Changing The DNA
A patient-first strategy is important but without the culture to back it up, companies will struggle to truly embrace patient-centricity.
Culture eats strategy for breakfast; this 21st century truism has never been more relevant than when applied to the challenges facing pharmaceutical companies as they seek to spread and embed a renewed focus on the patient throughout their organizations.
As many have discovered along the journey towards patient-centricity, engineering a new culture that encourages every employee to think ‘patient first’ is easier said than done.
For Gabriela Mondino, Head of US Multiple Sclerosis Public Affairs at Sanofi Genzyme, the secret ingredient is translating patient focus into concrete goals for every area of the organization. While Sanofi Genzyme has been very focused on patients since its inception, prior to her current role, Mondino led the charge toward patient centricity in a different part of the company.
“We did a lot of work to better understand the value of a patient-centric approach,” she says. “While we can agree that putting patients first matters, when change is supported by a strong rationale applied to everything we do, it will stick for the long-term.”
A key element of success was clear overall company direction and support from senior leadership, she says, pointing out that Sanofi was one of the first pharma companies to hire a chief patient officer and that role has continued to evolve to focus on patient solutions.
“Senior leadership supported the change but we also needed a champion at a local level – that was our General Manager. Then, we had to make sure that we had the right roles in place to support patient engagement, as well as a budget dedicated to advancing patient centricity. This was the structure we needed to make it a reality.”
Engineering the everyday
With the structure in place, a next challenge was winning buy-in from the entire organization, says Mondino. “It takes a lot of different approaches – not only securing endorsement from leadership but engaging the teams to start shifting their way of thinking and, more importantly, translating that change into tactics and results. We can all agree that it makes sense to engage patients but changing our day-to-day behaviors to support patient-centricity is another thing entirely.”
This was necessary not just to ensure that the patient focus was long term but to guarantee successful execution of patient-centric initiatives. “We were in uncharted territory so that meant starting from proof-of-concept and going all the way to global launch of patient engagement initiatives. It also meant building capabilities in the teams,” she says.
A combination of top-down and bottom-up approaches seemed to work best. “You need the top to give direction and resources, and the bottom to be convinced it’s the right thing to do and to develop the necessary skills, because it is only through bottom-up momentum that you ensure execution and continuity.”
For Christine MacCracken, Director of Patient Support at Janssen, the change towards patient-centricity is no different than any other culture shift. “For me it boils down to what a lot of other things boil down to – relationships and communication. When we talk about patient-centricity, there’s no one that doesn’t think that’s a good idea, but, the reality is that it’s very easy to have your lens clouded and get mired down in the day-to-day tasks you have to accomplish,” she says.
Putting the patients at the center of a business inevitably changes the relationships with other stakeholders, says Mondino, who points to the need for new definitions of value. “What is the value to physicians, now that pharma companies put more emphasis on engaging patients? Why should physicians come along with a more patient-centric approach as well? What is in it for them?” A shift to patient-centricity means a redrawing of the relationship between the pharma company and physicians, previously the number one focus for all activities.
Yet, value is a markedly different proposition within each organization, says McCracken. “How it’s perceived and defined is a different journey for every company. Janssen’s credo challenges every employee to put the needs of the people we serve first. For us, our first responsibility is always to patients, families, doctors, nurses, and anyone who touches us or who we touch. As a company, the culture has always been that we focus on anyone we have the privilege of working with first, they are our primary focus. We try not to value one more than another. As such, we have to listen to the voice of the patient, the family, the doctor, any stakeholder, because what we think is important may not necessarily be important to them.”
Time is a key factor to be planned for, she adds. “For us, we look at successful culture change – and I say this jokingly – like weight loss; you can’t do it quickly. You have to do it methodically and you have to do it slowly; it takes time to manage relationships and processes, for sustainable change where the patient becomes the primary focus of what everyone does, regardless of the role. And I mean everyone; even if you don’t have a role that directly touches patients, if you work in manufacturing or finance, you still impact the lives of patients. That’s what we try to convey to everyone in our organization.”
McCracken cites the example of Janssen’s collaboration with the New York University School of Medicine that evaluates and delivers compassionate-use and pre-approval access to medicines. “We have always had a culture that assessed pre-approval access but the NYU collaboration has bolstered certain aspects. This may create additional steps for employees, so helping teams assess that change and supporting them through it is essential. Asking people to make a change, even for an excellent cause, it is human nature to be averse to change.”
What’s the return?
In business, one question is inevitable – what’s the ROI? So, have Janssen and Sanofi developed precise definitions of the value that patient-centricity delivers?
“We have to find ways to quantify what that means,” says Mondino. “We have to be very concrete in the way we are talking – for example, if we put together a program to help patients adhere to treatment, we should first and foremost look what that means in terms of improving outcomes for people living with MS, in addition to physicians and payers.”
While McCracken says it’s still too early to concretely measure the impact of the new patient-centric approach on her business, she also doesn’t believe it will be as simple as black-and-white numbers on a screen. “Measurement has to be tailored to each initiative; for example, the culture change around pre-approval access is ongoing and we are carrying out very frequent assessments,” she says.
To muddy the waters further, McCracken believes that in order for companies to become truly patient-centric, they may need to work together to deliver the best solutions. “As part of our collaboration with NYU we have always said openly that we will share our learnings with other companies, and we have also benefitted from the work of other companies.”
She points to Bristol-Myers Squibb’s Universal Patient Language initiative. “We have spoken to them and looked at how we might incorporate this into our programs. We are seeing less resistance now; five or 10 years ago, you wouldn’t have seen the level of collaboration across companies that you see now.”
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