Pascal Soriot's appointment to AstraZeneca last October was one of the most eagerly-awaited hires within the pharmaceutical industry in years.
Investors had feasted on their defenestration of the former chief executive, David Brennan the first victim of the so-called Shareholder Spring and after three months of endless speculation, the board announced the 53-year-old Frenchman would take the helm of the company.
His credentials to run Britain's second-biggest drugs maker were described as "perfect" by one analyst, but he stepped into a hornets' nest of problems, not least disgruntled shareholders wanting radical action. Winning them around was never going to be easy.
Investors are still undecided on Soriot, and are counting down the days until he sets out his plans for restoring AstraZeneca to robust health. The results of a strategy review are expected at the end of the month alongside the company's full-year results. Soriot is expected to outline to investors that the shareholder dividend is secure, as he pursues a fundamental "re-rating", a revaluation by analysts following a management change or a new strategy.
Last week, the Frenchman applied some shock therapy, culling his head of research and head of commercial operations on the same day as part of a major management shake-up. The "aggressive" move came, unusually, before Soriot sets out his ideas for the group on January 31, and has left shareholders and analysts guessing at where the former Roche chief operating officer wants to take the company.
AstraZeneca's problems are well documented. A toxic cocktail of scientific setbacks, a decline in discoveries of new drugs, mixed with the so-called "patent cliff" with key blockbuster drugs losing protection gives Soriot an unenviable task. He needs to restore the FTSE 100 (FTSE: ^FTSE - news) company to growth.
The patent that expired on AstraZeneca's Seroquel last year, which generated more than $1bn (£630m) of annual sales, came less than a week after a US court refused to block the sale of a generic version of the schizophrenia medicine. From next year protection on another blockbuster drug, Nexium, for heartburn, will expire.
Regulatory pressures and weak growth, particularly in the eurozone, which has seen health budgets plummet, add to the business's woes.
Speaking to those close to the company, it appears that the restructure will give research and development an unprecedented voice at the top table, signalling where the FTSE 100 company might be headed.
As part of the changes, three R&D managers have been promoted to AstraZeneca's executive leadership team. Biologic products treatments involving living cells to repair tissues have been given an equal ranking to small-molecule drugs, reflecting Soriot's vision that internal, or so-called "organic" R&D, is a big focus for the company.
But for a company facing myriad risks and uncertainties in the year ahead, pinning its hopes on finding the next "wonder pill" won't be enough to keep shareholders happy.
There has been an expectation that Soriot's first big move will be to buy up smaller biotech firms to speed up growth. His suspension of the share buy-back programme halfway through its timetable, on his first day in his new job, said as much to the City and he is expected to focus on bolt-on acquisitions.
Last week, traders were hearing suggestions of interest from AstraZeneca for Shire (LSE: SHP.L - news) , sending shares in the pharmaceuticals group that specialises in attention-deficit disorder treatments soaring.
Many shareholders are against a major takeover because of the risks involved, although Soriot is said to be aware he cannot rule this out. But critics point to the fact that AstraZeneca's purchase of Medimmune for $16bn (£10bn) in 2007 failed to deliver the kind of big new products expected.
Indeed, Standard & Poor's, the rating agency that recently claimed the global pharmaceutical industry will achieve sales growth this year despite the industry's patent cliffs, said AstraZeneca's AA rating could be at risk if it conducted a big deal.
Olaf Toelke, S&P credit analyst, said: "AstraZeneca is going to lose a tonne of cash following blockbuster patent expiries. But if they decide to [go] for a major deal initially, the rating will be under pressure."
Some analysts believe that "radical action" will, of necessity, equate to risky takeovers. Navid Malik, an analyst at Cenkos Securities, points out that Sanofi (NasdaqGM: GCVRZ - news) 's takeover of Genzyme in 2011 for more than $20bn catapulted the healthcare company's standing in innovative products: "I genuinely don't understand where growth can come from unless it's through an acquisition. The internal R&D engine at AstraZeneca is broken. Spending five or six years waiting for products that may or may not come through an internal pipeline, or that may or may not be approved by regulators, won't fix it."
Britain's biggest drug maker, GlaxoSmithKline (Other OTC: GLAXF - news) , has long had a diversified portfolio, with consumer healthcare and toothpaste products thus relying less on the "uncertain outcomes" associated with organic R&D. That strategy is reflected in the share price, Mr Malik said.
AstraZeneca aims to strengthen its pipeline by identifying projects that can be accelerated from Phase II to Phase III, where drugs are tested on more than 1,000 patients sources expect it to have a "dramatically different pipeline" by 2016.
Over the long term, the company believes a focus on innovation is the right one and will be looking to create an environment that facilitates that. The management changes reflect a desire to accelerate decision making, simplify reporting lines and enhance collaboration between AstraZeneca's own divisions.
It is understood Soriot's approach will focus on "targeted" medicines that affect a smaller number of sufferers but are more effective, and he is likely to cut down on research projects but spend more on those that remain. The idea is that renewed focus on early-stage discoveries, while improving the productivity in later-stage development, will lead to growth.
But in the short term AstraZeneca expects a decline in revenue and profit due to patent losses primarily, but also as a result of government pricing pressures, where austerity measures have put severe constraint on government funding.
Added to trying to develop the next big drug, pharmaceutical companies need to market it, obtain regulatory approval and distribute it. Over the past two decades, annual investment by pharmaceutical companies has increased by $100bn, but the number of licences granted by the US Food and Drug Administration the sector's biggest market is stuck at around 25.
To plug any revenue gaps in the short term, the company is understood to be considering accelerating the $7bn diabetes franchise established last year with Bristol-Myers Squibb.
That deal took place when AstraZeneca was in a state of limbo; before Soriot's arrival, but after the departure of Brennan, following shareholder concern over performance. It is the latest in a string of collaborations and mergers made since the company was established in 1999 as a result of the merger between the Swedish-based Astra with UK firm Zeneca.
The appointment of Soriot, a former vet by training, but with stints at Sanofi and at Swiss drugs maker Roche, was said by Malik to be "perfect" an experienced breath of fresh air that AstraZeneca desperately needs. But there are still headwinds including high levels of competition and whether the company has the right business model to operate in emerging markets.
Hans Nyctelius, a researcher at Roland Berger consultants, said: "AstraZeneca (LSE: AZN.L - news) has to adapt its Western operating models to emerging markets; it needs to have the right people. In China, for example, you need to be very close to both [political] parties. They'll need to accept lower margins.
"When you do a launch of a new product today, you need to think globally. AstraZeneca has the muscle to do that, but they need to partner, they've not been so active as other companies like Roche."
Soriot's rapid management restructuring last week suggests he has concluded it is now or never to pursue growth and encourage staff to take risks again. He seems keen to reinject a can-do attitude among workers, who may have lost confidence following scientific setbacks. But in a company so used to being risk-averse, he has a mammoth task ahead.