Tag Archives: healthcare crisis

Healthcare systems in crisis – the NHS as a case study

by Isabelle Widmer on

Only three weeks until the DIA meeting in Brussels, the agenda is final, and I am in the midst of writing presentations and finishing up workshop preparations. We have a large group of attendees from all over the world coming to be with us in Brussels, I hope to see you there. If you’d like to chat with me at the meeting consider dropping me a line so we can plan ahead.

Today’s blog topics:

• Best practice for scientific content provision in an omnichannel environment
• Med Info and Med Comms meeting Brussels 2023
• Healthcare systems in crisis – the NHS as a case study
• Leadership: The role of unconscious bias in the Lucy Letby case

Best practice for scientific content provision in an omnichannel environment

Customer access is a challenge for the pharmaceutical industry. Physicians have limited time and many companies vying for their attention. As access becomes harder, the provision of service on demand via the channels of the customer’s choice is becoming an important business differentiator. In addition, companies are looking to reduce cost and improve impact by making better use of available headcount and by using integrated data analytics to inform strategy. Taken together these factors explain why many pharmaceutical companies are rolling out omnichannel solutions.

Unfortunately, these solutions often fall short of their potential because they don’t factor in the human element. An area where inefficiencies are frequent is content generation, management and harmonisation, which is often managed by different teams. As structures and customer engagement evolves it is worth reflecting on whether the right people are engaged in the right activities at the right time. For example, used well, a Medical Information team can be the beating heart of scientific content generation in a company, working efficiently across teams and departments in the service of all.

Medical information professionals are product experts who excel at communicating scientific information tailored to the customer’s needs, they understand internal and external customers and support internal colleagues, including medical affairs colleagues and sales representatives with scientific enquiries. They write response documents, perform literature searches, and consult with teams including quality and safety. As Medical Information teams receive unsolicited enquiries from a broad range of customers, they are also in tune with customer needs, and able to offer valuable insights.
If you want to find out how best to provide scientific content and how to do more with less join us in Brussels at the Medical Information conference) We will discuss models, channels, solution providers, content generation cross-functional collaboration, pragmatic use of resources and how to generate meaningful metrics and insights

Key take way: As your business model evolves review if you are using your resources effectively and whether you are making the most of your Medical Information team’s ability to free up your in-field team in order to improve overall impact.

Medical Information and Medical Communications meeting Brussels September 2023 – Last call

Preparations are ongoing for the Medical Information and Medical Communications DIA meeting that will take place in Brussels. Thanks to the stellar submissions we received we have put together a great agenda.

Topics cover contact centre management, evolving the medical information structure, the value of medical information, putting theory into practice, digital content, content dissemination, a workshop on navigating medical information and an open microphone session, where we welcome participation from the floor.

If you haven’t signed up yet, do consider coming. You can also still submit a poster to the meeting. Every year a group of experienced individuals in the industry, as well as smaller companies, or biotechnology companies that are identifying how best to meet customers information needs meet, this is a good opportunity to increase your knowledge, share best practice and make connections. The meeting is especially useful for individuals who are new to medical information or who are tasked with building a medical information approach from scratch and want to fast track their efforts.

You can find out more about the speakers, and the agenda as well as sign up here.

Key takeaway: Instead of finding your own path why not stand on the shoulders of those who came before?

Healthcare systems in crisis – the NHS as a case study

During the pandemic health care professionals (HCPs) were celebrated. People stood on balconies clapping. HCPs worked long hours under difficult conditions wearing insufficient or faulty personal protective equipment in the service of patients and the healthcare system. Yet despite being officially feted health care professionals’ working conditions in many countries remain challenging. Frequently, those who provide healthcare to others do not work in a healthy environment which is one of the reasons, I suspect, why there is a global lack of healthcare staff.

In the UK the situation has come to a head as junior doctors and consultants prepare to strike. A 2022 survey by the British Medical Association of 4000 junior doctors, who are in the first 6-10 years of training after getting their degrees, showed that almost 90% are concerned about the impact of the rising cost of living on their personal situation. More than half the respondents said they had struggled to pay for utilities and lighting in 2022 and 45% said they struggled to pay for commuting, essential travel and rents and mortgage. Eighty percent of those surveyed reported that if they had to reduce their income at all they wouldn’t be able to meet their essential outgoings.

Almost 80% of respondents are considering, and 65% have actively researched, leaving the NHS in the past 12 months. A third of these is planning to work abroad. More than three quarters of respondents had friends and colleagues who had already left the NHS and gone to work as a doctor in a different country. Reasons for considering to leave the NHS include pay and pension schemes, deteriorating working conditions and personal well-being, increased workload, lack of recognition, workforce supply shortages and a lack of flexible working patterns.

The NHS is already in crisis: according to a recent article in the Times “More than half of people who died in England last year were on an NHS waiting list. The estimated toll of 340,000 was up from 240,000 five years before, a 42 per cent rise. The figure represented more than 60 per cent of all deaths in England, according to data provided to The Times by NHS trusts under freedom of information laws”. Patients are already being affected but now the doctors’ strikes will further compound the problem. While the leading issue cited in the media is salary, the BMA survey highlights many other topics, that are relevant for the UK but also beyond the UK’s borders.

An article written in the (Swiss Medical Weekly) by three Switzerland based physicians with experience of the NHS. discusses the results of the BMA survey. Although they acknowledge that young Swiss doctors are in a better position than their UK peers, they note that according to survey data, junior doctors working in the Swiss healthcare system experience similar areas of dissatisfaction. Their conclusion matches mine: the BMA survey results are worth paying attention to. As we face a global shortage of HCPs, and HCPs vote with their feet moving to locations with more favourable working conditions and salaries, the challenges in accessing healthcare faced by underserved populations, such as those in Africa increase.

While recruiting HCPs from other countries may temporarily address developed nations’ healthcare system woes, in the absence of a change of strategy to solve this problem we are heading into challenging times.

Key take-away: The situation in the NHS may seem relevant only for the UK, however, doctors the world over are turning their backs on local clinical practice to work overseas. In many cases the drivers underlying this decision will match those highlighted by the BMA survey. If we want patients to have access to healthcare, we need to reinvent healthcare provision.

Leadership: The role of unconscious bias in the Lucy Letby case

Last week British nurse Lucy Letby was convicted of murdering infants in her care. While widely covered in UK media it was not widely covered by the media elsewhere so I will summarise some key aspects.

The case is tragic because initial concerns about the nurse were raised in the month after the first child was killed, yet it took another year, four more murdered babies, and six known murder attempts until action was taken.

Physicians working at the hospital raised concerns about the nurse repeatedly during this time as she was the single common denominator in each case. Autopsies were not performed in every case and some autopsy results were lost in the post, absent a digitalised system. The head nurse and clinic manager defended the young nurse and the doctors who raised concerns were threatened with sanctions by the management team and forced to apologize. There are currently other cases ongoing in the NHS where physicians have been suspended for raising concerns with the quality of care provided to patients.

The reason I am highlighting this case is because there are some important lessons to be learned here. The first is about unconscious bias, where we tend to trust those who are like us, and there is a risk that we protect those who appear to need it most. In this case a young female nurse, who was the subject of complaints by the entire team of senior male physicians. In addition, there are different reporting lines in hospitals, nurses report into a senior nurse, doctors report in through a different structure, this can lead to an “us” versus “them” mentality and a protection of “one’s own”. The lack of availability of objective data, in this case autopsy reports, which would have confirmed suspicions, is a systemic process error. And lastly, it appears that senior leadership was reluctant to promptly investigate the allegations, possibly due to the anticipated consequences if the claims were verified; while this hesitancy was likely unconscious, it had very real impact on many lives. The NHS is now reviewing its whistleblowing policy.

Key takeaway: Companies value an external perspective when new individuals join their teams. In conflict situations, or situations where team members’ mental health is at stake, or allegations are serious, it is worth bringing in an external individual to support, mediate, moderate and assess as it is impossible to be unbiased as a leader in this situation.

Thank you for reading, I enjoy sharing my thoughts and I love hearing what piqued your interest or any feedback and thoughts. If you are currently working on a demanding project in the fields of medical, digital, systems, analytics, channels, or facing any team or personal challenges, feel free to reach out to me for an informal chat. I am always happy to explore how I might be able to support you.

Best wishes

Isabelle C. Widmer MD

Photo Credit: National Cancer Institute @ Unsplash

Fixing the healthcare crisis: patients as equal partners

by Isabelle Widmer on

In addition to visiting doctors, worrying about test results, calling the hospital, and wishing it was not so hot, I have managed to swim in the local river for the first time in years. It was glorious! I hope you too  have found time to something you enjoy as you wait for autumn.

Today’s blog topics:

– Fixing the healthcare crisis: patients as equal partners
– Questions to empower patients
– Data versus assumptions – a personal observation
– Leadership: the importance of role awareness and reflection

Fixing the healthcare crisis: Patients as equal partners

Around the globe healthcare costs are on the rise, limiting access to treatments in many places as governments worldwide seek cost-effective care solutions. In a recent newsletter, I highlighted Singapore’s innovative healthcare model which performs comparably to Switzerland’s system at a quarter of the cost (link to article). The difference? Patients benefit directly if they use less healthcare resources.

However, while beneficial, I don’t believe that focusing solely on financial incentives to consume less will be enough in the longer term. The global shortage of healthcare professionals (HCPs) translates to less time per patient, the risk of mistakes and less time for conversations with patients. Despite everyone’s hopes even if AI does take on routine tasks in the clinic, physicians will be asked to see more patients, not to spend more time with individual patients.

Healthcare professionals do their best, they work under difficult circumstances, but, given that no one is more invested in a patient’s health than the patient themselves, and that pressure on HCPs looks to increase, maybe it is the right time to empower patients to take a more engaged role in their health management by giving them easier access to information. Currently, accessing information beyond prescription details is challenging for non-HCP patients. Whether seeking original clinical trial data and publications, or pre-emptively researching a product, such information is often available online, but the key lies in a patient’s ability to find it. Another resource, pharmaceutical industry medical information departments, often does not cater to complex patient inquiries. Typically, patients who contact pharmaceutical companies with questions about their prescriptions are referred to their clinicians. 

Especially in markets with direct-to-consumer drug marketing, I think it is worth considering that patients are permitted to query pharma companies about products they have been prescribed or that have been proposed as treatment options, so that they can reach an informed position and compile a list of questions before the next appointment with their clinician.

While not every patient will be interested, or indeed able, to manage their health more actively many will be, as shared by patient advocate Suz Schrandt when she told me in 2017 about the information she would like to access as a patient but struggles to do so (link to article medical Information patient needs).  As we navigate a new era in healthcare, I suggest that it is time to give patients the opportunity to take more ownership in managing their health by removing access restrictions to relevant information.

I realise this may be a controversial position, so I am interested to hear your opinions. 

Key takeaway:  Resource constraints limit access to healthcare services as time pressures increase on HCPs.  Engaging patients more actively as managers of their health by giving them access to key information could improve patient health and through patient engagement also potentially improve compliance.  

Questions to empower patients

As a physician I often support friends and family members when they face healthcare challenges, usually once things look as though they are going wrong. This experience has made me think about the questions patients should have ready to ask when meeting their doctors to discuss treatment options. Naturally, the opportunity to ask questions and the available choices will vary depending on local culture, the local healthcare system and other local factors, however, regardless of the system I believe in being prepared.

I recommend the following approach, especially when seeing a new doctor:

Start by making a list before you go to visit your doctor, if your doctor doesn’t have much time, you may otherwise find that you have left the practice without having all your questions answered.

List any recent symptoms you have experienced, what the context was and if they were reproducible. Ensure you have a list of all medications you are taking including any over the counter supplements you take,. If you are being assessed for surgery, ask about alternatives, risk factors, prognoses, the experience of the doctor performing the surgery, how often she has performed this surgery before and what her success rate is. Ask about typical outcomes, risk versus benefit for you personally and what the outcome will be if the operation is not performed. Also ask about timelines for operation, what is the urgency, is there any or can you delay? Also ask about considerations for managing at home post-operation and rehabilitation options. Finally, consider finding out whether doctors are incentivised to perform surgery.

Further questions to ask include whether there are medical treatment guidelines and whether the recommended treatment is in line with these guidelines. Ask whether your doctor thinks his colleagues would recommend the same approach, and potentially whether the doctor would treat his family in the way recommended. Depending on your situation it is also important to weigh the quality of life versus the impacts and benefits of therapy.

If you are receiving a new prescription ask about alternatives, pros and cons, potential interactions with medication you are already on, foods you shouldn’t eat while taking the medication and whether there is anything else you should be aware of, sensitivity to light for example, whether you can still drive and whether your can drink alcohol. Also ask about potential interactions with common over the counter drugs or other medicines you may take periodically such as antihistamines.

Depending on the market you are in, ask whether the prescribed medication is the best one for the condition, or whether it is currently the only one available in your market, or the only one that is financed in your market. If your doctor says there are better, newer products available, but they are currently not available in your market, ask whether you can be included in a clinical trial or whether there are other ways to access the product and whether this is worth looking into.

This isn’t an exhaustive list. If anyone has additional suggestions I would be very interested to read them. Please share them with me.

Key take-away: Nothing beats good preparation.

Data versus assumptions – a personal observation

I recently subscribed to Nature. Having spent years immersed in basic research, analysing promoter regions, experimenting with cell cultures, assessing protein expression levels, and generating antibodies, my love of science is an enduring one. In addition, I’m also a physician. So, when the mRNA vaccines were rolled out, one might have expected me to dive into the research, scrutinize the publications – though of course there wasn’t much available initially – and engage in deep contemplation. Surprisingly, although not within the context of the pandemic, perhaps, I didn’t. I got vaccinated and moved on.

What intrigues me about this situation is how I made many assumptions about the design of the mRNA vaccines, based on my background, only to discover upon reading Nature publications that I was mistaken. This serves as a reminder of how often we draw conclusions based on our unique perspectives without verifying the accuracy of our assumptions, often leading to surprises down the road. For more information on the history of mRNA vaccines Johns Hopkins has an excellent summary here

Key take-away: Data beats assumptions almost every time.

Leadership: The importance of role awareness and reflection

In my work with teams and leaders two recurring themes appear. First, the desire to make a meaningful impact and have contributions recognized. Second, the mismatch between expectations of others and reality. While issues vary, considering roles often offers insights.

Among the many aspects, I will focus on one factor that can be transformative: role awareness.

Role awareness starts with reflecting upon the roles we hold. We are children by birth, parents by choice, doctors by training, in my case, and general managers by successful navigation of the career ladder. Additionally, socialisation and valency prime us for further roles: the outspoken one, the caregiver, the problem solver, the paternal figure, and more. While companies employ tests like Myers Briggs, Belbin, and Insights to enhance performance and self-awareness, the significance of assumed and designated roles, coupled with adeptly handling role shifts, is often overlooked, yet critical for success.

Once you understand the range of roles you embody and adopt it is worth considering your work-related role. This includes assessing whether your understanding of your role aligns with the organization’s perspective. In the event of a mismatch here, or a lack of clarity, future issues are almost certain.

In addition to understanding the roles you inhabit; it is worth considering best practice in role initiation and role relinquishment as your career progresses. In practice, when taking on a new role, consider what this role requires of you and what you need to leave behind. To perform well in one role, you need to fully exit from an old role. If you do not, you risk confusion for yourself and your stakeholders. In addition, as long as you inhabit a role that you have officially left there is no “space” for the new role holder to succeed in it.

When role assumption and relinquishment are an issue, the situation might be viewed as follows by the manager, who was promoted from the role, stating, “I expected better performance and more autonomous decision making from the new role holder” and the new role holder saying, “despite the promotion, he’s still immersed in daily operations, and I cannot make any decisions”.

Key takeaway: Focus fully on the tasks associated with your current role and job title, step away from operative activities related to your old role to allow your successor room to excel. Provide guidance only as appropriate, i.e., if is part of your new role, or you have been asked to mentor

Thank you for reading, I enjoy sharing my thoughts and I love hearing what piqued your interest or any feedback and thoughts. If you are currently working on a demanding project in the fields of medical, digital, systems, analytics, channels, or facing team or personal challenges, feel free to reach out to me for an informal chat. I am always happy to explore how I might be able to support you.

Best wishes

Isabelle C. Widmer MD

Photo credit: Annie Spratt @Unsplash