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Received (in revised form): 18th August, 2000
was formerly Sales and Marketing Director for Mediprod UK and remains a senior sales and marketing executive in the industry.
Is the Managing Consultant of PragMedic, a consultancy which supports business planning in medical markets and a Doctoral Researcher at Cranﬁeld University School of Management. He is also Managing Editor of the International Journal of Medical Marketing.
culture, healthcare, marketing, medical, medical devices, strategy
Abstract This paper describes a challenge common to many medical device companies; that of developing a market-led corporate culture in order to create sustainable competitive advantage. It describes the constraints encountered, the methods employed and the results and lessons that were the outcomes of the process. Its principal lesson is that organisational culture change is possible and rewarding, but that it is slow and diﬃcult. Moreover, it requires much more than a cursory knowledge of both culture and marketing. Without a deep knowledge of both these topics, cultural change should not be attempted.
The company described in this paper is a real company and the events described are an accurate record of actual events. To preserve commercial conﬁdentiality, the name of the company has been replaced with the ﬁctional Mediprod and certain characteristic facts have been altered slightly without aﬀecting the valuable lessons contained in this case. Mediprod is a medium to large medical device company operating in a number of diverse sectors of the industry. Although Mediprod is a multinational company, operating in all developed and most developing markets, this case relates to activity in Mediprod’s UK subsidiary.
Keith Rowland Sales and Marketing Director, Cook UK Ltd, Monroe House, Letchworth, Hertfordshire SG6 1LN, UK Tel: +44 (0) 1462473100 Fax: +44 (0) 1462 473192 E-mail: Keith @ cook.co.uk
THE SITUATION FACING MEDIPROD
The situation facing Mediprod in the late 1990s was one faced by many, if not most,
well-managed medical device companies. Namely, the company was successful, growing and proﬁtable, but conscious of problems on the horizon caused by market changes and increased levels of competition. The challenge in this situation is always to change in anticipation of these approaching problems despite the lack of external pressure, as current performance was excellent. Mediprod UK was perhaps the archetype of this situation, having achieved very impressive recent growth but sensing the threats created by market maturity, globalisation and industry consolidation. The management team of Mediprod UK reasoned that part of their task was to identify and implement the changes that were necessary to maintain their growth in the light of these evolving threats. The principal features of the evolving market situation will be familiar to many readers, irrespective of the particular sector of the
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We also had a weight of organisational culture and norms. Like competitive forces. generally speaking. We saw all of these factors. technically focused. we faced in each sector one or two major players that were often much better resourced and capable of better economies of scale. As a global company. On the other hand. Our direct competitors were consolidating and becoming. ﬁre. but over which we had no control.Rowland and Smith medical market in which they operate. In our case. they included some technological developments in clinical practice. Internally. and with a bias for immediate action over planning. for instance. These came variously from new entrants. 1. Operating in the UK. these were moving away from a simple sale to a single decisionmaking clinician towards a consolidated decision-making process involving many other people in addition to the clinician. as well as simply our sales. this trend was exacerbated by the near-monopoly buying power of the National Health Service. we observed important changes in needs-based market segmentation and the nature of the buying processes. from distribution channels that were consolidating and becoming more powerful. did preclude certain courses of action. reactive rather than proactive. in some cases. there were those problems arising from the external macro-environment that are sometimes remembered in the acronyms PEST or STEP or SLEPT (social. With the rise in cost and diﬃculty of product development. changes in legislation concerning regulation and trading laws. On one hand. 3 215–223 # Henry Stewart Publications 1469–7025 (2001) . First. it should be 216 International Journal of Medical Marketing Vol. global product standardisation was one of our goals. customer trends were made more diﬃcult to manage by our operation in so many diﬀerent medical device sectors. Generally. They were and are common problems facing many companies that count clinicians and allied professionals as their customers and deem their products to be technically complex. aim’. while they could not match our resources. we were trying to drive towards a global approach that had to be factored-in to our nationally based market strategies. although useful and positive in most aspects. substitutes and. We also faced competitive threats to our proﬁt. Finally. in some sectors. This competitive vice was made more complex and problematic by our presence in a large number of market sectors. might better serve the small proﬁtable niches of each sector. economic. in varying degrees and intensities. we were conscious of the implications that developments within to our organisation held for our business. changes in social expectations of healthcare systems. combining to create diﬃculties for a company that had historically thrived on the simple concept of technical excellence. Lest this be interpreted too negatively. political and technological). we joked that the Mediprod way was summarised in the instruction ‘Ready. Secondly. each with their own market dynamics. In few areas could we claim to be the market-share leader and we were increasingly faced with a two-pronged attack by competitors in each of our chosen market sectors. which controls 85 per cent of all UK healthcare spend. The extant culture of Mediprod UK reﬂected its origins: product-oriented. we perceived other threats also arising from the external microenvironment: those concerning customers and competitors. fewer and bigger. which. we faced a multiplicity of small specialist companies who. Perhaps dominant among these were the combined political and economic changes that were increasing demand for proven costeﬀectiveness across all market sectors. In terms of our customers. These were problems that impacted on Mediprod UK. legal. and many other small but inﬂuential changes.
We knew too that this increased proﬁtability could no longer be assumed to ﬂow from our traditional technical leadership. by dint of our research and development responsiveness. However. they were not suﬃcient. This thumbnail sketch of the Mediprod UK situation is. . as a management team. Simply put. manufacturing and quality processes and so on. these were as follows. physical and incremental. and the ﬁnancial resources they used. Critical resource allocation – We recognised that some of our most critically important and scarce resources were becoming so stretched as to be of concern. We knew that our strategic goals called for sales and proﬁt growth that was not matched by growth in headcount. THE CONCEPTS OF ORGANISATIONAL CULTURE AND ORGANISATIONAL EFFECTIVENESS The concept of organisational culture turned out to be both more complex and more useful than we had anticipated. distribution and logistics facilities. These included changes in IT systems. We felt the same applied to the many tangible process and systems improvements we continued to make. the management team of Mediprod UK was involved in the development and implementation of myriad changes in order to maintain its competitive advantage in the light of market changes. rarely lasted long.Achieving a market-led culture: A case study remembered that this culture had been part of a success story of over 30 years of growth and proﬁt. We saw the resources that we allocated in order to add value were largely our people and their skills. of course. Sustainability of product leadership – We identiﬁed that the product leadership we so frequently created. range of sectors was becoming increasingly diﬃcult. As the UK sales and marketing subsidiary of a global company. We therefore turned to the softer issue of organisational culture to see if we could derive competitive advantage from that source. The time taken for our ideas to be copied by cheap imitations was shrinking rapidly. We turned our attention to the outstanding problems that we perceived to be unresolved by the tangible changes we had made or were making. 3 215–223 International Journal of Medical Marketing 217 . With # Henry Stewart Publications 1469–7025 (2001) Vol. Naturally. which did and still do play a vital part in maintaining Mediprod UK’s competitiveness. a simpliﬁcation. This would remain necessary but become an incomplete solution. as well as our senior management. product specialists and product managers. This was not only a competitive issue. 1. Escalating technical and regulatory development costs meant that purely technical product leadership across a wide The concerns over these two key issues were captured by the measure of productivity. not just how much of it we each did. The large majority of those changes were tangible. our perspective on this was especially human resource biased. were the means by which we diﬀerentiated ourselves and created competitive advantage. but also a macro-environmental one. must be allocated eﬀectively and that this was not a product of the tangible changes we were already making. We were concerned that these critical resources. That is. . But it catches the main elements of the circumstances facing us in the late 1990s and is probably not unfamiliar to many readers. Our sales people. which suggested that we needed to consider what we were doing. we recognised that while these improvements in capability were necessary. We saw two related key issues that would not be fully resolved by the changes we had already set in place. This paper does not seek to deprecate the importance and necessity of those changes. they were visible and obvious improvements to existing systems and processes.
In reality of course. Loose. 3 215–223 # Henry Stewart Publications 1469–7025 (2001) . That rapid response to of individual clinician’s feedback is the best way to develop new products e. This deﬁcit was made worse by the way in which the terminology surrounding the subject of organisational culture is misused and misappropriated. and any company.g. although in a state of constant dynamic ﬂux3. It seems appropriate. Processes to identify new clinical ideas and incorporate into new product development Underlying beliefs and assumptions about what makes an organisation successful. incremental.g. is based on hundreds of assumptions.g. At the risk of this.2 Schein postulates that culture derives from basic assumptions that an organisation holds concerning what is the right thing to do.Rowland and Smith hindsight. Humanistic rather than mechanistic management procedures e. rewarded and encouraged by the organisation e. that we spend a few words explaining the concept and its practical implications.1. Rapid. Tangible rules and structures that reflect and direct the day to day activity of the organisation e. individualistic HR processes designed to ensure commitment e. therefore. This understanding of the ideas behind organisational culture was central to the practical steps we took and the progress we made.g. 1. These assumptions usually derive from the founders and. each leading to one or more values. Organisational culture is a complex topic that invites dangerous oversimpliﬁcation. the organisational culture of Mediprod.g. we think that Schein’s model of organisational culture is useful.g.g. We have tried to clarify Schein’s model. Cultural artefacts are the result of the interaction of many diﬀerent values. These assumptions lead to organisational values and these in turn are manifested in cultural artefacts. as we now (we hope more usefully) understand it. Significant resource allocation to relationships with clinicians rather than quantified market analysis Behaviour that is valued. in Figure 1. are ‘singularly persistent’4. Allocation of budgets to technical product development rather than formal market research e. usually originating in the beliefs of the founder and endorsed by subsequent success of the founder and endorsed by subsequent success e. That technical superiority of the product is the single most important determinant of commercial success Figure 1 The structure of organisational cultures (adapted from Schein5) 218 International Journal of Medical Marketing Vol. new product development based on informal processes e.g. our knowledge of the subject at this stage was incomplete and insuﬃcient.g. That personal commitment of employees is the paramount HR objective e. with reference to the Mediprod example.
we were aware that the implementation of formal marketing planning processes as a step towards market orientation would be diﬃcult. to create a programme to develop market orientation that was Mediprod UK speciﬁc. not replace.15. customer feedback had to be augmented by systematic market analysis and planning.33 We drew two conclusions from studying the ideas of organisational culture and its relationship to performance.12. 1.30.9. We realised that barriers would exist.22. therefore. would not work well. valid in the days when a new product took only weeks and thousands of dollars to develop. we then sought to understand the relationship between it and organisational eﬀectiveness.18. for instance. Although recognising the complexity of the problem. For instance. values and artefacts that had given us a successful history. those assumptions. the process by which Mediprod UK set about developing a more marketoriented aspect to its organisational culture was incremental and gradual rather than a # Henry Stewart Publications 1469–7025 (2001) Vol. We sought. There is extensive management research that discusses the folly of attributing organisational success to any one factor.27. In terms of Schein’s model (Figure 1).8 There is also extensive previous work about the diﬃculty of managing organisational culture change. . our research in this area also provided strong evidence for the relationship organisational culture and business performance. there seems to strong evidence for a correlation between one aspect of organisational culture.31. we recognised that some of our existing cultural assumptions were less valid than they were when the company was founded. 3 215–223 International Journal of Medical Marketing 219 . with business performance.13. We needed to develop the organisational culture of Mediprod UK to incorporate a greater degree of market orientation. This assumption. In this modern environment.Achieving a market-led culture: A case study The picture is much more complicated than Figure 1 implies and practitioners are again reminded of the dangers of oversimpliﬁcation. particularly in the sense of marketing eﬀectiveness.29. that of marketing orientation.32.28.11 This work set our expectation levels. .14.25 In particular. it would also be a deliberate development of our cultural assumptions that would cascade through into changed behaviour and improved competitiveness.10.6. Having built a better understanding of organisational culture. whatever process of cultural development we adopted would need to recognise that this extant culture may create barriers. THE PROCESS OF DEVELOPING A MARKET-LED CULTURE In truth.26. We did not want to damage or discard those parts of the culture that still gave Mediprod UK competitive advantage. we challenged the assumption that product development should be solely driven by reaction to customer feedback.19.23 This work by previous researchers all pointed in the direction that adaptation of our organisational culture to include market orientation would be beneﬁcial. we did not expect organisational culture change to be the Holy Grail of improved eﬀectiveness.17 In particular. Much of the published work in this area discusses the manner in which culture hinders strategic planning. was incomplete in the face of market maturity and increasing regulatory burdens. This again proved to be a ﬁeld more complicated but more rewarding than we ﬁrst appreciated. The route to this cultural development would need to recognise the strengths and weaknesses of the current culture. Our study of this area also suggested pitfalls in attempting such a cultural transition. we reasoned. In addition.24.7.21. This would be more than simply a process change.20. These were as follows. without regard to the speciﬁcs of our context. We argued. We wanted to build on. that simply imposing the text book disciplines of strategic marketing planning.16.
while strategic thinking and market understanding were given greater recognition. A more autocratic culture would have struggled to gain consensus on a fundamental topic like organisational culture. . and other formal training initiatives were used to meet speciﬁc needs. in some cases. These. These were exempliﬁed in comments such as ‘It’s all very well in theory’ or ‘Yes. Fire-ﬁghting and tactical steps were seen as necessary and expected. These were used to help direct choice of role and. however. in early parts of the cultural change process.34 The process began about three years ago and. these were as follows. . This agreement was not unconditional. even individuals who had been in sales and marketing posts for some time (by virtue of their technical knowledge) had knowledge . technical or other similar background. it was among this group that the greatest potential for resistance lay. In roughly chronological order. Shift in emphasis of job roles and speciﬁcations – As with the whole programme. Agreement in principal of the management team – This seems to be an essential prerequisite to any signiﬁcant change programme. It involved some re-allocation of management responsibilities and some shifts of emphasis within existing roles and structures. we demonstrated the importance of using the existing culture which has traditionally allowed great personal latitude to managers. this was gradual and incremental in nature. formal training of some of the team was implemented via study for Chartered Institute of Marketing qualiﬁcations. mostly recruited from a nursing. ethical market such as ours. when the culture change seemed to cause individuals particular problems. was that targeted at our Product Managers. assuming as it did that the work would be completed without drastic change in either spending budgets or revenue targets. it involved changing the visible emphasis that day-today management placed on individual actions. In this. and Insight’s Colour Quadrants. or skill gaps exposed by the shift from a technical to a marketing culture. Formal skills training – In some cases. . In sales. Rather than being one preconceived process. strategy development or tactical implementation. Personal development guided by diagnostic tools – Since much cultural change involves a degree of self-examination. the most aﬀected employees were given access to personal proﬁling techniques such as Thomas International’s DISC method. not simply replace them with something new. we had met what seem to be standard responses to the initiation of market orientation. This part of the team had little or no formal training in market analysis. at the time of writing. it’s OK for consumer markets but not for a technical. We encountered signiﬁcant amounts of initial scepticism and just the sort of barriers to implementation that our background research had prepared us to expect. It seemed obvious to us that a standard. 220 International Journal of Medical Marketing Vol. were also used therapeutically. 3 215–223 # Henry Stewart Publications 1469–7025 (2001) . were central to creating competitive advantage. Already.Rowland and Smith single coherent plan. Signiﬁcant steps have been taken and worthwhile progress made. These individuals. It was their task to devise and implement any new components of our value proposition and to direct resource allocation accordingly. In marketing. Less formally but importantly. formal training was initiated using the Dale Carnegie Organisation. As with other aspects of the existing organisational culture. we wanted to retain and use the useful parts of the current situation. oﬀthe-shelf programme of marketing training would not work well. it was more an example of ‘logical incrementalism’.’ We anticipated that the depth of technical expertise that made these people so good at that part of their role would also make it harder for them to adopt the perspective needed for marketing planning. Ironically. is still a work in progress. Probably the largest single component of our programme. 1.
it also meant that the results of the programme could be used in practice. The practices of our team. The latter was aided by large amounts of close support by both the external agency and line managers. the programme was built around our own business. The Mediprod UK management team has tried to evaluate objectively the success of the programme and has concluded that it has been a success. particularly in important value-added areas such as resource allocation and development of the value proposition have changed demonstrably. of course. . It was simply not possible to hide behind our own jargon and technical detail. as some members of the team simply complied with new processes but without real commitment. In its implementation we employed a lot of detailed work to ensure that it was eﬀective but did not damage the useful parts of the existing culture. Our supporting evidence for this comes from the following observations. This approach was quite tough. 1. the coordination of our team eﬀorts has been # Henry Stewart Publications 1469–7025 (2001) Vol. It is these parts of the process that stand out as essential to overall success. OUTCOME As all of our preparation work indicated. which showed the long-term ﬁnancial implications of not changing. added no real value. and it is not yet complete. In addition to this. The result was that. we did not expect rapid and sudden change.Achieving a market-led culture: A case study Our solution was a tailored. The second signiﬁcant diﬀerence was the use of a consultant with speciﬁc medical market knowledge. The former we achieved via competitive analysis and the linked gap analysis. We therefore undertook a second set of PragMedic workshops in which our new plans were tested and retro-ﬁtting was uncovered and corrected. strategy development and tactical implementation using his or her own business unit as a live example. Although this approach of a self-case study using a market specialist was undoubtedly better than a more general programme. This helped make best use of our time. ‘We’ve got nowhere to hide’. we saw many examples of ‘retro-ﬁtting’. the retrospective ﬁtting of existing plans to the new process to make it look as if the new cultural assumptions had taken root. increased competition and many other external factors. First. Overall. The complete process of cultural change has involved these and many other smaller elements. Each Product Manager was helped to use formal market analysis. As one Product Manager expressed it in a moment of honesty. in the worst cases. Nor did we expect the results of cultural change to translate into ﬁnancial results undiluted by the impact of market changes. Using PragMedic. Not only did this diﬀuse objections that the work was not relevant. Out-of-workshop projects and continual support by PragMedic augmented the workshops. a specialised medical marketing consultancy. it did not achieve immediate results. 3 215–223 International Journal of Medical Marketing 221 . customised programme that was part training and part consultancy. we devised a series of workshops spread over several months. After the ﬁrst part of the work. There were two very signiﬁcant diﬀerences between this programme and other work we carried out to support the cultural change programme. we bore in mind those models of change management that advise both increasing survival anxiety (making explicit the threats inherent in the status quo) and decreasing learning anxiety (reducing the fear associated with new habits). we witnessed some of what has been called ‘resigned behavioural compliance’. This. This helped identify and overcome some of the avoidance tactics that some people will attempt when faced with diﬃcult change.
don’t lose it’.F.Rowland and Smith enhanced by the development of a marketoriented vocabulary. environmental uncertainty and performance’. . San Francisco: Jossey-Bass Inc.R. K. .J.F. (Eds. has been kept to a very low level. in: Peter Drucker. California: Sage. despite the possible distraction or disruption of cultural change.. Neely. The ﬁnancial performance of the organisation has continued to meet and exceed targets. 1st edn. and Platts. 5 6 7 . in amended form. International Journal of Research in Marketing 9. International Journal of Operations and Production Management 19. Resigned behavioural compliance and retro-ﬁtting are the easiest ways to respond to change initiatives and many employees are adept at providing these responses. Not only is it easy to be misled by the oversimpliﬁcation of ‘airport books’. Thousand Oaks CA: Sage. Notwithstanding that. A. 80–116. (1995) ‘Performance measurement system and design’. Drucker. of course. Gregory. Lundberg. (Eds. (1999) The Corporate Culture Survival Guide. 243–253. these are as follows. International Journal of Operations and Production Management 15.F. Be aware that any cultural change programme will need to contain multiple elements. Neely.) Managing for the Future. 1st edn. broad and general. Moore.. These lessons are. Any that hold up single ‘panacea’ answers are very unlikely to work. References LESSONS FOR OTHER MEDICAL COMPANIES It seems premature and dangerous to draw lessons three years into a process that is as open-ended and continuous as cultural change. Wilderom Celest and Peterson. . This UK based and limited programme has now been picked up and copied. Nevertheless. there are some clear lessons that we can give to others contemplating such a change. . Oﬀ-the. 1. (1999) ‘The performance measurement revolution: Why now and what next’. which diﬀers signiﬁcantly from managing more tangible and self-contained projects.J. and Martin. S.M. Finally. Louis. it is very easy to actually damage the organisation by ill-informed meddling with the ‘soul’ of the company. M. L. A. always a barometer of successful change management. 3 215–223 # Henry Stewart Publications 1469–7025 (2001) . Schein. . (1992) ‘Strategic marketing planning.. E. Hatch. M. J. (Ed. standardised programmes ﬁnd it hard to gain acceptance from those who see their position as unique. E. Further. (1991) op. (1993) ‘Corporate culture: Use it. P. 8 Schein. Oxford: Butterworth Heinemann. Newbury Park. C.) The Handbook of Organizational Culture and Climate. Recognise that any programme must be tailored speciﬁcally to the needs of the company. we hope they will be useful to other practitioners. 150–154.C. The turnover of our team.. In no particular order (since they are interlinked). Recognise that cultural change is an openended process that impacts on every aspect of organisational functioning.H.H. have not been degraded by the addition of a marketorientation. Lysonski. A. Beware of early apparent success that is the common result of cultural change. (1991) ‘What is culture?’ in Frost.H. M. This is a major consideration in managing the process. 1 2 3 4 Do not attempt cultural change without a profound understanding of the subject. M. . Recruitment and retention policies have been heavily inﬂuenced by the new cultural assumptions that are now taking root. 205–228. cit.. 247–255.shelf programmes seem unable to cater to the cultural peculiarities of individual organisations. 222 International Journal of Medical Marketing Vol.) Reframing Organizational Culture. pp.. 1st edn. N. and Percottich. Schein. . perhaps the most ﬂattering evidence of our success lies in its imitation. The dominant useful aspects of the previous culture. P.. by our pan-European colleagues. E. such as commitment to individuals and technical excellence. pp. (1999) ‘The cultural dynamics of organisational change’ in Ashkanasy.
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