talking points

Building prescriber loyaltyby Jean-Michel Peny, Claire Dadou-Willmann and Jean Baron-Mazloumian

Scienoficdocumentation

qualily

Colleagueopinion

Scientific

qualityofmedica!

meetings

Quality of service. Majordiscrepancies were highlightedagain in the perceptions of GPsand industry executives to thesecond component of the qual­ity mix, service.

Sorne 85% of GPs said the

quality of the service they receivefrom phannaceutical companiesinfluences their prescriptionbehaviour. The study highlightedtwo main types of serviceexpected by the GPs. Firstly,good quality scientific informa­tion about the product and therelated pathology during Contin­uous Medical Education (CME)programmes, medical meetings,and from medical calls. Sec­ondly, rapid response to the doc­tors' requests for scientific docu­ments or samples, a 24-hourinformation service, and educa­tional materials produced bycompanies to inform the pre­scribers' patients.

However, suggestions ofnew services, such as an infor­mation officer or department atthe company's head office todeal specifically with prescriberrequests, and training sponsor­ship to improve the quality ofthe doctor-patient relationshipor to enhance patients' loyaltyto doctors, obtained low scores(Figure 2).

Phannaceutical executives,on the other hand, assignedlower value to CME pro-

•• Pharmaceutical executives

Specialistopinion

Scientificqualityof

productstudies

1.28

GPexperiencewiththeproduct

perceived quality of the drugs.The key factors behind a

GP's perception of productquality are, in decreasing orderof importance: his own experi­ence with the product, the scien­tific quality of the studies car­ried out on the product, theopinion of the specialists, andthe scientific quality of the med­ical meetings organised or spon­sored by the company promot­ing the product.

ln contrast, however, the phar­maceutical executives had a ten­dency to underestimate the rela­tive importance attached by GPsto the scientific quality of theproduct studies, and to overesti­mate specialistopinion (Figure 1).

~ Other servicesD Logistic quality

directly related to a pre­scriber's perception ofquality - quality in termsof the company's image,its products and its ser­vices. Optimising thesethree components, knownas the 'quality mix', canimprove company prof­itability by influencingprescribers' prescriptionbehaviour and thereforeloyalty.

Bain & Co, with stu- Figure1: Factorsinfluencingperceivedqualityoftheproducts(gapanalysis).dents of the Paris busi-ness school ESCP, recently car­ried out a pilot study in Franceto asses the impact of the qual­ity mix on general practitioner(GP) prescription behaviour.

Face to face in-depth inter­views were conducted with 68

GPs and with 56 marketing andsales executives from 21 of the

top 30 pharmaceutical compa­nies in France. Both groupswere asked identical questionsto enable a gap analysisbetween the GPs' statementsand industry perception of theGPs' (prescribers') opinions.

Product quality. The studyfound that 96% of the GPs sur­veyed believed their prescrip­tion choice to be affected by

_ Scientific information quality

0.5

1.5

2.5

Law l.0

None 0

Moderate 2.0

Factor importance

High 3.0

Figure2: RelativeimportanceofservicesdeliveredtoGPs.

Major phannaceutical com­panies like Merck, Bristol­Myers Squibb, Syntex, Searle,Upjohn and Lilly haveannounced restructuring mea­sures as a way to restore prof­itability. An additional measurethat could help phannaceuticalcompanies gain a competitiveedge is the adoption of strategiesalready being used by majorcompanies in the service indus­tries. These involve a move

away from product-oriented tocustomer-, or in this case, pre­scriber-oriented marketing.

According to a study carriedout by international manage­ment consulting firm Bain & Coin association with Harvard

Business School, companies canboost profits by between 25%and 85% - depending on theindustry - by retaining just 5%more of their customers.

Links between quality, satis­faction and customer loyaltyhave aIready been weIl docu­mented in a number of indus­tries. Recent analysis in thephannaceutical industry sug­gests a similar correlationbetween prescriber retentionand satisfaction with a product.This satisfaction is itself

Scrip Magazine September 1993

talking points

Figure 3: Perceptual map of quality mix performauce ranking.

manufacturer sent the requestedscientific data 42 days later.Moreover, the study found thatit was rare for the telephoneoperator to connect a calI to theright person first time.

ln order to evaluate the qual­ity of the communi­cation between the

marketing and salesdepartments, productmanagers wereasked to inform a

medical representa­tive to calI the secre­tary of the doctor par-ticipating in this trialto fix an appoint­ment. Less than a

quarter of the companies calledback.

The study also contacted Ilcompanies' head offices duringa week day between 7.3Opmand 8.3Opmto request advice ona patient prescription. So~40% of the drug manufacturersdid not answer, and among the60% who picked up the phoneor had an answering machine,only half of them (that is onethird of the companies studied)were able to deliver scientificadvice or information by a med­ical or pharmaceutical specialistin less than 15 minutes. More­over, the head offices of sorneleading international companieshad no telephone operator onduty after 5.30pm, making itimpossible to contact anybodyuntil the next working day, ortwo days later if the calI is madeon Friday evening.

Bad experiences such asthese may ultimately result in aGP switching to a competitorthat operates a better informa­tion service out of businesshours. Indeed, what this studyillustrates is a missed opportu­nity for the company; first todifferentiate itself from its com­petitors by delivering a qualityservice to the prescriber, sec­ondIy to overcome efficiently aproblem the prescriber facedwith the company' s product,and thirdly to strengthen pre­scriber loyalty. Of course itcould be argued that few doc­tors contact companies withproblems they are experiencing

Service

quality

Imagequality

"What this study c1earlyhighlights is industry'spoor understanding of

what shapes a GP's view ofa product."

Product

quaIity

ceutical companies in France.Sorne 30% of the companiesdid not answer and only fourcompanies out of the 30 repliedwith a letter in less than eightdays.

The request asked the com­panies to send a bibliography,as well as a chart comparingthe pharmaco-clinical proper­ties of one of their productsand its competitors. Aroundhalf of the companiesapproached did not send thebibliography, arguing that therequest was too large or thatthey did not have the facilitiesto provide it. Only one of thecompanies called the doctor theday it received the request toask him to be more selectiveregarding his bibliographyrequest, which was intention­ally extensive.

For the same request formu­lated by telephone, 43% of thecompanies contacted did nOtanswer. Around a third of the

companies sent documentswithin five days, and one drug

offered by the leading pharma­ceutical companies operating inFrance.

For the purpose of the study,a medical doctor sent a standard

written request for scientificdocuments to 30 major pharma-

Service

quaIily

ImagequaJity

Product

qualUy

tage, differentiation alohg theother two dimensions of the qual­ity mix - corporate image and/orservice - may be a serious optionto consider.

It is not surprising, therefore,that more and more companiesare starting to implement newcommunication strategies inorder to build a stronger corpo­rate image. An interestingexample is the French-basedcompany, Laboratoires Servier,which for years has used pressreleases and other techniques totell the medical community andthe general public about itsresearch activities. The com­

pany also organises visits forGPs and specialists to itsresearch facilities and manufac­

turing plant, and has been activein highlighting the importanceof its efforts in terms ofemployment and exports, twothemes which convey, alongwith research, an attractiveimage.

Servier is an unusual exam­pIe, however, and in the phar­maceutical industry corporatecommunication is still very lim­ited. ln France· fewer than ten

companies, including Pfizer,Glaxo, and Roche, advertise inprofessional journals, and noneof them seems to have built anintegrated institutional commu­nication strategy, conveying astrong, consistent and originalcorporate identity.

The quality of service avail­able to prescribers - the secondmost valued component of thequality mix - may become anincreasingly important optionfor differentiation. Bain & Co

and the ESCP recently evaluatedthe quality of the services

grammes, medical meetings,and round-the-clock informa­tion services.

Company image. The thirdcomponent of the quality mix ­image - was found to be lessimportant than perceived drugquality and quality of service,but was still a significant factorin a GP's prescription choice.The study showed that justunder 70% of GPs recognisethat a company's image influ­ences their prescribing.

Company rankingWhat this study clearly high­

lights is industry's poor under­standing of what shapes a GP' sview of a product. Indeed, whenthe study ranked the top 30French pharmaceutical compa­nies in accordance with the rat­

ings they were given by theinterviewees, there were sorneimportant discrepancies betweenthe two groups. For instance, thedrug manufacturers Servier andRoussel were ranked better bythe GPs than by the industry interms of company, product andservice quality. For the Frenchsubsidiary of Merck & Co thereverse was true.

Ranking by quality mix canobviously help a company iden­tifY its competitive weaknesses(Figure 3). Moreover, if thiskind of study is carried out peri­odically it would be possible tomeasure the effects of a correc­tive action plan. Such a planwould need to look carefully atnew sources of differentiation.

A competitive edgeWhile the study indicates that

the perceived quality of the prod­uct is the most valued componentof the quality mix for GPs, it isnot sufficient to create strongcompetitive advantage. The cur­rent proliferation of me too prod­ucts - chemically and clinicallysimilar - means that productquality, on its own, is unable toprovide sufficient differentiation.To date, for example, there are14 branded ACE-inhibitors with

a very similar therapeutic profùeavailable on the French pharma­ceutical market. To establish a

substantial competitive advan-

Scrip Magazine September 1993

ta/king points

Product defectionThe major causes of defec­

tion were identified during faceto face interviews with pre­scribers in the Bain/ESCP study.Sorne 46% of GPs said that bad

results observed with drugs wereresponsible for either reducedprescribing of that drug or aswitch to another product. This

communication with prescribers.The worst that can happen

for a pharmaceutical companyis to lose a prescriber withoutknowing it, and without know­ing why. ln fact, if companiesknew what it reaHy cost to losea prescriber, they would setstrategies and design actionplans to retain them. By solicit­ing feedback from defectingpreseribers, pharmaceutical com­panies could identify the weak­nesses and strengthen thembefore profits start to decline.

_Onen

parameters of the quality mixmust be descriminant enough toenable the prescriber to differ­entiate products whose thera­peutie profiles are too similar.To achieve this, pharmaceuticalmarketing needs to shift itsemphasis from product to ser­vice. Such an approach wouldhave direct implications on theway the doctor/company rela­tionship is managed. Specificfocus should also be given tothe root causes of a prescriber'sdefection, to defining priorityactions, and to designing correc­tive action plans.

Optimising the three compo­nents of the quality mix mighteffect a positive influence ondoctor's prescribing behaviourby increasing loyalty. Consider­ing the positive correlation estab­lished by economic modelsbetween the level of customer

loyalty and company profitabil­ity, strategies designed to opti­mise quality mix must bring withthem a competitive edge. li1l

Reports of this study areavailable free of charge fromBain & Co, 18 rue-Hamelin,75116 Paris, France. Tel: 14505 7575. Fax: 1 4505 1385.

·Jean-Michel Peny is a Con­sultant at Bain & Co and a lec­turer at the Paris BusinessSchool ESCP. Claire Dadou­Willmann and Jean Baron­Mazloumian are Manager andVice-President, respectively, ofBain & Co, an internationalmanagement consulting firm.

confirms the neces­

sity for the companyto track the problemsthat the doctors'

patients may experi-ence.

The second mostfrequent cause ofdefection is the pre­scription switch initi­ated by referred spe­cialists. Here too astrong, regular anddirect two-way com­munication between

the company and thespecialists is impor­tant in limiting the

disastrous snowball effect onprescriptions of a trendsetter dis­appointed by a product. Otherfactors in decreasing order ofimportance are: the excessivenumber of medical calls, theentry of new products on themarket, and problems with themedical representatives (Figure4). Interestingly, industry execu­tives were again out of touchwith the needs of GPs, overesti­mating the impact of negativewords-of-mouth and poor prod­uct knowledge on the part of thecompany's sales force.

The quality mix is undoubt­edly the starting point for pre­scriber retention. AH three com­

ponents of the quality mixinfluence a GP's prescriptionbehaviour. The perceived qual­ity of a product certainly plays apredominant role, but it rarelyensures a clear competitiveadvantage. The remaining two

Insufficienl MedJcal

numberof representa-medicalcaUs tivetumover

Medi:caJ

reprmnta­lives'poor

pruduct

knowledge

Poo,m<k.

delivmd

_Sometimes

Baclreed­backrrom

colleagues

Problemswilblbemedical

represenla.üve

Poo,treatment

results

60

40

20

Percentage of GPsDefeding

100

Figure 4: Root causes of prescriber defection.

with their products, and there­fore it is not worth investing inservices for such a limited num­ber of prescribers.

According to the TechnicalAssistance Research Programme(TARP) sponsored by TheWhite House Office of Con­sumer Affairs in 1979 and

updated in 1986, 96% of cus­tomers do not inform suppliersabout the problems they facewith a product. However, con­sidering that they inform nine orten other people of their prob­lems and that 95% of the cus­

tomers whose complaints havebeen satisfactorily and rapidlyhand1ed state they will repur­chase the product, it is essentialto put incentives in place forclients to inform suppliers ofany problems. This can beachieved by pharmaceuticalcompanies establishing conve­nient, direct and continuous

Scrip Magazine September 1993