Achieving a market-led culture:

A case study
Received (in revised form): 18th August, 2000

Keith Rowland
was formerly Sales and Marketing Director for Mediprod UK and remains a senior sales and marketing executive in the
industry.

Brian Smith
Is the Managing Consultant of PragMedic, a consultancy which supports business planning in medical markets and a Doctoral
Researcher at Cranfield University School of Management. He is also Managing Editor of the International Journal of Medical
Marketing.

Keywords culture, healthcare, marketing, medical, medical devices, strategy

Abstract This paper describes a challenge common to many medical device

companies; that of developing a market-led corporate culture in order to create
sustainable competitive advantage. It describes the constraints encountered, the
methods employed and the results and lessons that were the outcomes of the process.
Its principal lesson is that organisational culture change is possible and rewarding, but
that it is slow and difficult. Moreover, it requires much more than a cursory knowledge
of both culture and marketing. Without a deep knowledge of both these topics, cultural
change should not be attempted.

INTRODUCTION well-managed medical device companies.

Keith Rowland
Sales and Marketing
Director, Cook UK Ltd,
Monroe House, Letchworth,
Hertfordshire SG6 1LN, UK
Tel: +44 (0) 1462473100
Fax: +44 (0) 1462 473192
E-mail: Keith @ cook.co.uk
The company described in this paper is a
real company and the events described are
an accurate record of actual events. To
preserve commercial confidentiality, the
name of the company has been replaced
with the fictional Mediprod and certain
characteristic facts have been altered
slightly without affecting the valuable
lessons contained in this case.
Mediprod is a medium to large medical
device company operating in a number of
diverse sectors of the industry. Although
Mediprod is a multinational company,
operating in all developed and most
developing markets, this case relates to
activity in Mediprod’s UK subsidiary.
THE SITUATION FACING
MEDIPROD
The situation facing Mediprod in the late
1990s was one faced by many, if not most,
Namely, the company was successful,
growing and profitable, but conscious of
problems on the horizon caused by market
changes and increased levels of
competition. The challenge in this
situation is always to change in
anticipation of these approaching problems
despite the lack of external pressure, as
current performance was excellent.
Mediprod UK was perhaps the archetype
of this situation, having achieved very
impressive recent growth but sensing the
threats created by market maturity,
globalisation and industry consolidation.
The management team of Mediprod UK
reasoned that part of their task was to
identify and implement the changes that
were necessary to maintain their growth in
the light of these evolving threats. The
principal features of the evolving market
situation will be familiar to many readers,
irrespective of the particular sector of the

# Henry Stewart Publications 1469–7025 (2001) Vol. 1, 3 215–223 International Journal of Medical Marketing 215
Rowland and Smith
medical market in which they operate.
They were and are common problems
facing many companies that count
clinicians and allied professionals as their
customers and deem their products to be
technically complex.
First, there were those problems arising
from the external macro-environment that
are sometimes remembered in the
acronyms PEST or STEP or SLEPT
(social, legal, economic, political and
technological). These were problems that
impacted on Mediprod UK, but over
which we had no control. In our case,
they included some technological
developments in clinical practice, changes
in social expectations of healthcare systems,
changes in legislation concerning
regulation and trading laws, and many
other small but influential changes. Perhaps
dominant among these were the combined
political and economic changes that were
increasing demand for proven cost-
effectiveness across all market sectors. We
saw all of these factors, in varying degrees
and intensities, combining to create
difficulties for a company that had
historically thrived on the simple concept
of technical excellence.
Secondly, we perceived other threats
also arising from the external micro-
environment: those concerning customers
and competitors. Our direct competitors
were consolidating and becoming,
generally speaking, fewer and bigger. In
few areas could we claim to be the
market-share leader and we were
increasingly faced with a two-pronged
attack by competitors in each of our
chosen market sectors. On one hand, we
faced in each sector one or two major
players that were often much better
resourced and capable of better economies
of scale. On the other hand, we faced a
multiplicity of small specialist companies
who, while they could not match our
resources, might better serve the small
profitable niches of each sector. This
216 International Journal of Medical Marketing Vol. 1, 3 215–223
competitive vice was made more complex
and problematic by our presence in a large
number of market sectors, each with their
own market dynamics. We also faced
competitive threats to our profit, as well as
simply our sales, in some sectors. These
came variously from new entrants,
substitutes and, in some cases, from
distribution channels that were
consolidating and becoming more
powerful.
In terms of our customers, we observed
important changes in needs-based market
segmentation and the nature of the buying
processes. Generally, these were moving
away from a simple sale to a single decision-
making clinician towards a consolidated
decision-making process involving many
other people in addition to the clinician.
Operating in the UK, this trend was
exacerbated by the near-monopoly buying
power of the National Health Service,
which controls 85 per cent of all UK
healthcare spend. Like competitive forces,
customer trends were made more difficult to
manage by our operation in so many
different medical device sectors.
Finally, we were conscious of the
implications that developments within to
our organisation held for our business. As a
global company, we were trying to drive
towards a global approach that had to be
factored-in to our nationally based market
strategies. With the rise in cost and difficulty
of product development, for instance,
global product standardisation was one of
our goals. We also had a weight of
organisational culture and norms, which,
although useful and positive in most aspects,
did preclude certain courses of action. The
extant culture of Mediprod UK reflected its
origins: product-oriented, technically
focused, reactive rather than proactive, and
with a bias for immediate action over
planning. Internally, we joked that the
Mediprod way was summarised in the
instruction ‘Ready, fire, aim’. Lest this be
interpreted too negatively, it should be
# Henry Stewart Publications 1469–7025 (2001)

remembered that this culture had been part
of a success story of over 30 years of growth
and profit.
This thumbnail sketch of the Mediprod
UK situation is, of course, a simplification.
But it catches the main elements of the
circumstances facing us in the late 1990s
and is probably not unfamiliar to many
readers.
Naturally, the management team of
Mediprod UK was involved in the
development and implementation of
myriad changes in order to maintain its
competitive advantage in the light of
market changes. The large majority of
those changes were tangible, physical and
incremental. That is, they were visible and
obvious improvements to existing systems
and processes. These included changes in
IT systems, distribution and logistics
facilities, manufacturing and quality
processes and so on. This paper does not
seek to deprecate the importance and
necessity of those changes, which did and
still do play a vital part in maintaining
Mediprod UK’s competitiveness.
However, as a management team, we
recognised that while these improvements
in capability were necessary, they were not
sufficient. We turned our attention to the
outstanding problems that we perceived to
be unresolved by the tangible changes we
had made or were making.
We saw two related key issues that
would not be fully resolved by the
changes we had already set in place.
Simply put, these were as follows.
. Sustainability of product leadership – We
identified that the product leadership we so
frequently created, by dint of our research
and development responsiveness, rarely
lasted long. The time taken for our ideas to
be copied by cheap imitations was shrinking
rapidly. This was not only a competitive
issue, but also a macro-environmental one.
Escalating technical and regulatory
development costs meant that purely
technical product leadership across a wide
# Henry Stewart Publications 1469–7025 (2001) Vol. 1, 3 215–223
Achieving a market-led culture: A case study
range of sectors was becoming increasingly
difficult.
. Critical resource allocation – We recognised
that some of our most critically important
and scarce resources were becoming so
stretched as to be of concern. As the UK sales
and marketing subsidiary of a global
company, our perspective on this was
especially human resource biased. We saw
the resources that we allocated in order to
add value were largely our people and their
skills. Our sales people, product specialists
and product managers, as well as our senior
management, were the means by which we
differentiated ourselves and created
competitive advantage. We were concerned
that these critical resources, and the financial
resources they used, must be allocated
effectively and that this was not a product of
the tangible changes we were already
making.
The concerns over these two key issues
were captured by the measure of
productivity. We knew that our strategic
goals called for sales and profit growth
that was not matched by growth in
headcount, which suggested that we
needed to consider what we were doing,
not just how much of it we each did. We
knew too that this increased profitability
could no longer be assumed to flow from
our traditional technical leadership. This
would remain necessary but become an
incomplete solution. We felt the same
applied to the many tangible process and
systems improvements we continued to
make. We therefore turned to the softer
issue of organisational culture to see if we
could derive competitive advantage from
that source.
THE CONCEPTS OF
ORGANISATIONAL CULTURE
AND ORGANISATIONAL
EFFECTIVENESS
The concept of organisational culture
turned out to be both more complex and
more useful than we had anticipated. With
International Journal of Medical Marketing 217
Rowland and Smith

hindsight, our knowledge of the subject at
this stage was incomplete and insufficient.
This deficit was made worse by the way
in which the terminology surrounding the
subject of organisational culture is misused
and misappropriated. It seems appropriate,
therefore, that we spend a few words
explaining the concept and its practical
implications, as we now (we hope more
usefully) understand it. This understanding
of the ideas behind organisational culture
was central to the practical steps we took
and the progress we made.
Organisational culture is a complex
topic that invites dangerous
oversimplification. At the risk of this, we
think that Schein’s model of organisational
culture is useful.1,2 Schein postulates that
culture derives from basic assumptions that
an organisation holds concerning what is
the right thing to do. These assumptions
usually derive from the founders and,
although in a state of constant dynamic
flux3, are ‘singularly persistent’4. These
assumptions lead to organisational values
and these in turn are manifested in cultural
artefacts. We have tried to clarify Schein’s
model, with reference to the Mediprod
example, in Figure 1. In reality of course,
the organisational culture of Mediprod,
and any company, is based on hundreds of
assumptions, each leading to one or more
values. Cultural artefacts are the result of
the interaction of many different values.

Tangible rules and structures that reflect and direct the day to day activity of the organisation

e.g. Allocation of budgets to e.g. Humanistic rather than e.g. Significant resource allocation
technical product development mechanistic management to relationships with clinicians
rather than formal market procedures rather than quantified market
research analysis

Behaviour that is valued, rewarded and encouraged by the organisation

e.g. Rapid, incremental, new e.g. Loose, individualistic HR e.g. Processes to identify new
product development based on processes designed to ensure clinical ideas and incorporate
informal processes commitment into new product development

Underlying beliefs and assumptions about what makes an organisation successful, usually originating in the
beliefs of the founder and endorsed by subsequent success of the founder and endorsed by subsequent success

e.g. That rapid response to of e.g. That personal commitment of e.g. That technical superiority
individual clinician’s feedback is employees is the paramount HR of the product is the single most
the best way to develop new objective important determinant of
products commercial success

Figure 1 The structure of organisational cultures (adapted from Schein5)

218 International Journal of Medical Marketing Vol. 1, 3 215–223 # Henry Stewart Publications 1469–7025 (2001)

The picture is much more complicated
than Figure 1 implies and practitioners are
again reminded of the dangers of
oversimplification.
Having built a better understanding of
organisational culture, we then sought to
understand the relationship between it and
organisational effectiveness, particularly in
the sense of marketing effectiveness. This
again proved to be a field more
complicated but more rewarding than we
first appreciated. There is extensive
management research that discusses the
folly of attributing organisational success
to any one factor.6,7,8 There is also
extensive previous work about the
difficulty of managing organisational
culture change.9,10,11 This work set our
expectation levels; we did not expect
organisational culture change to be the
Holy Grail of improved effectiveness.
Although recognising the complexity of
the problem, our research in this area also
provided strong evidence for the
relationship organisational culture and
business performance.12,13,14,15,16,17 In
particular, there seems to strong evidence
for a correlation between one aspect of
organisational culture, that of marketing
orientation, with business
performance.18,19,20,21,22,23 This work by
previous researchers all pointed in the
direction that adaptation of our
organisational culture to include market
orientation would be beneficial.
Our study of this area also suggested
pitfalls in attempting such a cultural
transition. We realised that barriers would
exist.24,25 In particular, we were aware that
the implementation of formal marketing
planning processes as a step towards
market orientation would be difficult.
Much of the published work in this area
discusses the manner in which culture
hinders strategic planning.26,27,28,29,30,31,32,33
We drew two conclusions from
studying the ideas of organisational culture
and its relationship to performance. These
# Henry Stewart Publications 1469–7025 (2001) Vol. 1, 3 215–223
Achieving a market-led culture: A case study
were as follows.
. We needed to develop the organisational
culture of Mediprod UK to incorporate a
greater degree of market orientation. In
terms of Schein’s model (Figure 1), we
recognised that some of our existing
cultural assumptions were less valid than
they were when the company was founded.
For instance, we challenged the assumption
that product development should be solely
driven by reaction to customer feedback.
This assumption, valid in the days when a
new product took only weeks and
thousands of dollars to develop, was
incomplete in the face of market maturity
and increasing regulatory burdens. In this
modern environment, we reasoned,
customer feedback had to be augmented by
systematic market analysis and planning.
This would be more than simply a process
change, it would also be a deliberate
development of our cultural assumptions
that would cascade through into changed
behaviour and improved competitiveness.
. The route to this cultural development
would need to recognise the strengths and
weaknesses of the current culture. We did
not want to damage or discard those parts
of the culture that still gave Mediprod UK
competitive advantage. We wanted to build
on, not replace, those assumptions, values
and artefacts that had given us a successful
history. In addition, whatever process of
cultural development we adopted would
need to recognise that this extant culture
may create barriers. We argued, for
instance, that simply imposing the text
book disciplines of strategic marketing
planning, without regard to the specifics of
our context, would not work well. We
sought, therefore, to create a programme to
develop market orientation that was
Mediprod UK specific.
THE PROCESS OF DEVELOPING
A MARKET-LED CULTURE
In truth, the process by which Mediprod
UK set about developing a more market-
oriented aspect to its organisational culture
was incremental and gradual rather than a
International Journal of Medical Marketing 219
Rowland and Smith
single coherent plan. Rather than being
one preconceived process, it was more an
example of ‘logical incrementalism’.34 The
process began about three years ago and,
at the time of writing, is still a work in
progress. Significant steps have been taken
and worthwhile progress made. In roughly
chronological order, these were as follows.
. Agreement in principal of the management team –
This seems to be an essential prerequisite to
any significant change programme. This
agreement was not unconditional, assuming
as it did that the work would be completed
without drastic change in either spending
budgets or revenue targets. In this, we
demonstrated the importance of using the
existing culture which has traditionally
allowed great personal latitude to managers.
A more autocratic culture would have
struggled to gain consensus on a fundamental
topic like organisational culture.
. Shift in emphasis of job roles and specifications –
As with the whole programme, this was
gradual and incremental in nature. It
involved some re-allocation of management
responsibilities and some shifts of emphasis
within existing roles and structures. Less
formally but importantly, it involved
changing the visible emphasis that day-to-
day management placed on individual
actions. Fire-fighting and tactical steps were
seen as necessary and expected, while
strategic thinking and market understanding
were given greater recognition.
. Personal development guided by diagnostic tools –
Since much cultural change involves a
degree of self-examination, the most affected
employees were given access to personal
profiling techniques such as Thomas
International’s DISC method, and Insight’s
Colour Quadrants. These were used to help
direct choice of role and, in some cases,
were also used therapeutically, when the
culture change seemed to cause individuals
particular problems.
. Formal skills training – In some cases, even
individuals who had been in sales and
marketing posts for some time (by virtue of
their technical knowledge) had knowledge
220 International Journal of Medical Marketing Vol. 1, 3 215–223
or skill gaps exposed by the shift from a
technical to a marketing culture. In sales,
formal training was initiated using the Dale
Carnegie Organisation. In marketing,
formal training of some of the team was
implemented via study for Chartered
Institute of Marketing qualifications. These,
and other formal training initiatives were
used to meet specific needs.
Probably the largest single component of
our programme, however, was that
targeted at our Product Managers. These
individuals, mostly recruited from a
nursing, technical or other similar
background, were central to creating
competitive advantage. It was their task to
devise and implement any new
components of our value proposition and
to direct resource allocation accordingly.
Ironically, it was among this group that
the greatest potential for resistance lay. We
encountered significant amounts of initial
scepticism and just the sort of barriers to
implementation that our background
research had prepared us to expect. This
part of the team had little or no formal
training in market analysis, strategy
development or tactical implementation. It
seemed obvious to us that a standard, off-
the-shelf programme of marketing training
would not work well. Already, in early
parts of the cultural change process, we
had met what seem to be standard
responses to the initiation of market
orientation. These were exemplified in
comments such as ‘It’s all very well in
theory’ or ‘Yes, it’s OK for consumer
markets but not for a technical, ethical
market such as ours.’ We anticipated that
the depth of technical expertise that made
these people so good at that part of their
role would also make it harder for them
to adopt the perspective needed for
marketing planning. As with other aspects
of the existing organisational culture, we
wanted to retain and use the useful parts
of the current situation, not simply replace
them with something new.
# Henry Stewart Publications 1469–7025 (2001)

Our solution was a tailored, customised
programme that was part training and part
consultancy. Using PragMedic, a
specialised medical marketing consultancy,
we devised a series of workshops spread
over several months. Out-of-workshop
projects and continual support by
PragMedic augmented the workshops.
There were two very significant
differences between this programme and
other work we carried out to support the
cultural change programme. First, the
programme was built around our own
business. Each Product Manager was
helped to use formal market analysis,
strategy development and tactical
implementation using his or her own
business unit as a live example. Not only
did this diffuse objections that the work
was not relevant, it also meant that the
results of the programme could be used in
practice. This helped make best use of our
time. The second significant difference was
the use of a consultant with specific
medical market knowledge. This helped
identify and overcome some of the
avoidance tactics that some people will
attempt when faced with difficult change.
It was simply not possible to hide behind
our own jargon and technical detail. As
one Product Manager expressed it in a
moment of honesty, ‘We’ve got nowhere
to hide’.
Although this approach of a self-case
study using a market specialist was
undoubtedly better than a more general
programme, it did not achieve immediate
results. After the first part of the work, we
witnessed some of what has been called
‘resigned behavioural compliance’, as some
members of the team simply complied
with new processes but without real
commitment. The result was that, in the
worst cases, we saw many examples of
‘retro-fitting’, the retrospective fitting of
existing plans to the new process to make
it look as if the new cultural assumptions
had taken root. This, of course, added no
# Henry Stewart Publications 1469–7025 (2001) Vol. 1, 3 215–223
Achieving a market-led culture: A case study
real value. We therefore undertook a
second set of PragMedic workshops in
which our new plans were tested and
retro-fitting was uncovered and corrected.
This approach was quite tough. In its
implementation we employed a lot of
detailed work to ensure that it was
effective but did not damage the useful
parts of the existing culture. Overall, we
bore in mind those models of change
management that advise both increasing
survival anxiety (making explicit the
threats inherent in the status quo) and
decreasing learning anxiety (reducing the
fear associated with new habits). The
former we achieved via competitive
analysis and the linked gap analysis, which
showed the long-term financial
implications of not changing. The latter
was aided by large amounts of close
support by both the external agency and
line managers.
The complete process of cultural change
has involved these and many other smaller
elements, and it is not yet complete. It is
these parts of the process that stand out as
essential to overall success.
OUTCOME
As all of our preparation work indicated,
we did not expect rapid and sudden
change. Nor did we expect the results
of cultural change to translate into
financial results undiluted by the impact
of market changes, increased competition
and many other external factors. The
Mediprod UK management team has tried
to evaluate objectively the success of the
programme and has concluded that it has
been a success. Our supporting evidence
for this comes from the following
observations.
. The practices of our team, particularly in
important value-added areas such as
resource allocation and development of the
value proposition have changed
demonstrably. In addition to this, the co-
ordination of our team efforts has been
International Journal of Medical Marketing 221
Rowland and Smith
enhanced by the development of a market-
oriented vocabulary.
. The turnover of our team, always a
barometer of successful change
management, has been kept to a very low
level. Recruitment and retention policies
have been heavily influenced by the new
cultural assumptions that are now taking
root.
. The dominant useful aspects of the previous
culture, such as commitment to individuals
and technical excellence, have not been
degraded by the addition of a market-
orientation.
. The financial performance of the
organisation has continued to meet and
exceed targets, despite the possible
distraction or disruption of cultural change.
Finally, perhaps the most flattering
evidence of our success lies in its imitation.
This UK based and limited programme
has now been picked up and copied, in
amended form, by our pan-European
colleagues.
LESSONS FOR OTHER MEDICAL
COMPANIES
It seems premature and dangerous to draw
lessons three years into a process that is as
open-ended and continuous as cultural
change. Notwithstanding that, there are
some clear lessons that we can give to
others contemplating such a change. In no
particular order (since they are
interlinked), these are as follows.
. Do not attempt cultural change without a
profound understanding of the subject. Not
only is it easy to be misled by the
oversimplification of ‘airport books’, it is
very easy to actually damage the
organisation by ill-informed meddling with
the ‘soul’ of the company.
. Be aware that any cultural change
programme will need to contain multiple
elements. Any that hold up single ‘panacea’
answers are very unlikely to work.
222 International Journal of Medical Marketing Vol. 1, 3 215–223
. Recognise that any programme must be
tailored specifically to the needs of the
company. Off-the- shelf programmes seem
unable to cater to the cultural peculiarities
of individual organisations. Further,
standardised programmes find it hard to
gain acceptance from those who see their
position as unique.
. Beware of early apparent success that is the
common result of cultural change.
Resigned behavioural compliance and
retro-fitting are the easiest ways to respond
to change initiatives and many employees
are adept at providing these responses.
. Recognise that cultural change is an open-
ended process that impacts on every aspect
of organisational functioning. This is a
major consideration in managing the
process, which differs significantly from
managing more tangible and self-contained
projects.
These lessons are, of course, broad and
general. Nevertheless, we hope they will
be useful to other practitioners.
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