Stop looking for perfect KPIs for the MSL! Let’s build acceptance and set fair targets.

Did you know that the average rating given by MSLs in Spain to their current KPIs as ‘the best possible’ for measuring their performance is just 6 out of 10?

And what about the fact that this score drops to 5.6 out of 10 when they are asked whether those same KPIs are useful for fairly comparing their work with that of the rest of the team?

These figures from The MSL Excellence Project (initiated by AMIFE and carried out by 1levelup Consulting) reveal a key fact: the problem is almost never the metric itself, but rather how we manage it.

The challenge in Medical Affairs has two distinct and sequential aspects:

1. To foster genuine acceptance of KPIs as a sensible tool that allows for peer comparison.
2. Set fair, realistic and achievable targets for each KPI.

The endless cycle of KPIs in Medical Affairs

If you’ve been in the industry for a while, you’ll have come across this scenario: “The current KPIs don’t reflect what an MSL does; we need some new ones.”

Dashboards are redesigned, and metrics relating to quality, scientific interaction and insight generation are added… yet after a while, the underlying feeling remains largely unchanged.

The argument put forward in this article is uncomfortable but liberating: probably the problem isn’t the KPIs. Perhaps we are chasing the perfect metric when the real issue lies in the acceptance of the indicators and the calibration of the targets.

When a KPI is perceived as a loss

Measuring a function based on professional autonomy, such as that of the MSL, often triggers a process of psychological grief rather than a methodological debate.

It is worth recognising this, because it explains why ‘improving the KPI’ almost never resolves the underlying problem:

• Denial: “We don’t need KPIs; my work can’t be measured that way.”
• Anger: “This isn’t fair; they don’t reflect what I do; they’re just trying to control me.”
• Bargaining: “I’m not sure it’ll make me any better.”
• Depression: mourning the loss of freedom, the feeling that everything is now “more work, with no guarantee of results”.
• Acceptance: reorganising the way we work and focusing on professional development.

A common mistake is to try to skip stages 1 to 4 by introducing a ‘better’ KPI. But a new KPI does not resolve anger or resolve negotiations: it merely resets the grief process. Acceptance does not come from having a more sophisticated metric; it comes when the team realises that the need to measure is not going to go away and that their energy is better spent elsewhere.

The lesson we learnt from the sales department

The sales teams followed the same path:

• They moved from simply measuring sales figures to introducing activity metrics.
• They faced the same initial rejection.
• They looked for ‘more sophisticated’ KPIs without getting rid of the complaints.
• Until they reached a turning point: accepting a set of KPIs that were ‘good enough’ and shifting the focus of the discussion to what really matters: demanding realistic targets tailored to each context.

The decisive change was not finding the perfect metric, but accepting a reasonable one and negotiating the level of rigour with care.

Step 1: building acceptance

Before discussing targets, we need to address something more fundamental: does the team view the current KPI system as a reasonable tool? Do they accept it as a tool that allows them to measure their performance and compare themselves with other MSLs without feeling at a disadvantage?

The team needs to believe that the KPIs are appropriate and fair. Without that conviction, any target set—however well calibrated it may be—will continue to be perceived as arbitrary, because the mistrust lies at the heart of the system, not in the final figure.

Building this acceptance is not a one-off communication exercise (“I’ll explain the new KPI at the kick-off meeting”). It requires three elements sustained over time:

💡Transparency regarding the rationale: explain which alternatives were considered and ruled out, and why the chosen KPI is the most reasonable one available today — not the ideal one, but the best possible compromise.

📊 Evidence of comparability: demonstrating, with data, that the KPI is measured and assessed using the same criteria for everyone.

💬Space for the bargaining phase: allow the team to question the system openly, without treating every objection as resistance to change. It is a stage of the grieving process, not a problem of attitude.

Only when this acceptance is in place does it make sense to move on to the second stage.

Step 2: Set fair and achievable targets

Once the metric has been accepted, the relevant question changes:

❌ Which KPI best reflects the scientific value provided by an MSL?

✅ Is the target set for this KPI realistic and does it allow for a fair comparison between team members?

It is a subtle but crucial difference, because it shifts the team’s focus towards something that can actually be resolved using data and sound judgement, rather than seeking a philosophical consensus on ‘what constitutes good work by an MSL’, which we are unlikely ever to achieve.

For an objective to be fair, it must meet three conditions:

1. Objectivity: the objective is defined using explicit and verifiable criteria (size of the territory, number of centres, therapeutic complexity, maturity of the area), not on the basis of a manager’s intuition or case-by-case negotiation.
2. Realism: the objective is based on historical data and the actual context, not on management’s aspirations. An unachievable objective is not motivating; it reinforces the ‘anger’ phase and heightens the sense of injustice.
3. Comparability: objectives tailored to the specific characteristics of each area to ensure fair competition.

Two separate issues with KPIs

It is worth distinguishing between two elements that are often conflated in these discussions, as they require different solutions:

1. The KPI is poorly defined. This occurs when the metric involves a value judgement without explicit criteria. The most common example in Medical Affairs is measuring ‘high-quality scientific interactions’: who decides what constitutes quality? The MSL themselves, based on their own perception? The manager, during a subsequent review? If there is no operational definition — for example, that the interaction is recorded in the CRM, has a documented scientific objective and is subject to verifiable follow-up — then quality is not being measured; self-perception is being measured. This cannot be resolved by adjusting the objective: it is resolved by properly defining the KPI, replacing the subjective adjective with quantifiable criteria.
2. The target is poorly calibrated. This happens even when the KPI is perfectly objective and measurable, because the same figure is demanded of people from different This is the central problem on this second front, and it is what truly determines whether the system is perceived as fair.

A simple, practical example. Let’s take a clear, unambiguous KPI: ‘number of recorded scientific interactions with centres of excellence per quarter’. It counts; it does not interpret.

Two MSLs, same KPI, same current target: 40 per quarter.

• MSL A → urban area, 60 referral centres, a mature therapeutic area with well-established clinical guidelines.
• MSL B → sparsely populated rural area, 15 centres, a new therapeutic area where relationships still need to be built from scratch.

With the same objective, A achieves it effortlessly whilst B ‘fails’ systematically, quarter after quarter. The KPI is identical and objective. The injustice does not lie there: it lies in the target.

The solution is not to invent a new KPI, but to adjust the target using explicit criteria: the number of accessible centres in the region, the maturity of the therapeutic area, and geographical dispersion or actual travel time. Applied to this case, B’s target could be lowered to 22 and A’s raised to 55. Same KPI, clearly defined. Different, calibrated, comparable targets. Both MSLs are then competing in the same race, not in separate races with the same finish line.

An uncomfortable (and practical) conclusion

There’s no need to find the ideal KPI for the MSL. It probably doesn’t exist, just as it never did for sales teams. What is within our control — and what really determines whether the system is perceived as fair or arbitrary — are two distinct and sequential tasks: first, building genuine acceptance that the current KPI system is reasonable and comparable amongst peers; then, setting realistic and achievable targets based on it for each context.

The sense of fairness does not come from the KPI itself; it comes from the team accepting it as reasonable and from the bar being set at the right level for each context.

Accepting the current KPI as ‘the least bad’ is not resignation: it is the stage that makes it possible to stop arguing about the ideal metric and start discussing whether the system is suitable and whether the bar we have set for each person is achievable.

The system will not reach maturity when we define the perfect KPI, but when the team accepts an imperfect one and we learn to build, on top of it, objectives that are truly fair and achievable.