Marketing Masterclass

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1 Marketing Masterclass Are pharmaceutical (or healthcare) companies achieving true marketing excellence? Paul Stuart-Kregor is a Director at The MSI Consultancy, a specialist pharmaceutical marketing company providing consultancy, strategic research, training and IT solutions for the pharmaceutical industry throughout the world. Over the last 10 years, Paul has acted as consultant to many top pharmaceutical companies, developing a reputation for delivering insight and workable solutions to commercial problems. For more details go to Paul Stuart-Kregor The MSI Consultancy Ltd Weaver s Yard West Street Farnham GU9 7DN, UK Tel: +44 (0) Fax: +44 (0) INTRODUCTION Much has been written and discussed recently about marketing excellence in the pharmaceutical industry. With the increased pressure on companies to increase the return on the investment in research and development (R&D), clearly companies are looking to add or extract the maximum value from corporate assets. With the increasing costs of salesforces, companies are recognising the need to act smarter, in part through more effective marketing. This survey is an attempt to see just how good marketing is in the healthcare industry, and where there is need for improvement. METHODOLOGY A schema covering all aspects of Marketing Excellence was developed, (Table 1) from a number of sources and based on experience, that includes understanding the market and the customer (true market insight), ation, developing the value, strategy, successful implementation, measuring profitability, monitoring the value delivered and innovation. Within each of these areas, the key drivers of marketing excellence were detailed, and a range of performance defined for each driver. In some cases, there were a maximum of five levels of performance, in others four or three. In total, 22 key drivers were assessed. Marketers and their managers from a range of healthcare companies were then invited to participate in a self-completion process on a secure website. They were asked to choose the level of performance for each key driver of marketing excellence appropriate to their perception of marketing within their organisation, from the performance level options presented, derived from the Marketing Excellence benchmark. This method relies on the respondent understanding the definition of the performance level. Therefore, care was taken to ensure that the definitions were clear and where necessary, expanded. These expanded definitions were available by mouse-over movements when online. The results are based on the perception of the respondent without any direct or objective third-party assessment. In many cases however, the author and his colleagues knew the respondents and their marketing. Where responses were clearly erroneous or incomplete they were not recorded in the overall analysis. # Palgrave Macmillan Ltd /06 $30.00 Vol. 6, Journal of Medical Marketing 19

2 Stuart-Kregor Table 1: Schema used for analysis 1 How do you define your market? 2 How well do you understand customers current needs? 3 How well do you understand customers latent needs? 4 How do you monitor motivators of customer choice 5 How well do you manage the future Marketing excellence audit Understanding the market and the customer; true customer insight Defining markets Markets not defined IMS single class IMS class definition market definition market covering all true competitors Defining markets Markets not defined IMS classification single class-based definition Understanding customers current needs identified and understood Understanding customers current needs identified and understood Understanding customers latent and potential future needs identified and understood Understanding customers latent and potential future needs identified and understood Understanding customer behaviour Future environment predicted and assessed 6 How well do you understand drivers of drivers of success success beyond the product/ brand, eg company capability Customer needs not understood Customer needs not understood at all No attempt to identify future needs No attempt to identify other needs that could become important Drivers and motivators of customer choice not researched No process for identifying change in market No understanding of what really drives success in the market Basic customer needs understood at market level Customer needs understood at a very basic and market level: efficacy, safety, tolerability, convenience and price IMS classification (multiple) class-based definition covering all true competitors Basic customer needs understood by Customer needs understood at a very basic level by : efficacy, safety, tolerability, convenience and price Basic customer latent Basic customer and potential needs latent and potential understood at market needs understood level at level Customer latent and potential needs understood at a very basic and market level: future efficacy, safety, tolerability, convenience and price Drivers and motivators of customer choice only researched irregularly Macro change in market conditions identified but no understanding of impact Customer latent or future needs understood at a very basic level by :: future efficacy, safety, tolerability, convenience and price Drivers and motivators of customer choice only researched when there is a need to do something different Integrated process for identifying market change and impact by Some understanding of what drives success in the market in general Customers determinant needs understood by Customers determinant needs understood at level in addition to efficacy, safety, tolerability, convenience and price for each Customers deeper latent and potential needs understood at level Customers latent and potential needs understood at level in addition to efficacy, safety, tolerability, convenience and price for each Sporadic system for checking drivers and motivators of customer choice, at intervals appropriate to the market Integrated process for identifying market change, impact by and acting upon them Customer-based definition Customer-based definition: based on what the brand does for the customer Current true motivators to brand usage understood for each Current true motivators and/or inhibitors to brand usage identified and understood for each Potential true motivators to brand usage understood for each Potential true motivators and/or inhibitors to brand usage identified and understood for each Regular system for checking drivers and motivators of customer choice, at intervals appropriate to the market Segment strategies future-aligned with strategic options based on different environmental scenarios Clear definition of each capability and the optimum level that drives success in each 7 How well do you understand advantage Understanding advantage Perception of advantage based on internal perspective product/brand differentiating features and benefits from customers perspective product/brand choice determining features and benefits from customers perspective your true advantage from an internal analysis based on customer perspective (of value ) and intelligence Clear understanding of your and your competitors advantage from fact and analysis based on customer perspective (of value ) and intelligence 20 Journal of Medical Marketing Vol. 6, # Palgrave Macmillan Ltd /06 $30.00

3 Marketing Masterclass 8 How do you use intelligence Monitoring competitor activity Monitoring competitor activity No understanding of competitor activity No understanding of competitor activity what competitors do but not their marketbased capability what competitors do but not how they measure against drivers of success in the market/ what competitors do and why, but not their market-based capability what competitors do and why, but not how they measure against drivers of success in the market/ what competitors do, why and how they measure against drivers of success in the market/ what competitors do, why, their strategies and how they measure against drivers of success in the market/ Competitive intelligence in place that obtains relevant information, interprets it and derives a so what, eg decodes their strategy Competitive intelligence in place that obtains relevant information, interprets it and derives a so what, eg decodes their strategy 9 How good is your ation? Segments defined Segments defined No s defined No s defined Segmentation unclear and/or not actionable Segmentation unclear and/or not actionable Segmentation Segmentation based on standard variables Segmentation based on standard variables, eg channel; speciality; disease states Segmentation based on additional variables but not true customer ation Segmentation based on additional variables, eg patient type, but does not lead to true customer ation Customer s that provide a basis for a truly differentiated and value Customer s defined that provide the basis for a truly differentiated and value 10 Are your value s compelling? Putting together (superior) value s to meet those needs Putting together (superior) value s to meet those needs Value undefined Value undefined: just product features based Developing the value Customers do not perceive the value of your offering Customers do not perceive the value of your offering to be meaningful and differentiating and do not see value for money Customers perceive your offering to be meaningful and/or differentiating but not value Customers perceive the value of your offering to be meaningful and differentiating but do not see value for money Each target customer perceives the value of your offering and acts on it Each target customer perceives the value of your offering to be meaningful, differentiating and value for money and acts upon it 11 What is the basis for your strategy 12 How is your strategy Basis for strategy Basis for strategy Competitive in every way No definition of strategy based on Opportunity Attractiveness/ Competitive Position No definition of strategy based on Opportunity Attractiveness/ Competitive Position Strategy does not sustain advantage over time Strategy SWOT aligned but strategy only at global market and company level SWOT aligned, ie based on Opportunity Attractiveness/ Competitive Position: but strategy only at a global market and company level Strategy builds and sustains advantage over time (medium to long term) SWOT aligned: based and progressive over LRP period with CSFs clearly identified by SWOT aligned, ie target s based on Segment Attractiveness/ Competitive Position: based and progressive over LRP period with CSFs clearly identified by Strategy builds and sustains advantage over time and manages competitor action or reaction # Palgrave Macmillan Ltd /06 $30.00 Vol. 6, Journal of Medical Marketing 21

4 Stuart-Kregor Competitive in every way Strategy does not build and sustain advantage over time: either short-term focussed; or does not build true advantage Strategy takes into account how to build and sustain advantage over time (medium to long term) Strategy takes into account how to build and sustain advantage over time plus accounts for and predicts competitor action or reaction 13 How well do you plan? 14 How effective is your internal communication of your strategy? Planning Planning Communicating the value s to those in the organisation responsible for delivering them and getting these people to buy into their role Communicating the value s to those in the organisation responsible for delivering them and getting these people to buy into their role No marketing plans exist No marketing plans exist Business management can explain strategy Business management can explain strategy Successful implementation Marketing plan at market level Business and marketing management know market strategy and value Business and marketing management know strategy and value for the market For market overall: strategic intent, value, action plan, measures of success Business and marketing management know for each : strategy, value Business and marketing management know for each : strategy, value Marketing plan at market level with some adaptation by For market overall: strategic intent, value, action plan, measures of success with some adaptation All people in all key functions know for each : strategy and value All people in all key functions know for each : strategy and value Plan for each : strategic intent, value, action plan, measures of success For each : strategic intent, value, action plan, measures of success All people in all key functions understand the value, their role and achieve their relevant objectives All people in all key functions understand the value, their role in delivering it and achieve their objectives relevant to that 15 What role do you play in implementing the strategy 16 How do you measure success? Playing an appropriate part in delivering these value s Measures of marketing success defined Marketing team does not understand their roles and responsibility in defining and delivering the value s No measures of success set for salesforce activities Marketing team understand their roles and responsibility in the marketing process and deliver required outputs set for some activities Success defined and measurable results set and monitored for majority of activities Marketing team understand their roles and responsibility in delivering the value over and above internal processes, ie with customers Success defined and measurable results set and monitored for all key aspects of plan 17 Do you measure profitability? Delivering results No measures of success Profitability Measure only revenue and volume Measure global profit Profitability measures defined by 18 What is the customer perception of value, brand and benefits Customer perception of value, brand and benefits Value delivers no value to customers Monitoring the value delivered Value delivers some value but fails to meet target customers expectations Right brand, right benefits, right relationship that continues to deliver value that meets or exceeds target customer expectations 22 Journal of Medical Marketing Vol. 6, # Palgrave Macmillan Ltd /06 $30.00

5 Marketing Masterclass 19 How do you monitor customers value perceptions 20 How integrated is your marketing strategy with budgeting? Customer perception of value, brand and benefits Monitoring and reviewing the perceptions of customers and the value actually delivered. Monitoring and reviewing the perceptions of customers and the value actually delivered. Integration into budget planning Value delivers no value to target customers as shown by market research No measurable targets No measurable targets No link between market plans and budget plans and irregular measurement of some aspects of value and irregular measurement with target customers of some aspects of value Cursory consideration of market plans for budgeting Value delivers some value to target customers but fails to meet customer expectations shown by market research and irregular measurement of key aspects of value by and irregular measurement with target customers by of some of the key aspects of value Budget planning is completed at a market level and consistent measurement of key aspects of value by and consistent measurement with target customers by of some of key aspects of value Budget planning linked to a marketbased forecast but still at market level Right brand, right benefits, right relationship that continues to deliver value that meets or exceeds target customer expectations shown by market research and consistent measurement with target customers by of all key aspects of value and consistent measurement with target customers by of all key aspects of value Budget planning is completed at a level linked to a level market-based forecast 21 How innovative are you? 22 Do you improve continuously? Creation of new differentiating offerings within value Continuous improvement No evolution of value in last 3 years No continuous improvement Innovation based on insight Some changes in value in previous 3 years but no incremental value Basic annual review of plans Changes in value in previous 3 years that customers say has added incremental value or advantage Regular business team review of ation, strategic intent, value s, marketing mix, measures of success Changes in value in previous three years that customers say have added significant incremental value or maintained advantage Integrated process for continuous improvement of rolling annual plans Actual responses were assessed against a 5-point scoring system, with a range from 1 to 3. RESULTS A total of 36 marketers or their managers submitted complete and valid answers, from 10 companies and 13 countries. Of these, 18 responses were from Top 5 companies, and 13 from companies focusing in limited therapy areas. The majority of the 36 were from European countries but there were 10 responses from personnel in global, international marketing or management positions. Initial analysis shows a population that sees their marketing as being good but on the basis of this benchmark, shows that there is room for improvement. Of all the responses, 22 per cent of the possible scores were top scores (3) and 43 per cent of the possible scores were at the next level (2). Nearly all the scores were at the mid-level or above. # Palgrave Macmillan Ltd /06 $30.00 Vol. 6, Journal of Medical Marketing 23

6 Stuart-Kregor Customer insight Markets still appear to be defined in the main by using the Institute of Medical Science/World Health Organization (IMS/ WHO) drug classification as shorthand for the market in which the brand competes. More than half the managers perceived that the company uses customer-based market definitions, but the operational marketers in particular saw a more IMS driven definition that covers all the key competitors. When it comes to understanding customer needs, the overall impression is that marketers and their managers perceive there is a good understanding of the needs at level and the needs on which the prescribing choice is made by. One-third of respondents felt they understood true motivators to brand usage by, with another third understanding customers determinant needs by. The final third understood customers basic needs by. Only in one response were basic needs understood at market level. There was a marked difference when it came to the perception of the understanding of latent needs or potential true motivators of prescribing. Only onethird considered they understood the deeper latent needs or potential true motivators; half the respondents felt that they understood basic latent needs at level. Monitoring motivators of customer choice is not a regular, periodic and systematic process in the pharmaceutical industry. Only 25 per cent of respondents said they checked the customers drivers and motivators at appropriate intervals for the market, and these were mainly managers. Approximately half checked sporadically with the rest, only checking irregularly or when there was a need to do something different. When it comes to managing the future, less than 15 per cent of respondents said they had strategies future aligned, plus strategic options based on different environmental scenarios. Onethird had an integrated process for identifying market change, the impact by and appropriate actions, with another third having a process for identifying market change and impact by, while one-quarter still only identified the macro environmental changes without understanding their impact. What drives success in a market is perceived to be well understood by 25 per cent of the respondents, ie clear definition of each capability and the optimum level that drives success in each, with 70 per cent having some understanding. The majority of respondents felt they had a good understanding of advantage, with 50 per cent understanding their true advantage from an internal analysis based on customer perspective (of value ) and intelligence and 20 per cent from a fact and analysis basis. The remaining quarter only had an understanding of product/brand features and benefits that determined choice from the customer s perspective. Only 10 per cent of respondents appeared to have an effective competitor intelligence system, ie that obtains relevant information, interprets it and derives a so what, eg decodes their strategy. Understanding what competitors do, why, and how they measure against drivers of success in the market/ was recorded by 28 per cent of respondents, while 50 per cent understood what competitors do and why, but not how they measure against drivers of success in the market/. Segmentation Only a minority practise true customer ation. Of all the respondents, only 22 per cent (8) have a ation model 24 Journal of Medical Marketing Vol. 6, # Palgrave Macmillan Ltd /06 $30.00

7 Marketing Masterclass based on customer s that provides the basis for a truly differentiated and value ; 33 per cent use standard variables, eg channel; specialty; disease states, while 42 per cent use additional variables to the standard ones, eg patient type, but this does not lead to true customer ation. Value Not surprisingly, only 10 per cent of respondents therefore think that each target customer perceives the value of the offering to be meaningful, differentiating and value for money and acts upon it. Only one of these respondents however, had a customer-based ation model. The rest of the respondents who said they had a customer ation model (20 per cent) were in a similar position to the majority (58 per cent) who think that their customers perceive the value of their offering to be meaningful and differentiating but do not see value for money. The remaining 10 per cent thought that their customers do not perceive the value of their offering to be meaningful and differentiating and do not see value for money. Strategy Strategy appears to be defined in line with good planning practice. The majority (61 per cent) of respondents felt their strategy was SWOT aligned, ie the target s were based on an assessment of Segment Attractiveness and their Competitive Position, the strategy was based and progressive over long-range planning (LRP), with Critical Success Factors (CSFs) clearly identified by. The rest felt their strategy was SWOT aligned, ie based on Opportunity Attractiveness/ Competitive Position, but strategy only at a global market and company, not, level. When it comes to the ness of that strategy, performance is not perceived to be as strong. Only 25 per cent of responses suggested that in addition to building and sustaining advantage over time, the strategy also accounts for and predicts competitor action and reaction; 61 per cent felt their strategy built and sustained advantage over the medium to long term but without taking account of competitors, while 14 per cent felt their strategy does not build and sustain advantage over time either because it is too short-term focussed; or it does not build true advantage. Successful implementation Implementation of the strategy is not as good as it could be. While everyone writes marketing plans, only one-third do so at level, ie for each : strategic intent, value, action plan, measures of success; 53 per cent develop a marketing plan at market level with some adaptation by and the rest just plan at market level, even though they are local country marketers. Internal communication of those plans clearly needs improving. Only 14 per cent of respondents agreed that all people in all key functions understand the value and their role in delivering it and achieve their objectives relevant to that ; 25 per cent felt that all people in all key functions at least know for each the strategy and value. In the majority of cases (53 per cent) however, it is only business and marketing management that know the strategy and value by or overall. The role marketing plays in delivering the strategy suggests that the function is not as customer facing as it needs to be. Only in one-third of cases does the marketing team understand their role and responsibility in delivering the value over and above internal processes, ie with customers. Two-thirds # Palgrave Macmillan Ltd /06 $30.00 Vol. 6, Journal of Medical Marketing 25

8 Stuart-Kregor still see their role purely in terms of the marketing process and delivery of the required outputs. Measurement of success is clearly top of mind however, as 25 per cent of respondents agreed that success was defined and measurable results set and monitored for all key aspects of the plan, a further 50 per cent doing so for major activities, while 25 per cent only set measurable targets for some activities. Only in two cases were measures either not set or just set for salesforce activities. Profitability The majority of companies still only measure global profit (78 per cent) with 14 per cent still measuring just revenue and volume. Three companies however, measured profitability by. Monitoring value delivered Customer perception of the value, brand and benefits delivered is sub-optimal. Only 17 per cent felt that they had the right brand, right benefits, right relationship that continues to deliver value that meets or exceeds target customer expectations, as shown by market research. These were predominantly managers. The majority (81 per cent) felt that the value delivered some value to target customers but failed to meet customer expectations, as shown by market research. Monitoring target customers value perceptions across the whole value is only carried out by 10 per cent of respondents; 42 per cent have measurable targets and consistent measurement with target customers by of some of the key aspects of value, with a further 16 per cent doing this irregularly. One-third however, either measured certain aspects irregularly on a global target customer basis or not at all, more so at operational marketing level (Figure 1). The result of the marketing strategy is 3 2 SCORE QUESTION OPERATIONAL MARKETING MEAN Figure 1: Operational marketers 26 Journal of Medical Marketing Vol. 6, # Palgrave Macmillan Ltd /06 $30.00

9 Marketing Masterclass generally well integrated with the budgeting process, with 39 per cent planning the budget and forecasting at a level and 47 per cent doing so at a market level, in both cases using market based forecasts. Innovation Two-thirds of respondents felt that changes they had made in the value in the previous 3 years have added incremental or significant incremental value, based on customer feedback. One-third had however, either made changes that added no incremental value or not evolved the value at all in the previous 3 years. There is clearly an intent to improve, since 10 per cent said they had an integrated process for continuous improvement of rolling annual plans and 50 per cent said they had regular business team reviews of ation, strategic intent, value s, marketing mix and measures of success. The rest perform a basic review of plans annually. Interestingly, it is at international level that there tends to be only the basic annual review, with only a few exceptions. DISCUSSION In a previous issue of this Journal, this author asked whether healthcare marketing can be classed as excellent. 1 The present results help answer that question in part. The results however, have to be treated with care, as they are self-completed surveys, where interpretation of the definitions may be variable, with no postsurvey validation through examining the real marketing processes or the outputs derived from them. Our findings suggest that the current state of healthcare marketing is, like many, an end of term report, good in parts but could do better; the phrase room for improvement springs to mind. Smith has demonstrated that using a robust and appropriate process is the key to developing strong strategies, with a strong strategy targeting real s, having specific value s, being SWOT aligned, predicting the future and being unique. 2 In support of Smith s findings, 3,4 this survey suggests that healthcare companies have adopted good practice when it comes to the strategic planning process, eg all companies believe they develop SWOT aligned strategies and write marketing plans, but the quality of the output clearly is short of being excellent. A tenet of the strong strategy argument is having compelling specific value s. In the majority of cases in this survey, the marketers clearly thought that customers perceive their value as meaningful and differentiating, but not value for money, thereby failing to deliver true value as perceived by the customer. Where a -based value has been developed it is only seen as compelling by the customer in 10 per cent of cases. While many of the products that healthcare companies market are expensive when compared with generic equivalents, this does not mean they cannot be seen as offering value. Excellent marketing has to be about creating a value, the right mix of functional benefits and emotional benefits that justify the price in the eyes of the customer. This can be a challenge in healthcare, as there is the perception that customers want everything to be cheap. If marketing creates the right value however, then the target customer should perceive that the brand offers value for money. Recent experience with customers suggests that new approaches to treatment are often seen as expensive because the true value is not fully understood. Over time, this value becomes clear and then the cost is not questioned. An example cited by a # Palgrave Macmillan Ltd /06 $30.00 Vol. 6, Journal of Medical Marketing 27

10 Stuart-Kregor customer recently compared the perceived cost of stents when they were first introduced, and the consequent debate to the situation of clopidogrel today. Stents have since become the mainstay of coronary vascular interventions. The failure to demonstrate value may in part be due to the level of true customer and market insight. Only a minority of respondents felt they really understood the true motivators of prescribing behaviour, current or latent, nor was there a process in place to check those motivators at appropriate intervals. Rather there was sporadic checking or only when there was a need to do something different. Developing truly compelling value s is going to be dependent upon the bases used for ation. These results suggest that healthcare ation is still a long way short of true customer ation. While ation has moved on from using basic parameters, only 22 per cent of respondents admitted to a true customerbased ation model. Without customer-based ation it is hard to see how truly compelling value s can be developed since our customer base is not homogeneous. Just ing on the basis of one or two parameters, such as patient and/or disease type, identified in earlier research, 5 is hardly likely to enable us to develop customer centric value s. There is no way we can identify areas that need to be improved however, if customer perceptions of our value perceptions are not monitored regularly. Only a very small part of the sample monitored the whole value regularly. This may in part be due to a lack of true marketing foundation, ie not knowing what a value in healthcare should look like. Too often the focus is just on the product not on the brand and/or added value beyond the purely functional aspects of the product. The survey also suggests that the focus of marketers is still more internal than it should be. In addition to the lack of customer insight, many are not managing the future effectively, nor are they really taking account of competitor action and reaction. In addition, marketers still see their role as process output rather than truly customer facing. The natural marketers recognise the need to be in tune with their customers, which can only come from customer contact. How much marketers should be involved in delivery is a debatable point, but surely we have got beyond the days of ivory tower marketing. There also seems to be a blind trust in activity driving results. It is worrying that by far the majority do not think they understand what drives success. In which case, how can they possibly be excellent in their marketing? One likely result is the sub-optimal use of resources, with potentially much effort wasted, let alone effective development of meaningful value s. When it comes to implementation, something that marketers pride themselves on, there are areas for improvement. Not so much from marketing implementation, but communication of the strategy and its execution. If the strategy is to be successfully implemented, then those implementing it must understand it and their role. These results suggest that only a minority ensure that this happens, with the majority appearing to rely on management to communicate as required. It is essential that all key parties should understand what they need to do and why. What is encouraging however, is the increased focus on the measurement of success. This will help address some of the gaps in understanding that lead to excellence, including what drives success. Finally, the differences between managers of marketers and the operational marketers are intriguing (Figure 2). 28 Journal of Medical Marketing Vol. 6, # Palgrave Macmillan Ltd /06 $30.00

11 Marketing Masterclass 3 2 SCORE QUESTION MANAGERS MEAN Figure 2: Managers of marketers Table 2: Results True score means (range: 1 3) Managers Operational marketing Local marketing managers International marketing Top 5 Top 5 major markets All How do you define your market? How well do you understand customers current needs? How well do you understand customers latent and potential future needs? How do you monitor motivators of customer choice? How well do you manage the future? How well do you understand drivers of success? How well do you understand advantage? How do you use intelligence? How good is your ation? Are your value s compelling? What is the basis for your strategy? How is your strategy? How well do you plan? How effective is your internal communication of your strategy? What role do you play in implementing the strategy? How do you measure success? Do you measure profitability? What is the customer perception of value, brand and benefits? How do you monitor customers value perceptions? How integrated is your marketing strategy with budgeting? How innovative are you? Do you improve continuously? n # Palgrave Macmillan Ltd /06 $30.00 Vol. 6, Journal of Medical Marketing 29

12 Stuart-Kregor Given the size of the sample it is hard to be definitive, but as some of the managers and operational marketers were from the same operating companies, it suggests differences of perception. The managers scored a number of factors noticeably higher than their teams: market definition, monitoring customer motivators of customer choice and value perceptions, managing the future and innovation. The question is who is right, the manager or the operational marketers. If it is the latter, then one can hypothesise that the managers are complacent and/or not pushing the teams hard enough to truly excel. On the other hand, the operational marketers may be more pessimistic because they do not feel they know all the answers, and need more information (Table 2). CONCLUSION The overwhelming impression from this survey is of an industry that thinks it is doing a reasonable job, but is not pushing itself to excel. In many cases, the result is a reactive rather than proactive approach to the market, with not enough effort being made to keep up with changes in customer drivers, nor to effectively manage the future. On the basis of our customers perception of the value delivered, healthcare marketing is far from being excellent. The processes are in place to drive excellence, the question is, is there the will? References 1 Stuart-Kregor, P.A.C. (2005) Can healthcare marketing be classed as excellent?, Journal of Medical Marketing, 5(2), Smith, B.D. (2004) Making marketing happen: How great medical companies make strategic marketing planning work for them, International Journal of Medical Marketing, 4(2), Smith, B.D. (2003) An empirical investigation of marketing strategy quality in medical markets, International Journal of Medical Marketing, 3(2), Smith, B.D. (2003) Making marketing happen: Success and failure in marketing strategy making: Results of an empirical study across medical markets, International Journal of Medical Marketing, 3(4), MacLennan, J. and MacKenzie, D. (2000) Strategic market ation: An opportunity to integrate medical and marketing activities, International Journal of Medical Marketing, 1(1), Journal of Medical Marketing Vol. 6, # Palgrave Macmillan Ltd /06 $30.00

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