Dec 122014

How do you effectively manage creativity to result in a more innovative organization? Particularly in a science-driven sector where silos exist between functions at both client and agency sides and the cultures of creative, strategic, scientific, medical and marketing span a continuum that is often hard to interconnect. Achieving a balanced approach to the fundamental tension between harnessing and unleashing these distinctive talents is not easy. This piece in the HBR characterises the important paradoxes well.


Organizational innovation requires both organizational willingness and ability. Clearly, any group that wishes to innovate must be able to collaborate, experiment, and integrate possible solutions. That is, it must possess the skill to undertake those activities productively. But, given all the barriers to innovation, leaders and their people must also be willing to do the hard work of innovation. Successful organizations develop a deep sense of community that helps individuals endure the tensions and stress, and that prevents the organization from flying apart due to all the opposing forces at play.

Dec 022014

The decision by The BMJ to further try to enforce its separation from industry is somewhat at odds with the essentially wholly private sector leadership of pharmaceutical R&D.  The lay perception of the #BMJ might be of a respected medical journal, but in fact it’s a USD120m+ revenue international publishing enterprise with 50+ journals. While potential conflicts of interest are important to consider, assess and account for, to assume that industry connectedness is entirely or even somewhat negative is shortsighted and destructive given the increased complexity of R&D. And The BMJ is part of that same health care industry, happily profiting off its back. To put in place yet more barriers to prevent leading investigators articulating the clinical meaningfulness of their trials is surely counter productive. As they address diseases ever more specifically and in ever smaller more segmented patient cohorts, it seems folly to try to stymie the debate that should ensue from these trials’ findings. The BMJ seems to have overlooked the fact of the multi million dollar business that it has become, that open access is increasingly democratising science, that peer review should be about what you’ve done not who you are, and that Impact Factors aren’t perhaps what they once were.

Nov 242014

Straightforward pharma-bashing on one level but given that this is a UK column written through an ostensibly religious lens by Canon Fraser, it’s hardly being charitable in not mentioning pharma’s increased commitment to, eg rare diseases and CSR over the last few years. And, jarring with the principles of Fraser’s position (freedom of choice being a core tenet of Christianity) – it seems to overlook any notion of personal responsibility… for example he doesn’t consider that if people tried a bit harder to manage their diets and didn’t impose such high obesity-related costs, there would be more public resources freed-up, to be deployed in targeting those areas on which pharma quite legitimately can’t focus heavily. The author probably has a pension, it’s highly likely some of that balanced portfolio is invested in health care. Yes, it’s an opinion piece, and yes it’s in a left-leaning vehicle but even in this context it’s still a bit of a shame that shortsighted, unbalanced dogma persists about an industry and sector that has worked through a difficult few years.

Aug 302014

If it’s true that many people fear public speaking more than death, it’s equally true that businesspeople are condemned to a thousand small deaths in client pitches, in boardrooms, and on stage. And that death can turn slow and torturous when you are asked to speak unexpectedly with little or no time to prepare. One of the key demands of business is the ability to speak extemporaneously. Whether giving an unexpected “elevator pitch” to a potential investor or being asked at the last minute to offer remarks to a sales team over dinner, the demands for a business person to speak with limited preparation are diverse, endless, and — to many — terrifying.

Too many in agency land go for quantity, as if by anaesthetizing the audience, those tricky questions aren’t going to come at you. The point is not (usually, anyway) that quality is lacking but it seems there’s a belief that the more knowledge you can demonstrate you have – and by laying out that sheer mass of evidence of days and weeks spent crafting your approach – somehow this is going to be the differentiating factor. Quite apart from wasting the real dialogic engagement opportunity of having your client in the same room for two hours, there has to be a better way than struggling to get your less comfortable presenters into a space whereby their values and insights rather than their presenting shortcomings are brought into focus. And anyway, who wants to sit through, let alone present a 2-hour monologue?

Five Steps to a Positive Pitch Presentation

Five Steps to a Positive Pitch Presentation

Jul 032014

Going by almost daily anecdotal evidence the UK’s NHS is not a system in whose care you’d look forward to putting your life. On the other hand its sacrosanct nature is part of the national psyche. The recent publication by the US Commonwealth Fund, which attracted significant coverage in the UK acted as a lightning rod for the ‘it’s not broke so don’t touch it’ brigade. And while interpretation of its findings leaves something to be desired by the mainstream press, let alone the public it should be noted that the analysis was undertaken through the lens of the US health care system. So pretty much anything else is going to look relatively good. Nevertheless the NHS tops out on multiple measures and commenters have leapt on these findings as valid reasons to leave the NHS well alone, heaping vitriol on anyone who talks of reform, and more particularly on any suggestion of private involvement.


Don’t touch what’s not broken is the mantra. Except that the real issue is that the NHS is very broken but just manages to deliver in spite of its hamstringing. So why does any attempt to reshape the NHS inspire this response? Without comprehensive reform the NHS will die. What the public doesn’t understand is that the destruction of the NHS is not going to be due to effective use of public private partnerships. For the last two decades billions have been wasted by meddling, tweaking, restructuring, devolving and recentralising and etc. It’s a mess, and as the report notes, the UK lags on health outcomes. When you look at the world’s best health care systems (and I mean best in terms of health outcomes – not ‘best’ in the sense of the usual sentimental, untouchable infallibility notion of ‘best’ that is ascribed to the NHS) they are mostly partly privatised – or at least more integrated with private partners than is the NHS – and partly co-paid.

Take Singapore or Australia as examples – spend on health is similar or lower than the UK and outcomes are better. There are more pragmatic aspects to health care provision that this report doesn’t really touch on. In the UK a GP appointment can be nigh on impossible to get, which drives urgent cases to the emergency room – which wastes resources. At least in markets with a moderate co-pay you can see a primary care practitioner when you want, and importantly out of office hours. Again, reducing indirect economic costs. Specialist referrals tend to be much faster too and because private care is more widespread, it is more accessible and more affordable.

Societally, privatisation has tended to be stigmatised in the UK because of a focus on the bad (British Rail) over the good (British Airways) and the suspicion that national assets have been sold off at below value to enrich the few. However, if regulated, privatisation means managers perform roles at which they are expert. The NHS has for years had highly paid and totally disconnected managers interfering with clinicians’ ability to carry out their work. A lot of the criticism has been about managers interfering with clinicians, yet one of the biggest recent changes – the creation of 211 Clinical Commissioning Groups (CCGs), has placed about 60% of the NHS budget in the hands of local doctors and health workers. Some CCGs have figured out ways to realign the incentives of hospitals, which are often paid per procedure, with those of GPs, who aim to keep people healthy and at home.

For me the single most telling point in this report is the placing of the UK in 10th out of eleven on the ‘healthy lives’ measure.  A healthy life of course is very much a personal choice and way beyond the remit of the NHS. However it is evident that much of this self-inflicted unhealthiness is what is burdening the health care system in the first place. People need to start to take a degree of responsibility for their own long-term health as a starting point for unburdening the system.

Even the USA has lately taken a more proactive and collaborative approach to fixing its horrendously inefficient and outrageously unaffordable healthcare system. So yes, as commenters say, the NHS has some of the best clinicians in the world. But if it continues to be run as it is it will fall over. The problem of the NHS won’t be solved with a ‘don’t touch’ approach, by ring-fencing it and pouring unlimited amounts of money into it. It needs to be disassembled and rebuilt fit for the present day.

Feb 052014

After reviewing the space, agency imperatives and some of the challenges over the last weeks, let’s take a look at some of the growth drivers… some of which might seem a bit counterintuitive

  • Inevitable increasing focus on value and rationalised access to newer more expensive therapies vs restrictions to listing on grounds of cost
  • Emerging models of universal healthcare systems, which will both constrain expenditure and call for rational prescribing of innovative tx, but grow overall volume potential
  • Increasingly complex and evidence-based messaging will be required by healthcare providers to its publics, payors and prescribers
  • Connections and value of exchange between opinion leaders are not well understood (despite intensive use of social media); this offers scope for more rationally targeted communications
  • Increasing westernisation of lifestyle-driven disease, increasing class of consumers able to pay out of pocket for unreimbursed products (private market), increasing access to healthcare through progressive move to universal access will drive growth
Jan 292014

Last week I looked at the agency as a species in the context of Asia. Today I topline some of the emerging challenges, which though nuanced are in line with the increasingly complex demands of the sector globally.

  • How is or will value be created through deployment of new healthcare technology/therapeutics?
  • How will healthcare systems need to restructure/adapt to facilitate deployment of new technology/agents in a way that enables their value-extraction?
  • How will different demographics be satisfied? Populations differ constitutionally within markets, and they differ across markets, but they increasingly share the convergent aspirations of an increasingly homogenous ‘middle class’?
  • How to translate increasingly available – but not necessarily easy-to-use, and often fragmented – data into meaningful quantifiable value messages?
  • How to respond to the fact that payers, providers and patients will determine the value of healthcare – physicians will no longer be the sole – or even decisive – arbiters of what’s best?
  • How to communicate the genetic aspects of targeted drugs, personalised medicine, small and dispersed patient cohorts?
  • How to marry the changing status of the frontline practitioner with the growing concept of wellness, increasing consumer choice/activism, and active engagement in treatment selection vs the traditionally unengaged patient?
  • How to respond to the gradual shift of specialist treatment and primary care into integrated practice units, while providing a seamless continuum of care?
  • How to measure healthcare outcomes in the context of the real world setting? As the dominant lever for extracting value, the complexity of science+economics+multiple publics’ opinions will make messaging increasingly complex.
Jan 222014

I wrote last week about the changing demands on communicators in healthcare. How does this frame up from the perspective of the Asian region?

  • Some of the critical challenges in AsiaPac are the same as anywhere else; an increasing need to determine insights into an ever more specialised and fragmented environment for pharma and healthcare providers
  • To find these insights means understanding increasingly complex networks – compared to the social network mapping of physician insights and physician-patient connectedness happening elsewhere it’s still a bit desk-based and ultimately hierarchical/deferential in Asia
  • In my experience in AsiaPac though there is a determination to achieve the notional ‘integrated’ agency, this is a rare beast. An agency that can communicate cross-disciplinarity in the key areas described above (ie not dominated by a visual creative/overwhelmingly advertising heritage) has a potential space to occupy
  • Agencies, regardless of their networks tend to focus on their heritage business and do not maximise use of either their local cross-discipline networks, nor globally leverage their peer set within discipline
  • Networked agencies have recognised opportunities in the space for more market-shaping science-oriented comms, but they have not historically effectively activated their acquisitions – ‘integrated network’ descriptions tend to be capabilities presentation rhetoric
  • Within pure play medical communications the independents are relatively strong in their niche –leveraging their global intellectual therapy area value to maintain reasonably consistent business in Asia – they are the right size to be firewall-free
  • Boutique independents in med comms survive on project-based business – hard to sustain
  • In advertising, the networks have the lions share of the business, reflecting their heritage
  • Digital is a space competed for ever more vigorously by independents, ad agencies and generalist networked digital agencies
  • The recognition of the value in data insights and examples relating to health is starting to come to the fore, as per the example here in Singapore
  • For an agency to position itself successfully in Asia it needs to disrupt both the networked and specialty agency categories – in a sense create turbulence, the ripples of which speak to the new entrant’s energy more than its size
  • How capability to deliver is established is critical – it tends to mean a core of implementers on the ground combined with transferable global strategic insight. Developing a network of partners as the business grows is important
  • Must be able to demonstrate genuine and tangible integration of its components – larger independents are probably in the sweet spot. Sitting within the the walls of an acquisitive network is increasingly showing stymied growth
Independent firms, meanwhile, continue to outperform the holding companies in terms of growth, with Edelman only the most prominent example. Overall, independent firms submitting information to the Holmes Report 250 experienced growth of better than 12%, compared to average growth of around 4% for the public relations operations of the major holding companies. – See more at: spend is often – and perhaps increasingly – determined by globally-led strategy; without effective joined-up global-Asia engagement, opportunities will be smallerAgency-side cross-discipline talent in healthcare is not widesprea

“Independent firms, meanwhile, continue to outperform the holding companies in terms of growth, with Edelman only the most prominent example. Overall, independent firms submitting information to the Holmes Report 250 experienced growth of better than 12%, compared to average growth of around 4% for the public relations operations of the major holding companies.”

  • Pharma spend is often – and perhaps increasingly – determined by globally-led strategy; without effective joined-up global-Asia engagement, opportunities will be smaller, perhaps unsustainable
  • Agency-side cross-discipline talent in healthcare is not widespread
Jan 152014

To me the future challenge in healthcare is increasingly about value; about communicating the product’s place not just vs its peer set, but about understanding the patient pathway in the context of continual challenges to this pathway given evolving care and payer systems (market access). How we communicate product evidence is one thing (science-focussed medical communications); how we identify and use (and generate) additional evidence to be able to make it more persuasive moves us into the territory of social media, data and analytics… this is where we need to be finding the story and exploiting the earned and shared space in which to tell it (digitally). Creative and the owned space will diminish relative to the above – at least this is what I see happening. The old med comms rhetoric of creative+science = effective product story is all a bit generic as a standalone.

…which way?


Mar 242013

Just came across this piece from a few months ago. Still, a perennial question remains about how to extract value from networks. Beyond the veil of security offered to clients from the array of dots on a map, which is nothing more than a virtue of scale, what really is there in terms of value-add? Given the realities of network members, namely…

  • the unique market parameters within which any given business unit works
  • the market-centric nature of the P&L
  • no apportioned P&L reflection of cross-market collaboration
  • few tangible rewards for individuals driving value growth beyond their profit centre,

what us there in reality to motivate networks – and their key business drivers – to leverage their collective potential. Surely agency roles should exist to disrupt this shortsightedness and focus on extracting bottom-line benefits accruing from collaborative drivers. Quite aside from the bottom line benefits, which should be motivating enough to mandate this approach, without adding some tangible nature to the nebulous concept of ‘the agency network’, in reality what evidence is there to help the client visualise the value?