The healthcare systems of the world are broad and complex. There are many steps between the creator of a drug, device, treatment, or therapy and the patient who ultimately benefits from it.
Stakeholders from pharma to hospitals have begun to incorporate patient centricity and patient engagement into their cultures in an effort to keep the patient’s needs and interests at the forefront of development processes. Too often, however, this becomes a formality or a box to check midway through a process or even towards the end of it, rather than the force that drives a process from the start.
“A lot of digital tools are developed by super bright people that know how to program and are good marketeers, but they’ve often never even met somebody who lives with heart failure,” said Martin Cowie, clinical vice president, cardiovascular, renal, and metabolic research and development at AstraZeneca. “They have an idea of what ‘good’ would look like to develop it to a high standard, but when you test it with the target users, it all falls apart because somebody who is 75 doesn’t generally have the digital skills of a 25-year-old.”
It’s not hard to understand where that disconnect comes from: successful innovators often draw lessons from other industries, where there isn’t anything comparable to the patient. Stefan Vlachos, the head of Health Works, described his realisation coming into healthcare from other fields.
“In other industries I’ve worked in, we’ve measured innovation based on growth and profitability,” he said. “In healthcare, that’s not a metric for success. We want to measure whether people are living the lives they want, and very rarely do they want to spend months in a hospital.”
Health Works, an innovation hub within AZ, started a little less than two years ago to find new ways to improve healthcare experiences, support health system sustainability, and drive equitable access to quality care. The team partners with patient groups, providers, and other stakeholders to really invest in understanding their problems first – before starting to look for solutions.
“Quite often, we don’t get to understanding the problem until it’s a little bit too late,” Mia Ekdahl, head of communications and relations at Health Works, said. “We’re so immersed in the opportunity of solutions, so we jump to solutions before we fully understand exactly who has a problem or what needs to be done to address it.”
Cowie now works for AstraZeneca, but first worked with Health Works as the head of the heart failure unit at Brompton hospital.
“Health Works brings together all parties – not just developers of digital technologies – to understand the problem they’re trying to address,” Cowie said. “They ask people living with conditions about their experience directly, rather than learning about it from a nurse, doctor, or textbook. In my experience, it’s been helpful to engage with patients from the beginning rather than later, when it’s difficult to change tack.”
“We want to find collaborators who want to work with us to solve the situations, opportunities, challenges that they’re aware of,” Ekdahl said. “We’re looking for patient groups. We’re looking for healthcare organisations – either single hospital groups or NGOs linked to healthcare. Companies can also be part of a project application, but we really want the users – the healthcare organisations, the patients – represented.”
They ask partners to come in and work with them, putting in equal time. And no money is exchanged in the process.
“We are looking for, number one, projects that involve at least one external party, maybe several, where we work in a real partnership,” Vlachos said. “That means that all parties put equal skin in the game. So, we are not paying someone else to do work for us. That might make it harder to find those partners, but it makes it much more likely that it will move on after that.”
And while the inspiration may have come from digital tools, the problem-driven work covers a much broader canvas.
“Some of the public literature people reference is from 20 years ago, but we don’t know if the problems of people living with liver disease, kidney disease, or heart disease today are different than they were back then,” Cowie said. “What’s important to patients in 2022? What would they see as an improvement? For example, in heart failure, doctors focus on breathlessness, but patients struggle most with fatigue and lack of social interaction. Health Works’ goal is to take it back to basics and understand the core problems we’re trying to solve.”
Truly understanding problems is more complicated than it sounds. It means understanding them from multiple perspectives and ultimately recommending a solution that works for patients, fits into providers’ workflows, and is sustainable in terms of business models.
“Service-centred design is at its core about finding the empathy,” Vlachos said. “In order for a solution to stick and last over time, there has to be a viable business model, and not only in terms of costs and revenues on the positive side. We have the ability beyond the project to reach the people that we need to reach, to build the partnerships that we need to be in place for things to work for end users in a way that’s viable long term.”
Following a design-thinking process – coined the “double diamond” method – Health Works starts out interviewing stakeholders to find out what the real problems are: what patients see as their problems and what problems doctors run into trying to address those problems.
“Then we boil it down to understanding what is it that really needs to change to make a difference,” Ekdahl said. “Once we understand that, we’re going into the creation phase, what do solutions look like to fit this defined problem?”
And those solutions, like the problems, can involve digital health – or not.
“The scope of what types of output could come from a Health Works project could be very many different things, and that’s what we’re working on a lot right now,” Vlachos said. “The output could be a new product of some kind, It could be a suggestion that we need to change policies or the ways patients interact with different caregivers. It could also be a suggestion of how reimbursement models can change for this solution to live on sustainably.”
Health Works doesn’t go as far as to actually create or even solicit those solutions. Instead, it builds a detailed blueprint that its partners can take into the solution phase. The solution may well turn out to be something that’s already in the market, or something out there might work with some tweaks.
“I strongly believe that for a lot of the challenges we have, there are already solutions,” Ekdahl said. “It’s about matching the right problem to the right people for the right solution. And that is partly what Health Works is trying to do. We’re just taking a more people-centric view rather than a techy or scientific, biology view to the process.”
“The most common question we get is what’s in it for AstraZeneca if you’re not earning money, if this is not affecting the bottom line,” Ekdahl says. “But I would say it does impact the bottom line, in the long run, because we’re learning new things, we’re building new networks, we’re seeing things we might not have thought about, which, of course, will benefit our research and development in other areas.”
“If we understand how medical problems affect people better, we’ll be better drug developers,” Cowie added. “So, it’s not a dollar kind of return within a short time period. It’s more a long-term resetting, recalibrating, ‘rising tide lifts all boats’ type approach, which I think is admirable.”
And of course, there is an element of philanthropy in the investment as well.
“Health Works is one of the things AZ does to support a long-term investment in healthcare sustainability,” Cowie said. “It’s part of being an ethical drug developer; you may profit from some things, while others support the general good.”
Health Works does make some effort to tailor its projects to line up with AZ’s core therapeutic areas, Vlachos says. But they never steer their work toward AZ solutions.
On the one hand, the group leverages its position inside the organisation – Ekdahl says that part of the value proposition for partners is access to AZ’s 80,000 experts around the world. On the other hand, their position outside of the core pharma business, and their close work with non-pharma companies, are seen as a strength.
“Pharma companies, as many specialists do, tend to view people from a very specific perspective,” says Vlachos. “When I worked at Karolinska [Health], the neurosurgeons tended to see people as a brain with some neurons dangling into the spine. We tend to see people as some molecules that we add other molecules to drive health outcomes. People who are sick or at risk of being sick don’t think of themselves like that. So that’s part of what we need to understand.”
Ultimately this perspective shift is, in itself, a value Health Works offers to its parent company.
“We can never rid ourselves of our preconceptions, but we can train ourselves to put them in one bag and then look at what can we learn,” Vlachos said. “And then we can say, ‘These are my preconceptions. This is where they match [reality]. What do I need to learn? What do I need to re-learn?’ This is how we have the greatest impact.”
Martin Cowie is clinical vice president, cardiovascular, renal, and metabolic research and development, at AstraZeneca.
Stefan Vlachos is head of Health Works at AstraZeneca
Mia Ekdahl is head of relations and communications at Health Works, AstraZeneca
Jonah Comstock, Editor-in-Chief
Jonah Comstock is a veteran health tech and digital health reporter. In addition to covering the industry for nearly a decade through articles and podcasts, he is also an oft-seen face at digital health events and on digital health Twitter.