Does anyone at a big pharma company come into work thinking about ways to help people navigate complicated healthcare decision-making? They have lost track of who we serve and, more importantly, why.

If you asked daily: “did I create value for our customers today” you’d get very different answers from everyone in the industry. Overall big pharma is a culture where it’s more important to “get along” than fight for patients. Those who push back or fight for patients and caregivers are labeled “hard to get along with” as senior managers do everything to maintain their status and salaries.

There is a collective delusion that their actions are exceptional because the drugs they develop save lives. And as in all such fantasies, the deluded ones are the ones who don’t care that people can’t afford medications or that cancer patients wipe out their savings to stay alive.

When new people join pharma, they brainwash them. They insist on doing things because “that’s the way we do it.” Never mind if most people quietly complain about the inefficiency and incompetence of wasting money on tactics that don’t help patients.

Pharma has unarguably antiquated internal processes. It is almost as though they are stuck in a time warp from two decades ago with waterfall planning processes focusing on profits over patients.

Hiring at pharma is always a problem because it leads to bad hires, and those bad hires create more bad hires. “Bad” is subjective — every person can be individually good, but are they placed in positions that maximize their strengths and minimize their weaknesses?

The flip side of hiring is talent management and retention. From what I saw, pharma could do much better identifying and nurturing talent, moving talent to the best-fit roles, and optimizing the people already in the company. Instead, the pattern seems to be to wait till someone is unhappy and leaves, then open a req to replace them—a minimal effort to steer people to alternative roles and maximize talent. Even when someone is promoted, they usually move to an area where they have no expertise and, as a result, lose motivation.

Several other leadership challenges are reflected in poor strategic and tactical decisions, mainly because people make decisions with roles or titles rather than people with expertise.

Almost all decisions are made at the VP level or above, usually by people who have position power and like to voice their opinion. To make matters worse, VPs rotate to different products or come from other companies but start making critical decisions, often barely knowing their customers.

Then there are the endless meetings that could have been emailed. I witnessed a small biotech startup hire people from a big pharma company and slowly become big pharma with back-to-back meetings. People employed as VPs often got into trouble for making even minute decisions without asking their Senior VPs. This endless communication cycle doesn’t minimize risk; it ensures that customers are put behind brand profit objectives.

Can pharma transform into a business that focuses on customers and realizes that what’s suitable for people is good for business? I’m still determining. It seems that too many industry insiders stay within the industry even when they screw up.

I recently interviewed for a VPs position in the industry. After three days of Zoom calls and endless questions, the SVP was afraid to hire me because she felt I would have difficulty integrating with their staff. The HR manager told me they needed someone to come in and shake things up, but I told her that approach scares too many people. That is an excellent summary of the industry today.