Robert Barzelay You forgot two groups of stakeholders who expect to benefit: your shareholders and your employees. They may not be your clients, but definitely beneficiaries. I agree, in Life Sciences it's a balancing act.

Chris Sawyer This is why stakeholder analysis and needs is critical to success in this sector. Particularly when introducing new technologies and solutions. The Business Case needs to clearly communicate how the stakeholders needs will be addressed. Positioning the product to meet the needs of different locations (countries) is also very important particularly considering that there are different systems in place.

Used to be only the end-user Physician
This is not the case anymore, especially in Europe, Middle East and Asia
A different set of buying influences have been developed down the road, as Health Care budgets are constraint. Namely Hospital Administrations, Central Tender evaluators etc.
I, therefore, agree with Chris that an in depth stakeholder analysis and individual needs identification is critical to success

I hate to answer a question with a question, but the answer is dependent upon this question: What is the device's value proposition? And by that I mean: Is it a time saver? Is it an improved patient outcome? Does it provide a quicker recovery time? Is it a device that costs substantially less than others in the market segment? Etc....Granted, it will ultimately be beholden to all of those things, but the reason the device is being brought to market is one or more of the above, and dependent upon the value proposition(s), the customer that should be targeted to whom to sell those devices is based upon that/them. Of course, as Mr. Griziotis points out above, knowing the specific device segment is even more critical now, as it dictates who holds the purse strings, and how much influence physician preference has over obtaining devices for use in patients, since it's not only the physician who makes the decisions anymore.

John G. Caruso It is a balancing act among several players, but it seems to me that the "customer" is the one that you have to convince to purchase, and train to use. In most cases that would be the doctor.

James (Jim) Dent, LSSBB, DTMx2 Very interesting question Jim Gustafason.

Karen Boyd, ASQ CQA I agree, very interesting question!
IMO - I would say the "customer" (in the eyes of the manufacturer or seller) is multi-faceted and should be considered as - the hospital, the treating physician(s) or users, and the patient(s) receiving treatment via the assistance or implantation of the medical device. The medical device needs to be a worthwhile investment for the hospital, an appropriate / effective device for the treating physician(s), as well as safe and beneficial to the health / welfare of the patient(s). Balance the "customers" in both fiscal and functional terms; always for the greater good!

This is a common problem when you operate in various B-2-B scenarios, and one that manufactures and sellers often have a difficult time balancing. Frankly, IMO, the behavior will change dependent upon how each element of the organization is compensated and whom they serve. So, sales will see the hospital as their customer, customer service will see the patient or physician as the customer, etc. Ideally, an organization would have strategic KPIs and incentive plans based upon those which would drive outcomes that are beneficial for all involved.

One more "customer", which I do not think has been mentioned, and that is the regulatory agency. Because "if momma ain't happy, ain't no one happy".

Karen Boyd, ASQ CQA I agree with Ashleigh's views on customer perceptions via sales, customer service, etc.. I think her points serve to demonstrate how often a disconnect seems to occur within organizations and their understanding or definitions of the "customer".
As far as regulatory agencies...I don't see them as "customers", but rather as the oversight and governing "parental" bodies (as they are). I do like the humor of "if momma ain't happy....". I'd like to politically correct and say, if momma and daddy ain't happy... :)

Paul Baim Unfortunately, you stopped at the insurer. Who pays the insurer, the patient does. So, the great circle of medical life starts and ends with the patient. Seems clear to me. The entire existence of the rest of your ecosystem revolves around the needs of the patient. Without patients, the rest would vanish in a puff of (blue) smoke. Forgetting this leads to a lot of badness.

The patient's involvement in the decision-making process for their healthcare treatment options is ever-increasing. As a patient becomes more empowered through the educational content found online and through other channels then they will begin to question/challenge a physician's recommendation. An educated patient is an empowered patient. So in addition to our "traditional" customers, the patient is becoming a customer too. The way the healthcare landscape is shaping up will only accelerate this transformation.

Jim Gustafson Paul B, you are right. But when the patient pays the insurance company, he is not paying for a medical device. He is paying for health care insurance. So I think of it as not a circle, but a spiral: by the time things come back to the patient, it is not on the same plane.

Paul Baim Jim,
I disagree. When the patient pays the insurer they expect the best and most cost effective care possible and that's what they think they are paying for. No one 'buys insurance' as a commodity, they buy the expectation of care, including medical devices when necessary. Insurance is a means, not an end. Everything that contributes to the size of their premiums is of ultimate concern to them. The fact that their payments are pooled makes no difference to the patients thoughts or their place in the ecosystem. In fact, Noah's comment that "the patient is becoming a customer too" shows how broken our notion of the role of the patient is. If insurers and doctors consider the patient incidental to their businesses, that's broken, and, in fact, that explains many of the ways our healthcare system has become bloated, inefficient, and too costly.

While the trend is clearly toward more involvement and influence from the patient, the patient is not the customer until they can direct the selection of the device (including the company / brand from which the device originates). So, consider this a mathematical function: the device selection is a 'Function' of the preference driven by influencing stakeholders (payer, provider, physician, patient and policy makers). The coefficient associated with each stakeholder is not equal and is differs depending on the device category, provider type, payer type, and degree of patient involvement.

Leading device manufacturers need to recognize this algebraic equation and develop their messaging and value proposition (clinical and economic) so that it aligns with the stakeholders interests. Of course, the equation is dynamic and understanding the trend is also critical to developing the future state medical device business and sales models.

Paul van Saarloos The "customer" is who ever makes the purchasing decision. Depending on a range of factors, this can be any of the above mentioned entities.

Karen Boyd, ASQ CQA If a patient (end-user) sustains long-term injury and/or necessitates lifelong medical treatment or therapy as a result of a faulty device, does that change the perception of "customer"?
We can go back to the poster's original question, considering devices such as a pacemaker or other implants. Wouldn't the implanted patient be considered a "customer"? They're using the device for direct medical benefits / treatment.
Consider even common, every day prescription devices, such as contact lenses. I purchase and rely on contact lenses to see the world clearly and certainly consider myself the "customer".

the patient

Chris Sawyer The patient is not the customer unless they directly purchase the product/service. The patient is the end-user and the insurance companies customer. The customer is the purchasing entity and dependent on the item being purchased may comprise of more than one stakeholder contributing to the decision making process. For example the patient does not decide which MRI device is going to be purchased by a hospital and the same goes for the pacemaker. I do however agree that the informed patient is becoming far more powerful particularly when it comes to consumer purchases and out of hospital solutions. This seems to be the case particularly in the US, which is relevant here as many of the comments above seem to be based on the US market.

Pat Ridgely, MD I second Karen and Ashleigh's view that there are in effect multiple customers. In fact, this harkens back to the Miller-Heiman "Strategic Selling" work of the last few decades.

An aspect of all this that I think is all too often neglected is the role of the patient when an implantable device comes up for replacement. While many patients will just go along with replacement as an "of course" step, some don't re-up for the therapy; sometimes the percentage of the latter is surprisingly high.

The "customer" is multifaceted. It can be the purchasing agent, the CEO of the institution, the physician, the lab specialist, the patient. All should be treated as the potential "customer" and serviced as such. The patient is ultimately the customer or end user of the product.

Jerrold Shapiro If we broaden Jim's original question to include FDA Class II devices, and focus only on those used or implanted in hospitals, then we see that multiple stakeholders contribute to the buying decision, so that no one of them is "the customer." The CEO of a company with a medical device for bringing the edges of large wounds together so that they heal told me that he sends seven sales teams into a hospital, one team per stakeholder, in order to make the sale. My personal experience selling to physicians who own their own practices is that economics plays a large role, and that just because patients clamor for a nonsurgical, drug-free solution to a vexing medical problem doesn't mean the physician will provide it for them.

Hi everyone, interesting discussion!

I think it is more appropriate ti use the word user (as intended by regulations and guidance) rather than customer and then all the categories will fit in the definition of user. The patient will actually use the service provided by the device, the MD or surgeon will use the device as well as accessories and other devices when treating the patient. The hospital will be a user as it will probably in charge of storage and inventory management.

When it comes to your example of a car it is true if you buy it for yourself. However if you are a sales rep and as a benefit you have a leased car, you might end up being in the same situation with more "users" involved: the one who pays, the one who drives.....

The customer is the boss in any medical device you are trying to sell. You treat your customer as anything else but the boss and you will see your product decline.

James (Jim) Dent, LSSBB, DTMx2 The customer is the person(s) who receive the output of your process - internally or externally.
Just like there is a Supply Chain, there is a "Customer Chain". It's whoever uses the output from your process.

If you write a design report at work, who receives it? That is your report's customer.
A cook in the kitchen prepares a dish which was ordered by a person sitting at a table in the dining room. The cook places the prepared food on the pick-up table for the waiter to deliver the food. The waiter checks the food over first to ensure it matches the order - who's the cook's customer? The waiter or the person sitting at the table? The waiter and the person are both in the Customer Chain. The waiter is the cook's immediate customer, the cook is the waiter's supplier. The waiter then becomes the person's suplier and the person is the waiter's customer.

Ee Bin Liew From Jim's original post:

"Four of the things a customer does: I benefit, I choose, I buy, and I pay"

I benefit (or need) - patients, or sometimes the caregiver/clinician
I choose - doctors, department heads, purchasers, increasingly the patients
I buy - patients, insurers, reimbursement
I pay - patients

In the example of the car - there should be a last statement "I approve" (because as you know you can say you need it, select, buy and be willing to pay, but there's always special someone that would need to give the 'ok', right? ;-) )

does that apply to healthcare devices? - is that the patient or the doctors/hospital?

Alessandro Mazzarisi This is almost an ethic question. In my opinion, not only as a dreamer, customers are only the end-users. They pay all. It's not true that are insurances and institutions who pay for medical devices, and in general for technological resource equipment. People pay tax. All other actors are customers of mankind. Who forget this fundamental principle does an abuse of its claim authority - baseless. About question concerning who decide which technology, which therapeutic path a patient must follow, it is a matter of awareness and how persons are empowered. An economic point of view is what industries and stakeholders want, not what is fair. Internet has already changed the rules.

Well the patient is never the customer. They just receive the benefit of the product or service. Basically like a cab ride, you don't choose the car, driver, tyres etc but receive the benefit of the service.

The insurer is not the customer, they just pay the bills, a bit like giving your kids pocket money and they spend it on what they want. I admit they are an influencer but that is all. Just like I tell my kids to think if spending their money on that is a good idea.

The hospital again is only an influencer. They may appear to be the customer, but believe me if a surgeon does not think the product is suitable for that patient they will reject it. If various products are suitable the surgeon will allow the hospital to choose (he won't object to the hospital's choice).

The customer is the surgeon, as it is ultimately his decision what he uses.

You have to sell to the surgeon but also get the influencers onside. The more unique, complicated and specialist the product the less important the influencers are.

Alessandro Mazzarisi @Les Charneca DipM FCIM, I am that patient that chooses a hospital and their surgeons with what they can give to me at the best. I choose: resources, medical devices and techniques that are right for me. I am the only one who can take a final decision. I think that industries’ customers is not the hospital and is not the surgeon, or radiologist or physicians in general. Nowadays, people choose a service-package, all together. I believe in a public-private partnership between healthcare innovation leaders and main healthcare actors, included surgeons and radiologists etc. oriented to reach a significant general and extensive agreement in the interest of patients. If all surgeons, radiologists and physicians with their requests, represent the hospital business card, they not stand for citizens’ interest. In the future, operators’ decision-power should be reduced, and new institutional subjects, in behalf of citizens, might be the new industries’ customers. About taxi: I can choose to get one or another.

Interesting. To me it is about the customer! When Apple develops products it is not from what technology would be best. It is what would work best for the customer. Always end user driven. So regardless who writes the check to purchase the thinking should be what is best for the customer/ie the patient. So the sales presentation is to all groups involved in the purchase "tree".

Pat Ridgely, MD At least in the US, I think the idea that the surgeon is the sole customer.is too limiting. Referral physicians, for example, can dramatically affect whether a patient even considers a therapy, which is a crucial step before an implanter decides on a given brand product for that therapy.

I think all have to be considered. Our ultimate customer is the patient, but in order to get to him, the product has to be convenient for the doctor to handle, the cost has to be reasonable and the insurance has to cover it. Unless it's a unique product, or one that will save a life, convenience goes over innovation and the product might not become available for the customer to use. I have seen patients prefer, for example, a hook to a robotic arm, because it's easier to handle and not worth the cost. I am working in the development of a product and the surgeon is instrumental in the design process, because it will be implanted.. To me, everyone who has a stake, is a customer.

Brian Dawson Indeed, our industry's customer base is not as simple as most businesses, and to further complicate the picture we have another entity to satisfy in the regulators. The medical device firm needs to ensure the product satisfies the needs of the four customer roles noted above, and also that the product can be confirmed by the regulatory authorities to meet all the legal requirements.

Very clever.
But I think, now, doctors/medical staff, depends on kind of product, are our customer. Patient can't decide having no experience and no knowledge about the choices. And doctors are the part of the hospital and the hospital has got it's budget.