A New Era of Training The challenge for sales trainers is creating an environment in which sales reps are provided with the ongoing education they need to effectively market and sell the drugs they represent to health practitioners who are seemingly more and more reluctant to welcome them with open arms and an open door. Forum May 2007 VIEW on Sales Training The effectiveness of pharmaceutical sales reps relies heavily on a set of core values that include solid product knowledge fortified with ongoing continuing education. According to the National Association of Pharmaceutical Sales Representatives (NAPSR), the majority of the big pharma companies are implementing a hefty dose of e-learning programs in the form of virtual classrooms and Web-based training coupled with good old-fashioned hands on training, pharmaceutical sales certification, and evaluation programs to their ongoing training improvement processes. The evolution of the sales rep is in a constant state of change, however. The days of multiple reps from the same company knocking on the door of the same physician are long gone. Some doctors now employ a strict closed-door policy when it comes to the sales rep. In a recent industry snapshot, Glenn Abrahamsen, senior director of global analytics for Schering-Plough, estimated that 7% of doctors nationwide now refuse to meet directly with drug sales reps, and in some regions, such as Wisconsin, that number can be as high as 50%. Today’s surviving sales reps must come armed with a solid knowledge of FDA guidelines and codes, safety data, a positive clinical trial track record, and products that have a clear edge over the competition. “Hot” sales training techniques remain firmly rooted in providing an opportunity for sales reps to continue educating themselves while also providing comprehensive information to physicians and their patients. They no longer, however, include the courting methods of the past, which included freebees such as pens, notepads, and even dinner reservations to four-star restaurants. To keep up with the changes, sales trainers have been relying heavily on the use of virtual classrooms and e-learning rounded out by the implementation of hands-on classroom training to reinforce effective face-to-face interactions. Challenging Times Pharma training departments are reinventing themselves in response to growing market challenges, with reliance on more on scenario-based training, a sharpened focus on continuing education, and proving the value of medications. Industry experts divulge the biggest challenges they face as training executives. Galan. Astellas. While there are many challenges that face today’s pharmaceutical sales training executives, the most pressing are some of the oldest: time and relevance. With the advent of the computer era, the pace of the medical profession has become one of rapid information dissemination and creation. Within this context, it is difficult to keep sales training on the cutting edge while ensuring new and existing salesforce members receive the appropriate and necessary information they need to be a valuable resource to their customers. Today’s pharmaceutical sales representatives must navigate a rapidly changing and challenging medical marketplace. As with other entities within the pharmaceutical industry, sales training must overcome these obstacles to continue to be a valuable and relevant resource to its internal customers. Foote. OAPI. One of the biggest challenges is delivering high-quality training while maximizing the representatives’ time in the field. Reaching a diverse group that has different learning preferences and who all live in different locations adds to the challenge. E-learning, conference calls, and self-study are ways to address the challenges but there is nothing that rates higher than the traditional face-to-face learning. Additionally, maintaining training as an ongoing process instead of an event is challenging. Encouraging individuals to practice what they have learned immediately to make it stick is the ultimate goal. Harris. Shire. The biggest challenge we face is maximizing the learning experience for every participant. This requires a balanced and blended delivery approach, and finding the right mix is really more of an art than a science. While distance learning is user-friendly and relatively flexible for participants, it often falls short of achieving the desired behavioral objectives. Simply put, knowledge transfer via e-learning often fails to develop the demonstrable skills necessary for improved performance. This brings us full circle to the age-old training dilemma of taking time away from the field to invest in training. The challenge for a training department is to deliver a valuable performance return to the organization for the investment of finances, time, and personnel necessary to develop its employees. Boylan. Eisai. Continuing training after joining the company is a big challenge. All companies, no matter how experienced the representatives are, have some sort of initial training that covers products, policies and procedures, administration, selling models, and so on. The challenge then becomes how to train and develop personnel two, five, 10 years after their initial training. Plan of action meetings, also known as POAs, are normally held two or three times a year, but they are usually packed with information and may not be conducive to focused training. Besides, since most organizations have people with various degrees of experience and knowledge, it is difficult to develop a one-size-fits-all approach. The goal is to provide training and development for people who will keep up with the changing landscape of the industry. Providing Real Value With the current upheaval and ongoing transformations in pharmaceutical salesforces, it’s become vitally important for sales representatives to provide “real” value to physicians. As such, our Forum experts discuss the types of information physicians are most interested in learning about during a detail and what they are asking for. Galan. Astellas. New and innovative treatments are becoming more complex and will require pharmaceutical representatives to provide information within the “new” context of the practitioners’ world: a time-starved, competition-based medical environment. The old adage “be bright, be brief, and be gone” has increased relevance in today’s medical office. Sales representatives must be able to deliver a concise message on many different topics of interest to the provider, adhere to legal and FDA compliance, and maintain a high level of general knowledge as well. Foote. OAPI. Generally, physicians want informative and accurate product information, including key efficacy and safety data. They also are seeking knowledgeable representatives who provide balanced information. In addition, the types of information, such as clinical data and patient education materials, that physicians ask for varies practitoner to practitoner. Harris. Shire. Physicians continue to ask for current information, outcomes data, and the managed-care status of medications. Physicians seem to find real value when the sales representatives’ interactions with them are based in reality. I believe their expectations are three-fold. First, they want reps to be persuasive advocates of their medications, while communicating the risks along with the benefits of the products. Second, they want focused conversation on the realistic health outcomes that can be expected and they want to be kept abreast of emerging trends. Third, they want us to train them and their staffs to effectively use the vast educational tools provided by the industry to improve the health of their patients. Boylan. Eisai. Physicians ultimately want credible information that will make them better doctors. They want peer-reviewed information that is balanced and transparent. Unfortunately, some sales representatives cherry pick information from reprints or articles to make their product look good. Doctors want honesty and credibility. Controlling the Dialogue The dialogue between sales representatives and physicians, in addition to the patient-physician dialogue, remains key to the overall improvement of medical decisions. Industry experts discuss best-in-class training techniques to improve the dialogue between the sales representative and the physician. Galan. Astellas. We implement a hands-on approach to sales training to ensure our field salesforce is best in class. Beginner and advanced classes are small in size, they incorporate technical and practical learning as a core curriculum, and they are designed to allow for integration of specialty and primary-care representatives into one classroom. Most classes culminate in a multiday practicum of facilitated role-play simulation that allows for repetitive skill development in both technical learning and sales skills practice. We take great pride in our small company feel, while providing the service more often associated with larger company quality. Foote. OAPI. The selling skills program that we use in basic training includes a module on listening skills. This is extremely helpful in coaching the representatives to listen to the physicians to identify what their needs are and what is important to them. This prepares them to focus on information that is important to the physicians. Also during basic training, we invite experienced representatives in to provide insight into the current selling environment and to share best practices and lessons learned in regard to selling the products and other representative duties, for example expense reports, adverse event reporting, and so on. For advanced training we teach the representatives about the different personality styles and how best to relate to each style. We encourage representatives to think about their physicians and determine what their styles are and how best they can adapt when interacting with them. Harris. Shire. We’ve implemented a multi-step learning process which, when combined with an emphasis on listening and questioning skills, leads to a more natural dialogue between our sales representatives and their customers. Sales management direction and field coaching must be consistent with the training for the best results. Boylan. Eisai. We have adopted an approach that focuses on asking the right question, which helps to uncover the needs of the physicians. No one will buy anything unless they perceive a need for it. We train all of our representatives how to ask the right questions to uncover information that will allow them to fulfill the need of the doctor. Adjusting the Detail to Meet Changing Dynamics All healthcare providers play an essential role in the care and treatment of patients. However, their roles are unique and require varied levels of knowledge sharing and education. Experts discuss ways to adjust the in-person sales details to meet the needs of different healthcare providers, for example nurse practitioners, physician assistants, and so on. Galan. Astellas. There are both major and minor differences between the traditional physician and the mid-level practitioner. The advent of monetary rewards for integrated healthcare plans and clinics that demonstrate partnerships between these types of medical practitioners has created a dynamic in which the pharmaceutical industry must provide all medical professionals with a comparable level of information, respect, and attention. In some areas of medicine, the mid-level practitioner is an important decision-maker who greatly affects all spectrums of the healthcare environment in which he or she operates, including interactions with the pharmaceutical industry. We must make diligent strides to ensure that as an industry we recognize the importance that mid-level practitioners play in the medical delivery model and urgently respond to this rapidly emerging profession. Harris. Shire. It’s really important that our representatives have a customer-centric mindset when interacting with physicians. Our intent is to understand their particular roles and needs in the healthcare continuum, and then we will find numerous opportunities to use our knowledge, educational material, and medications to improve their practice and the health and lives of patients. If we engage our customers with only a message-centric approach, we often see a short-term impact that tends to plateau in the longer term. In a nutshell, a customer-centric approach facilitates more successful and sustainable interactions with a full range of customers in the healthcare community. Boylan. Eisai. I don’t think that the sales detail needs to be adjusted at all. I truly believe that the importance of the nurse practitioner and physician’s assistant needs to be recognized and not underestimated. NPs and PAs play a vital role in the care of the patient. We must treat them the same as the physician by providing credible, honest information that will make them better healthcare providers. They have needs that must be met as well. Incentivizing the Field Effective sales incentive programs begin with understanding what motivates sales representatives. This includes being able to enforce ethical standards while also encouraging team members to achieve optimal results. Our Forum experts outline the best ways to incentivize their sales representatives to become top performers without compromising integrity. Galan. Astellas. To incentivize top performers, companies need four components in the incentive compensation plan. First, to determine how best to incentivize top performers, it is important to define what top performance is. Second, companies must incorporate the ethics and compliance expectation. Most companies will respond in surveys that they value some type of core ethics as extremely important. Yet, if this is not a key performance rating, the actionable consequence does not always match the stated value. Third, incentive plans also should be based upon individual motivational desires, as each person should be a recognized entity who has individual aspirations, goals, etc. Fourth, top performers should receive top compensation. While it may be impractical to design a custom program for each person in the company, it is possible to design a way to identify how people are culturally motivated and empower middle management to address such individual motivational capacities while the big picture items, such as monetary incentive plans, are handled at a macro level. Overall, a company must match its incentive programs to its stated goals and processes through actionable and definable rewards and consequences that are both desirable and attainable. Foote. OAPI. It’s important to set aggressive, but realistic sales goals. It’s also important to add an incentive for the representatives to focus on targeted physicians as well as to set goals for reach and frequency. Harris. Shire. Although each of us probably has very different ideas on the best incentive methods, I believe there are a few core themes of effective incentive compensation, also known as IC plans. First, perceptions are critical. The IC plan must be easily understood, viewed as equitable, and provide the appropriate level of reward. It becomes imperative then that the authors of the IC plan are truly aligned with the desired results and measurements that will be employed. A reflection of the mission and values of the organization are also essential when formulating the plan. There must be consistency with what an organization claims to value and what it actually rewards. Boylan. Eisai. Incentives can come in many forms. Obviously, the form most recognized is being paid for performance through the company IC plan. Other incentives include being promoted into positions of greater responsibility, such as a field trainer, manager, home office trainer, or marketer. Hot Techniques Being able to implement successful programs that yield positive results is key to maintaini g an effective salesforce. Experts reveal what they believe are the “hottest” sales training techniques. Galan. Astellas. While many companies strive to generate a competitive advantage with size or monetary expenditures, we have found that the simple act of personal attention and high standards of excellence have resulted in a strong and dedicated salesforce. Dedication to maintaining a personalized classroom with small class sizes coupled with planned and strategic advances in technology and education have allowed for tangible success in the field. Our primary care and specialty representatives who detail the same products train together, which forges bonds that allow our salesforces to work more closely and provides for a more rapid strategic deployment of highly effective and skilled representatives. Harris. Shire. Our best technique is a multi-step, targeted, learning system that we are implementing in our initial sales training courses. We have found it to be very effective for taking material from the information stage to the behavioral application stage of learning. We have increased our use of standardized coaching tools for the field trainers in this process and this has decreased the variability in coaching and direction from our trainers and increased the clarity and performance of our trainees. We have found that basic training principles, when well executed, deliver better results than the latest fads in the learning and development world. Boylan. Eisai. In my region we are employing the “Sell It, Don’t Tell It” technique. This is not flashy, but we envision the need to have the physician “buy or purchase” our message. When a consumer “purchases” something, he or she takes it with them. Sooner or later they will use what was purchased and will have to purchase it again. The same technique applies. Physicians need to feel as if they have purchased something. They now have “skin in the game” or own it and will put it to use. We even can close by presenting an analogy such as, “Doctor, if what I have just presented were an item in a store, would you purchase it and take it home?” If the answer is yes, then the sales representative ends the close by asking for a particular action. If not, the rep has to find out why and try again. Evaluating Results Continuing education also equates to continuing evaluation. Experts discuss the metrics, aside from increased scripts, they evaluate their sales reps on. Galan. Astellas. Our sales representatives are rated on selling skills and clinical acumen at least three times per year following their initial sales training experience. This allows for the sales training department to track the skill and development of our representatives as they progress on both a monthly and yearly basis. We also have developed an advanced training curriculum that allows for monitoring and tracking of both clinical and sales skills in a senior classroom environment. Additionally, compliance metrics also have been incorporated into our performance program for sales representatives. Boylan. Eisai. Other metrics used to evaluate sales reps are reach and frequency. We need to evaluate whether our representatives are reaching their top physicians and at the right frequency. PharmaLinx LLC, publisher of the VIEW, welcomes comments about this article. E-mail us at [email protected]. New and innovative treatments are becoming more complex and will require pharmaceutical representatives to provide information within the “new” context of the practitioners’ world: a time-starved, competition-based medical environment. Roy Galan Astellas thought leaders n Edward J. Boylan. Southwest Region Sales Director, Eisai Inc., Woodcliff Lake, N.J.; Eisai is the U.S. subsidiary of Tokyo-based Eisai Co. Ltd., a research-based human healthcare company that discovers, develops, and markets products throughout the world. For information, visit eisai.com. n Karen Foote. Senior Manager, Sales Training and Development, Otsuka America Pharmaceutical Inc. (OAPI), Rockville, Md.; Otsuka America Pharmaceutical commercializes Otsuka-discovered and other product opportunities in North America, with a strong focus on and commitment to neuroscience, cardiovascular, and gastrointestinal therapeutic treatments. For more information, visit otsuka.com. n Roy Galan. Assistant Director Sales Training, Community Care, Astellas Pharma US Inc., Deerfield, Ill.; Astellas US is a division of Astella Pharma Inc., which is dedicated to improving the health of people around the world through the provision of innovative and reliable pharmaceutical products. For more information, visit astellas.com/us. n Kenneth Harris. Senior Director, Sales Training, Shire, Wayne, Pa.; Shire focuses on meeting the needs of specialist physicians in the areas of attention deficit and hyperactivity disorders, human genetic therapies, and gastrointestinal and renal diseases. For more information, visit shire.com. The biggest challenge we face is maximizing the learning experience for every participant. This requires a balanced and blended delivery approach and finding the right mix is really more of an art than a science. Kenneth Harris Shire Generally, physicians want informative and accurate product information, including key efficacy and safety data. They also are seeking knowledgeable representatives who provide balanced information. Karen Foote OAPI Training Days During First Year on Job On average, U.S.-based organizations provide more than 44 days of training per new rep during the first year on the job — about 14% above the average for the non-U.S. segment. Source: Best Practices LLC, Chapel Hill, N.C. For more information, visit bestinclass.com. We have adopted an approach that focuses on asking the right question, which helps to uncover the needs of the physicians. Edward Boylan Eisai Average Budget Per Rep Trained In the U.S. segment, companies invest an average of $4,257 annually on sales training for every representative, including both new and experienced employees. Note: Weighted Average is the volume-weighted average of all benchmarked responses. Median is the midpoint number of the data set. Source: Best Practices LLC, Chapel Hill, N.C. For more information, visit bestinclass.com. Average Budget Per Rep Trained — New reps only The budget for sales training for each new rep in the U.S. averages almost $10,500 each during the first year on the job. Note: Weighted Average is the volume-weighted average of all benchmarked responses. Median is the midpoint number of the data set. Source: Best Practices LLC, Chapel Hill, N.C. For more information, visit bestinclass.com.

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