[PRACTICE NOTE] Up-Leveling Voice of the Customer for Competitive Advantage

Voice of the customer is usually run as a measurement function, and it belongs in the strategic half of the commercial system. The difference shows up in the portfolio rather than on a dashboard.

Organizations listen in the way they are built to listen. A function assembled to report will produce reports, and a function assembled to decide will produce decisions, whatever arrives at the door. Voice of the customer has spent most of two decades inside the reporting half of that divide. Pharma inherited the arrangement intact and had reasonable grounds to keep it.

Those grounds deserve respect. A manufacturer that does not control the transaction between its science and a patient has every incentive to measure what it can defend. The cost arrives later, when the listening apparatus can describe sentiment in detail and still cannot tell a brand team what its customers' lives are about to require. Up-leveling is the work of closing that distance.

Three levels of listening, and only the third is strategic

Voice of the customer can be run at three levels, and the levels form a progression rather than a menu. The first produces a score, the second a diagnosis, the third foresight. Each level costs more to operate than the one beneath it and returns something that one cannot see. Most organizations run the first, fewer run the second well, and almost nobody runs the third on purpose.

Voice as a score tells an organization how it is doing

At the first level the organization learns how it is doing. A score is comparable across periods, benchmarkable against peers, and simple enough to survive a quarterly review. Those virtues are real, and the research underneath them was sound. Fred Reichheld's original loyalty research argued that what customers say about a company predicts how it will grow.

Bain reports that differences in Net Promoter Score explain anywhere from 10% to 70% of the variation in subsequent revenue growth. A range that wide is a finding about listening rather than an instruction to install an instrument. Most industries drew the second lesson, pharma among them.

A score is also close to impossible to act on. Two brands carrying the same number can be failing for opposite reasons, one losing patients at fulfillment and the other at the first refill. I have watched capable teams spend a full cycle debating a two point movement that no decision depended on, which is part of why Net Promoter Score in pharma has aged poorly.

Voice as diagnosis finds where a journey stops progressing

The second level asks where progression breaks and for whom. Measurement here attaches to a stage rather than to a relationship, which makes it specific enough to assign to an owner. A prescription written and never filled is a measurable event with a cause, and that cause usually sits in a handoff rather than in a sentiment.

This is the level at which value leakage becomes visible as something other than an accounting surprise. Each break has a location on the Path to Prescribe, the Path to Fulfill or the Path to Adhere, and each carries a measurable effect on the Realization Rate. Gartner's work on service channels found that 62% of customer service channel transitions are high effort, and every handoff between pharma functions is one of those transitions. Diagnosis of that kind is genuinely actionable, which is why it earns its investment.

Its limitation is that it remains reactive, because a diagnosis describes a journey that already exists, built around a need the market recognizes. Deloitte's work on engagement shows how far an internal reading can drift from the external one. Only 28% of healthcare professionals believe pharma's customer engagement strategies meet their needs, while 82% of life sciences executives are satisfied with those same strategies. The internal view measures the organization's own effort and the external view measures the customer's, which puts the listening itself in question.

Voice as foresight reads a world before a market forms

The third level is the strategic one. Here the organization learns what its customers' lives are making them need, before any market has formed around that need. Customer consciousness in its upstream sense is exactly this, the capability that produces categories rather than campaigns. Very few organizations run it deliberately, which is why the ones that do tend to look lucky in hindsight.

Signals at this level rarely sit inside an instrument. They sit in what people do when nobody is asking them anything, in what they tolerate, what they work around, and what they quietly reorganize a week to accommodate. In my book I grouped the unmet needs that matter most here as underlying, unarticulated, undervalued, unrecognized and unaddressed. Each category is invisible to a question, because a customer cannot report a need she has not yet named.

What observation catches that an instrument never will

The research behind The Customer Excellence Enterprise was observational and ethnographic rather than survey based. It examined how customer experience outliers such as Amazon, Chick-fil-A, USAA, Trader Joe's and The Ritz-Carlton behave in front of customers, over time, in public. What the method surfaced was a shared organizing principle, which I named helpfulness. No survey would have produced it, because no respondent describes an organizing principle.

Behavior tends to be a better signal than self report, because behavior escapes the courtesy that surveys invite. A physician asked to rate a manufacturer will often be generous, and the same physician, observed, will route around a portal she finds unusable without filing a complaint. Her workaround is the finding, and no instrument was ever going to collect it.

I learned this before I learned pharma. At The Ritz-Carlton Leadership Center, where I led delivery, the Credo names the genuine care and comfort of guests as "our highest mission". Care of that kind cannot reach a guest who has not first been understood. Forrester reports that customer obsessed organizations saw 41% faster revenue growth than the rest.

The seven conditions of the Convergence Readiness Model

Foresight of this kind can be run as a method rather than left to instinct. The Convergence Readiness Model is the instrument built for it, reading seven conditions in a customer's world. Those conditions are persistent need, normalized burden, identity intensity, cultural readiness, self recognition, scientific unlock and ecosystem potential. When enough of them hold at once, a category is close to forming whether or not anyone has named it yet.

The useful property of all seven is that each is observable in public behavior rather than in proprietary data. Burden normalizes in plain sight, in what people stop bothering to complain about, and identity intensity shows up in how a condition gets discussed by those living with it. A reading like that is available to any organization willing to run it, so the advantage goes to whoever looks rather than to whoever owns the largest dataset.

Pharma's version of the third level has already happened

The clearest recent example here is one I have written about at length. Two companies read the human context of obesity correctly, seeing a need that was metabolic and also bound up with identity, mobility, confidence and standing in a room. Much of the industry treated the result as weather, a demand event to be reacted to rather than a reading to be learned from. My work on customer consciousness and the GLP-1 phenomenon sets out what those companies saw and when they saw it.

What the episode reveals about the commercial system matters more than the category itself. A need that had been persistent for decades, normalized as personal failure, and intensely tied to identity was legible well before a market existed. Reading it required attention to how people live rather than access to a proprietary panel.

The frontline is already running an upstream listening system

Pharma holds an advantage at the third level that most industries would envy. The frontline is one of pharma's most underutilized intelligence systems, encountering barriers long before dashboards detect them. Field colleagues observe rather than recall, in specific accounts rather than sampled ones, and currently rather than in arrears. Their intelligence arrives attached to the moment progression broke, which makes it the most unimpeachable material in the commercial system.

The difficulty here is structural rather than human. Most field organizations have no path by which an observation becomes a consequential decision, so it dies in a weekly call. FieldOS exists to build that path, and its loop runs in six stages: Capture Signal, Classify Barrier, Assign Owner, Intervene, Measure Progression, and Learn and Improve. The Transfer Coefficient measures how much intelligence survives the trip from observation to measured effect, and that proportion is low.

A voice of the frontline capability is not an addition to voice of the customer. It is the part of it that reaches context no instrument can reach. Pharma's position, standing one step away from the patient transaction, makes that reach more valuable here than almost anywhere else.

Voice run at the strategic level becomes a portfolio input

The test of whether up-leveling has happened has little to do with the sophistication of the listening stack. Customer consciousness is the degree to which customer reality is present in decisions before they are made, rather than sentiment about customers. By that test, a program that produces an elegant quarterly report and no earlier decision has up-leveled nothing.

At the first level, voice is a service input. It tells a service organization where to apologize and what to repair. At the second level it becomes a commercial input, informing where to intervene on a journey and what the intervention is worth. At the third level it becomes a portfolio input, informing what to develop, which populations to design around, and which category to enter before it is one. That last move is the one pharma has most to gain from and least practice at.

The instruments are ordinary. Reviews, panels, observation, social listening and field conversation have existed for decades, and the consumer companies that read their markets early mostly used exactly those. The advantage came from treating what the instruments produced as direction rather than as decoration.

Key Takeaways

• Voice of the customer can be run as a score, as a diagnosis or as foresight, and the three levels return very different things to the business.
• A score is comparable and benchmarkable, and it is close to impossible to act on without a diagnosis underneath it.
• Diagnosis locates where progression breaks on the Path to Prescribe, the Path to Fulfill and the Path to Adhere, which makes it assignable and reactive at the same time.
• Foresight reads what a customer's life is making her need before a market forms, and the seven conditions of the Convergence Readiness Model make that reading repeatable.
• Observation often beats self report, because behavior escapes the courtesy that surveys invite.
• The frontline already holds upstream context, and the limiting factor is the absence of a path from observation to consequential decision.

Diagnostic Questions to Consider

1. Name the last three commercial decisions that changed because of something a customer said or did, and state how far upstream each decision sat.
2. Describe which of your listening instruments produces a score, which produces a diagnosis, and which produces foresight.
3. Identify where in your brand plan an unarticulated need appears as a design input rather than as a research finding.
4. Estimate what proportion of frontline observation survives the trip to a consequential decision inside your organization.
5. Explain which of the seven convergence conditions your category currently satisfies, and name who is accountable for watching them.

Closing Reflection

Most organizations do not have a listening problem in the sense they believe they have one. They hold a great deal of customer data and very few places where that data arrives before a decision is made. Adding another instrument rarely changes the picture, because the constraint sits in the operating model rather than the collection layer. Much of the work of voice of the customer in pharma is the work of moving the arrival time earlier.

The three levels are cumulative rather than competing. An organization still needs to know how it is doing, and a diagnosis without a score loses its sense of proportion. What changes at the third level is the horizon, because the question stops being how customers are experiencing what has been built and starts being what their lives are about to require. Answering that second question well may be the closest thing pharma has to a durable commercial advantage.

Experience was left to default in this industry while brand and product were deliberately designed, and listening largely inherited the same fate. Rebuilding it as a strategic function is slow work, and it starts with an admission that a score was never going to carry the weight placed on it. Scientific value is realized when the patient accesses, starts, continues and benefits. Listening that cannot see that far ahead has not yet been up-leveled.

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.