example, the sales executive can ensure only reliable key accounts are visited that day, and so the direct manager may not gain a full impression of their performance. “Shire is not supportive of the use of 360 feedback (anonymous feedback) for the purpose of performance management,” Chris Quinn, Training and Development Manager at Shire, explains. “We believe feedback related to an individual’s performance and therefore merit based pay, should be transparent and direct. We do, however, support the use of the tool for developmental purposes.  Anonymous feedback can often shed a light on areas requiring development and ways to improve manager performance. The tool changes slightly when applied below the manager level within Shire, but it could still provide useful multi-rater anonymous feedback for developmental purposes.” The limitations So why isn’t 360 feedback used more widely? This is essentially a question of investment, both in terms of finances and commitment on the part of the organisation. Much like a nail gun, 360 feedback can be a dangerous tool in the wrong hands and requires proper management. “360 feedback must not be used as a stick to beat people with, but only to show them areas where they need to develop and allow them to look at these as they choose,” says Chris Quinn “We do not use 360 feedback in conjunction with performance reviews or appraisals. The feedback session is also conducted by a professional coach and not by the individual’s line manager.” Advocates of 360 feedback insist that it must be supported by training and managed by a professional coach, and this represents a considerable investment for the company. There are also reservations about extending the process to all members of staff, due to fears that it will be abused by colleagues. Chris Quinn expands: “There is a risk that the anonymous nature of the feedback could encourage childish behaviour among some members of staff, i.e. through story-telling or complete fabrications. I believe 360 feedback could be used more widely, but it can be a dangerous tool if not managed well.” It also vitally important that 360 feedback is followed up appropriately, to ensure the benefits of the process are realised. “The next steps are very significant,” explains STAR’s Lucy O’Neill. “We make sure each employee is supported by a realistic, achievable action plan, revisited regularly, to help them overcome issues and stay motivated.” Confidentiality is another issue that can affect the trust employees have in the 360 feedback process, so it is critical that the company addresses these concerns and communicates clearly who will have access to the data and for what purpose. The use of an online 360 feedback provider and professional coach can go some way to reducing these worries. The process must also be regularly assessed and updated with input from users as to how successfully it is working.

Taking a turn

When managed well, 360 feedback can provide valuable information to an individual about how they are perceived by those around them, particularly if this is extended to include clients or customers. And, more often than not, the focus is on strengths rather than weaknesses. “Sometimes feedback can be painful, but overall people have found it a positive experience,” says Chris Quinn. “It is only once you are aware of the impact you are having that you can do something about it. People often feel more in control afterwards, as they are aware of the areas where they need to improve.” However, this positive experience should no longer be available to only senior level management. As the role of the sales force expands, and companies demand more of their field-based staff, it is important that this kind of assessment is expanded to include them in all companies rather than just a minority. By seeking feedback from peers, direct reports and customers, field-based sales executives and managers will be able to gain a more realistic impression of their performance and improve accordingly. A thoroughly thought-out and well-implemented 360 feedback strategy for the field force could make a real difference to an organisations bottom line. It’s time for companies to invest.

A new ultrasound breast scanner that provides accurate volume images and can be used to diagnose cancer in dense breast tissue is now available across Europe.

The Acuson S2000 Automated Breast Volume Scanner (ABVS) from Siemens Healthcare has been installed in radiology and gynaecology clinics in Switzerland, France, Portugal, Norway and Germany.

The new system is the first multifunctional ultrasound breast scanner that automatically acquires volume images of the female breast. The accurate 3-D images enable a much higher early detection rate of breast cancer among women with dense breast tissue.

The ABVS system provides clinicians with data about the entire breast - including a coronal view (in a plane parallel to the skin), which had not previously been available with ultrasound systems. The system can display a coronal view of the breast in slices, making diagnosis faster and easier.

The new system's automatic image acquisition also shortens the examination time: while conventional ultrasound examinations take up to 30 minutes, the ABVS can be used in less than 15 minutes.

Dr. Frank Stöblen of the Diavero Diagnostic Center in Essen, Germany, commented: "The ABVS system is a fascinating advancement from the previous method of manually guided ultrasound examinations. The automated system provides consistent image quality, regardless of the examiner."

The new system will have an important role in breast cancer screening, according to Dr Stöblen: "This technology will play a key role in early detection. It can also be used for the examination of high-risk patients, for example in case of genetic predisposition or for follow-up during and after cancer treatments."

 
Acuson S2000 ABVS

Eschmann Equipment has won a national manufacturing award for the processes by which it fulfilled a major contract to supply operating tables to Iraq.

The Sussex medical equipment company received the Innovative Working Practices Award at the first national EEF Future Manufacturing awards.

Eschmann's award recognised the radical approach taken by the company in order to fulfil an export order for 300 operating tables, needed in the rebuilding of Iraq's hospitals. Eschmann was able to deliver the order two months ahead of schedule, meeting all the demanding specification and logistical challenges.

Philip Kennedy, Managing Director of Eschmann, said: "By innovating across our entire business, we have been able to expand the scope of our operations to deliver one of the largest contracts in the firm's history and set a new platform for future growth. This has been an enormous team effort and we are delighted to have received this recognition for our work."

The EEF awards recognise world-class performance in four categories: innovation, enterprise, environmental responsibility and skills development. The Chair of the Judging Panel, Prof Stephen Evans, commented: "Eschmann not only delivered the order but re-engineered the company along the way. The deal has left an impressive legacy for future growth."

Based in Lancing, West Sussex, Eschmann designs and manufactures equipment for operating theatres and other healthcare environments, including operating tables, lighting systems, surgical suction units and electrosurgery units.

EEF is a manufacturers' organisation that provides companies with business services, government representation and industry intelligence. Around a quarter of the UK's manufacturing businesses are EEF members.

Professor Alan Barrell, Executive Chairman of Health Enterprise East (HEE), has been appointed Chairman of the new NHS Regional Innovation Council.

The Innovation Council, established by the SHA for the East of England, is responsible for building partnerships to promote innovation across NHS organisations by supporting and sharing best practice in order to meet the requirements of the QIPP (quality, innovation, productivity and prevention) agenda.

The Innovation Council will also oversee and advise on the allocation of the £1.6 million Regional Innovation Fund for 2009/10.

Members of the Council include stakeholders from industry, academia, the NHS, voluntary and public sectors.

Alan Barrell, who has spent almost 30 years in senior executive positions in technology-based industries, commented: "Innovation in the NHS has never been higher on the agenda, and I am delighted to be chairing this new initiative to maximise its promotion within the East of England. This role is highly complementary to my position of Chairman at Health Enterprise East, the region's NHS Innovation Hub, which is now in its sixth year and going from strength to strength."

Based at Papworth Hospital in Cambridgeshire, HEE provides a broad range of professional IP management services to NHS Trusts across the region. It also provides services to medtech companies, facilitating access to NHS expertise and providing advice on clinical evaluation and market research to support the adoption of new medical devices.

 
Alan Barrell

NICE is to convene to decide the fate of Bayer Schering Pharma’s Nexavar (sorafenib) in the treatment of advanced hepatocellular carcinoma (HCC).

The Institute will consider Bayer’s appeal (submitted in December 2009) of its draft negative Final Appraisal Determination (FAD) for Nexavar in HCC, which was published after nearly two years of consultation.

Bayer appealed on the grounds that NICE failed to act fairly and in accordance with its own published procedures, as well as failing to consider the long-term benefits of innovation.

Following the outcome of the hearing, NICE will issue its final ruling in March 2010.

Nicole Farmer, Business Unit Head of Bayer Schering Pharma Oncology in the UK, said: “It is so frustrating that for the 600 liver cancer patients who could really benefit from Nexavar, there still remains the chance that they will be denied. We really hope that NICE takes this opportunity to reconsider some of the data and ensures that real innovations in healthcare, like Nexavar, are made available to all who need it, not just those who could afford to pay privately.”

Since NICE’s negative ruling in November, patient groups and clinicians have been involved in a high-profile media appeal, including a systematic letter writing campaign by oncologists to NICE and the media.

Nexavar is the first systemic drug for advanced HCC to show a significant survival benefit after 30 years of comparative trials, and has demonstrated a 44% increase in survival for advanced HCC patients compared to best supportive care alone.

Professor Karol Sikora, Professor of Cancer Medicine and Medical Director of CancerPartnersUK, said: “Since NICE’s decision not to fund the drug in November, many clinicians (a number of whom would have been involved in the UK trials of the drug) have been put in the painful position of having to deny their patients the only survival option for them.

“As we reach the end of this laborious process, which has left both patients and clinicians in limbo for far too long, we can only hope that NICE will use this final window of time to properly consider the very strong recommendations from UK oncologists, who only want the best for their patients.”

Cases of liver cancer have almost tripled over the past three decades, according to figures recently published by Cancer Research UK. In 1975 there were 865 cases of primary liver cancer in the UK, and in 2006 that had risen to around 3,200 new cases. HCC accounts for 80–90% of these primary liver cancers.

Top pharmaceutical and biotech companies will face a major decline in sales growth up to 2014, according to a new report.

However, those companies that have been able to diversify into biologics, niche products and generics will still enjoy positive growth, says business analyst Datamonitor.

The report, Pharmaceutical Company Outlook to 2014, considers the forecast performance of the world’s biggest pharma and biotech companies, termed the “PharmaVitae Universe”.

The analysis reveals prescription sales are expected to rise at a compound annual growth rate (CAGR) of 1.2% up to 2014, compared to a historical growth rate of 10.5% over 2002–08. The report blames patent expiry and generic competition for this sharp decline.

“The major obstacle to the PharmaVitae Universe’s continued expansion is undoubtedly the growth of the generics market, eroding sales of major brands and market value. While this will directly impact products facing patent expiry, there will also be an indirect impact to patented brands as they are forced to compete with alternative generics,” said Rebecca Whitham, Datamonitor Analyst.

However, the report forecasts that several companies will outperform the PharmaVitae Universe average growth rate, particularly those that have diversified into the biologics sectors of monoclonal antibodies and therapeutic proteins. Datamonitor expects Roche, for example, to benefit from its early move into the monoclonal antibody market due to the sector’s high growth.

Mid-sized companies Gilead, Actelion and Celgene are also expected to achieve double-digit CAGRs, due to their strategy of targeting niche indications and areas of high unmet need. In addition, the report points out, companies such as Novartis that have developed their own generic presence will benefit from the growth in this market.

Other companies will weather the storm through mergers and acquisitions. “Where M&A has acted as the PharmaVitae Universe’s biggest growth driver over 2002–08, this unknown quantity will likely continue to play a key role in driving company performance going forward,” concluded Whitham.

“Despite bearing the impact of generic competition to some of the world’s biggest pharmaceutical brands, the large-scale M&A witnessed in 2009 will see Pfizer-Wyeth and Merck-Schering-Plough become the first and second largest companies within the PharmaVitae Universe by 2014.”

The report Pharmaceutical Company Outlook to 2014: Analysis of the Top Pharma and Biotech Companies examines the forecast performance of the world’s 43 biggest pharmaceutical and biotechnology companies according to 2008 prescription pharmaceutical revenues.