[PRACTICE NOTE] Overcoming Pharma's Cultural Blindspot

Pharma's culture was built to be careful, and that carefulness is why its science is extraordinary. The same instinct, carried into the experience around the medicine, can produce caution where boldness is needed.

Institutions rarely behave the way their strategy documents describe, and they behave instead the way their beliefs allow. Those beliefs were formed long before the current strategy was written, and they tend to outlast the people who formed them. In pharma they surface most visibly around the experience surrounding a therapy rather than the therapy itself.

Culture here is not mood or morale, and an engagement survey will not find it. I define it as the institutional mindsets, beliefs, mental models and behaviors that make up the collective consciousness of a company. These are the underlying factors that drive how a company thinks and functions. They also decide how customers are to be viewed, valued and treated.

Pharma companies are patient-centric by nature. The change they now face is entering the consumer arena, where people have choice and compare freely. Consumer-Grade is a capability to be designed in rather than a conviction to be held, which makes this a design gap rather than a character gap. Treating it as a character gap is how most culture work loses the room.

Mental models work behind the scenes

Mental models are cognitive frameworks formed by the collective experience and points of view of leaders and employees. They carry core beliefs, perceptions and assumptions, and they work behind the scenes, guiding decision making, problem solving and how resources are allocated. They also decide which opportunities are judged worthy of pursuit.

In a commercial organization that does not control the transaction between its science and a patient, those models carry unusual weight. A company releases a prescription into a system it does not own, and what happens next is governed by beliefs about whose job that part is, which are rarely written down. They are the reason organizational DNA is the hardest of the four layers to move.

Three beliefs that shape how customers are treated

The three beliefs below are not failings, and none of them is held cynically. Each was accurate once, each was earned through experience, and each still produces sensible decisions inside the function that holds it. What they share is a quiet effect on where experience work is allowed to happen.

Regulation prevents it

Regulation governs claims rather than burden. Almost none of the friction a patient meets between a prescription and a first dose is legally required, which makes most of it unowned rather than mandated. The belief survives because it tends to be cheaper to assume a constraint than to test one.

The customer is the prescriber

This was true for forty years, and it built a commercial model of real sophistication. It is incomplete now that adjudication, affordability and persistence sit along the Path to Fulfill and the Path to Adhere. Teams working to a prescriber-only definition of the customer can be excellent and still never see where value is lost.

We benchmark against pharma

Imported customer experience was rejected in this industry because the first iterations did not fit it. That rejection was rational. The wrong lesson drawn from it was that the standard should therefore be set inside the sector, and peer benchmarking confirms that a company performs adequately against others carrying the same blind spot. Deloitte found that only 28% of HCPs believe pharma's customer engagement strategies meet their needs, while 82% of life sciences executives are satisfied with those same strategies. A gap of that size is what an internal standard looks like.

Reimagine the art of the possible, then ask why not us

The first counter move is to reimagine the art of the possible, which in practice means decoding what customer experience outliers actually do rather than admiring them from a distance. Expectations are now set by companies that transcend industry and geographic boundaries, and patients and clinicians carry them into every clinical encounter. Decoding at that level has little to do with copying a retailer or a hotel. It is about walking in a customer's shoes closely enough to surface the practices underneath.

Decoding is also where regulated industries find most of their room. In healthcare, financial services and government, real or assumed constraints place unnecessary limits on what is considered possible. Close study of what outliers do can reveal ways to navigate those constraints without compromising compliance. The compliance function is often a better partner in that work than it is given credit for.

Embedded in that first move is a question a company can ask of itself. Why not us. Asked seriously, it is the counterpunch to the "that won't work here" mental block that ends most experience conversations early. Bain's work on commercial productivity found that about 40% of a doctor's drug recommendations relate to overall experience with the company rather than the product alone, which is the commercial case for asking.

Codify the obligation to customers

A new belief does not hold because leadership announced it. It holds when the obligation to customers is codified into company-specific Customer Excellence principles the whole organization can read. Codification turns the good intentions of customer centricity into a form that can be understood, trained, implemented and sustained. What it raises is customer consciousness, which is the degree to which customer reality is present in decisions before they are made rather than sentiment about customers.

Principles do work that values statements cannot, acting as a compass for the decisions nobody wrote a policy for. They also carry the experiential factors a company chooses as its basis of competition, which is why two companies using the same word can mean different things by it. Personalization at one company may mean an algorithm surfacing relevant options, and at another a customer's name written on a cup.

Predisposition is the point of all of it. The term means the company being predisposed to deliver exceptional experiences structurally and systematically. It does not mean the customer being predisposed toward the brand, and it does not mean excellence produced through frontline heroics.

Co-design from inside, document, then cascade

Customer-centric cultures and the principles that embody them have to be created and owned from inside the organization. Outsiders can facilitate the design process, and I have facilitated many of them. The culture itself must flow from the collective consciousness of the company. The practical mechanism is a multidisciplinary design team of culture carriers and respected corporate citizens who build the principles in the company's own language.

Co-design is an activation strategy rather than a drafting exercise. Employees who help shape the principles tend to become their advocates and defenders, which is how adoption gets de-risked before any rollout. Documentation then removes whatever ambiguity remains, which is why the outliers commit theirs to writing. Zappos does it with its annual Culture Book, HubSpot with its Culture Code and the Ritz-Carlton with its Gold Standards.

Cascading is the step most often skipped. In many companies accountability for customer outcomes sits with a relatively small group in customer care, customer experience or customer success, who carry the weight of customer centricity for everyone else. Narrow delegation tends to produce chronic experience gaps and an untenable burden on the people holding it. Knowledge diffusion, formal learning pathways and a tiered capability structure equip a critical mass of employees instead. A field team with the language and the permission behaves differently from a field team with a dashboard.

Culture change fails where measurement stays the same

The hardest honest point here is that culture change in pharma fails most often not because people disagree with it. It fails because nothing in the measurement system changes alongside it. A company can run the co-design, publish the principles and train the organization, then watch the new belief evaporate in the first tight quarter. Two other layers decide whether that happens.

Leadership DNA determines whether the commitment survives contact with a quarterly target, because leaders reveal their priorities in what they fund, escalate and stop. Commercial DNA determines whether measures and incentives reward realized value rather than declared intent. Without those two layers moving, culture work becomes a communications exercise with a design team attached. The tenet I keep returning to is that Customer Excellence must become an enterprise capability, not another program, department or training initiative.

Heroics are a subsidy the organization keeps paying

Most companies have a small team that keeps rescuing the joins. They know which hub to call, which form releases a stalled authorization and which colleague will answer on a Friday afternoon. Their work is real, and it is often the only reason a patient reaches a first dose on time.

That team is also the clearest available evidence that the culture has not yet changed. Heroics as a subsidy means the organization is paying for an outcome it has not learned to produce by design. It pays out of the discretionary effort of people who were never resourced for it, and the cost stays invisible because nothing in the system was built to see it. When the heroics stop being necessary, the belief has moved.

Key Takeaways

• Culture in this context means the institutional mindsets, beliefs, mental models and behaviors that make up a company's collective consciousness.
• Pharma companies are patient-centric by nature, and the change they face is entering the consumer arena where people have choice.
• Three beliefs do most of the quiet work, and each one was accurate before it quietly became incomplete.
• Reimagining the art of the possible and asking why not us reopen what a company believes is available to it.
• Codified principles, co-designed and cascaded into ways of working, raise customer consciousness and build Predisposition.
• Customer Excellence must become an enterprise capability, not another program, department or training initiative.

Diagnostic Questions to Consider

1. Name the specific regulation behind the three largest sources of friction between a prescription and a first dose in your lead brand.
2. Identify who holds the authority to remove a step in the access pathway, and whether that person has ever been asked to use it.
3. Describe the standard your experience performance is measured against, and whether any customer applies that same standard.
4. Locate the small group of employees who rescue the joins each week, and estimate what their effort is quietly substituting for.
5. State which incentive in the current commercial plan rewards realized value rather than declared intent.

Closing Reflection

Culture is the slowest layer to move, and it decides what the other three are permitted to do. Pharma has the harder version of the problem, because its carefulness is load bearing and nobody should want a company that discovers medicines to become casual. The work is to keep that carefulness where it protects patients and retire it where it only protects a process.

A company that becomes predisposed to serve customers structurally does not get there by believing harder. It gets there by codifying what it owes customers, designing that obligation from inside, documenting it, cascading it, then changing what it measures so the new belief has somewhere to land. That sequence is unglamorous, and it is the only one I have seen hold under pressure.

The test is simple enough to apply this quarter. Find the people who are quietly making the system work, and ask what would have to change for their heroics to become unnecessary. Their answer is the culture agenda, stated more precisely than any survey will state it.

About the Author

Wayne Simmons is the founder of The Customer Excellence AGENCY and the author of The Customer Excellence Enterprise (Wiley, 2024). He is founding faculty of the MS in Customer Experience Management at Michigan State University's Broad College of Business. He led global customer excellence in Pfizer's first Chief Marketing Organization and in Bayer's Customer Powerhouse.

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.