I hope you have had a wonderful summer holiday and are getting ready to head back to the office full of energy!
To help you get started, today’s topics are all practical:
– How not to fail at anything in biotech & pharma – Key tips for effective panel discussions – Global, regional, local regulations, codes and compliance – How to demonstrate integrity
How not to Fail at Anything in Biotech & Pharma
Success is elusive for large and small pharmaceutical companies. While the challenges big and small players face are similar, start-ups have no pipeline to cross-fund failures and are often dependent on one key investor. I sometimes mentor biotech start-ups and I recently presented and managed a panel discussion on the topic “Why biotech start-ups fail.”
Start-ups attract investors by having an excellent idea or product, for which there is a market. The product needs the support of a good team and a realistic strategic roadmap to get the product to the market.
Start-ups often fail due to flawed financial strategy, inexperienced management, lack of requisite skill sets (clinical trial planning, biostatistics, knowledge of regulatory requirements etc.) and bad timing. In my experience, projects in pharma companies fail for similar reasons. Investors invest because they see a huge upside potential to their investment. Senior leaders invest in projects that will lead to a competitive advantage, reduce costs, or reduce risk.
Start-ups often fail because they lack the experience and expertise in house to be successful, and they don’t know enough about the gaps they have, in order to be able to identify the skill set they need to bring in to support them.
Projects in pharma often get delayed because teams rooting for them struggle to communicate the benefit to the business in a way senior leaders understand. When projects do secure funding, it is sometimes hard to deliver, because teams are under resourced or inexperienced. A friend of mine once said, “You don’t learn how to fly a plane by reading an instruction manual, you learn from an experienced instructor.” In other words, it’s not possible to compensate inexperience with intelligence, success depends on both. In order to succeed, it helps to be humble, to accept you cannot know everything and to bring in experts from within your business, or from outside to help you succeed.
Key Tips for Effective Panel Discussions
As a moderator, a key skill is the ability to tease out topics that will interest the audience, summarise different opinions and share key output. Obviously, it helps if you know the topic well. Recently a friend asked me to teach her how to run engaging panel discussions.
Having run many panel discussions over the years I am happy to share the tips I shared with her with you too.
Do’s:
First, know your audience. What do they want to know, what are their pain points? Ask registered attendees before the meeting.
Second, choose your panellists, aim for diversity: backgrounds, opinions, age, gender, race, geographical location and personalities.
Third, have some questions prepared, ask your panellists what they would like to talk about. Weave in questions from the audience.
Fourth, engage the audience. Use polls if you are running an online panel. Engage the audience directly if you are in a room with them.
Fifth, summarise key points, tell the audience who to go to with further questions after the event.
Be open to spontaneous interjections, follow-on thoughts, and manage the discussion with a light hand. If it suits your personality, inject humour into the conversation.
Things to avoid include: 1) not asking each panellist to answer the same question, this becomes very boring for the audience, it’s an interrogation not a discussion and 2) not asking the audience to provide you with questions and then to not ask your panellists a single one, this is a mortal sin.
Remember you are there for the audience! If you follow the above suggestions, you cannot go far wrong. If you need an experienced moderator to help you run a panel discussion, I’m also always happy to help.
Global, Regional, Local Regulations, Codes and Compliance
Many of my customers work in global roles, some also manage marketing material compliance and face push-back from affiliates regarding what is permitted locally and what is not. Ever since researching European codes and regulations for a book a few years ago and training teams on compliance and promotional review, I have found this topic fascinating.
There are too many aspects to cover here, however, it’s an important topic, so instead of a summary of key points, I am sharing some questions for you to reflect on.
Did you know that in some countries you can use real patients in your materials but in others you need to use actors? Are you aware that some legislators consider the depiction of smiling patients in advertising materials misleading? Did you know that what constitutes evidence to support your scientific claims is not necessarily identical in every country? Have you ever thought about when you can start advertising a product, is it A) following regulatory approval? B) following regulatory approval and reimbursement? What about linguistic requirements e.g., when can you share materials in English, when does it have to be in local language?
Food for thought.
Naturally, I could have just asked you whether you know the answer to this question: “Are you permitted to give HCP participants to an educational event run by your company a wine bottle as a parting gift?” but that would be too easy!
Key take-away: understanding the legal requirements to do business in different geographical locations is truly as complicated as we always thought it was.
How to Demonstrate Integrity
A research team spent years working on a project. Finally, the results were published. However, after publication, the team discovered that the results were in fact invalid, due to early cross-contamination of the bacterial strains they had been working with. The team could have kept this insight to themselves, being as they are dependent on external funding which depends on their ability to publish. Instead, they retracted the paper. You can read the full article here
I hope my blog provides you with some useful insights and, as ever, I look forward to hearing your thoughts. And if you have a challenging project or would like to discuss coaching to help you achieve that next level, please reach out for an informal chat.
– Why hospitals should adopt a Medical Information approach – Why biotech start-ups fail – Making clinical trials more accessible for people with disabilities – Age is just a number
Why Hospitals Should Adopt a Medical Information Approach
In the past weeks I have been a frequent visitor to the local hospital’s ICU. The level of medical care is incredible, as is the access to interventions, day or night, and the skill level of the teams I have encountered. Witnessing what skilled HCPs practicing modern medical science can achieve is: “it’s all for the patient” in action.
However, due to staff rotations the medical team changes frequently. Consequently, we have rotating physicians to interact with. This means conversations are often repetitive and, as resilience is waning 12 days into an ICU stay, the entire family is noticing the strain. This is not to complain as the nurses and doctors are fantastic. However, the hospital has a lack of qualified staff due to a combination of summer holidays and illness and translating intensive care medicine into lay language takes time and energy, which the doctors on duty don’t always have. Hence, after meetings with the medical team, my family often turns to me with any unanswered questions.
When I was a clinician working on a ward, I had more time than the ICU doctors. I would draw diagrams to explain interventions and disease. I would draw hearts and lungs, kidneys and livers, explain how blood circulates, and what happens when “things go wrong.” I used plumbing analogies frequently, I still do, they are extremely helpful. I have used medical analogies with plumbers too. The analogies work well both ways I have discovered.
Medical Information teams communicate complex information in stakeholder adapted terms. After my experience of the past weeks, I think an analogous role in an ICU could be beneficial. An experienced medical doctor, or nurse who takes on the role as point person for families to engage with and who is able to communicate complex content simply. Having a dedicated liaison could provide continuity of communication, while engaging families and also freeing up highly skilled ICU personnel.
The need for accessible scientific communication with which to engage laypersons is common across disciplines. A recent article in Nature (published 19th July 2022) highlights this for the climate science field. Farmers told climate research expert Jessica Eise that what they need is straightforward tips on how to adapt to a shifting climate. Eise reviewed the literature and found little information to address real-world needs. Addressing the gaps, however, is critical in order to work across disciplines and stakeholder groups. You can read the article here.
Why Biotech Start-Ups Fail
On the 26th of July, I will be speaking and chairing an online seminar hosted by Nanobotmedical on top reasons biotech start-ups fail.
I’ll share insights from CEOs of successful start-ups and include learnings on what investors look for when identifying promising new companies. Topics will include: getting from an idea to a product, financing, clinical trial set-up, regulators, building a team, communicating with stakeholders and timelines.
The challenges are complex, and in today’s economic climate, financing is not as easy to get as it was in the past. Join me, together with Jason Marks, Alexander Lagerman and Andrii Koniukh from Nanobotmedical. You can register here.
Making Clinical Trials more Accessible for People with Disabilities
According to the CDC, around 25% of US adults live with some form of disability. BMS is partnering with the non-profit organisation Disability Solutions, to create a new initiative titled: Disability Diversity in Clinical Trials DDiCT). The program’s initial focus is to identify a set of recommendations to improve access, enrolment speed and trial participation for people with disabilities in clinical trials. The article was published in Endpoints News and you can find the entire article here. I recently posted an article on how Eli Lilly Canada is making web content more accessible for people with disabilities, you can read more on my blog here.
Age is Just a Number
I sometimes encounter the conviction that older individuals are not as flexible, enthusiastic, open to change or willing to learn, as younger individuals. I have never believed this to be true, as I’ve met narrow-minded younger people and creative, open-minded people in their eighties and nineties, for whom age is just a number.
Often in interviews with older employees, who question a project approach, it transpires that their questions are based on experience in a discipline and an organisation and not due to change resistance. More often than not, their questions are critical and relevant.
A young entrepreneur I spoke to recently champions diversity in his team because he believes that a diverse team will give his company the best outcomes. He has employed a 60-year-old as his sparring partner at the top of the organisation. The entrepreneur told me “My sparring partner challenges me every day, it is hard to deal with. However, his challenges really focus my thinking.”
Motivation and interest are more important predictors of behaviour than age, I have found. Case in point, my 81-year-old mother streams films on her IPAD, texts family and friends all over the world, and recently set up an online account to sell items online. Something I have never done. After receiving the item, the buyer wrote my mother an enthusiastic review and commended her on her beautiful wrapping.
In a short story, Camus wrote something along the lines of; “just because someone is wearing clean socks does not mean he has dirty feet.” To paraphrase, “just because the individual questioning your project approach is in his fifties doesn’t mean he is wrong.”
Key take-away: Curiosity is not age dependent!
I hope my blog provides you with some useful insights and, as ever, I look forward to hearing your thoughts. And if you have a challenging project or would like to discuss coaching to help you achieve that next level, please reach out for an informal chat.
Last week I was in Brighton for a board membership meeting of the charity I am involved with, called The Virtual Doctors. We discussed how to improve healthcare access for more people in Africa. Currently we are working with Malawi and Zambia, and we hope to expand to more countries in the future.
Healthcare provision is changing, how patients access healthcare is changing and this will naturally impact how pharma companies interact with key stakeholders. Today’s blog focuses on digital health, telemedicine and our need to put things in boxes. I also share a story about patience, patients, time and love.
Today’s topics:
– A day in the life of a telemedicine provider – Let me put you in a box – Digital health and technology Tyto care – Patience in a room without time
A Day in the Life of a Telemedicine Provider
A colleague sent me an article from the website Second Opinions on how physicians perceive working as telemedicine providers.
Topics of the interview included the pros and cons of working remotely, key challenges that are faced when managing remote patients, key personality traits that make a physician likely to enjoy working in and succeed in remote settings, as well as information on scheduling visits, and long-term patient care. One physician also listed the key factors he checks to make sure he can trust a telehealth company: 1) ensuring the company follows corporate practice of medicine laws 2) checking ethical billing practices 3) ensuring the team is mindful of patient and provider needs.
Benefits of providing remote care include a better work-life balance, as visits can be scheduled to fit with other commitments, this translates into the ability for healthcare providers to spend more time with their young families. Key differences between remote work versus seeing patients face to face included the observation that patients seen remotely appeared to be more focused and less stressed. The doctors hypothesised that this might be, because they were being consulted in the safety of their own home. In addition, some doctors observed there are fewer no-shows for digital appointments than there are for face to face.
Asked whether performing 100% telemedicine would work to manage most patients, some doctors said they preferred to offer a mix of services, including seeing patients face to face at least once in order to perform a physical exam, but then doing follow-up visits remotely.
One of the most challenging aspects of providing telemedicine, according to the doctors interviewed, is that it is hard to know if you missed something unless you are also the patient’s primary care physician. I would suggest that this is true for any specialist providing support to a patient for a specific condition, even face to face. You can find the entire article here.
Let me Put you in a Box – on Labels
A few weeks ago I was asked “Are you Swiss or German?” I replied with a question: “Why do you ask?” The response was: “I am trying to figure out whether you are Swiss, neutral, with no strong opinions about anything or…” the speaker, paused, reflected, and changed the topic. I smiled. The speaker has known me for a while, and he realised he didn’t need to know my nationality to know the answer to his question. Putting labels on people and situations helps us manage uncertainty and leads us to believe that once we have assigned a person, a situation or a company to a mental folder, we don’t have to think about that topic again. What we believe of other nationalities often falls into this category.
Naturally, I label situations too. Sometimes, I find myself sharing a thought from one of these old mental folders, and as I speak, I realise that I no longer believe this thought. While it’s always a surprise, it is also a wonderful way to learn about how my thinking has changed.
Labels and gender pronouns are also very much a topic of the moment. A friend told me his child has refuted male/female pronouns, on one level the desire to live a life that is free of the constraints of societal gender expectations seems to have played a role in this decision. I could very much relate to what he told me.
The world is complex, ever changing and overwhelming and so we put things into boxes in the hope that that will make things simpler. It’s a natural impulse and helps us make sense of things around us. However, it’s important to remember, boxes are a crutch.
With the exception of cornflakes, the world isn’t made to fit into boxes.
Digital Health and Technology TytoCare
Healthcare is changing and there are not enough healthcare professionals. This is true for many African countries where in rural areas there are few trained physicians, but also increasingly in every other country. Telemedicine is one way to get healthcare to patients.
Since the Covid pandemic, telemedicine has been booming, but even before, for example in Switzerland, you could reduce your insurance premiums if you called a telemedicine service before visiting your physician. The telemedicine provider triages you to the correct speciality. This weekend I experienced telemedicine in my family. My mother called the telemedicine services and explained my dad’s health. The conclusion the remote doctor reached was absolutely different to the one I and a medical colleague reached. This highlighted to me how much you can miss when a non HCP is reporting symptoms and you can’t see the patient.
One of the challenges of remote consultations is of course that a doctor cannot easily examine a patient, which in the example of my father would have changed the remote diagnosis dramatically.
An Israeli company, TytoCare, has come up with an elegant solution. TytoCare provides a telehealth platform along with an integrated exam kit that incorporates a tool that can function as an otoscope, a stethoscope, and a camera that can take close-up photographs of skin lesions as well as photographs of the oral cavity. This tool is provided in a hard case.
TytoCare is used to support patients with chronic conditions. Patients can perform self-examinations using the toolkit, the data is then saved in the TytoCare app and can be submitted to their physician for further assessment prior to an online consultation.
TytoCare could also help provide improved healthcare for rural populations by giving health workers in these communities the ability to share exam results with more highly trained specialists and to get a second opinion without having to refer patients to hospital. The approach is also used to support community nurses who, when visiting patients, would like a second opinion and quick access to a doctor.
I recently saw a demo of the system. The tool seems intuitive to use, the software pretty straightforward. It is another interesting approach in making healthcare accessible to more patients. Link to Tytocare website.
Patience in a Room without Time
Recently I lost a friend. Eva was vivacious. A force of nature. Despite a degree in psychology, she never stopped working as a nurse. Eva was passionate about so many things. She was loving, supportive, opinionated and fiercely loyal to her patients, her friends and her family.
In the last months as I visited her, I watched the light, her light that always burned so brightly, fade from visit to visit. As I sat by her bed, I asked her if she would prefer me to be silent or if she would prefer me to talk. She said, “I am too tired to talk much, but I am happy to listen.”
In those few visits we didn’t talk about death, we talked about life. We talked about families, friends and our childhoods and work experiences. Despite her fading energy, her spirit was still fiercely alive. She was so present with me, despite her exhaustion. As she lay in her hospice bed and I sat beside her, our conversation covered the same topics we would have covered in a bar; the setting was different, but our friendship was the same.
As I think of her now, the memory of her is strong, and I am grateful for the time I was able to spend with her. One visit I said, “Eva, a friend recently said to me, Isabelle, have you thought about the friends you have lost over the years?” I told her that this question had made me sad. Eva replied, “It’s true, Isabelle, you may have lost friends, we all have, but think of all the ones you have gained.” Eva was one of those later-in-life friends, and her vehemence, despite her weakness, touched me. I still smile at her wisdom, the memory of her saying this, and the love she was able to give me in that moment.
On that visit Eva told me that there was no clock in her room. She said, “I am too weak to hold my phone anymore, I cannot unlock it. I sleep a lot and when I wake up, I never know if it is morning, afternoon or evening. I feel disorientated, I am really struggling.” Back when I travelled to San Francisco I remember arriving in my hotel room, having a nap and then waking up in twilight, looking at the LED figures outlining 04.00 on the bedside alarm, frantically trying to figure out if it was 4am or 4pm. I could relate to how Eva felt in her hospital room. A room that had apparently fallen outside time. I said, “Can’t the nurses put a clock up?” She said, “Ha, they said it is a philosophical question that they have been discussing for a while in team meetings and that they haven’t yet reached a consensus.”
I mentioned the situation to another friend. This friend said, “But she is in a hospice, why does she need to know what time it is?” The answer is: it doesn’t matter, she does. Patient needs are not abstract, philosophical issues, they are real. When patients tell us what they need, we should listen, even if we don’t understand. In general, perhaps we should focus less on why someone feels a certain way, if it’s hard for us to understand, and instead just try to listen and respond appropriately. Eva died on Easter Sunday.
I hope, as ever, that my blog provides you with some useful insights. I look forward to hearing your thoughts. And of course, if you have a challenging project or would like to discuss coaching to help you achieve that next level, do reach out and we can arrange to chat.
Last week I enjoyed a bike ride through France with a fabulous group of people. In the group we had a nurse who referred to herself as the princess, and her husband, an entrepreneur who left home at sixteen to travel the world and went on to build a successful business. There was also a lawyer and, lastly, a singer who went from opera to performing on Broadway; she entertained us with songs on our last evening.
Today’s topics:
– When you are in the right environment, magic is possible – How your approach can influence the outcome – A case study in patients, patience and bioethics – All you have to do is change
When you are in the Right Environment, Magic is Possible
Something we are not taught at school is that, while getting good grades and working hard are essential to success in our jobs, getting on with other people and the environment we are in, are also very important factors.
Last week I visited a monastery. The chapel is famed for its great acoustics. Visitors are encouraged to whisper to each other to experience how well sound travels. Finding myself alone, I started to sing. I used to take singing lessons; I have been told I have a beautiful singing voice and it is something that I enjoy, but I do it rarely. And as I sang in that chapel, I did not want to stop. The way my voice sounded in the room, clean and pure, clearer than I have ever experienced it, made me want to stay and sing. To experiment with different melodies, to marvel, at how even the softest notes filled the entire room.
Working with the right team and in the right environment can bring out the best in us. Naturally we need to work on ourselves too, in order to bring the best of ourselves to our work, in the same way a voice needs to be trained in order to perform at its best, but the combination of our best effort and the right environment can lead to incredible results.
How your Approach can Influence the Outcome
A few years ago, I renovated my flat and had a new floor installed. I had my doubts about the result of the work, but the company foreman assured me that it had been fitted well. I reached out to the owner of the company. He came to my house, had a look at my floor and said, “I am terribly sorry, we have done substandard work for you, please accept my apologies.” Later that night he called and said, “I have discussed the situation with my partners. We have agreed that we will redo all your floors for you. Whenever it suits you, just tell us when you want us to start.”
On my bicycle ride through Cognac and Normandy I met an American litigation lawyer who focuses on the construction industry. I told him my story. His response? “No, that is impossible, that never happens.”
Often our expectations of a situation impact the outcome. Going into situations expecting a no, influences how we communicate, which in turn influences the reaction we are likely to receive. There is a German saying: the way you shout into the forest, dictates the echo you will hear.
A Case Study in Patients, Patience and Bioethics
I once gave bioethics training to a group of senior medical affairs leaders from emerging markets.
I presented a case study with the blessing of a close family member, who had been enrolled in a clinical trial at a Swiss university hospital.
The trial protocol required quarterly bone marrow biopsies. Two years into the trial, a friend who is a practicing oncologist, told me that PCR is the method of choice to monitor CML, not regular bone marrow biopsies. I called the hospital to ask why they hadn’t adapted the protocol. They said, “You are correct, however we like to have access to the data and the cells, so we didn’t amend it.” It took another few years for them to amend the protocol. My relative decided to remain in the trial despite this, because he had grown to trust the team who was managing his treatment. Years later my family member was informed by phone, “Your CML has progressed, please double the dose of your medicine starting from tomorrow.” When I called the hospital asking to speak to the physician in charge of the clinical trial, I was told there wasn’t one. When someone called me back, they started the conversation with: “So you are the difficult family member? Well, I have some good news, your relative’s CML has not progressed. Please inform them they don’t need to change the dose.” Years later, when progression finally did occur, my relative informed me that a bone marrow biopsy was not planned. I called the hospital again and was told: “We thought a biopsy would be tough for an older patient to tolerate.” I asked if they had discussed it with my relative, they said, no. So, the decision was taken without discussing the pros and cons with the patient.
I used this case study as part of my bioethics training because I know the case intimately. The message I wanted to convey was: if this happens in Switzerland, it can very possibly happen elsewhere. I wanted senior medical affairs leaders to see how things can go wrong. And to highlight that if we want patients enrolled in clinical trials, we need to make sure these things don’t happen.
The reactions in the room were varied. The discussion was rich. However, one reaction I received that remains unforgotten, because it astonished me, was the following: “You realise you cannot sue the pharmaceutical company who produces the product?”
Putting patients at the centre of what we do makes sense for the patient, but it also makes sense for the business. Focusing on the patient ensures that clinical research is tailored to patient needs, and that the products that are developed address the real problems not the ones we think are important. This in turn will impact how a product performs in the marketplace. Focusing on patients is an ethical imperative that also makes absolute business sense. It seems obvious to me, however, the lesson I learned that day is that it is still not obvious to everyone. Not the doctor, who called me an annoying relative, nor the individual, who called my relative to tell him, that his cancer had progressed, and not the medical affairs director, who thought, I was interested in making money out of my relative’s predicament, when the reason I shared it, was to highlight areas, where there are gaps, in the hope, that anyone involved in research is sensitised to potential issues so that less patients will experience what my relative experienced.
All you Have to do is Change
As an executive coach and a member of the ISPSO (International Society for the Psychoanalytic Study of Organizations) team dynamics, personal growth and career advancement interest me. As we all know we cannot change others, we can only change ourselves.
Knowing what we want to change can be easy. Test results and 360-degree feedback forms are useful tools here to support the identification of areas for growth but using this information to achieve meaningful growth can be challenging, unless the feedback makes sense to the recipient. For example, telling someone based on 360-degree feedback test results that they need to be more empathetic, more outgoing, communicate better, have more gravitas, etc., in order to be a better leader, is ultimately rarely useful because behaviours, that are exhibited at work, are behaviours that have been developed throughout years of living, and in all aspects of a person’s life. In addition, nobody works in a vacuum.
In order to change anything, an individual can benefit by exploring not what they want to change, but ultimately why. Questions that can help include: why do I interact in this way? How does my behaviour impact me and others? How do others perceive me? How do I perceive them? And the biggest question of all: do I truly want to change? And why? How will a change in this area lead to an improvement in my life overall?
These questions are critical to understanding both behaviours and motivation. Unless changes occur within, none are sustainable.
I hope, as ever, that my blog provides you with some useful insights. I look forward to hearing your thoughts. And of course, if you have a challenging project or would like to discuss coaching to help you achieve that next level, do reach out and we can arrange to chat.
Only 213 days to the end of the year. Sounds like a lot, but if you deduct weekend days (60) you realise just how quickly time is passing.
Today’s topics:
– Do you work for good or bad pharma? – Unplug and play – In celebration: one of the best subject lines ever! – It’s later than you think
Do you Work for Good or Bad Pharma?
Last month, Pfizer announced that it will make 23 patented medicines and vaccines available to the world’s poorest countries on a not-for-profit basis, in a bid to address the global healthcare gap that came under renewed scrutiny during the Covid-19 pandemic (link to the Forbes article).
I mentioned this during dinner to a colleague who works for a large pharmaceutical company. She reacted defensively, saying, “Naturally, this is a great initiative, but we have many initiatives ongoing that facilitate healthcare access for patients in lower-income markets. Financing negotiations are held, and creative financing models are regularly implemented. Unfortunately, outside the industry, people only ever talk about the cost of medicines and the high profit margins.” She continued: “Obviously, we are not a non-profit sector, but then the risks of drug development are high. I wonder why we do such a bad job communicating the good things we do?”
It was an interesting question and it reminded me of my time before pharma. When I said I was leaving clinical work to join pharma, my hospital colleagues said in collective horror, “So, you are joining the dark side?” I remember pointing out, “Without the pharmaceutical industry we would be prescribing willow bark extract, laying our hands on our patients and chanting them better with fervent Oms.” While I experienced both hospital processes and payer interactions as painfully inefficient, I realised fast that my attempts to reduce spending on my ward were doomed to failure.
Healthcare systems are complex. Most people don’t think about them at all unless they are directly impacted. In addition, unless you have worked in one, or engaged with payers, it’s impossible to know how inefficient they are. Also, it’s hard to estimate how much money is wasted due to inefficient processes, as different stakeholders are involved, with conflicting interests. It’s not easy to understand nor identify how best to improve the system. Costs keep rising however, and accepting that nothing else can be done, perhaps focusing on drug prices and the profit margins of the pharmaceutical industry is a practical scapegoat. While I was acutely aware of the inefficiencies of the hospital that I worked at, I also remember my surprise when, on joining pharma, I saw a chart showing the annual healthcare expenditure in Switzerland and learned that prescription drugs represented only 8% of the overall costs.
But back to my colleague’s question: “Why do we do such a bad job communicating the good things we do?” While there are reasons that public perception is what it is, her question on why we don’t communicate better, struck me. So I will share one more story.
At a conference, a fellow speaker said to the audience, “We need to tell our customers that we are not commercial functions, and therefore they can trust us.” I have heard variations of this sentence many times. When I stepped onto the stage, I held up a bottle of pills and said, “If this bottle represents your company, your functions are represented by the pills. Customers will see the company first, the function second. They will trust all of you, or none of you.” And I added, “If you don’t think your colleagues are trustworthy, why should customers trust your company?”
In summary, change starts within. If even employees don’t have a balanced view of the business they work for, it is impossible to expect anyone else to have one.
Unplug and Play
My day invariably starts with this question: “How much can I get done, how fast?” Mundane tasks are handled as fast as possible. When things go to plan, I am happy. Unfortunately, however, things are often out of my control.
In a recent example, my list included the following item
Place an online order
Sign a document in online banking
Cancel a subscription
I expected to be finished in under an hour. Four hours and six conversations with customer service agents later, two out of three tasks were completed.
The problem with my time estimate? I don’t live in an ideal world, where websites have been tested and call centre agents know when their product has technical issues. By noon I was annoyed that I had made almost no progress on my day’s planned tasks.
In the past, I would have sped up to compensate for lost time. Now, instead, I take breaks and do something fun. Stepping away, instead of soldiering on, is much the best approach in any situation where irritation has displaced joy. I have discovered I achieve much more if I take a break to do something fun, than if I force myself to continue, when my heart is not in it.
“Almost everything will work again if you unplug it for a few minutes, including you.” Anne Lamott
In Celebration: One of the Best Subject Lines Ever!
When I joined pharma, there was a beautiful orchid on my desk. I gave it lots of coffee grounds so it flourished. I remember this incident because it was a wonderful welcome to a new company. Another memory is my manager saying: “The day you joined my team was a red-letter day.” As a European I thought this was a bad thing, but she explained, no, a red-letter day is a special one.
As my own manager I don’t celebrate myself much, but sometimes I am celebrated, and it feels amazing. In response to my last newsletter, I received four messages. One reader said he loves my writing. He also keeps asking me when I plan to write a book. The answer to that question is: “I am working on it, but it’s slow going”. Another reader wrote she enjoys my newsletters and that my last one made her think of the film Chicken Run. A third reported that he was: “Giggling like a schoolgirl”, at my MRI experience; if you missed that story, you can find it here (My ankle is not your patient). And a fellow consultant, who is in the business of writing spectacular newsletters, sent me a one-liner: “One of the best subject lines ever!” in response to the title My Ankle is not Your Patient. I adore his writing, so his compliment means a lot. The experience reminded me that it’s important to celebrate yourself, your teams and the world in general. In fact the working world, in particular, would be a better place if there were more authentically spoken words of admiration. And as you can see from my examples, a small act of kindness can mean the world to someone and may very well be remembered many years later.
It’s Later than you Think
The end is nigh. There are 127 working days to the end of the year, in Switzerland, excluding weekends and public holidays. If you are in the US, it’s even less. Whichever way you look at it, the first six months of the year are gone. So, if you are only just getting started on your projects, it’s time to get a serious move on. Here are some classic activities that you can make lots of progress on by the end of the year if you start now:
Understand your current customer engagement approach and identify a future-focused multichannel, department and globe-spanning improved approach.
Analyse your current med info set-up, identify gaps and plan for a better future.
Assess how your company uses data.
Where is it stored?
Who has access?
Taxonomy? Ontology? Is there any metadata?
Do you have data lakes or data cemeteries?
Are you making use of cross-functional, data-sharing opportunities?
Do you know what data might be useful by market? Why not meet with peers in other countries and identify what insights might be useful
Identify opportunities to collaborate, plan an improved data management approach and move your day-to-day business away from metrics towards actionable insights
If you already have great databases and harmonised data access, discuss how customer insights can be used cross-functionally to better support customers, thereby improving customer-centric business and safer use of medicines.
Increase overall efficiency to improve effectiveness.
Design, write, review and publish a global SOP, including all stakeholder input and sign-off depending on the complexity of your company and the number of stakeholders involved.
Then again, you may not want to start something new. Whatever you are working on, I wish you the best of luck with your endeavours.
I hope, as ever, that my blog provides you with some useful insights. I look forward to hearing your thoughts. And of course, if you have a challenging project or would like to discuss coaching to help you achieve that next level, do reach out and we can arrange to chat.
The last two weeks have been quite demanding. After returning home from my UK trip, where everything that could possibly go wrong, did, my Swiss doctor took one look at my ankle and sent me for an MRI scan. Beyond the doors of my home, pharma is perpetually reorganising itself, the stock markets have taken a tumble, the news – and my emotions – follow the war in the Ukraine, talks on NATO, stagnation and inflation and the individuals I know, who are severely impacted by rising gas prices.
Resilience is important and easy to lose sight of when faced with the demands of the world. The topics I am covering today are influenced by: being a patient, finding direction in a challenging world, and a recent comment on a post about knowing when to change your job.
Today’s topics:
– Patient experience – or my ankle is not your patient – Patient-centric hospital design. Where do I have to go? Follow the path! – Is your disenchantment really a burnout? – What chickens have taught me about global programme management
Patient Experience – Or my Ankle is not your Patient
On a recent trip to the UK, I twisted my ankle. The NHS did an X-ray. I was relieved that it was not broken.
Back home, my Swiss doctor sent me for an elective MRI saying, “It won’t change the clinical outcome but it would be good to know what shape your ankle is in.” Liking to know what to expect and not liking the thought of being inserted into a tiny space, I checked the MRI provider’s website for information. There was information on the team, on the sites, on the history of the company – everything a business would tell you about what they do. There was even a photo of an MRI machine. But no data on aperture sizes, scan duration, what to expect when you have a scan, things to consider, and what to do if you don’t like small spaces. There was no information on open/closed machines, magnetic fields or which machine can be used for which examination. As it was an elective procedure, I considered cancelling a number of times.
As I searched the internet, I noticed a stark contrast between Swiss MRI provider websites and US MRI provider websites. On the latter there was a lot of information for patients.
Finally, my key question: “If I am having a scan of my ankle, how far into the machine will I be inserted?” was answered by my calling two friends who had had knee scans, considering their height relative to mine, and then concluding with the help of a tape measure that I would be mostly outside the machine.
When I arrived at the site I was stressed and found it difficult to navigate the building; fortunately a friend was accompanying me and helped guide me to my provider. The technician was hurried. I asked him how often patients were nervous. He misunderstood my question and answered, “Oh, I have learned to not let it get to me at all.” As he put me into the machine, I felt like a product on a conveyer belt. When I asked him if I could talk to him during the scan, his answer was: “No, I will be working, so I won’t have time to talk.”
I got the scan results the next day and read them. They were not great. I was surprised by how impacted I was by reading them. When I saw my doctor, he said: “Oh, you shouldn’t have read your results, I would have broken the news to you gently”. It hadn’t crossed my mind to leave the breaking of the bad news to him. In retrospect it would have been a better idea.
It was, overall, an unpleasant experience from start to finish but it highlighted for me that what I need as a patient, is very different to what I need as a doctor; that when I am hurt and concerned, my worries are not technical in nature. It highlighted to me, the madness of developing anything for patients, that doesn’t involve the patient. A patient advocate once said to me, “When you design a car seat, you take the driver into account, so how can you design medicines and not take the patient into account?” You can read that interview here.
What a patient needs, what she desires to know, how she experiences a treatment, what she wants to know about the treatment schedule, timeframe, etc., nobody other than a patient can tell you that. Today it is a given that it is critical to involve patients in the development of any treatment, treatment process or information that is designed to help them make decisions on their healthcare. My experience highlights that not all cultures are equally attuned to this yet and that there is still work to do. This leaves me with two questions: Why is it taking so long to implement changes that are obviously needed and make sense? And why is it that every service provider asks me for feedback and enquires how they can improve their service, except the MRI healthcare service provider where my feedback might actually help improve other patients’ experience.
Patient-centric Hospital Design. Where do I Have to Go? Follow the Path!
Credit: Isabelle Widmer – San Raffaele Hospital Milan
The Italian healthcare system operates in an interesting way. While funding is regional, patients can choose to be treated in any hospital in the country that they like; the hospital then receives the funds from the region the patient is from. Patients from all over Italy travel to leading research hospital San Raffaele in Milan to be diagnosed and treated. In 2016 I accompanied a friend there.
San Raffaele is a giant. The hospital provides 1.5 million outpatient services and 30,000 surgical interventions each year. I remember being overwhelmed by the size of the car park, comparable to large shopping mall car parks in the US. The size of the hospital was even more daunting; navigating the long hospital corridors was like trying to find your way around Heathrow Airport.
However I was impressed by the hospital’s navigation system. It was simple and effective, with a coloured line for each speciality. All patients have to do is follow that line, without thinking. I remember walking for ages, I remember linoleum floors in sunny yellow. I remember following the yellow line round corners, up and down stairwells and in and out of buildings. Other coloured lines ran alongside the yellow one, splitting off down different corridors, until just the yellow one was left. While in 2016 I admired the system, it took my experience of going for an MRI scan last week, to highlight just how important a simple navigation system is. When I went for my scan, my mind was on my scan and I found it a challenge on coming out of the car park to identify the correct building and floor for the MRI provider. I remember being embarrassed that I couldn’t do it and immensely grateful to my friend who kindly led the way.
Healthcare is not just about the right drug for the right patient at the right time. It is also about making things as accessible as possible for patients, whether in the real world, as in San Raffaele hospital, or on a website, using simple navigation menus and ensuring your medical scientific content is more accessible (more on how to do that here).
Is your Disenchantment really a Burnout?
In my last newsletter I wrote that when you no longer care about your job, it is time to change it. A fellow coach, MD and GM Michal Kazmierski commented on my post saying, “Isn’t it called “burnout”? If we don’t watch carefully, it will slowly and sneakily develop over time until we may find ourselves in a place where both our well-being and health are in danger…” He had me at sneakily.
Our current world is challenging. I meet many individuals who are in companies that are being reorganised. Some are hoping to receive a severance package. Some present their plans for next year to their teams and hear only laughter, after which they conclude that, perhaps in the future, they won’t have a job. Others report that the acronyms are changing, the organisational structure is changing, that budgets and headcount are reduced but that despite all the ongoing changes they are still trying to perform at their old levels.
Being disenchanted is perhaps natural, depending on the circumstances, however burning out is a real risk. One disenchanted individual I remember, did as little work as possible, he spent his days printing out job adverts on the office printer and applying for new positions. He was cheerful, fun to be around and just generally didn’t care about the position he was in any more. He left soon after and went on to have a stellar career elsewhere. Burnout is very different and as Michal writes, burnout happens slowly and sneakily. It is worth considering whether you are at risk of a burnout, whether that tiredness you cannot shake is a symptom of something more than just being chronically overworked.
Some things to consider: do you feel tired a lot of the time? Have issues sleeping because of work projects? Find it hard to achieve recovery after a weekend away from work or a holiday? Find it harder to prioritise your daily activities than perhaps in the past? Are you engaged in many projects with different leads? Do you struggle to say no to deadlines, even if they are unreasonable? Are you generally dedicated, loyal and have a perfectionistic nature? Do you worry about not disappointing anyone? When under work pressure do you reduce your leisure activities so you can focus more on work? Are you more emotional than usual, more easily triggered, more irritable? Do you find it hard to be joyful? Do you feel that a lot of your work life is out of your control, and you have little influence on your day-to-day workload and outcomes? Do you think of changing jobs, but you worry that you wouldn’t have the energy to go to interviews, or to even perform a job search?
Unfortunately, burnout creeps up on you, it’s hard to self-diagnose and so many soldier on. It helps to ask trusted friends for their thoughts if you suspect you might be at risk. It also helps to not look around your department and think, everyone else is struggling too, it’s normal. If you are managing a team, it’s important to keep this awareness in mind in these challenging times.
What Chickens have Taught me about Global Programme Management
If you have ever run a global project, you will have heard a variation of “This won’t work in my country”. Sometimes, you will be told: “It’s against the regulations”, sometimes: “No other company in my market does this”, sometimes: “It’s not a cultural fit with our customers”. If you are running a global project and you don’t hear any of the above from any country, what you will likely discover if you check how your project was implemented, is that something was done, but it wasn’t what you hoped for or expected. As a friend of mine said: “We get global recommendations all the time. We have given up saying, “This won’t work for us”, so what we do instead is say, “Yes”, then implement something else… nobody ever checks”.
Sometimes, global teams feel that the local teams are exaggerating. However, it helps to make sure you understand the objections. Cultures can be very different, and sometimes differences are in such basic areas, that you wouldn’t think to expect a difference.
To illustrate I am sharing my experience with chickens. Once in Russia in winter I went to a big market and bought a chicken. Telling me the price, the salesperson held the chicken carcass up to my face and spread the thighs at me, demonstrating that the internal cavity was empty. As this is how I buy my chickens in Switzerland, I was very confused. I kept nodding and saying, “Da”. Great conversations are not made when the speakers have less than five words in common. I later discovered that in Russia, at that time, chickens were sold intact and that I had bought a more expensive bird because someone else had already eviscerated it.
In another example, in an Ethiopian cookbook that was printed for the Ethiopian market, the instructions for preparing chicken are: kill your chicken, then submerge it in hot water and remove the feathers. Visiting my brother in Hong Kong, he told me his neighbours bought live chickens at the market and killed them in their flats. And an example from a Ukrainian friend, he once told me that during the time of communism he would go shopping and come home saying, “I found a goose” or, “I found a chicken”, because he could never predict ahead of time what the market would have in stock. Having grown up in the West this was unimaginable for me, although when he explained it made sense.
I share these examples to illustrate that differences in approach may not be obvious to you. You may not even think to ask. You may take a certain approach for granted, as I did with my chicken purchase in Moscow. This means you need to ask open questions and allow time for the responses. You need to be curious and open-minded. You need to avoid assumptions. If you don’t ask, you won’t know and if you don’t know you cannot accommodate for local variations, at which point your global project is potentially at risk of not being the full-scale success you’d like it to be.
I hope, as ever, that my blog provides you with some useful insights. I look forward to hearing your thoughts. And of course, if you have a challenging project or would like to discuss coaching to help you achieve that next level, do reach out and we can arrange to chat.
Recently I’ve been thinking about customer experience. All my memories of the times it’s been great are related to the individuals representing the brand, not the brand itself. After all, if I buy a premium product, I expect it to work. It’s the extra human factor that adds joy. Last week I experienced some incredible customer service and it made me think again about the value of human communication and connection for business.
Today’s topics:
– Make sure the great awakening is not a rude awakening – Why a website will never replace you where it counts – The beauty of an open mind – experience versus expectation at an NHS A&E service – Getting from metrics to insights in pharma
Make Sure the Great Awakening is not a Rude Awakening
You need good products, but you are nothing without good employees. A Swiss Key Opinion Leader once said to me, “I won’t remember the company you work for, but, if I enjoy working with you, I will work with you, regardless of your employer.” The absence of talent has been a topic for years. More recently with the great resignation/great awakening, the subject of keeping talent has come into sharp focus. Finding talent is time-consuming, nerve-wracking, frustrating and expensive.
So how can you ensure that your employee’s great awakening is not a rude awakening for you? Check in regularly. Take feedback seriously. Act upon things that you can change and be transparent about the things you cannot. Keep your word and if you cannot, communicate early. Manage expectations. People leave managers, not companies; they leave situations they have tried to change, but have not been able to. If you have a trusting, open, transparent relationship, your employees are unlikely to be tempted to move. We are all evolving and improving all the time. Or should be.
Accept that great managers are made, not born, although undoubtedly some are more talented at managing than others. Great leaders need nurturing and difficult situations are rarely the fault of only one party. Sometimes when situations are hard, you might hope that a team member will move on, but there is no guarantee that the person you replace them with will be a perfect fit. However, people do leave, and when that happens, use leaving interviews as an opportunity to learn more about the ‘why’ so you can improve your organisation.
Why a Website Will Never Replace you Where it Counts
When selecting a hotel, a restaurant or the garden of a stately home to visit, I habitually check online ratings. Over time, I have come to the conclusion that the ratings often tell me more about the rater than about the establishment being assessed. Then, last week as I wandered around Hidcote gardens, taking photographs and ignoring my low battery warning, my mobile phone’s battery died.
The Cotswolds are hard to navigate without Google Maps and at 5pm I had not booked a hotel for the night. I asked an employee of the gardens for directions to a nearby village. She reeled off a long complicated set of instructions, then, seeing my confusion, she said kindly: “Oh, I pass through it on my drive home so just follow me.” I ended up following her to my destination. When I got there, I stopped a couple of people on the street asking for hotel recommendations. Most were tourists and couldn’t help. But then the next person I talked to said “I am a tour guide”. She recommended a hotel in the next village, so I drove there and booked the last room they had available. The room was lovely, the food excellent and the employees extremely customer focused.
My hotel selection was less confusing than going online, faster – and the result was a better fit than many choices I have made on online portals. Years ago, in a job interview, I was asked, “As a doctor, what would you want from a pharma company, if you contacted us?” My response? “The right answer, at the time I am asking it, from a competent individual, or a great website.” After years of online chats, online searching and comparing options, I have come to the conclusion that for most of my needs, talking to a person is usually faster and more tailored.
At every conference I attend, a variation of the following question comes up: “Will AI replace me in the near future?” The answer is apparent in what is going on currently. Companies are reducing their field force, but they are expanding online consultation services in every field. Websites are great for simple answers, but, to date, in my experience, nothing beats a human for a fast and tailored experience.
The Beauty of an Open Mind – Experience Versus Expectation at an NHS A&E Service
Last week I met a number of NHS employees. They lamented the way the system works, its inefficiencies, and told me how they would welcome a transformation consultant coming to work with them, to help improve processes and efficiency. I also met a number of NHS patients, who told me how long they had to wait to be seen, the general inefficiency of the system, and that NHS doctors are trained to not treat, if possible, to save money.
Based on all the stories I was glad I didn’t need to depend on the NHS. Then, after a horse ride, I twisted my ankle, very badly. After four days of hobbling around I decided I might need an X-ray after all.
The North Cotswolds hospital was bright and clean. I was asked for my NHS number. I said I live abroad. They said never mind and wrote down my last UK address. The doctor saw me after 45 minutes and sent me for an X-ray. The whole experience took under 3 hours, which is comparable to Switzerland. I was impressed. Fast, friendly, competent. Not at all what I was expecting. I offered to pay for the service but I was told not to worry. The staff were courteous, professional, caring, and the hospital was excellent. The experience reminded me how important it is to keep an open mind in every situation.
Getting From Metrics to Insights in Pharma
Metrics are easy. Metrics are the stuff of KPIs. How many doctors and patients called? Call duration? Key topics? Materials used? How satisfied were customers? How long does it take for a service provider to pick up a phone? These numbers are used to charge a client, or to adapt the service. For example, repeat questions that are not in the prescribing information, might merely make you write a standard response document. A classic metrics-driven approach.
An insights driven approach would be to ask why? Why are doctors asking this now? A classic situation might be that a competitor has launched a product and doctors are assessing which product they want to use. Understanding the context of the question could dramatically change how you approach the situation. You might still write a standard response document, however, you might also identify that a multi-team, international approach could be beneficial.
Depending on the importance of the question, the lifecycle of the product, etc., various ways of addressing the topic beyond a standard response document might become apparent. You might write a publication or share data at an educational event. Or you might run an advisory board or liaise with your regulatory team, to assess the feasibility of adapting the PI.
Insights are considered to be hard to attain, although, insights are where the fun is at. While life science companies have a lot of data, they don’t regularly check the data in order to make decisions. While it’s not easy to change a company’s data practice I have three tips that will help you move beyond mere metrics to insights:
Share knowledge: understand your market and what activities are ongoing with your customers that are led by other teams. Be connected and curious. Look beyond the ‘what’ to the ‘why’. Have regular cross-functional meetings to share key insights across teams.
Single centre of truth: think beyond metrics, consider all the unstructured data that your company has, and think about how this can be made accessible for learning. Work towards having a single centre of truth: a central repository, or data lake, with all mixed, structured and unstructured data, word, pdf, images as well as internal financial or logistics data so that you can mine data and perform topic clustering of information, assess the sentiment being expressed across different data sources and so see what is emerging.
Harmonise what you share: a single source of truth. If you can harmonise the key components of the scientific content you share, you will find identifying trends in new questions coming in will be easier.
I hope, as ever, that my blog provides you with some useful insights. I look forward to hearing your thoughts. And of course, if you have a challenging project or would like to discuss coaching to help you achieve that next level, do reach out and we can arrange to chat.
Thanks to the pandemic, I developed an exercise habit. I cycle most days. The reason I go out is as much for my soul as it is for my body. Rain or shine, every day nature has new surprises in store for me and I arrive home re-energised. Balance is the key to a happy life, I find, although it doesn’t come naturally to me, I have to work hard at it. However, it is important. So, in today’s blog I share my thoughts on how to introduce balance into your activities to improve performance, communication and job satisfaction. In addition, an interesting report on a poster presentation at MASC regarding Medical Information use by patients and caregivers.
Today’s topics:
– Fun theory – or how to trick yourself into better habits – The art of communication – silence is active – Knowing when it’s time to change jobs – The value and impact of medical information acquired by patients and caregivers
Fun Theory – or How to Trick Yourself Into Better Habits
There is an initiative, supported by Volkswagen, called the Fun Theory. The idea is simple: people are most likely to change their behaviour for the better if something is fun. The Fun Factory team transformed stairs located next to escalators at Swedish metro station Odenplan into a functioning piano to see if, by making stair climbing entertaining, more people would be tempted to take the stairs. The idea worked. Once the stairs were musical, 66% more people than before chose to use them.
This example may not obviously translate to the working world, but I have a personal example that does. As a medical student I worked for a Medical Diagnostic Imaging Centre. I was paid by the hour to type up medical reports. I quickly got bored. To challenge myself, I started timing my performance. Every hour I would see if I could beat my previous best total. By turning the job into a game it was suddenly much more fun. I concede that my approach of turning the job into a competition with myself won’t work for everyone, but if you can find a way to make your challenge, at work or at home, more rewarding for you and your team, the rewards can be immense. When we have a task that is hard to do in some way, the temptation to do it fast is always there. But when things are fun, like going biking to observe nature, typing faster to hit a target or jumping up and down on stairs to make music, it’s easy to perform consistently, and time spent doing these things well doesn’t feel like a chore. And with consistency comes great progress.
The Art of Communication – Silence is Active
We value silence for introspection, when we meditate and when we pray, but we rarely think of silence in the context of communication. I’ve had some wonderful conversations on silence in communication recently and am sharing insights that I believe have great value.
At a party, a friend was dispensing dating advice. Her key recommendation: “Don’t talk about yourself too much.” She shared her approach as a younger woman: “When on dates, I wanted to know all about them. There was nothing new I could learn from listening to me. And it wasn’t a job interview, I just wanted to find out everything I could so I could decide if I wanted to see the person again.” In another conversation, a fellow coach said to me, “It is always interesting to see what happens in silence,” referring to his experience with a very loquacious individual who suddenly fell silent during a session. He told me that he held the silence as a tool, enabling his coachee to experience the power of being in a coaching interaction in silence, despite the temptation to ask a follow-up question. Another friend said to me: “Silence is active.” During a training course on intercultural communication I remember a US team colleague saying, “When there is silence, I like to jump in, so that all the time is being used efficiently.” However, the point my friend was making was this: that silence is not a passive state at all. In silence we process, try out new ideas, read a room. We communicate in different ways. In a group setting, when silence is not possible, I believe innovation is at risk.
So in your next meeting consider using silence to learn more about the person you are talking to, to let a mentee find their voice or to give a group space to create new ideas.
Knowing When it’s Time to Change Jobs
Many years ago, I was invited to dinner by a friend who works in HR. She is enthusiastic, engaged and cares deeply about her role and the individuals she works with and whose development she supports. Her passion is palpable in everything she says. Her guests were also all predominantly HR experts. HR, not being an area where I have much practical knowledge, I cast around for a good conversation topic. I recalled another friend of mine who also works in HR who told me how hard it was for her to make employees redundant during recurring reorganisations. I remembered how it felt when I experienced a reorganisation: my simultaneous feelings of relief but also guilt, that I still had a job, while others didn’t. I was certain I had found a good topic for a longer chat. I said to the HR expert sitting next to me: “I cannot imagine working in HR, I imagine it is full of challenging moments, when you have to make someone redundant, for example?” Her response ended the conversation abruptly and has stayed with me for years. She replied: “You know, you might be surprised how many of us just don’t care.” I remember when I was a doctor how sometimes I was so exhausted that I also found it hard to care as much as I felt I should have. Perhaps, this is what she meant: she was too exhausted to care. I hope so. However, whatever the reason, when you get to the point that you don’t care anymore about your job and you have lost sight of what it is that attracted you to it in the first place, it’s time for something new.
The Value and Impact of Medical Information Acquired by Patients and Caregivers
A poster presented at MASC 2022 by first author Rena Rai PharmD, Medical Information and Executive Leadership Fellow at phactMI (last author Evelyn R. Hermes DeSantis) focused on the value and impact of Medical Information acquired by patients and caregivers. 1000 non-healthcare professionals who had searched for medical information in the previous 12 months were surveyed by an independent market research organisation. Participants included 680 patients (68%), 225 (23%) caregivers and 95 (10%) who identified as both patients and caregivers. Age groups: 55% of patients were 60 years or older, 15% of caregivers were 60 or older and 28% of patients/caregivers were 60 years or older. The survey assessed what resources were used to find medical information, including company websites, professional websites, patient leaflets and online search engines, etc. In addition, the survey captured search behaviour including number of searches and when searches were performed. Searches were more frequent just prior to receiving a prescription compared to other timepoints, younger individuals were more likely to search out information and the caregiver and caregiver/patient group reported higher frequencies of searching compared to patients. Resource value and resource trustworthiness were also assessed as well as how the information that the individuals found was used. In the discussion the authors noted that over 50% of patients and caregivers rated the sources they used to access information (including HCP, med websites, pharma company websites etc.) as having extreme or good value and trust. The information that was acquired was used most frequently for HCP discussions and supported confidence in healthcare decision-making. The authors concluded that by understanding how resources are used and to what end, medical information providers can develop higher value resources to better meet the needs of patients, patient/caregiver and caregivers.
I hope, as ever, that my blog provides you with some useful insights. I look forward to hearing your thoughts. And of course, if you have a challenging project or would like to discuss coaching to help you achieve that next level, do reach out and we can arrange to chat.
How fast things change. Last April, I spent a month in England. This entailed ten days of self-isolation, four mandatory PCR tests and daily phone calls from a UK government agency monitoring my adherence to the self-isolation rules. Covid vaccines only started being rolled out for my age group in May and that is when I flew back to Switzerland.
Access to public life in Switzerland was only possible with a Covid certificate. Now planes are back in the skies, masks are rarely seen, nobody wants to see my certificate and most people I know have had the virus, with the exception of my entire family and my closest friends. One might be tempted to think Covid is a thing of the past, however some changes will likely stay with us for much longer. That is what this newsletter will focus on.
Today’s topics:
– Has the pandemic hastened the end of the field rep? – A new operating model for pharma: post-pandemic priorities – Why the future of customer engagement is a hybrid model – Leadership: don’t tell your teams you’ll let them fly, then clip their wings
Has the Pandemic Hastened the End of the Field Rep?
The pandemic has changed the way we work. From one day to the next, face-to-face meetings were impossible, all conferences were virtual and working from home was mandatory. While companies are making tentative efforts to have employees back in the office, the learnings of the pandemic are here to stay. Virtual engagement has proved effective and is impacting the face of pharma operations. For example, Pfizer reduced its US sales staff based on expectations that HCPs will want fewer face-to-face interactions with salespeople after the pandemic. According to the CNBC article, the company said in a statement: “We are evolving into a more focused and innovative biopharma company, and evolving the way we engage with healthcare professionals in an increasingly digital world.” The CNBC article quotes Pfizer as saying: “There will be some changes to our workforce to ensure we have the right expertise and resources in place to meet our evolving needs.” This change has been driven by the expectation that HCPs prefer virtual formats. Beyond physician preference the change also makes sense from an old-fashioned resource management perspective.
According to a survey published Jan 2018 in Forbes, almost 2/3 of pharma sales reps time pre-pandemic was spent on non-revenue generating activities. When I was a medical manager in 2006, I went out with a sales rep. I remember spending a lot of time in his car and in cafes. I also remember that meetings were planned months in advance. Today, we are used to immediate access, doctors are increasingly time poor, meetings are moved with nonchalance last minute on WhatsApp and so the old operating model seems increasingly anachronistic.
Moving physical meetings to virtual has obvious benefits; a single sales rep can engage with many more physicians than otherwise possible, physicians can identify topics they are interested in at short notice, enabling companies to tailor meetings and content to an individual HCPs needs. No more: “I will contact someone at HQ and get back to you.” Instead, HCPs have direct access to the content they want, when they want it, in its entirety.
A New Operating Model for Pharma: Post-pandemic Priorities
A survey performed by McKinsey in December 2021 focused on assessing how the pandemic has influenced pharma operating models and priorities. Of particular interest, participants were asked to review a list of twenty different organisational initiatives and assess them by current level of implementation within the company as well as their perceived value. Initiatives were allocated to one of three groups: customer engagement, agile methodologies and operational structure.
The initiative that was ranked highest overall, both by perceived net value and level of current implementation was, unsurprisingly, in the digital space, in the customer engagement group of activities: raise digital and analytics capabilities company-wide. The most important initiative in the agile methodologies sector was: deploy agile ways of working more broadly, to accelerate clinical trials, launches, content development etc. And regarding the operational structure, the survey results indicate that companies are, once again, or still, focused on realigning team structures around common deliverables/end products and working cross-functionally. The second organisational focus area is the significant reduction of traditional field force in favour of other roles. You can find the full survey results here.
Why the Future of Customer Engagement isa Hybrid Model
Many companies are significantly reducing the traditional field force in favour of other roles, according to a survey by McKinsey. According to a CNBC article on Pfizer’s field force reduction in the US, a key driver of this change is the belief that in the future, healthcare professionals will prefer more than 50% of their interactions with pharma companies to be remote. This may be true, however, the shift to virtual is necessary for other reasons too, because, regardless of HCP engagement preference, absent the implementation of new operating models, pharma companies will struggle to engage widely with key new markets. The rapidly ageing European and US populations, where the classic pharma operating models have evolved, make up only 9.6% and 4.7% of the world’s population respectively. In contrast, 60% of the world’s population is in Asia and 17.2% is in Africa (source worldometer). There are millions of HCPs and patients spread across immense territories. For example, in 2020 in China there were 3.87 million HCPs and 35,394 hospitals (source Statista), and the country covers nine time zones. Even if most key HCPs are concentrated in the big cities, effectively engaging them using MSLs and field reps would require huge teams who would have to navigate immense territories. Consequently, I believe that the only way to reach customers in these markets will be through the implementation of hybrid operating models: combining virtual engagement on demand, with targeted face-to-face engagement for specific topics and specific customers, and a broad range of digital self-service offerings.
Leadership: Don’t tell your Teams you’ll let them Fly, then Clip their Wings
Agility is important. Being able to prioritise is important. Independent thinking, creative approaches to problem solving, and self-determination, are all very important. Companies have realised that people who are free to innovate, are people who are engaged. However, putting it into practice is often not as easy as it sounds. A colleague mentioned that resources in her company had been reallocated so that individuals no longer work directly with a specific team, instead providing pooled support across product teams. This significantly complicates the working process as emails come into a group email address and are worked on by whoever picks them up. Despite low engagement with the change, the team took comfort in the fact that they had been given the freedom to outline their standard operating procedures and how they want to work, which softened the impact somewhat. The reality of the situation is, however, that to date, not a single proposal the team has made on how to optimise the way they work, has been accepted by their management. This is impacting morale and will likely lead to low performance in the long run.
I hope, as ever, that my blog provides you with some useful insights. I look forward to hearing your thoughts. And of course, if you have a challenging project or would like to discuss coaching to help you achieve that next level, do reach out and we can arrange to chat.
I have just “got back” from a virtual Medical Affairs and Scientific Communications (MASC) meeting, held on 21st-23rd March in Orlando, Florida. While I didn’t miss the travel experience – planes, masks, navigating gargantuan US airports trying to find my rental car, and jet lag – I did miss seeing everyone after a two-year hiatus.
However, I experienced a well-run hybrid meeting and heard some interesting presentations. I will share some learnings from the conference, as always, along with my own thoughts.
Today’s topics:
– Lessons from horseracing – focus on the finish line – Digital innovation – accessibility of scientific content – Effective delegation means letting go – Can we celebrate both process and customer centricity? A medical information call centre experience
Last but not least this year’s European Medical Information and Communications Conference will be held in Sevilla on the 5th-6th October 2022. The call for abstracts just went out. If you have a topic you want to submit please get in touch.
Lessons From Horseracing – Focus On The Finish Line
Humans, like horses, are social animals. Running with the herd feels safe, and lulls us into thinking we are on the right track. And while we might be, we are unlikely to be charting new territory. So while understanding how companies approach their customers is important, understanding your company and your environment and what your customers want, is more likely to put you ahead of the field.
Three things we can learn from horseracing.
First: Before every race, a jockey assesses the competition. That is: who he will be competing against in that race, on that day. He doesn’t compare his novice racehorse to a Grand National champion.
Second: On the day of the race, the jockey assesses the racecourse and the vicinity. Is the ground muddy and slippery, or dry and very hard? Is there anything in the vicinity of the course that could spook his horse, such as flags that might wave in the wind, for example?
Third: A jockey understands his mount. He knows how his horse performs in mud, where to place his horse relative to the field to get top performance, when to push, when to fall back. In short, he knows, how to ride to win.
Translated to business, this means: know your company, understand your environment, know your competition and benchmark wisely. Don’t assume a big company is doing a better job than you in a certain area because they are bigger. Remember, what works for global giants like Roche, Novartis or Pfizer, is unlikely to be a good fit for a biotech company with a small footprint, who is only just starting to engage HCPs. While learning from others is great, learning from yourself also has value. At MASC a presenter said, “94% of the industry is operating contact centres for customers for 12 hours a day, 8am to 8pm, but most of these companies don’t assess their customer contact data to understand whether this makes sense.”
There is safety in doing what everyone else does, but that doesn’t mean it is right for you.
Remember, if the riders in the image focused on each other rather than on the finish line, they would all just crash into one another, but nobody would finish the race.
Digital Innovation – Accessibility Of Scientific Content
During MASC, Marie-Ange Noue from EMD Serono led a session on digital innovation in the communication of scientific content. Speaker, Joanna Rizos, Associate Director Med Affairs, Eli Lilly Canada shared Lilly Canada’s efforts to make medical online content more accessible to a wider range of people with disabilities. Eli Lilly is a member of the valuable 500, a global collective of companies who are innovating for disability inclusion. In addition, in 2021 when Joanna’s team was getting ready to launch their Med Info website they learned that the website and associated content needed to meet accessibility standards as outlined in the Accessibility for Ontarians with Disabilities Act, which adopts a stepwise approach to entrench accessibility in all domains by 2025. According to Joanna’s presentation, 1.3 billion people worldwide have a disability, 253 million people of these are visually impaired, and 80% of disabilities are non-visible. According to the social model of disability, disabilities are not caused by an impairment alone but by the barriers put up in society.
One of the most common challenges faced by users with access needs is that websites are too crowded. Additional considerations for accessibility of content include website navigation, the visuals, the links, and calls to action in the content. Technical standards for websites are outlined in the WWW consortium, while accessibility standards can be found in the web content accessibility guidelines (WCAG 2.0).
Taking these guidelines into account the Lilly team focused on clean layouts, easy to read text fonts and good contrast. Lilly’s digital team focused on technical requirements, while the Medical Information team concentrated on content including medical letters, videos, FAQs and visuals. Screen readers were employed to make text more accessible, however, 25% of Lilly’s content comprised graphs, images and videos. One WCAG stipulation for content accessibility is that websites offer text alternatives for featured images.
The Lilly team addressed this by adding subtitles and captions to video content and alt text to all images to provide access to screen readers. Lilly employees were engaged as internal experts to assess the content for accessibility. Following these activities, the Lilly team has gone on to provide accessibility training across Lilly med info. Expert users have been brought in to share the user experience, alerting the team to the experience and how the content and its presentation impacts different user groups.
While this topic is very much in focus at Lilly, a poll of the audience at MASC to assess whether other companies are taking steps to make online medical content more accessible to a wider range of people with disabilities (accommodation for blindness, low vision, deafness, hearing loss, limited movement, speech disabilities, photosensitivity, and combinations of these) showed that other attendees are either not working on this topic currently or are not aware of ongoing efforts at their companies. Responses to the question, “Is this currently in focus at your company?” were: Yes (5%), No (44%), Not sure (50%) 38 votes.
Effective Delegation Means Letting Go
One of my most beloved managers and now a dear friend once asked me to write a document. She gave me carte blanche. I wrote the document. I handed it in. When I got it back, it was entirely rewritten. We had a frank conversation. I said I’d always deliver projects to her specifications if they are provided. However if I am given the freedom to work according to my own direction and this work is then rewritten, that is something I find upsetting. Thanks to a trusting relationship and the willingness to find a path that suited both our personalities and preferences, we found an approach that worked for both of us. Like all skills, delegation is not a given; it takes practice, the courage to communicate when things are challenging, and it isn’t always easy – as I learned when I founded my own company.
My mentor, Traugott, who was 88 when he started mentoring me, had grown a family company from 50 to 600 people in the course of his career. Sadly, he is gone, but his company lives on as his work legacy. And his memory and wise words are always with me. He told me to focus on my core strengths and delegate everything else. I follow his advice and am grateful to be surrounded by talented people who do the things well that I can’t or don’t like to do: Jane and Belinda handle admin, Barry does the website, Christian manages finances, Datarun manages all my IT activities and Mark does design. Delegating has, for me too, been a path of growth. Initially, when discussing my website with Mark, I had so many ideas. I would send him screenshots and photographs, I was enthusiastic. And as it is my company I was very involved. But in working with him, and through his gentle feedback, I came to understand that my job is the vision and his job is the visuals. So I let him get on with it, and I am very happy with the result.
What I have learned over the years. Effective delegation depends on four things: 1) Identifying an individual you trust to handle the project 2) Clearly communicating your expectations regarding the outcome 3) Accepting that no two people will perform tasks identically and if what is delivered is of high quality but different to how you would have approached it, then that is fine too 4) Managing your anxiety about the outcome and any linked urge to micromanage your team.
Can We Celebrate Both Process And Customer Centricity? A Medical Information Call Centre Experience
What processes do your Medical Information teams follow when a call comes in that is not related to medical information. Let’s say, it’s the plumber calling to speak to your company’s maintenance team. Is your team empowered to reroute that call to the correct individual in the company? I recently called a company looking to speak with someone. I was erroneously connected to someone in security on my first try, who recommended I call back and press 0 to reach an operator. This put me through to Medical Information, for some bizarre reason. I highlighted that my call had reached them in error and asked if there was a switchboard they could transfer me back to. I was informed that it is not possible to transfer any calls from the Medical Information team. The gentleman was charming, friendly and courteous; he logged my call, said he would send it on internally, and that I would be contacted by email. Processes describing how to handle Med Info enquiries are important, processes describing how to handle non-medical information enquiries that reach your Medical Information team are also important. Documenting all calls, ensuring call logs match system logs, is great, and noting calls that come in to Med Info by mistake is also useful from an audit perspective. However, from a customer’s point of view, having provided all necessary details to the Medical Information expert, I would have welcomed a transfer to the central switchboard, followed ideally by being connected to the individual I was seeking to speak to.
I hope, as ever, that my blog provides you with some useful insights. I look forward to hearing your thoughts. And of course, if you have a challenging project or would like to discuss coaching to help you achieve that next level, do reach out and we can arrange to chat.
