Previously

Susan is the new Global Head of Medical Affairs of a small US based company which is expanding to Europe. There is currently no European footprint, and the first launch is planned in 12 months.

Susan’s task? Design and build European Medical Affairs set-up to support product launch. When we last saw Susan, she presented her approach to her boss Mark and asked for resources to support the project. Mark agreed she needed support and tells her the good news: he has found her a Medical Affairs Lead for Europe and a programme lead neither of which is qualified. When Susan voices concerns Mark tells her she will make it work, because she is very good.

The Conversation the Boss Should Know About but Doesn’t

“Do you have time for a coffee?” Susan texts her friend a senior leader at her company.

They meet in the cafeteria. When he arrives, Susan is already there looking out of the window at the palm trees and the pretty garden. The company has a lovely cafeteria with natural light, and Susan, who has worked in many places where coffee was just a machine with no light, is briefly grateful.

Mourad seats himself at her table, notes her tension and says, “I’m guessing this is not a social coffee?”

Susan smiles and says, “Well it is, and you are right, it also isn’t. I always want to see you, but today I also need your guidance, I want to think something through” he nods.

Susan continues “So you know I got promoted recently to build and design Med Affairs in Europe, and you know we launch in 12 months?”

Mourad says “Yes, of course I do, we celebrated, remember? I also remember telling you to think very carefully before taking the job, as it will be tough, there is so much riding on it for the company”

Susan sighs “Yes, you did. And I hate it when you are right. I took everything you said on board, you know? I discussed what I’d need in order to succeed upfront with Mark, I was friendly, professional and explicit, especially around agency, as I’ve had several jobs where I ended up trying to rescue projects but I wasn’t given the authority to perform well”

Mourad smiles wryly, he has after all known her for a very long time “Yes, I know”

Susan continues “And the great thing is Mark agreed, he said he would give me his full support and the freedom to design and structure the approach, he said he knows it will be hard, but that he would have my back”

“Let me guess” Mourad said with a theatrical flourish “It has, astonishingly turned out to not be quite what you signed up for?”

“Well, no” Susan said “He has supported me so far. He agreed with my suggestions and it all looked good until I asked him for resources, I told him in order to design, build and rollout Europe I will need someone who understands Medical Affairs, the European market, someone who can connect with the local teams, and I had someone in mind Giovanna, she has recently been let go from a big pharma company, is based in Italy and is super experienced. I also asked him for an experienced project manager”

Mourad nodded.

Susan continued “For the project position I suggested Vilma, you know her, Finnish, understands Europe, has broad expertise, has managed international programmes in big companies – so she can pivot across topics and get stuff done”

Mourad says “Ah yes Vilma, she is great. But as we are here, I am guessing things didn’t go according to plan? What happened?”

Susan says, twiddling the sugar packet in her fingers, “Well, we have a different view on what will work. I presented my approach to Mark last week. He was just back from his first trip to Europe. It was his first trip. He was super excited. He told me all about the pasta in Italy, the croissants in Paris, and that Switzerland speaks four languages. So I thought, great, he’s seen the diversity up close, he’s a fan, he’ll understand that I need local experts”

Mourad smiled and waited. He had the feeling he knew where this was going.

She continued “So Mark listened to everything I had to say, and then told me his good news – he already has two people to fill my open positions for a Medical Affairs Lead for Europe and a Programme lead” she paused for effect, and do you know who those two people are? A junior IT project lead based out of the Mumbai office and Alex”

Mourad said “Alex from regulatory affairs?”

“Yes” Susan said “Alex from regulatory affairs”

“Oh” said Mourad and was silent for a moment. “Does he have Medical Affairs experience?”

Susan shook her head. Mourad said “So how do you feel?”

Susan twiddled with the packets some more spilling sugar all over the table without noticing “Well, I’m having problems sleeping, I don’t know how I can run this project with a junior IT project manager, however, enthusiastic, and well, Alex – but I don’t feel Mark wants to hear that”

Mourad said “Yes, that’s going to be tough. Where are you launching first?”

“Germany” she said “We launch in Germany, they are typically one of the faster markets to achieve reimbursement, so I learned recently, faster than many of the others”

“So, that’s good then? Germany, Alex is German, that should help?” Mourad said hopefully.

“He is German, yes, but he’s been here in the US since his post-doc, and he has only ever worked in regulatory affairs, he’s a physician, but he likes things to be predictable and structured, the way they are in Regulatory Affairs, and I don’t see this project providing that”

“So, I’m worried” she added.

“I see” Mourad said “What did Mark say when you told him about your concerns?”

Susan said “I told him what I need, I told him why, I suggested people, I even had names and rough CVs. He said, great news: I have two people for you; we can get started immediately, time is of the essence, Susan”

Mourad said “And?”

“So, Mark was proud that he had my headcount issues sorted, although I still need a digital lead, and he seemed a bit peeved that I wasn’t happy with his suggestions. He told me that the junior lead was suggested by HR and that Alex is on secondment, and that he has no choice and when I asked him if I could speak frankly and told him that I am worried I cannot do it under these circumstances he said that he supported my promotion although I am quite young and that not everybody did and I am overcomplicating things”

“I see” said Mourad.

“He also said I shouldn’t let me down, and that he has every confidence in my abilities” Susan added.

“I see” said Mourad “How do you feel? You look tired”

“Stressed, and I can’t sleep as I said. I have a huge project, it has so many dependencies, so many moving parts, I have been allocated resources that won’t be able to support me and a boss, who I think is supportive but he doesn’t understand what the project needs and he is under pressure to place resources”

She reached across the table and broke off a piece of Mourad’s bagel and chewed thoughtfully.

“Are you going to talk to him again? It is really the only thing you can do” Mourad said.

“I don’t know” she admitted “I have thought about it, but when I tried to share my concerns, Mark said I should aim for speed over perfection and not overcomplicate stuff” she pushed grains of sugar across the table with her index finger as she spoke.  “And he did mention my promotion, and he said I shouldn’t let him down. I feel that if I say I can’t do it under these circumstances then he will regret having backed my promotion. After all, from his perspective he did provide me with resources, and he doesn’t want to consider that they are not fit for purpose”

“What did he say when you told them they are not fit for purpose?” he asked.

“He told me to train them, he said he knows I am good, and that I can bring them up to speed easily” she answered.

She looked at Mourad and added thoughtfully “But he did say that he has budget to support me, and his door is open, so maybe there is something I can do, I am just figuring out what it is”

Mourad pushed his bagel across the table “I got this for me, but you’ve eaten most of it, although I’m not sure you noticed, so I am giving the rest of it to you”

Susan looked at the mangled remnants of the bagel and said, “Have I just eaten your whole bagel?”

Mourad said “Yes, I thought you hadn’t noticed. Have you been eating? Sleeping? You don’t look great”

Susan said “Honestly? I have been drinking a lot of coffee, I can’t relax, the situation is keeping me up, and I don’t have much of an appetite, I keep going over and over the situation in my head”

Mourad said “So what are you going to do?”

“Well, I’ve asked myself, if there is any way I can do this myself. Maybe if I work faster, am more organised, work harder, liaise with experts in the company. Maybe get a consultant? I’ve managed impossible projects before, on impossible timelines, it is one reason I was promoted. I’ve also done clinical work, have a lot of Medical Affairs experience and I know I am really efficient. So, I thought maybe I can train Mark’s recruits up and get them up and running and manage to deliver this project”

She fell silent and pushed the bagel crumbs around the plate. Mourad noted how low on energy she seemed, and this was one of his most energetic and enthusiastic friends.

“And” he prompted “what conclusion did you reach?”

“I’ve realised I can’t do it. Nobody can. I am really good, I know my stuff, I work hard, I understand the issues, but nobody can design and implement a medical affairs operation in 12 months, without a team. We don’t have a global team set up yet, the plane is being built while we are flying, and so I have to depend on the goodwill of the US team to help me with certain aspects of the European build. I can’t identify, manage and follow everything and regardless of how good the IT project manager is I need him to be able to anticipate needs, to identify gaps and to support me with his knowledge and somebody needs substantial knowledge to do that and he doesn’t have it”

“I agree” said Mourad, “I thought it was going to be hard when you first said you had been promoted, but I didn’t want to discourage you once you had decided. So, what will you do?”

Susan sighed “I have two options I can talk to Mark again, and perhaps we can make this work or it will definitely fail, but I don’t know how to get through to him so that it’s clear it’s not my incompetence that is in the way but that the project was impossible to start with”

She looked at him “What do you think?”

“Well, it looks like you have been thrown into a swift river, the riverbanks are made of glass, you can’t get out, so you need a way to stay afloat without drowning, you need a way to make it work. But I agree the challenge is how do you address the challenges, when it sounds like nobody wants to hear them?”

She smiled, but Mourad noted the smile did not reach her eyes, and added “You have no idea, there is an additional challenge, I found out that Germany is hiring their Med Affairs team and I don’t have an approach or a structure yet, the river is fast and I don’t want to go under.”

She added “The thing is I am used to identifying challenges, then coming up with solutions and recommendations and presenting them to my manager for discussion, but here I don’t have the authority to identify issues and propose solutions that are considered. I am worried I will be overridden going forward. And how can I lead a project under those circumstances?”

She mixed the bagel crumbs with the sugar on the table creating a swirly paisley pattern.

Mourad looked back as he left the cafeteria and saw Susan deep in thought, she hadn’t moved and was still playing with the crumbs on the table. He sighed.

Mark Has an Invisible Problem

On her way back to her desk, Susan sees Mark coming out of his office at the end of the hall. She knows she looks tired and she is still unclear about her course of action, so she waves briefly, hoping she can leave it at that for now.

Mark says, “How is it going? You look a bit pale, are you ok?”

Susan says “Yes, I am fine, just really busy. But I am making progress. There are lots of moving pieces, I have set up some chats with key people, to get an idea of what other teams have planned for Europe”

Mark says “That sounds good, great progress, see I told you that it would all start making sense once you get stuck in. Have you talked to your team members yet, they should be starting soon, right?”

Susan says she hasn’t yet, she doesn’t say she is dreading it, because she is worried that her expectations will be confirmed, that her team won’t be much help.

Mark says “Good, good, ok I’ve got to go, back-to-back meetings all day today, but keep me posted, and let me know if you have any issues”

He hurries off down the corridor a bounce in his step, convinced that Susan has it all under control, he doesn’t spend more time thinking about it because he has a long list of things he needs to get through today.

Susan feels a bit dizzy, and she is left wondering why she didn’t take the opportunity to say how she really feels. She could feel the words in her mind, they formed, she was so close to saying “Can we talk, we really need to talk, there is an issue” but somehow, she couldn’t say them and then Mark was gone.

Mark now has an invisible problem. His employee is talented and hard-working, she knows what the issues are in the project, and rightly or wrongly she also has the impression that Mark wants to hear mainly positive forward momentum.

Invisible problems can derail projects, make entire teams very miserable, and still go unvoiced, because employees are afraid of repercussions, of looking incompetent, negative or of voicing a concern but that concern falling on deaf ears. Invisible problems are those that employees discuss with spouses and friends but never bring to their boss.

Susan tried once to voice her concerns, and they went unheard now she needs to find the confidence and the approach to bring her issues to Mark in a way that he can hear them.

Because Mark is remarkably busy too, managing several direct reports, some less capable than Susan, and he is involved globally and in region Europe’s commercial roll-out he doesn’t have the bandwidth to focus on Susan’s feedback. So, her concerns go unnoticed and the European launch project is now at risk.

An invisible problem is putting the European Drug Launch at risk, unless it can be addressed it will impact the project’s success.

Susan Is in the River – Is She Reading It Right? The Experts Weigh In

Susan needs to onboard a European team, and with them connect the dots between market access, regulatory, research and development, look into disease awareness, Key Opinion engagement, scientific communications, and digital channels. She also needs to assess digital engagement and plan product training for commercial and medical teams.

Following her chat with Mark, she is currently looking to do this with two individuals without relevant experience, and she still needs a digital lead and the energy to network with key stakeholders, both globally and in Europe.

It is clear that she cannot do this project alone, I have seen many young professionals try, they end up very exhausted and even if the project is successful, then they do not enjoy the work while they are doing it nor have the energy to celebrate at the end.

Ideally when you have a hard job, as Susan does, you enjoy the journey, find support, and celebrate the milestones and the outcome.

In response to the last instalment readers who have followed Susan’s story so far were both empathetic and pitied her. Ekaterina Sokavera, a Medical Affairs expert, shared the opinion of many in her comment “Quite a typical story, unfortunately.”

Ingrid Witherell – safety scientist and medical writer observed “the last thing you need… (in this situation) …. is miscellaneous “help” to train and align with” agreeing with the point Susan made to Mark that she needs teammates who complement her skill set, not individuals she needs to train.

Dr Elsa Zekeng said “One theme that stood out is the difference between accountability and authority. Asking experienced leaders to deliver ambitious outcomes without giving them the expertise, structure, or decision rights they know they’ll need is a challenge many organisations underestimate”

Dr. Maaike Addicks noted that Susan is in a tricky situation “Poor Susan, she’s gone from no help to help that is …. not helpful. Now, as you so rightly say, it is HER fault if she fails, because she has help, doesn’t she?”

Echoing Susan’s concerns. Susan knows Mark is confident she can train the team to deliver so she is hesitant to speak up. If she doesn’t, she risks failure, if she does, she risks his confidence in her, as she is essentially questioning his judgement.

In order to be successful Susan needs to figure out how to work with Mark as soon as possible.

As Maaike notes Susan must find a way to work together so that he stops making decisions without her or for her: “She needs to do this now immediately, before this becomes a normal way of working”

As the saying goes you need to start as you mean to go on.

Susan’s situation is not unique. Many leaders in complex roles find themselves here. They are hard-working, competent, and organised and their manager sees everything is working well.  Competence is mistaken for capacity, and these employees are then allocated more tasks. While employees can compensate for a while, at some point they cannot.

Susan needs to look after herself, or she won’t be able to look after the project.

Susan Prepares Her Raft

Susan gets back to her office, her whiteboard full of colour-coded sticky notes on a rough project outline – and a flipchart where she notes down any ideas that come to her during the course of her day.

She likes to sit on the edge of her desk letting all the information on her whiteboard and the flipchart flow over her as she continues to evolve her approach to the project. It gives her more distance than looking at everything on computer screens.

The sky is sunny outside her window and here too she can see swaying palm trees. The mood outside is joyful and normally Susan really loves the view.

She reflects on today’s meetings with Mourad and the chance encounter with Mark. She considers how she will approach her next meeting with her boss and the best way to engage him.

She knows that Mark has the impression everything is going swimmingly. She knows that perhaps the enthusiasm and speed with which she pulled together the key project aspects, flagged gaps, and mapped out a timeline led him to this conclusion. But she also knows that she needs to disabuse him of this impression before it hurts the project.

That said, Susan is experienced enough to know she needs to proceed with extreme caution. She knows she needs data to help validate the next steps and changes to the approach that she’d like him to consider.

Susan Checks Her Crew

Susan knows she needs to be able to back up her claim that the team Mark has selected is not in a position to perform.

Thinking about how to make her case she considers asking Mark, who enjoys white water rafting, whether he would be comfortable on a dangerous river on a raft crewed by individuals who have never been on a boat. However, in order to make this point she knows she needs to have a deeper understanding of her future rafting team.

She schedules meetings. She pops over to the regulatory department, to see Alex.  He is scheduled to transition into his secondment role at the end of the month, but Susan just wants to meet him for an informal lunch.

“Hey, how are you?” she says as she walks up to his cubicle. “I thought I’d pop over quickly to say hi”

Alex looks surprised to see her, and a little nervous “So good to see you” he manages “It’s ages since we worked on that last project together.” He trails off, then rallies “I didn’t expect to see you till the end of the month, “but he looks pleased.

Susan notes he is playing with his biro. He looks flushed. Looking at him, she knows she made the right decision coming to see him.

“Well,” she says “I’m just a few floors down and I thought it would be nice to say hello. I wanted to ask if you are free for lunch sometime soon, I’d love to catch up”

Alex says “Well, I usually go for a run at lunch to get out of the office” noticing her face he adds hurriedly “But yes I’d love lunch, thank you”

That taken care of Susan calls Sally in HR. The goal? Discuss an approach for a digital lead – ideally in-house, Susan hopes that Sally has connections and wants to find out how a junior IT project lead in Mumbai was assigned to a project of this size.

Susan hopes, in the triumph of optimism over experience, that perhaps she is mistaken and her team-mates will turn out to be perfect for the job at hand. If that is true, she can avoid unpleasant conversations with Mark and just focus on delivering the project. However, if her concerns are confirmed, she will be in a better position with Mark when they next assess her progress.

Her last task is to send an email to the new German General Manager’s administrative assistant requesting a short introductory conversation with Hans-Jörg. She knows Hans-Jörg is hiring and she wants to connect with him and the German Medical Affairs team as soon as possible.

She takes a quick break to admire her flipchart and the large mapped-out project timeline.

Susan Hits the Rapids

The computer pings.

It is an email from the German admin:

Dear Susan

Hansjörg thanks you for reaching out. He wanted me to inform you that he has been briefed about your Global Medical Affairs role by Mark. He is happy that you are building a team and looks forward to having his team work with you.

I’ve put a meeting in your calendar for a first introduction call.

Hans-Jörg also wants me to let you know that considering the pressure the German affiliate is under he is close to signing up the new team.  He hopes to have them on board in the next month. The German affiliate is currently growing fast, and we have a meeting planned to explore the German markets challenges and collaboration between key teams as soon as we have everyone on board. Hans-Jörg plans to have his Medical Affairs Director, market access, the commercial leads, the marketing team, and the new medical affairs team members in this first meeting to kick-off.

I’ve put a placeholder in your calendar.

Hans-Jörg really wants you to join us, you can discuss it in more depth when you speak with him this week.

Thanks so much

Heike

Admin Assistant to Hans-Jörg Dietrich, GM German Affiliate

Susan is excited. Finally, some good news. She was worried that perhaps the German team wouldn’t want to work with her, but no, they were inviting her and wanted her to come.

Then she checks her calendar and sees the meeting is in the middle of her long-awaited two-week vacation – the first vacation in a year.

She knows she needs a break, but she asks herself, how can I not go? How can I tell Mark I am not going? This is an excellent opportunity, and our timelines are so tight. But she also hears another voice, loud and clear in her mind it tells her that she will need a holiday if she is to deliver this project successfully.

She decides to check options, so she calls her travel agent to find out if she could potentially move her holiday by a week or two. She texts her partner “Babe, we may need to move our trip by a week or two, I have a potentially urgent meeting in Europe” – she sees typing, but no message, the typing starts up again, still no message. Her heart sinks.

In response to the European trip, her first impulse is no, but her sense of duty says “You have to at least assess it, because we know Alex cannot go”

Thus, Susan starts quietly compensating for issues that are happening with the project due to staffing and communication challenges. This is another invisible problem.

She absorbs potential friction, in order to ensure success, making the challenges and the cost hard to see.

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Find out more about invisible problems and how to fix them in this short post and video: here

If Susan’s plight resonates or you are nagivating a complex transformation – set-up a short 30-minute chat with me, bring your problem, and I will give you my take: here

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