How to Improve Patient Engagement by Partnering with your Legal Team

Jutta Ulbrich & Kristin Buetecke, Abbvie share their experience of creating a legally-supported manual to facilitate patient engagement.



Jutta Ulbrich, Head of Patient Engagement, and Kristin Buetecke, Head of Legal, for AbbVie Germany, presented a case study at the recent Barcelona 2016 conference. The study detailed efforts that the German affiliate had embarked on to help translate the concept of patient centricity into reality. As they explained, “Employees often haven’t been as patient-centric as they’d like to be because they worry that by trying to help, they might end up inadvertently over-stepping the mark.”

The realization that employees were often deterred from engaging with patients out of fear that they might act inappropriately motivated the Patient Engagement Team to seek a solution. They decided to partner with the legal department to create a guidebook for patient interactions. The digital manual that has been produced provides a comprehensive framework of information that can be used daily by all staff, and offers guidelines for many of their interfaces with patients. The intention was not to create another policy but to develop a ‘one-stop’ digital manual where all policies, legal requirements, applicable codices, and rules were referenced, as well as putting procedures and various templates into one document.

As Ulbrich states, “Legal teams may occasionally be seen as a bottle-neck for pharma companies, but when you’re talking about the healthcare of people, the support from the legal department and compliance are of key importance, as are the Codes of Conduct.” By allowing the legal department to become an enabler, the manual has actually increased the number of patient-centric projects that the AbbVie German affiliate has been able to embark on. As Buetecke says, “Staff now know exactly where to look to have their questions answered and where to access company guidelines for most situations that face them, so are more willing and able to make decisions that will ultimately benefit the patient.”

Compiling the digital manual

The journey began with the patient engagement and legal teams requesting all staff to submit their customer interaction experiences. This collection of data was to ensure that the document being compiled would deal with real-life situations. “Anyone who has been interviewed by the media,” Ulbrich explains, “knows what it’s like to be caught unawares by a question. If you don’t have time to think something through and aren’t prepared, you might make a fool of yourself. It is exactly the same when facing a request from a patient that you are unsure how to handle.” With the accumulation of actual real-life examples, it was possible to ensure that the manual would be as relevant as possible, and would provide necessary tools for the various situations in which employees might require guidance.

Staff now know exactly where to look to have their questions answered and where to access company guidelines for most situations that face them, so are more willing and able to make decisions that will ultimately benefit the patient.

Eight guiding principles employed in the creation of the manual

The starting point was to begin with local laws and policies, as well as the AbbVie Code of Conduct. Buetecke explains that, although patient compliance is ingrained in most staff, different departments were mostly familiar only with their own Standard Operating Procedures. It transpires that any refresher is valuable. “Even people who’ve been in the industry for a long time said they’d re-read the codes, and benefitted,” she says.

Included in the manual were guidelines for topics such as whether giving or receiving any gifts would be considered appropriate, if meals or any entertainment could be provided for patients, what information could be conveyed by a sales rep when being approached by a patient in an HCP’s office, and which locations for events would be suitable - all of those anchored to everyday business situations where these questions might occur. It also provided convenient links to any other important information, such as the German Pharma Association Code of Conduct.

Another consideration was to produce a framework to enable projects to be started appropriately. For example, guidelines were documented outlining how best to approach patients, as well as the importance of engaging doctors and patient organizations in first interactions with patients. Ulbrich stresses that the primary relationship remains between doctor and patient so, even though patient centricity is of great importance, another principle was to emphasize the importance of assisting but not interfering with that relationship.

This transparency allows patients to make informed decisions about whether they want to be part of a project or not.

Something that became clear during the discovery stage, when information was being gathered, was the importance of clarifying various issues to ensure mutual understanding. “What we found interesting in Germany was that we were almost divided by a common language,” says Buetecke. “There was a misconception of what various terms meant, so we clarified what was meant by, for example, an allowance, or an honorarium, as well as what constitutes collaboration or a sponsorship. Now, when we need a contractual agreement for a sponsorship, we have a common language.” With respect to sponsorships and events, templates were also provided for accurate reporting. “For some people, this was such a big deal, that they almost avoided becoming involved in sponsoring events. We’ve shown them exactly how to report these in the manual, and now it’s quick and painless.”

Patient confidentiality was another issue that received much consideration. The manual gives commercial teams clear guidelines as to how patient statements can be used, and the permissions required. Ulbrich explains that data privacy is particularly stringent in Germany, so it was important to clearly delineate the steps that need to be taken to ensure that patients are fully informed before they sign up for a program. “This transparency allows patients to make informed decisions about whether they want to be part of a project or not.”

Putting all the information together

Although there were already Standard Operating Procedures in place, it took the Patient Engagement team and the legal department about seven months to assemble the company specific information. Thereafter, in order to keep the manual user-friendly, there were many edits to get it to a workable size. It was important to present it in such a way that people could easily access and read those sections that were of high interest or relevance to them. The manual comprises six chapters, which encompass patient enquiries, patient events, patient surveys, collaboration with patient organizations, AbbVie patient support, and other studies.

Intensive training then took place, often using videos, which were produced to work in tandem with the manual. All employees, including receptionists and support staff, are involved in the training as every staff member might have contact with customers. Also, training on the digital manual now forms part of the induction process.

To date, the usage figures have been extremely encouraging. “People really seem to have accepted this as a tool for their daily use,” says Ulbrich.  She feels that this success can be attributed to the intention behind the manual, which was to be helpful in providing answers to everyday questions and situations. Given the enthusiastic response to the document since its launch, she believes it would be useful to any pharma company wishing to improve its patient centricity by providing an enabling manual that provides clear guidelines for all customer interactions.

There have already been many requests from other companies in Europe for assistance in putting together a similar document, and Buetecke says the team is happy to share the basic framework. However, she cautions that content needs to be company specific, with examples taken from a company’s daily practice in order for a manual to be relevant to the business. Ultimately, she believes that the manual AbbVie has produced provides an easily accessible framework that documents a wide-range of daily challenges to all staff and the steps that should be taken in each situation. Having convenient access to this knowledge assists employees in their patient centricity by allowing them to act confidently and within the boundaries of compliance.


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