Service Quality Evaluation In the Pharmaceutical Industry: Development of Qualitative/Quantitative Methodology: A case Study

Nstor Cohen
Director of Research, Healthcare Marketing Group, Argentina
Mnica Soto
Director executive, Healthcare Marketing Group, Argentina

INTRODUCTION

We have been conducting different measurements since 1996, which were generally aimed at assessing the service quality of a number of laboratories. It was borne in mind from the very beginning that we were dealing with a service that, unlike most other services rendered, had the particular feature that its quality would affect those not consuming the product involved.

But this feature did not produce any detachment at all between the person to whom the service was provided (the physician) and the person consuming the product (the patient), but rather the opposite: a satisfied physician considerably increases the probability of the patients consumption. Moreover, we always understood that a necessary condition for a physicians satisfaction was that his patients would positively evaluate the service of the physician himself. This is why we say that a satisfactory performance in the service rendered to the physician produces a rebound effect in the service the latter renders to his patients.

However, while rendered to the physician (even when cooperating in a patients treatment), the service is actually implemented in the setting of the physicianlaboratory relationship. And it is the success of this relationship that allows the constitution of a positive and satisfactory link. Hence, in the realm of medical prescription products also known as 'ethical' products of the pharmaceutical industry, customer service means physician service.

In this report we present a case referring to a study conducted for JanssenCilag Farmaceutica Argentina S.A. This is a laboratory with sound experience in Argentina in some medical specialties, such as general practice, neurology, gyneacology and psychiatry, among others.

We are particularly interested in introducing the methodology that was used, as it allowed us to obtain reliable and valid results, while commercially useful as well. We will show some of the results obtained in the items we consider more significant.

METHODOLOGY USED

Our first concern in order to conduct an appropriate research was to define the subject matter under study: what did we understand by physician services? Secondly, we had to determine which services were involved.

Regarding the first question, it was assumed that they were actions taken by laboratories and addressed to physicians, inasmuch as those actions were targeted at specific needs of these professionals. This definition presumes the existence of physicians needs that the companies can respond to. On this particular issue we set an important question: are laboratories aware of all of these needs; are these needs limited to those which laboratories intend to meet by service rendering or are there other more latent demands of which laboratories are not aware of or which they consider foreign to their relationship with physicians?

In this respect, our decision was to propose a methodology that would not only assess the level of satisfaction as regards services, but that would also let us explore which services were involved.

In doing so, a two stage qualitative/quantitative nature methodology was designed: the first exploratory stage using the 'mini focus group' technique; and the second diagnosticdescriptive stage using the technique of individual structured interviews.

The initial stage comprised tracing of the concepts then used in the following stage to evaluate services.

Exploratory stage

The selection of the 'mini focus group' technique was based on the need to apprehend the debate among physicians of each specialty as to what they understood by service rendered by laboratories, the meanings they attributed to service and the services they usually received from laboratories in general.

Five 'mini focus groups' were set up, each composed by four or five physicians of the specialties indicated below. The preference for a quantitatively reduced group structure was intended to achieve a more effective interaction and the consequent formulation of a richer collective discourse.

Physicians were in all cases selected at random, regardless of whether they were served by the laboratory interested in the study. This condition was very important inasmuch as the objective was to determine the kind of perception of the universe of services, whether rendered by said company or not. We did not want to evaluate based on the companys assumption, but based on the experience of the physician himself. Information was gathered that would let us know the universe of expectations, wishes and predisposition of physicians towards the services rendered by laboratories, going beyond the preconceptions guiding commercial actions in this industry when services are concerned.

The selection of specialties was obviously determined by the laboratorys interest:

  • general practice,
  • gynecology,
  • neurology and psychiatry,
  • dermatology,
  • gastroenterology.

The contents of the surveyed information were analysed, the material was interpreted and a report was issued which served as supporting material for the following stage.

Descriptive diagnostic stage

This stage was thus conducted based on the results obtained from the conceptual analysis of the discourses in the previous stage. Selected from a universe of professionals visited by the laboratory, 350 physicians were interviewed through an disproportional stratified sampling starting at random, with a 95.45% reliability limit and a 5.60% estimated error.

  • general practitioners

  • gyneacologists

  • neuro/psychiatrists

  • dermatologists

  • gastroenterologists

The final composition of the sampling was as follows:

  • Age:        Up to 40 years old        = 116
                   41 years old and over   =  225
                   DK/DA                        = 9

  • Sex:        Males                            = 223
                   Females                        = 127

Analysis strategy

A grid comprising twenty five services was drawn up, which reproduced the universe of services physicians had recognized as such, plus some additional ones that were included as a result of the laboratorys marketing strategy.

Care was taken in using the language detected in the mini focus groups, so that physicians were interviewed in terms of their own codes.

In summary, from that point the physicians interviewed were asked to rank them by order of importance or significance for their professional task. They were then asked to assign a performance grading on a 1 to 10 scale for each service to the laboratory at issue and to other two competitors proposed by us. Competitor laboratories varied according to each specialty. Thus, we obtained:

  • a ranking of importance of services for each specialty;
  • an average grading of performance for each laboratory and for each service, also in each specialty.
  • By using 'a' as weighting factor of the usefulnesssignificance of the services and applying the factor correspondence analysis appropriate for qualitative variables, which allowed the grouping of the most interrelated services based on the evaluations in 'b', we were able to detect the performance of each laboratory not only in terms of the better or worse evaluation received, but also in terms of the usefulness-significance attained by such service.

Based on the relation between the significance of the service and the performance of laboratories, four areas were set up for each laboratory, inside which the services at issue were distributed.

Once the information was obtained, the interpretation thereof was made pursuant to an information matrix (Figure 1), which defines four areas for evaluating the services rendered by laboratories. These areas are the result of crossing the significance assigned by physicians with the corresponding performance.

A matrix was designed for each laboratory under study, thus having three matrixes one for JanssenCilag and another two for their competitors for the analysis of each specialty.

In doing so, we could obtain charts showing the following:

  • JanssenCilag performance in absolute terms, meaning how physicians perceive it in terms of quality or service efficiency;
  • performance in relative terms; in other words, the effect their strategy produces on the market by way of knowing how their stronger and weaker areas are composed: which services are in one place and which in the others;
  • performance in comparative terms, through the interpretation of their competitors performance.

The rest of the questionnaire comprised three different sets of closed and open ended questions:

  • One was referred to those issues of particular interest to the laboratory and related to some specialties. Even when these questions were somehow associated with the services rendered, they were mainly aimed at knowing the physicians opinion rather than to get a comparative evaluation of JanssenCilag visvis their competitors.
  • Another set of questions was very important because it measured the incidence of service quality on medical prescription. In doing so, we had to resort to questions that would force physicians to choose one of two products with identical pharmacological composition. Respondents had to take into account other elements such as services, institutional image and/or experience, relationship with medical representative, etc. to substantiate their choice.
  • A third set of questions was of a sociodemographic nature and intended to classify respondents.

MAIN RESULTS OBTAINED

We are now going to introduce merely some aspects of interest for information purposes, showing some approaches to the information surveyed.

Expectations as to service rendered

The following information shows the scenario of physicians expectations. It gives an indication as to what physicians expect as regards the service rendered by the pharmaceutical industry and what is the meaning they assign to the physicianlaboratory relationship.

The physicians interviewed were asked about their expectations (to some degree their wishes and needs) as regards the services rendered by laboratories in general. This information allows an ordering (ranking)  of services according to the qualities physicians assign  them, regardless of the strategy adopted by each particular laboratory.

It is worth noting that this does not mean to assume that every strategy should be subordinated to customer wishes and needs, but we deem it essential that every strategy be developed taking such needs into consideration among its different inputs.

To that end, in the course of our research, twenty five different services were brought to the attention of those being interviewed, and asked them to rank these services in order of importance from the most to the least important. Based on the results obtained, we grouped them in seven levels of significance (wish or need). (See Table 2.)

TABLE 1: SEVEN LEVELS OF SIGNIFICANCE

1st Level Politeness and professionalism of medical representative.
satisfactory service level of medical representative
2nd Level Fulfillment of promises
Prompt resolution of specific inquiries by medical representative
Compliance with product specifications
Updated scientific demand
3rd Level Quick response to demands
Clear promotional message by medical representative
Continuity of rendered service
Organisation of special events of interest for different specialities
Publication and distribution of scientific magazines at no charge
Donations to various hospital services
Support to young physicians
4th Level Phone access to information network
Diverse research grants
Invitation to scientific events
5th Level Comprehensive brochures
Efficient phoneinquiry service
Organisation of atheneums in hospital services
Free delivery of medicinal products to patients
6th Level Support of personal instruction
More affordable prices for medicinal products
7th Level Concern for the environment
Interesting computing courses
Various and appropriate gifts fro recipients

Notice that the medical representative sets himself up as the main bearer of physicians needs. The great significance lies on how well prepared the medical representative is to relate and deal with physicians and how efficient he is in rendering the service. Regardless of the different services provided by the laboratory, the medical representatives performance determines the kind of relationship between the company and the professional. In the second place, the fulfillment of promises whatever these may be a prompt response to inquiries and the update of any scientific information offered, all contribute to strengthening this relationship.

The support given to physicians, be it in the form of invitations, grants, gifts, scientific magazines, access to information network, etc. appears at different need levels, but not as a priority. The interpretation stemming from the foregoing is that the support is focused on responding to physicians inquiries and needs; in other words, on the laboratorys attitude of 'being ready to ...,' rather than going out to offer. It would seem that physicians assign less value to what laboratories offer than to what they themselves pursue; and their pursuit takes place mainly through the medical representative.

Now then, when analyzing the above information by specialty, some differences arise, see Table 3.

TABLE 2: LEVELS OF SIGNIFICANCE BY SPECIALITY

1st Level Politeness and professionalism of medical representative (general practitioners, dermatologists and gastroenterologists)

Satisfactory service by medical representative (general practitioners, dermatologists and gastroenterologists)

Compliance with product specifications (gyneacologists and neuropsychiatrists)

Updated scientific information (gyneacologists)

2nd Level Fulfillment of promises (all except gynaecologists)

Updated scientific information (all except gynaecologists)

Politeness and professionalism of medical representative (gynaecologists and neuropsychiatrists)

Satisactory service by medical representative ( gynaecologists and neuropsychiatrists)

Prompt resolution of inquiries by medical representative (general practitioners, gynaecologists and dermatologists)

Compliance with product specifications (general practitioners and gastroenterologists)

Publication of scientific magazines at no charge (gynaecologists)

Donations to hospital services (neurologistspsychiatrists)

Organisation of special events (gastroenterologists)

3rd Level Continuity of rendered services (all)

Clear promotional message by medical representative (all)

Organisation of special events (all except gastroenterologists)

Publication of scientific magazines at no charge (all except gynaecologists)

Donations to hospital services (general practitioners, gynaecologists and gastroenterologists)

Support to young physiscians (general practitioners, neuroprsychiatrists and gastroenterologists)

Quick response to demands (general practitioners, dermatologists and gastroenterologists)

Fulfillment of promises (gynaecologists and dermatologists)

Promt resolution of inquiries by medical representative (neuropsychiatrists and gastroenterologists)

In the first place, although there are differences by speciality, we can observe a relatively similar behaviour amongst general practitioners, dermatologists and gastroenterologists on the one side and gynaecologists and neurologistspsychiatrists on the other side.

In the second place, and in relation with the above paragraph, general practitioners, dermatologists and gastroenterologists set their main expectations on the medical representatives performance, entrusting him their greater needs; the remaining specialties prioritize the product itself and any scientific information they can receive.

Evaluation of services by laboratory

Following is an outline of the way the areas were finally set up for a given laboratory. The reason why we are presenting it in this manner is because we cannot disclose the results obtained since they constitute reserved information (see Figure 2).

Strength area
  • Compliance with product specifications
  • Publication and distribution of scientific magazines at no charge
  • Critical area
  • Satisfactory service level of medical representative
  • Politeness and professionalism of medical representative
  • Prompt resolution of inquiries by medical representative
  • Clear promotional message by medical representative
  • Fulfillment of promises
  • Updated scientific information
  • Quick response to demands
  • Invitation to special events
  • Support to young physicians
  • Continuity of rendered services
  • Donations to hospital services
Area of nonsignificant performance
  • Phone access to computer network for information
  • Efficient phone service
  • Support of personal instruction
Area of indifference
  • Various and appropriate gifts for recipients
  • Concern for the environment
  • Organisation of atheneums in hospital services
  • Free delivery of medicinal products to patients
  • Comprehensive brochures
  • More affordable prices
  • Diverse research grants
  • Organisation of scientific events

The performance of medical representatives is to be underlined as one of the most vulnerable issues in the laboratory services.

Moreover, what appears quite worrying is that it is not considered as fulfilling its promises, giving quick response to demands or continuity in the services rendered. These three features of the laboratory services confirm a company profile that shows little concern for their external customers.

While it is true that the comparison is made against leading laboratories, it is worth noting that an appropriate strategy in the provision of services must be designed minding as a reference for those having a more successful performance.

A companys course is towards leadership, no matter how distant or difficult it may appear to be. Avoiding this kind of comparison is just refusing to see where the company itself stands. Its standing is always determined with reference to the leaders; the distance may be nil, or it may be more than that.

REFERENCES

Bangs, David H. (1992). Creando clientes. Ediciones Macchi.

Cohen, Nstor and Gmez Rojas, Gabriela. (1996) Un enfoque metodolgico para el abordaje de escalas aditivas, Of. De Publicaciones de CBCUniv. De Bs. As.

Crivisqui, Eduardo (1993) Anlisis factorial de correspondencias. Universit Libre de Bruxelles.

Crosby, Philip B. (1989). Hablemos de calidad. McGrawHill / Interamericana de Mxico S.A.

Horovitz, J. (1994). La calidad de servicio. McGrawHill / Interamericana de Espaa S.A

NOTES & EXHIBITS


FIGURE 1: services: evaluation matrix


FIGURE 2: services: bi�dimensional distribution

1) Politeness and professionalism of medical representative; 2) Fulfillment of promises; 3) Satisfactory service level of medical representative; 4) Prompt resolution of inquiries by medical representative; 5) Clear promotional message by medical representative;
6) Updated scientific information; 7) Quick response to demands; 8) Invitation to special events; 9) Continuity of rendered services; 10) Support to young physicians; 11) Donations to hospital services; 12) Compliance with product specifications; 13) Publication and distribution of scientific magazines at no charge; 14) Organisation of scientific events; 15) Diverse research grants; 16) Comprehensive brochures; 17) Free delivery of medicinal products to patients; 18) Organisation of atheneums in hospital services; 19) More affordable prices; 20) Concern for the environment; 21) Various and appropriate gifts for recipients; 22) Phone access to computer network for information; 23) Efficient phone service; 24) Support of personal instruction.