Systems are often bamboozingly complex. Peek under the hood of any system, like a nation’s health care industry, and you will see a self-governing and self-perpetuating series of mechanisms and interrelated parts that create their own unique behavioural patterns: franchises structured into Oncology and Pharmaceuticals; companies specialising into rare diseases; mega-mergers and acquisitions consolidating the industry; the exodus of top pharma talent to small biotechs; demand for real-world evidence to accelerate clinical trials; and value-based pricing, to name but a few.
When functioning well, the self-governing nature of systems can inspire awe: take how starlings form murmurations in response to predators. When organisations face threats or opportunities, their responses are not typically so coordinated and impressive. In complex systems, patterns emerge from the interactions of many players, and the study of the players and patterns falls under systems theory and complexity science.
There is a human dimension to systems that is often downplayed or plain misunderstood. Systems may seem mechanistic, but the interacting players are people and the ideas and assumptions that underpin them are inherently human. Understanding this human component is integral to identifying the levers that can trigger systemic change.
David Komlos recognised this when he co-founded Syntegrity in 2002 with David Benjamin. Syntegrity sought to take systems theory and turn it into practice, by figuring out how to repeatably create solutions to the complex challenges faced by human-based systems like governments, integrated delivery systems, and pharmaceutical companies.
Central to overcoming complex challenges faced by organisations is to “bridge the gap between those who are managing the day to day responsibilities, operations, mandates, imperatives of an organisation — whether at a product level or a business unit level or the enterprise level—and the folks who are tasked with thinking about tomorrow and beyond,” says Komlos.
This gap is particularly wide within the pharma industry, says Komlos. He cites siloed departments; creation of business strategies for major product launches and patent loss; pricing and reimbursement; and shouldering the pressures of the wider healthcare system and patient communities as some of the defining challenges. “Speed, new thinking, and complete alignment are necessary, but so often missing.”
All the raw talent is there, he says. Every individual in every function has value to contribute. But the siloed nature of these organisations prevents cross-functional collaboration, which makes devising meaningful solutions at pace practically impossible. This leads to a major dysfunction within complex, human systems: delayed feedback loops. How far do you tumble down the rabbit hole before it is too late, or your system spins out of control?
Putting theory into practice
To bridge these gaps, it is important to start by framing the goals and challenges you have as a question, says Komlos.
“If you're launching a product you might ask the question, ‘What do we have to do now and over the next nine months to ensure all patients have access to our novel therapy and that we capture leading market share sustainably at launch?’ That's one way of framing the question. Whatever the challenge is, it's really important to frame it in the form of a question that is unbiased.”
The next step is to think about who all the right players are — the actors in a human-based system — that you need to bring together to answer this question, based on their talent, experience and knowledge.
Komlos advises dividing the players into two buckets: “Whose contents do I need, and whose buy-in do I need?”
“When you start listing the people that you require inside your organisation and outside your organisation to inform the thinking and solution on a product launch, or on the enterprise strategy for a pharmaceutical company, or on the turnaround plan for a business unit,then you start to list many of the usual but also non-usual suspects.”
Syntegrity has devised a method for pooling together key players and encouraging a cross-pollination of ideas that, in David’s words, is “so often missing.” The process culminates in a two-day event, where a pharma company will convene with its key internal and external stakeholders to thrash out a solution to the problem at hand.
The event itself has no pre-determined agenda of topics, each group will simply be asked to come up with an answer to the central question. On the surface, this may seem unstructured and ill-prepared, but the legwork is in the preparation.
Syntegrity will determine people’s profiles, functions and subject matter expertise in advance. This information is then fed through algorithms that systematically sort people into teams that it deems would be most constructive to answering the question. The impartiality of the selection process removes the risk of bias posed by hierarchies and echo chambers by mixing functions; critics and proponents; authority and front liners. This creates an unbiased, creative and candid exchange. All this legwork is architecting the conditions for answers to emerge from interactions of players from across the human system.
To help identify actors in the system, and what they need to solve, Syntegrity also makes a calculated prediction about what topics and solutions might crop up by using a proprietary tool that processes thousands of these sessions and identifies the handful of topics that keep coming up for a given challenge—no matter what the challenge (or system) happens to be.
And as for the gaps in the pharma industry? “The fruits of having brought these people together is that they answer the central question; whether it's about a product launch or what they're going to do about a loss of patent or how they're going to command market share over the next three years et cetera. They go back into the business and execute, and influence others who need to execute.”
Speeding up the process of collaboration and alignment can help to tackle the delayed feedback loops that cause dysfunction in complex systems. Shorter feedback loops mean we can keep up with the systems around us, even when they’re rapidly changing. When you can rapidly make decisions and get people aligned, it also encourages a “fail fast” culture.
Policy, pharma, and health system leaders should pay heed. It could turn the tide on major systemic challenges and accelerate valuable medicines and technologies to the patients who need them most.
To find out more about the practical steps you can take to overcome complex challenges, check out David Komlos and David Benjamin’s upcoming book ‘Cracking Complexity: The Breakthrough Formula for Solving Just About Anything Fast’.
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