Most organisation charts I've inherited were drawn for a plan that no longer existed. The brands had changed. The customers had changed. The team hadn't. So a hospital brand was sold by a team built for retail calls, and tenders went to whoever had a spare afternoon.
At country level, the organisation is what turns a plan into calls, accounts and results. A team built for last year's plan will quietly slow this year's, however hard people work.
Step 5 of the Pharma Career Ladder for country managers is building the organisation. Here's how I approach it, from the chart to the culture.
Design the team the plan needs
Alfred Chandler studied large companies and found that structure follows strategy. Start from the choices, the brands, segments and channels the plan backs. Map the work they create: hospital accounts, tenders, key pharmacies, specialist calls. Design the roles around that work, then match people to them fairly, with HR, and explain every change to the people it touches. Draw the strategy first. Then draw the organisation chart.
The same logic tells you how many reps you need. Count the customers who must be seen, how often each segment needs a visit, and a realistic number of calls per rep a day after travel, meetings and training. The headcount almost calculates itself. Explain the logic to the team before a single territory moves. And when a brand isn't growing, check the message before asking for more reps. More people only carry a weak message further.
Then work out the span of control from the coaching each rep needs: field days per rep, how far apart the reps are, the experience mix, and the manager's other work. If a manager can't coach every rep, the span is too wide, whatever the budget says.
Check the whole organisation, then train for the gaps
I've seen good strategies fail for reasons that had nothing to do with the strategy. The plan said hospitals, and the incentives still paid for retail volume. The McKinsey 7S model is old, and I still find it one of the most practical checks a country leader can run. Strategy, structure, systems, shared values, style, staff and skills have to pull the same way. The first 3 are easy to change on paper. The last 4 decide whether anything changes at all. Before announcing any change, ask what it means for the other 6.
Then build a capability map. List what next year's plan needs. Write what the team can do today, from what you've seen on double visits, in tenders and in account reviews. Mark the gaps, and give each one an owner and a date. The map is about the organisation, never a rating of individuals, so build it with your managers. A plan that needs a capability you don't have is a training plan first.
Donald Kirkpatrick's 4 levels of evaluation, from 1959, still decide whether training reached a doctor. Reaction and learning happen in the room and belong to the trainer. Behaviour and results happen in the clinic and belong to the sales manager. You see behaviour on a double visit in weeks 3 to 6, or you don't see it at all. Training is measured on the call, not on the certificate.
A calendar of workshops is a list of events. A training curriculum is a sequence. In my teams it runs in 4 layers: foundations first (product, disease area, compliance), then 1 call skill per cycle, then first-line managers coaching each module on double visits, and finally measuring what changed.
Choose and grow your managers
A manager's job is other people's results, so hiring managers needs a different bar from hiring reps. Ask for the people candidates have coached and what changed for them. Let them watch 2 reps practise a call and debrief one. Ask about a hard conversation they led. Run the same process for every candidate, with HR.
Inside the team, the top name on the ranking is the easy choice, and promoting the right manager means looking for different evidence. Who do the other reps call when a doctor says no? Promote for the job they will do, not the job they did. When the answer is not yet, give a strong seller a real path: senior rep, key accounts, a project they care about.
You'll never coach every rep, but you can develop your second line. Agree 1 development gap with each manager. Join their double visits and watch them, not the rep. Give them real decisions: a hire, a project, part of the budget. Every quarter, ask how their people have improved. Your reps grow at the speed your managers grow.
Then plan for succession without drama. Name the critical roles and find 2 names for each, one ready now and one ready with development. One name is a hope. Two names is a plan. Review it twice a year with HR, never promise a role, and never leave people guessing.
Keep people, and change teams with care
When a good rep resigns, the budget can look better for a few months. The cost of turnover lands elsewhere: a vacant territory, hiring hours taken from coaching, a learning curve of months, and colleagues wondering if they should be next. Ask your best reps what keeps them before a recruiter does, and read exit reasons across the team.
When you take over a country, you inherit the team. Michael Watkins, in The First 90 Days, makes the point that new leaders should assess before they restructure, and in changing a team you inherited I've found order matters more than speed. Listen first. Assess each role against what next year needs. Decide fairly, with HR. Each person hears it first, in private.
Occasionally the whole structure has to change. Link it to the new strategy, never to personalities. Let HR lead, following local law exactly. Tell people face to face, give those who leave fair terms and a good reference, look after those who stay, and tell customers who to call. People remember how they were let go long after they forget why.
Culture, under pressure and at scale
Culture is what you tolerate. The team learns it from what happens next: the manager who speaks badly to a rep, the top seller who cuts a corner. Name the behaviour the first time, calmly and in private, and hold the top seller to the same standard. The behaviour you walk past is the behaviour you've approved.
You find out which values survive a bad quarter when sell-out slows. Say plainly where you are. Don't load the trade. Keep the code, protect the coaching days, and thank the rep who did it the right way with a smaller number.
Gallup's Q12 asks about the basics of work, and a few of its questions I watch closely: do people know what's expected, do they have what they need, have they been recognised, is someone backing their growth? Share results with every team, keep answers anonymous, and let each manager work on 1 or 2 items. Next year, start with what you changed.
Your checklist for this week
- Write the 3 choices your plan backs, then check your org chart against the work they create
- Recalculate headcount from target customers, call frequency and realistic calls per rep
- Ask each first-line manager where their week actually goes
- Start a capability map with your managers: plan needs, evidence today, gaps, owners
- Name your critical roles and write 2 successor names for each
- Agree 1 development gap with each of your managers
- Share last survey's results with every team and pick what changes
That's Step 5. Next week Step 6 begins: working across functions, starting with how sales and marketing build one plan.