Digital health implementation strategy (for healthcare providers & pharma)

"We need a digital health strategy"

I imagine that these words have been heard in many organizations in recent years but this simple phrase hides a great deal of complexity.

Digital health strategies designed to promote change combine the challenge of digital transformation with the complex and often counter intuitive nature of digital health. Whilst many organizations have sought to embrace digital health it is perhaps not surprising that such efforts have produced mixed results.

In this article I will try to:

• Outline the basic components of an implementation strategy for individual organizations (strategy to help organizations embrace digital health through the deployment of such technology).
• Why organizations think they have an implementation strategy but are actually caught up in a form of learning & dissemination strategy.
• Why it's easy to become confused between digitization, digital transformation and digital health strategies.
• Why you may not need a digital health strategy.

I will avoid any detailed reference to go to market strategy which was covered in edition 3 of this news letter and will return to this subject along with other aspects of commercial strategy in due course.

Glossary

• Digital health implementation strategy: A high level plan to effect change through the deployment of digital health technology.
• Digital health learning & dissemination strategy: A high level plan to help organizations actively gather information and promote learning about digital health.
• Go to market strategy in digital health: A high level plan to help organizations launch their digital health product or service.
• Commercial growth strategy in digital health: A high level plan to help organizations grow their business in digital health.
• Digitization: To carry out existing processes using increasing levels of digital technology (a form of automation).
• Digital transformation: A high level plan to help organizations embrace digital technology.
• Change strategy: A high level plan to effect change within an organization.

Common ground

It may not be immediately obvious but there is much commonality between strategies to help health service providers and pharmaceutical companies embrace digital health. What follows is an outline guide to the essential components of a successful digital health implementation strategy.

Defining purpose

From my perspective, strategy is a high level plan to get you from where you are now to where you need to be at some point in the future and for that to happen, someone has to define and communicate the purpose of the strategy.

The phrase "We need a digital health strategy" is a little ambiguous.

Asking the question "why should we embrace digital health?" is a good starting place to define purpose.

• If you're working for a public healthcare provider your answer might be along the lines of "we want to increase efficiency and enhance the quality of care".
• If you're working for a private healthcare provider your answer might be "to increase efficiency and enhance the quality of care such that we can make more money".
• If you're working for a pharma company, it might be "we want to increase the efficiency of discovery and development and make more effective drugs (and to save money/make more money in the process)".
• and so on. These are mission-based objectives (the fundamental goals of an organization)
• if your answer to this questions is along the lines of "we need to develop better products/sell more/grow our business, I'll cover commercial strategy in another edition.

It's high level stuff and I've been a bit blunt but if a digital health strategy isn't built out from your organizational objectives, is it likely to be relevant? Will you be able to get buy-in?

Once you have defined purpose, you'll need to communicate the essence of your proposed strategy. Whilst detail isn't essential at this stage, a clear and easily communicated vision will help going forward but before you start to do this, it's time to "think people".

There are typically a large group of individuals and organizations both within and outwith your organization who will dictate the likely success or failure of your strategy so the next step is to map out these stakeholders. You can then begin to define your core team (which may well include people who don't know they're in your team!) who will help develop and implement your strategy.

So the critical first steps:

• Define the purpose
• Create a vision with clarity
• Map your stakeholders
• Identify your core team

Research

If you're going to develop a digital health strategy, you'd better know something about digital health and the factors that could influence your strategy at local and global levels. What you read on LinkedIn probably doesn't represent the real world as everyone is (understandably) keen to put their best foot forward and not to be overly negative in public. The real world of digital health is complex, and fast moving with dynamics that are often uncomfortable and counterintuitive (see edition 2 of this news letter). As part of this exercise, you need to check out relevant failures and successes. Search for precedent and learn from this.

Of course you need to be informed about the nature of digital health (the technologies, their application, current state of the art, their limitations and potential, how they relate to each other, etc.) but also the factors that influence their deployment and ability to scale.

Outside of the world of digital health there will be many factors that could influence the design and execution of your strategy and an extensive research phase is likely to pay dividends later down the line.

When you do your homework under the following headings keep "one eye on local and one eye on global".

• Trends & drivers
• Barriers and enablers 
• Market dynamics
• Precedent

Learning & Dissemination

You may have done your homework but will you be successful implementing a digital health strategy in an organization that knows nothing about digital health? Will you get buy-in from management and colleagues who don't understand what it is and what it can do for their organization? Your organization may not have sufficient knowledge and understanding of digital health at this moment in time to support an implementation strategy in which case, it may be beneficial to focus on a learning and dissemination strategy either as a stand alone precursor or as inherent and early phase within an implementation strategy.

If you know your "market" through stakeholder mapping and you have the confidence to proceed with strategy development, you'll need the knowledge, skills and structures to engage and influence. You'll need to embrace market communications.

• Consider introducing a learning & dissemination strategy
• Get buy-in through influencing & engagement
• Indulge in the art of marcomms

Developing a strategic framework

Before we go on, let's consider a fundamental principle; a digital health strategy isn't a digitization strategy or a digital transformation strategy (although liberally speaking, a digital health strategy could incorporate elements of both).

• Digitizing processes that used to be performed with pen and paper can be powerful but this simply makes existing processes more efficient.
• A successful digital transformation strategy can be truly transformational but in the context of healthcare, a digital transformation strategy that does not incorporate digital health will have limited effect on tackling some of healthcare's biggest challenges.
• Our healthcare systems evolved to deal with acute situations and struggle to address today's challenges presented by chronic (lifestyle associated) disease and an ageing population. Digital health offers the potential to address these challenges and thus drive fundamental change in the way in which healthcare is delivered (as covered in a previous edition).
• The pharma industry is presented with challenges which have also proved to be largely intractable and although its long standing business model and core processes are still effective, the ability to develop better drugs in shorter time scales with less spend is becoming a powerful driver. Implementing digital health technology offers significant potential in addressing these challenges.

Let's consider this with some tangible examples but first, we should cover another fundamental.

Working With Objectives

So how are you going to take your organization from where it is now to reap the rewards offered by digital health? Firstly, if you build your strategy out from your organizational (mission-based) objectives, you'll avoid a major and common pitfall.

If you put SMART objectives (specific, measurable, achievable, relevant and time bound) into your strategy that relate to your organization's mission-based objectives you'll also stand a better chance of making a difference and measuring this difference within a sensible time frame. It also makes it more difficult for dissenters to object to a plan that's built around the core objectives of their organization.

Once you know where you want to go, you can then think about how you'll get there but first, follow the process below to help map out your destination.

A Process

I'll illustrate this process with examples in the following text but here's a brief summary.

• Define your mission-based objectives.
• Drill down from the mission-based objectives to identify key challenges
• The number and breadth of your key challenges will define the scope of your strategy and vice versa.
• Create strategic challenges from your key challenges
• and then derive digital health related, strategic objectives which relate to the needs and challenges of your organization.

Here are some examples to illustrate this approach:

Public healthcare providers

• For a public healthcare provider I would suggest that the mission-based objectives (an organization's raison d'etre) are "to enhance the efficacy and quality of care whilst increasing efficiency".

By way of example, let's drill down to create a single, tangible key challenge that we hope to address through our strategy. I provide the following example with focus on a particular area to help illustrate this process (it's an area that I'm not an expert in but will use to demonstrate principles).

Key Challenge: "We need to change our diabetes management service because it is being overwhelmed."

(I'm sure some might want to phrase this differently)

• List the parameters that could be used to measure the extent of this challenge.

...Total number of new patients under management, number of in-patients under management, number of outpatients under management, number of exacerbations requiring emergency admissions, time spent per consultation, spend associated with listed factors above, waiting times, patient satisfaction, etc... I'm not an expert in this area but you get my gist.

• Ask which of these factors could provide the biggest potential (positive) impact on the key challenge, related to your mission-based objectives, if a change is made?
• By way of example let's select "number of exacerbations requiring emergency admissions" because if this can be reduced, it's better for patients (enhanced quality of care) and will save on resources in terms of man hours and cost (efficiency). This could be supported and formalized with data on time and cost associated with an exacerbation.
• Translate this into a strategic challenge (the test of a strategic challenge? If you successfully address this challenge your strategy will in part, have succeeded).
• Strategic Challenge: How can we reduce the number of exacerbations requiring emergency treatment associated with our diabetes management service?
• Consider what elements within the field of digital health could impact these strategic challenges most and thus maximise benefit?
• How could we measure this change?

On answering these questions you can then form one or a series of strategic objectives with the following structure.

Strategic objective: To make a change in: name factor, degree of change required and method of measurement, define time scale. (you may choose to scope out the digital health technologies and approaches within this objective or not).

This could translate to:

Strategic objective: To reduce the the number of exacerbations requiring unscheduled, emergency treatment (recorded either as admission to the emergency department or an unscheduled visit by a healthcare professional) by 25% within a year.

(I include this only by way of illustration so please don't get hung up on the detail as healthcare varies by geography and I don't claim to be an expert in running a diabetes management service... in addition, I accept such an approach may fail if the budget holder of the diabetes service is required to invest but doesn't feel the benefit (i.e. the beneficiary is the emergency department which is under a separate budget to the management service) and the powers that be don't account for this dynamic - something that should have been picked up during the research phase.)

Here's an important point. If you are reading this and think "I have no idea how/which digital health technologies can help achieve this" you may require a learning & dissemination strategy during which you should:

• Learn by reading and talking
• Learn by doing (pilots)

When through this stage, your organization should have sufficient knowledge of digital health to develop and implement a digital health strategy.

Let's take a subtly different example to illustrate the process again.

Private healthcare providers

• For a private healthcare provider your mission-based objectives are probably "to enhance the efficacy and quality of care whilst increasing efficiency to improve profitability".

Drill down and translate to create a tangible key challenge. I'll use a similar example as above.

Key Challenge: "We need to change our diabetes management service to become more competitive.

What parameters could be used to measure the extent of this challenge?

There are many but this time let's focus on patient satisfaction to create a strategic challenge:

Strategic Challenge: How can we improve levels of patient satisfaction in our diabetic management service in order to make it more competitive?

Proceed as in the previous example above to create a strategic objective (note: it's not unusual to derive more than one strategic objective from a strategic challenge)

Strategic objective: To increase levels of patient satisfaction in our diabetes management service by 10% within a 12 month period as measured through our existing patient e-survey.

If you achieve this, you'll go some way to delivering a successful strategy but this probably needs to be accompanied by another objective about return on investment and/or budget.

Pharma companies

• For a pharma company, the mission-based objectives might be "to increase the efficacy of new drugs whilst reducing time to market and increasing profitability".

Let's choose a specific challenge.

Key Challenge: "We need to reduce time and spend in phase III trials whilst improving outcomes"

• What parameters could be used to measure the extent of this challenge?
• Choose the most appropriate to form strategic challenges and associated strategic objectives.

Once you have listed your strategic objectives you need to think through the kinds of policies, activities and approaches that will help achieve these objectives BUT BECAUSE THIS IS A DIGITAL HEALTH STRATEGY, THESE POLICIES, ACTIVITIES AND APPROACHES MUST RELATE TO THE FIELD OF DIGITAL HEALTH.

It would be quite legitimate to consider other policies, activities and approaches outside of digital health to achieve these objectives but if so, you will not be following a digital health strategy.

Why you may not need a digital health strategy

I could make a strong argument as to why organizations don't need a dedicated digital health implementation strategy in that digital health solutions could simply feature as an inherent part of any change strategy within healthcare and life science organizations.

Consider the challenge and objective below.

Key Challenge: Levels of patient satisfaction in our diabetic management service need to improve in order to make it more competitive.

Strategic objective: To increase levels of patient satisfaction in our diabetes management service by 10% within a 12 month period as measured through our existing patient e-survey.

Digital health solutions could make a significant contribution to reaching this objective but other "non digital health" measures could be effective too.

Whilst it's entirely legitimate to argue that a dedicated digital health strategy isn't required, the real problem is that most organizations simply don't have the knowledge of digital health or the experience to incorporate digital health technologies into more general change strategies and thus digital health becomes overlooked, confined to pilot status and technologies are thus never deployed, missing out on its transformational potential not offered by conventional change/digital transformation strategies As such, I strongly recommend a dedicated digital health strategy.

Pathways & Modeling

Describing the type of actions and policies required to achieve the strategic objectives is another necessary level of detail and if you can model alternative ways forward before nailing down your strategy, you're more likely to choose the right route forward, particularly if you involve your team in the process. You can then establish the meetings and processes that will ensure your strategy is heard, acted upon and reviewed.

To reach back to the example based on a diabetic service, you may wish to keep your options open in terms of the strategic path to achieving the objective or you may wish to be more specific (based on research and modelling and include something like the following (again, please don't get hung up on the specific content - I can't say I've indulged in more than 2 minutes of thinking let alone a few weeks research which would typically be required)

Strategic objective: To increase levels of patient satisfaction in our diabetes management service by 10% within a 12 month period through convenient, digitally enabled information entry, data sharing and scheduling between patient and HCPs, digitally enabled behaviour change programs and continuous monitoring and management systems, as measured through our existing patient e-survey.

• Match your strategy with organisational objectives
• Set SMART strategic objectives
• Explore strategic themes & model transition scenarios
• Define and develop strategic governance through internal & external structures

Implementation

At some point, your organization is likely to get its hands dirty with some new technology in which case, put processes in place to help identify and then evaluate technologies to move your strategy forward. Ensuring that these basics are available along with appropriate project and change management skills in your organization will increase the chance of successful implementation (see previous article).

Be prepared to be agile and learn quickly. Review without judgement. Start "small and quick" and build from this. Understand the difference between learning, assessment and scaling and you'll avoid "pilotitis".

Keep your stakeholders informed of progress.

• Develop processes for technology evaluation
• Ensure appropriate project management skills are available
• Create risk registers for strategic and operational initiatives and review
• Indulge in change management processes

Measuring success

You'll need not only an excellent strategy but also excellent implementation. As such, you'll need ways of measuring progress through regular reviews against SMART objectives which should be included both in project plans and your strategy. Making this information easily accessible in an understandable format will keep your key stakeholders informed and hopefully happy. If there are issues, you should be able to differentiate between issues in execution (project-based issues) and issues with the strategy itself.

• Create a dashboard
• Use data to inform decision making
• Use these data to determine the associated ROI
• Review your progress at operational and strategic levels at agreed intervals and act when necessary.

Not everything covered here is specific to digital health but digital health does seem more prone to many of these issues than other sectors.

Concluding Comments

• The confusion between digitization, digital transformation and digital health is not a case of semantics but for those not experienced and knowledgeable, the difference is often not clear.
• It's easy to understand why a collection of digital health pilots are seen as an implementation strategy when they are either stand alone activities or are unconsciously, part of a learning & dissemination strategy.
• I have argued that organizations don't need digital health strategies (beyond L&D and GTM) as digital health should be part of wider change/transformation strategies but in effect, most organisations are best served by a dedicated strategy.
• Digitization and digital transformations strategies that do not incorporate digital health cannot address the fundamental challenges in healthcare.
• Finally, strategies that have grand ambition and seek "to boil the ocean" are less likely to succeed than those that are more limited in scope and more specific. An implementation strategy that has demonstrated success in one corner of an organization is a great start.

Beyond This Newsletter

The articles in this "digital health & strategy" series are designed help illustrate not only the complexity of digital health but why developing strategy is so challenging. One of the challenges of writing these articles is to keep them to a manageable length but as you might appreciate, there is much detail that could not be shared in this format. As such, here are a few options to access more in depth content.

Free Strategy Event For Healthcare Providers & Pharma Companies

This live session (Feb 22nd, 3pm - 4pm CET) will expand upon some of the strategic concepts touched upon in this article. Given we know that diary space is at a premium, a recording will be available to anyone who registers even if they can't attend.

Strategy Course: How To Create A Successful Strategy In Digital Health (For Healthcare Service Providers and Pharma Companies).

Exercise your training budget to access a 6 week, online training course in which I'll share a level of detail that's impossible in a news letter or a 45 minute free event. You can access detail on course content through this link. We'll share dates and pricing when available with those who register their interest.

1:1 Mentoring

Finally, having talked to various parties about our Masterclass in Go To Market Strategy in Digital Health, there appears to be a need for bespoke support as well as formal learning and a such, I'll be building on my experience as a "supermentor" on the EIT Health Catapult program by offering 1:1 mentorship to interested parties (as described to me: "Supermentors are stringently selected, seasoned former mentors or jurors, with expertise in healthcare startups financial and business strategy."). If of interest, arrange an informal introduction through my LinkedIn profile.

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