Elephants or finches? The need for healthcare communications to develop for the future

Chris Stevenson of Protinus Solutions explores the evolving needs of pharma clients and how the world of healthcare communications needs to keep adapting to meet clients’ future needs.

As someone who spends a lot of time with both healthcare communications organisations and pharmaceutical company personnel I have observed over recent times a remarkable lack of change in traditional healthcare communications companies despite significant change within their clients. In addition, from my vantage point I am privileged to see new types of organisations entering the domain of healthcare communications. The potential for significant change to the market is clearly present.

This article will suggest why change in healthcare communications organisations is slow and offers advice to those leaders in healthcare communications who want to remain relevant to their clients’ needs in the future.

Work for hire

The traditional healthcare communications industry, and much of it remains like this today, is based upon individual projects. The Americans call it a “work for hire” model and this describes the approach of many businesses in the field. Basically, when the client asks them to do work, they do it, once the purchase order is agreed. When the client doesn’t provide a project and a purchase order, it is rare to see a healthcare communications organisation continuing to work in the field with opinion leaders, or even with background investigations into the market their client is in. I know it’s understandable; if the client isn’t paying, why do the work?

However, this leads to a project-based mentality, however many projects the organisation completes in a year. I rarely find an organisation that looks beyond, or especially between, the projects they do. Some may look for internal efficiencies, but few look for ways to make projects more valuable in a broader sense. This contrasts markedly with many other suppliers to the pharmaceutical industry, some of which are beginning to encroach on the traditional healthcare communications market. Take CRO’s as an example. They have built an industry on integration of services through IT. Their focus has been on offering services that maximise their ability to manipulate their client’s data from study design through data collection to regulatory submission and beyond. They may not have been wholly successful in the past at grabbing a slice of the healthcare communications market. However, as data becomes more integrated, as it no doubt will, this may well change.

The “Work for Hire” model constrains thinking in healthcare communications. It stops people thinking about how they can leverage the core of what they do. Publication planning is a good example. Of course, publication planning is in itself an attempt to elongate a piece of work beyond a single publication, and it is often successful in that. However, it has never really been focused on the understanding and use of data. Surely that is the core. This is why CRO’s have the largest share of the regulatory writing market with healthcare communications organisations having an almost negligible share of this market segment. I appreciate that healthcare communications companies have a larger share of the promotional / published medical writing market, though there is no reason why this should remain the case. Indeed, high cost is a significant reason why clients will look for lower cost options; through the use of other outsource options and the use of technology to create savings.

“…high cost is a significant reason why clients will look for lower cost options…”

Sleepwalking in to a changing market

Another general observation is that healthcare communications organisations, unlike CRO’s and organisations that are entering the market for data understanding, use and manipulation, like the IT consultancy businesses, spend little time asking their clients about the future. Many ask about the quality of the work they deliver today, what work they might get tomorrow, and tend to go no further than that. Very few consult with their clients in a structured way, or with external experts, on how the future will look and what their future client needs will be. This propagates a “Business as usual” culture, a sense that because no one is telling you otherwise, things must remain the same. As a famous detective once said about the premature and wrongful conviction of an innocent man, “You got your man and you simply stopped looking”. Healthcare communication organisations need to avoid the first conclusion and to keep looking and asking questions. This is a new way of thinking about the future.

Elephants or finches?

What should healthcare communications organisations do to make themselves “Future Proof”, or, as I might say, able to exploit the putative changes in the market? Are these changes like the elephant in the room, so big that no one wants to talk about them? Or are they more like Darwin’s finches, where subtle change can make a big difference? The answer is a little of both. Some big changes will be needed in how businesses are managed both in terms of outlook and finance. Long-term views on investment, perhaps especially in bespoke IT systems, not something healthcare communications organisations have had to think much about in the past, will be necessary, and this will require longer-term thinking about markets and the direction they take. More subtle will be the way the healthcare communications business orients itself towards its clients and the impact this has on organisation structure and culture.

Driving or being driven?

The drivers of change at the pharmaceutical client are clear. Simply, IT development which enables new approaches to data management allows things to happen and supports improvements in internal efficiency (things to cost less and be done at a competitive speed) and the need for external speed (beat your competitor through the regulatory hurdles). These are the fundamentals and other allied topics such as the reduction in sales force, the growing importance of medical affairs and the relative reduction in importance of marketing spend are happening alongside and are in line with the major objectives.

“The drivers of change at the pharmaceutical client are clear.”

Key areas for future change

I have highlighted three distinct, though related, areas below. They are not all encompassing, though they are fundamental in changing the way healthcare communications organisations look at their business and how they plan and change the future of their business. I believe they form a challenge to leadership to develop strategies to address these issues and to prepare their organisation for the future.

1) Integration with data

Developments in IT, and market developments such as electronic regulatory submission mean that a clients’ clinical data has a fully electronic path from data collection to regulatory submission and beyond. CRO’s and IT consulting businesses have already made significant moves to become invaluable partners in the creation and management of the data and offer IT solutions that manage data through the various stages of the process through to registration in a seamless way, consuming different service offerings along the way. They have placed themselves in the path of the data, in the clients’ data workflow. This is a model worthy of understanding, respect, and perhaps envy. I’m not suggesting these businesses are perfect, but their position is strong and barriers to entry and exit are becoming increasingly large.

Healthcare communications businesses are almost always out of the flow of the data. They ask for the clinical trial reports and are often out of the communication about what else is happening with the data. They are not in the flow of the data and this is a weakness and a danger to the future of the business. Barriers to entry and exit are relatively low. Even those that profess to have long-term relationships with data through a publication planning model are in danger of being literally sidelined. I’m reminded of that wonderful American word disintermediation. And it will not be sufficient to rely on the quality of writing that the organisation offers. This is often perceived as a commodity and clients are pressing on price accordingly. And, of course, the IT consulting businesses are already employing writers to support the regulatory submission process. Therefore, in the future, writing will no longer be a means of differentiation, merely something you must have to stay in the game.

Healthcare communications organisations need to force themselves into the electronic data workflow. This can be done by developing (that’s not what Work for Hire companies do!) IT systems that place them inside the client’s data workflow, by acquiring or merging with organisations like CRO’s that already have the systems and contacts and by understanding the whole process of data creation and management. Don’t be medical writing companies, be data management and communications companies. I’m sure some people will highlight that some CRO’s have developed medical communication arms with mixed success. Agreed. However, the trend towards integration of data and the need to place your business in the data workflow mean that these businesses are well placed for the future. Don’t assume that because someone had one false start that they will not eventually win the race.

2) Define what you do clearly, so you can make the right decisions

I have often asked leaders of healthcare communication companies what they do. I often hear about the patient being at the centre of what they do, value (whatever that is), writing being their differentiator (every writing company says this!), and customer focus being their priority. Rarely will anyone mention the understanding of data and the leverage of data, the promotion of data, the efficient management and use of data. Rarer still is the organisation that states that it actually makes a difference. Healthcare communications organisations need to challenge themselves and clearly define what they do. Those of you who have read previous articles from me may perhaps have heard me criticise the use of the term “Medical Education”. Unless it is impartial (like good CME is) it is not education it is promotion. This sort of sloppy thinking needs to be removed. Why? Because it gets in the way of clear strategic thinking, and if healthcare communications companies are going to make the right investment decisions, find the right partners and buy the right companies they need to be doing so with clarity. Leadership has a responsibility to be clear about the business it is in, so that it can make the right decisions about the future.

This may require a more structured dialogue with clients, a detailed review of what the market is really like and how it is evolving, and will require investment and decision making. In addition, it almost certainly requires a different way of managing the business. Long-term investments, potential acquisitions, and strategic mergers are topics rarely considered in healthcare communication organisation board rooms. The leadership of organisations need to ensure they have the right people in the boardroom to lead and decide on this new range of issues.

“Define what you do clearly, so you can make the right decisions”

3) Deliver tangible and definable results

I remain rather surprised at the lack of development in this area in the healthcare communications field. I’m surprised clients don’t ask for more, and I’m surprised (with some very rare exceptions) that healthcare communications organisations don’t provide outcomes data, outcomes guarantees, and other data to show that what they do works. The old adage, often quoted that “Half of what we do works, we just don’t know which half” is, truly, an old adage. Modern thinking is to define what works, understand why, and repeat it.

The provision of outcomes and remuneration related to outcomes and performance criteria is steadily growing in many medical fields. For example, many leading doctors have performance related pay and it is common in the running of clinical trials. The growing importance of real-world data is an example that pharmaceutical companies are starting to be remunerated based upon the actual outcomes in the real world not the promise of outcomes from clinical trials. Surely this concept will reach healthcare communications soon. To be clear, this doesn’t mean that everything a healthcare communications organisation does HAS to work or even has to be measured. That bar, in my opinion, is too high. However, there needs to be confidence that, in general, activities will have an impact, and that this should be measured from time to time. Perhaps a client of the near future might insist on 20% of activity being measured.

The “Work for Hire” approach to healthcare communications is a barrier to offering outcomes and to measuring the impact of what is done. As someone recently said to me “They (the client) asked us to do (the project), if they want to measure its success that’s up to them”. The healthcare communications organisations need to prove that what they do has value. Whether one measures change in behaviour over time, or take up of information or understanding of a concept, or merely awareness will depend on the circumstances. However, it should be a fundamental part of what a healthcare communications organisation does, and that requires a different approach to the business.

The issue of cost, that is who pays for the measurement, needs to be dealt with and resolved. Are outcomes an additional line item in a quotation or are they a fundamental part of a project that is not negotiable? Who owns the outcomes data may decide who pays for it too. I realise this is a challenging issue. Nevertheless, it needs to be addressed.

The future is different, and is arriving fast

We have seen enough over recent years to realise that the future of healthcare communications is not an extrapolation of the trends from the past. Those that extrapolate will eventually be marginalised and left behind by developments in technology and a growing sophistication in the type of services offered. The rewards for those that develop for the future are a closer integration with the client’s data, a growth in the perceived value of what they do, increased barriers to entry and exit and the continued longevity and success of their business. The pace of change will not be defined by the leadership of healthcare communications organisations as it has been over recent years, it will be defined by the client as other players such as IT businesses begin to encroach on the market and offer new and attractively priced, integrated, services. Those that recognise the business they are in, and have confidence that what they do can change thinking and behaviour, will succeed.

About the author:

Chris Stevenson is an expert in medical communications, with over 20 years’ experience in helping pharmaceutical companies develop and deliver high impact programmes and in helping medical communications organisations develop change strategies that provide sustainable growth and improving margins in an increasingly competitive environment. Chris can be contacted at chris.stevenson@protinussolutions.biz

Closing thought: What should healthcare communications organisations do to make themselves “Future Proof”?