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Talent and culture needs for the thirdera of medical affairs: Impact @ scale
Preparing for medical affairs as the healthcare integrator
By Andy Higgins, Lucy Snowdon, Hensley Evans, Alex Turok and Bora ErdemliWHITE PAPER

Medical affairs is at another crossroads. For most of its history, medical affairs’ mission has
been straightforward: ensuring that healthcare professionals (HCPs) treat patients in thesafest, most efficacious and most appropriate way. It accomplished this mission throughtrickle-down education, meeting with key opinion leaders (KOLs) and other top HCPs to makesure they understood the latest scientific data, and then relied on those leaders to cascade
scientific opinion across the practitioner universe. We might refer to this as the “first era of
medical affairs,” a time where medical affairs presented itself as the field’s scientific expert.
In more recent history, medical affairs has been asked to become a strategic “third pillar”
of the pharmaceutical industry. Medical affairs accepted the invitation to join the table withother functional strategic decision-makers, including commercial and R&D. ZS estimates thatbetween 2019 and 2023, the percentage of medical affairs leaders who report directly to theircompany’s CEO doubled, from approximately 30% to near 60%. And while that still leaves
many medical affairs leaders without a comparable seat at the table, the rise of medical
affairs’ critical contributions to the pharmaceutical industry and to healthcare more generally
is undeniable. As others have noted already, the “second era of medical affairs”—as thestrategic partner—has begun.
Medical affairs as a function within pharma continues to change, and the changes we’reseeing within medical affairs organizations are unprecedented. These changes are occurringin response to many factors: growing clinical inertia, the proliferation of generics andbiosimilars, tougher HCP access coinciding with an explosion in the volume of scientific dataand patients’ increased role in their treatment journeys. Medical affairs is responding tothis in a wide variety of ways, ranging from reinvestment in internal capabilities to entire
organizational redesigns and transformations.
Medical affairs organizations are meanwhile investing in digital and analytical innovations
that span from real-world data analytics models that quantify patient care gaps andlarge language model (LLM)-enabled medical science liaison (MSL) listening channels tothe digitalization of medical business processes and deep system integration to create
an ecosystem of capabilities related to insights, strategy, tactics, execution and impact
measurement. According to recent ZS research (see the 2023 ZS medical affairs outlook
report), approximately 45% of medical affairs organizations have a centralized data andanalytics hub. These transformations, while challenging for organizations, are aimed atfurther unlocking the value that medical affairs can realize in the new era.

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FIGURE 1:

The third era of medical affairs will be defined as the era of medical
impact at scale
From• Sharing data with KOLs

To

• Changing how care is delivered• Driving product understanding via scientific exchange • Driving product definition via differentiated evidence• Product-based scientific exchange• Disease-level scientific exchange, incl. clinical,• Optimizing for today• Shaping tomorrow

economic and social determinates of healthThis paper explores two primary questions:
1. What is this third era of medical affairs? What is driving it, when will it be here and whatchanges can we expect to see?
2. What are the talent and culture needs that medical affairs will require to meet the newchallenge of medical impact @ scale?

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Medical affairs’ third era: Healthcare integrator
to create impact @ scale
Change isn’t new for medical affairs. The evolution of medical affairs encompasses three
distinct eras, each characterized by the forces that shaped how medical affairs operated
within the context of the pharmaceutical industry:
FIGURE 2:

The 3 distinct areas of medical affairs’ evolution

Second era

First era

• Medical aﬀairs’ original scopeand purpose was to ensure thesafe and appropriate use ofpharmaceutical products.
• This mission was at ﬁrst
achieved primarily through “datadissemination,” but the strategy
soon evolved to prioritize
scientiﬁc dialogue between MSLs
and KOLs.
• This scope has been the focus of
medical aﬀairs for a signiﬁcantportion of its history and is what
has generated signiﬁcant trustand credibility for the function tothis day.

Third era
Medical aﬀairs as thehealthcare integrator

Medical aﬀairs as thestrategic partner

Medical aﬀairs as thescientiﬁc expert

Many medical aﬀairs
organizations are still settling
into the ambitions and promiseof this second era•

Over the past decade,pharmaceutical organizations
have increasingly recognized
medical aﬀairs as a strategic
partner, sitting them alongside
their commercial and R&D
teams.

•

Medical aﬀairs now plays aleading role in developing asset
strategy, particularly within
integrated evidence strategy
and planning, whereapproximately two-thirds ofpharmaceutical enterprises
employ medical aﬀairs in thelead role. As a result, medical
aﬀairs now engages with asigniﬁcantly expanded set of
external stakeholders beyond
the KOLs that were their focus•

Treatment pathways are
becoming more complex andfragmented as scientiﬁcinnovation skyrockets. In thisera, medical aﬀairs will continue
to play a strong role as a
strategic partner, but also needs
to evolve beyond its earlier
visions. To ensure scientiﬁcinnovation reaches patients asquickly and eﬀectively as
possible, medical aﬀairs needs
to transform care pathways atscale.

in the earlier era.

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The medical affairs mandate
How can medical affairs deliver better patient outcomes at scale? First, it’s importantto recognize that medical affairs has coalesced around three core areas of work that are
essential to patient impact. Success in the third era is less about changing what medical
affairs does, but how it does it. We might call the “what” of medical affairs “The medical
affairs mandate.” The areas are:
1. Creating differential medical value: Making innovation more valuable to external
stakeholders over the life of the asset by generating differentiated and valuable evidence
that motivates and compels external stakeholders for the benefit of patients
2. Enabling evidence-based healthcare decisions: Translating science into trustworthy andmotivating directives that enable changes in routine clinical practice
3. Generating insights that inform strategy: Combining scientific expertise with external
stakeholder knowledge to drive strategic decision-making
Medical affairs organizations are currently falling short of delivering on this mandate. Those
failures can typically be attributed to four factors:• Pharma organizations continue to struggle with early R&D success. While this isn’t solely
the domain of medical affairs, one implication is that medical affairs needs to be involved
early in the life cycle, often as early as phase 2. In some organizations, medical affairs
joins new product planning matrix teams, bringing their expertise on where treatment
is heading (as opposed to where it stands) and helping deliver a label that can be more
quickly adopted at the community level.

• It takes too long for scientific innovation to reach patients in clinical care settings,
especially at scale. On average, it takes approximately 17 years from the time a new
product is approved to when guidelines and protocols are updated to carry through thisinnovation to patients who need it.

• Individual launch ROI is shrinking and the potential for future blockbusters is diminishing.
One way that pharma organizations are responding to this is by coalescing around specificdiseases and disease areas. Pharma organizations are thinking disease-specific, whichmeans that medical affairs departments have tremendous roles to play in strategic launchplanning through evaluating and consolidating information at the disease level to develop
stronger disease strategies.

• Partnerships between pharma and other ecosystem stakeholder groups, such as
hospitals, medical associations and patient advocacy groups, have failed to scale. And
while medical affairs organizations have all the main ingredients to broker partnerships—
including access, trust, credibility and the ability to drive outcomes for all members of thepartnership—most aren’t yet sufficiently sophisticated or resourced to do it at scale.
To transform their organizations, medical affairs leaders need to start with an assessmentand evolution of their talent-mix and culture.

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The medical affairs revolution
ZS has developed the Organization rEvolutionTM framework to guide healthcare leaders,
including those in medical affairs, to ensure that their organizations are equipped to meet thedemands and challenges of driving better patient outcomes.
The ZS approach is centered around talent and culture while remaining rooted in enterprisestrategy and purpose. In our experience, most transformations over-index on the moretangible elements of organizational transformation, including organizational structure,
governance, processes and data—the outside levers of the model described below. But what
is often neglected are the more intangible elements, such as talent and culture. ZS recognizes
that all organizations are, ultimately, collections of people, and if we don’t place the people(talent) and the collective values and behaviors of those people (culture) at the center, theneven the best “hardware” and “software” elements will fail to achieve a transformational
impact.
FIGURE 3:

The ZS Organization rEvolution framework
HardwareBehavior

Culture

tn

er

sh

ip

s

of
ys
Wa rking
woStrategy
and purpose

TalentPar

Org
capabilities

re

sp

St r

d
an
ta
Da te c huc
a t uron nd e
sib
ili t
ie s

Objectives
andincentives

Organization
performance

Governance

S of t ware
Hardware/software citation: Michael L. Tushman and Charles A. O’Reilly III’s “Winning Through Innovation: A
Practical Guide to Leading Organizational Change and Renewal,” and, more recently, “Lead and Disrupt: How to
Solve the Innovator’s Dilemma,” the second edition, by the same authors.

ZS places talent and culture at the center of its organizational design. Talent and culture
are the motor oil that enables the operating model to drive change and organizational
performance.

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Meeting medical affairs’ talent needsin the third era
The profiles of medical affairs practitioners have historically been highly scientific in nature,often recruiting candidates from academia and clinical care. This made perfect sense in thefirst era and has continued to work reasonably well in the second. This scientific expertise
will, and must, continue to serve as the foundation for all medical affairs organizations going
forward. However, scientific expertise is increasingly becoming table stakes, with other skills
and competencies emerging to differentiate medical affairs organizations from one another.
The third era will require four competencies from medical affairs talent: adopting a “futurist”
mindset, promoting digital fluency, driving partnerships and navigating organizational
dynamics.

Adopting a futurist mindset
Medical affairs sits in a uniquely advantaged position—able to draw simultaneously on deep
scientific knowledge and external stakeholder feedback, attitudes and perceptions. No
other function occupies this vantage point. Medical affairs leaders must draw on these deep
insights to meaningfully advance the science within a disease to continually improve patient
outcomes well into the future. This requires working hand in hand with leaders in a disease
area to understand the frontier of science (for example, new endpoints, biomarkers, testing)that will shape future treatment guidelines in five to 10 years. Success will require two main
actions: cultivating a competitive spirit and identifying trends more systematically.
Cultivating a competitive spirit requires leaders to encourage activities that challenge theinternal view of how the future is likely to unfold, such as strengthening how competitive
intelligence is woven into medical strategic planning (including medical brand planning andevidence strategy) or deploying “competitive war-gaming” approaches. This happens insome organizations today, but as a whole, medical affairs has been reluctant to embrace acompetitive spirit on par with their commercial colleagues.
To be systematic in the way they identify trends, medical affairs teams should look at thebroader industry and understand the implications of these trends for the organization. For
example, teams should interrogate how AI will change healthcare for patients and what thosechanges will mean for the medical function. Note that this approach requires more comfort
with ambiguity than medical affairs is typically accustomed to; futurists are wrong much
more often than they’re right.

Promoting digital fluency
Data and technology are once again taking center stage in healthcare. Medical affairs
organizations need to embrace data and technology both in how they leverage thesecapabilities internally and in response to how HCPs and patients are newly interacting withhealthcare information, given the availability of LLMs like ChatGPT-4. This shift requires
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product managers, and significant upskilling across the rest of the organization. Field medical
teams will also need to adopt technology into their ways of working.
Establishing dedicated medical “intelligence” teams within medical affairs is one action thatleaders should consider. Medical affairs has historically made small n-size decisions based on
feedback from steering committees and KOL engagement at key meetings. With the power of
LLMs and generative AI, medical can unlock new value from unstructured data (such as MSL
notes, advisory board recordings and medical information transcripts) to inform strategy inreal time. These teams should be staffed with talent whose core expertise lies in generativeAI, data, technology and analytics but who also understand the challenges that medical
affairs seeks to overcome and who are close to the medical “business” stakeholders they
serve. Medical affairs leaders should fight to add these talent profiles to their teams.
Another thing leaders can do is invest in large-scale transformational learning programs to
upskill the rest of the organization. Medical affairs organizations will need to attract new,expert talent, including data scientists and AI engineers, among others. While medical affairs
practitioners need not have advanced training in building algorithmic models or creating
medical data lakes, they ought to be comfortable with these types of ideas; efforts atorganizational change will be hampered by low organizational digital fluency.
Stronger digital capabilities within medical affairs drive stronger performance across nearly
all medical affairs domains. In a recent organizational capability benchmarking evaluation,
ZS observed that medical affairs organizations that rated higher on data and technology
capabilities also rated higher across multiple other organizational capabilities, including
medical strategic planning, scientific exchange and scientific communication. When we lookat specific cases, the causation is clear: Conscious investment in data and tech is driving
superior medical impact.

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Driving partnerships
Recruiting talent who will serve as an “adaptive” or “integrative” layer, creating connections
both inside and outside of the pharma enterprise, is critical to driving partnerships andensuring strong global-to-local coordination. These adaptive skills haven’t historically beenprioritized in medical affairs. ZS envisions that new talent can be grouped into two roles:
brokers who navigate gaps between different agendas and connectors who navigate gaps
between similar agendas in different places. Collectively these roles would bridge theorganization’s science, innovation, business and operations layers. Today’s tasks for medical
affairs leaders include:• Creating new roles within medical affairs to manage an expanding and diverse base ofpartners, including diagnostic and device partners, AI partners and technology companies• Establishing co-creation models and frameworks to more effectively navigate partnershipdiscussions with external health systems, focusing on outcomes that matter to them

• Ensuring field medical teams are participating in broader multidisease treatment and“total office” interactions focused on understanding the unique nuances of care delivery,
protocols and patient flow within their targeted disease areas

Navigating organizational dynamics
More and more functional leaders are asking challenging questions to their medical affairs
leadership counterparts: What impact are you delivering? How can you quantify this impact?
What is the ROI on our investments? These questions indicate that these leaders remain
skeptical toward medical affairs’ role within their organizations. Often these questions stemfrom misunderstanding the industrywide challenge to “prove” impact. Answering thesequestions requires that medical affairs leaders understand hidden organizational dynamics
and unwritten power structures. Building trust and increasing influence will enable medical
affairs leaders to promote their value in a way that aligns better with how commercial
leaders think and communicate. In other words, understanding these dynamics will empower
medical affairs leaders to speak in terms that their cross-functional leaders will understandand in a way that will resonate with them.
Medical affairs leaders need to be capable of having the seat at the C-suite table, and theyneed to leverage that position by speaking fluently about both science and business strategy
simultaneously, demonstrating their impact on both patients and the organization. Doing so
requires striking the right balance between maintaining the integrity of medical affairs via its
nonpromotional mandate and supporting broader organizational goals.

Getting culture correct in medical affairs’ third era
Most transformations focus on process, structure and governance models at the expenseof culture, even though most medical affairs leaders would acknowledge the importanceof culture on the organization’s success. (Peter Drucker’s supposed quip that “culture eats
strategy for breakfast” still looms large.) Part of the mismatch stems from levers other© 2024 ZS | 8

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than culture being easier to understand: Establishing new roles changes the organization’s
structure, for instance, much like investing in new systems and applications changes theorganization’s relationship to technology. But culture has historically been hard to analyze,
and even harder to change, especially by leaders not trained in its influence on teamproductivity. When embarking on a transformation, organizations must identify the featuresof their culture that act either as accelerators of or barriers to the new organizational
purpose. Because culture is such a significant driver of behavior, organizationaltransformations can fail to achieve their core purpose without changes to the culture or tothose behaviors.
The ZS Cultural Topography innovation enables leaders, in medical affairs and elsewhere,
to apply science to the art of culture. Our AI-based approach uses an LLM to analyze
unstructured text collected through an employee survey. In contrast to “constrained” models
in which employees select from a predetermined list of cultural dimensions, unstructured
text analysis enables ZS to map and understand an organization’s unique culture andsubcultures more accurately.
Medical affairs leaders need to understand the cultural hallmarks of their organization
today, which will enable the organization to move seamlessly into the third era and which will
require targeted interventions to evolve. Across all organizations, there exists culture tension.
The tension between getting the details right and “thinking big.” Tension between individual
accountability and driving toward consensus. Even the tension between work-life balance anda drive toward high performance. Each of these dimensions presents an unavoidable tension,and organizational culture is defined by the extent to which each dimension “dominates”
another. Identifying the dominant cultural dimensions allows leaders to understand thesebarriers and unlock the levers of organizational change.
Organizations need to leverage the dominant features of their culture throughcommunication, training and talent strategies to enable a change in how their organizations
work. We expect a few cultural changes will be required for medical affairs to thrive in thethird era:

• Moving from a “perfectionist” culture to one that operates under the “80-20” rule,prioritizing areas that drive the greatest impact• Moving from scientific collaborator to strategic decision-maker• Moving from a risk-averse culture to one that seeks to break the status quo• Moving from a rigid, rules-based culture to one that embraces adaptability• Moving from tech-skeptic to digitally literate© 2024 ZS | 9

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An organization’s strategy and purpose drive the rest, and for medical affairs the strategy
and purpose are largely a function of:• The disease areas in which the organization operates• The relevant external stakeholders and customers• The enterprise’s overall portfolio and life cycle
These factors will drive significant variability and diversity in how an organization’s structure,roles and processes, among other features, are activated.

Mapping a path forward for medical affairs
Change is once again on its way to medical affairs. As in past transformations, whether laying
the foundations to create medical affairs’ first era or evolving into the second, only thoseorganizations that proactively prepare will be positioned to thrive. And those that don’t willbe left behind. Transformations must begin with an organization’s vision for what medical
affairs can accomplish in the third era, and how that vision enables the company’s strategy
and its patients. But the work doesn’t end there; after settling on a vision, organizations
must closely examine their talent and their culture to identify the biggest friction points inachieving that vision. Once those points are identified, medical affairs organizations can map
a path forward that addresses all the other essential elements of organization design.

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About the authors
Andy Higgins is an associate principal at ZS and leads the strategy
and excellence vertical for the global ZS medical and evidence practicearea, as well as the medical and evidence team in Europe. He has ledorganizational transformation initiatives, large-scale capability-building
programs and has worked across all medical affairs domains at the global
and affiliate level.

Lucy Snowdon is a manager in the ZS strategy and transformation
practice focused on organization design. She supports clients throughout
the organizational design journey from strategy and capability
development through to implementation and change enablement. Lucy
has a particular focus on culture and its role in enabling or preventing
successful change in organizations.

Hensley Evans is a principal at ZS and leads the global transformation
practice. Her work integrates organization design, program management,
talent and learning, and change enablement to help clients pull throughkey transformations and ensure that the organization is able to realize theexpected value of these decisions. Hensley and her team often start bycreating a clear vision for the organizational transformation and building astrong business case for change.

Alex Turok is a principal at ZS and leads the integrated evidence strategy
and planning service line and is also the medical affairs lead for AmericasEast. He helps clients deliver a differentiated evidence package to external
healthcare stakeholders. Alex also focuses on bringing innovative
solutions and building a deep community of experts who can support
functional transformation.

Bora Erdemli is a principal at ZS and a leader at ZS’s global medical affairs
and evidence practice. With extensive experience in the life sciencesindustry, Bora focuses on developing robust medical affairs strategies,
creating comprehensive evidence and data generation plans, and driving
scientific exchange through strategic external engagement. Bora also
excels at helping organizations effectively gather and communicate
critical insights, leveraging a deep understanding of real-world data andadvanced analytics to enable data-driven decision-making.

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About ZS
ZS is a management consulting and technology firm
focused on transforming global healthcare andbeyond. We leverage our leading-edge analytics,
plus the power of data, science and products, to help
our clients make more intelligent decisions, deliver
innovative solutions and improve outcomes for all.
Founded in 1983, ZS has more than 13,000 employees
in 35 offices worldwide.

Learn more: zs.com

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