Clinicians and Product Sales Representatives: Developing a Relationship that Works

   As healthcare becomes more business-oriented, traditional roles change.¹ Clinicians are challenged with assuming greater fiscal responsibility and meeting the expectations of cost containment.

This requires more direct involvement in product evaluations and decisions, which necessitates developing a working relationship with sales representatives. A number of articles have been written about the relationships between physicians and pharmaceutical sales people. However, information about the relationship between other clinicians and product representatives has not been published in the literature. Basic educational programs in healthcare fields can be as short as a 1-year training program, as in the case of an operating room technician, or longer in programs such as nursing that offer a college degree. One common goal of all programs is that client-centered care is planned and delivered to help maximize wellness. As a rule, methods for coordinating product evaluations, performing cost-benefit analysis, or obtaining sales negotiations skills are not formally taught. Clinicians in specialty areas such as wound care or the operating room often acquire the necessary skills to navigate sales relationships through experience and trial and error. Expensive mistakes can occur when a clinician is not prepared for common sales tactics - mistakes that can have a negative effect on the practitioner's credibility or potentially lead to a negative outcome for patients.

   Creyer² notes that the most important traits influencing the physician's perceptions of sales representative are trustworthiness, ethical behavior, and the ability to provide accurate information. Crosby³ asserts that sales opportunities are affected by the ability of the representative to build trust and satisfaction into a sales relationship. The sales representative is often the primary source of contact with a company, making it critical for the representative to establish a reputation for accuracy of information.

The Sales Force

   The sales representative's main agenda is to demonstrate that the products will be beneficial and solve a current problem. The mission is to provide education about the product(s) and to generate enough interest to persuade the listener to make a purchase.⁴ To this end, medical sales companies commonly hire product representatives with previous experience in either sales or healthcare. Any skills lacking are added to the basic training curriculum on an individualized basis. Topics in a typical sales training program may include effective listening, accurate assessment of customer needs, product demonstration, research-based product validation, customer service skills, and creating and projecting the right image.⁴ Companies use a variety of methods to teach skills that are considered essential by their organization. These methods involve didactic instruction, demonstration, and role-playing. After training, a more experienced representative or territory manager commonly shadows the novice for a period of time until the necessary skills for success are sufficiently demonstrated.

   Most sales representatives exude enthusiasm and are knowledgeable about the product(s) available through their company. Some are knowledgeable regarding the competitor's products as well. Exceptional representatives will be familiar with the purchasing history of an institution as it relates to their products. This type of expertise is important in projecting credibility. Credibility and trust are essential to the sales relationship.³

   After the training period, a territory manager may travel with the representative. This allows direct observation of the skills of the less experienced sales representative and provides expert assistance in resolving more complicated questions about product acquisition and negotiations. The territory manager may be able to identify additional opportunities for the company's products. The manager typically has more authority and, therefore, greater bargaining power than the front line sales representatives. Sometimes the third party exerts pressure that has not been present in the previous discussions between the representative and the clinician.

   The goals of the clinician are not any different in the presence of a third party. Calling in an upper level manager if pressure or conflict arises at any point in discussions may be warranted.

Meetings, Samples, and Trials

   Usually, the relationship between the clinician and a product representative begins with a brief phone call. The product representative usually initiates the first call, although a clinician may call to inquire about a product. Once a clinician is contacted, the representative will seek an appointment by briefly providing some background information about the company and the category of products represented. Healthcare contacts are selected either by referrals or job title. Clinicians are advised to validate that a meeting will be of benefit before committing to an appointment. Time parameters and a goal for the meeting should be determined in advance.

   The first meeting is critical for both parties. This is where the bulk of information is shared, products are introduced, and the goals of future meetings are defined. Subsequent meetings may take less time. Satisfaction depends on roles assumed and performed by the clinician and the sales representative in this situation. Early establishment of role parameters is critically important.³

   Rapport also is important. Both parties should appear interested in the potential of the first meeting. Company representatives are naturally enthusiastic about their products, and in most cases, the representative will have demonstrated considerable effort for the meeting. Clinicians should remember that the most desirable outcome is to express interest in the product and eventually make a decision to incorporate that product into the new setting.

   The primary reason for a first meeting with a company representative might be only to seek information. A clinician who states the purpose of the meeting at the beginning will help establish a trusting relationship.3 For instance, the clinician may not be interested in performing a large-scale trial or stocking the warehouse with this item; rather, he or she wants to be knowledgeable about a product for use in a select group of patients. At other times, the clinician may like the concept and want to trial the product in a select area on a small scale with a few staff members who can be depended upon to provide good feedback.

   The most critical element in the initial meeting is honesty. Several key elements are important in early communications. If a competitor's product has been proposed and/or a trial is underway, that information should be divulged. If for some reason no possibility of adding another product to current stock exists, the clinician should reveal that information. Often, purchasing options are limited by large blanket-purchasing agreements.

   Product trials and samples. If the product cannot be considered without a trial of at least three cases of free product, the representative should be advised. In one study of the relationship between pharmaceutical representatives and physicians, free samples were associated with a positive attitude toward the sales representative.⁵ Although establishing a positive attitude is important, actually using the product to see the outcomes first hand is invaluable. Drug samples from pharmaceutical companies have come under recent scrutiny, and some physicians have effectively banned pharmaceutical sales representatives and their samples from their practices.⁶ In the ET nurses' practice, however, samples are critical. In fact, in most cases, a purchase of wound care products should not be considered without a direct trial, even on a small scale. The company needs to provide safety and effectiveness data before the product is trialed in an individual institution. Clinicians should be realistic about the quantity of products that can be evaluated at one time and ensure that whatever is promised is planned.

   At the end of this meeting, the clinician should summarize what information is still needed. Published clinical trials are often essential to the evaluation process. Before implementing a trial, educating staff who will trial the product may be required.

   Evaluation. Evaluation is an important part of the sales process. Clinician feedback is important to the company. Many companies will offer printed evaluation forms relating specifically to their product. These should be used to document clinician use, product performance, and future plans. Such feedback may be helpful to the product development department, so thorough and honest assessment and sharing of ideas is emphasized. The representative should be advised as to what kind of assistance will be helpful. Representatives often are willing to make appointments with other key people in the clinical setting to help staff become familiar with products. Again, honesty is crucial. If the product demonstrated is not be applicable to a particular situation or department, that information should be shared. Follow-through is important in building and maintaining a trusting relationship.

   Sometimes an appointment has been made with the nurse or department manager when a meeting with someone in a different department or at another level in the organization would be more beneficial. Directing the salesperson to the individual in the organization with the expertise related to the product in question would be appropriate.

   Distractions. In speaking with most product representatives, one can get carried away discussing house plans, hobbies, and vacations, leaving little time for business. Rapport is important and needs to be established, but all parties share responsibility for time management. Time is important to everyone. If structure is not built into the meeting, disappointment may arise when an hour has passed without accomplishing the intended agenda. Focus, too, is important. If time is left after the meeting, other stories can be shared.

Value Added Services

   As part of exploring product information, the clinician also should ask about "value-added" services. These include assistance with a cost-benefit analysis, educational programs, videos, patient teaching materials, and other services provided by the company. For instance, several companies identify staff who can provide continuing education programs for credit. Such programs are arranged by special request. Also, clinicians should ask about service. What is the process if a product or piece of equipment fails to perform as anticipated? If equipment is purchased, clinicians need to know about warranties, trade-in allowances, or upgrades as new technology comes on the horizon. What is the process for handling defective products? One of the most valuable services offered today is consultation by telephone with the company's ET nurse. Company representatives will share this information.

After the Sale

   The sales representative can be a valuable resource after the sale. Will the representative be the contact in case of problems or will another department be the main resource? Will a monthly call meet the organization's needs or would weekly contact be more appropriate? The clinician should clarify the type of relationship desired at the start of the relationship and keep necessary business cards handy.
In follow-up meetings, goals should continue to be set. Clinicians should communicate in advance any information still needed, such as clinical studies or samples. Discussions should include an opportunity to summarize progress by either party - an exercise in good time management skills.

   By this time, the clinician and the product representative will have developed a good sense of how communication will flow. As time goes on, the boundaries initially set may need to be adjusted. Providing the sales representative with guidance will save everyone time and avoid frustrations in communications. Preferences for intervals between sales calls should be communicated and the frequency of visits to the clinician's city should be validated. If the representative intends to make telephone contact 1 week before a visit, an appointment can be scheduled if desired. If no concerns arise, the parties can consider skipping the meeting for that month unless a new product is being introduced.

When Problems Arise

   Occasionally, the relationship encounters problems. Several common scenarios that lead to problems with some strategies for managing these are listed below.

   "The cold caller." Occasionally, a company representative will arrive for a visit without an appointment, requesting 5 minutes in which to make an introduction and explain a product. Most of the time, these meetings take far longer than initially planned. To serve everyone's best interest, appointments should be scheduled in advance and not hurried. The best approach for the clinician may be to share a greeting and consult a calendar, taking care to ask what length of time is desired. A sales representative dropping in and expecting to have an impromptu meeting is inappropriate. Boundaries should be established early. They can be relaxed later, but if an extremely liberal visitation policy is set in the beginning, setting different boundaries at a later time can be difficult.

   Sometimes a representative will make contact from a telephone in the lobby. If time is available to meet later that day, the clinician has no reason to be impolite, but dropping everything to meet at an inconvenient and unscheduled time conveys the message that this practice is acceptable. Sales meetings are an option and should be scheduled at the convenience of the clinician.

   Promises made, but service falls short. Promises should be validated and certainty should be built into any agreements that are reached - in writing, if necessary. Follow-through is important; promised support may not materialize (ie, inservices, complementary items billed for, samples that do not arrive, or service that is less than optimal).
Whatever the issue, the problem needs to be addressed with the representative directly. If the problem cannot be resolved at that level, a representative from the customer service department or the territory manager should be consulted. Often, the mix-up is a simple oversight, but some representatives lack follow-through skills. Reputable companies will correct problems - their reputation and future sales rest largely with the front line sales representative. The customer is never wrong, but it is important not to abuse this trust.

Pressure Tactics

   Personal style, former training in a different field of sales, or the promise of a commission may induce the sales representative to pressure the clinician. For instance, the sales representative may frequently call to inquire whether or not paperwork has been completed to purchase a product or to push company trial statistics rather than wait for a facility's numbers to be collected and plugged into a formula for a cost analysis. This can come across as harassment or a time crunch, when time is not a factor.

   In such cases, an effective response from the clinician would be, "I am feeling pressured in this situation; I need time to evaluate the product correctly." A simple request such as, "Please do not page me. I may be in a meeting. I can speak to you weekly if you call on a Monday afternoon," might provide adequate guidance.

   Clinicians should remember that any criticism, regardless of how minor, of a currently stocked product may be viewed as an opening for a salesperson. From the sales viewpoint, if a customer is not 100% satisfied with a product, trialing a competitor's product becomes more likely. An innocent generalized criticism may open the door for unwanted pressure.

   Free lunches, dinners, and games of golf . In 1998, the major pharmaceutical companies spent nearly $6 million on sales activities such as free lunches and product samples.⁷ Historically, physicians were the main recipients of these activities, but nurses are becoming more common targets.¹ First, clinicians should learn their employers' policies regarding acceptance of such "gifts." If a company allows such practices, remember that these methods are employed by sales companies for a purpose. Secondly, a lunch invitation with a sales representative implies that it will be a business lunch. Typically, these perks are business meetings with the added benefit of a meal. In another sense, they are, in fact, sales calls.⁴ They are designed to create good feelings toward the sales relationship and to build trust.²

   A word of caution is indicated. If the sales representative can persuade the clinician to play an afternoon of golf on the company or to have lunch at an expensive restaurant, expectations are that these efforts will lead to a positive outcome. The clinician's feelings of obligation may work for the company. Accepting these "gifts" may also leave the door open for others to suspect a conflict of interests.

Discussion

   Bridging the gap between clinicians and the sales force can be easy if some basic rules are used as guides. One way to develop a good partnership with a sales representative is to follow the model (see Figure 1). Plan meetings before the representative arrives. Make an accurate assessment of needs before the meeting. Do not let the representative dictate to the clinician what the organization needs. Be prepared to report any results of trials, feedback from users, and the like. Teaching will occur on both sides to facilitate meeting the needs of both parties. Evaluate constantly. Reassess and make changes as needed.

Conclusion

   In today's healthcare climate, clinicians with input into product selection decisions need to learn successful sales navigating skills. These skills include understanding how sales relationships are conducted, how to safely conduct a product evaluation, how to develop a cost analysis, and how to negotiate purchases for your organization. These skills may not be part of basic healthcare education or training. Because healthcare has become a business, questions arise: Why aren't these skills being addressed? Why are clinicians and healthcare workers learning these skills by trial and error? When errors occur, they can be costly to the institution and possibly to a patient.

   The product representative is key to helping clinicians maintain the expertise needed to remain credible to others who look to them as experts. Sales representatives are a limited resource. A clinician should base practice on evidence, not the word of salespeople, requesting safety/effectiveness data before conducting product trials. Research data is an essential part of the evaluation process. Sales staff are a small part of the overall package.

   A relationship exists between free gifts and company expectations. Accepting free samples and gifts is laden with ethical considerations. Gifts are given as a way to influence purchases. Before all else, the clinician should consider how the purchase will affect the patient.

Acknowledgments

   The authors would like to acknowledge Jon Slade and Keith Walker, sales representatives for Medline Industries, for their input and ideas on building successful relationships.

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