Tag Archives: pharmaceutical industry

AI see you

by Isabelle Widmer on

The leaves are turning yellow, the temperatures are cooler now, and my favourite season, fall, has finally arrived.

I have come across some interesting AI use cases that I wanted to share with you.

Today’s topics:

-AI see you
-AI generated images and copyright
-Business: AI generated content and human preference
-Leadership: Why you cannot divide and conquer in pharma

AI see you

“You must leave your shopping trolley in the centre aisle” the security guard said as I entered the pharmacy. When I asked why he said “It’s to help prevent theft. People used to steal items by walking out with unpaid items in their trolleys. When we stopped them they expressed surprise and said the items must have fallen into the trolley as they brushed past them while walking past the shelf”.  

“We have a new system in place now though” he said, pulling out his phone and indicating the cameras on the ceiling. He continued “the camera feed is monitored by AI, when there is suspicious activity, I receive a video clip”.  He pulled up some clips to demonstrate. In one a man took a product out of its packaging and slipped it into his pocket leaving the empty box on the shelf.  In another a couple leaving the pharmacy with purchased items exchanged the package contents with more expensive products they had placed close to the exit.

He said, “the system is good, but it is also learning all the time, I validate every clip I get to identify false positives, for example when someone puts their phone in their bag”, adding “of course I can’t personally stop everyone, but as the camera feeds from the shop, the mall and the parking lot are integrated, we can track people to their cars and get their number plates, at that point we involve the police and they take it from there”.

Key takeaways: 1) Everyone you meet can teach you something if you listen 2) The lower the margins the faster AI is adopted 3) Have a good business case for AI adoption and you will likely get funding.  

AI generated images and copyright

Needing an image to illustrate a post I thought I would try text to image system Dall E3. I had a clear image in my mind and after providing many prompts and failing to get the quality I was hoping for I finally resorted to adding “generate an image in the style of Magritte and Dali”. Many images were provided, but they either fell short of my expectations, or looked like collages made using other people’s work which had me worried about copyright infringements.

When using ChatGPT I ask for source documents, which I check to validate content veracity and origin. This isn’t possible with text to image systems which are typically trained using millions of images that may or may not be in the public domain. While trying to identify the training data set for Dall-E I couldn’t find the desired information on the providers website, but I did find some text telling me that any images I generate are mine to use as I wish.

However,  in 2023 several companies using AI to generate art have been sued for copyright infringement, in one case by visual artists in another by Getty images for using images to train AI models without permission or compensation (Ref 1, 2). And while I am not sure what this means for the end user I prefer to use content that I know I can reuse without any issues at all.

Further interesting reading can be found at the Verge – the scary truth about AI copyright is nobody knows what will happen next (3).  

Key takeaways: The field is moving quickly, whenever you use online generative AI tools with a view to sharing the content, consider carefully, and check multiple sources for guidance on use. Also for business use get guidance from your legal team and other internal experts. 

Reference articles:

1) Lawsuits accuse AI content creators of misusing copyrighted work, Blake Brittain, 17 Jan 2023 Reuters  2) Getty Image, 2023s AI art generator Stable Diffusion in the US for copyright infringement; James Vincent, 6 Feb 2023, the Verge  3)The scary truth about AI copyright is nobody knows what will happen next 15 Nov 2022; James Vincent, the Verge 

Business: AI generated content and human preference

There is widespread excitement about the potential to improve business efficiencies by using generative AI for example when writing scientific responses for customers. However, whenever optimisation is looked at it is important to take the human element into account.  

A recent article by researchers at the Massachusetts Institute of Technology (MIT) did just that, exploring people’s perceptions, and bias, toward generative AI in the article “Human Favoritism, Not AI Aversion: People’s Perceptions (and Bias) Toward Generative AI, Human Experts, and Human-GAI Collaboration in Persuasive Content Generation” by Yunhao Zhang, Renee Gosline, published in 2023 (link). An article on the MIT website by Dylan Walsh posted in October 2023 outlines the key points (link), I have put together a short summary for your convenience below: 

The authors Zhang and Gosline performed the study with the goal of identifying how people perceive content depending on whether it was generated by AI, humans or a combination of both, eliminating bias in some of the assessors by blinding them to how the content they were evaluating had been created. 

The content was generated in one of four ways

1) Professional human authors only
2) GPT-4 generated ideas shaped into final content by professional human authors
3) Human generated initial content completed by GPT-4  
4) GPT-4 only generated content.

The content was assessed by three groups: Group 1 was unaware of different content generation approaches; Group 2 was told about the four different approaches and the Group 3 knew which  approach was responsible for the content they reviewed. 

When reviewers didn’t know how content had been generated they preferred AI generated content. However, assessments of content improved when reviewers were told that a human had been involved in its generation, showing what the study authors called “human favoritism”, however, knowing a text had been generated by AI only did not diminish reviewer’s initial assessments.  

From Dylan Walsh’s article: “The most direct implication is that consumers really don’t mind content that’s produced by AI. They’re generally OK with it,” Zhang said. “At the same time, there’s great benefit in knowing that humans are involved somewhere along the line — that their fingerprint is present. Companies shouldn’t be looking to fully automate people out of the process.”

Key takeaway: Generative AI is set to revolutionise content generation. Consider how you can balance process improvements with customer preference in your specific area as well as how to assess customer satisfaction objectively. 

Leadership: Why you cannot divide and conquer when engaging with customers in pharma

A while back I was caught in the rain as I biked to the recycling plant. Stopping at a tram shelter I passed the time by separating my disintegrated paper bag from my recycling bottles and throwing the bits of paper into the trash. A tram came to a stop, and far ahead, the driver got out of his cabin. He walked up to me and handing me a large plastic bag said, “it looks like this might come in handy”.

I was touched by that simple act of human kindness from an employee of the tram company.

In many professions I have worked in there has been an us versus them mentality. The belief that one team has the customers best interests at heart, while another team does not.  For example, when I was a physician, the nurses said “we truly care for patients, whereas you doctors just come and go”.

In pharma, medical affairs teams may feel commercial just cares about numbers, while commercial team members have been know to think that medical affairs colleagues slow them down and lack creativity and customer centricity.

While an employee’s specific department is significant to them, most customers are primarily concerned with resolving their issues. A patient who departs the hospital in good health typically appreciates all the staff they’ve encountered. Similarly, a healthcare professional’s perception of a pharmaceutical company is shaped by her interactions with its employees, regardless of whether they work in sales, medical, or clinical development.

Case in point, I feel positively disposed towards the entire tram company because of a single positive interaction with an employee that made a huge difference for me.

So, while I have seen leaders build strong teams using an “us versus them” dynamic, I think instead of fighting for the “customers’ favour” it makes more sense to identify customer needs and then to work together across functions to meet those needs. 

Key takeaway: Customers perceive a company as a whole and company employees as company brand ambassadors, regardless of the individual employee’s function. 

Thank you for reading, I enjoy sharing my thoughts and I love hearing what piqued your interest or any feedback. If you are currently working on a project in the fields of medical, digital, systems, analytics, channels, or facing any team or personal challenges, feel free to reach out to me for a chat. I am always happy to explore how I might be able to support you.

Best wishes

Isabelle C. Widmer MD

Image credit: Alex Knight @unsplash

Medical Information: don’t get lost in transformation

by Isabelle Widmer on

After a week in Brussels, I am now happily back home.

Last week’s DIA Medical Information and Communications meeting was fabulous, we had more attendees than ever before, the event was a success from beginning to end, great shares, some wonderful new contacts and inspiring presentations.

It will take me some time to process it all but I will share my key takeaways from the meeting with you in future blog posts.

Today’s topics:

-Metrics and insights – a vending machine example
-Medical Information transformation – how not to get lost
-Business: Are you using tech to bridge or block your customers’ path?
-Leadership: effective transformations

Metrics and insights – a vending machine example

At the airport two vending machines stood, side by side. They were stocked with similar items, only one was full, and one was empty. Both machines are managed by the same company.

If the performance of the machines is monitored independently, with different teams involved, they might not connect the information. One team may overlook any issues with the fully stocked machine, or incorrectly conclude that stock is not moving, because of the location of the machine, or unappealing products, while another team, focused on the empty machine, could mistakenly attribute it to their superior product selection.

Both teams would be looking at simple metrics, trying to draw relevant business conclusions from that data set. This is a frequent occurrence in companies when data sets of interactions with the same customer group are not integrated and are assessed in isolation.

Wanting some water, I approached the machines. The full machine had the product I wanted, but it didn’t take credit cards. Like many people nowadays I rarely carry cash, so I couldn’t buy anything. Unfortunately, the empty machine didn’t have what I needed, so no sale was made, despite there being a willing customer with a credit card on hand.

The reason the vending machine was full was simple: customers couldn’t access the products.

Key takeaways: If you look at your data in isolation you can neither understand your business environment nor adapt your strategy to enhance your business. Metrics represent raw data, while insights emerge when you combine this data with your understanding of additional factors from diverse sources, revealing what truly matters.

Medical Information Transformation – how not to get lost

Last week I got lost between Brussels airport and the hotel. It’s embarrassing I know.

I hopped on a train. Because I was distracted by thoughts of my lost luggage and the conference ahead it took me a while to note that the train was speeding through open countryside. This seemed odd, so I asked a couple on the train to confirm my direction of travel. They confirmed that “yes, you are heading towards Brussels”. When we got to Leuven it became apparent that I was not.

As the next station was fast approaching decisions on next steps needed to be taken fast. Luckily another local helped me: he identified the stop I should get off at, the train I needed to switch to and which platform I would take it from. With little time to spare his help was invaluable in helping me course correct.

I used this example when talking about implementing changes in companies. Often the roadmap seems straightforward, the task appears manageable and the topics clear, whether it be the implementation of a new IT system, working with different cultures and languages, content revision strategies, cross-functional collaboration or any one of the other myriad topics that teams face when improving how they work.

However, even if what you want to do seems simple, if you don’t know the terrain it can be more challenging that you might imagine. This is why people hire guides and city maps have circles with “you are here” I have experienced this many times, the first time I take a route I ask for directions, and I still sometimes get lost, but once I know the route I can do it blindfolded at midnight.

Key takeaways: Even if you know where you are and where you are going, and you have a map to follow, if you haven’t taken the path before, you are more likely to get lost. Plan in extra time and budget and hire a guide if you don’t have the experience you need in your team.

Business: Are you using tech to bridge or block your customers’ path?

Last week at Brussels airport travelers clapped as their luggage arrived. It struck me then that we now celebrate things we used to take for granted.

While the world celebrates automation, and conference presentations are all about efficiency gains through digital means and the power of AI to improve things beyond recognition, my customer experience in the real world is often unsatisfactory.

Technological advances can be wonderful, provided they are used intelligently and they are used in conjunction with a customer service foundation that works. Unfortunately, often tech is implemented before processes have been improved in order to support it, or it is used as a barrier instead of as a bridge. A classic example is that new customers can always reach the sales team fast, while existing customers often struggle to reach anyone.

Beyond using tech as a barrier, companies often also use tech to provide services that do not serve the customer. A key consideration here is “just because it is easy and cheap to implement, and it keeps you in constant contact with your customer, it may not serve your customer and your customer can tell.”

Classic examples of services that do not serve include daily reminders that I booked a restaurant or that I will soon be staying in a hotel, or the invitation to download a hotel app so I can check in ahead of time, which, according to a colleague changed her check-in experience at the hotel not at all.

Ultimately what customers want is straightforward and identical across industries: a fast tailored solution to their problem without extra mental load.

I experienced an almost perfect example – Lufthansa put my luggage on a later flight, they sent me a text message telling me where it was and when to expect it, they also sent a link so I could register my delivery location. I was impressed. Only the app didn’t work, so I went to a service kiosk, entered all my data and then was told that delivery may take nine days. The gentleman at the kiosk recommended I pick my luggage up myself.

Key takeaways: Technological solutions cannot compensate for underlying system errors so ensure your business foundation is solid before you implement. Make sure whatever you implement works. Automation cannot replace a human connection, automate with care.

Leadership: effectively leading transformations

Last week during the DIA Medical Information conference I ran a workshop on operational excellence and strategic alignment. I provided participants with a tool to self-assess digital and harmonization maturity within their function and organization.

A participant said, “from the perspective of the global team we are fully harmonized and digitally mature, from the perspective of the non-global teams the situation is very different”.

The situation highlights something that happens frequently when transformation programs are run from the “head” downwards. If your head, or global organization, sees a goal on the horizon and decides that that is the destination, but the “body” and the “feet” and the “gut brain” of the organization, i.e. everyone else, is not informed nor involved in designing and charting the journey, what happens is the head believes that a change has occurred, because it has “thought” its way there, whereas the rest of the organism has remained exactly where it was before, growing disengaged and frustrated in the process.

If this is where you landed, the problem is, you may not even be aware of it. Also, if after a long time of running a transformation programme this is where you are at, it will take a big effort to get back on track.

Key takeaways: Good transformation programs take time, the involvement of all stakeholders and clarity of vision and approach. Be clear on how you will approach your transformation and ask anyone consulting to you or supporting you how they approach and monitor transformation success.

Thank you for reading, I enjoy sharing my thoughts and I love hearing what piqued your interest or any feedback. If you are currently working on a demanding project in the fields of medical, digital, systems, analytics, channels, or facing any team or personal challenges, feel free to reach out to me for a chat. I am always happy to explore how I might be able to support you.

Best wishes

Isabelle C. Widmer MD

Photo credit: Isabelle C. Widmer – Airport Basel-Mulhouse

Intelligent Health 2023, African healthcare innovations and melanoma detection

by Isabelle Widmer on

In an attempt to enjoy the last weeks of summer I have been swimming in the local river in addition to work activities like attending an AI in healthcare meeting and getting ready for the DIA Medical Information and Communications meeting in Brussels. If you plan to be there, drop me a line,so we can set up a meeting.

Today’s topics:

– Intelligent Health 2023 – learning about healthcare access from African Startups
-Pitching to your audience – how to build trust and how to lose it
-How to ensure your customer engagement channels are fit for purpose
-Leadership: Don’t blame your minions, read on to find out why

Intelligent Health 2023 – learning about healthcare access from African Startups

Last week I went to the Intelligent health 2023 conference in Basel run by Inspired Minds.

The talks range from the general “How AI is revolutionizing healthcare” to the practical “Revolutionizing surgery with surgical operating systems: The future of integrated healthcare” by Ozanan Meireles, director of the Surgical Artificial Intelligence and Innovation Laboratory (SAIIL) at the Massachusetts General Hospital.

Beyond main session presentations, I particularly enjoyed pitches by African startups because when limited resource meets huge medical need the only solution is innovation, which may provide some insights for struggling Western healthcare systems.

In conversations about African healthcare systems I was reminded that in most countries outside of a few regions including the US, Canada and Europe, patients pay for treatment out of pocket and upon admission to a healthcare facility. That standards of care are different, and that this in turn means that operating techniques are different, which translates to the fact that training materials or medication guides that are not generated with an African context in mind are unlikely to provide the desired value.

Presentations that stayed with me included providing patients with a zero interest credit card that gives them immediate access to healthcare when they need it, rather than when they have saved sufficient funds. A diagnostic tool that facilitates breast cancer and cervical cancer diagnosis, and two telemedicine services, one that provides clinics an online presence making it easier for patients to access medical consultations both online and in person with a physician of their choice and that also handles all payment related aspects so that healthcare providers and hospitals can focus on their core activity, providing healthcare. And the second that provides Ethiopian women with access to information and tools regarding sexual and reproductive health.There were also pitches on managing non-communicable diseases including hypertension and diabetes.

While not all the solutions presented can be implemented as is in other geographical regions, many of them harbour a seed that could, with minimal adaptation, grow elsewhere.

Key takeaway: When facing a challenge, look around for inspiration from other teams, departments, or systems. While unique contexts may yield specific solutions, with the right adjustments, these can often have broader applicability.

Pitching to your audience – how to build trust and how to potentially lose it

“No, but it’s not really a problem, as darker skinned people don’t really get skin cancer” the presenter said, after some reflection, he added, “well only rarely” in response to an enquiry from an audience member on whether the melanoma app he was presenting is able to detect malignancies in brown, dark brown and black skin. He did qualify his statement with the information that for the trials they had run on his software they hadn’t had sufficient individuals with darker skin on which to train the application and that they would be remedying this soon, clarifying that this is in focus.

Up to that point the presentation had focused very much on the brilliance of the product, the fact that the product is much better than the competition, the size of the global market, projected patients in the years to come and in general on the great earning potential of this app; in short why investing in it would be a wonderful thing. It was a pitch after all.

However, following that comment, as I listened, I reflected on what I know about skin cancer and AI, which included: AI for facial recognition is known to perform better in white skinned individuals than in darker skinned individuals “because it is trained that way” (link WEF). Tech solutions are often designed to serve Caucasian populations. And, while the incidence of skin cancers in those with darker skins may be lower, they also often present with more advanced disease, and at a higher risk of lesions being misidentified and underdiagnosed due to a lack of awareness by health care professionals and patients alike.

Once at home I investigated further. The publication “Disparities in Dermatology AI Performance on a Diverse, Curated Clinical Image Set” published in August 2022 in the Journal Science Advances by Roxana Daneshjou et al, from Stanford University, with co-authors from the Sloan Kettering Cancer center, amongst others, on AI performance in the diagnosis of dermatological lesions, identifies three key issues when using/training AI algorithms to detect skin cancer including, the third of which is a human factor “there are differences in dermatologist visual consensus label performance, which is commonly used to train AI models, across skin tones and uncommon conditions”. The publication also noted that “access to dermatological care is a major issue with an estimated 3 billion people lacking access to care globally” (Link).

While the product might be wonderful, what stayed with me was the presenter’s statement about detecting skin cancer in non-white individuals.

Key takeaways: It is hard to predict what your audience will take away from your presentation; but being prepared, thoughtful, knowledgeable and transparent about the strengths and weaknesses of your product goes a long way to building trust.

How to ensure your customer engagement channels are fit for purpose

A friend of mine, who recently moved to the states tells me that her most frequent sentence when engaging with company contact channels is “I want to speak to a human”. I too often try this sentence, tragically the response is often “I didn’t understand, please rephrase”.

This raises the following question:

When considering how advanced and effective your customer engagement strategy is, do you look at the channels you have implemented, and say, we are well set up? Or do you look at how the channels perform to meet customer needs?

Many companies measure their success by the fact they have transitioned from a multichannel to an omni-channel approach, by the fact that customers seem to be using these channels and by the number of channels that are available to customers.

However, what really matters is that the channels work.

I recently tried to contact an international service provider using a web form. When I didn’t hear back, I called the help-desk. After waiting on hold for a while, I was informed that the lines were unmanned and instructed to leave a message. However, the mailbox was full, and the call was subsequently disconnected. After failing to reach the company both via web form and phone I finally went the personal route, messaging a LinkedIn connection at the company. I received a response within an hour.

This is but one example of many. If you are the sole provider of a product or service clients will persevere in their attempts to contact you, for everyone else, it’s worth making it easy for customers to engage with you.

Key take ways: Regularly evaluate your customer engagement channels for functionality and user-friendliness. Regularly monitor your service for underperformance, check for technical issues, see if you can enhance usability, and review customer engagement

Leadership: Don’t blame your minions, read on to find out why

Whether you are in the UK, and interested in the UK health system or not, you currently read about it every two weeks courtesy of my musings. This week I am intrigued by Prime Minister Rishi Sunak’s approach to evolving NHS wait times.

In January 2023 Sunak reportedly said, “NHS waiting lists will fall and people will get the care they need more quickly,” a promise he has unsurprisingly, considering the challenge, failed to deliver upon.

What is surprising, however, is that in an article by Chris Mason, published on the BBC.com website on the 15 September 2023 Mason writes this about Sunak’s self-assessment on performance against goals: according to Sunak “the government was making “very good progress” before the strikes. And without them, he (Sunak) reckons, he would have kept his promise”. Link.

In not so many words Sunak lays the blame for his failure at the feet of junior doctors and consultants who are going on strike for a pay rise.

To quote Chris Mason: “It sets up an invitation for you to decide who you blame: Medics on picket lines or the prime minister?”

The NHS, a cornerstone of UK health, has faced criticism for years. From long waiting lists for treatment and prolonged A&E wait times to a scarcity of healthcare professionals—a situation worsened by Brexit. News articles recounting infant deaths and subpar clinical care in numerous trusts bear testimony to the system’s struggles. The system cannot be fixed without the help of the healthcare professionals, naturally the strikes are impacting NHS wait times, but the strikes are not the reason for the wait times. The junior doctors did not break the system.

What is astonishing in a situation as clear cut as this is that a leader would attempt to shirk accountability. When leaders fault juniors instead of leading them to find solutions, they show their true limitations as a leader. Moreover, if such behavior is evident in clear-cut situations, it likely reflects a habitual approach, which does not foster trust.

Key takeaway: How you treat others says a lot about you: never blame your minions.

Thank you for reading, I enjoy sharing my thoughts and I love hearing what piqued your interest or any feedback and thoughts. If you are currently working on a demanding project in the fields of medical, digital, systems, analytics, channels, or facing any team or personal challenges, feel free to reach out to me for an informal chat. I am always happy to explore how I might be able to support you.

Best wishes

Isabelle C. Widmer MD

Photo Credit: Francisco Venancio @ Unsplash

Healthcare systems in crisis – the NHS as a case study

by Isabelle Widmer on

Only three weeks until the DIA meeting in Brussels, the agenda is final, and I am in the midst of writing presentations and finishing up workshop preparations. We have a large group of attendees from all over the world coming to be with us in Brussels, I hope to see you there. If you’d like to chat with me at the meeting consider dropping me a line so we can plan ahead.

Today’s blog topics:

• Best practice for scientific content provision in an omnichannel environment
• Med Info and Med Comms meeting Brussels 2023
• Healthcare systems in crisis – the NHS as a case study
• Leadership: The role of unconscious bias in the Lucy Letby case

Best practice for scientific content provision in an omnichannel environment

Customer access is a challenge for the pharmaceutical industry. Physicians have limited time and many companies vying for their attention. As access becomes harder, the provision of service on demand via the channels of the customer’s choice is becoming an important business differentiator. In addition, companies are looking to reduce cost and improve impact by making better use of available headcount and by using integrated data analytics to inform strategy. Taken together these factors explain why many pharmaceutical companies are rolling out omnichannel solutions.

Unfortunately, these solutions often fall short of their potential because they don’t factor in the human element. An area where inefficiencies are frequent is content generation, management and harmonisation, which is often managed by different teams. As structures and customer engagement evolves it is worth reflecting on whether the right people are engaged in the right activities at the right time. For example, used well, a Medical Information team can be the beating heart of scientific content generation in a company, working efficiently across teams and departments in the service of all.

Medical information professionals are product experts who excel at communicating scientific information tailored to the customer’s needs, they understand internal and external customers and support internal colleagues, including medical affairs colleagues and sales representatives with scientific enquiries. They write response documents, perform literature searches, and consult with teams including quality and safety. As Medical Information teams receive unsolicited enquiries from a broad range of customers, they are also in tune with customer needs, and able to offer valuable insights.
If you want to find out how best to provide scientific content and how to do more with less join us in Brussels at the Medical Information conference) We will discuss models, channels, solution providers, content generation cross-functional collaboration, pragmatic use of resources and how to generate meaningful metrics and insights

Key take way: As your business model evolves review if you are using your resources effectively and whether you are making the most of your Medical Information team’s ability to free up your in-field team in order to improve overall impact.

Medical Information and Medical Communications meeting Brussels September 2023 – Last call

Preparations are ongoing for the Medical Information and Medical Communications DIA meeting that will take place in Brussels. Thanks to the stellar submissions we received we have put together a great agenda.

Topics cover contact centre management, evolving the medical information structure, the value of medical information, putting theory into practice, digital content, content dissemination, a workshop on navigating medical information and an open microphone session, where we welcome participation from the floor.

If you haven’t signed up yet, do consider coming. You can also still submit a poster to the meeting. Every year a group of experienced individuals in the industry, as well as smaller companies, or biotechnology companies that are identifying how best to meet customers information needs meet, this is a good opportunity to increase your knowledge, share best practice and make connections. The meeting is especially useful for individuals who are new to medical information or who are tasked with building a medical information approach from scratch and want to fast track their efforts.

You can find out more about the speakers, and the agenda as well as sign up here.

Key takeaway: Instead of finding your own path why not stand on the shoulders of those who came before?

Healthcare systems in crisis – the NHS as a case study

During the pandemic health care professionals (HCPs) were celebrated. People stood on balconies clapping. HCPs worked long hours under difficult conditions wearing insufficient or faulty personal protective equipment in the service of patients and the healthcare system. Yet despite being officially feted health care professionals’ working conditions in many countries remain challenging. Frequently, those who provide healthcare to others do not work in a healthy environment which is one of the reasons, I suspect, why there is a global lack of healthcare staff.

In the UK the situation has come to a head as junior doctors and consultants prepare to strike. A 2022 survey by the British Medical Association of 4000 junior doctors, who are in the first 6-10 years of training after getting their degrees, showed that almost 90% are concerned about the impact of the rising cost of living on their personal situation. More than half the respondents said they had struggled to pay for utilities and lighting in 2022 and 45% said they struggled to pay for commuting, essential travel and rents and mortgage. Eighty percent of those surveyed reported that if they had to reduce their income at all they wouldn’t be able to meet their essential outgoings.

Almost 80% of respondents are considering, and 65% have actively researched, leaving the NHS in the past 12 months. A third of these is planning to work abroad. More than three quarters of respondents had friends and colleagues who had already left the NHS and gone to work as a doctor in a different country. Reasons for considering to leave the NHS include pay and pension schemes, deteriorating working conditions and personal well-being, increased workload, lack of recognition, workforce supply shortages and a lack of flexible working patterns.

The NHS is already in crisis: according to a recent article in the Times “More than half of people who died in England last year were on an NHS waiting list. The estimated toll of 340,000 was up from 240,000 five years before, a 42 per cent rise. The figure represented more than 60 per cent of all deaths in England, according to data provided to The Times by NHS trusts under freedom of information laws”. Patients are already being affected but now the doctors’ strikes will further compound the problem. While the leading issue cited in the media is salary, the BMA survey highlights many other topics, that are relevant for the UK but also beyond the UK’s borders.

An article written in the (Swiss Medical Weekly) by three Switzerland based physicians with experience of the NHS. discusses the results of the BMA survey. Although they acknowledge that young Swiss doctors are in a better position than their UK peers, they note that according to survey data, junior doctors working in the Swiss healthcare system experience similar areas of dissatisfaction. Their conclusion matches mine: the BMA survey results are worth paying attention to. As we face a global shortage of HCPs, and HCPs vote with their feet moving to locations with more favourable working conditions and salaries, the challenges in accessing healthcare faced by underserved populations, such as those in Africa increase.

While recruiting HCPs from other countries may temporarily address developed nations’ healthcare system woes, in the absence of a change of strategy to solve this problem we are heading into challenging times.

Key take-away: The situation in the NHS may seem relevant only for the UK, however, doctors the world over are turning their backs on local clinical practice to work overseas. In many cases the drivers underlying this decision will match those highlighted by the BMA survey. If we want patients to have access to healthcare, we need to reinvent healthcare provision.

Leadership: The role of unconscious bias in the Lucy Letby case

Last week British nurse Lucy Letby was convicted of murdering infants in her care. While widely covered in UK media it was not widely covered by the media elsewhere so I will summarise some key aspects.

The case is tragic because initial concerns about the nurse were raised in the month after the first child was killed, yet it took another year, four more murdered babies, and six known murder attempts until action was taken.

Physicians working at the hospital raised concerns about the nurse repeatedly during this time as she was the single common denominator in each case. Autopsies were not performed in every case and some autopsy results were lost in the post, absent a digitalised system. The head nurse and clinic manager defended the young nurse and the doctors who raised concerns were threatened with sanctions by the management team and forced to apologize. There are currently other cases ongoing in the NHS where physicians have been suspended for raising concerns with the quality of care provided to patients.

The reason I am highlighting this case is because there are some important lessons to be learned here. The first is about unconscious bias, where we tend to trust those who are like us, and there is a risk that we protect those who appear to need it most. In this case a young female nurse, who was the subject of complaints by the entire team of senior male physicians. In addition, there are different reporting lines in hospitals, nurses report into a senior nurse, doctors report in through a different structure, this can lead to an “us” versus “them” mentality and a protection of “one’s own”. The lack of availability of objective data, in this case autopsy reports, which would have confirmed suspicions, is a systemic process error. And lastly, it appears that senior leadership was reluctant to promptly investigate the allegations, possibly due to the anticipated consequences if the claims were verified; while this hesitancy was likely unconscious, it had very real impact on many lives. The NHS is now reviewing its whistleblowing policy.

Key takeaway: Companies value an external perspective when new individuals join their teams. In conflict situations, or situations where team members’ mental health is at stake, or allegations are serious, it is worth bringing in an external individual to support, mediate, moderate and assess as it is impossible to be unbiased as a leader in this situation.

Thank you for reading, I enjoy sharing my thoughts and I love hearing what piqued your interest or any feedback and thoughts. If you are currently working on a demanding project in the fields of medical, digital, systems, analytics, channels, or facing any team or personal challenges, feel free to reach out to me for an informal chat. I am always happy to explore how I might be able to support you.

Best wishes

Isabelle C. Widmer MD

Photo Credit: National Cancer Institute @ Unsplash

Tech for good in healthcare: Insights from a virtual panel discussion

by Isabelle Widmer on

While the summer holidays are sadly fleeting the range of topics I come across that fascinate me and keep me energised and engaged is luckily infinite. I have picked some that I find particularly relevant to share with you today.

Today’s blog topics:

– Tech for good in healthcare: insights from a virtual panel discussion
– If you see a zebra don’t tell yourself it is a horse
– Leadership: Handling the statement “this won’t work here”
– Singapore and Switzerland comparing healthcare systems

Tech for good in healthcare: Insights from a virtual panel discussion

Last week I participated in a virtual panel discussion hosted by 3SC, a company dedicated to using technology for good to change lives. The topic of the discussion was “Tech for Good in Healthcare and Wellness.” I was invited to participate in my role as a member of the board of trustees for charity the Virtual Doctors.

The panel brought together a diverse group of experts, including Ariana Vargas, the founder of STIGMA, a mental health app; William Spencer from the British Red Cross; Alisandra Wederich from the Planned Parenthood Federation of America; myself; and Dr Daniel Grace, the Medical Director of the Virtual Doctors charity.

We spoke about the potential of technology to improve healthcare access considering increasing financial and human resource constraints in the sector. We also explored global considerations, including disparities in technology access, varying levels of tech literacy, data privacy, trust in healthcare providers and in technology, and the challenges of implementing tech solutions in different healthcare systems.

An important highlight from the discussion was the gap in tech adoption and maturity between different markets. Dr Daniel Grace shared his experience as a GP within the UK’s National Health Service (NHS), revealing how the COVID-19 pandemic accelerated the adoption of telemedicine in the UK, which until then had not played a role in the UK’s healthcare delivery. I contrasted this with data from the Swiss market, where telemedicine has been part of healthcare provision for almost two decades. In Switzerland health insurance providers leverage telemedicine companies as the first point of contact for patients with health concerns, leading to reduced costs. Patients are incentivised to use telemedicine services before visiting their family doctor through reduced premiums.

The panel discussion was recorded, you can find the recording here . I hope that anyone, who couldn’t take part, can still benefit from the insights we shared during our conversation.

Key take-away:  Tech in healthcare is not a one size fits all proposition, there are significant differences from market to market, regarding adoption readiness etc.

If you see a zebra don’t tell yourself it is a horse

In my last post I wrote about metrics and insights and about the broadly held but mistaken belief that you cannot manage what you cannot measure (link). A reader on LinkedIn agreed with the statement initially and added in the comments section “also, treatment without diagnosis is malpractice”. However, this is not necessarily true, because as a doctor you will often need to treat a patient’s symptoms while performing additional tests to diagnose the underlying condition.

The discussion reminded me of a great medical example that illustrates what happens when you only look at the obvious data, or the data that you can measure or easily collect, instead of exploring additional information or viewing the data in context to understand what is going on:

One of my relatives was diagnosed with bilateral carpal tunnel syndrome. Based on this the GP wanted to schedule an operation. I recommended we seek a second opinion, asking myself “why would a patient, who is retired, who does not spend hours doing manual labour, and never did, suddenly present with bilateral carpal tunnel syndrome?” Further assessments confirmed there was an underlying cause, extremely rare, but nevertheless. My relative received treatment avoiding operations that were not indicated and would not have alleviated the issue.

At medical school one of my favourite professors used to say, “when you hear hoofprints, don’t think zebras.” Conversely, if you see a zebra, don’t try to convince yourself it is a horse.

Key take-away: The data you collect is just the beginning, context is everything.

Leadership: handling the statement “this won’t work here”

In the course of any project, you will likely encounter the statement “Unfortunately, that approach won’t work here” often masked as “I don’t think you understand our specific situation”. While you might be tempted to interpret these phrases as a polite way of saying “No”, I encourage you to resist the temptation.

The reasons given will vary – market size, culture, geography, language and more. Often the phrase is shared with regional and global leads working with individual markets, but I also recall a colleague collaborating with individual teams in two distinct geographical locations within a large country who encountered the sentiment.

When faced with this situation, I always emphasize the importance of maintaining an open mind, listening actively and being open to constructive conversations, all of which will enable you to understand your colleagues’ position better. This in turn will permit you to adopt an effective management approach. A method that I have frequently found useful is to shift the focus from “how” to “why.” By identifying the driving force behind the desired change, teams can unite and work towards a common goal of finding a solution. If at all possible, try to engage in these conversations face to face.

Regardless of whether your project is met with enthusiastic support or critical questioning, I suggest you respond with the curiosity of a researcher reviewing data: there are no good or bad research results, just data. Every experiment provides you with information upon which you can act.

Try not to take resistance personally or view it as a challenge to your authority or qualifications. Admittedly, this can be easier said than done.

Lastly, it’s tempting to push forward despite encountering resistance, but remember “slower is faster.” Rushing teams forward without achieving clarity or agreement on the direction puts you at risk to fail. Take the time to address concerns, foster understanding, and ensure that everyone is aligned before advancing.

In conclusion, practice embracing the phrase “this won’t work here.” Be receptive to diverse perspectives, seek common ground, and approach obstacles with curiosity. By doing so, you will navigate uncharted territories more effectively and lead your team to success.

Key take-way: When faced with the sentence “this won’t work here” always take it as an invitation to a conversation.

Learning from Singapore: a health system case study

Singapore and Switzerland, despite their differences in geography, have much in common including an internationally recognised high standard of living and the availability of superior healthcare with comparable outcomes. However, in an article published in Swiss newspaper Neue Zürcher Zeitung (Sunday edition 9.10.2022) by R. James Breiding author of the book “Too Small to Fail: Why Some Small Nations Outperform Larger Ones and How They Are Reshaping the World,” Singapore achieves comparable healthcare results to Switzerland at 25% of the cost.

In 2021, Switzerland’s healthcare expenditure amounted to USD 7178.6 per capita, and the country was surpassed only by the United States and Germany according to various sources, you can find links to the data here.

So, how does Singapore achieve this admirable result? The answer, says R. James Breiding, is by incentivising citizens to reduce costs and by rewarding them directly for doing so.

“MediSave, introduced in April 1984, is a national medical savings scheme which helps individuals put aside part of their income into a medical-focused savings account to meet their future personal or immediate family’s hospitalization, day surgery and certain outpatient expenses”. Source

While in Switzerland, individuals pay a monthly insurance premium without any incentive to reduce healthcare consumption, as the premium is lost regardless of healthcare usage, Singapore’s system rewards good stewardship of health budgets. Surplus funds from an individual’s Medisave account are transferred to the individual’s pension fund once a sufficient amount has been saved according to the article by R. James Breiding. Thus individuals who consume less healthcare are able to save more for their pension fund. In addition, these savings can be inherited by family members in the event of death. Beyond the MediSave scheme additional insurance is available to cover chronic diseases, such as diabetes, or treatment for illnesses such as cancer, where the costs are particularly high, thus sharing the risk across the entire population in Singapore.

The model in Singapore shows that when patients become an integral part of the healthcare system, deciding where, when and how to invest funds to access healthcare, and benefiting if they invest less, cost control becomes feasible.

The topic is much bigger than what I can reasonably share here, however, I hope it has sparked your curiosity.

Key take-away: Involving patients in health expenditure and allowing them to benefit individually from how they chose to spend on their health can lead to dramatically improved health outcomes at a fraction of the price.

I hope my blog posts provide you with useful insights and I look forward to hearing your thoughts. If you have a challenging project or personal challenge where an external perspective or potentially team or individual coaching might help, please contact me for an informal and confidential chat.

Best wishes

Isabelle C. Widmer MD

Photo credit: Screenshot of 3 sided cube Panel “Tech for Good in Healthcare and Wellness.” Panelists Dr Daniel Grace, the Medical Director of the Virtual Doctors charity and myself with Adriana Vargas, CEO Stigma, William Spencer from the British Red Cross and Alisandra Wederich from the Planned Parenthood Federation of America.