The “last yard”:

Bringing consumption into the supply chain

Peter Ward

Service Systems Research Group and

Supply Chain Research Group at University of Warwick

Agenda

• Why bother?

• The “last yard”

• Literature review

• Three steps to patient-centricity

• Step 1: gaining a deeper understanding of

the “last yard”

• Conclusions

Why bother?

• “It is vital that patients are at the

center of a beyond the pill strategy

to make it meaningful in terms of

outcomes… improving adherence

will always be near the top of the

list.”

– Debraj Dasgupta, Head of Specialty

Commercialization and Adherence,

Novartis

• “Understand what payers are

looking for… demonstrate value

beyond the pill”

– EyeForPharma.com

The “last yard”

• We are familiar with:

– The last mile

– The last 50 yards

• But these only get us to the

surgery, pharmacy or shelf

• To be patient-centric we need to

understand consumption

– The “last yard”

– Ultimate purpose of the supply

chain

• Referring to consumption using

the supply chain lexicon helps to

align it with supply chain thinking

Literature review

• “Patient-Centric Healthcare Supply Chains in

sub-Saharan Africa: State of the Art and Possible

Implications”

– Performed for the Gates Foundation in early 2014

• Focused on answering two questions:

1. What is the current State of the Art in terms of research

into patient-centric healthcare supply chains?

2. Based on the State of the Art and thought leadership in

this area, what are some possible implications for the

future in terms of drug product design, drug supply

chain, ICT enablement and business models in the

context of sub-Saharan Africa?

• Defined three steps required to achieve patient-centricity

Three steps to patient-centricity

• In order to move towards genuine patient-centric health

supply chains, it will be necessary to:

1. Gain a deeper understanding of patient needs

“…research should be performed to improve the

understanding of issues around patient adherence in

resource-poor environments in sub-Saharan Africa as the

basis for planning change”

2. Communicate these to supply chain partners

3. Determine how and where in the supply chain to make

changes to improve value propositions

• With this approach there is the opportunity to deliver “beyond

the pill” solutions that improve patient adherence and thus

enhance outcomes

Step 1: adherence and patient needs

• What facilitates and inhibits medicine

consumption in resource-poor environments?

• Historically the focus has been on changing the

patient through motivation improvements

– Behaviour Change Techniques (BCTs)

– Latest BCT taxonomy includes 93 BCTs in 16

“clusters”

• “The behavior change technique taxonomy (v1) of 93

hierarchically clustered techniques…”

– Behaviour Change Wheel

• “The behaviour change wheel: a new method for

characterising and designing behaviour change

interventions”

• But is there more? Is the patient the only thing we

can change?

Quick Service-Dominant Logic (SDL) primer: four axioms

1. Service is the fundamental basis of exchange

2. The customer is always a co-creator of value

3. All economic and social actors are resource

integrators

4. Value is always uniquely and phenomenologically

determined by the beneficiary

Service-Dominant Logic

Step 1: adherence and “last yard” consumption using

SDL lens

Change the

patient

Change the

offering

Work

Religious community Local community

Extended family

Partner

Step 1: consumption context – SDL service ecosystems

Self

“relatively self-contained self-adjusting

systems of resource integrating actors

connected by shared institutional

logics and mutual value creation

through service exchange”

Step 1: “last yard” obvious examples of inhibitors

• “Take 3 times a day with food”

– But can’t afford food

– Reformulate? Provide food with prescription?

• “Take 3 times a day with water”

– But no access to clean water

– Reformulate? Provide water with prescription?

• “Take as prescribed”

– But unable to read or to understand

– Simplify instructions?

• “Take as prescribed”

– But unacceptable in a particular service ecosystem

– Can supply chain address this?

• There will be more that supply chain can address

Conclusions

• Pharmaceutical manufacturers wish to deliver “beyond the

pill” propositions to benefit patients and to demonstrate

value to donors, NGOs, Ministries of Health

• One important proposition is adherence improvement

– “increasing the effectiveness of adherence interventions

may have a far greater impact on the health of the

population than any improvement in specific medical

treatments”

• WHO quoted by Sabaté, 2003

• Motivation is not the only determinant of adherence

• Understanding what happens in the patient’s consumption

context is the starting point

• Phase 1 of my research starts January 2015

– Interested?

Thank you!

Peter Ward

SDL’s view of value creation

Selected references

– Dasgupta, D., & Wenzel, M. (2013). Beyond the Pill: The Big Questions. eyeforpharma.com.

Retrieved November 08, 2014, from http://social.eyeforpharma.com/sales-marketing/beyond-pill-

big-questions

– Lusch, R. F., & Vargo, S. L. (2014). Service-Dominant Logic: Premises, Perspectives, Possibilities

(p. 225). New York, NY: Cambridge University Press

– Michie, S., van Stralen, M. M., & West, R. (2011). The behaviour change wheel: a new method for

characterising and designing behaviour change interventions. Implementation Science : IS, 6(1), 42

– Michie, S., Richardson, M., Johnston, M., Abraham, C., Francis, J., Hardeman, W., … Wood, C. E.

(2013). The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques:

building an international consensus for the reporting of behavior change interventions. Annals of

Behavioral Medicine: A Publication of the Society of Behavioral Medicine, 46(1), 81–95

– Sabaté, E. (2003). Adherence to Long-term Therapies: Evidence for Action (p. 211). Geneva

– Vargo, S. L., Maglio, P. P., & Akaka, M. A. (2008). On value and value co-creation: A service

systems and service logic perspective. European Management Journal, 26(3), 145–152

– Ward P. (2014). Patient-Centric Healthcare Supply Chains in sub-Saharan Africa: State of the Art

and Possible Implications. WMG Service Systems Research Group Working Paper Series, paper

number 03/14, ISSN 2049-4297, from http://wrap.warwick.ac.uk/60686/