Nothing in pharmaceutical sales compares to having your product added to a hospital formulary. Imagine the thrill of winning a therapeutic interchange, so that every time a physician orders a competitive product, the order is filled with yours. Envision boxes of your pharmaceuticals being stocked at the pharmacy. Picture a medicine cart with your product mixed and rolling by on its way to a patient. When these images are my reality, I've done my job.

Selling in hospitals is like sleuthing as a detective. Identifying key decision makers is job one, and you do that by profiling each account and department. Expect to invest lots of time and energy before you see the positive effects of your work. Professional victories in the hospital setting can be huge. A question remains then: What knowledge is required to sell successfully in a hospital setting? Begin by knowing the hospital environment, key customers and your selling opportunities.

Hospital environments

You may be selling in a variety of hospitals: community, teaching, government-owned and others. Hospitals can be further classified as primary (providing basic care), secondary (offering advanced care) and tertiary (usually teaching institutions with advanced technology for acute care). Hospitals may specialize in one or two service lines. It could be, for example, a mother/baby hospital or a heart hospital. Knowing this information will guide your selling approaches.

Regardless of the service lines provided, you need to know how the hospital is organized and where the departments are that you need to influence. A sales representative once warned me to "avoid the pharmacy at all costs!" Experience taught me that was poor advice. I start at the pharmacy. Usually, each hospital has guidelines regarding how representatives are to conduct themselves in its facilities, including where they can go and whether sampling is allowed. Health Insurance Portability and Accountability Act guidelines concerning patient confidentiality are making this even more important. If the pharmacy is not the key holder, then check with the purchasing department. Signing in and obeying hospital rules will ensure continued access for you and your peers. This approach also helps develop trust and respect with your customers.

Each hospital has a formulary, a list of drugs that are available to prescribe in the hospital. Know the status of your products and that of your competitors'. Understand the formulary system. Is it open or closed? Open formularies, which allow physicians to order any drug, are rare. Closed formularies are more common and restrict the drugs available to healthcare providers. The hospital's pharmacy and therapeutics committee determines formularies. Try to learn who is on the committee and how often it meets. Is there a subcommittee you need to know about? The identity of the members of the P&T is usually a closely guarded secret, but don't be afraid to try and find out. You'll be surprised what you can learn.

Be familiar with which group purchasing organizations your accounts are affiliated with. Group purchasing organizations represent hundreds of hospitals and negotiate directly with pharmaceutical companies on behalf of their members. I've found their influence to be very strong in my accounts, and therefore on my business.

Key customers

After I was promoted into hospital sales, I discovered that everyone I spoke to had the potential to prescribe or influence those who prescribed my products. Physicians, fellows, residents, pharmacists, buyers and nurses are all important when it comes to generating hospital sales. The sheer volume of practitioners you speak with each day may be surprising at first. Group selling skills are critical to success in a hospital. Be able to moderate a group's discussion so you can achieve your call objectives.

As in office-based selling, access is a hurdle to be cleared in the hospital. If you can't see a physician on the unit, be willing to look outside the hospital for occasions to sell. Offices and clinics can provide a better environment for selling. Maintain good relationships with local office-based reps. Your colleagues may be able to provide access to a targeted physician or a member of the P&T. A veteran rep once told me he made more high-quality calls in the hospital cafeteria than anywhere else. Physician lounges, libraries and medical records departments can also be fertile ground.

Physicians may order the product, but do not underestimate the power of nurses, who administer drugs and influence doctors' decisions. Nurses should be in-serviced on your product. In-services can usually be set up through the nurse manager or clinical nurse educator for the unit. Nurses are also an excellent source of information. They can tell you which physicians admit to the unit and provide you with information you can leverage with those physicians. In many states, nurse practitioners have full prescribing rights and carry just as heavy a patient load as physicians. Some also teach and help educate future healthcare professionals.

Pharmacy personnel are also key to achieving success in the hospital. As a hospital representative, you will find yourself presenting new contracts to the director of pharmacy. When discussing the proposed addition of a new product to the hospital formulary, you will be meeting with the clinical Pharm.D., who will want a formulary kit. Pharmacists are also staffed in units and can have a direct impact on a physician's drug choice. Staff pharmacists are influential because they may be calling the doctor and asking him or her to switch the ordered drug to the hospital's preferred product. The buyer is another person to know in the pharmacy. The buyer does the actual ordering of products. It is crucial to keep him or her in the loop if stocking issues occur. Working with buyers has saved me a lot of business. Know who their wholesaler is and establish a relationship. You and the wholesaler have customers in common and can work together to keep those customers supplied and happy. Be aware of whether the wholesaler has product on the shelf, and be willing to contact your customer service department with purchase order numbers to get order fulfillment and shipment confirmation. Provide the buyer with the company account number if he or she needs to order product direct. Pharmacy personnel can help you build market share if you take the time to develop the right relationships.

Most prescriptions in a teaching hospital originate with fellows and residents. Fellows and residents are eager to learn and also develop life-long prescribing habits during this phase of their education. For these reasons, they are a critical audience. Residents in their first year are called interns. The most influential contact among residents is the chief resident, who has administrative and educational functions, as well as authority to make therapeutic decisions. Other residents look to the chief for guidance. Get to know the resident coordinator, as that person can provide monthly rotation schedules and maybe even pager numbers.

Other opportunities

By doing what salespeople do best – probing to uncover a need, using our active listening skills and identifying solutions for our customers – representatives will come across endless promotional and nonpromotional opportunities. There will be lunch-and-learns, peer-to-peer programs, call dinners, in-services to schedule and grand rounds to support. Working the occasional odd hour can go a long way with underappreciated second and third shifts. Get to know the continuing education department staff. Ask your customers what professional organizations they belong to. When you have rapport with your clinicians, they will seek you out. I've also learned about important opportunities from my competitors, who were willing to help the "new kid on the block." Finally, don't forget about all the resources your company may provide. These tools can help you create opportunities and improve your chances of success.

You're the one who must have the confidence and the courage to walk through those intimidating hospital doors if you want patients to benefit from your product. PR