Why Digital Health Strategies Fail

Developing and executing strategy is difficult but if you layer in the complexities of digital health, the challenge increases significantly. In this article I'll share some examples of where things go wrong if only because with this understanding, it's easier to get things right.

I'll not cover failures in GTM strategy in this article as there are many specific digital health-related reasons associated with failure of this particular type of strategy (maybe there's a part II to be written).

And so.... why do digital health strategies fail?

It's Not A Strategy

Many Strategies Fail Because They’re Not Actually Strategies. Harvard Business Review

Not everyone has an interest in strategy. Not everyone understands strategy. Fewer still understand strategy & digital health. The results:

Collections

Some large companies find themselves with a collection of digital health projects. Equally, healthcare service providers are renowned for their fondness of pilots. If an organization has "more pilots than the RAF" this typically indicates an absence (or failure) of strategy.

It may sound obvious but a collection of activities isn't a strategy.

Executive Suggestions

"Hey, why don't we do something with "insert name of latest buzzword technology".

You may think this doesn't happen in big companies but it does. Someone once shared the anecdote about one of their medtech-based senior team leaning around their office door as they passed onto another meeting using exactly that phrase. It's as far away from a strategic approach as I can think of.

Definition

Having started writing this article, I realize that it is in effect a summary of my previous articles including this anecdote.

I knew someone who enthusiastically took on the digital health role in a large pharma company. I met them some time later and they looked a little drained as they had interviewed many internal stakeholders who "all had a different opinion on what digital health is".

This very much feeds into my subsequent point about learning & dissemination (L&D) so if there's little agreement on what digital health is (apparently in the case above, quite a few people thought it was about using email and social media) you need an L&D strategy.

These are examples of what happens in the absence of strategy but even when there is a desire for a guiding plan to coordinate activity, things can go wrong.

Digital Health Strategy

"We need a digital health strategy". It's a simple phrase which hides a great deal of complexity. There are different types of digital health strategy and different types of strategy that aren't specific to digital health but are commonly applied within the field. In addition, not all strategies are really strategies.

Strategies, Policies and Guidance

I used to get lectured by a former CEO in American civil war strategy as applied to business. It was a fascinating and valuable experience and I thought I could get involved in strategy. I could and I did, but my early attempts were more akin to guidance or policy. I've seen policy dressed up as strategy but from my perspective, strategy is a tangible plan that results in measurable progress towards its objectives. In my eyes, that's different to "a direction of travel"... "a road map"... policy... guidance.

I have too often seen strategies that are actually a toxic mix of wishful thinking combined with a jumble of incoherent policies. McKinsey

Learning & Dissemination

A learning and dissemination strategy is one of the most vital contributions to any organization aiming to embrace digital health but in 15 years in this space, rarely have I come across a formal L&D strategy. Additionally, upskilling is a critical activity and should be incorporated within this strategy.

No strategy?... then you're assuming the appropriate information and learning is reaching the right people in your organization at the right time and that you'll identify any gaps to be filled by recruitment in a timely and organized fashion... but without any plan to guide your efforts.

Hmm...

When developing a digital health innovation strategy or a digital health change strategy, an L&D sub-strategy is more than a good idea. Depending on your chosen framework, it could actually be essential .

The Upskilling Strategy That Your Business Needs . Forbes

Running Before You Walk

Trying to implement any kind of digital health strategy without a knowledgeable workforce is going to be challenging... and when I say this I mean your technical, commercial and regulatory teams. Crawl... then stand... then walk... then you stand a chance of moving forward with effect... not only does this relate to L&D strategy but also scope.

Trying to run too early?... the chances are you'll fall.

Scope

It's a tired phrase but it's not a good idea to "boil the ocean". Frameworks that are designed to create a narrow scope that can easily be expanded offer advantage over those that offer breadth and need to be trimmed down.

"We don't have enough technology" is never the challenge.... so don't tie your scope (or framework) to technology if your interest is in service/process change or innovation. Technology is the means to get you where you need to be.

The Confusion Of Categories

You need the right tool for the job. As a house builder and "DIYer++" I learnt this the hard way in my early days. With respect to digital health there are different strategies which will do different jobs for you!

One of the fundamentals is therefore defining purpose. When purpose becomes clear, you're in a strong position to develop an appropriate strategy.

Purpose

Digital health is inherently innovative.

Assuming you have an effective L&D strategy in place the first question to ask yourself should be "why do we want to access/embrace this innovation?".

• If you want to change the way that you deliver your healthcare services (assuming that's what you do), you'll need a different strategic framework than ...
• If you want to innovate to produce new digital health products and services (assuming that's what you do), you'll need a different strategic framework than ...
• If you want to enhance your core processes within a pharma company (assuming that's what you do), you'll need a different strategic framework than ...
• If you want to explore the relevance of a specific digital health technology to your organisation's interests.

I've covered this ground in previous posts but suffice to say that there's ample opportunity for confusion here.

A pharma company may need a digital health innovation strategy to produce new products/services (or to enhance an existing product portfolio) and a digital health implementation strategy to enhance their core processes (of discovery, development, sales marketing and surveillance). These are two different strategies with two different frameworks. If your executive team doesn't know a great deal about digital health and employs consultants with similar levels of domain expertise, then you have one of the answers to the question posed in the title of the article.

Digital Health vs Digitization Strategy vs Digital Transformation

As illustrated above there can be plenty of confusion about what type of digital health strategy is most appropriate. Add in two types of strategy that are more generic (not focused on digital health) and you can see how management teams can get very confused about what type of strategy they need (particularly if they don't know too much about digital health).

• Digitization Strategy: This strategy seeks to enhance the efficiency of existing process through digital technology. The processes don't change but their efficiency does.
• Digital Transformation: Everyone knows the phrase. These are holistic strategies to help organizations "embrace digital" and are wide ranging in scope and can be applied to organizations out with and within the healthcare sector.

It's possible to develop these strategies without knowing anything about digital health. It's also possible to develop a digital transformation strategy with an element of digital health. It's also possible to develop a digital health strategy with many of the elements of a digital transformation strategy.

The art is to understand the differences and to develop an appropriate strategic framework based on an appropriate level of experience and knowledge relevant to the task ahead.

Implementation

In 2016, it was estimated that 67% of well-formulated strategies failed due to poor execution. A 10-year longitudinal study illustrated 61% of executives were not prepared for the strategic challenges they faced upon being appointed to senior leadership roles. Harvard Business Review

Alignment Plummets Between Top Executives and Their Direct Reports: Strategic alignment falls off a cliff from the organization’s top executives to their direct reports and continues to decline, although more gradually, among lower-level managers. MIT Sloan Management Review

Strategy As A Branding Exercise

If your people don't know about your strategy/ can't remember it/are too busy doing other things, it just isn't going to work.

I accidently discovered this early on in my career. Having adopted an "as it says on the tin approach (I was a scientist so thought this might be a good approach) I discovered not everyone was as excited as I was or could even remember what my strategy was about. I "borrowed" a very snappy and intuitive phrase from my old stomping ground of genomics and used it as a strap line. Everything seemed to change quite quickly. Doors opened that had been closed and everyone (more or less) wanted to be involved. I discovered the power of treating strategy as a brand because not only do you need to convey value to your stakeholders, you also need to convey identity.

Having learnt from this all our strategy courses have a module on treating strategy as a branding exercise. Get it right and it works.

Stakeholders

I was interviewed by an academic who was researching digital health strategy. I chipped in with a few thoughts about the fundamentals including the need for creating stakeholder maps. Apparently, in 70+ interviews with leaders in the field (consultants, healthcare managers and industry execs) only one other person had previously mentioned stakeholder mapping. How do you know who to influence and how to influence them without a stakeholder map and a communication matrix?

What's the phrase?... "driving blind"

...and what about those stakeholders who hold the keys to the appropriate resource to develop and execute your strategy?

Measurement

Okay, this isn't something specific to digital health strategy but if you can't measure it, how do you know whether you've succeeded or failed? I had that conversation about my first digital health strategy some 15 years ago and lessons were learnt.

It may be more comforting to produce a road map or a framework which lacks the structure and definition to support objective reviews because everyone likes "wiggle room". From an organizational perspective, management needs to know if any issues arising are a result of the strategy or implementation and so this needs to be built into the framework and governance structures. In addition, its helpful to know whether the strategy is performing as hoped so whilst not specific to digital health, working with SMART strategic objectives and the necessary governance structures is essential.

Has your digital health strategy worked? How will you know?

Project Management

I transitioned from technical to commercial with some project management along the way. It's a highly skilled role that doesn't require digital health domain knowledge per se but managing a digital health based project is different to managing, for example, a life science project.

• Digital health projects are typically highly multidisciplinary.
• They are likely to be people oriented.
• They are likely to involve data.

Whilst you can legitimately argue that project managers don't have to be domain experts, I think it helps a great deal if they have more than a cursory knowledge of the elements involved such that they can aid stakeholder communication, input sensibly into the planning process and ensure any potential risk areas are identified and mitigated. Digital health is sometimes very different to "traditional healthcare and the life sciences" and without any proof to back up my gut feel, I think it helps for project managers to know something about digital health.

According to studies, some 60–90% of strategic plans never fully launch. The causes of derailment vary widely, but execution consistently bears the blame. While that can be — and perhaps often is — a fair diagnosis, it isn’t the whole story. The strategy design itself can be the real problem, however difficult that might be to admit. Harvard Business Review

Frameworks

This is a subject that I'll delve more deeply into in the next edition but its safe to say that you need to adopt a framework that's appropriate to the strategic challenge. Map-based or matrix-based frameworks can work well when developing strategy around particular elements of digital health (such as digital therapeutics or digital biomarkers for example) where the challenge is to deduce how the technology may benefit an organization. For example, digital biomarkers offer the following utility:

?? Medical Research and Diagnostics: Based on health-related data from outside of traditional clinical settings DBs can help us understand disease and develop new treatments.

?? Clinical Development: DBs can support clinical development by providing novel insights into the efficacy of treatments and help tailor approaches to personalized medicine.

?? Patient Centricity: Based on real-time health data, DBs can empower patients by providing them with insights into their health to improve outcomes and patient satisfaction.

?? Predictive Analytics: DBs can predict the risk of diseases or to guide treatment decisions based on patient response to therapies.

and so on...

These can be effectively listed in the Y axis of a matrix alongside the relevant activities and interests of the organization along the X axis from which potential value can be explored and strategy built out. In comparison, a map-based or matrix based approach isn't appropriate for a digital health innovation strategy as segmenting digital health is simply too subjective and complex and will lead to confusion and ambiguity. In such circumstances an inverse rolling framework provides a way forward.

A little like putting the wrong concrete mix in a house foundation, choosing the wrong framework may not lead to immediate and obvious consequences but over time, shaky foundations start to show. More on this in future editions.

So to round off let me just say:

• Digital health is vitally important for the sustainability of healthcare.
• It's a tough market and technical development is extremely challenging.
• For want of a less tired phrase "it's the future of healthcare" so why would you not be an active player even if it's not your core business?
• And so any organization seeking to get ahead in digital health should have a plan...
• But as you have seen, developing a digital health strategy, even in great organizations can go wrong.
• I hope this article helps you to avoid some of the many pitfalls because, for all the current difficulties, we need digital health. to become "the future of healthcare" as quickly as possible

ABOUT

I launched my first digital health strategy in 2009 before hearing the term "digital health". On co-founding one of the first digital health consultancies in Europe in 2013, I was invited into various workshops and discussions about digital health strategy by third parties due to my domain knowledge (which was rare in the early days); a unique experience in learning what worked (and what didn't).

I now combine 15 years of digital health with firm foundations in the life science with strategy consulting.

I used to travel a lot and I still travel for some assignments but more recently I have started to offer my expertise and experience through online programs: Strategy Programs ( dhv-net.com )

What next?

• Interested in an off site workshop?
• A residential course in South West France?
• Sun, serenity and strategy; a winning combination.

Let me know if some immersive learning at "La Belle Maison" might appeal? Drop me a line via LinkedIn.