I have just a few more remaining weeks as a student on the Health Systems Transformation course with the School of Systems Change.
We have been carefully defining and refining our ongoing personal enquiries – questions we are asking of ourselves, our communities and society more broadly. Framing up these “how might I/ we” questions with precision and intention can have a profound influence on the work that we do within systems change.
The first question – to myself – is “how might I increase my personal autonomy to challenge norms within the status quo that are creating health inequities and harming the planet”. As an extension of this, I also ask “how might medical affairs develop greater autonomy to collectively disrupt norms within the status quo that are creating health inequities and harming the planet.”
Recognising that I do not know the exact right “answer” to these questions, I have a number of hypotheses that I would like to share in this blog.
But before we get into the possible solutions, lets first attempt to make the diagnosis.
Some of you might have seen a post last week from Paul Simms of Impatient Health asking “who is the most forward-thinking innovator you know, working in medical affairs?” The answers were illuminating - from “sorry, not a single name comes to mind”, “to there are probably some but not audible”, and “the (lack of) replies and reactions say enough”.
What is going on here?
I would argue there are several roots causes, and my diagnosis might hurt a bit. But if we cannot see clearly, we might struggle to move forwards.
First, medical affairs lacks a strong collective leadership identity that is visionary and ambitious. We have forgotten that we have a unique voice to use, and our core values as medical doctors and scientists have been challenging to consistently uphold.
Second, is our operating context. Although there is a tendency to blame medical for its lack of leadership and inability to live up to its potential, we neglect to recognise that the operating context and culture we work within can be disempowering. For example, most businesses have a one-sided focus on outcomes to demonstrate short term impact leaving little time or space for nurturing creative experimentation or working on projects at the edges away from the mainstream that may lead to longer term value.
As an aside, organisations often have a genuine desire to value diversity but in reality reward rational science based ways of thinking above other forms of knowledge such as intuitive, imaginative, cultural, feelings-based or ideas that are rooted in traditions.
Finally, and this is especially relevant in relation to the topic of future orientated health transformation, the industry has a narrow and limited view of what health transformation actually is. We focus predominantly on technological and institutional transformations, neglecting other perspectives on the future of healthcare such as social, ecological and economic transformations. More on this coming soon.
Considering this, I think that we need to do 3 things.
1) We need to know and feel secure in who we are as medical affairs and form a collective leadership identity. This means defining the unique contribution we make to the business, to patients, to society and to the planet. It means building collective leadership rather than individual hero-centric leadership capabilities. And it means team development and psychological growth.
2) We need to find our voice in medical affairs to activate our potential as advocates for change. This means building our own inner confidence that what we have to say is not only worth hearing, it is critical that it is heard.
3) We need to take action by building operational skills and capabilities that broaden the value we bring to the business and work to break down functional silos. For example gathering future orientated healthcare market insights to inform commercial strategies beyond what they need to be today, integrating climate and health data to shape policy change and elevating the patient voice to influence corporate ESG strategies.
Do you agree? Let me know!
Now that the first week of the Health Systems Transformation Basecamp at the School of Systems Change has drawn to a close, it seems like a good moment to reflect on what systems change actually is, and why it is useful to life science businesses.
When I first started work at GSK, I sat next to one of the cool and trendy Marketing Directors who had a t-shirt with the slogan “Change Agent”. I remember thinking – “that’s awesome, to change something, I wonder if I could do that?” I imagined a pioneering maverick, a heroic character, that courageously went out there and made a real difference to the world.
What I did not appreciate was that we are all “change agents” - because changing things is a very natural part of life. It is part of growing up, forging relationships, learning and contributing to society through our work. We are living systems that are constantly changing ourselves and the world around us, either intentionally or unintentionally. The first question, then, is how we get more intentional about this unavoidable change. That’s where the practice of systems change can help.
“A system is a set of things—people, cells, molecules, or whatever—interconnected in such a way that they produce their own pattern of behaviour over time.”
Meadows 2009
Another way of looking at it is to recognise that almost every large pharmaceutical company has been through a huge raft of organisational changes in the last 12 to 24 months somewhere in the world. No matter how many strategic consultants we hire, the external environment is changing so fast that business models of today are no longer fit for tomorrow.
Systems change helps us to detect and prepare for these patterns of change that are coming our way, a little bit like weather forecasting. It helps us take the right actions at the right moment in time. This saves the business money in the long run, making sure it is resilient to cope with the storms that lie ahead.
“The purpose of a system is what it does. There is after all, no point in claiming that the purpose of a system is to do what it constantly fails to do.”
Anthony Stafford Beer.
When a life science business is struggling – maybe pipelines have failed or employee retention is low, or sustainable business models seem impossible, or tenders and sales are being consistently lost - it is tempting to say that the system is “broken”. But one of the things we learn early on at Basecamp is that systems are not broken. They are perfectly designed to do the things that they are designed to do.
Rather than trying to fix what is broken, we begin to realise that something about the way the system is structured or organised, and something about its ultimate purpose and goal, needs to shift and change in order for the business to thrive and survive.
At this point we are almost certainly dealing with complexity - complex processes, complex relationships and complex structures. This is when the tools and processes of systems change can help us to diagnose and locate where in the complex system we need to intervene in order to shift the patterns of structures and relationships towards better outcomes.
In summary, systems change is the intentional practice and process of reshaping complex patterns and structures within businesses to anticipate and even dance with the external forces of change to improve outcomes.
This was a very short overview of systems change! If systems change is something you are curious about for you, your medical team or your purpose-driven business, please do get in touch for a conversation. I also encourage you to reach out to the School of Systems Change to find out more.
Have you heard the popular and somewhat cliched quote “life is a journey, not a destination?” This is certainly true in my lived experience. The medical degree I got at the age of 23 felt like a significant high point in my life, but it was the experience of actually working as a doctor within the NHS that was far more valuable and rewarding.
Today was the first session along our 4 month journey into health systems transformation at the School for Systems Change and it got me thinking; how often do life science businesses prioritise the “journey” of the lived experience of employees, customers and communities over the “destination” of its financial bottom line? In an ideal system, these two things would go hand in hand.
A business needs to make a good return on its investment, but there are many other non-outcome related aspects of a business that hold value - from the continuous growth and development of its employees, to the space for creative sharing of ideas that spark unexpected innovations and the fostering of multi-cultural diverse communities. A healthy business also considers these process orientated dimensions, not just its measurable and reportable outcomes.
Lets take another relevant example from the life science sector – clinical trials. We usually design trials to evaluate the benefit of a medicine or vaccine on health related outcomes in a pre-specified population. The focus is predominantly on the health outcome - the data that will convince regulators, clinicians and patients that the medical innovation has a benefit that is worth the risk. We might look for ways to measure an outcome that is more “patient centric”, but it is still the outcome that matters most.
Yet something we have known for a very long time is that many people derive a benefit from being part of the process of a trial, even beyond the medication they receive – the so-called placebo effect. Participants have access to medical care that exceeds the usual standards and receive more intensive support when they have symptoms or concerns. Expanding access to trials to ensure diverse representation of populations in need therefore contributes to the broader healthcare shift to equitable models of health.
On the other hand, the process of delivering the clinical trial could involve recruiting patients from very large geographical distances, especially if it’s a rare disease. The transport required to get them to clinic visits could generate greenhouse gas emissions that contribute to worsening climate change with negative impacts on public health. The process of the trial could then influence health negatively, a risk that might not be worth the benefit at population levels.
This type of complexity is what the practice, process and outcomes of systems change helps us to navigate. I look forward to sharing more as the week unfolds.
