Patient centricity in the healthcare service sector - what does it mean and how can it evolve? A call for definitions and certification

I admit to being a long-term sceptic about the claims made by healthcare commercial service sector firms to be patient centric or to put the patient first. I have viewed such claims as fashionable rhetoric without much meaning. Everyone says and writes it, it has little if any value. My view has strong foundations, including

• The concept of ensuring that scientific rigor is applied, that spurious claims are not made, and that patients are not harmed is as old as the service sector itself. If this is what patient centric means then I get it, though it is hardly a revelation. In marketing terms it is merely a CSF (as defined by Michael Porter of Harvard Business School) a basic requirement of being involved in a market. After all, we don't see companies stating they are NOT patient centric!
• If thinking about and sometimes involving patients and advocacy groups is what patient centricity is about then, again, it has always been the case. I don't see any change in this in over 30 years. In my experience patients have always been involved in the design of devices, tablets and even the colors of tablets, and pharma companies have always wanted to understand the issues around patient quality of life
• Those firms that are a "Work for hire", and even consultancies that think they are not (but really are), are significantly distanced from the patient and are driven by the commercial reality of wanting to please the client and react to data, perspectives and strategies that come only from the client. Again, not doing anything that knowingly harms patients is hardly worth claiming, it's just a CSF
• Far from defending patients, one argument says that history shows that the service sector provides, understandably, what their client wants, whether it is right or not. The US CME crisis of 20 years ago, the opioid crisis, and several other dubious or criminal practices often involving disguised promotion were supported by service firms doing (and I have direct experience of service firms proposing) activities that were at least grey in nature and often clearly wrong, because their clients wanted them to. I'm not suggesting that all service firms do or have done this, only that the reality and commercial necessity suggest that service firms are so far removed from the patient that they find it difficult, maybe impossible, to know - beyond the simple "Do know harm" concept - what is best for patients. Indeed, in the crises mentioned above, law enforcement did not go after the service companies , they want after pharma, exactly because they viewed the service firms as not being close to decision making, to simply being a "Work for hire" and doing what their clients wanted

Beyond the simple "Do no harm" concept, what is best for patients?

• Indeed, to go further on what is best for patients, the concept of what is best has become evermore complex. Is a national review body recommending NOT to reimburse a treatment good for patients? It might be. Is the IRA good for patients? Pharma says no, government says yes. Look at the complex arguments around gene therapies going on today. Thinking in terms of a single patient or a group with the same illness and assuming that a new medicine should be approved and paid for is a narrow view. One can go as far as to ask "Do patients know what is best for patients?". And, in a world of limited resources it can be argued that one approval may take away from another set of patients. Service firms are not well positioned to make decisions on patient centricity in the modern world.
• If one imagines what full patient centricity would look like in a service firm it might mean a firm assessing a client's assets in the context of the whole market, the competition, the patient pool, the impact on healthcare resources and using this information to decide whether the firms work (surely aimed at getting more patients on the clients drug than without the firms work) is overall in the best interests of patients. Maybe we would see a service firm define the group of patients that, in their studied opinion and beyond the SmPC, will benefit from a treatment and undertaking to only talk about those patients and develop material that only focused on those patients. I don't see or hear of service firms not working with a client because of this sort of analysis. And if a service firm states that their role is only to provide information and that others decide what to do with it they both devalue their service and make a nonsense of their claim of patient centricity

What happens next - how do we take patient centricity to the next level?

Do we need to take patient centricity in the service sector to another level, beyond the "Do no harm" concept? I don't know, but it will happen anyway. It is a void, an area many try to exploit without a meaningful offer. Some will see this void as an opportunity, where they can do something different and unique and take ownership of patient centricity at a higher level, giving them leverage, margin and differentiation.

First we need a definition of patient centricity

Perhaps first we need a definition of patient centricity, and perhaps there are different levels. Level one being "Do no harm", and additional levels building on this. This raises the first conundrum in this discussion, who decides what patient centricity is? If individual companies do it (see below) it may lack credibility, but maybe this is where we start. Should bodies like the Healthcare Communications Association (HCA) define what patient centricity is? In my opinion, yes they should. The HCA works hard to raise professional standards and the ubiquitous nature of claims about patient centricity bring the service sector into disrepute. Defining patient centricity through the HCA will set an industry standard and make it mean something and be understandable to those outside the sector.

We are seeing the signs of an evolving patient centricity landscape

We are seeing the signs of an evolving patient centricity landscape. I will provide two examples (I have no affiliation with either company), and there may be more, of companies attempting to evolve definitions and leverage patient centricity for commercial means, and these developments may well lead to clearer definitions of what firms mean AND ways in which patient centricity can be measured and assessed. Maybe, even patients will get the opportunity to understand what patient centricity is.

ALIRA HEALTH, Humanizing Healthcare | Health & Life Sciences Advisory | Alira Health,

Alira Health is a large, over 800 person, consulting company that focuses on humanizing healthcare and patient centricity in how they describe their business. It looks good, sounds good, but a review of their website does not provide anything that suggests they do anything different to other firms, they just talk about it more. It seems they have noticed the opportunity and stepped into it without a substantial offering of what makes them meaningfully different. I'm hopeful, because there are many smart people at Alira, that this is a first iteration and that they are serious about defining what "Humanizing Healthcare" means and what it looks like, and what they are doing/ will do differently to deliver a patient centric result. Alira have taken the "Do no harm" concept and moved it further, to a point where they appear to claim that patient centricity builds better, more effective, strategies that result in greater patient benefit. I'd like to see what they do to deliver this that is different.

OVID HEALTH OVID Health | Health PR & Communications Agency | OVID Health Home

Ovid are a part of Baird's CMC, a global communications company. They have developed a "Patient Centricity Index" that, I believe, assesses how patient centric a communication or set of communications is. Fascinating, and another example of people spotting the void and creating something that drives the definition of patient centricity. Good for them. Of course, it is flawed, it's only the OVID view of what should be measured (even if they have an advisory board), it lacks independence, and is open to commercial bias (such as approving your own work, and not approving competitors work). Nevertheless, it requires clear definitions, can be used to stratify what types of patient centricity can be achieved, and could lead to transparency and clarity and a higher degree of professionalism. It would be great if the HCA could operate such a scheme with clear definitions, certification, objectivity and transparency. This would promote a debate about what patient centricity means, what value it has, who should be responsible for it and how it can be implemented AND how it will change the ways service firms work. Coincidentally, the USA CME landscape mentioned above gives some useful pointers to how a reputable scheme of certification could be created.

To be clear, I am not critical of ALIRA or OVID. I applaud their initiatives and their desire to move the discussion along. They are pioneers, corporate entrepreneurs. That they have not got to the end of the evolution is completely understandable and they deserve credit for both looking at the market and making decisions about how it might evolve and for taking action, as most have not. What this author would like to see is the discussion about patient centricity to become central to the definition of the modern service company and both of these companies are posing questions and shining a light on what may be possible

Thinking about patients interests, however complex it may be, is a critical part of the future of the service sector and will enhance quality, value and professionalism

Thinking about patient interests, however complex it may be, is a critical part of the future of the service sector and will enhance quality, value and professionalism. Quality will improve because, in a world of patient centricity, the more the interests of the patients are served the better the work. Value will improve because those firms that deliver on patient centricity will be viewed as "Better" than those that don't, and professionalism will grow because those firms seen as having higher values than mere commercial success will be recognised as having higher standards of professionalism.

Of course, there's nothing wrong with the "Do no harm" approach, with making money a close second to this goal. Perhaps it should be "Knowingly do no harm to patients and don't break laws or regulations". It has been like this for decades. However, the patient centricity jack is out of the box and those that can define it, make it meaningful, and create something unique and valuable from it will be well positioned as more valuable and more professional than those that don't.

In the view of this author, if we are to make patient centricity valuable and for it to have value to the patient themselves we must evolve from meaningless claims, slogans on websites and create clarity and substance. We need independent definitions of the types of patient centricity that could exist, a transparent way of assessing and certifying this, that will allow external parties such as clients and patients themselves to understand what is meant when a firm or client claims their work is patient centred. We must believe in the good of patient centricity and strive to make it real. Then, perhaps, my scepticism will abate and the service sector will live out its claim of being patient centric.

Chris Stevenson

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