A Vision for the Future of Healthcare

William N. Hait peered into the future and saw a different and better way to practice medicine. He consistently and eloquently communicated that vision to his teams, and they shared his excitement about it. But then they would go back to their offices and laboratories and do the same things that they always had, pursuing the same projects in the same ways.

Dr. Hait was the global head of R&D at Janssen, the pharmaceutical division of Johnson & Johnson. He commanded a budget of roughly $7 billion and led thousands of scientists around the world. With his visionary boss Dr. Paul Stoffels, J&J’s chief scientific officer, he and his colleagues oversaw a renaissance in productivity that led to the development of thirteen new drugs launched between 2011 and 2017 that generated over $50 billion in cumulative revenue in the 2011–2018 timeframe. Many of those drugs were transformative in their impacts, redefining the standard of care for devastating diseases like prostate cancer and multidrug-resistant tuberculosis. But as well as things were going for Janssen, it wasn’t enough for Hait.

“I always tell my teams—quoting John F. Kennedy—that the best time to fix the roof is when the sun is shining,” Hait says. “With our success I felt we had earned the right to think beyond the present.”¹ Looking forward, Hait saw a clear need and a tremendous opportunity.

When I was practicing as an oncologist, patients always asked me the same heartbreaking question—“What could I have done to avoid getting cancer? Could I have prevented this?” The stark reality you face is that too many of your patients die. With some cancers, nearly all of them do. Most of our existing treatments are designed to keep things under relative control for as long as possible, but for too many patients, that isn’t very long at all. When we have a new therapy, we sometimes get excited about Kaplan-Meier curves that demonstrate improved survival rates of only several months. As a doctor, I’d always wondered why we couldn’t do a better job of preventing cancer from happening in the first place, or intercepting a cancer-causing process. Then, when I got to Janssen, I saw that a similar pattern held for other diseases, like Alzheimer’s, diabetes, and auto-immune disorders. Our treatment paradigm is so limited. In the future, people will look back and consider it primitive that we waited until we were diagnosed with a disease before we did something about it. As a leader at a major global healthcare company, I wanted to use my platform not just to predict what could come to be in time, but to make it happen as fast as possible.

Hait gives the example of colorectal cancer. In its advanced state, cancer cells mutate rapidly, outpacing the therapies with which doctors attempt to control them. Patients suffer, the drugs and surgeries are enormously expensive, and mortality rates are extremely high. But every colon cancer begins as a polyp that can be snipped out in a matter of seconds during a routine colonoscopy. The fundamental problem, then, is less how colorectal cancer is treated than when. If it were possible to intervene earlier, when disease-causing processes are just beginning, outcomes would be much better.

The same pattern plays out with other diseases. Heart attacks and strokes ravaged developed countries for decades; treating high cholesterol with statins well before a heart attack or other advanced cardiovascular event occurs changed that. Hip fractures can be a death sentence for the elderly; strengthening bones with proactive osteoporosis therapies can prevent them. Scientists also suspect that the best time to treat Alzheimer’s disease is before cognitive symptoms appear; once memory loss becomes apparent it may be too late to significantly alter its course.

Still, the dominant mode in our healthcare system is “break/fix”—something breaks, and doctors rally to fix it. This is a matter of practicality, as scarce resources are triaged to solve the most acute problems. But it’s also a relic of an era when we knew very little about the underlying mechanisms that cause disease. Biological understanding has increased exponentially in recent years, presenting new possibilities.

“In the not too distant future,” Hait predicts, “each of us will know the diseases to which we are susceptible. An ecosystem of passive biosensors and trackers—like the step-counters on our smartphones—will monitor our biometric signals, and the equivalent of a check engine light will turn on when something inside of us begins to go ‘out of spec.’ In many cases we won’t be sick yet—but we will be at risk. Society will demand new types of solutions to address these risks, and the company that creates them will be the next Johnson & Johnson.

“We’re already Johnson & Johnson, so why shouldn’t it be us?” Hait challenged his teams. “J&J is the biggest, arguably most innovative healthcare company in the world. If we trained our awesome firepower on intercepting disease with targeted investments in the health products that will define the future, it would not only change the way that medicine is practiced—it would drive breakthrough growth for our company.”²

Everyone at Janssen could see the incredible promise of disease interception—but when push came to shove, they hesitated. Again and again, when Janssen’s investment plans were drawn up, the programs that received the most funding were the ones that were focused on strengthening and extending its current positions.

It wasn’t that Hait’s colleagues didn’t believe in the mid- to long-term-oriented business ideas that emerged from his vision—Janssen’s is a drug discovery and development business after all, where all new ideas are risky and long-term oriented. The problem was the ideas didn’t fit neatly into established industry business models and therefore carried new, unknown, and hard-to-quantify risks. How can you ascribe value to something that prevents a disease from happening rather than cures it when it does? They didn’t always have benchmarks to estimate pricing or established regulatory paths to follow. In many cases, they’d require new capabilities that stretched beyond the boundaries of the pharmaceutical business, like tools and techniques to identify risk and encourage behavior change. In short, Hait’s vision was potentially disruptive to the core business, and a core business that is as established and well-run as Janssen’s instinctively rejects potential disruptions. Its systems are designed to stamp out variation and limit risk.

In 2016, Hait realized that a vision alone wasn’t enough; he’d have to reprogram the management system through which Janssen organized and allocated its resources. To do that, he needed a method to translate his personal vision into a powerful vision for the organization and then convert it to an implementable strategy—one others could see, understand, embrace, and systematically bring to life.

Informed by principles derived from our work on transformational growth and innovation strategies with leadership teams at many dozens of large organizations, and from our study of the intuitive habits of visionary leaders, our future-back methods are designed to help leaders develop visionary strategies and bring them to life.

As the graphic shows, the future-back process unfolds in three major phases, which are described in chapters 3, 4, and 5:

Phase I:  Develop an inspiring vision that is fully actionable

Phase II:  Translate it into a clear strategy

Phase III:  Prepare for and manage its implementation