In the precision medicine era, the line between products and services is blurred – PMLiVE

Precision and personalised medicines are more than products, they are services in their own right. So, how should pharma approach this uncharted territory to ensure targeted therapies work for patients?

Personalised and precision medicines are exciting fields that focus on the development of treatment and prevention strategies for a single patient or patient group. The treatments are developed using cutting- edge technologies such as genomic sequencing and genetic engineering, helping to account for the individual variability in both patient and disease characteristics.

This has gained a lot of attention in recent years due to revolutionary breakthroughs in debilitating chronic diseases such as cancer. Traditionally, cancer patients are treated using one size fits all interventions like chemotherapy, radiotherapy and surgery. These vary in their effectiveness and result in damage to healthy tissues.

Personalised and precision medicine, however, can offer specialised treatments that target the patients unique cancer subtype, its genetic mutations, and the affected tissues.

These therapies involve novel pathways and complex processes to aid and deliver treatment, making each therapy a service in its own right. They depend on many touchpoints, stakeholders, partnerships and interdependencies to treat patients.

As a result, designing suitable services to support patients, caregivers and healthcare providers throughout the treatment pathway is essential. However, doing so successfully depends on understanding how to best approach the design of services in this challenging landscape.

Optimising the service behind the personalised and precision medicine is crucial for turning the treatment into a viable and differentiated option for patients. To make a real difference and ensure the therapy is competitive, we need to adopt a service design approach.

Service design is a multidisciplinary art and science that enables us to take a holistic view of the service experience, along with a deep understanding of the target groups, such as patients and healthcare professionals, and the context they operate in. This can include using empathic methodologies, such as in-depth interviews and field studies.

Gaining a comprehensive understanding of the customers needs, how they experience the current service, and how future services address their unmet needs.

Involving different stakeholders throughout the design process to gain a wide range of knowledge and expertise, and to further drive customer-centricity across the business.

Using visual tools such as sketches, maps and prototypes to improve and ease communication and collaboration between the different stakeholders involved in the creative process (surpassing language and knowledge boundaries).

Following a learning-by-doing approach via continuous prototyping and testing to evaluate solutions before investing time and resources on development.

Understanding how the customer experiences the whole service journey and then identifying insight gaps and opportunities for service innovation by looking at the big picture.

Personalised and precision medicines are naturally patient-centred (compared to traditional pharmaceuticals), as the individual patient is central to the product design. Taking this empathic approach throughout the design process provides a deeper understanding of those needs as well as their context.

This means not only adopting collaborative thinking during the design phase but also during production and development.

To deliver these unique therapies to patients, pharmaceutical companies must partner with a wide range of specialised third parties including laboratories, manufacturers, shipping and storing providers.

Looking at the entire service and all of its touchpoints from above is crucial

By engaging with multidisciplinary teams from all levels across the organisation, as well as numerous stakeholders during the co-creation process, you will increase the organisations knowledge and expertise, resulting in better and more fit-for-purpose solutions. Bring this sense of collaboration into the design process to encourage a higher level of consistency, placement and commitment to the patient and ensure they are at the centre of the service philosophy.

Novel therapies require designers to be adaptive. New developments such as changes in the supply chain, shorter genomic sequencing process or the need for an additional quality assurance step, often lead to changes to the envisaged treatment pathway. As a result, it is necessary to have a view of the whole service, in one place, which can be continuously updated.

Visual tools such as customer journey maps and service blueprints are a core part of service design. Journey maps (such as the one featured on p.16) provide an overarching view of the customer experience, along with the pain points, gaps, unmet needs and opportunities for engagement. Service blueprints visualise the process behind the service and the people impacted by it. These tools not only make it easier to understand the service, but they can also help simplify communication and increase alignment between the many individuals engaged in the project.

For personalised and precision medicines, patient journeys and service blueprints can help capture the front-end of the service, which is visible to patients, and the back-end processes, which are used by healthcare professionals. This gives us insights into the interactions, touchpoints and relationships between the patient and various stakeholders, such as the different healthcare professionals, carers and patient groups. Looking at the entire service and all of its touchpoints from above is crucial for making improvements that enrich the customer experience.

CAR-T is a new individualised cancer immunotherapy that has taken precision medicine to a new level. In a nutshell, CAR-T therapy involves extracting T-cells (a type of white blood cells that play a key role in immune response) from the patient, genetically engineering them to target the cancer cells and infusing them back into the patients body.

The CAR-T treatment pathway for a blood cancer involves a uniquely large number of stakeholders, touchpoints and interdependent processes that take place both in the front-end (i.e. visible to the patient) and back-end (i.e. visible to healthcare professionals). Below is a high- level overview of a typical CAR-T journey that can illustrate this complexity:

1. After the patient has identified as a suitable candidate for CAR-T therapy, they are referred by their primary oncologist to a specialised treatment centre to further assess treatment eligibility

2. Once eligibility has been established, the patient undergoes leukapheresis to extract T-cells

3.The samples are sent to a separate facility where they are frozen and prepared for shipping

4. The cells are then sent to a manufacturer where they are genetically engineered to target the patient's cancer cells and multiplied - to create the CAR-T product

5.The product needs to be shipped back to the treatment centre and stored frozen until the patient is ready for infusion

6. The shipping and manufacturing processes can take 34 weeks, during which the patient receives bridging therapy (to slow down disease progression)

7.A few days before the infusion, the patient undergoes lymphodepleting chemotherapy to prepare their body

8. After the infusion, the patient needs to be closely monitored for side effects for 1-3 weeks. Some side effects (e.g. Cytokine Release Syndrome) can require hospitalisation

9. The post-infusion period involves continuous tumour assessment and long-term follow-up

We recently pitched to a pharmaceutical company preparing to launch their new CAR-T therapy to help them design a set of patient-and caregiver-supporting services. We quickly became aware ofthe complicated nature of this therapy and decided to kick off by mapping the treatment pathway and the actors involved.

We normally kick off this type of project by conducting primary research with customers (using empathic methodologies) to generate insights that can inform the journey design. However, due to its novelty, it was difficult to access patients who have recently undergone CAR-T therapy. Instead, we carried out in-depth interviews with different types of stakeholders who had considerable experience working on early CAR-T therapies and clinical trials. This gave us insights into the healthcare professionals experience and visibility into the back-end processes.

The insights we gathered allowed us to understand the experience of patients and their caregivers. We could identify their emotional, practical and information-related needs and highlight the pain points that need to be addressed by the future services.

We also created empathy maps, another tool from the service design toolkit, to visually articulate what we know about the customers.

Once we completed the CAR-T patient and caregiver empathy maps, we created the CAR-T journey. The process relied heavily on co-creation by gathering input from key collaborators from the client company, including both medical and commercial personnel.

The continuous consolidation of insights from primary research, secondary research and stakeholder research was highly iterative. This ensured that the journey captured the envisaged treatment pathway in an accurate and comprehensible manner and that we were able to identify insight gaps as they emerged. From there we could then initiate the required steps to address them through additional research.

When executed correctly, a good customer journey is also adaptive and can be re-worked to reflect the changes that naturally occur over time. This is particularly important for journeys that have beencreated pre-launch and need to be revised, post-launch, to align with the emerging reality of the treatment, and for dealing with complicated treatments that are prone to nuanced changes. Both of these scenarios were true in the case of the CAR-T treatment.

The patient journey can also be used in collaborative design workshops with the client and their partners, as it successfully communicates a complicated pathway in a structured, easily digestible visual manner. It acts as a common language that different collaborators from different roles and backgrounds can use to achieve a shared understanding of the envisaged process and the end-to-end customer experience.

Last and perhaps most importantly it can be used to inform and generate new service ideas collaboratively using the journey as a stimulus, by focusing on key pain points and unmet needs.

This type of work is not possible without service design methodologies. These tools enable a diverse group of professionals from different roles and companies to come together and benefit from holistic, visual, customer-centred tools like empathy maps and customers journeys that make iteration and co-creation possible.

To find out how we can help you design a service for a complex medicine, contactsimon.young@fishawack.com

If you would like to request a free, full copy of our CAR-T Service experience map (snippet pictured above) please get in touch withnatasha.cowan@fishawack.com

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In the precision medicine era, the line between products and services is blurred - PMLiVE