Management is a constant series of choices

The management of the health services was a constant series of choices, whether in the allocation of funds for the purchase of an innovative medicine or the provision of extra home care packages, there was only a finite resource that was far outweighed by demand, Mr. Liam Cullen, Director of External Affairs and Public Policy, GSK told the Conference.

Liam Cullen
Liam Cullen

He said that in such circumstances, personal judgement was critical and there was a constant balancing act between getting it done and getting it right.

“Hopefully, they are one and the same thing. However, we know only too well that the lines can be blurred and words like Mid Staffs, Hillsborough and Deep Water Horizon become synonymous with tragedy. Our own pharmaceutical sector is not immune from examples of poor judgement and there are several well publicised cases where we have gotten it wrong.

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“When reflecting on the theme of today’s conference I thought of the immense challenge of what ‘Getting it Right’ actually entails for the vast majority of health managers and people in positions of responsibility within the health service. Undoubtedly, there are a myriad of Key Performance Indicators, budgetary targets and other measures that from a performance point of view at least, tracks whether you are Getting it Right.

Through our 72 manufacturing sites, we serve customers in 190 countries, moving our products over 350 million kilometres each year and all of this against a background of the need to reduce costs.

“But often for the majority of the public, it means swift access to an Emergency Department and the availability of a bed when admitted to a hospital. The complexity surrounding the staffing and various protocols required to oversee the smooth running of an Emergency Department is enormous and yet the public expectation is quite rightly high. For a patient or relative sitting in an Emergency Department, ‘Getting it Right’ means being treated in a timely and dignified fashion – all of which sounds very straight forward but is anything but.

“In the case of GSK, there are, I think, two main drivers of the need to ‘Get it Right’ and these are regulation and corporate culture. In such a heavily regulated sector as pharmaceuticals, external regulation and scrutiny is key. Without approval from the HPRA, the FDA or any other regulatory agency you simply cannot operate. More bluntly, regulatory approval is your license to operate. Through our 72 manufacturing sites, we serve customers in 190 countries, moving our products over 350 million kilometres each year and all of this against a background of the need to reduce costs. In order to make sure that each product or medicine produced meets the highest quality standards we have a rigorous and exacting internal audit process. And we are audited regularly. Our plant in Sligo had been audited three times this year by external agencies and the pattern is much the same for our sites in Cork and Dungarvan.”

Mr. Cullen said that In terms of corporate culture, GSK aspired to be a good corporate citizen. “That sounds worthy but what does it actually mean? Well at least in the view of Fortune Magazine it means the successful ‘balancing of scientific progress, social impact and the profit motive.’. It means eschewing short-termism for longer term sustainability. In March, GSK announced that we will no longer file drug patents in the lowest-income regions of the world—an integral part of our patient access strategy and we reinvest 20% of any profits we make in the least developed countries into training health workers and building medical infrastructure.

“We are trying to modernise the way we do our business – our behaviours and business practices. Put simply, we are trying to earn trust, or win back trust, that has been eroded and we are doing this through a number of measures.

In our respiratory portfolio in Ireland we have launched our three most recent medicines at a price equal or below the generation of medicines that we are aiming to replace.

“We are the world’s first pharmaceutical company to stop any payments to representatives as an incentive to generate prescriptions. Why? Not because it’s illegal or wrong but it can create the wrong perception. We want medicines to be prescribed on the basis of what is the best medicine available to prescribers. We have stopped all payments to Health Care Professionals to speak on our behalf. They are our customers, not our employees. The vexed question of pricing and affordability is central to the way in which the public and Governments view the pharmaceutical industry. We undermine trust when we cannot explain the value of a product and then seek a price above the current standard of care. In our respiratory portfolio in Ireland we have launched our three most recent medicines at a price equal or below the generation of medicines that we are aiming to replace.

“And just to keep it local for a minute, working with a smaller workforce with increased business demands we simply have to be more efficient. Earlier this year, we launched a ‘Getting it Right First Time Initiative’ and to take one example we focused on the expenses process. We have one employee who manages the expenses claims of all 1,800 GSK employees across Ireland. The system requires a high level of personal responsibility and input. What we found was that while people were fairly diligent in filling out their claims, there was a consistent pattern of rejection for small mistakes and repeat serial offenders. By highlighting the extra workload that this was putting on Louise, our expenses administrator, and by identifying the repeat offenders, we significantly changed behaviour and dramatically improved the process. Interestingly, there was no penalty imposed for the mistakes but an element of peer pressure and personalising the consequences of the behaviour had a significant impact. A small but hopefully illustrative example of ‘Getting it Right.’”

Mr. Cullen said he wanted to thank the HMI again for the partnership and friendship that had been built up over the last number of years.

“This is the sixth year that GSK has been associated with the HMI and the annual conference. The relationship with the HMI is one that we value and it fully aligns with our ambition to help support a dynamic and progressive health care system in Ireland. “