Marketing training strategies that pharmaceutical sales managers use to reduce unethical behavior.

BACKGROUND: Some pharmaceutical company sales representatives are using bribes to encourage increasing medication prescriptions. In 2012, GlaxoSmithKline paid $3 billion on a felony charge related to bribing doctors to prescribe the company's medications. Using Hunt and Vitell's general theory of marketing ethics, the purpose of this qualitative multiple case study was to explore strategies some sales managers in the pharmaceutical industry used to improve marketing training to reduce unethical sales representative behavior.
MATERIALS AND METHODS: Data were collected from company reports and documents provided by sales managers and semistructured interviews with five sales managers of different pharmaceutical companies in the northeast region of the United States. Data were analyzed using thematic analysis and Yin's 5-step process of compiling, disassembling, reassembling, interpreting, and concluding thematic data analysis.
RESULTS: Three themes emerged from data analysis: developing ethical standards, developing organizational policy, and implementing training and development programs. A key recommendation is that pharmaceutical sales managers identify ethical standards to inculcate in their business practices to achieve ethical marketing training that can result in sales representatives' ethical behavior. The implications for positive social change include the potential for sales managers to develop strategies to reduce unethical behavior in the pharmaceutical industry.
CONCLUSION: Reducing unethical behavior may lead to more trust between patients and physicians, improving patient satisfaction and promoting prosperity for the community through enhancing the quality of health care. Copyright:

Introduction

The occurring unethical sales representative behavior is a phenomenon that destroys the credibility and reliability of the pharmaceutical industry.[1] Some of the pharmaceutical company sales’ representatives use bribes while marketing medications to doctors to encourage increasing prescribing medication.[2]

Marketing strategies are important to the pharmaceutical companies because there is a positive correlation between marketing strategies and business performance.[3] Marketing strategies in the pharmaceutical industry include marketing the products through the deployment of sales representatives.[4] The sales managers, in the pharmaceutical industry, provide essential and extensive training to ensure following all measures for selling the products to the physicians, clinics, or hospitals, but unethical situations occur in the field.[5] The sales managers provide ethical considerations to sales representatives when performing their practice, but their strategies tend to become unethical due to illegal transactions and relations with the physicians, hospitals, or clinics.[678] Therefore, it is imperative to conduct empirical research to determine the actions and strategies used by sales managers in addressing the concerns shown by their sales representatives.

Pharmaceutical company sales’ representatives are marketing medications to doctors, and some are using bribes to encourage increasing prescribing medication.[2] GlaxoSmithKline paid $3 billion in 2012 on a felony charge related to bribing doctors to prescribe the company's medications.[9] The general business problem that was addressed in this study was that unethical behavior of pharmaceutical company sales’ representatives results in financial losses for the companies in the pharmaceutical industry. The specific business problem that we addressed in this study was that some sales managers in the pharmaceutical industry lack strategies to improve marketing training to reduce unethical sales representative behavior.

For the conceptual framework of this study, we used the general theory of marketing ethics. In 1986, Hunt and Vitell developed the general theory of marketing ethics, and they explained decision-making processes that marketing managers employed to resolve ethical conflicts.[10] Hunt and Vitell used a combination of teleological (intentional) and deontological (judgmental) assessments throughout their theory to create ethical marketing strategies.[10] Teleological assessment means the action is right if its outcomes have benefits to the majority, whereas deontological assessment means looking at the morality of action itself based on rules rather than based on the consequences of that action.[10]

The purpose of this qualitative multiple case study was to explore strategies that some sales managers in the pharmaceutical industry use to improve marketing training to reduce unethical sales representative behavior.

Materials and Methods

A qualitative research method was used for this study. A case study research design was used to determine the development of strategies used by sales managers in reducing unethical sales representative behavior. Through a case study, an identification of the perspectives of the sales managers led to the development of strategies used to address the identified concerns in the pharmaceutical industry (i.e., unethical sales representative behavior). Furthermore, using a case study paved the way to understanding possible similarities and differences of strategies used in addressing the unethical sales representative behavior. A multiple case study design was used because several cases (not only one case) were explored in depth within the representatives’ real-world environments.

Population and sampling

We used the purposeful sampling method for this study. The population of the study includes the sales managers in the northeastern region of the United States. The northeastern region includes New England (Connecticut, Main, Massachusetts, New Hampshire, Rode Island, and Vermont) and Middle Atlantic states (Delaware, Maryland, New York, New Jersey, Pennsylvania, Washington DC, Virginia, and West Virginia). The target sample size was five sales managers, from three pharmaceutical companies, who had successfully used marketing training strategies to reduce unethical sales representative behavior. The interview (45–60 min) with sales managers was over the phone to make it convenient for us and for the participants.

Ethical research

Selection of the participants started after receiving approval from Walden University Institutional Review Board (approval # 05-27-20-0659768). The invitation and informed consent was e-mailed to the potential participants to ensure that they had detailed information related to the process of collecting data before deciding whether to take part of this study. The informed consent contained the objective of the study, background information, research procedures, some interview question examples, and my contact information. An introductory call was scheduled with the potential participants to explain the information available in the informed consent and to answer questions they had.

The potential participants had 1 week to make their decision if they wanted to be a participant in the study. If a potential participant agreed to participate, they needed to indicate consent by responding to the invitation e-mail with the words “I consent.” Then, a participant provided the day and time they were available to conduct a 45–60-min phone interview.

Only individuals who e-mailed their consent to participate in the study became participants. The informed consent stated that their participation in this research was voluntary and no monetary or any other forms of incentive were to be provided for participating in this study. There was no obligation on the participant to continue the study and the participant could withdraw from the study at any time until the publication of the results. If a participant decided to withdraw from the study, they could have e-mailed or phoned their withdrawal. No participant withdrew from the study. In the documentation process, there was no personal information included to ensure maintaining the privacy of the participants. A unique identifier was assigned to each participant that was used during the data collection process and reporting the results.

Data collection instruments and technique

The data collection process included reviewing the company documents and reports provided by the participants. Examples of the company documents include marketing strategies and memos). The data collection process also included conducting semistructured interviews over the phone with five sales managers of three pharmaceutical companies in the northeast region of the United States.

Interview questions

What training strategies do you use to improve marketing training to reduce unethical sales representative behavior?

What framework(s) did you use to develop and implement your ethical marketing training program?

How did you assess the effectiveness of your strategies for marketing training?

What were the key challenges to implementing your strategies for ethical marketing training elements?

How did you overcome the key challenges in the implementation of ethical marketing training elements?

What additional information would you like to share that was not covered during this interview about the strategies to improve marketing training used to reduce unethical sales representative behavior?

Ensuring data saturation, in this research, was through using a triangulation method. Triangulation is collecting data from multiple sources to have a comprehensive understanding of the topic.[11]

Data analysis

The prevalence of the phenomenon was identified in the data, which justified the purpose of the study (i.e., exploring strategies that some sales managers in the pharmaceutical industry use to improve marketing training to reduce unethical sales representative behavior). NVivo® 12 was used to help organize the collected data. Yin's logical and sequential process for the data analysis of a case study qualitative research was used.[12] The data analysis process was started by compiling the relevant collected data from multiple sources (interviews, documents, and reports provided by participants). Then, the next step was to disassemble data into separate categories. After that, we started data coding and grouped the data into identifiable themes. The next step was interpreting the data. The final step of data analysis was determining the conclusion.

After the data transcription and data analysis, member checking was used. A summary of the analyzed data was sent to the participants with a request for a response detailing any changes they thought should be included in the results. The key themes were correlated with the literature and the conceptual framework.

Results and Discussion

Three themes emerged and subthemes were found under each theme [Table 1]. Two of the major themes were to develop ethical standards and organizational policy. In addition, another major theme was found to provide training and development programs.

Table 1

Strategies implemented to reduce unethical sales representative behavior

Strategy	Percentage of use by participants (sales managers)
Developing ethical standards
Ethical communications
Building relationships
Marketing and selling products	100
Developing organizational policy
Preventing bribes and kickbacks
Handing financial transactions
Regulating activities	100
Training and development programs
Training on ethical business practice
Training on the standard operating procedures
Building and sharpening skill set	100

Theme 1: Developing ethical standards

According to Sridhar and Lyngdoh,[13] relational selling behaviors and sales performance are significantly influenced by ethical selling. In agreement with Sridhar and Lyngdoh, P4 stated, “Ethics defines the relationships and operations of the pharmaceutical industry and its practitioners.” P4 further mentioned that managers perceived many sales force personnel to have innate weaknesses that revolve around ethical issues. Sridhar and Lyngdoh found that the flow of information is an indispensable aspect of ethical selling behavior. Sridhar and Lyngdoh defined the flow of information as the state of complete engagement in an activity by an individual to the extent that they ignore everything else. To validate the interview data, the training manuals from P1, P3, and P4's companies were examined to see if they contained the ethical standards of the company. P1 was emphatic when this report was given: salespeople may conduct unethical behavior owing to internal pressures of minimal supervision and having to meet sales quotas. P1 indicated, “Developing ethical standards is critical in all pharmaceutical companies to reduce unethical behavior.” P1 further mentioned that ethical standards should include the boundaries of communicating and building relations with external stakeholders during the process of marketing and selling pharmaceutical products.

All companies of the interviewed participants had ethical standards that were meant to promote ethical behavior through the standards strong influence on the salesperson. P3 indicated that influencing sales representatives helps in motivating them to maintain ethical measures in the workplace. P3 statements were consistent with Miska et al. who explained that organizational influences through ethical standards determine ethical behaviors.[14] Therefore, managers at pharmaceutical companies can minimize unethical sales representatives’ behavior by addressing the ethical concerns and related organizational influences that affect their sales personnel. Malik et al. explained,[15] ethical activities comprise an active engagement in literacy programs targeting the medical community to influence the physicians’ prescription behavior to improve sales. However, one of the obligations on sales representative in the pharmaceutical industry is to adhere to the code of ethics (p. 246).

Malik et al. further noted that having a code of ethics is critical while communicating and building the relationship with physicians during the pharmaceutical marketing. In this study, three subthemes emerged from the strategy of developing ethical standards: using ethical communications, building relationships, and marketing and selling products.

Ethical communications

P2 stated, “Ethical communication between stakeholders is important in every business.” P2 mentioned that communication is a critical method in promoting and complying with the ethical standards of the business. In addition, all participants in this study agreed that communication is vital and helps to engage stakeholders in the business’ code of ethics. Katamba et al. indicated that managers use key performance indicators to show how the adoption of a business code of ethics and conduct is essential in registering commercial feasibility void of any immoral practices.[16] Katamba et al. further mentioned that poor communication of the business code of ethics and conduct creates intentional rebellion from the stakeholders, specifically the staff.[16] Excellent communication of the ethical standard generates universal acceptance and creates strategic competitiveness, reputational improvement, and increased probabilities of winning cross-border collaboration among concurring pharmaceutical players.[16]

Shaw and Whitney asserted that managers at companies in the dynamic business environment anticipate ethical standards and greater transparency.[4] The participants in the interview concurred that communicating effectively with stakeholders increases their trust and confidence in the business and helps in compliance with ethical standards. In addition, the participants mentioned that effective communication with stakeholders can create transparent and ethical business environments that there is an increasing trend toward stringent regulations that demand the separation of commercial practices from medical activities in pharmaceutical businesses. P4 indicated that this separation could be a requirement in some pharmaceutical companies toward maintaining a code of ethics and conduct in fulfilling medical activities to match regulatory requirements. However, P4 mentioned that effective communication should help to remedy unethical inclinations of staff in undertaking these medical activities.

According to Min et al., communication with stakeholders is part of the corporate social responsibilities (CSR) initiatives conducted in pharmaceutical companies.[17] P5 mentioned that CSR involves communication with the stakeholders of a business to update them on corporate activities and events and the extent to which the business is socially responsible to its internal and external stakeholders. P5 mentioned that maintaining ethical standards embarking on transparency and greater ethical foundations in communication with stakeholders provides a clear picture of the organizational goals and contributes to controlling unethical behavior of the sales force. P5 stated, “Transparent communication delivers business's objectives to stakeholders to achieve social, environmental, and economic goals.” P5's stance is consistent with the triple bottom line mentioned by Min et al.'s study that comprises social, environmental, and economic strategies that are in play to ensure management of the business that produces an overall positive effect.

Building relationships

According to Kazadi et al., building relationship with stakeholders has been associated with creating benefits in pharmaceutical industries such as exceptional knowledge bases and resources.[18] Kazadi et al. further indicated that stakeholder theory relates to the development of organizational relationships with multiple stakeholders.[18] The participants in this study indicated that the high management teams at the organizations remained informed about stakeholders’ concerns and integrated some stakeholders in the decision-making processes. Kazadi et al. explained that stakeholders stand as valuable sources of exceptional knowledge during the innovation process.[18] The stakeholders remain the locus of the firm's innovation and innovation networks couple diverse aptitudes, knowledge, and resources which are not necessarily available through market transactions (p. 3).

Kazadi et al. further noted that the increasing complexity of products and services demands the input of stakeholders to drive a firm's capacity to manage its innovation networks and subsequently improve its creativity and overall outcomes.[18] P1 stated, “Building relationships with stakeholders is critical and it should be based on ethical standards.” P1 further mentioned that through building relationships, stakeholders can suggest ethical standards to be incorporated in innovation processes that may help to minimize immoral practices among the employees.

Franco-Trigo et al. (2020) mentioned that building relationships and stakeholder involvement optimizes promoting the integration and acceptability of new health services as well as health planning.[19] P5 asserted that collaboration with stakeholders facilitates the overcoming of challenges associated with community pharmacy services. All participants in this study confirmed that building relationships and active participation of stakeholders in key organizational processes could help to maintain an ethical sales force in pharmaceutical companies. In addition, Lorenzini et al. found that building effective relations, having long-term alignments, and engaging stakeholders are valuable aspects in driving innovative packaging solutions in the pharmaceutical industry.[20] Building relationships with stakeholders can help to mitigate problems arising in packaging and health-care services.[20] Stakeholders can also contribute to environmental aspects such as user-friendliness and CSR, both elements of ethics.[20]

Marketing and selling products

Many researchers focused on ethical and unethical behavior in developed countries and fairly highlighted the plight of these issues in emerging economies, especially in the pharmaceutical sector.[21] Haque et al. mentioned that patient-centric marketing strategies are increasingly used by managers at pharmaceutical manufacturers to target medical practitioners prescribing medicines for patients.[22] Since patients are at the core of the health-care system, all participants in this study agreed that ethical standards in marketing strategies, adopted by managers at pharmaceutical companies, are an important aspect of ethical behavior. Javed and Ilyas showed that the presence of unethical standards in pharmaceutical-based marketing strategies influenced patient satisfaction.[23] P2 stated, “Marketing mix strategies of pharmaceutical companies comprise various communication channels such as, the use of electronic, mass, and print media as well as e-Detailing through literature.” P2 explained that marketing communications of pharmaceutical companies are strictly regulated, but recent trends show a rise in unethical marketing practices among sales representatives in the pharmaceutical industry.

However, P1 indicated, “The religious core-values of the managers as well as sales representatives could have impact and influence on the process of marketing and selling to make it ethical.” According to Haque et al., some religions endear ethical considerations in patient-centric marketing strategies.[22] Haque et al. revealed that ethical standards in marketing enhance the health-care service provider's reputation.[22] Participants in this study said that prioritizing patient satisfaction through ethical marketing strategies and communications translates to increased market share and use of service. Fatima[24] indicated that in the era of increasing competition among organizations, differentiation through customer-centric and ethical selling is a plus. Sales personnel need to engage in honest actions that foster lasting relationships with customers and promote customer trust and satisfaction with the marketing communication applied (p. 69).

Fatima further noted that marketing management should perceive the corporate social audit as a chance to show its concern for the safeguarding of consumer rights. The high management team can remove uncertainty surrounding the marketing function by monitoring, assessing, prescribing marketing processes, and creating a marketing-centric ethics code.[24]

Kadic-Maglajlic et al. mentioned that an ethical organizational climate improves the optimistic impacts of the industrial ambiance on customer orientation.[25] Ethical marketing fosters ethical organizational climates that embody truth and ethics when targeting customers.[25] Interviewed participants in this study concurred that ethical marketing and selling create an industrial climate that positively impacts the organization's reputation. The utilitarian perspective implies that ethical actions are those that achieve the greatest good for the largest number of people.[21] Ethical marketing strategies have multidimensional benefits for pharmaceutical industries, companies, practitioners, and customers.[21] All participants agreed that ethical marketing and selling standards reduce unethical sales representative behavior in the pharmaceutical industry.

Theme 2: Developing organizational policy

Mehralian et al. indicated that organizations with the ability to create and amass knowledge according to ethical organizational policies can sustainably compete.[26] According to Mehralian et al., pharmaceutical companies have all the characteristics accredited to knowledge-based firms, and managing knowledge in the industry is an important aspect that contributes to organizational performance.[26] Huang et al. asserted that organizational implementation of ethical policies is a critical factor in realizing registration and reporting of outcomes in clinical trials.[27]

Huang et al. indicated that managers at pharmaceutical companies are providing access to raw data in order to elevate the transparency of their clinical trials.[27] Huang et al. mentioned that policy embodies ethics and affords the stakeholders an opportunity to scrutinize the full compliance of the data and its presentation with the ethical code of conduct.[27] Beck-Krala and Klimkiewicz[28] explained,

Due to increasing concerns related to unethical behavior in the pharmaceutical industry, organizations should have organizational policies to limit unethical behavior. GlaxoSmithKline is an example of a pharmaceutical company that has designed an organizational policy to reduce unethical behavior, improved work processes, efficient resource consumption, and financial savings (p. 48).

Beck-Krala and Klimkiewicz further noted that ethical organizational policies are valuable to ensuring that sales representatives in pharmaceutical companies perform their duties within ethical bounds.[28]

P5 stated, “Organizational policy goes hand in hand with ethical standards in such organizations.” P5 indicated that their organizational policy includes information that is crucial to reduce unethical behavior. P5 further mentioned that organizational policies represent facets of information that managers should share in an organization. The policies from P5's company were reviewed to validate the interview data. The policies from P5's company aligned with the collected data. In addition, all participants observed that organizational policy was assuming the addition of intellectual capital on ethics, improving the ethical position of the business and employees. Three subthemes emerged from the strategy of developing organizational policy: preventing bribes and kickbacks, handing financial transactions, and regulating activities.

Preventing bribes and kickbacks

Managers at pharmaceutical businesses considerably depend on aggressive marketing strategies to obtain the loyalty of patients and physicians, which at times embodies corruption.[2] Therefore, there is a need to adopt counter strategies ranging from using transformational leadership in employee help programs and appraising performance goals associated with sales to providing certified employee training on important company policies and antibribery laws.[2] P4 stated, “It is very important to prevent all types of corruption including bribes and kickbacks.” P4 further added that instituting suitable anticorruption controls (separating the sales function from the marketing division), encouraging whistleblowing and an open-door policy, evaluating corruption risks linked to having business operations in poorly performing regions, and sensing common corruption plots help an organization promote ethics in business dealings with physicians and clients.

Mackey et al. mentioned that health-sector corruption has created a menace in the industry through inhibiting access to safe and effective medicines, quality health services, and destabilizing systems targeting financial risk safeguards.[29] Mackey et al. mentioned that corruption slows progressive efforts aimed at realizing universal health coverage.[29] The World Health Organization estimated that close to U. S. $415 billion was lost in health-care abuse and fraud in 2008.[29] All interviewed participants said that organizational policy targeting corruption should facilitate ethical behavior among practitioners and employees (e.g., sales representatives).

Researchers showed that corruption in health care has more than a financial impact and associates with a detrimental effect on individuals’ status quo and poorer health.[29] P2 mentioned that many aspects make the health-care industry a corruption zone such as sophistication of country-specific health-care systems, the internationalized nature of the health-care supply chain, and information asymmetries that can result in slackened decision-making. P2 indicated that internationalization of the health-care system increases the number of corruption access points. Participants in this study agreed that instituting corruption-free environments (penalties) could help to discourage organizational corruption. The participants mentioned that stakeholders should engage in fostering collaboration with industry players to mitigate the causes of corruption.

P3 stated, “Formalized payment structures can help reduce corruption.” P3 also mentioned the importance of implementing tight controls on payment methods and procedures to ensure that managers handle medical finances effectively and accountably. Implementing safer procurement and delivery procedures could also help to prevent kickbacks and bribes. P1 added, “Limiting supply chain intermediaries is a step towards mediating risks associated with long supply chains and bureaucratic procedures.” According to David-Barrett et al., third-party certification is another positive commitment toward fighting health-care corruption.[30] Third-party certifiers such as the International Federation of Pharmaceutical Manufacturers and Association are global institutions whose commitment lies in promoting and supporting voluntary ethical principles and practices in the pharmaceutical industry.[30] All participants agreed that organizational policy that embeds anticorruption policies could also help to reduce sales representative and practitioner-based unethical practices in the pharmaceutical industry.

Handing financial transactions

Witchey highlighted how managers at the health-care sector can improve transactions using validation systems.[31] Witchey presented a blockchain method of handling financial transactions in the health-care sector and found that conducting financial transactions should include corresponding health-care parameters such as clinical evidence, results, outputs, and inputs.[31] Validation systems help to establish a transaction's validity. Participants in this study mentioned that validation systems help to foster transparency of financial health transactions, thus ensuring minimal unaccountability of the system. The participants also mentioned that validation systems help in generating coordinated data of a patient by incorporating the patient's history in the blockchain. The participants further indicated that managers can use a level of coordination and responsibility to prevent unethical practices among the sales force in the pharmaceutical industry.

Nunoo (2019) suggested an Enterprise Resource Planning System (ERPS) for handling transactions.[32] In Nunoo's study, the use of an all-encompassing ERPS was the key to reducing inefficiencies and optimizing business performance.[32] Nunoo also showed that the appropriate implementation of an ERPS ultimately increases business performance and directly controls the optimization of revenue and sales in pharmaceutical companies.[32] Nunoo further asserted that the ERPS can provide important information to a senior management team that is comprehensible and applicable when formulating strategic decisions to improve the performance of the business.[32] Hassan and Daud posited that eco-organization is an important facet of eco-innovation.[33] Hassan and Daud defined eco-organizational innovation as the upgrade of business’ management processes through novel eco-methods in the firm's practices.[33] Eco-organization is linked with enhancing corporate performance through enhancing employee and workplace satisfaction levels, sustaining critical changes, reducing suppliers’ costs, and minimizing transaction and handling cost.[33] P1 stated, “The use of transaction handling methods and systems can significantly reduce unaccountability and the loss of critical patient information.” P1 further mentioned that transaction handling methods and systems also improve ethical working by motivating responsible behavior among employees concerning handling of patient and miscellaneous transactions in pharmaceutical companies.

Regulating activities

Researchers showed that there are many activities between physicians and employees (e.g., managers, sales representatives) at pharmaceutical companies.[34] P3 stated, “The main benefits of activities between physicians and sales representatives at pharmaceutical companies are rewards for services.” P3 further mentioned that physicians in the pharmaceutical industry require motivation to perform beyond expectations.

P4 indicated that physicians showed a positive appreciation and approval of these conferences that managers at pharmaceutical companies’ sponsor. However, P4 mentioned that managers regulate conferences and other activities (through organization policy) to reduce unethical behavior. All participants in this study agreed that knowledge gained through conferences and stringent policies against excessive interaction between sales representatives and physicians could reduce unethical behavior in the pharmaceutical industry. The participants also mentioned that sales representatives provided information regarding specific drugs to the physicians and used promotional tools like sending direct mails, face-to-face interactions, and offering free samples for distribution to patients. In addition, sales representatives use other activities (e.g., buying dinners, event tickets, paying for meals and vacations for families, and honorariums) to foster products during events and foster loyalty among physicians to certain products and pharmaceutical companies.[35] All participants mentioned that managers at pharmaceutical organizations have organizational policies that cover regulating activities between sales representatives and physicians to reduce the chance of having unethical behavior.

According to Gupta et al., establishing organizational policy allows physicians and sales representatives to know the extent of the ethics code of conduct and to align their activities that include interactions and behavior accordingly.[36] Alowi and Kani suggested the important need to establish an organizational policy because of the scrutiny of promotional activities (seminars, sponsored travel, exclusive gifts, etc.) by sales representatives toward doctors.[35] P2 stated, “The organizational policy should ensure that doctors and sales representatives act in the best interests of the patients and company.” P2 also mentioned that organizational policy that promotes ethical interactions between doctors and sales representatives is vital to maintaining a strong ethics code.

Theme 3: Training and development programs

Muddukrishna et al. indicated that training and competency levels play a key role in ensuring the effectiveness of medical staff in pharmaceutical industries.[37] According to Muddukrishna et al., training and development are complimentary and parallel to competency levels in the pharmaceutical industries.[37] All participants in this study said that training and development programs help employees to be more determined to apply learned knowledge and skills in daily practice. Part of the knowledge obtained in the interviews included the importance of conducting ethical training in the workplace. The participants said that having training programs could reduce sales representatives’ unethical behavior in the pharmaceutical industry.

Babapour et al. indicated that training provides nontechnical skills such as professional ethics, negotiation skills, behavioral skills, and organizational values, which are relevant to increasing the effectiveness of employees in the pharmaceutical companies who are medical practitioners.[38] However, Dhainaut et al. argued that training on the standard operating procedures remains inadequate.[39] Dhainaut et al. mentioned that robust training and development programs should focus on pharmaceutical companies creative healthcare solutions.[39] In addition, all participants indicated the importance of training and development programs in reducing sales representative unethical behavior. The three subthemes that emerged from the strategy of developing training and development programs were training on ethical business practice, training on the standard operating procedures, and building and sharpening skill set.

Training on ethical business practice

There is an increasing trend toward the institutionalization of training programs in the pharmaceutical industry.[40] Training may include an external communication cycle comprising communicating data to a suitable audience, listening to stakeholders to obtain insights, and gathering data founded on stakeholder necessities.[40] P3 stated, “Stakeholder input and needs assessment is essential in the design and implementation of training program focused on ethics in pharmaceutical industries.” P3 further mentioned that education is part of the training programs in such organizations. Setia et al. further indicated that advisory boards in the pharmaceutical industry promote the generation of credible educational content.[40] This content is relevant to promoting ethical standards among industry professionals.

Sales representatives collaborate with health providers to focus on gaps in educational needs or clinical practice and improve the global health and well-being of people.[4041] P2 mentioned the importance of collaboration between sales representatives and physicians. P2 stated, “Collaboration can provide insight on ethics gaps in the industry and foster much needed change in the ethics code of conduct for sales representatives.” P5 stated, “Sales representatives could rely on such content to adapt their moral compasses to fit industry and business-specific requirements.” P5 further mentioned that having training on ethical business practice helps to reduce unethical behavior.

Chisholm posited that managers should react to educational needs of sales representatives to impart necessary skills and knowledge to avoid unethical behavior.[42] Industry requirements make imperative the development of training programs for educational provisions that impart qualities such as analytical thinking, innovation, self-direction, problem solving, and flexibility to promote industrial growth and practicality.[42] These skills could help to minimize unethical practices in the industry. Chisholm further suggested that disruption in health care is affecting education to adapt the industry professionals to a volatile, uncertain, complex, and ambiguous world. The interviewed participants in this study concurred with developing ethics training programs to adapt medical practitioners and impart necessary competencies that effectively engage them in positively changing the industry.

P4 stated, “Dynamism in the pharmaceutical industry also demands ethical conduct training when dealing with stakeholders.” P4 also mentioned that training on ethical business practices is a critical factor to combat unethical behavior among sales representatives. Chisholm observed a need for increased training and education focus on ethics business training.[42] This training could impart moral considerations among sales representatives to allow them to perceive the seriousness of unethical behavior issues.[42]

Training on the standard operating procedures

Quality management is indispensable in the pharmaceutical industry because employees need to follow a standard operating procedure to comply with the regulatory requirements and to avoid unethical issues.[43] P2 stated, “Following standard operating procedures is mandatory for employees at pharmaceutical companies to maintain ethical business practice and credibility.” P2 indicated that sales representatives need to have quality management training to facilitate their duties. P2 also mentioned that through training on the standard operating procedures, sales representatives engage in ethical practices while communicating with physicians. In addition, having a quality management system facilitates the execution of transparent, efficient, and effective structure and processes that help to achieve consistent compliance with regulatory frameworks.[44] In addition, training on the standard operating procedures and having quality management systems help the managers to realize customer satisfaction, improved quality, inspection readiness, and optimized costs.[43]

P1 indicated that global regulators have found deficiencies in the way that some pharmaceutical companies manage quality control, standard operating procedures, and training. P1 mentioned that there are many challenges with utilizing cross-functional data, and this is considered as a primary concern related to standard operating procedures. P1 stated, “These concerns reflect in the sales representatives of pharmaceutical companies leading to operational inefficiencies and propagating unethical conduct.” Shanley (2019) mentioned that improved standard operating procedures should help to ameliorate problems in pharmaceutical companies and improve efficiency.[45] P3 indicated that the use of digital tools helps individuals to refer directly to the most appropriate standard operating procedures, important data, and protocols. P3 also mentioned that training sales representatives on the use of these digital tools can help them to effectively manage reports, data, and discourage unethical conduct.

Pai et al. mentioned that personnel training for pharmaceutical industry should include training on the standard operating procedures necessary for the performance of delegated responsibilities and duties.[46] Interviewees in this study mentioned that training on standard operating procedures allows employees to perform their duties without supervision and do so in accordance with the procedures. Training on standard operating procedures also empowers employees to comply with the values of the organization during the performance of their duties. This training could help sales representatives to behave ethically as per the stated norms and standard operating procedures of pharmaceutical companies.

Building and sharpening skill set

Modern medicine focuses on effective and efficient provision of services and products. In this era, the need for a competent and skilled workforce in pharmaceutical industries is ever rising. Yusuff indicated that changes in the field of pharmaceuticals focused on building the skill set of employees, deepening knowledge, and sharpening the competencies of health-care practitioners.[47] Yusuff suggested that more focus that targets physicians and medical professionals is needed.[47] These health-care professionals should ensure they absorb the culture of effective and safe prescribing, consistent professional education, and logical use of medicines. Moreover, considerable attention has been paid to enhancing the quality of facilities and pedagogical strategies applicable when training health-care professionals.[47] This focused training has helped to have high standards of performance and ethics in meeting their obligations.

P5 stated, “Building and sharpening skill set is meant to reduce unethical behavior of medical professionals in the fields of sales and marketing.” P5 indicated that exposure to learning opportunities continues to ensure that sales representatives engage in self-directed metacognitive practices, formulate their own learning, and promote ethical behavior. P4 mentioned that providing the opportunity to the employees to complete their graduate studies (e.g., master of business administration) helped sales representatives to increase their knowledge and sharpen their skill set to contribute to radical changes in training, duty performance, and practice inside the company. P4 further mentioned that building skill sets and sharpening competencies could continue to dissuade unethical practices in the pharmaceutical industry.

From 2014 to 2019, there was a rise in dialogue between global regulators and pharmaceutical manufacturers on the best ways to measure quality.[45] Health impact assessments (HIAs) have been studied in relation to quality assurance in health care. Green et al. defined HIAs as tools for measuring the effect on a population's health and well-being of proposed policy and strategy.[48] These tools include training and how the training impacts health workers in performing their duties and helps to maintain the quality of services offered by sales representatives and training received. P2 stated, “Through HIAs, the level of training of the sales representatives can be reviewed and appropriate suggestions made to effect necessary changes.” P2 further indicated that it is possible that HIAs have an indirect impact on building the skill set and sharpening the competencies of medical professionals, which are relevant to reducing untoward behavior such as unethical behavior.

Study limitations

One of the study limitations is using purposeful sampling. However, according to Duan et al., using the purposeful sampling method helps in leveraging limited resources and selecting rich-information cases.[49] Ames et al. indicated that researchers use purposeful sampling to narrow down the inclusion criteria when a large amount of data is available.[50]

The population of the study includes the sales managers in specific location (the northeastern region of the United States). There are 1182 pharmaceutical companies in the northeastern region, with a minimum of five sales managers in each company.[51] Considering these numbers, there was an advantage to focus on this region from which to select the target number of sales managers. However, another study limitation is the inability to generalize the study findings to other locations.

Conclusion

The findings of this study bring to conclusion that developing ethical standards and acting in accordance with them is possible through communication, building relationships, and marketing and selling products. Developing organizational policy on ethics targets corruption prevention, handling financial transactions, and regulating activities. Training and development programs provide training on ethical business practices and standard operating procedures and building and sharpening skill sets. The study found there is an alignment between the findings and the general theory of marketing ethics. Ethical considerations were found to be important in medical professional practice. These findings determined that ethics are an indispensable aspect of modern pharmaceutical industry and have a significant impact on social change. Ethics help in achieving sustainability in medicine discovery, production, and distribution. The findings demonstrate that pharmaceutical companies can use these strategies in enhancing their marketing training packages to realize ethics for sales representatives. There is also an urgent need to invest time and intellect toward advancing knowledge in eco-organization and eco-innovation. Other areas of interest in relation to the findings of instilling ethical behavior in the pharmaceutical industry include digital marketing training, evaluation of medical professionals’ relations with the industry, and marketing techniques directed to young adults and children.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.