A Soldier of the Patients’ Will
Anne Beal at Sanofi knows that listening to patients is the key for pharma.
As pharma acknowledges the need for greater patient centricity, and makes real moves towards it, a few pathfinders are showing the rest exactly how much work needs to be done to get there.
One such is Dr Anne Beal: a pediatrician by profession, she is also Sanofi’s Chief Patient Officer and sees everyone in pharma as being, in her memorable phrase, a ‘soldier of the patients' will’. “People need to understand that they are responsible for generating a patient-centric mindset,” she explains in an interview ahead of her presentation at eyeforpharma Barcelona 2016. “It is about trying to drive each and every employee to see what they can do to touch patients and to help other people in the organization to touch patients. It allows everyone in the organization to take this mindset: fundamentally, people are interested in doing work that is meaningful to them, that has a purpose.”
This sounds exemplary – but people can be set in their ways, so Beal must surely have encountered some internal resistance to this idea? Not with the idea itself, she insists, but perhaps with the logistical nuts and bolts of the process. “The only pushback has been in questions such as: ‘But how do I do this?’” she explains. “This is particularly from people who are not in forward-facing parts of the organization. Also, we get the comment ‘I thought I was patient-centric’. People want to know what more they can do.”
Leading by example
Beal knows exactly what is required. Her distinguished career in the philanthropic side of medicine started at the Commonwealth Fund, where she was Assistant Vice President for the Program on Health Care Disparities, and then as President of the charitable Aetna Foundation.
Throughout her work in the field, there is a thread of promoting equality in access to healthcare – for different racial and ethnic groups, for example – and of addressing the rise in diseases such as adult and childhood obesity in the US.
In its own move to patient centricity, Sanofi seeks to use practical cases internally to illustrate to staff how things can change. “We highlight and feature a lot of the work and activities that are already going on with peers,” Beal continues. “But it cannot be a preachy approach – we have to lead by example.”
But the pharma industry is made up of people who come from clinical, research backgrounds and perhaps you have to drive it slightly differently with them. You use phrases like ‘exemplary customer service’, ‘meeting patients’ needs’, and ‘science and service’. But the common thing is that people need a sense of mission.
At its most basic, the process is about generating insight into, and understanding of, pharma’s end user. However, she concedes, since it is fair to say that there is some confusion in pharma over who the end user actually is – for many, for example, it is the doctor rather than the patient - her messages need to be tweaked to hit home with some internal audiences.
“Patient-centricity is part of a practical business framework,” she explains. “But the pharma industry is made up of people who come from clinical, research backgrounds and perhaps you have to drive it slightly differently with them. You use phrases like ‘exemplary customer service’, ‘meeting patients’ needs’, and ‘science and service’. But the common thing is that people need a sense of mission.”
Defining pharma’s terms
An important step in all this is to be rigorous about terms and defining exactly what pharma is talking about. The word ‘patient’ is mentioned in mission statements by companies that seem to have little actual regard for patients, for example – so what are the main challenges to embedding a patient-centric culture in an organization?
“It’s not about pharma focusing on patients as their main customer,” counters Beal. “It’s about bringing patients in to the process as another customer.” To put it a different way, pharma is a science-based undertaking, but it is not as though the science becomes any less important when the needs of physicians and payers are taken into account – all these elements play a part in informing how the industry goes about its business. “It’s about being holistic,” Beal explains.
A keynote speaker at eyeforpharma Barcelona, Beal sees three pillars to patient-centricity in practice: input and understanding, solutions and outcomes and culture and community - all of which revolve around helping the patient take or regain control of their life and condition. This begins with a focus on patients and leads on to engaging – and then empowering – them, giving people and their conditions a seat at pharma’s table. Such inclusion has long been part of the fabric for Beal: before joining Sanofi, she was Deputy Executive Director and the first Chief Engagement Officer for The Patient-Centered Outcomes Research Institute (PCORI) in the US.
Improving healthcare quality
She has found that physicians, naturally enough, are likely to feel that they are working hard to provide the best care to patients: “I am already patient-centric” is a common response. But Beal believes that looking at the healthcare quality movement over the past couple of decades – with its push towards developing quality measures within a framework, identifying needs, assessing performance, and determining the causes when there are problems – gives some clues as to where patient-centricity is heading. “I like the analogy: it’s been a 20-year process with healthcare quality and when we started, physicians insisted they were already delivering high quality care” she suggests. “Patient centricity is quite similar because people feel they are already doing it, but we can do more. We’ll need to define, operationalize, measure and improve performance. To some extent, it’s a question of mindset: when patients are engaged, when they are telling us they are having an exceptional experience, then we will know it is working. But it’s going to take a significant amount of time.”
Part of the problem is that patients are often seen as a mass rather than as individuals – perhaps even by patient organizations themselves – so overcoming that blanket approach would seem to be an important step. “That’s a great question,” Beal says. “Patients are saying: ‘I’m a person with a condition, not a patient’. It’s perhaps the case that when we think about healthcare and research, we have lost some of the nuances that patients bring. It’s a challenge but there are now significant conversations about addressing patients with many chronic conditions.” While Beal accepts there is a way to go – “we are taking baby steps” – she thinks that this means things are on the right track.
The place of ROI
However, a question which no-one seems comfortable asking is whether or not we can ever say, hand on heart, that being more patient-centric will have a positive effect on the bottom line - it seems as though there is something almost distasteful about linking better care to greater revenue. Beal is not so sure that this is the case, and frames the debate in a slightly different way. “When you are thinking purely in terms of ROI, it’s very reductionist,” she says. “For example, in pharma we have to think about quality and safety and you are never going to be able to make an ROI argument for that, but we all agree those are important areas for the industry. More important than the bottom line is to bring value to the organization. You bring value to patients by producing more responsive medicines, for payers by helping with patient needs and for physicians by improving patient outcomes.” The importance of this can be seen in the way that regulators such as the FDA and EMA are talking about ‘value’ more and more, she continues, insisting on requirements to include patient experience measures in drug development programmes to ensure that their needs are being met.
Learning from children
Early in her career, Beal worked with a mobile medical unit project for children living in homeless shelters in New York City and was also a health services researcher at Harvard Medical School within the Center for Child and Adolescent Health Policy at Massachusetts General Hospital. This work has influenced her approach to other patients. “With a child you are thinking about them in various ways: in school, in the community, as a member of the family,” she says. “Pediatrics is holistic in its approach.”
Perhaps it has also contributed to her optimism about the future of healthcare, even when the challenges seem overwhelming. Various things give her hope: “Meeting with patients, talking about their multiple chronic conditions, to hear them say: ‘Thanks for listening’. Above all, you realize there is this willingness to participate: it’s very energizing.” Patients, for their part, know that in Beal, they have someone who is firmly on their side.
Anne Beal, Chief Patient Officer will be presenting at the Patient Summit USA, October 19-20.
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