Lynn Baxter rose from the ranks as a medical representative in the UK through local, regional and global positions leading different products and markets in various countries such as China and Belgium. She is currently the President of GlaxoSmithKline (GSK) in the Philippines. GSK is a research-based, patient-focused global pharmaceutical firm. She shares her insights on the sales innovation process happening in GSK.
Q1: GSK is operating in a highly regulated pharmaceutical industry, yet, it added another layer of internal process where the sales force is no longer rewarded based on the number of prescriptions generated. Why was this practice changed? What new metrics will you use? What are your options if this doesn’t work out?
A: At GSK our mission is to help people do more, feel better, live longer. We do this by aiming to be one of the most innovative, high performing and trusted healthcare companies. These elements are not mutually exclusive; in fact, I am convinced that they are interdependent. In an industry concerned with improving health, rightfully, there are high expectations of us. So in order to perform as a business, we need to have the trust of the healthcare professionals we engage with, the government and the regulators, the patients we serve, and the communities in which we operate. In order to innovate, we need to perform so that we can continue to invest in research and development to help bring more products of value to those who can benefit from them.
As a foundation for making changes to our operating model, we need to make ‘how’ we do things just as important as ‘what’ we do. This means having a strong values-based culture throughout GSK –operating with high integrity, focused on building trust, respecting people inside and outside of the company, and always keeping focus on the patient.
It is a well-established practice in the pharmaceutical industry, globally, including the Philippines, to incentivize individual medical sales representatives and sales teams based on the number of prescriptions written by doctors. This commercial practice, which GSK Philippines also applied in the past,could open Filipino patients and the public to view a conflict of interest, real or perceived,in the interaction between pharmaceutical companies and doctors. For patients,this could ultimately undermine trust and confidence in the treatment choices made for them.
We in GSK want to change this, and as a global healthcare company, we believe we can play an important role in making bold choices to innovate and lead the change. As we aim to be one of the most innovative, best performing and trusted healthcare companies, we need to make “how” we do things just as important as “what” we do.
In 2015, we announced the implementation of significant new measures in the way we market and sell our medicines and vaccines to doctors. Transforming our business model to ensure patients are at the heart of every decision we make included changing how we incentivize our medical sales representatives. Around the world,our medical sales representatives no longer have individual sales targets. Instead, alongside group performance, they are now incentivized based on a broader set of business performance measures that helps ensure they deliver high-quality, balanced, and patient-centric discussions and activities to doctors.
I firmly believe that it is the right thing to do in fulfilling our role of helping doctors make informed decisions for their patients.While bold and unprecedented, I see that there are many benefits for patients and doctors, and for business performance. In my engagements with many doctors all over the Philippines, I have been very encouraged by how they are commending the change GSK is leading.I am inspired by their positive feedback on the increasing quality of their interactions with our medical sales representatives which is consistent with the feedback we are receiving from doctors around the world. With the changes we are leading, we want the Filipino patients to feel confident that whenever they are prescribed a GSK medicine or vaccine by their doctor, the decision was based on understanding and belief in available scientific evidence.
Q2: How do you reconcile the sales targets of upper management with the deliverables of the sales force? How do you assure attainment of sales target then?
A: As a global corporation,we have obligations to deliver sustainable returns to our investors and shareholders. Like any other local operating company, our business in the Philippines is expected to perform and contribute to these financial objectives.
Our strong 2016 global Group performance has been achieved under this new model which retains a focus on performance but simply decouples individual medical sales representative incentives and individual doctor prescribing. Now, more than two years under the new incentive model, we recently reported our global 2017 Q1 performance where we continue to see positive growth and improved margins.
Alongside trust, for our business to succeed, it is important that all of us in the company work together in an aligned way to do great business – everyone accountable, everyone contributing.In many of my engagements and conversations with our teams, wherever in the organization, I always emphasize the importance of the role of each individual and team to understand and deliver on their contribution to the company’s success.
Among our sales teams, they remain clear that they are the business owners in their area of operation, fully accountable to deliver business performance. So while there are changes in how we are incentivizing their performance, their primary role remains – to convince doctors to prescribe the right GSK products to the appropriate patients who will benefit, based on scientific evidence communicated in a balanced and ethical manner.
In addition, it takes a huge cross-functional effort to ensure our medicines and vaccines ultimately get to the patients and deliver our business results. It is, therefore, equally important that all other individuals and teams,irrespective of function or department, understand their role and the required expectations. Whether in Regulatory Affairs, Supply Chain, Quality Assurance, Human Resources or Finance, we need each GSK Philippines employee to be committed to contributing his/her best to achieving our shared goals and to doing it in the right way, in line with our values.
I am of firm resolve that pharmaceutical industry performance and stakeholder trust to the industry will increasingly be inextricably linked. Making innovations to modernize the way we do things and build the trust of Filipino patients, doctors, and partners is essential for the sustainability of our business.
Q3: GSK stopped direct payments to doctors when they speak on your behalf during events. This means VIP doctors’ endorsement is no longer a key factor for success. What innovation replaced this and why?
A: From drug discovery to regulatory approval, developing a new medicine, on average, takes 10 to 15 years and costs $2.6 billion.1 It is a long, costly, and complex process, however the years of scientific and clinical research conducted means that pharmaceutical companies like GSK are experts on our products and the science behind them. Further, we recognize the important role companies like us play in supporting continued medical education of doctors and providing them with the information they need to make appropriate treatment decisions for their patients.
In helping provide education to doctors, decades-long practices in the Philippines and elsewhere by pharmaceutical companies include paying honoraria to doctors who speak on a company’s behalf about its products. While we believe in the importance of the industry’s continued commitment to support medical education of doctors, our past experiences with this practice raised questions on the intent of our action, especially as these doctors being paid could prescribe our medicines and vaccines.
We see that there is an opportunity for the industry to transform and modernize this established way of providing support to professional medical education,in a way that removes any perceived or real conflict of interest and builds trust.Involving doctors, patient groups, and a wide range of experts in the pharmaceutical industry, we engaged in global discussions on how we could work together to build a new approach.
This helped lead us to a decision to end the practice of paying doctors to speak on our behalf about our medicines and vaccines before their colleagues. Instead, we took a bold investment decision to actively recruit more medical doctor experts and specialists to work within GSK so they could have access to the latest scientific and clinical information to support them to effectively speak and answer questions about our medicines and vaccines, without raising questions on conflict of interest.
In the Philippines, we worked hard to achieve the right complement and quality of internal medical doctor experts to ensure that they are highly capable to provide up-to-date, balanced medical information to healthcare professionals in world-class settings across different channels and platforms. We have successfully recruited extremely credible and experienced doctors who are highly regarded both locally and globally, many of them were attracted to join GSK due to our focus on innovation, performance, and trust.
I am personally delighted with the feedback we have received from the vast majority of Filipino doctors who expressed that their experience in GSK-initiated meetings delivered or facilitated by GSK-employed medical doctor experts was very good, if not outstanding. This further convinced me that doctors will benefit greatly from the change we have initiated. Importantly,patients prescribed a GSK product can be assured that the information their doctors received through this type of interaction, which may have supported treatment decisions, is balanced, based on the latest evidence, and places the patient at the heart.
1. Joseph A. DiMasi, Henry G. Grabowski, & Ronald W. Hansenc (2016).Innovation in the pharmaceutical
industry: New estimates of R&D costs. Journal of Health Economics 47 (2016) 20–33.
Q4: GSK is now heavy on digital media, educating doctors via webinars and online resources instead of inviting them to attend seminars in 5-star hotels. What has been your experience on this so far? How is the invitation extended since some hospitals has already disallowed visits of med reps?
A: I believe there is a strong case for the pharmaceutical industry to transform and modernize its approach to interacting with doctors, especially in terms of providing them with information and supporting their medical education. For example, there are evolving regulations in healthcare settings that limit traditional face-to-face interactions between doctors and our medical sales representatives. In addition, for doctors in Metro Manila and in key business hubs all over the Philippines, traffic bottlenecks are posing a significant challenge to doctors’ attendance in our meetings.
I acknowledge that doctors are increasingly challenged by the demands of both their professional and personal life. For them to make timely and appropriate treatment decisions for their patients, they need information and answers fast – tailored to their needs, whenever, wherever, in a way that is convenient to them. Importantly, today’s rapidly changing world offers new opportunity through technology-aided platforms and alternative channels that allow sharing of information faster, broader, and in cost-effective and convenient ways.
The pharmaceutical industry needs to catch up with modern ways of delivering good customer experience and in facilitating learning and information-sharing amongst doctors. Most of us in the industry, not only in the Philippines, generally have been holding on to the traditional approaches of providing information to doctors within the confines of a meeting venue at an appointed time, delivered face-to-face, with no flexibility.
To better respond to doctors’ needs and,at the same time,deliver an improved customer experience, we in GSK decided to significantly invest to scale-up and accelerate our multichannel interaction platforms through which doctor scan access relevant information– whether it is on their smartphones during their journey to work, their computers in the clinic or their tablet devices in the evening at home.
For example, we have developed extensive live webinar program schedules for doctors in the Philippines. Imagine it to be like a cable TV programming, only the shows are presentations and discussions on various topics relevant to their respective medical practices!When a doctor missed the live webinar, he/she can access the video-on-demand later through GSK Philippines doctor online portal. Alternatively, he/she may ask our medical representatives during the next visit to discuss with him/her the content of the missed online meeting.
Additionally, doctors are able to speak to a GSK medical doctor expert through digital media, either during a face-to-face meeting facilitated by our medical representatives, or at their appointed time. Our medical representatives can also help them access trusted third-party resources through GSK’s doctor portal, accessible on their mobile devices. When doctors want easy access to information– like patient information on appropriate product use or to learn about how a new GSK medicine works – we enable them to access a variety of short online tutorials at their convenience for access.
We believe that the professional direct relationship between doctors and medical representatives remains central. For the future,we are looking for ways for our multi-channel activities to amplify the traditional face-to-face interactions and to reach more doctors whom we could not possibly reach through direct contact. This may be embedded practice already in many other industries, but in the highly regulated pharmaceutical industry, this way of working is still in relative infancy!
So far, the feedback we have received from doctors is really encouraging, although we still have challenges to address such as the limitations of the country’s internet connectivity in some areas.I am personally very proud to see how we have led the industry in introducing to the Filipino doctors various channels and platforms on a significant scale and engaging with them in these new ways, facilitated by our internal medical doctor experts and medical representatives.
Our goal is for doctors to enjoy an exceptional experience with GSK, viewing us as a primary source forup-to-date, balanced information that they can access in convenient ways to support their prescribing decisions to ultimately benefit patients.
Q5: How was the change launched and initiated? What was the reaction of the sales force and the doctors when they found out about the changes?
A: We have been on a global journey for some time to build greater trust in the interests of patients, doctors, and our stakeholders through making industry leading changes in multiple and diverse aspects of our business. That journey began as far back as 2004, when we launched the first Online Clinical Trial Register, providing open access to all of our clinical trial data. Since then, we have continued to transform and modernize the way we do business.
Further changes in our business operating model, including the more recent ones,are intended to realize two significant opportunities, both of which we see will help drive GSK performance: (1) to invest in new digital ways of engaging with doctors at a time, place, and through channels convenient to them; and (2) to increase patient trust by helping remove any perceived conflict of interest between GSK and doctors prescribing our medicines and vaccines.
Conscious of the size of the changes we would be making, we launched in phases. Through time, we have been proportionately leveraging digital technology to maximize our customer experience and build trust by providing increasing positive interactions with doctors in our various channels – when, how, where they want it.
Among the changes, we revised in 2015 the way we incentivize our sales teams. The following year, we started recruiting more medical doctor experts to speak about our own medicines and vaccines, and stopped paying external doctors to speak on our behalf.
While now fully embedded globally, including in the Philippines, these innovations have been challenging to introduce as these go to the heart of questioning how the pharmaceutical industry has been operating for decades. Some observers questioned our approach as radical, and much has been debated about whether this new model would work amidst commercial realities.
In the Philippines, as in during any major organizational change, introducing the decisions encountered some form of human resistance. It was important for me as their leader to not only acknowledge that individuals react differently to change – with some sincerely embracing to others frankly trying to undermine the change and hesitating to jump over the curve – but to also understand the different reasons why this could be the case so we, together, could accordingly work them out.
Throughout the whole change journey, it was important for leaders in GSK Philippines to repeatedly communicate and encourage active discussions across levels of the organization the details surrounding the changes. Reinforcing the rationale, raising the issues and challenges, and engaging around the benefits the whole organization and individuals would gain when the changes were fully embedded.From the outset, strong leadership alignment was critical to guide the whole organization towards the desired state with the right mindset and capabilities to evolve and adapt.
For doctors, this brought changes in the ways of interacting with GSK and, in some aspects, was different to the rest of the industry. We also encouraged transparent discussions with doctors on why we were making these changes and when they understood our fundamental goals to modernize the way we do business in a way that is more convenient for them and tailored to their needs, and to build trust in our partnerships with them and with patients, the vast majority were supportive and appreciative of our bold and industry-leading moves.
Our commitment to partner with healthcare professionals and to support their continued education and access to scientific information is unchanged, but we believe this is a different and better way to do it.
Q6: What were the challenges in the beginning? What challenges do you still need to overcome?
A: In the early stages, understandably,some internal and external stakeholders initially expressed reservations about the full implementation of the new business model, necessitating a series of stakeholder engagements to clarify the purpose and benefits of the changes we initiated.
Internally, GSK employees in the Philippines, especially our medical representatives,initially sought to gain deeper understanding of the new business model’s rationale and clarity on how it would be successfully implemented in the local Philippines setting. Understandably, our sales teams had to take time adapting to changes in what were expected of them, as these required building new capabilities and revising the basis of their incentives.
Externally, we were faced with some challenges on re-aligning our ways of working and redefining the relationship between our medical representatives and doctors. We needed to continually clarify the changes we were making and the positive benefits these would bring in helping doctors make informed treatment decisions for patients by providing information in different and convenient ways.
More recently in 2016, GSK Philippines took up the mandate to embrace and “industrialize” the delivery of GSK’s new business model at a faster pace – scaling up execution of doctor interaction activities through several different channels,aiming to deliver exceptional customer experience. This ambition required stronger dedication, commitment, and focus of the whole GSK Philippines organization. It is critically important that we innovate with pace and agility to operate efficiently and effectively to realize our vision of a modernized operating model that delivers sustained business performance and builds trust.
Today, I believe that we have significantly progressed in terms of the overall belief and confidence in delivering business performance through our new business model and,with increasing demand,we have significantly scaled up our doctor engagement activities across digital channels. I am extremely proud of how our medical representatives have adapted from the traditional face-to-face interactions to taking on an active coordination role at the center of our multichannel engagements. This has given us organizational momentum which positions us to be at the forefront of the pharmaceutical industry in modernizing the way we do business.
Over time, we will continue to learn and build customer insight to further enhance positive experiences for doctors in our interactions with them through our channels. These channels will be expanded and improved as capabilities and technology advance, making it easier for doctors to access our various touch points.It is critically important that we innovate with pace and agility to operate efficiently and effectively to realize our vision of a modernized operating model that delivers sustained business performance and builds trust.
Q7: Looking back, what would you have done differently in the execution phase of these changes?
A: GSK is taking an industry-leading position to meet the expectations of patients, doctors, and society in general. We are committed to effectively embedding our new business operating model, irrespective of how other pharmaceutical companies respond. As the first mover in challenging many established industry practices, we expected challenges and roadblocks in moving from strategy to execution, and we certainly didn’t get everything perfectly right first time!However, in leading this positive journey for GSK Philippines to transform and modernize the way we do business in a complex environment, there were some key elements fundamental to executing our bold decisions and changes:
1. Set direction and inspire. Set a meaningful ambition with strong buy-in and ensure that leaders are capable and confident to communicate both internally and externally in a way that resonates and is simple to understand. Focus on being forward-looking about the clear benefits and excitement in innovating and shaping a new model rather than “grieving for the loss” of the old ways of working. This requires taking time to build pride and belief in treading a new path. We had to build our own evidence to show that it works both for employees and doctors, and rapidly share learning and successful experiences, both in the Philippines and globally.
2. Build ownership, accountability, and capability. Ensure every individual in the company understands his/her role and what is expected of him/her to deliver or enable execution of the changes to create the desired impact. This meant setting crystal-clear objectives, having new metrics in place and rigorously tracking them, taking corrective action when required, and empowering individuals to be accountable. It also required us to implement capability-building initiatives to support employees to develop some new skills and competencies to be able to operate effectively in our new ways of working.
3. Create space for two-way communication. Make sure that listening opportunities are in place to provide forums for those closest to the execution and the customer to rapidly provide feedback to the center on how changes are being implemented and received. This loop and frequent sharing of ideas and challenges support us to address issues and make business decisions and interventions in a timely manner.
4. Learn fast and adapt. Work out quickly what works and what doesn’t, then invest and scale-up where most impact is seen. We found that some engagement channels or activities create higher impact and more meaning to doctors so we focused on those as a priority. However, this is evolving so we need to be more dynamic, faster, and agile to respond to the needs of our customers and to deliver results as an innovative, high performing,and trusted healthcare company.
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