How a THOUGHTFUL approach to change MANAGEMENT SPED VIAGRA TO MARKET... AND extra earnings of $270m.

By Philip Cox-Hynd, MD, Harley Young

In the mid 1990s I found myself at a friend’s dinner party one Friday evening, rather tired from a full-on week, trying to adjust my brain to a social evening and the beginning of the weekend. I was motioned to the seat next to a man I hadn’t met before, of similar age, who happened to look very similar to how I felt.

After a bit of an awkward silence between us, and probably spurred on by the ever-increasing level of easy social interaction between the other guests, we turned to each other and I asked, “So what do you do?” He took a big breath as if preparing himself for a confessional answer and replied, “Ah well, I’m a... a... [pause] consultant.” I smiled and with a sense of relief replied, “Me too”.

Even at that stage of my career that particular ‘c’ word was one I’d become uncomfortable with. Yet to this day I‘ve not found a replacement word that doesn’t sound pretentious to my ear. Calling myself a specialist, an expert or a troubleshooter always sounded contrived. Anyway, as we talked further it became apparent that he harboured his own discomfort in calling himself a consultant, as he, like me, considered himself a ‘doer’ and not a theorist in his field of endeavour, change management.

I too worked in change management, but my area of expertise was very different from his and he was fascinated when I talked about the cultural side of managing change. He worked in IT for CSC Index, a US management consultancy, this being the first time I’d heard of them. He knew that the firm needed to evolve its own way of thinking and out of that evening there developed a working relationship between my company and the senior consultants within CSC Index London.

At that time initiatives to implement the teachings of the bestselling Reengineering the Corporation had begun to hit up against the bulwarks of entrenched management power. As chairman of the consultancy entrusted to oversee such initiatives, Jim Champy, resolved to write a sequel, Reengineering Management. The problem was that ‘collegiate leadership’, the subject matter of the second book, was proving difficult for the CSC Index consultants to live out. Being a consultant in a firm is often a competitive way of life, not a collegiate one!

A life-changing telephone call

After a couple of months from starting to work with these guys I received a telephone call one evening from the managing director of CSC Index London. After we’d exchanged pleasantries he said, “We’ve just won a large contract with Pfizer Pharmaceutical. The brief is simple: we need to help them get their drugs to market more quickly, so less of the patent life of each drug is lost in development and more of the 20-year licence is used selling it.”

My initial thought was ‘How interesting’ and ‘What’s led you to call me with this news at 7pm?’ His reason for the call started to become clearer as he explained this: “The problem is we’ve spent a few weeks with the company and realised that it’s not just about reengineering processes or the accompanying IT systems: there’s a major job to be done in changing attitudes and the culture of how they operate.”

I agreed to meet him, still not completely clear how we might be able to help and yet the meeting that took place turned out to be momentous - for Pfizer, for my career and for the direction of our thinking towards ‘change by choice’, a methodology that we went to develop.

It’s not what you do, but the way that you do it

The truth was that CSC Index weren’t clear how to bring about the cultural change that they were starting to realise was necessary. It was the way people thought, their attitude and mindset that were the key to changing what they did. This uncomfortable realisation was compounded for CSC Index by the fact that, around that same time, some of their other process-reengineering projects were starting to go sour. This was mainly due to their clients’ staff perceiving the reengineering of processes as an imposition and resenting it. They felt these new ways of doing things were being parachuted in, without there being any awareness of a case for action let alone any buy-in to the action proposed. CSC Index was fearful that the Pfizer project might go the same way.

The crux of the meeting that followed was the request for my firm to be an associate company to CSC Index on the Pfizer project. Our goal was to bring about such managerial and cultural changes as were necessary in order for the process and system changes to be effective. There was a further twist: the lead CSC Index consultant who lived in Boston USA, who was going to drive the project, would be based in Groton, Connecticut where the drug development team that Pfizer had given him to work with was based.

Pfizer then changed this initial decision as they wanted to minimise risk. They asked us to ‘experiment’ on a drug development team that was working on a slightly less important angina drug, a drug that nevertheless had interesting side effects. This team was based at Pfizer’s plant in Sandwich, Kent.

Teaching ‘stiff’ lessons about change

So having accepted the role of ‘culture change expert’ within the team of consultants, I found myself attending a three-day conference on the south coast of England to learn about this new angina drug. On my second day there, I found out that the head consultant wasn’t prepared to live and work in the UK for the 18-month life of the contract so, by default, I was to be the lead consultant.

I spent those three days furiously writing notes, trying to understand how the pharmaceutical industry worked. The conference decided that they would recommend to the Pfizer Board that they should commit the company to the huge cost of the phase-three trials of this failed angina drug, as its side effects might have a small, but worthwhile market. The code name of the compound was UK96480; the trade name later selected was Sildenafil and, further down the line, the name chosen to market it under was, of course, Viagra.

It would probably be somewhat priggish not to mention some of the stories relating to this product. Many of them convey an important change lesson to be learned. Others were just plain funny. For instance, I have been privy to Viagra jokes like, ‘Don’t leave them under your pillow as they will give you a stiff neck.’ Probably a comment made at the end of the conference was the funniest, the laughter springing from who said it as much as from what was said.

But first some context about how this drug enforced a range of changes on an organisation that may have been planning change, but not this!

The original compound had been trialled in phase-one studies (in the lab and on animals) to test the effectiveness of the indication, namely that it could reduce the effects of angina. The results were poor, but not poor enough to scrap it, so phase-two trials were designed and carried out. These were small-scale trials on people. Again the results for helping with angina were still quite poor but some of the men, who had been unable to get an erection, found themselves ‘rising to the occasion’ if there was a nurse they fancied in attendance! (The point about the nurse needing to be one that the man found attractive indicated that it was not an aphrodisiac, which increases libido or sexual desire, but only worked in conjunction with what would normally turn these men on.)

The conference I attended had been organised to gather all the Pfizer research and development scientists together from all over the world. They were there to debate the evidence and to see if there was a consensus for recommending phase-three large-scale trials in people to the board. Any phase-three trial is a very expensive and lengthy process.

Unforeseen change of branding and change of direction

It became apparent that this pre-phase-three conference was like no other, for several reasons. Firstly, even if phase three could prove that the compound was safe and effective in helping ‘erectile dysfunction’, as the condition is called, was there a market for it? And if so, is it a market a respectable pharmaceutical company should be involved with? This had important ramifications for Pfizer. Did the company want to change its brand by developing a drug in this area? Did the scientists, who had a real passion for helping mankind, want to be associated with this kind of drug? This issue was emerging as a significant change in tone if not in substance, and so it was becoming critical to obtain a strong degree of buy-in to the proposed action

By the time of the conference, the British tabloids had managed to get hold of the story of the phase-two discoveries. This led to several knock-on effects. One was that the general information desk at Pfizer was suddenly bombarded with the world’s press telephoning, along with many ‘pervy’ blokes, saying all kinds of sexually-orientated things down the line! The problem was this information desk was populated by several part-time women, all in their middle years, who were only used to a trickle of calls about the latest diabetes drug or vaccination being developed. Calls about experiments to arouse men were not something these women were used to. This called for another unplanned change. A large crew of unshakeable media-savvy telephone answerers had to be drafted in. One of many unforeseen impositions on Pfizer’s existing culture.

Is there a market for this?

As for the market need, I remember several letters being read out at the conference from men as far apart as Indonesia, Italy and India. They had all got to hear about the phase-two trials and were pleading to be considered for the phase-three trials, as their marriages would be ‘in ruins’ if they were not helped to be able to father children. Interestingly, there was no process in place at this stage of drug candidate development between R&D and the marketing department, so no one in marketing was asked to find out if such a potential market existed. Another part of the status quo that would need to be changed!

Although there was anecdotal evidence from men who were desperate enough to father children that they spoke out, there was no reliable data on erectile dysfunction and therefore no idea of the extent of the market for a treatment. This was mainly due to men’s embarrassment in admitting to something that up until then was not thought to be curable by medicines outside of the herbal and alternative variety.

The thought that most of those who went on to use Viagra would do so as a lifestyle drug was something completely outside of the Pfizer way of thinking. That entailed a change in Pfizer’s view of itself that wasn’t so much resisted as never considered. Pfizer employed serious-minded scientists who worked on mainstream research and who hitherto could not have imagined themselves developing something so frivolous as a lifestyle drug. Who would have predicted it would gross the company $1m per day a few years after its launch!

It was against this rather straight-faced backdrop that, at the end of the third day of the conference, the compound development director, David Cox, stood in front of his 70 or 80 fellow scientists to sum up the conclusions of the three days. He finished his summary by announcing the decision to recommend to the Board that they should move to phase three.

Then, in his tweed jacket and open-toed sandals over socks, he announced that a mission statement would be needed to bring everyone together in the common cause that lay ahead of them. As he was saying they needed a mission statement, he was unbuttoning his shirt! This produced some giggles. He had a white T-shirt on underneath and with flawless timing he undid the last button, quickly drew back both sides of his opened shirt and in a deep, Patrick Stewart-type voice, read out the words on his vest: “Our mission is to boldly go, where no man has come before!”

A failure to read the prescription

The two years that followed, working on the Viagra project, were fascinating, exciting and very demanding. I learned a tremendous amount about how mainstream consultancies worked, of process reengineering and of systems design and implementation. My role in all of this was to ensure that there was a blended approach to change-in-the-round, not just a blinkered obsession with one aspect, such as processes or systems or culture.

One thing became very clear to me fairly early on as the project proper got under way. The reason that process reengineering seemed to have had such shortcomings wasn’t to do with the process-reengineering concept being flawed, it was to do with the way the new processes were developed and implemented.

Nobody seemed to spot that if you take the cream of an organisation, stick them in a room for three months and get them to design the best integrated processes they can think of, that there may be a problem when you try to introduce these flashy new processes to a workforce they hadn’t seen for 90 days! There seemed to be a blind spot among those who had been seconded to the process labs and the consultants fired up with their brave new world. Why wasn’t a more all-involving approach taken by CSC Index as championed by their own chairman, Jim Champy, in Reengineering Management? You must make a compelling argument for change, he said. That’s the wedge for getting people unstuck. Then you must ensure everyone understands what the company needs to become, the vision. That’s the magnet.

Ironically the answer to the question was to do with the prescribed three-stage approach NOT being followed. In simple terms, the people who had designed these flash new processes had bought into the case for action and vision in a way that those not present hadn’t, i.e. the people back in the plant who found themselves being tasked with doing things differently, without having been consulted, without having been part of the thought process.

‘Not invented here’: a real stumbling block to change

If those not party to the reengineering deliberations had been involved, they may have come up with similar conclusions; but ‘not invented here’ is a visceral reaction - a syndrome frequently encountered by CSC Index in its client work. Where staff haven’t bought into the need for change, the more that new processes are pushed, the more they refuse to be responsible for making the changes work. In a few extreme cases when people were held accountable for implementation failures and threatened with dismissal they, quite understandably, were prepared to fight.

In short, no buy-in.

The breakthrough with the Viagra project was when my fellow consultants came to agree that winning the hearts and minds of the broader Viagra team we were working with was important, and that enabling all team members to understand the case for action and put forward ideas for what needed to change was a critical first step. This all had to happen before we could start to look at processes, systems, structure and behaviours.

Pfizer senior managers were initially reluctant to afford the extra time needed to build up this buy-in to the case for action and the proposed changes because, to them, the answers were obvious. However they relented, and the extra months invested in getting the rest of the Pfizer V-team on board and, importantly, prepared to come forward with their own ideas as to what needed to change, proved hugely productive in the long run.

This team alignment was especially important as the Viagra project hit up against some unforeseen change. Unexpected change is unsettling and can’t be planned for, or buy-in to remedial action sought so easily, so the fact that the whole V-team understood the case for action, had helped choose the proposed action and had signed up to play their part in implementing it, was crucial to moving forward with one mind in the face of unexpected eventualities.

Certainly a lot easier than me and a band of consultants with a few senior managers trying to push change upon them from the top down!

Choice-led change

One of the consequences of this more considered choice-led change was a desire, in the form of requests from team members, to have their progress measured, and to be held accountable! The achievement of this degree of commitment created a momentum for change that grew in strength over time and only needed guidance, rather than constant pushing.

The success of the team that trail-blazed an integrated approach to doing things inspired others within the Pfizer organisation. The change process we fashioned not only ended up getting Viagra to market months ahead of schedule, but also formed the blueprint for how to get drugs to market more quickly for other drug candidate development teams within Pfizer.

In summary

Next time you want to change something, be it at home, your local pub or at work, consider all those affected, and help them to (a) understand and buy in to the need for change, (b) envisage a better way of doing things, and (c) contribute to making the ideas reality.