Updated: Sep 1, 2020
The leadership cases look at a different kind of leadership: the kind that goes 360° round.
360° Leadership is leadership that radiates towards the team you lead, but equally towards your superiors (+1 and beyond) as well as towards your peers. You lead from your most heartfull intentions (and not your ego that needs strokes). This results in having impact all around you.
This case will provide a great example and 3 major tips of how it is done. I am interviewing B. currently Managing Director of a top 3 pharmaceutical company in a European country.
B. used to be a colleague at a Business School. She is a real friend to me and a constant inspiration in terms of personal growth and leadership. A few months ago she told me this incredible story and during the winter holidays I invited her to discuss it in more detail and analyse it thoroughly, so we could share it with you.
A complex challenge
For a good understanding of this leadership story you have to understand the context of the pharmaceutical industry. After years of relatively empty pipelines, with limited new drugs coming out, we now see an important increase of truly innovative medicine being developed successfully for different diseases. One of these revolutionary breakthroughs is the field of immuno-oncology. Immuno-oncology drugs activate the body’s own immune system to attack cancer cells and by doing so these drugs can significantly reduce cancer progression and in some cases even cure patients and this with far less side effects than chemotherapy.
This case is about the introduction of such a drug on the Belgian market.
So, on this typically Belgian, gray Saturday afternoon before Christmas, we are sitting by the fireside, nice and cosy and B. starts to tell me her story.
"I had just started in a new position as Access and Public Affairs Director. I was heading of a department where we prepare the reimbursement of new drugs on the Belgian market. In Belgium we talk mainly to RIZIV, the Belgian equivalent of the NHS in the UK. It is our role to make sure that our medicines become available for Belgian patients at a fair price.
The key challenge is to strike a fine balance between speed (the later the drug is available, the more lives are lost), broad access (meaning get it refunded for all patients who can benefit), and this without jeopardizing the social security system ànd get a good price for us (to make sure that we can maintain our activities and fund our future research).
We had a powerful new medicine, which had demonstrated its efficacy in first types of cancers and it promised to have many more applications for different kinds of cancer in the future. For some of these cancers there are many patients, for some there are far less. Over three hundred clinical studies were running simultaneously and the expectation was that over the next few years, 10 to 15 new cancer indications would become available – al based on the same basic drug."
Facts of the Industry
"So let me give you a few facts of the industry:
1. Clinical studies are as costly for rare indications with few patients as for common ones with many patients.
2. A new drug needs to be accepted by the EC first and then by the local authorities.
3. In Belgium on average one year passes between the approval at EC level (which means the drug is safe and has demonstrated benefit) and actual being reimbursed for patients. This time lapse is due to the different steps in the reimbursement process followed by sometimes lengthy negotiations on the price.
4. In general, the more patients for a certain drug, the lower the price RIZIV is willing to pay per patient.
5. With every new indication for a certain molecule and therefore extra patients, the price drops, never to go up again, not even if there are totally new groups of patients for which the drug proves to be very valuable.
All of this make a lot of sense in general and it is the framework within which reimbursement have been going on for years."
"With this specific molecule however, there were two major challenges.
The first one regards time and the fact that between each granted indication on EC level, another year goes by until Belgian cancer patients obtain access. For 10 - 15 indications over the coming years, this would mean an endless period of time and cancer patients don’t have time. We risked that many people would die while we are negotiating indication by indication without an opportunity to access this new drug.
The other challenge was about the price of the drug. With the current system, prices would go down with each new cancer indication, even if it was a rather rare cancer, with only limited number of patients. This would actually take away the incentive to launch indications for rare cancers, which of course would be a big issue for those patients. "
A road less travelled
"I asked my team: why can't we negotiate access for all upcoming indications at once?
The immediate answer was a glance of consternation in my direction and a faint: 'it just does not work that way', ‘there is a strict regulated reimbursement process that needs to be followed’ and also 'the company does not like bulk deals', 'it will never be accepted at HQ'.
I could not simply accept ‘it has never been done before’ as a valid argument. I believe that there are always options and that different situations require different actions. Also, I have a habit to take baselines and company values literally. If we claim 'patients first, profits will follow' then I simply must do what it takes to live up to that.
After thinking it through, I decided to give it a try. What harm could a couple of phone calls do to important decision makers in the Belgian reimbursement system as well as within the company?
I prepared well for each phone call, with the help of the team. I succeeded in scheduling a 'pipeline meeting' with the Minister of Health's right hand. We would meet to inform them about the new medicines in our pipeline and to explore possibilities, nothing more. This was a safe place to start. The fact that the meeting was granted did not really surprise me. Why would the Ministry of Health not want to discuss breakthrough drugs, and how to accelerate access?"
Negotiating is a job of respect and patience
"From there we took it one step at the time. We were doing something that had never been tried before, in the Belgian healthcare system and in our own organization. A lot of stakeholders were involved and needed to be aligned.
But together we succeeded. We reached a bulk agreement that was fair and reasonable for both the RIZIV and our company. It took hours and hours of cautiously informing each other and negotiating with each other and also influencing our respective stakeholders. That was really the difficult part, but finally the deal was accepted by both organizations.
It was done against all odds, and against all existing customs within both the Belgian reimbursement system and our company. But the fact is that the drug became available 10 months earlier than it would have when we would have negotiated the normal way and for all next applications it will be immediately be reimbursed after EC approval. This has saved many real lives.
The moment I received the message that we reached the final agreement, was one of the best of my career."
Influencing the big boss
But the story does not end there. As the reimbursement of this new drug was so uncommonly swift in Belgium, while other countries were lagging behind and still struggling to handle the multiple indications, B. was invited to present the case at the worldwide General Managers Meeting of the company.
At the end of the presentation, she received explicit complements from the CEO. He turned to the assembly of top management and said: "I want all of you to think this way."
After the presentation, the CEO came up to B. and introduced himself. 'I know who you are,' said B. with a smile. She shook his hand and added: 'I am B.' He could not help himself smiling. 'I know that now too,' he said.
In this way, the leadership circle was complete: B. had set an example that went 360° round, as it included not only her team, but also her superiors and peers as well.
What does it take?
Our actions are always preceded by our thinking, even if this thinking is subconscious. These are some of the enlightning quotes on B's thinking, I assembled from the conversation.
About doing. I listen to understand. I stand on the same level, not above or below people.
About competencies. Listening, thinking, rationality.
About values and beliefs. I am not afraid to shine. A better solution exists. I don't want it all to be for nothing. We have a task here. Patients first. There are always other options. Other people are partners, not adversaries or enemies. We are going to make a bigger pie together. It was the right thing to do. It is good for all involved. If I fail, I will still be all right. Even if I am fired, I will still be all right.
About role. I am the slightly naive, but very curious access and public affairs manager. Being new in a role and not knowing the customs is a key strength.
About mission. Patients first, correctness, joy.
Ask yourself the question: are these the kind of thoughts you have when you face a challenge?
How was this leadership developed?
I remember B. as intelligent and straight forward, but she was not always the inspiring leader she is today. Wat helped you evolve?, was my next question.
"I would say: Investing in myself and making my personal development a priority. I took every opportunity to learn and evolve. I regularly changed jobs and took stretch assignments to get me out of my comfort zone. Over the years, I also followed several leadership trainings and coaching sessions. I’m lucky to work for a company which provides opportunities to employees to develop but not everybody uses this to same extend. For most of the trainings I followed, I pro-actively asked for it. I also read a lot – in particular business books and books or articles about leadership topics and I reflect on it. And I ask regular feedback to my peers, managers and my direct reports so I know what I should focus on going forward”
Do you make efforts to keep fit?
"I do. Athletes know that the moments of rest and recovery are just as important as the trainings sessions to be able to perform at your best during a race. I believe, this is also true in a work environment. I build in regular moments of recovery. These are real breaks where I clear my mind (weekly joggings, longer walks with my family, short lunch breaks during the day, …)
And beside that I also keep my priorities in the right order. I remember a time when I had to leave the negotiations because I had to get my daugther from school. I am not only my job, I am a mother as well and I am not afraid to express this.”
Conclusion: three pillars of inspiring leadership
Sorting it all, you can see that B. is standing firmly on the 3 pillars of 360° leadership.
1. Heart. Find a mission and be true to it.
For B. the highest value is 'joy'. From the place of joy that is her essence, she is able to play the right role and pursue her values. Saving her own position is not on her mind. Doing the right thing is.
2. Mind. Fear not and be rational.
From those strong beliefs, and due to lack of fear resulting from that, she can be patient, resilient and most of all rational. She can observe, look at the facts and generate options until a solution is found.
3. Body. Take care of your health and well-being.
Underpinning it all is taking care of your body and your general well-being. Taking care of loved ones can also be part of that. Not identifying completely with the job can help to stay fresh and alert. B. knows this: you can not do this if you are dead tired.
And so, it is no surprise that B. is happy and that she is getting noticed, in a good inspiring way.
And what about you?
Of course you would you like to feel creative and fearless like B.
Discover how far evolved you are and take the test to give you an idea:
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Kristien De Wolf is a certified career coach accepting VDAB cheques.
You are entitled to these cheques if you work in the Flamish region as an employee or independent.
Kristien De Wolf is personal business coach with 20 years of international experience, certified in NLP and Transpersonal Coaching and Counseling.
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