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Whither Reps:Time for a Re-think! Tom Peters/ spbt/ Toronto/ 06.17.2002. All Slides Available at … tompeters.com Note: Lavender text in this file is a link. Friday.

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Whither Reps:Time for a Re-think! Tom Peters/ spbt/ Toronto/ 06.17.2002


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    1. Whither Reps:Time for a Re-think!Tom Peters/ spbt/ Toronto/ 06.17.2002

    2. All Slides Available at …tompeters.comNote: Lavender text in this file is a link.

    3. Friday.

    4. Nardelli’s goal ($50B to $100B by 2005): “… move Home Depot beyond selling ‘goods’ to selling ‘home services.’ … He wants to capture home improvement dollars wherever and however they are spent.”E.g.: “house calls” (At-Home Service: $10B by ’05?) … “pros shops” (Pro Set) … “home project management” (Project Management System … “a deeper selling relationship”).Source: USA Today/06.14.2002

    5. Saturday.

    6. “A WHISTLE-BLOWER ROCKS AN INDUSTRY: Doug Durand’s Risky Documentation of Fraud at TAP Is Prompting Wider Probes”Headline: Business Week/06.24.2002

    7. Sunday.

    8. “Clinic to Drug Reps: Pay Up and Take a Seat”—Seattle Times (06.17.02), on Polyclinic, a physician-owned, multi-specialty group based in Seattle

    9. One person’s opinion …

    10. Sorry, Elliott/spbt … the issue is not the delivery of training. The issue is … training for WHAT!

    11. Issue #1:NOT… “How to do what we do better.”IS…“What the hell should we be doing?”**I am largely convinced that both your content and field processes are all screwed up.

    12. ??????From: “We are pill peddlers.” To: “We are providers of ‘Integrated, demonstrable health- & wellness-enhancing outcomes’ … in partnership with … CMOs, HMOs, state AGs & Govs, Patients, docs … of which pills may or may not be a/the central part.”

    13. E.g.: Should we … abolish drug co. sales forces? And replace them with … Integrated Marketing Services/ Solutions Teams that (1) focus on outcomes, (2) include “sales,” “marketing,” “drug discovery process teams,” and various outsiders?

    14. “No longer are we only an insurance provider. Today, we also offer our customers the products and services that help them achieve their dreams, whether it’s financial security, buying a car, paying for home repairs, or even taking a dream vacation.”—Martin Feinstein, CEO, Farmers Group

    15. The Future of Reps: Whoops!

    16. “Consultative selling requires dialogue … and the time for that dialogue. Unfortunately, this seldom happens in today’s hurry-up complex world of pharmaceutical selling.”—newspost/spbt

    17. Study of 500 Reps*: 65% “had face-to-face conversation with the physician for less than30 seconds per visit. In fact, more than half of the 65% admitted that the average time is less than 15 seconds.”*Holy shit!Source: newspost

    18. “Research reveals no evidence of overall superior selling behavior related to experience beyond five years. Quite the opposite …”—newspost/spbt

    19. TP/06.2002:“So, tell me about reps …

    20. Pediatric cardiologist & practice head: “I don’t see them, period. I study, write papers, use the Web, attend a minimum of 4 or 5 major conferences a year. My staff may see them, but I in general find their views uselessly prejudiced. Call it, I’m afraid to say, ‘hucksterism.’ If I want anything at all from them, it’s thoughtfulness—good luck!”

    21. Family Practice Office Administrator (3 Docs, Midsize town)TP: “How often does Dr. X see Reps?”PA: “He doesn’t.” [Emphatic.]TP: “That was sharp in tone! Why?”PA: “We used to set aside a two-hour block, once a month. But a lot of the Reps missed appointments. That, however, was the least of it. The biggest problems were the Reps who kept pushing the same thing, visit after visit. They had absolutely nothing new to say.”TP: “So how does Doc X keep up?”PA: “The Internet.” [T.O.V. = “What else?”]

    22. Internist (Silicon Valley): “The Web is generally better. I spent a year of painstaking study, and now I have a system that keeps me informed in a ‘push’ fashion. I began as a skeptic, harassed by a few of my techie patients—and I’ve become a ‘believer’ and proselytizer. Now I find myself haranguing other doctors.”

    23. Oncologist (Urban Med Center): “They are, or can be, helpful to the two-thirds of docs, to be frank, who don’t study much. I’ve got one or two I’ll call, but otherwise I’m ‘not available.’ Quiet study, and increasingly the Internet, are my tools of renewal.”

    24. Pharmaceutical exec: “Truthfully, we hire attractive women as much as we can get away with. That plus pens are huge influencers—it’s what our focus groups tell us.” (The “attractive young women” theme was a constant refrain. “I find it laughable, to a point,” a female M.D. told me. “What I fear is that it works.”)

    25. ER doc/exec: “It’s pathetic. The docs are half-assed in their learning styles. Most don’t even pretend they are keeping up. Reps? She who has the best pens wins. Health care is out of control—and laughably unscientific. Whatever your nightmare stories are, Tom, trust me and my 25 years of experience, the reality is far worse.”

    26. Plastic surgeon & practice head: “My practice has changed 100% in the last 10 years. Sadly, that’s not true for three-quarters of my colleagues. Information technology is a big part of it. It’s extremely user-unfriendly. It took me and my partners and office staff a year to customize our approach—and as we did so the role of the reps became less and less important. I won’t even let our staff schedule time with them. It’s inefficient, and most of them are humorously biased—and insult us by imagining it’s not transparent. I’m not complaining—but, fact is, I’m busy.”

    27. My voyage: (1) “Hey, I’ll do TP’s eLearning pitch.” (Not as good as Masie’s.) (2) “Why do docs waste time with reps? Isn’t the Web the answer?” (A: Docs don’t spend time/much time with reps.) (3) “Hey, the fundamental concept of pharma’s selling relationship may be all bollixed up.” (Hmmmmm …)

    28. Any Idiot’s Conclusion: The System Is Busted. (And: You are part of the system … not spectators from the “privileged drug co.s.”)

    29. “Without being disrespectful, I consider the U.S. healthcare delivery system the largest cottage industry in the world.There are virtually no performance measurements and no standards.Trying to measure performance … is the next revolution in healthcare.”Richard Huber, former CEO, Aetna

    30. “As unsettling as the prevalence of inappropriate care is the enormous amount of what can only be called ignorant care. A surprising 85% of everyday medical treatments have never been scientifically validated. … For instance, when family practitioners in Washington were queried about treating a simple urinary tract infection, 82 physicians came up with an extraordinary 137 strategies.”Demanding Medical Excellence: Doctors and Accountability in the Information Age, Michael Millenson

    31. “Quality of care is the problem, not managed care.”Institute of Medicine (from Michael Millenson, Demanding Medical Excellence)

    32. CDC 1998: 90,000 killed and 2,000,000 injuredfrom nosocomial [hospital-caused] drug errors & infections

    33. 1,000,000 “serious medication errors per year” … “illegible handwriting, misplaced decimal points, and missed drug interactions and allergies.”Source: Wall Street Journal/ Institute of Medicine

    34. “In a disturbing 1991 study, 110 nurses of varying experience levels took a written test of their ability to calculate medication doses. Eight out of 10 made calculation mistakes at least 10% of the time, while four out of 10 made mistakes 30 % of the time.”Demanding Medical Excellence: Doctors and Accountability in the Information Age, Michael Millenson

    35. YE GADS!New England Journal of Medicine/ Harvard Medical Practice Study: 4% error rate (1 of 4 negligence). “Subsequent investigations around the country have confirmed the ubiquity of error.” “In one small study of how clinicians perform when patients have a sudden cardiac arrest, 27 of 30 clinicians made an error in using the defibrillator.” Mistakes in administering drugs (1995 study) “average once every hospital admission.” “Lucian Leape, medicine’s leading expert on error, points out that many other industries—whether the task is manufacturing semiconductors or serving customers at the Ritz Carlton—simply wouldn’t countenance error rates like those in hospitals.”—Complications, Atul Gawande

    36. It’s (measurable, systemic)outcomes, stupid!

    37. “Practice variation is not caused by ‘bad’ or ‘ignorant’ doctors. Rather, it is a natural consequence of a system that systematically tracks neither its processes nor its outcomes, preferring to presume that good facilities, good intentions and good training lead automatically to good results. Providers remain more comfortable with the habits of a guild, where each craftsman trusts his fellows, than with the demands of the information age.”Michael Millenson, Demanding Medical Excellence

    38. Leapfrog Group/med errors: “Not since Jackson Hole Group guru Paul Ellwood, Jr., M.D., coined the term ‘HMO’ in 1970 has one idea so fully captured the imagination of the healthcare industry.”—HealthLeaders/06.2002

    39. Leapfrog Group:CPOE/Computerized Physician Order Entry*ICU staffing by trained intensivists**EHR/Evidence-based Hospital Referral****Duh I: Welcome to the computer age.**Duh II: How about using experts?***Duh III: If you do stuff a lotta times, you tend to get/be better.Source: HealthLeaders/06.2002

    40. Computerized Physician Order Entry/CPOE: 5% of U.S. hospitalssource: HealthLeaders/06.02

    41. The Benefits of …FOCUSED EXCELLENCE Shouldice/Hernia Repair: 30-45 min, 1% recurrence. Avg: 90 min, 10%-15% recurrence.Source: Complications, Atul Gawande

    42. Empire Blue Cross and Blue Shield: 4% quarterly bonus for hospitals that meet Leapfrog’s CPOE and ICU-staffing standards.Source: HealthLeaders/06.2002

    43. Whose motto?*: We hate change!*Choices: AMA, AHA. Both

    44. Tom’s World

    45. NEW BUSINESS. NEW CONTEXT.

    46. All Bets Are Off.

    47. “There will be more confusion in the business world in the next decadethan in any decade in history. And the current pace of change will only accelerate.”Steve Case

    48. Way to Go, Guys …2002 write downs from recent acquisitions

    49. $1,000,000,000,000**$1 trillion (Source: Harper’s Index 04.2002)

    50. “When asked to name just one big merger that had lived up to expectations, Leon Cooperman, former cochairman of Goldman Sachs’ Investment Policy Committee, answered:I’m sure there are success stories out there, but at this moment I draw a blank.”Mark Sirower, The Synergy Trap