It’s more than just a conversation

So a friend of mine in a university business development office has been chatting to me recently about starting a conversation between engineers and clinicians to foster a cross-discipline culture within the university, and perhaps more specifically, in the area of medical technology.

And it got me thinking – why hasn’t this culture taken off properly yet? Why are we having this conversation in 2013? And what’s the goal of making clinicians talk with engineers? What does my friend aim to achieve on behalf of the university? For my friend’s benefit, I’ve decided to write a more in-depth, thought-out response. The ideas and context, for the uninitiated, can be seen a as foreign and complex. My hope is to de-mystify the area as best I can.

What I find surprising is that in our time, healthcare systems are highly dependant on technology and yet in our country, a leading academic/research institution appears to be grappling with how to foster the key internal links in healthcare technology development.

I believe that in the early stages of technology development, universities have a critical role in incubating and developing the next generation of technologies to meet the increasing demands of healthcare systems globally. Their vast internal networks traverse a wide range of resources, giving them a competitive edge when it comes to giving birth to new technologies. What is broken is the way in which these resources are pulled together in a meaningful and productive way.

In considering my friend’s professional plight, I’ve decided to consider in this post the fundamental basics of healthcare technology development, and hopefully I’ll address the challenges in the process. My friend’s challenge isn’t an isolated case, I suspect that many academic institutions around the globe face the same problems.

The development of new healthcare technologies requires a number of elements to be put in place. A key consideration is the outcome of what the technology will provide to the user, to the payer, and to the public in general. Context is key to streamlined technology development. Essentially, the technology needs to achieve an outcome. Engineers can build whatever you or they may dream of, but if the context isn’t there, or it’s the wrong context, these amazing pieces of technology are likely to disappear very quickly. If the need is not there, the technology won’t succeed commercially.

What this implies is that user requirements need to drive technology development – something that undoubtedly has been part of business plans for millions of companies, both in healthcare and other areas. What this also implies is that for anyone developing a new product, technology, or service, they need to have an understanding of the problem are trying to solve, and the context in which that problem resides. In healthcare, the problems can be identified (i.e., cancer, cardiovascular disease, etc). But what’s more difficult to identify and frame is the problem domain itself – a domain that often spans more than just the physical presentation of the disease and the patient. The interaction between the doctor and the patient is only part of a huge pipeline of how medical care is delivered to people; this pipeline must be considered when trying to define the problem and its domain.

Today, governments and private donors globally invest millions of dollars in medical research, and technology companies raise large sums of capital in private or on public markets to develop technologies that they hope will one day, address the most problematic diseases we face. Some are more successful than others, because some organisations/companies/individuals have encompassed other critical elements when they defined their technology’s problem domain, such as government, project financing and the research community.

Engineers are great at coming up with new, innovative technologies. Doctors are constantly identifying new problems and possible solutions for dealing with problematic diseases. Research scientists are at the cutting edge of incorporating new knowledge into developing new interventions and therapies. But what is lacking in this model? This stuff is all great, but how do you get it to all work together?

What is missing is entrepreneurship. A champion of the technology or solution. Someone who will catalyse everyone’s activities in this problem domain to work towards a common goal. A person that truly believes that an engineer can solve the technical hurdles that others have not overcome. A person that understands how the latest research discoveries can truly impact a patient and their quality of life. A person that can motivate the busy doctor to change his medical practice for the better. This is the medical technology entrepreneur.

Stanford University’s BioDesign incubator is the perfect example of how a university is training medical device entrepreneurs. It trains their BioDesign Innovation Fellows in how to understand the various problem domains of a disease, how to solve it with technology, verify the performance of the technology in the hospital/healthcare setting, find the capital to bring that technology to a minimum viable prototype with a view to launching that company into the wider market. The BioDesign fellowship is now entering its 14th year as of 2013, and has been expanded to India and Singapore as well – testament to its on-going success.

Of course, Australia has a longer way to go. Critical mass is difficult to achieve for a whole host of complex reasons, but that’s not an excuse for universities to put small initiatives into the too-hard-basket. Nor can they say that they don’t have the resources at their disposal to attempt these initiatives, because they do. They just don’t come in the form of “low hanging fruit” that you’d see in Silicon Valley.

Enough of the theorising. I don’t want to sound like all talk and no action. In order to facilitate healthcare technology/solution development in a university setting, here’s what I see needs to be done….

…at the undergraduate level

  1. Form an on-going set of undergraduate units for medical, engineering, health science, and commerce students that are all focused on developing possible solutions in healthcare. I would like to envisage these as a set of units where students from all different disciplines attend the same lectures, where the lectures are delivered by key figures in all the different disciplines required for getting a technology to the market. Doctors, research scientists, venture capitalists, engineering project managers from industry– all of them delivering content to enrolled students. This would give them true context about how the different elements in medical technology development affect each other in an ecosystem. Real world stuff, for all students of various backgrounds to learn and understand.
  2. Form an on-going project concerned with addressing a particular healthcare problem. Have representatives from each element (healthcare domain experts from a local hospital, senior engineers from a tech development company, an enthusiastic senior research scientist, a financier/venture capitalist) identify projects that can be tackled in small “bits”, where the work is performed by the undergraduate students in an environment where they get the correct training to do things “right”. Students in the engineering stream would have technical/project management training from the tech development company, commerce students would have mentoring in how to raise capital and complete internships, science and medical students would go into hospitals and research institutes to gain further insight under the guidance of senior research fellows. And of course, students from ANY discipline should have access to the resources that other students of differing streams have available.The way that I would see this done would be to have a few business development associates from the university watch over the ongoing running of the project, with the project divided into parts that each discipline tackles. The project may run from year to year, and a seasoned entrepreneur providing the overall championing of the project to ensure it stays on track.
  3. Reorganise some of the university’s statutes with regard to intellectual property to facilitate more flexible use, and provide incentive for student inventors. I remember when I was going through the fourth year of my engineering degree, we were tasked with making up a fictitious technology and writing a business plan that highlighted the technology’s potential. I clearly remember a friend of mine saying that he did not want to describe anything “too good”, because the university would automatically own the intellectual property generated, and that he did not want to give it over to the university. Sad as it was, I can understand his sentiments – the sentiment that the university would simply take the idea, then sit on it and do nothing with it. My friend had understood that the university did not have the will or the capability to take any of these ideas (good or bad) to a commercial solution would benefit someone.What I am suggesting is that for this particular set of undergraduate units, that any relevant intellectual property generated by inventors the officially recognised. If the intellectual property needs to be filed for patent as part of the overall IP strategy, have the students listed as co-inventors and give them a share in the spoils if the technology is successful further down the line. If the invention is to be kept as a trade secret, have some formal agreements that acknowledges the student’s/students’ contributions and again, give them a share of the profits upon exit.

The benefits are that the undergraduate students get real world experience, but in a safe learning environment. Yes, there are inherent risks, and all partners need to be aware that there will be a chance of failure. Failure is not necessarily a bad thing – it will allow for future projects to be more successful and everyone to learn.

…at the postgraduate level

This is a little more complex to implement, but may follow on from the undergraduate model

  1. Allow students participating in the undergraduate units a chance to continue developing the project in their respective areas. As part of their on-going postgraduate research, part of their time may be spent working on this university-born, industry-assisted, undergraduate program. Postgraduate students would have a chance to “continue where they left off”, and take the technology or research into a deeper level of complexity and understanding.
  2. Have postgraduate students be mentored by industry leaders. This will allow students to gain better insight as to how they take the technology to market, and how their postgraduate work impacts on the progress of the technology.
  3. Give postgraduate students the opportunity to be medical device entrepreneurs. We have lots of talented young scientists and engineers, but not all are going to be able to establish a career in medical research given the current funding arrangements for medical research in Australia. However, there is a skills gap in science entrepreneurship, we need more in this country and these opportunities will afford our bright PhD graduates the training needed to fill the gaps in this highly specialised  area.

Certainly, there are many other options that would be afforded to postgraduate students should they be allowed to maintain contact with the project. In response to the Chief Scientist of Australia, could this be a way to provide industry-relevant training to our PhD graduates? Well, we’ll never never know if we never never go.

So effectively, I’m proposing a small-scale, early-stage, faculty-interfacing incubator that could be used as a model for pulling together all the relevant domains within the university setting that are required for bringing healthcare technology to fruition. Certainly not on the scale of Stanford. Of course, there are a number of variations to this model that can also be considered, but for such programs to succeed, they require the absolute commitment of everyone involved. The university must not waiver in its support of such a program if it truly wants to be seen as facilitating health technology development.

So let’s return to my friend’s original musings about facilitating conversations between engineers and clinicians. I’m going to go out on a limb here and say that perhaps, they’re somewhat misguided. And I mean this in the most professional way possible – she’s a great friend of mine!

My view is that even if the engineer-clinician conversations were to take place, they would not amount to any significant action unless the university creates some sort of an environment in which these conversations could be taken further to a measurable outcome. I don’t feel that the “goal” here should be to work out a way to facilitate conversations between engineers and clinicians, such conversations should be the outcome of a well thought-out program to encourage health technology development in a university setting. If we’re asking what can be done to get engineers and clinicians to talk, then we’ve asked the wrong question. I can easily get a conversation started between an engineer and a clinician – just organise a drinks night with lots of booze and they’ll all be there. But somehow I don’t think that’s the objective here.

See, if an inventor wants to mature a technology (in context of my discussion, let’s assume it’s a technology relevant in healthcare), there’s really only a few options. Currently, a start-up and/or tech development company can do this, provided there’s enough money and an entrepreneurship element championing the technology/solution. The university simply licences out/sells the IP, and that’s the end of the story. The start-up would engage other external parties to further commercialise the technology. There would be no interaction between the inventor and others within the university ecosystem (i.e. clinicians) about the technology until perhaps a presentation/press release about the technology years down the track, where maybe a university-affiliated clinician sees it and say “Hey, why didn’t this guy speak to me earlier? Why did they go to another hospital on the other side of the world to do clinical trials when we could have done them here?” Quite boring really, but that’s the way it’s generally done – lots of missed opportunities because there’s no internal incubator. An incubator would allow the inventor to go to a “one-stop-shop” where there would be a mechanism in which the university could verify the problem-solution space using all its available technical expertise, not just the expertise it has in business development.

But enough of the university-bashing. I know they’re trying hard to move away from the out-licensing model so I have to give them credit there. The fact that my friend has been tasked with this challenge indicates that they’re aware they need to be more innovative.

Universities have one unique, abundant resource: young, energetic, students. Give them an industry-focused project and I can assure you, most will jump at the opportunity to test themselves. This is an opportunity for universities to be truly innovative not only in bringing healthcare technologies to life, but also in the education of students. It requires the university business development teams to be innovative! A challenge for my friend perhaps?

We know that senior academics in a university are always under pressure to do more with less, take on more teaching, bring in more research income, as well is perform research and supervise students. It is unlikely that these researchers will have the time available to take on any new research opportunities, unless their existing research commitments are diminishing, or they are an early-career researcher looking for a new area to move into. In order to prepare these early career researchers for this type of academic-based, commercially-oriented activities, we need to start training our students to deal with this new model as soon as they come into the university.

All this means that the university would need to innovate its existing structures to host all of these high-energy interactions. A big challenge for any business development team, but one that’s not insurmountable.

But of course, I’m just a PhD student, what would I know?

Thoughts and comments are always welcome.

@ayftan

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