How will you measure your work?

Book notes is a monthly letter. Each month I take one book that has shaped how I think and read it for people who build, sell and measure in Indian healthcare. This month: How Will You Measure Your Life? by Clayton M. Christensen, with James Allworth and Karen Dillon (2012).

Clayton Christensen spent his career at Harvard Business School explaining why good companies fail. Near the end of it, while he was being treated for the cancer that later took his life, he turned those same theories on a harder question: why do capable, well-meaning people end up with lives they never meant to build?

His answer is uncomfortable. The logic that makes someone a good executive can make them a poor parent, partner or colleague. Some parts of life give back quickly and visibly: a closed deal, a good month, a promotion. Others give back slowly and silently, sometimes over decades. Left to ourselves, we pour time and energy into whatever pays back fastest, and every single decision looks reasonable at the time.

I have read this book more than once. This time I read it as someone who leads a field force, and I want to share four of its ideas the way they look from where I sit.

1. Money is not motivation

Christensen leans on the psychologist Frederick Herzberg, who separated two kinds of factors at work. Hygiene factors are pay, conditions, status and job security. When they are missing, people are miserable. When they are present, people are not unhappy, but they are not inspired either. Motivators are a different list: work that is challenging, responsibility that is genuinely yours, recognition, growth, and the sense that what you do matters to someone.

People join a company for the first list. They stay, and they give their best, because of the second.

Pharma sales in India runs almost entirely on the first list. Targets, incentives, contests, foreign trips. None of that is wrong, and a field force that is underpaid will not be fixed by speeches about purpose. But I have watched enough representatives over twenty-six years to know that incentive alone produces a particular kind of work: enough to qualify, and not much more. The representative who walks back into a small-town clinic late in the evening because a patient there needs a spacer demonstration is not doing it for the incentive slab.

2. Your real strategy is where your resources go

The book’s central chapter makes a simple point that is hard to live by. Your strategy is not what you say it is. It is where your time, energy and money actually went last month. The stated plan and the real allocation are two different things, and they drift apart quietly.

Every pharma company says it is “patient-centric”. The calendar tells the truth. How much of a representative’s week goes to the doctor who can move the most strips this month, and how much to the doctor in a small town who sees the poorest asthma patients and will never be a top prescriber? How much of the training budget goes to product slides, and how much to teaching people how to make sure a patient can actually use an inhaler?

At Bayu we have written down a goal that sounds idealistic until you try to allocate against it: guideline-recommended inhalation therapy for even the poorest asthma patient in the villages of Uttar Pradesh. Not a nebuliser when the attack comes. Not a reliever bought one strip at a time. The controller medicine that the guidelines recommend, at a price a daily-wage family can sustain every month, used with a technique that actually gets the medicine into the lungs.

We call this mission #RTI, the Right to Inhalation. Christensen’s test is the right one for it. The mission is real only to the extent that our hours, our training and our rupees go there, especially in the months when a quicker return is available somewhere else.

3. The job the patient is hiring you for

Christensen’s best-known idea from his business work is “jobs to be done”. In one study, researchers found that many people bought milkshakes in the morning not because they wanted a milkshake, but because they needed something to make a long, boring commute bearable. Once you understand the job, you understand the customer.

Ask what job the asthma patient in a village is hiring us for, and the answer is not “an inhaler”. It is: let my child sleep through the night; let me get through the harvest without gasping; let me stop spending what we do not have on emergency visits. The inhaler is only useful if it does that job, which means it has to be affordable every month, the family has to trust it, and someone has to show them how to use it.

When the Bayu Warriors, our field force, demonstrate an inhaler technique, sit with a frightened mother who has heard the word “steroid”, or help organise an awareness camp in a block where no company bothers to go, they are doing the job the patient actually hired us for. The prescription was always only half of it.

4. Just this once

The book ends with a warning about small exceptions. The cost of breaking a principle just this once always looks low. The full cost is paid later, because once you have made one exception, every future case becomes a negotiation. Christensen argues that it is easier to hold a principle 100% of the time than 98%.

I would put it a little more carefully. Business has real grey areas, and someone who can never make an exception is rigid, not principled. The better rule is to decide in advance the few principles that never bend, and hold those absolutely. In respiratory medicine one of mine is claims. A chest physician who catches one unsupportable claim about a medicine will discount every claim you make after it, and he will be right to. There is no quarter-end exception to that.

How will we measure it?

Christensen’s own answer to the question in his title is not about money or titles. He concluded that the metric for his life would be the individual people he had helped to become better.

I find that a useful way to think about a pharma company too. Our quarterly numbers matter; a company that does not grow cannot serve anyone for long. But the measure I care about is quieter and harder to count. It is a farmer who now takes a preventer every morning instead of waiting for the next attack. It is a child who is back in school instead of at home struggling to breathe. It is a Warrior who chose this work because it pays, and stays in it because of moments like these.

That satisfaction is exactly what Herzberg meant by a motivator. No incentive scheme can manufacture it. It comes from doing work that matters to someone, and knowing it.

A question to take into your month: open your calendar for the last four weeks. Where did the hours actually go, and how much of it went to the patient you say you serve?

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Why read it. It is short, warm and unusually honest for a business book, and it will make you look at your own calendar differently.

Where it is weaker. It argues by analogy, applying theories built for companies to marriages and families, and a life is not a firm. It is also written for readers with a lot of choice about how they spend their time. A field representative on a fixed salary and a demanding territory has far less room to reallocate, and the book never quite acknowledges that.

Next month: another book, read for the people who build, sell and measure in Indian healthcare. If someone forwarded this to you, you can get the monthly email here.