Why the APBI and NHS Confed collaboration needs the Beyond the Fog framework
It’s really good to see the ABPI and NHS Confed launching an ambitious attempt to create a step-change in the effectiveness of collaboration between the NHS and industry in its report: “A new ambition for cross-sector collaboration with the life sciences industry to support NHS sustainability and transformation”.
Much of what is described in the manifesto chimes with the vision described in Beyond the Fog where we describe a healthcare ecosystem encompassing not just an integrated health system and pharma but also other sectors, academia, community services and others delivering the benefits described in the manifesto — such as better patient outcomes, a more sustainable NHS and a boost to the economy.
The manifesto also has an excellent analysis of what makes collaboration difficult, including lack of capacity to explore future models; incentives in unhelpful directions; lack of resource for sustained initiatives; inability to scale; lack of clarity about the problem we’re trying to solve; and perhaps hardest of all, softer issues around trust, leadership and culture and lack of explicit permission to collaborate (perhaps because of the above).
We believe that the framework vision described in Beyond the Fog has the potential to help address many of these issues. Our future-back approach describes what is possible as the megatrends affecting health land at scale if (and only if) we get the response right. And that absolutely includes an enlightened relationship between industry and the system.
Our vision is to shift the emphasis in discourse about these issues away from “Where do we go from here”, where everyone has a different view of what “here” is like (towards a focus on “How to we get there”, where there is a shared view of, broadly, where “there” is.
This is vital because it is extremely difficult to see (and believe in the possibility of attaining) the benefits of such collaboration at a system level when views are entrenched within a huge, complex, siloed system with misaligned incentives and low levels of trust, trying to work out how to move forward from here.
If we are to break through the complexities and entrenched views that colour reactions to new ideas and thoughts before they are understood, let alone properly developed, we need a combination of three things:
- a shared system-level understanding of where things are heading and why;
- an emergent approach to strategy; and
- a level of psychological safety that is, to say the least, missing from most public discourse these days.
Shared system-level understanding — because we need to have a shared destination. The NHS Confed-APBI plan is just one element in a massive ecosystem. As in all large, complex systems, central co-ordination of change is too difficult. Local decisions will continue to be made at all levels in the system with not enough visibility (in a fog of uncertainty) — a shared understanding of the destination at a system level will help them to be made in a broadly complementary manner. Beyond the Fog shines a light on the destination for the system as a whole.
Emergent approach to strategy — because we need to understand that the world is unpredictable and that we need to constantly heed the landscape in which we operate and adjust course as necessary.
Psychological safety — possibly most importantly in the atmosphere of distrust between industry and the healthcare system (and, let’s face it, within the different siloes of the system and of industry) because our brains are wired to look for threat; they look for clues based on previous experience and, when they see a pattern, they shortcut to responding without fully listening to or understanding what they are responding to. Add to that the fact that pretty much all players are facing enormous disruption — existential threats even — in business models and traditional roles, and it’s clear that open, authentic conversations about motivations, hopes and fears on all sides are needed.
We believe the vision in Beyond the Fog provides a framework for dialogues which embrace all of three of these.
If the ABPI and NHS Confed want to make a sustainable success of their ambitious and laudable initiative, promoting and placing itself within a much bigger system-level conversation could be a great start.