In addition, there is advice on how to cope with complexity: simplify your space and communicate it widely. No leader should
ever fear sounding repetitive because rare is the organization that can digest—and then execute—a vision with dozens of moving
parts. And every statement must be graded to illustrate what you are putting at stake, in a way that is understandable to everyone in the organization first, and then to the world outside.
This "no surprises" approach may appear to institutionalize the mundane, but it is very important to the relationship with
the customer, who, in contrast to 30 years ago, has many new options in contracting around value. Trust is critical, not only
in the hard evidence that customers now insist be built in to any deal, but in managing the many human intangibles that contribute
to successful partnerships.
Likewise, what constituted evidence 30 years ago, in the form of the narrow theoretical construct of the randomized clinical
trial, is now yielding to "real world" clinical experience. The change offers a different opportunity, in that companies able
to communicate that experience well and engage more broadly with accessible messaging have a leg up in winning the regulator's
support. FDA commissioners are people too!
Thus, a proactive communications culture can deliver benefits at every level of the organization. But doing it well means
starting at the top.
But what resonates most from our talks from past to present is the enduring importance of an industry that can position itself
as part of a community—the arbor master around the tree of life. In that regard, assessment of company reputation is emerging
as a real source of competitive edge, even if it lacks real metrics. This is increasingly because government—embodiment of
the public interest—is certain to occupy root and branch in this tree, as high-profile regulators and, increasingly, as penny-pinching
payers. It's equally true that, as in any solid community, membership occurs by invitation, expressed in the quality and breadth
of the relationships that C-suite executives build in day-to-day business. Decorum counts: Who wants to break bread with a
neighbor with messy table manners? As Novartis Chairman Daniel Vasella says, the best way to preserve that claim to community
is to clean up the compliance mess and end the appearance that paying fines is just a temporary business expense.
Ultimately, however, the health sector of which we are a part is a reflection of the frailties of the human condition. Regardless
of the accomplishments that decorate this special issue, we know from history that in health, progress is partial while disease
is permanent. The best science still provides little protection against poverty, waste, ignorance, corruption, and discrimination.
And now that health is rightly classified as a development issue—another sea change from 30 years ago—the negative impact
of these on progress against disease is statistically measurable.
The dilemma of the health disconnect is best illustrated by something I witnessed a few years ago in India. There, in a rural
village, I saw a young girl astride a mule-drawn cart, loading one ripe shiny melon after another, presumably to deliver a
hefty price at market, while a few feet away, at the back of the cart, an equally determined young goat was pulling each melon
off, biting it once and moving on to the next. Talk about a conflicted mission—or a contradictory result. And despite being
in close proximity, neither of the two knew what the other was doing; talk therapy was, at least in this case, likely to fail.
This is the essence of health policy: two steps forward, but always one step backward too. Over the next 30 years, let's hope
the industry we represent keeps extending its own footprint to ease the long walk to health.