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?
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/
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