Innovation Strategy as a Top Management Priority
R&D has long been perceived as the holy grail of the pharmaceuticals,
diagnostics, and medical devices industries, and rightly so. While
improvements in processes such as distribution and customer service can
create incremental value for companies, it is the “quantum leap” innovations
in products and technologies that yield the huge growth and profitability
improvements demanded by shareholders. And while many factors are
necessary for success, the companies who best manage their innovation
process tend to enjoy differential returns: Pfizer, who has invested heavily in
innovation and is renowned to have one of the strongest R&D pipelines in
the industry, outperformed the Dow Jones pharmaceuticals index by 48%
over the period 1991 to 1997, even before the introduction of Viagra.
But the hurdle is rising for companies seeking to
“Quantum leap” innovations
develop new products. Despite the adoption of new
in products and technologies
techniques like combinatorial chemistry and high
yield huge growth and
through-put screening that have greatly improved the
profitability improvements.
productivity of drug discovery, the average R&D
investment required to bring a new drug to market
has more than doubled in the past decade, rising from $230MM to $500MM
or more. In the medical devices industry, the cost to develop just one
product can exceed $100MM. Furthermore, R&D investments are still
extremely risky, with only 2-7% of all pharmaceutical innovation projects
is a Manager in Bain & Company’s
A number of factors are to blame for these spiraling
Innovation as Strategy: The Importance of Process
innovation costs. First, the “low hanging fruit” of the
Corporate strategy, innovation strategy, and R&D
health care industry has in many cases been harvested.
need to be explicitly connected, and in the best-run
Advances in treatment and technology have brought
organizations they are indeed tightly linked. The
under control many of the better understood diseases
enormous sums invested in R&D, the lengthy time-
and conditions, and companies are now focusing on
to-market for pharmaceutical, medical devices and
indications that are increasingly complex, some of
diagnostics products, and the high risk of development
them targeting even narrower patient populations.
failure make it critical that innovation strategy, resource
Second, pharmaceutical companies now face even more
allocation, and ultimately, the activities of the R&D
stringent regulatory requirements for clinical studies and
department are carried out with the broader corporate
approval of drugs applying novel technologies.
Third, the rise of managed care approaches, combined with
To illustrate, consider some of the questions managers
the availability of more products for the same indication,
face as they fashion an effective innovation strategy:
has led to heightened emphasis on the economics of new
• What are the key medical and pharmacoeconomic
drugs and products, especially in the United States.
Regulators and payers alike now assess not only a product’s
• In which therapeutic areas does the company hold
performance, but its impact on overall system costs. Often,
the greatest pockets of knowledge, competence,
significant total therapy cost improvements are required
and resources, and how can they be leveraged?
for the product to gain market acceptance, thus creating
increased challenges for the R&D organization. This trend
• Which clinical indications/physiological pathways
is likely to intensify in coming years as managed care gains
and market segments should the company target?
• How do customers define therapeutic/medical
In the midst of these fundamental changes, however,
value, and what are the key levers and associated
a few companies manage to wring exceptional returns
profit economics by which we can create a
from their innovation dollars, and produce “blockbuster”
drugs and products that lead them to market
• What data should the company generate during
dominance. What distinguishes these companies?
development to prove the value proposition?
Our experience working with the leaders in the global
• What revenue and profit targets need to be
health care industry has convinced us that being a
world-class innovator requires not just great scientists
and research facilities. It requires a great process for
• What resources are available for reinvestment?
managing the generation, development, and in some
cases, acquisition of ideas. This process must provide
a systematic method for evaluating, prioritizing, and
investing in the best research projects, and then
Being a world-class innovator requires not just
driving these projects through the development stage
great scientists and research facilities, but a great
to generate profitable products. Critical to the success of
process for managing the generation, development,
this innovation process is a direct link to the corporate
and in some cases, acquisition of ideas.
and/or business unit strategy of the company1.
A sound strategy, devised at the highest levels of
Managing the Innovation Process
the organization, will take all of these factors into
The goal of the innovation framework presented here
consideration. Yet the activities that turn strategy
is to create a structured approach to the innovation
into results occur further down in the organization,
process, ensuring that the most promising research
and when the link between corporate strategy and
projects are invested in and eventually brought to
innovation strategy breaks down, the results are
market, and that the innovation strategy is carried
predictable: R&D teams drift into projects that aren’t
out in concert with the broader corporate strategy.
leveraged, while exceptional capabilities within the
To illustrate, let’s use a hypothetical example. Assume
organization are under-utilized; products are generated
that a pharmaceutical company — we’ll call it
that offer no advantages relative to those of competitors,
PharmCo — has decided after a strategic review to
or worse, aren’t viewed by customers as providing
bolster their presence in cardiology. To do this they
significant value; key decision-makers lack a clear
are seeking to develop drugs to combat a variety
definition of desirable outcomes, and so misallocate
of indications, including, for the sake of argument,
hypertension. Working together in an iterative process,
When the link is clearly established, however, the results
the marketing, sales, and R&D departments have
can be dramatic: an R&D organization leveraging its
established a set of revenue and profit targets and
core competencies to bring to market products that
timelines. Now the organization must deliver.
1 represent fundamental pharmacoeconomic or
Based on an understanding of the underlying pathology
medical improvements over existing offerings,
and the regulation of blood pressure, scientists have
2 are valued by key customer groups, and
identified “biological mechanisms” to regulate either
cardiac output or peripheral vascular resistance. For
3 improve the overall strategic positioning of
decades, drugs such as diuretics or β-Adrenergic
antagonists (commonly known as β-Blockers) have
When all these gears are turning together, the result
been on the market to treat hypertension. Other drugs
is higher profits and higher share prices. Profits can
such as Renin inhibitors that target different sites or
then be funneled back into innovation, perpetuating
work via alternative pharmacological mechanisms are
a “virtuous cycle” of value creation.
What follows is a framework for systematically managing
Questions surround these different mechanisms:
the assessment, prioritization, and development of
Which will provide the most efficacious treatment for
research projects. While it is understood that the
hypertension? What will be the pharmacoeconomic
innovation process must remain linked to a company’s
impact of each possible drug? And will any of them
overall strategy, this paper focuses only on managing
fulfill the strategic objectives — such as revenue and
the innovation process, and does not directly discuss the
profit targets and competitive positioning — that have
steps needed to develop a long-term corporate strategy.
1For the sake of simplicity, the term “corporate strategy” will be used throughout this piece to denote either a corporate or business unit strategy.
2A value proposition is defined as the combination of attributes of a product or service that a specific customer segment values differentially versus competitors’ products. For some customers, a product’s value proposition may be driven primarily by one attribute, such as price, or quality. Other customers may consider a combination of attributes, such as price, quality, and convenience, in evaluating a product’s value proposition.Figure 1: Innovation Framework Identify and Develop Assess Internal Value and Prioritize Implement and Manage Innovation Options Capabilities Innovation Options the Innovation Strategy Key activities
In the midst of these unknowns, PharmCo must decide
Step I: Identify and Develop Innovation Options
upon an innovation strategy. The framework that allows
A pharmaceutical “innovation option” is a possible
us to prioritize the allocation of our innovation
investment in one or a set of treatment mechanisms that
investments is as follows (Figure 1):
together represent a distinct strategy for developing a
Step I: Identify and develop innovation options
product to treat a stated indication. In medical devices
and diagnostics, an innovation option consists of one or
Step II: Assess internal capabilities
a combination of product prototypes or technologies. Step III: Value and prioritize innovation options
To better illustrate both what constitutes an innovation
Step IV: Implement and manage the
option and to demonstrate how these options fit into
the broader context of our framework, let’s continue
This is a straight-forward approach. Its power derives
not from any new analytic tool or valuation technique,
As mentioned before, a strategic review has established
but from its insistence that the decision-maker consider
cardiology, and in particular hypertension, as key areas
innovation investment systematically, in a way that
of focus for PharmCo. Revenue and earnings growth
coordinates with the overall strategic direction of
targets have been set, and a budget has been allocated
for the generation and development of new products.
But there are numerous mechanisms for developing a
drug to treat hypertension. Which are viable, and how
should PharmCo allocate their scarce R&D resources?
I.2 Market Overview and Customer Value Proposition Analysis
We begin by assembling a robust fact-base consisting
We have two goals as we conduct the market and
customer overview: to refine our estimates of the
potential revenues and profits available to us from
each of the mechanisms under research, and to clearly
identify the key levers necessary to create a superior
value proposition for hypertension treatment.
First, we already have an idea from our prior strategic
Once we have assembled our fact base we can develop
review of the broad demographics and market potential
the different innovation options available to us.
of a new hypertension drug. But the market potential of
a drug could differ based on the mechanism from which
By surveying our internal scientific knowledge-base and
it derives. For instance, there may be segments of the
R&D department, talking to outside experts (academics,
hypertension population for which a drug based on
independent scientists, even competitors), reviewing
Renin Inhibition wouldn’t be appropriate due to
contemporary literature, and utilizing emerging sources
possible drug-drug interactions or dose-limiting side-
of information (such as Genome projects), we can
effects. If this is the case, the potential market size for
develop an understanding of all the known mechanisms
Renin inhibitors would differ from that of hypertension
for fighting hypertension. We must also investigate any
products utilizing other treatment mechanisms.
drugs that are either on the market or in development,
Secondly, we must identify the key criteria that will
seeking to understand their pharmacological mode of
allow us to develop a product with a value proposition
action, stage of development, likelihood of development
superior to anything currently offered or under
success, projected time to market, patent status, and
development by competitors. In order to create a
availability for licensing. Technologies for generating
“breakthrough” product, there must be a fundamental
and screening molecular leads should also be investigated,
improvement over the existing value proposition (e.g., in
with the goal of identifying the technology owner,
improved pharmacoeconomics or via causal rather than
patent status, and availability for licensing if the
symptomatic treatment). The degree of the improvement
technology is not available in house.
over current offerings will drive the speed and size of
Output: A list and basic understanding of all possible
mechanisms that are available to us for fighting
For instance, before Viagra, sufferers of impotence
hypertension. A list of technologies that could
had effective but physically uncomfortable therapeutic
assist in the identification, testing, and production of
options available to them. Viagra is efficacious, but
different possible molecules (drug candidates).
more importantly, it represents a huge quality-of-life
improvement over existing therapies. The result has
To create a “breakthrough” product, there must
been an extremely fast adoption rate, and a blockbuster
be a fundamental improvement over the existing value proposition.
The key value proposition criteria as judged by
customers will, of course, differ based on the indication
The profit pool is the sum of all profits
being treated, the therapeutic alternatives available to
earned along the value chain of an industry,
physicians/patients, and the offerings of competitors.
and can be segmented by product, customer
Customer groups must be segmented to identify the
group, channel, geography, or other criteria.
value they would place on improvements along each of
the five criteria for evaluating pharmaceutical products:
existing mechanism but exhibits distinct pharmacological
drug safety, drug efficacy, outcomes, cost effectiveness,
advantages. Alternately, it may simply place more
and patient quality of life. Once the key customer levers
importance on the marketing and sales organizations
have been identified, each drug candidate should be
to effectively sell our product if it is similar to those
re-visited to see which might offer improvement on
the most important of these key criteria.
Identifying trade-offs like these requires a thorough
The key value proposition criteria will also differ based
investigation not only of competitors’ current and
on who the customer or decision-maker is. For instance,
future product portfolios, but of their overall strategic
in pharmaceuticals the key decision maker might be the
positioning, including relative market share, sales and
physician actually prescribing the drugs, or it could be a
marketing capabilities, and relative science capabilities. It
pharmaceutical buyer for a managed care organization.
is important not to underestimate this last point: smaller
Their selection criteria would likely differ. In the case of
competitors who have invested differentially in a specific
medical devices and diagnostics, the key decision-maker
treatment mechanism may hold a significant advantage
could be a scientist, physician, or lab technician, each of
in product development for that mechanism over larger
whom might also have different selection criteria.
competitors who have spread their innovation investments
across many mechanisms or scientific areas (assuming
Output: For each treatment mechanism, a detailed
comparable quality of scientists and availability of
customer segmentation highlighting key selection
technologies). This is so because although a strong
criteria and purchase patterns of the decision maker,
element of serendipity still exists in the innovation
penetration and sales curve estimates (taking into
process, innovation is not akin to gambling; indeed, over
consideration the current and future products of
time, differential investment in certain capabilities will
competitors), and an estimate of the drug’s revenue
Output: A profile of key competitors, describing their
respective share of the market (revenue and profit pools),
Competitors may be — and probably are — working
key strengths and weaknesses, stated strategy, and a thorough
on projects similar to ours. Their current and future
listing of relevant products (current and developmental,
product offerings and strategic intentions will impact
including developmental stage, development risk and
how we position our product. For instance, in the case
likelihood of reaching the market, patent protection,
of hypertension, there are a number of effective
licensing status, and availability for licensing).
molecules on the market that exhibit the same mode of
action and similar pharmacological responses. This may
accentuate the imperative of finding a drug that combats
hypertension via another mechanism, or that uses an
By combining the three building blocks of Step I —
rather than incremental improvements4. Secondly, each
science, market, and competition — we are now able to
innovation option should represent a distinct strategy
develop a set of innovation options. In our PharmCo
for innovating towards a new product, even if some of
example, one innovation option might be to fund
the elements are shared across options. And thirdly,
research only on Renin inhibition — a fairly risky
innovation options need to be consistent with the
strategy since there is no guarantee of finding an
strategic objectives laid out for the company.
effective Renin inhibitor drug. A more moderate
Once we have defined the appropriate innovation
innovation option would be to invest heavily in research
options, we then need to more thoroughly assess
on Renin inhibitors, but to also invest in finding a more
them in light of our internal capabilities and resources.
pharmacoeconomically advanced drug that relies on a
Step II: Assess Internal Capabilities
mechanism that is already proven (such as Angiotensin II
Antagonists) (Figure 2). This would allow PharmCo to
The focus of Step I is primarily external: How big is the
maintain a presence in the hypertension market should
potential market? What are competitors up to? What is
the state-of-the-art science for each indication? In Step II
we turn our lens inward in order to better understand
Clearly a whole array of innovation options can be
the requirements for pursuing each innovation option.
identified for any given indication and for each strategic
scenario. As we develop our options, we must remember
Two primary building blocks make up Step II:
the main tenets of the innovation framework. First, we
1 capability and technology requirements, and
are searching for innovation options that will yield
breakthrough products and improved value propositions
Figure 2: Innovation Options of PharmCo Strategic Bolster presence direction in Cardiology Indications Possible treatment mechanism Innovation
economically advancedAngiotensin II-Antagonist
3For more information about profit pools and profit pool-based strategy, please see Profit Pools: A Fresh Look at Strategy, Harvard Business Review, June/July 1998 by Orit Gadiesh and James L. Gilbert.
4It should be noted that companies can and do create significant value through incremental enhancement of existing products. However, the process for developing these enhancements is different than for developing breakthrough products, and is not covered in this paper.
II.1 Capability and Technology Requirements
Next, we must define the requirements to successfully
The science and technology review of Step I provided
pursue each innovation option: What are the capabilities,
us with a broad overview of the different innovation
technologies, and expertise required to develop each
options: the “30,000 foot view” of different mechanisms
treatment mechanism? Do these capabilities and
and technologies for pharmaceuticals, and of different
technologies exist in-house? If not, can they be
technologies and product prototypes for medical devices
developed in-house or must they be sourced via
and diagnostics. Now we must better understand the
acquisition, alliance, or licensing agreement? What would
science of each mechanism, technology, or prototype
be the costs of doing so? What are appropriate target
contained in our innovation options, and identify the
resources necessary to develop them5. To illustrate, let’s
To answer these questions, we begin by cataloguing,
for each mechanism, all relevant in-house capabilities
Having outlined our innovation options for a hypertension
and technologies. These may be in the form of current
drug, we investigate each further: What is the actual
R&D projects, technologies from other projects that
science behind each treatment mechanism contained in
could be applied to a new mechanism, existing
our innovation options? What are the chances of each
molecules from past research, or researchers with
mechanism’s success or failure, both scientifically and
experience in a given area (Figure 3). We then look
commercially? What would be the likely side-effects
beyond PharmCo’s walls to identify external innovations
or short-comings of a new product? What interactions
and technologies, consulting scientific literature,
could be expected with other medications?
independent scientists, symposia, and the like.
Figure 3: Capability and Technology Assessment PharmCo Physiological Possible Drug Discovery Preclinical Manufacturing Clinical treatment mechanisms Development Delivery Development (pharmacological mode of action)
Note: Other drugs for treatment of hypertension include diuretics (impact on extra cellular fluid volume and cardiac output) or ß-adrenergic receptor antagonist (reducing arterior resistance and venous capacity) and apply different pharmacological mechanisms.
Output: A map for each innovation option of
Step III: Value and Prioritize Innovation Options
all required capabilities and technologies, and an
By the time we have completed Step II, we have a clear
understanding of the resources and time needed
set of innovation options from which to choose. We
to develop or acquire those we do not have.
have also compiled a fact base about the key strategic
and tactical elements of each option. The goal of Step III
This is a critical, and often overlooked, element of
is to prioritize our investment in innovation options,
managing the innovation process. Too frequently, R&D
using both quantitative and qualitative tools.
projects are conscripted on a one-on-one basis, only
We begin by calculating a present value for each innovation
to find that the cumulative requirements of all the
option, providing us with an “apples-to-apples” metric for
various outstanding projects overwhelm the research
comparing our options. We then balance this quantitative
and development functions. The result is a capacity
evaluation with a more qualitative strategic perspective,
bottleneck that can cause severe delays in the innovation
allowing us to direct our allocation of research funds.
process, and ultimately, in the development and
III.1 Probability-weighted, risk-adjusted present values
The first step in calculating a present value for each
To avoid these bottlenecks, we must manage not just
innovation option is to develop a base case financial
individual R&D projects, but the entire R&D portfolio.
scenario. In our PharmCo example, we describe the
We begin by mapping out the financial and human
most realistic revenue forecasts of the drug or drugs
resource needs for each innovation option. These
that would be the output of each innovation option.
“resource maps” must then be integrated to give a
We then factor in research and development costs
comprehensive picture of the demands that would be
(including any additional expenses incurred by acquiring
placed on research, development, and production teams
new technologies or adding R&D or production
over time depending on which innovation options are
capacity), production costs, sales and marketing costs,
selected. (Remember that the innovation process we
overhead, and so on, to arrive at a set of base-case
have outlined for hypertension is also being pursued for
discounted cash flows and a discounted present value.
other indications, and that the organization will need
Things may go better or worse than planned, of course,
to invest in multiple projects simultaneously.) In some
and we need our valuation to reflect this uncertainty. We
cases, qualified external resources such as Clinical
incorporate this risk by creating a set of scenarios — at the
Research Organizations (CROs) can be employed for
simplest level, an optimistic and pessimistic scenario — that
additional capacity. Any capacity planning should also
take into consideration the inherent risks of the business.
take into account the likely attrition of projects over time.
Typically these risks come in the form of clinical or
Output: Resource maps showing for each innovation
regulatory failure, market adoption, project attrition or
option the resource requirements and resulting gaps.
delay, patent issues, or competitive substitution. When
Cost estimates and timelines for the development of
combined in a thoughtful and consistent way, the result is
three scenarios with different — sometimes very different
5In some cases, the same mechanism or technology will feature in more than one innovation option, allowing information to be shared across innovation options.
6Alternative methods of valuation, such as option theory, may also be applied to innovation strategy. It is our experience, however, that while option theory may yield more precise valuations, the advanced technical requirements of such analysis render it less pragmatic than present value scenario modeling.
To complete our risk-adjusted present value we must
up to new competition. The implication might be that
weight each scenario for its likelihood of occurrence.
it is necessary to invest in the innovation option with
For instance, the optimistic scenario may yield an
the shortest development cycle, even if the present value
extremely high present value, but we may give it just a
20% chance of occurring. By combining the optimistic,
Strategic assessment of the innovation options requires
base case, and pessimistic scenarios with their probability
re-visiting the broader strategic objectives laid out for
weightings, and then summing them, we arrive at
the company. Managers should ask themselves whether
a probability-weighted, risk-adjusted present value for
collectively the innovation options they could invest in
each innovation option (Figure 4). This present value
(which essentially represent the company’s innovation
is a consistent metric by which to compare different
strategy) will allow the broader strategic targets and
imperatives of the business to be met. Making this
assessment may be difficult, for the resources necessary
The outcome of the financial scenario modeling
for this kind of strategic review are often concentrated
provides some powerful insights into the best paths
at the highest levels of the organization. The solution is
for innovation investment. However, there are strategic
to ensure, again, that innovation strategy and corporate
elements that the quantitative analysis may not overtly
strategy share an explicit link within the organization,
reflect, or that are difficult to include in a present value.
and that the time of key personnel is formally dedicated
For instance, PharmCo may have a product that is losing
to the ongoing process of developing both innovation
its patent protection in the near future, thus opening it
Figure 4: Probability-weighted, Risk-adjusted Present Value Calculation Projected cash-flows Probability- Probability- weighting weighted, risk adjusted present
By carefully balancing the quantitative and qualitative
When the primary goals and pre-determined milestones
aspects of each innovation option we can arrive at a
of R&D are ignored, the result is wasted time and money,
prioritized list of options deserving investment. It is
and the delay of other projects more deserving of scarce
now the responsibility of the manager to ensure that
organizational resources. A common trap that companies fall
into is a failure to eliminate projects that are not meeting
the results of innovation are realized in the form of
pre-determined milestones and goals. The key ingredients to
new products and heightened profits.
success here are discipline and objectivity: the discipline to cut
Step IV: Implement and Manage
off projects with “potential” if they’re not meeting their pre-
the Innovation Strategy
determined goals, and the objectivity to avoid the political
complexities that tend to inform many R&D-related decisions.
The notion of a “pipeline” has always connoted an
element of mystery: in the classic sense of the word,
Summary: Driving Exceptional
once something enters a pipeline it disappears from
Returns Through Innovation Strategy
view until it emerges from the other end. Step IV seeks
Innovation strategy has received increased attention in
to create transparency around the R&D pipeline, and
recent years, and it will continue to be a top priority of
to establish concrete goals and timelines that allow a
management as long as new product breakthroughs are
manager to control the flow of innovation projects.
the primary driver of value creation in the pharmaceuticals,
diagnostics, and medical devices industries. We strongly
The first and most important factor in successful
believe that the allocation of R&D resources is a critical
implementation of the innovation strategy is to establish
component in a company’s overall strategy, and that poor
a detailed migration plan. Each organizational unit that
management of the innovation process can have huge long-
is to be involved in the project — this includes production,
term economic and strategic implications. In an industry
sales, and marketing, not just R&D — should have a clear
where innovation and time to market are the key determinants
set of deliverables and timelines for turning the project
of success, the companies who best manage their innovation
into results. Multi-functional project teams should be
efforts stand to gain at the expense of their competitors.
established and empowered to facilitate decision-making
While there will always be a strong element of risk in
and to drive each project through the R&D process.
innovation, the process of managing innovation should
These teams must be sufficiently funded to be effective.
never be haphazard or risky. Instead, a holistic, balanced,
In addition, investments may be necessary to alleviate
and data-driven approach to prioritizing innovation
investments can increase R&D efficiency and greatly
Deliberate go/no-go hurdles and checkpoints need to
reduce the risks of research bottlenecks, wasted R&D
resources, or worse, product droughts.
be established for each research project, and progress
should be measured periodically against these checkpoints.
The framework for managing innovation proposed here
The checkpoints should be tied to the key criteria that
ensures that investments made in innovation are consistent
would make the project a breakthrough value proposition.
with the overall strategy established by the company. This
For instance, consider a project whose goal is to
link between innovation strategy and corporate strategy
introduce a new ACE inhibitor with an improved safety
must be established early and re-established often; the four
steps of the innovation framework should be part of the
profile and decreased costs. If at any stage the clinical
ongoing strategic process, not one-time events. Only by
data demonstrate that the efficacy profile is not superior
linking these processes in an ongoing cycle can a company
to existing ACE inhibitors, the development should be
ensure that the innovation strategy it designs is the strategy
terminated and the resources re-allocated, even if the B a i n & C o m p a n y : S t r a t e g y f o r S u s t a i n a b l e R e s u l t s
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Clinical Infectious Diseases Advance Access published September 9, 2012 Clinical Practice Guideline for the Diagnosisand Management of Group A StreptococcalPharyngitis: 2012 Update by the InfectiousDiseases Society of AmericaaStanford T. Shulman,1 Alan L. Bisno,2 Herbert W. Clegg,3 Michael A. Gerber,4 Edward L. Kaplan,5 Grace Lee,6Judith M. Martin,7 and Chris Van Beneden81Department of Pediat