This book is a true-life account of a year in the life of press photographer Keith Hern, starting with the discovery of a small and painless lump on his neck. Diagnosed with throat cancer, he experienced months of intensive treatment including radiotherapy, chemotherapy and surgery. The outcome has so far been successful.

Bangers & Mash is based on Hern’s diary and illustrated with photographs taken by him and others – some dramatic photos of him being prepared for radiotherapy and recovering from surgery were taken by nurses, using his camera. The title refers to his first mouthful of solid food after months of being unable to chew or to swallow anything but liquids.

Another form of treatment he received was psychological training from an NLP coach. NLP was developed in a clinical context long before its application to business practice, and Hern pays tribute to the coach who helped him to focus on ‘positive’ thoughts and images. He was less impressed by the NLP books and videos she gave him, however. MX Publishing is an NLP specialist imprint, but the book praises the therapy rather than the theory.

Hern’s case is a striking example of the power of early diagnosis and intervention. For anyone involved in commercialising technologies for cancer treatment, his account of the debilitating side-effects – at one point, he expresses surprise that an already sick body can endure such toxic intervention – is a valuable reminder of the patient perspective. The development of a more patient-centred healthcare culture depends on such voices being heard.

The financial aspect of his treatment is also worth noting. Hern received private treatment for his cancer thanks to medical insurance, but the company informed him that any subsequent health consequences of the cancer or its treatment would not be covered – which leaves him exposed for the future. Ironically, his year ended with a protracted argument over a travel insurance policy after his teenage daughter was taken ill on holiday. As we move towards a more finance-driven healthcare model, more and more patients will face issues of this kind.

This engaging and frank account is rich in humour and insight, and will give readers in the medtech industry some solid food for thought.

Three things in life are inevitable: birth, death and conferences. In the business world, the conference is a rite of passage without which you will never truly belong. Nothing actually happens there: it’s a work of performance art in the medium of business. Unless it’s a medical conference, in which case you will be an exhibitor. Bet you can’t wait.

What is a business conference for? We spend our working lives meeting people, communicating and sharing ideas. We don’t need to go to a remote hotel and live on canapés to do that: it’s what we’re good at. A conference isn’t about work, it’s about performance. Presenting the highlights of your year in a neat package: the best figures, the best soundbites, the joke that clinched a deal, the smile you keep for first dates. In a conference you neither work nor socialise, you network – another performance, a ritual with its own arcane rules.

A conference is rather like a 1980s pop video: a stylised collage of ‘golden moments’ lifted from elsewhere. It’s MTV (Medical Technology Video). You can approach it like Kylie, trading on your charm and a few daring moves. You can approach it like U2, pressing all the ethical buttons at once. Whatever your style, there is only one agenda: work it.

After a day of that, you’ll need to unwind. But then comes the frenetic ritual of corporate drinking – another performance whose elements are over-consumption, bragging, flirting, indiscretion and oblivion. Don’t fool yourself that no-one will remember what you said.

Then there’s the exhibition. In terms of the musical analogy, this is more like miming your hit single on a kids’ TV show… for three days. At least the customers are serious and there’s a chance to do some genuine work. Even if you’re dressed as a Carry On nurse and handing out tiny ablation catheters made from liquorice.

Conferences and exhibitions are designed to challenge your grip on reality. Don’t be blinded by the stage lights. Remember who you are, what you do and why. Be for real. Then there’s a chance you’ll enjoy it. You might even achieve something positive for your business.

Steve Gray answers your questions about compliance with the ABHI Code of Business Practice and other industry codes that govern commercial activity.

Thank you for the suggestions we have received regarding future articles. Do please keep sending in your questions and comments.

Dear Steve:

I read something in the newspaper recently about a new Bribery Act. Is this some new European legislation that I should be worried about?

Steve says:

The Bribery Act is new legislation that is specific to the UK. It affects all business transactions that take place in the UK, and all those that a UK company or UK employee carried out while abroad. In essence, you cannot offer an inducement for someone to do something that breaks the trust associated with that person’s role. The inducement does not have to be money – and it does not even have to be given directly to the person you are trying to influence. Giving a large amount of money to their favourite charity would also fall within the scope of bribery, for example.

Imagine that Lakeshore Monitoring Ltd is establishing a contract with Milton Keynes Trust for the purchase of 10 therapeutic monitoring devices for use in operating theatres. Dr Smith is on the decision-making committee.

You know that Dr Smith always enjoys the European Surgical Association events and that this coming year the congress will be held in Amsterdam. You decide to offer Dr Smith sponsorship to attend the congress in the hope that she will think favourably about your product in the forthcoming purchasing decision.

Your actions would be a breach of the Bribery Act. If it was later found out that Lakeshore Monitoring Ltd had not implemented any training on the Bribery Act for its employees, the company might also be liable to prosecution. If Dr Smith accepted the place in return for recommending the purchase of your product, then she would also have acted illegally.

Another example would be if Dr Smith travelled to the ESA independently, but while there received lavish hospitality from Lakeshore Ltd. This could also be regarded as an inducement if the intention behind the hospitality was to influence the purchasing decision when Dr Smith returned to the UK.

However, it is also illegal for someone to accept (or expect) a reward for ‘improper conduct’. So if Dr Smith supported the purchasing decision for Lakeshore’s equipment and then told the local representative about her support in order to obtain a benefit (such as funding to go on a course), that would also constitute improper behaviour and be subject to the Bribery Act.

Of course, the Eucomed and ABHI codes protect us all against accusations of this type. The principles of separation and documentation enshrined in the Code ensure that any decisions in respect of funding or support for clinicians are made in the interests of patients, not for a return in terms of business. Your company will undoubtedly be rolling out a specific training programme on the Bribery Act before long, as Lakeshore Monitoring will be doing for its employees. In the meantime, however, you can be assured that if you follow the Code you will be acting in the right way.

Remember that you must always write to the hospital management to tell them that a place has been offered to one of their employees. This supports the principle of transparency, which also protects you against accusations of inappropriate behaviour.

Steve Gray is an experienced compliance specialist and Managing Director of Compliance Hub Ltd. The company provides workshops and e-coaching courses on a wide range of regulatory topics, including the Eucomed and ABHI Codes and the Bribery Act. For more information, please contact steve@compliancehub.com or visit www.compliance-hub.com.

Do you have a compliance query for Steve Gray? If so, please e-mail your question to us at joel.lane@medtechbusiness.co.uk. Your anonymity is guaranteed.

What are your main priorities as Managing Director of Bespoke Healthcare?

My main priority is looking at what’s happening within the healthcare sector, particularly the NHS. That’s more important for us on the back of the current political and financial problems. It’s clear that most NHS organisations are now looking at a different model and want to save money, and we’re there trying to position our company so that we can respond to that need. Most of my time at the moment is spent talking to senior people within the NHS. And of course scanning the healthcare market, both private and NHS.

What challenges has the rapid growth of Bespoke Healthcare presented? How have you dealt with the challenges?

The challenge is always there for companies like ours: if they grow too quickly, they can start to dilute their quality in order to make more money. We haven’t: we’ve been growing at about 20% per year, and we’ve been taking on more and more people to satisfy that. We will never take on more work than we can cope with. Constantly we take on more consultants nationally, but don’t immediately use them – then, when we have bigger contracts from other organisations, we bring these people on board.

Also, we buy our own capital equipment – which people are not willing to do, particularly in the NHS: they don’t want to buy a machine for £100,000, they just want to pay as and when they need the service. Which is brilliant for the taxpayer and for us. We go in, and if we see ten patients then they pay for ten patients – as opposed to setting up a big system where they might see three patients in a day and the rest of the time is wasted.

The biggest area for us is data management. We’re dealing with highly confidential and sensitive patient data where people are diagnosed with a number of different diseases. We have never attempted to outsource any of our reporting services. We control the entire data management ourselves: we have our own data management systems, and all our internal and external servers are in Manchester. We have a team of medical secretaries within Lancashire who type all our clinical data and reports. Because we control the whole process, the chance of anything going wrong is reduced.

We have two people, including the Operating Director of the company, spending a tremendous amount of time constantly looking, auditing, checking for any holes in the system. This is one of the areas where we’ve actually ‘switched on’ the NHS, because most of our competitors have been either small companies dealing with a couple of consultants or a group of consultants working with their own computer system, which is used by a number of other people. Ours is dedicated to this alone.

How is the market for specialist diagnostic services changing in the UK? How is Bespoke Healthcare responding to these changes?

Before we started, services in the highly complex field of neurophysiology were only delivered within regional centres. For instance, in the North-West of England there were only three centres covering a population of 7.5 million that had 12 to 15 hospitals. Any hospital requiring complex tests would have to send their patient, in some cases, 100 miles to have these tests done. We’ve broken that by investing in highly complex machines and making services responsive to the patient and the doctor at the local hospital or GP surgery.

There is no test those centres can do that we cannot do locally – in fact, there are tests we do that some of the top centres can’t do. We’ve recently won major contracts with Wrightington, Wigan & Leigh Foundation Trust and the Countess of Cheshire Hospital NHS Foundation Trust. That’s a testament to the kind of services we’re providing and the flexibility we offer.

The environment is really interesting for us now. We’re opening a number of doors through the Department of Health, offering a different model from the previous one whereby you had to go to a hospital for complex tests and wait for six months or longer. We can complete the set of tests within 14 days, then get a report from a top specialist within three days. At the moment, I’m quite confident that there isn’t anyone matching that.

Following a disaster such as a civil war, a flood or an earthquake, clinicians often have to work under very difficult conditions. Surgery is performed in piecework, subject to limited hygiene and without anaesthetics or drugs. Companies whose medical products are used in relief work need to help clinicians deal with these problems.

Tankred Stöbe is the Head of the German section of relief organisation Doctors Without Borders. He worked in Sumatra in 2004 after the tsunami. In this interview, given to the website MEDICA.de, he talks about the need for creative thinking and resourcefulness when working under extreme conditions.

Mr. Stoebe, in a troubled region due to the absence of an operating table, sometimes a kitchen table is quickly transformed to perform surgeries. Have you ever personally experienced something like this?

Yes, Creativity is essential when working in troubled regions, since there is never enough of anything. Drugs, diagnostic equipment or medical instruments are not readily available. Doctors have to improvise to help people in a quick and effective manner. That is not always an easy thing to do, but actually it is the true medical artistry.

Could you give us an example?

While in Indonesia, I saw an old man in a hospital who presented all the symptoms of an acute heart attack. The hospital was not equipped to provide treatment. And since the necessary drugs were not available at the hospital pharmacy, I first had to buy them at an outside pharmacy. That is how we were able to save this man’s life.

Aside from drugs, surgical instruments are often missing. After the Haiti Earthquake some doctors were said to have amputated arms and legs using hand-or buzz saws.

Yes, while the staff of relief organizations is bringing the necessary tools to the location, planes might not be able to land due to the destroyed infra structure, like it was in the case of Haiti. And if hospitals at the location are also badly damaged, my colleagues sometimes resort to using a hand saw to save a life.

In 2004, you were on assignment in Sumatra after the Tsunami. Did you have to perform treatments that were especially terrible for you?

I remember one man coming to our clinic with a decomposing hand. His injury was too far progressed and we had to amputate the hand. That was tragic, because the man was a tailor. He did not come to the hospital sooner, because he was afraid that he might not be able to use his hand after any treatment. That was a false decision with terrible consequences. At another assignment shortly after the civil unrest in Liberia in 2003/2004, we had three men with severe burns coming to us – after an alleged burglary they were doused with gasoline and lit on fire. We could not save these lives, but were at least able to make them more comfortable by administering heavy pain medication.

If there are many casualties – such as after the Tsunami or after the Haiti Earthquake – doctors often resort to “triage“. This is a treatment procedure where injured people are not treated in the actual order they came in, but rather by severity of the case or by determining cases that promise the most success. By doing so, doctors make life and death decisions. How do you feel about having to do make this sort of selection?

Triage becomes a very emotional matter which needs to be learned, since it is only natural that you want to help the first person that comes to you for help. If there are many patients though, this could prove fatal, since the ones that need urgent and immediate help might not get it in time. For local doctors, Triage is an even more emotional matter than for an external doctor like me who has no personal relationship with the injured person. Sometimes the local doctors need to treat friends or relatives. This is why for these sort of treatment procedures, doctors need to be trained and educated time and again, since Triage – even if it is hard to do – is really more effective.

You get to see a lot of suffering, but you are also only human. How do you manage to do a good job despite working under such extreme conditions and enormous stress?

My work is emotionally draining and often just a drop in the bucket, but it is also very rewarding. At the end of the day, I know I have accomplished a lot. I realize that I am more challenged working in a troubled region than I would be working in Germany. There, I am merely a grain of sand in a Healthcare system which functions well with or without me, but in those troubled regions people’s lives depend on my work. With this knowledge, I am still able to do my job under extreme conditions.

You have worked with „Doctors Without Borders“ since 2002. What motivates you to do this work and how do you deal with the stresses and strains?

We often work under bad conditions. The climate is different, accommodations are basic and the often delicate security situation in civil war regions presents limitations for the staff. Yet I get a lot back and this motivates me. It is a great asset to meet people and get to know other civilizations. Sometimes I think I am getting more from this than I give. Since I never work alone and always with a team, I can always talk to my colleagues about my experiences. This is very important and helps me to deal with any strains.

At the moment, you are working as a doctor for a Berlin hospital. Are you going to trade this job for another job in a troubled region in the near future?

Not permanently, but I continue trying to work on a project in a foreign country for a few weeks. I hope that I will be able to do this once a year during my vacation time or when I take some comp time.

This interview was conducted by Simone Heimann and translated by Elena O’Meara for the website MEDICA.de.

Creativity is essential when working in troubled regions, since there is never enough of anything. Drugs, diagnostic equipment or medical instruments are not readily available. Doctors have to improvise to help people in a quick and effective manner.

In 2005 the UK Government designated six ‘Science Cities’ – Birmingham, Bristol, Manchester, Newcastle, Nottingham and York – to lead the development of links between business and the science base and ensure that science and technology succeed in driving economic growth.

With a strong track record in pharmacy (as the original home of Boots) and engineering, Nottingham is a natural centre for life science innovation. A major feature of its recent business activity is the development of BioCity, a life science ‘incubator’ of the kind pioneered in Scandinavia. The largest such incubator in Europe, BioCity brings together 70 life science companies and nearly 600 people within a single building.

As part of the City Council’s ‘Invest in Nottingham Day’, we visited BioCity Nottingham to see how giving a life science cluster its own home benefits the scientific and commercial development of SMEs.

Glenn Crocker

The right chemistry

BioCity Nottingham is housed in a former Boots R&D facility. In 2003 it was adapted as an incubator for start-ups in medtech, bioscience and pharma. Of its tenant companies, two-thirds are engaged in life science R&D while the rest provide support services to life science companies.

In contrast to a science park, where the tenant companies have little contact with each other, an incubator provides a business ecosystem where companies interact and share facilities and expertise. The internal economy helps to make resources stretch further – for example, an NMR is used by several companies that could not have bought it independently. No company is allowed to take up more than 20% of the building’s usable space, thus ensuring that there is no ‘daddy’ in the household.

Successful medtech products developed within BioCity Nottingham include the Monica foetal monitor, the FertilMate cooling patch and the BabyNose nasal aspirator. The recurrent ‘baby’ theme may be a coincidence, but scientific and commercial fertility are central to BioCity’s ethos – while the stylish design of the silver-grey building reflects its role as a showcase and meeting centre.

According to Glen Crocker, Chief Executive of BioCity Nottingham, the incubator provides a complete environment for taking an innovative idea from inception to market. The in-house support services available include NHS liaison, data management, regulatory guidance, IP management, health and safety, PR and asset finance. “No company works alone here,” Glen notes, and many tenant companies – including industry specialist Medilink East Midlands – find much of their business within BioCity.

The incubator plays a major role in the region’s business training. The Bio-Entrepreneur School provides a three-day course for people who want to start a life science company. The Germinator programme enables start-up founders to work with experienced life science entrepreneurs.

Glen emphasises the value to tenant companies of “staircase conversations”: informal interactions triggered by everyday contact. The quality of face-to-face meetings, he argues, has more business value than social networking sites or e-mail contact can provide. The development follows the outsourcing model of pharma, with “many small, fleet of foot companies working in collaboration”.

Alan Marsh

A touch of class

We spoke to two BioCity Nottingham tenants whose experience reflects the opportunities that the incubator provides for life science SMEs.

Alan Marsh is Director of Allmi-Care, the company responsible for Quool and other cooling patches for skin application. He notes that BioCity tenancy has provided his “micro-company” with vital opportunities to make contacts and develop partnerships – including the collaboration with BabyStart that enabled the two companies to develop the FertilMate testicular cooling device, “a marriage made in Heaven”.

BioCity has enabled AllmiCare to liaise with local universities for product development, and provided infrastructure and specialist support that have helped it to reach wide-ranging markets. Alan says of the incubator: “The whole is greater than the sum of the parts.”

Eric Hilton is Sales Director at Food and Drug Analytical Services, a firm providing product testing and validation services. FDAS does a lot of business within BioCity, but has also grown to reach new clients worldwide. Eric notes the value of BioCity as a professional “front” for its tenants. He also emphasises the cultural advantages of working there: the atmosphere of mutual respect and exchange of ideas, he says, “makes coming to work a pleasure”.

The growth in the assistive technologies (AT) market can be attributed to two general causes. Firstly, the focus of healthcare is shifting from clinical environments to the community – which means a shift from acute care to long-term support for independence. Secondly, the shift in decision-making from clinical professionals to the patient within a network of carers and service providers is resulting in an increasingly consumer-driven market for products to support mobility and independence.

As the market for disability products grows, manufacturers are increasingly aware of opportunities for AT development. A major component of the AT market is the world of training and education, where new technologies can be used to support access to skills development and qualifications. This article looks at one example of an institution that is not only purchasing new technologies to support access to education, but helping companies to design them.

Meeting complex needs

Hereward College in Coventry is a specialist residential college of further education that welcomes all learners, including those with diverse and complex support requirements. It has over 100 residential learners as well as day learners, both disabled and non-disabled. Many of its students suffer from conditions that mean they have complex support needs, such as cerebral palsy, spina bifida, muscular dystrophy, brain and spinal injuries, autism and learning difficulties.

The college uses technology in a wide range of contexts: communication, mobility, telecare, environmental control, handling and residential life. As Paul Doyle, Head of Access, Research and Development at Hereward College, explains, it is important to have technologies available that any staff member can use: “Assistive technology is wonderful, but only when it works and when it works when you need it, first time, every time.”

Hereward College was developed in the 1970s to help integrate special education into the community, being situated on a municipal estate and offering vocational links to local industry. The college’s access centre was developed through seed funding to develop access strategies for physical and cognitive impairment. It combines assessment of students moving into further education with R&D into significant technology.

The college procures ATs through funding from the Learning and Skills Council (LSC), capturing the complex needs of the student (clinical, personal and access) and making an individual funding application. The initial needs assessment report suggests human and technological interventions. The college has a bank of technologies to draw on – from wheelchairs to voice recognition software – and develops a bespoke solution for each student, including IT training.

Training for staff is also a priority – as Paul Doyle explains, it is often necessary to bridge the gap between the people skills and the IT skills of staff members. The college is involved in the ATVET (Assistive Technology Vocational Education and Training) project funded by the EU.

Many of the ATs used in the college have been developed through work with suppliers. The TSB project i-Deal developed models for AT, feeding back to suppliers and manufacturers. The college is partnered with the Health Design and Technology Institute (HDTI) at Coventry University, and both organisations support medtech R&D by giving companies exposure to users and carers.

The role of IT in delivering healthcare is increasingly fundamental, but there is a high rate of ‘technology abandonment’ because solutions do not transfer readily between users, carers or institutions. Hereward College has developed an in-house training programme for people who support AT users. To ensure that there is a continuity of care within and beyond the college, it needs to adapt mainstream devices that can be replaced and transferred.

Paul Doyle comments: “The amount of hidden support that students receive here is often not visible from the outside. When a student starts working at 9am, their journey to the classroom may already have taken two hours.”

Supporting further education

Hereward College’s educational facilities integrate ATs with mainstream technologies for education and vocational training. For example:

• The IT centre has the latest versions of industry-standard software, so that the students are up to date when they enter the world of work. The room also features a range of mobility and sensory aids.

• The performing arts centre is fully accessible, and is used for drama and dance as well as experience of handling lighting and sound.

• The media studio enables students to work with sound, video and animation towards BTEC, HND and NVQ qualifications.

• The art and design studio supports work in multimedia, painting and sculpture, and is used for degree-level work in fine arts.

• The TV and music studios provide facilities for students to record, develop and edit work to broadcast quality.

• The business studies centre enables students to gain an NVQ in business administration and gain work experience with embedded businesses.

• The multi-use sports environment provides space and support for competitive games such as boccia and wheelchair football.

Alongside its study facilities, the college provides background support for access to education, including speech and language therapy and physiotherapy. Products recently acquired by the college include the Thera Live trainer from MedicoTech Ltd, a postural management device that supports forward, backward and sideways movement.

The canteen also features a range of ATs, including the Neater Eater from Neater Solutions – a device that helps to reduce tremors from handling – as well as adapted mats and variable-height tables.

Residential independence

Hereward College has the capacity for 120 residential students, for whom it develops comprehensive personal care solutions. The agenda is ‘transition to independence’: the students are provided with the support they need to live independent lives, carrying out their own laundry, cooking and so on.

The communal kitchen features a height-adjustable work surface and a smart control system from Halliday James, which uses a fingerprint reader to control access to the elements of the kitchen and gives feedback to the user where needed.

The students’ rooms are fitted with environmental controls for off-the-shelf building management technologies that enable the occupier to control their personal space with regard to door access, lighting and electrical appliances.

Medtech and the education market

Suppliers of assistive technologies for the educational market need to be aware of the real human context of social life and activity in which they will be used. Products need to be assessed in terms of how they fit into the user’s life, not just the therapeutic context or the procurement context.

Paul Doyle is keen to pursue dialogue with industry about building educational solutions (see contact details below). He notes that the economic situation is changing. At present, LSC funding enables Hereward College to offer guidance to suppliers and manufacturers, developing solutions through partnership and consultation. However, financial pressure will soon force the college to seek tangible benefits from sharing its expertise and market information with suppliers.

The following pointers are worth keeping in mind if you are diversifying into the AT market:

• You need to view AT use in the context of individual patient needs. Don’t just talk to early adopters.

• The technologies will need to be embedded in the context of use. Without appropriate training, they will be used in a vacuum and soon abandoned.

• The ‘transition to independence’ agenda is fundamental. Users of ATs should be encouraged to use technology, but not led to fear that they will be adrift without it. Their knowledge of the technology needs to be grounded in real-life experience and to include risk management.

Hereward College has no preferred suppliers: the individual disciplines call in relevant companies, and the students make the choices. The supplier needs to start by demonstrating the accessibility of the product: how inclusive is the technology? The formal trial process that follows positions the user at its heart – thus setting an example of patient-centred treatment.

In the past, a lot of ATS happened to users, with the decisions being made by carers and therapists. In the future, especially in the educational context where the user’s capability is at a premium, that will not be the case. Paul Doyle concludes:

“There is a new generation of consumers who judge technology on personal grounds, challenging the healthcare provider. Maintaining the role of expertise will be a challenge for therapists in the future. The best way forward is to make the end user part of a multi-disciplinary team that trials and chooses technologies.”

To find out more about how Hereward College works with companies to develop assistive technology solutions for education, contact: Paul Doyle, Head of Access, Research and Development, Hereward College, Bramston Crescent, Coventry, CV4 9SW. Tel. 0247 642 6100. E-mail: paul.doyle@hereward.ac.uk

A key question for the UK radiology sector is: what’s the next ‘big idea’ in diagnostic imaging after PACS? The industry’s answers are mostly related to access, price and user comfort, reflecting the impact of three drivers: the patient-centred healthcare paradigm, the shift of services from the hospital to the community, and the economic pressures faced by the NHS.

Professor Mike Richards, DH National Clinical Director for Cancer, was expected to appear at UKRC 2010 to deliver an update on the National Cancer Strategy and the one-week target for diagnostic imaging. This lecture was cancelled at short notice, due to Professor Richards being called to a meeting with the Health Secretary – who, a few days later, announced that NHS waiting time and other targets would no longer be managed internally, but instead would be addressed through the mechanisms of patient choice and GP commissioning.

This change puts pressure on suppliers of diagnostic imaging systems to look to their wider marketing and communications in order to ensure that the clinical and financial benefits of their solutions are appreciated throughout the healthcare system.

Over 50 companies showcased their radiology products and services at UKRC 2010. The stands included a number of mobile radiology trailers, demonstrating facilities for supplying diagnostic imaging services in remote areas. Two kinds of innovation were displayed in parallel: the integration of digital image processing and data analysis systems at a macro level, and the creation of more accessible and user-friendly devices at the patient level.

A shared vision

Making high-quality diagnostic imaging services available more readily to all patients was a theme much in evidence at UKRC 2010.

Philips Healthcare launched its Multi-Transport 3.0T mobile MRI facility at the exhibition. Commissioned by medical charity Cobalt, the facility takes into the community a level of medical imaging technology not available in the NHS. This is the first mobile MRI scanner with the level of detail provided by a 3.0T magnetic field, and offers faster processing than previous 3.0T systems.

Lord Darzi, who launched the product at UKRC, described it as a classic example of how public-private partnership can increase patient access to innovative medical technologies. The system can be leased or trialled by a hospital instead of being purchased. As it can pick up lesions much earlier than 1.5T systems, it facilitates a shift from cancer treatment to prevention.

GE Healthcare launched its Optimum CT 600 scanner, a compact and energy-efficient system that reduces CO₂ emissions and dosing levels (using an ASIR algorithm). Its graphical screen interface assists patient identification and can be used to coach or calm the patient.

Siemens demonstrated its new Mobile Digital Mammography Unit. Developed in response to the extension of the NHS national breast screening programme to women aged 47–73, the system takes mammography PACS to the community. The digital images can be checked before the patient leaves, reducing the need for recall.

The Sectra MicroDose Mammography mobile service was also displayed. This unique technology slows down the scanning process for denser tissue, enabling the scanner to provide high-quality imaging at the lowest dose on the market. At less than 5 minutes per patient, the system is designed for high-volume screening.

The bigger picture

In the wake of the national rollout of PACS, the integration of diagnostic imaging data across modalities and regions is a major priority for the NHS.

US-based company McKesson, which recently secured a national contract to provide medical imaging solutions to Ireland, was showcasing its ‘enterprise medical imaging’ solutions at UKRC for the first time. These have the capability to manage the entire diagnostic process, bringing all imaging modalities into a single framework. McKesson’s database for PACS information sharing, www.mypacs.net, is described by the company as “Google for the medical imaging community”.

Siemens Healthcare is gaining success in the UK market through a combination of innovative equipment and data management systems. It specialises in hybrid systems that link modalities, and in systems for rapid, automatic post-scan image processing. Its focus on efficiency, both in patient processing and in diagnosis, has seen it secure NHS contracts ahead of lower-priced brands.

Healthcare IT specialist Agfa is launching its new electronic patient record system Orbis into the UK market. Already established in Europe, Orbis provides a total solution for medical document management and is configurable to a range of clinical sites.

Other radiology service providers at UKRC included 4 Ways Healthcare, which provides an out-of-hours diagnostic service for hospital trusts using their existing PACS data, and InHealth, a medical imaging service provider to NHS and private organisations that uses equipment from several OEMs.

These companies reflect the complexity and dynamism of the medical imaging market in the wake of the PACS revolution.

This article outlines some key points regarding the ever-growing set of responsibilities that are expected of global sales teams in the medical technologies industry.

Your value proposition is generally based on product innovation, superior service, brand image or cost leadership. Where customers demand innovations that improve their performance and experience, the delivery of your value package should reflect this.

The most effective way of delivering your organisation’s message is through personalised touch points for the customer. The seller is instrumental in the execution of strategy at the customer level, and can be the lead facilitator in some elements of your marketing tasks.

As new technology becomes a vital part of your sales team’s armoury, it will also create new benefits and challenges.

 
Figure 1

Facets of the sales team

The market-led sales team has four components, all of which feature significantly in the development and sales process:

Trainee: Starters are exposed to sustained training effort over the course of their selling careers.

Trainer: Those whose focus is to highlight the responsibilities of the sales team to their customers regarding the safe and effective use of your products and the ways they can facilitate this.

Marketer: As the definition of marketing changes, this role is more and more spliced into the responsibilities of non-marketing personnel.

Seller: The front line team whose core function drives your growth.

Figure 1 illustrates various situations that a sales team will encounter. Some key areas of the customer experience have been aggregated for the sake of brevity. The diagram shows that many tasks are required to both achieve and support the sale of products. In this example, the interactions are between the seller and the customer.

Needs discovery is the opportunity to reveal unmet clinical needs of the customer through a series of probing, high-gain questions, which lead to a solution that is aligned to your organisation’s competency. For the main part, this is a selling-dominant task.

The next step is the selection of solution. Building on the results of the needs discovery, you have the chance to incorporate a broader solution into the proceedings that better supports your focus product. This step is primarily associated with marketing concepts, and is thus labeled a marketing-dominant task.

The next phase involves taking your customer’s order through the hierarchy of the hospital group. This is possibly the most challenging and time-intensive part of the whole exercise, occasionally incurring long lead times. Many points in this process require clinical justification and health economics tools – however, this section is categorised as a selling-dominant task because negotiation is key to bringing your value to light, achieving the correct selling price and ultimately providing the customer with new products.

Provision of adequate training should always occur before the customer enlists your new products into their armoury. When it is a simple product, the seller can do the training on-site through formal workshops – in this case, it is the first trainer-dominant task. However, when the instrument is radically advanced from what they are currently using, immersive clinical training may be offered and the seller will take on the role of PR officer, delivering a professional and pristine experience for the customer.

Often, for capital equipment, there is an installation period where the sellers will introduce the new product to the whole clinical team. This is an information exchange followed up by some assessment of the team’s understanding, and is therefore categorised as a trainer-dominant task.

Since equipment servicing is largely an added value to the customer from a convenience point of view, notwithstanding the logistics and management required, the offering of this is a marketer-dominant task.

Finally, the seller may provide follow-up support for their innovative products, for the patients’ benefit and to help the clinical teams through the learning curve. This is best positioned as a trainer-dominant task.

Aspects of selling

Thus a brief qualitative assessment of the sales team’s actions reveals that your sales environment contains much more than sales per se. Starting from these basic principles, it is worth analysing the sales process in order to identify opportunities for innovation and for streamlining. There is the opportunity to consider leaving the traditional sales funnel approach behind, since it does not describe the value-adding process, ignores the buyer’s journey and fails to highlight the volume of work in each phase.

Looking at each facet of the sales process in turn:

1. The trainee. The sales training cycles of a medtech company sometimes require you to take on relatively inexperienced sales professionals, engage with them in training interventions, measure their performance and, if they make the grade, graduate them to represent the organisation to customers on your behalf.

It is generally accepted that a blended learning approach helps to transcend national boundaries, facilitates standardised messaging and allows a combination of e-learning and instructor-led training to create progressive, empowering curricula. The balance you strike will change constantly, based on how your organisation deals with the customer expectations of each seller and how well you integrate the e-learning and learning management technologies into your process. As an industry, we must always look to explore new ways of adding value to each customer, so imparting some training and selected marketing skills to your trainees is strongly advised.

During this process, you should enhance the image of front-line sales positions within your organisations so they are viewed as customer-problem-solving agents, and shift their focus to being business partners rather than product suppliers.

2. The trainer. Every day, your sales teams will encounter opportunities to train your customers in their working environment. The first contact will typically be instructor-led, through workshops that need to become more and more formal, possibly with certification in the future. It is the seller’s responsibility to make available any simulators, e-learning assets or associated collateral needed to support the customer on demand. This ensures that all customers have access to training and are helped to gain a full understanding of your new products. It is in the best interests of the patient, the hospital and your company.

3. The marketer. This is perhaps the broadest, least formal role taken on by the sales team. A new concept of marketing is evolving wherein each member of the sales team is responsible for developing multi-faceted relationships with valued customers and creating enduring advantage. This new era of marketing shifts it from being a specialist activity to being an integral part of the general management process.

Ideally, your sellers will engage with strategic, profitable and loyal customers. As part of your customer intimacy strategy, you need to consider how you will help sales teams to identify these ideal customers. The most appropriate way to facilitate this is through a robust Customer Relationship Management (CRM) platform that draws on multiple data sources. Sellers need to understand the difference between profitable and non-profitable customers. If they are servicing non-profitable customers, they are simply generating cost.

Likewise, the seller must have adequate knowledge in relation to solving a hospital’s clinical problems in order to deliver more value to your organisation in the long run than just selling products. To compete on solutions, the seller must become well versed in the hospital’s business. The seller must also understand the building blocks of the whole customer experience, not just the buying decision. This approach will aid your organisation in winning a share of mind, which will pave the way for a share of market.

The medical devices and diagnostics industry is competing with customer experiences offered by other industries, from hotels and airlines to car manufacturers and fast food. There is a well-known franchise offering each customer the option of having their own portrait appear on their pizza. The same experience is being offered by a global confectionary manufacturer. Our customers are now conditioned to personalised offerings of this kind. Some companies in our industry have offered tailored product offerings for individuals based on preference. Ask yourself:

• Is your offering really personalising the customer experience?

• How are your customers being treated?

• What does your organisation really know about them?

• Do you know their future needs, or just their historic needs, from your CRM platform?

Building strategies around value creation is a challenging task. Resources and communications must be combined in the spirit of collaboration. Some organisations have an easier time of this than others. It is a worthwhile pursuit, as adding value is about solving customers’ problems and customers will tend to migrate towards companies that can do this for them. That is the heart of customer focus.

4. The seller. This is the traditional behaviour demonstrated by a sales team. There are numerous published sales methods that all claim to be the best. The method by which you move through needs discovery, whether it be integrity selling, consultative selling or spin selling, is largely irrelevant. The important thing is that all of your customers are handled in a consistent way, and that you convincingly align their needs to the unique benefits your systems provide in order to improve their performance and patient outcomes. Along this journey, it is clearly important to maintain your average selling price through negotiation in order to ensure that your growth is balanced.

Measuring sales success

What does commercial success look like? Aristotle Onassis stated that the secret of success is to know something nobody else knows. If business intelligence underpins your customer engagements, your chance of success naturally increases.

Success may present itself in many forms:

• having loyal, profitable customers

• knowing what strategies your competitors are likely to follow

• offering a solution that your customers regard as having superior value

• delivering personalised service to each customer

• generating growth and protecting revenue.

To be successful, organisations need an appetite for change, since a success culture is one of continual change. Organisations also need to be open to new ways of defining success. Some initiatives simply need to happen as a matter of process, so it is sometimes better to look at return on expectations rather than return on investment.

Technology decisions – a balancing act

Selecting and applying the right technology to pull your sales teams together should be a strategic rather than a reactive process. A deep needs assessment will reveal insight into your current and future requirements to support organisational goals and facilitate growth. Be realistic about enlisting existing technologies if they aren’t designed to handle the rich engagements you are planning and the close relationships you are building with customers. The ultimate goal should be to successfully facilitate hyper-segmentation, breaking your customers into segments of one, and mass customisation to deliver a personalised experience to everyone.

New requirements need new thinking. Your systems should allow you to carry out all of these functions in a streamlined, automated way. Don’t expect your sales and marketing teams in each country to individually manage data to feed your systems. When it comes to your data, there should be only one version of the truth if you are planning a global solution. Corporate alignment, sustainability and data integrity are the main drivers of your strategy. Be prepared to develop a sales and marketing central nervous system.

A sales enablement strategy should include a robust closed loop marketing platform combined with a reputable CRM that has Sales Force Automation (SFA) functionality. When choosing hardware to support this strategy, be sure to carry out a customer value mapping exercise to ensure that you understand what activities you want your sales teams to carry out with customers and to match each of these with an appropriate delivery system. For example, a Smartphone is not a suitable platform to deliver meaningful on-site training to customers, but may be useful to display very short, high-impact videos or carry out mobile SFA tasks. Conversely, a tablet computer or laptop is better suited to training customers, launching products and delivering messages.

Remember that customer experience must come before seller convenience. It is a balancing act. To drive adoption across sales teams, you need to ensure that your new systems are delivering unprecedented value to end users and customers and are the path of least resistance.

The future of sales enablement will deliver even more enriching, personalised experiences for customers. Enlistment of next-generation haptics, augmented reality and holograms will promote your customer’s rapid understanding of your solutions.

Final thoughts

All organisations in the medical devices and diagnostics industry should at least aspire to use sales teams in order to comprehensively implement a value proposition.

Building a core competency around understanding what each market needs at every stage in the sales engagement process and providing streamlined support to sales teams is vital if you are going to compete successfully in the customer’s attention economy. At each step, you should be asking: How can I add value to the customer at this point?

Igniting the market’s interest in your solutions by offering knowledge partners rather than traditional sales representatives will introduce a new dimension of natural selection to the medtech industry.

Anton Cush is Global Manager, Sales Enablement at Covidien. Based in Ireland, Covidien is a leading global supplier of healthcare products.

Building strategies around value creation is a challenging task. Resources and communications must be combined in the spirit of collaboration. Adding value is about solving customers’ problems and customers will tend to migrate towards companies that can do this for them.

Medical technology companies are often saddled with chaotic sales force structures across Europe. Because of how they have evolved, a company’s sales force in one country may scarcely resemble its counterpart across the border. This prevents them from effectively executing their commercial strategies, and often leads to lack of alignment with important stakeholders. Payers and buying groups are becoming more powerful in Europe, and many medical products companies are struggling to address their needs – in part because of their own chaotic commercial structures.

While different national structures are not unusual, we have found they are often unnecessary and reflect local historical evolution rather than business need. With the increasing importance of commercial stakeholders, and with increasing cost pressure and need to drive margin, there is no better time for device companies to look purposefully at their sales structures. Redesigning these structures often requires a new role focused on commercial stakeholders, such as a key account manager (KAM).

Companies that adopt more ‘rational’ commercial structures – in which differences across countries are driven by a clear business rationale and meet the needs of economic buyers – are better able to execute their sales strategies and to position themselves for changes in their markets.

This article outlines the challenges that medical device companies in Europe face with their multiple sales force structures. It illustrates why companies should analyse their sales force structures to make sure these correctly reflect their strategy and the buying process.

Inconsistent sales models

It is common for medical device companies to have a European sales and marketing strategy. However, the same company often approaches customers using different sales models, depending on the country in which they are doing business. We have seen this often – for example, one medical technologies provider has separate sales representatives for two product lines in the UK, combined representatives in France, an additional senior representative role plus distributors in Spain and agents in Italy. As odd as this ‘chaos’ may appear, it is common throughout Europe.

There are several reasons for this variability. Structures have evolved over time through local management decisions and acquisitions. In some cases, the individual salespeople’s skills have determined the approach. Furthermore, rapid business growth has meant that many such structures went unchallenged. Because of successes in each country, corporate management saw no reason to question individual national structures.

It is not that companies’ sales structures today are ‘right’ or ‘wrong’ – rather, the sheer diversity we see in the market indicates that companies have not truly and objectively examined their sales structures.

What is the impact of this lack of purposeful assessment of sales structure?

• Companies have difficulty executing their strategies. Most device companies have regional strategies for key commercial levers such as pricing, positioning and segmentation. By going to market without a co-ordinated plan, companies struggle to execute these strategies effectively.

• Companies’ sales structures may be a poor fit with their customers’ buying process, which results in lost opportunities. This is especially true where there have been changes in the market, such as the increasing power of hospital buying groups in Germany.

• Companies miss out on the sales force effectiveness and efficiency gains that a homogeneous sales structure across Europe can bring, such as improvements in targeting and incentive plan design.

Case study 1

For one company, its approach in the UK – focusing on a specific product with a dedicated commercial team – led to the highest sales in Europe. But in France, the selling strategy meant that representatives discussed several products with their customers in each call, and the company’s incentive plan did not focus effort on one product over another. As a result, the company’s French sales were well below those in the other big European markets.

Different structures in different nations can subvert a company’s sales performance, as each country may have different structures, incentive plans and sales processes. These differences become engrained in how representatives interact with customers, and the results can be as uneven as they are disappointing.

Of the many device companies we have worked with in Europe, almost all had significant opportunities to improve their commercial structures. The time is right for companies to examine their disparate sales structures and take account of market changes and their own strategy.

From strategy to structure

Two key drivers, the customer buying process and the company selling strategy, should inform decisions about sales force structure. If a company examines its strategy and end-user buying patterns closely and finds them consistent across markets, then a consistent structure also makes sense.

The customer buying process is often more similar than variable, even if the titles and positions of the customers vary by market. Although mechanisms for evaluating products may differ, key usage and purchasing drivers are similar across markets. Buyers in any market need to make the same purchasing decisions. Healthcare funding is under scrutiny in all markets, and some kind of cost-benefit analysis is required at every level. Purchasing drivers usually include whether the technology delivers a clinical benefit, a decrease in costs or an increase in value-in-use – whether the customers make that assessment in Spain or in Germany.

Sometimes buying processes do vary by country. For example, companies selling ostomy products interact with different customer groups in Germany from those in the UK. In Germany, ‘bandagists’ sell medical and healthcare supplies that pharmacies do not. In the UK this group does not exist, and community nurses largely manage ostomy home care. This observable and important difference in the buying process may be a good reason to have different sales structures in the two countries.

If the buying process is often similar, what about the selling strategy? This is frequently consistent across countries, because most device companies have chosen to adopt regional sales and marketing strategies across key levers such as pricing, positioning and segment strategy. They recognise that there are more similarities than differences in customer needs, and devise strategies to market their products in similar ways across countries.

Sceptics may accept that different countries’ buying processes are similar, but still question the need to restructure. Even if market changes have occurred beneath their feet, they argue, what are the real benefits of spending the time and money to establish a consistent sales structure across the continent? Hasn’t the current model worked well enough?

The biggest benefit of changing to a more consistent sales model is being able to execute the strategy effectively. This is true whether the company is launching a new product, defending market share or targeting a different group of customers. A well-considered structure allows companies to manage cross-border influences – Key Opinion Leaders, conferences and websites often transcend national boundaries. A consistent structure also allows companies to improve their sales force effectiveness and focus their resources on the most profitable markets and customers.

As economic buyers become more important, companies need the right structures to manage these stakeholders effectively. That often requires a change in their commercial model – for example, adding a new role such as a KAM to focus on these commercial stakeholders. What this means is discussed below.

Case study 2

One company was planning to launch a new single-use surgical device to different target customer groups in different countries. Through market research the company identified that the buying processes of these customer groups were similar across Europe, so the company chose a common strategy.

As a result, it was able to position the new device consistently across countries. By selecting a specific group of target customers, it was able to minimise the risk of cannibalising existing sales. The product was launched consistently and successfully in each market.

The economic buyer

We have argued that the customer’s buying process and the company’s selling strategy should determine the sales structure. But the buying process has changed in many device markets with the emergence of important commercial stakeholders such as purchasing groups, hospital administrators and, in Germany, buying groups. How should companies alter their selling strategies to capitalise on these changes?

One valuable approach is key account management. The idea behind KAM is straightforward: empower a single salesperson to lead a major (‘key’) account, such as a government payer, hospital chain or buying group. As they are charged with handling institutional accounts, KAMs can help the company to deal with the emergence of commercial stakeholders in making purchasing decisions – many medical technology companies have plenty of clinical representatives, but few commercial ones.

A KAM has the experience, skills and gravitas to make a value-based business case to senior decision-makers. What makes the KAM structure ultimately different is that it enables the medical device company to offer its full value proposition to the client, rather than a series of individual product pitches. KAMs often work across a portfolio, bringing a wider range of product and service solutions to the customer. The KAM co-ordinates resources from within the organisation as needed to meet customer needs and to maximise the value of individual accounts.

Via KAMs, companies can develop a partnership with customers to generate mutual benefits rather than working as independent (and sometimes adversarial) entities. Since KAMs can represent a company’s entire product portfolio, they bring clients a wider range of solutions, and can co-ordinate corporate resources to meet customer needs in ways previously not possible. Salespeople with the right commercial skills can unlock opportunities that clinical sales representatives often fail to crack.

Case study 3

For example, one medical supplies company had relied on clinical specialists for each of its business units. These people were highly skilled, often with a background in a hospital or nursing setting. However, they lacked commercial capabilities – negotiation skills, analytical ability or business acumen – and were losing out to competitors who were engaging with commercial stakeholders more effectively.

The company decided to introduce KAMs to focus on large hospitals and buying groups. The KAMs typically spoke to customers who were one or two levels higher up in the decision-making hierarchy. As well as discussing the whole portfolio of products from across the different business units, they were able to discuss non-product solutions – which opened the door to some innovative value offerings, such as taking over supply and logistics for an entire class of products.

This helped the customer by removing a time-consuming activity, and helped the company to better demonstrate its product benefits through access to usage data. The clinical representative would not even have been allowed to have that kind of conversation.

Yes, we KAM

The KAM structure is not without challenges. Many medical device companies (and pharmaceutical companies) have added KAMs but have struggled to make them effective. Common issues include the following:

• Integration with the wider sales force. Many companies have struggled to define how KAMs should integrate with representatives, first-line managers and the local marketing department. They need to define these people’s respective roles, responsibilities and co-ordination points.

• Recruiting and retention. Many companies have difficulty finding and retaining the right people to be key account managers. A top salesperson will often not succeed as a KAM.

• Pay and benefits. KAMs are often not given the same kind of pay and benefits as a first-line sales manager, even though their responsibilities may be similar or greater in scope.

• Resources and value proposition. Many companies make the mistake of assuming that since KAMs are smart they will automatically figure things out, rather than taking the time to understand what KAMs require in terms of process, resources and support to be effective.

All of these problems are surmountable with adequate focus and some patience – a successful KAM structure may take a significant amount of time to develop fully.

In the end, however, the benefits of a well-integrated KAM structure are enormous. KAMs are creating industry-leading business models, influencing senior non-clinical decision makers and breaking down traditional sales barriers. Resources need to be directed towards both clinical and non-clinical customers – getting this balance right will be a differentiator of performance for medical technology companies in Europe.

Conclusion

Leaders of medical device companies in Europe often inherit chaotic commercial structures, with operations in one country bearing little resemblance to those in another. These structures are the result of historical evolution that has often gone unchallenged for years.

These inconsistent structures inhibit companies from implementing their strategy effectively, and from capturing opportunities with important emerging commercial stakeholders. Companies should examine their commercial structures and make sure they reflect the buying process in their key markets and their own strategy. This may often require some restructuring and the addition of new roles such as KAMs to interact with important non-clinical stakeholders.

Companies that focus on designing effective commercial structures will be winners in the medium term. They will be better able to manage the key customer stakeholders and to implement their own strategies.

Rohan Fernando is the Managing Principal of ZS Europe and is based in London. He has consulted with numerous medical device and pharmaceutical companies in sales force strategy, integrations/mergers, targeting, compensation, product launch strategy and customer segmentation.

Roz Lawson is a London-based Manager at ZS Associates. She has worked with medical and surgical products companies in Europe on sales force strategy, structure and sales effectiveness projects.

ZS Associates is a global management consulting firm specialising in sales and marketing consulting, capability building and outsourcing. It has assisted more than 700 clients in 70 countries. ZS Associates has experience across a broad range of industries, including medtech, pharma and biotech.

What makes the KAM structure different is that it enables the medical device company to offer its full value proposition to the client, rather than a series of individual product pitches. KAMs often work across a portfolio, bringing a wider range of product and service solutions to the customer.