Integrated, Centralized & Decentralized Models
of Digital Structure for Medical Affairs

Introduction
This paper is the second in a three-part series examining digital transformation in biopharmaceutical andMedTech organizations. The first article sought to define ‘digital’ as a mindset and way of thinking that goesbeyond specific platforms, tools or solutions to enable strategy and strategic thinking.1 The purpose of thisarticle is to examine three models that modern industry organizations have taken to structure digital within
their Medical Affairs departments. For the purpose of this article, we are defining structure as organizational
hierarchy, identifying how roles and responsibilities can be organized so a company can meet its objectives.

Digital Structure
Many factors are combined with structure and strategy to create an organization’s digital presence andpurpose including people, processes, ways of working, culture, management responsibilities, human andtechnology resources, operations and evaluations. Ideally, digital is interwoven into the activities of Medical
Affairs and the organization so that it becomes difficult to tell whether the structure of the organization isdriving the implementation of solutions/technology or whether the organization’s digital approach is driving
the organization’s structure. On the other hand, digital initiatives implemented on their own, without
considering how they may or may not resonate with the structure of the organization, run the risk of being
piecemeal implementations, never fully understood or implemented within the organization, and often
eventually abandoned. We think of this use of technologies like the arcade game “Whack a Mole,” in which
technologies are adopted reactively to solve emergent problems, but never implemented proactively todrive an organization forward. As such, technology and the organization must resonate and reinforce eachother; but on the other hand, there is considerable flexibility in pairing organizational structure with digitalstrategy and technological enablers, such that (nearly) any structure can be symbiotic with any (nearly) any
technologies, with careful consideration of the strategic priorities.
Organizational structure depends on vision, objectives and strategy, and aligns parts of an organization so it
can achieve its maximum performance.2 Structure defines how tasks are divided, grouped, led andcoordinated in organizations; it helps teams work together efficiently, sequencing and prioritizing the workthat needs to be done in order to meet the goals of the organization. In other words, digital tools add the“how” to structure, while structure provide the "why” for digital tools. In this way, structure can be the bridge
between digital solutions and strategic accomplishments.
This article provides top-level framework and broad conceptual categories for understanding digitalstructures within Medical Affairs and biopharmaceutical/MedTech organizations, helping leaders to makeorganizational decisions to drive their digital strategy with intention and purpose. That said, each organization
will undoubtedly personalize its structure such that any implementation will be unique, likely drawing on
visions/strategies and methods from multiple models.

Integrated, Centralized & Decentralized Models
of Digital Structure for Medical Affairs

Functional Areas & Roles
Part three of this paper series will dive deeper into the digital roles and competencies required for a modern
digital Medical Affairs organization, however, for the discussion in this article, when we refer to 'digital teams'
within an organizational structure for Medical Affairs, we are broadly referring to the following four general
digital functional areas identified in the previous MAPS paper Elements of a Successful Medical Affairs Digital
Strategy Framework: Omnichannel scientific engagement, advanced data generation, foundationalsystems/capabilities, and people/culture.3 For example, Omnichannel engagement roles may include
channel-specific roles such as web strategy and content strategists; advanced data generation may include
natural language processing leads and data scientists; foundational systems/capabilities may include CRM
managers and data analysts focused on metrics reporting; and people/culture digital roles may include
digital capabilities leads whose remit is to upskill digital competencies across the MA organization.

Integrated, Centralized & Decentralized Models
Three general models of digital structure within organizations exist, namely Integrated, Centralized andDecentralized models. Each can be equally appropriate depending on the broader organizational
ecosystem. There are, of course, also other models that fall in between or represent combinations of thesethree. Broadly, in ‘decentralized’ teams, people have ideas, try them out, and ideas that prove useful orsuccessful may be adopted by other teams. In the centralized model, Medical Affairs created dedicateddigital teams or digital roles within teams such that digital capabilities may be centralized by function.
However, digital and particularly the data underpinning the activities of digital, are unlikely to be siloed byfunction, prompting many companies to reconsider centralization by function in favor of digital‘centralization by capability’ (i.e., digital roles housed within centers of excellence). In the Integrated model,
companies seek to establish digital capabilities serving the core business, such that innovation is primarily
conceptualized at the organizational level, while digital centers of excellence may continue to provide
services by function or capability. Hybrid models certainly exist, for example a model that is decentralized for
efficiency and fast outputs (MVPs) but with a centralized mindset that allows teams to tap into establishedsystems.
In the attempt to describe how the majority of pharma companies structure their digital organizations, theauthors informally surveyed colleagues and members of the MAPS community to get a sense of how theircompanies are structuring digital for Medical Affairs. What became apparent is that although eachcompany has a unique approach to digital, the structures of their digital teams largely fell into integrated,centralized, or decentralized models. The following is our attempt to describe some of the advantages andchallenges with each of the models, and to enable the reader to identify where their company fits within thisframework

Integrated, Centralized & Decentralized Models
of Digital Structure for Medical Affairs

INTEGRATED COMPANY (CENTERS OF EXCELLENCE) MODEL
Digital roles are concentrated in one business unit that provides technology, services, and solutions acrossthe three pillars of the company (Commercial, Medical Affairs, and Research & Development), andequally serves global, regional and affiliate levels across these three pillars.

PROS
Cost savings as technologies, services,solutions and platforms are scaled
across functions, minimizing baseline
costs by avoiding duplication.
Concentration of various digital
expertise makes point-of-contact moreefficient.
Company-wide vision and purview; a“one-stop shop” approach allows forclear accountability and consistency.
Supports synchronization of technology,services and solutions as well as data
centralization, right to access, data
privacy and cyber security
management, plus capability
outsourcing/migration within and acrossall levels and pillars.

CONS
Potentially only high impact projects
prioritized with risk of leaving smaller
units without specific support.
Unless layered appropriately, thelong-term benefits of Medical Affairs
may struggle for priority support when
directly balanced against theshorter-term benefits of Commercial.
Many off-the-shelf digital solutions,services, technology and platforms
were designed for Commercial or R&D
first, possibly making them imperfect for
use in Medical Affairs.
Can be seen as a prescriptive,
top-down approach, especially if theinput and equality of the three pillars
are not adequately ensured.
Enterprise-wide, larger scaletechnology/digital rollouts that affect all
three pillars simply take longer.
Digital may lack the talent to effectively
deliver across all three pillars that havedifferent needs, functions and levels.

Integrated, Centralized & Decentralized Models
of Digital Structure for Medical Affairs

CENTRALIZED MEDICAL AFFAIRS MODEL
Digital roles are concentrated in one department within Medical Affairs, providing standardization andintegration of digital frameworks across all levels. The department is equal to and partners with similar
Digital departments in Commercial and Research & Development. The Centralized Digital department istypically concentrated with innovators who focus on identifying new technologies, services and solutions
and then rely on implementers across Medical Affairs to scale and ensure quality/compliance.

PROS
Clarity around roles and responsibilities
with a focus on Medical Affairs priorities
Cost savings in comparison with theDecentralized model, as platforms,technologies, services and solutions areoffered across Medical Affairs at scale.
Supports common language and digital
culture across the Medical Affairs
organization.
Highly supports synchronization oftechnology, services and solutions aswell as data centralization, access right,
data privacy and cyber security
management as well as capability
outsourcing/migration across and within
the levels of Medical Affairs.
A single hub collects innovators focusedon finding solutions that work for themajority of the Medical Affairsorganization. (Centralized data aids
gap analysis and downstream
communications strategy.)
Digital department may also include
sub-units of innovators andimplementers focused on the specificsolutions, services, platforms andtechnologies needed for moreindividualized situations.

CONS
Can be seen as a prescriptive,“top-down” approach if listening does
not occur equally across theorganization.
Slower and less agile than adecentralized model in adopting newtechnologies, services, platforms orsolutions
Large-scale rollouts across MedicalAffairs take longer than more focused
implementations.
Today, Medical Affairs Digitaldepartments may lack the right talent
to staff digital talent across theorganization.
If budgets trail those of Commercial,
Medical Affairs Digital departments
may be forced to follow larger,
Commercial-led implementations, orstruggle to scale innovations across alllevels of Medical Affairs.

Integrated, Centralized & Decentralized Models
of Digital Structure for Medical Affairs

DECENTRALIZED MEDICAL AFFAIRS MODEL
Digital roles exist across Medical Affairs functions, supporting teams with significant autonomy andself-governance. Innovation, digital operations, quality and compliance are developed andimplemented largely independently, with a lean global team helping to facilitate the governance andglobal support of initiatives. The vision of a decentralized model is optimized localization of roles, solutions,and ways of working as well as technology and services. Even in a decentralized model,organization-wide technologies (e.g., the CRM) commonly remain managed by digital roles within theglobal level of Medical Affairs.

PROS
Geographically distinct teams or those
focused on specific initiatives orproducts feel supported withhyper-localized solutions.
Individual digital teams are empowered
to trial and implement innovative
solutions at small scale.
Faster implementation processes due tosmaller scale and quick Minimum
Viable Products (MVPs) instead of highlysophisticated and fully developed
products that are often quite
expensive.
Local/national needs are addressedwith local solutions, technology, services
and platforms and with a deep
understanding of the external
national/local environment, potentially
expediting uptake within national/local
healthcare systems/technology.

CONS
Risk of duplicating efforts, resources,
technology, platforms and solutions
across independent entities within theorganization, along with associatedduplicated baseline costs
Perception of local teams being siloed
and/or unsupported by the company
or global level of Medical Affairs.
Synchronization and integration issues
due to variety of technologies, solutions,platforms and services, possibly resulting
in re-work, disconnect, loss of data, etc.
Issues in data centralization, accessmanagement and data security
Challenge for capability
outsourcing/migration across levels andaffiliates.
Possible issues with the quality of MVPs
arising from less resourced efforts.

Integrated, Centralized & Decentralized Models
of Digital Structure for Medical Affairs

Conclusion
Neither the centralized, decentralized nor integrated model will perfectly define the digital structure for any
single Medical Affairs organization or biopharmaceutical/MedTech company. However, keeping the generalbenefits and drawbacks of these models in mind can help Medical Affairs leaders proactively design digitalstructures to maximize pros while putting processes and expectations in place to minimize many of the cons.
The authors hope these broad models provide language and a starting point for the structure of ‘digital’across organizations.

References
1 Clark S., et al. How Digital Thinking Enables Medical Affairs Strategy, Elevate, 2022, 1-6.
2 Waterman, RH., et al. Structure Is Not Organization. Business Horizons, 1980, 16-24.
3 Chong, KW, et al. Elements of a Successful Medical Affairs Digital Strategy Framework. Medical Affairs ProfessionalSociety, 2022, 1-11.
4 Ji, H, and Jin Y. How Team Structure Can Enhance Performance: Team Longevity's Moderating Effect and Team
Coordination's Mediating Effect. Frontiers in Psychology: Organizational Psychology, 2020.

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