Tagged: MedTech

  • FDA scrutiny, financial pressures, and M&A inefficiencies push MedTech leaders to prioritise short-term issues over long-term strategies
  • Balancing short-term compliance with long-term strategic planning is crucial for survival
  • Innovation hubs, agile methodologies, customer engagement, and cross-functional teams are key to future growth and competitive advantage
A Playbook for MedTech Success
In December 2023, FDA compliance leaders convened at a conference hosted by the US Food and Drug Law Institute (FDLI) in Washington, DC, to discuss the year’s trends and plans for 2024. Keisha Thomas, the FDA’s Associate Director for Compliance and Quality, highlighted key issues from 2023, reporting that 89 inspections had identified violations requiring Corrective and Preventive Actions (CAPAs). Additionally, there were 790 device recalls, and ~70% of 28 device warning letters were associated with the use of unapproved devices. Thomas emphasised that in 2024, the FDA would target companies with a record of repeated infringements, “We’re developing strategies for addressing companies that are in and out of compliance within a short period of time,” she said. By June 5, 2024, the FDA had issued >45 recalls for medical devices.

Regulatory breaches arise from factors such as non-compliance, quality control issues, incomplete documentation, insufficient testing, inadequate risk management, poor communication and training, delayed reporting, lack of post-market surveillance, design failures, supply chain issues, and failure to implement corrective actions. Effective management of these issues requires comprehensive diligence.

However, these process-oriented challenges often do not receive the attention they require for optimal integration following acquisitions. MedTech companies have historically relied on mergers and acquisitions (M&A) as their primary growth strategy. While this approach has typically resulted in financial gains and increased company size, it has not always improved operational efficiency or quality. The financial complexities of M&A transactions often consume company resources, leading to insufficient attention to critical non-financial operational processes, which can increase the risk of non-compliance with FDA regulations.

To tackle these challenges, companies should prioritise digitising their production processes to boost operational efficiency and compliance, ensuring that growth does not compromise quality or safety. Heightened FDA scrutiny can divert resources from integration and process improvements to remediation efforts, which can be detrimental in a rapidly evolving healthcare landscape marked by advancing technologies and increasing investor scepticism.

Over the next decade, traditional companies must undergo transformations to generate new value for patients and shareholders. This requires rebuilding robust supply chains and leveraging the benefits of digitisation and Industry 4.0. Companies should be able to address FDA warning letters, while redesigning manufacturing and distribution networks, improving flexibility, driving innovation, and expanding market access. To support these initiatives, a strategic playbook is essential for driving growth, enhancing value, and boosting competitive advantage. Leaders must balance short-term compliance with forward-looking strategies to ensure long-term success.

In this Commentary

This Commentary provides a guide for MedTech leaders navigating the rapidly evolving healthcare ecosystem. It highlights key challenges such as heightened FDA scrutiny, financial pressures, and operational inefficiencies often resulting from sub-optimal M&A integration. The discussion underscores the importance of balancing short-term compliance with long-term strategic planning to sustain growth and maintain competitive advantage. Key strategies include continuous investment in research and development (R&D), integrating digital health solutions, and ensuring regulatory compliance. The Commentary also emphasises the need for enhancing patient-centric solutions, forming strategic partnerships, and maintaining robust talent acquisition and retention practices. Leaders are encouraged to adopt agile methodologies, establish innovation hubs, and leverage cross-functional teams to drive progress and improve market responsiveness. By focusing on these strategic areas, MedTech companies can foster creativity, enhance customer engagement, and ensure sustained growth in the dynamic healthcare landscape.
Key Drivers of Growth, Value, and Competitive Advantage
Technological Innovation and Integration
Technologically stagnant companies are unstable and prone to failure. Over time, they lose their ability to innovate and address challenges, ultimately leading to their downfall. To stay competitive, MedTech leaders must navigate rapid technological changes, particularly in AI, machine learning (ML), and personalised care. These advancements are transforming diagnostics, treatment, and patient journeys, making continuous innovation essential for increasing growth, enhancing value, and bolstering competitiveness.

Software has become a critical growth driver for companies. This shift requires adopting new approaches to product development and operating models like those of tech companies. Key strategies include: (i) building a resilient solutions stack with engagement, intelligence, and infrastructure layers, (ii) adopting best practices in software development, including reimagining product management, and (iii) strategically sourcing intellectual property (IP) and talent.

Integrating innovative technologies into traditional product lines is essential yet challenging, as it requires new skill sets, robust IT infrastructure, and strategic partnerships with tech firms. This approach can enhance patient engagement, improve outcomes, and streamline healthcare delivery.
Success in technology innovation and integration hinges on merging traditional medical expertise with cutting-edge digital innovations. Healthcare professionals must compliment their medical knowledge with an understanding of technological advancements. Leveraging digital tools like electronic health records, telehealth platforms, and AI enhances patient care. Such integration creates a blend of human expertise and digital innovation, leading to improved patient outcomes, efficient processes, and a more responsive healthcare system.
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Regulatory and Compliance Pressures
Navigating the regulatory landscapes, such as obtaining FDA approval in the US and CE marking in the EU, is both time-consuming and costly. These processes require meticulous documentation, rigorous testing, and continuous compliance, often delaying product launches and increasing expenses. Moreover, ensuring compliance with data privacy laws, such as GDPR in Europe and HIPAA in the US, while leveraging patient data for innovation presents another layer of complexity. Balancing the need for data-driven innovation with stringent privacy and security requirements demands robust data governance frameworks and advanced cybersecurity measures. Enterprises must invest in technologies and practices that protect patient information while still allowing for meaningful data analysis and use. Successfully managing these regulatory and compliance hurdles is critical for maintaining trust, achieving market access, and fostering innovation.

Market Dynamics and Competition
Large traditional MedTechs face increasing competition from both peers and start-ups. Every year, start-ups introduce new solutions to the market, often leveraging disruptive technologies and streamlined processes that outpace conventional approaches. To remain competitive, established companies must enhance their agility and speed to market while continuously innovating their product offerings.
Expanding into global markets, particularly emerging ones introduces additional obstacles. These markets come with distinct regulatory requirements, unique social and commercial norms, and varied healthcare infrastructures, leading to strategic and operational challenges. Successfully entering and thriving in these regions necessitates an understanding of local regulations, effective partnerships with regional entities, and tailored strategies that address the unique healthcare needs and economic conditions of each market. Navigating these dynamics and competitive pressures, enables MedTechs to unlock new growth opportunities and strengthen their global presence.

Cost Management and Efficiency
There are ongoing challenges associated with managing rising expenses. These include expenditures on R&D to stay ahead of technological advancements, costs related to recruiting, developing, and retaining top talent, regulatory compliance to meet stringent global standards, and manufacturing expenses. Balancing these financial demands while maintaining profitability requires strategic planning and resource allocation.
Enhancing operational efficiency is important to reduce costs and improve margins without compromising on quality or innovation. This involves streamlining processes, adopting advanced manufacturing techniques, and leveraging automation and digital technologies to optimise production. Additionally, implementing lean management practices can help eliminate waste, reduce lead times, and improve overall productivity. Emphasising cost management and operational efficiency allows companies to maintain their competitive edge, ensuring the efficient and sustainable delivery of high-quality, innovative products to the market.

Customer Expectations and Experience
In the evolving healthcare landscape meeting rising customer expectations has become an imperative. This has partly been driven by the shift towards more patient-centric solutions, which necessitates an understanding of patient needs and preferences, enabling companies to deliver personalised solutions and services that enhance outcomes and satisfaction. Embracing this approach requires robust data analytics and feedback mechanisms to ensure that products and services are aligned with customer expectations.
Equally important is the strengthening of relationships with providers. Effective collaboration with healthcare professionals is essential for the successful adoption and utilisation of new technologies and products. Companies should focus on creating strong partnerships, offering comprehensive training, support, and integrating their technologies into clinical workflows. Cultivating these relationships ensures that MedTech' innovations are effectively implemented, ultimately improving patient care and operational efficiencies.

Talent Acquisition and Retention
MedTechs face obstacles in attracting and retaining a skilled workforce, particularly in specialised areas such as AI, ML, and data analytics. The rapid advancements in these fields necessitate the recruitment of highly qualified professionals who can drive innovation and maintain competitive advantage. A 2023 McKinsey report suggested that demand for individuals with data science and natural-language processing skills is outpacing supply. To stand a chance of recruiting and retaining data scientist successfully, it is crucial for corporations to offer compelling incentives, continuous learning opportunities, and career advancement pathways.
Equally important is cultivating a corporate culture that supports innovation, collaboration, and agility. In an industry historically characterised by slow-moving processes, fostering a dynamic and forward-thinking environment is essential. This involves encouraging cross-functional teamwork, embracing new ideas, and being responsive to market changes. Developing a culture that values creativity and flexibility enhances companies'  ability to adapt to emerging trends, attracts top talent, and retains key employees motivated to drive long-term success.

Partnerships and Collaborations
Forming strategic partnerships is crucial for driving innovation and accessing new markets. Corporations must collaborate with technology companies, start-ups, and research institutions to leverage cutting-edge advancements and diversify their product offerings. Such partnerships can provide access to disruptive technologies, foster co-development opportunities, and facilitate entry into emerging markets, thereby enhancing the company's growth potential and competitive edge.
Additionally, strategically managing M&A is important for integrating new technologies and capabilities. This requires a balance to ensure that the integration of new assets does not disrupt existing operations. Companies must develop robust integration strategies that preserve the value of acquired entities while blending them into the corporate structure. This approach enhances MedTechs' technological capabilities and market reach, ultimately strengthening their industry position and driving sustained innovation and growth.

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Sustainability and Social Responsibility
Sustainability and social responsibility are increasingly important challenges for traditional corporations. Adopting sustainable practices in manufacturing and operations is essential to meet both regulatory requirements and stakeholder expectations for environmental responsibility. This involves reducing carbon footprints, minimising waste, and ensuring the responsible use of resources throughout the product lifecycle. Companies that prioritise sustainability can enhance their brand reputation and appeal to a growing segment of environmentally conscious consumers and employees.
Ethical considerations also play a role, particularly in areas such as AI in healthcare, data usage, and informed consent. As AI technologies become integrated into medical devices and healthcare systems, enterprises must ensure that these tools are developed and deployed ethically. This involves safeguarding patient data, ensuring transparency in AI decision-making processes, and obtaining informed consent from patients. Addressing these challenges proactively can build trust with stakeholders and ensure compliance with evolving legal and regulatory standards, ultimately fostering a more responsible and sustainable industry.

Funding and Investment
Securing sufficient funding for R&D can be an issue for traditional MedTechs. However, to stay ahead of the innovation curve, continuous investment in technologies and product development is essential. Established companies often face competition from start-ups that have access to venture capital funding, which enables them to innovate rapidly and take risks that larger, more conventional corporations might avoid due to their scale and existing commitments. To remain competitive, established firms must explore diverse funding sources, including strategic partnerships and government grants, while fostering a culture that encourages calculated risk-taking and agile innovation. This approach can help them maintain a leading position in the ever-evolving MedTech landscape.
Conquering Challenges

We suggest four initiatives to help MedTechs navigate these challenges, foster innovation, improve market responsiveness, and deliver value to customers, thereby driving growth, enhancing value, and increasing competitive advantage.

Innovation Hubs
It is recommended to establish innovation hubs or incubators within the company. These dedicated spaces are ideal for cultivating new ideas and technologies. Creating an environment that encourages creativity and experimentation enables enterprises to accelerate the development of novel solutions and services. Such hubs can also facilitate partnerships with start-ups, academic institutions, and technology firms, creating a collaborative ecosystem that drives innovation.

Agile methodologies
Implementing adaptive methodologies is crucial for speeding up development cycles and enhancing responsiveness to market changes. These practices emphasise iterative progress, flexibility, and close collaboration among team members. Utilising such frameworks allows MedTechs to reduce time-to-market for new products, quickly adapt to regulatory changes, and respond effectively to customer feedback. This adaptability is essential in an industry where technological advancements and market demands evolve rapidly.

Customer Engagement
Enhancing customer engagement through digital platforms, feedback loops, and continuous support is another key strategy. Utilising digital tools enables companies to gather real-time feedback from patients and healthcare providers, ensuring that products and services meet their needs. Creating robust support systems and engaging with customers through various digital channels can foster loyalty and trust. Continuous interaction with end-users helps in refining products and delivering superior customer experiences.

Cross-Functional Teams
Leveraging cross-functional teams is instrumental in driving integrated solutions that combine hardware, software, and services. These teams, composed of members from diverse departments such as R&D, marketing, sales, and customer service, can collaboratively address complex challenges and create comprehensive solutions. Encouraging interdisciplinary collaboration and eliminating silos enables companies to develop more holistic and innovative products and services that meet the needs of the healthcare industry.

The rapid evolution of medical technology markets demands that company leaders balance short- and long-term goals. Increased FDA scrutiny and financial pressures often shift leaders’ focus to immediate concerns, potentially neglecting long-term strategies. Traditional MedTech companies face numerous challenges that require strategic and adaptive approaches to maintain and improve their market position. Cultivating innovation, adaptability, customer engagement, and cross-functional collaboration enables enterprises to thrive in today’s complex healthcare landscape. Prioritising continuous R&D investment, digitisation, and regulatory compliance is essential for staying competitive. Enhancing patient-centric solutions, forming partnerships with start-ups, and attracting top talent are also crucial for driving innovation and market expansion. Embracing innovation hubs, utilising adaptive methodologies, and leveraging cross-functional teams can ensure sustained growth and maintain a competitive edge. Will traditional MedTech companies follow this suggested playbook to create lasting value for patients, shareholders, and the broader healthcare ecosystem or will they stick to their old tricks and hope for the best?
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  • Healthcare is shifting from uniform treatments to personalised care, driven by genetics, lifestyle, and technology
  • Patients benefit from targeted therapies that deliver early disease detection, enhanced therapies and proactive prevention
  • Traditional MedTechs, accustomed to one-size-fits-all devices, face challenges but also can find opportunities from individualised care for growth and innovation
  • To capitalise on these opportunities, conventional corporations must recalibrate their strategies and collaborate with start-ups and healthcare institutions
The Impact of Personalised Healthcare on Traditional MedTechs

Personalised medicine, also known as precision medicine, marks a departure from traditional medical practices by acknowledging the interplay of genetics, lifestyle, and environment in shaping an individual's health. Rather than adhering to one-size-fits-all treatments, individualised care prioritises early detection and proactive prevention, tailoring interventions based on each patient's unique genetic makeup. Digitalisation, together with advances in medical technology, enables the combination and analysis of genomic information with other diagnostic data to identify patterns that help to determine an individual’s risk of developing a disease, detect illness earlier, and determine the most effective interventions. For example, in cancer treatment, personalised therapies target specific proteins driving cancer growth, offering more effective alternatives to conventional methods like customary chemotherapy. Findings of a 2012 study published in Trends in Molecular Medicine found that the response rate to a targeted therapy for acute myeloid leukaemia to be at 90% compared with 35% for standard chemotherapy. Another notable development in customised care is the DNA medication pass, which enables clinicians to identify the most suitable drugs for individual patients, reducing adverse reactions and hospital admissions due to drug-related complications. Such personalised approaches empower patients with treatments aligned to their genetic predispositions and foster greater autonomy and engagement in healthcare decisions.

In today's data-driven environment, the emphasis on precision care is growing, and creating a shift in healthcare delivery. A recent research paper published in the Journal of Translational Medicine suggests that personalised medicine will lead to the next generation of healthcare by 2030. While many traditional medical technology companies are content with supplying standardised medical devices to hospitals, an increasing number wish to pivot and capitalise on the rapidly growing targeted healthcare segment. However, they face the challenge of adapting their established frameworks, which are not designed to create bespoke solutions and services. This emphasises the significance of adaptability across diverse healthcare settings. Forward-thinking corporations, however, recognise the need to evolve. By investing in novel R&D initiatives and fostering collaboration throughout the healthcare spectrum, they position themselves favourably. Conversely, companies resistant to change risk stagnation and eventual obsolescence in an era where personalised care is rapidly gaining traction.

In this Commentary

This Commentary delves into the impact of personalised healthcare on traditional MedTech companies, highlighting the imperative for alignment with customised care to remain competitive. It explores how targeted medicine, driven by advancements in genetics, digitalisation, and medical technology, is reshaping healthcare delivery by prioritising individualised treatments tailored to patients' unique genetic makeup. The Commentary emphasises the need to adapt conventional strategies amidst industry trends, addressing challenges such as regulatory complexities and technology adoption barriers. Through initiatives like partnerships, novel R&D, diversification, and strategic M&A, traditional MedTechs can position themselves to lead in the era of precision care. The Commentary offers examples of start-ups and established firms addressing this segment, insights into the opportunities and challenges traditional companies face in adapting to the growing emphasis on personalised healthcare, and emphasises the importance of innovation, collaboration, and proactive responses to industry shifts.
Brief History

The roots of personalised healthcare can be traced back to ancient civilisations where healers recognised individual differences in response to treatments. However, formalised concepts began to emerge in the late 19th and early 20th centuries with the advent of modern medicine. The discovery of the structure of DNA by James Watson and Francis Crick in 1953 laid the foundation for understanding the role of genetics in health and disease. Advances in DNA sequencing technologies in the late 20th century, particularly the completion of the Human Genome Project in 2003, enabled scientists to decipher the entire human genetic code, ushering in the genomic era.
In the late 20th century, researchers began to explore how genetic variations influence an individual's response to drugs. Pharmacogenomics emerged as a field focused on tailoring drug treatments to a person's genetic makeup, aiming to maximise efficacy and minimise adverse effects. Rapid advancements in technology, such as next-generation sequencing and high-throughput screening, have made it more feasible and cost-effective to analyse large amounts of genetic data. This has accelerated research in tailored therapies and expanded their application beyond pharmacogenomics to include risk assessment, disease diagnosis, and treatment selection.
As we suggested, one of the earliest and most successful applications of customised healthcare has been in oncology. Precision oncology uses genomic profiling to identify genetic mutations driving cancer growth and matches patients with targeted therapies designed to address their specific mutations. The success stories in treating certain cancers, such as leukaemia and melanoma have fuelled further interest and investment in personalised approaches.
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The rise of big data analytics and artificial intelligence (AI) has been instrumental in advancing targeted care. By integrating genetic, clinical, lifestyle, and environmental data, AI algorithms can identify patterns, predict disease risks, and recommend precise interventions targeted to an individual’s unique profile. Governments have recognised the potential of these approaches to improve patient outcomes and reduce healthcare costs. Endeavours such as the Precision Medicine Initiative in the US, the NHS Long Term Plan in the UK, and similar efforts in other countries aim to accelerate the adoption of customised medicine. As technology continues to evolve and our understanding of genetics and biology deepens, personalised healthcare is poised to become increasingly integral to mainstream medical practice, ultimately leading to better health outcomes.
Challenges and Barriers to Personalised Care

Customised medicine, while promising, faces challenges. One hurdle lies in the complexity and sheer volume of data required to tailor treatments to individual patients. Integrating diverse datasets from genomics, medical history, lifestyle factors, and environmental influences demands sophisticated analytics and robust privacy safeguards. Additionally, interoperability issues between different healthcare systems impede data exchange and collaboration among healthcare providers. Economic constraints further obstruct widespread adoption, as customised therapies often come with hefty price tags, limiting access for many patients. Regulatory frameworks must also evolve to accommodate the dynamic nature of tailored medicine, ensuring rigorous oversight without stifling innovation. Moreover, educating healthcare professionals and patients about the benefits and limitations of personalised approaches is essential for fostering trust and acceptance. Overcoming these challenges demands interdisciplinary collaboration, technological advancements, and a commitment to equitable access to focussed healthcare.
The Changing Landscape of Traditional MedTechs

Despite these challenges, the growing emphasis on personalised care represents a shift in traditional MedTech markets. Although the precise timeline for tailored therapies to substantially influence conventional corporations remains uncertain, the trend signals a clear direction for the industry. The International Consortium for Personalised Medicine (ICPerMed) envisions a healthcare landscape firmly rooted in customised medicine principles by 2030. This vision entails an ecosystem where individual characteristics inform diagnostics, treatments, and preventive measures, resulting in heightened effectiveness and economic value, all while ensuring equitable access for all individuals.
Historically, MedTech markets have exhibited a degree of reluctance in adopting new technologies, offering some comfort to conventional leaders in the field. However, the insights provided by the ICPerMed research should serve as a catalyst for traditional enterprises to re-evaluate their strategies and product offerings if they intend to capitalise on the growing trend of customised care. Notably, investments in innovative technologies that facilitate precision diagnostics, targeted therapies, and patient-centric interventions have already proven effective and are on the rise.
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Furthermore, the integration of data analytics and remote monitoring capabilities is reshaping the dynamics among medical devices, patients, and healthcare providers. This integration fosters enhanced connectivity and delivers real-time insights, thereby helping to transform the healthcare ecosystem. As tailored care gains momentum, traditional corporations must embrace agility, collaboration, and an understanding of patient preferences to thrive. This necessitates a proactive re-evaluation of their strategies.
Healthcare Firms Leading the Shift Towards Personalised Care

Many early-stage MedTech companies and established healthcare firms are leveraging evolving technologies and data to meet the growing demand for personalised healthcare. Omada Health, for instance, offers a platform combining connected devices and data analytics to help manage chronic conditions through tailored lifestyle interventions. iRhythm Technologies' Zio patch, a wearable cardiac monitor, uses advanced algorithms to detect heart conditions more accurately. Butterfly Network's Butterfly iQ is the first smartphone-connected whole-body ultrasound system, enhancing imaging quality and diagnostic capabilities through AI. Mature enterprises like AliveCor and Fitbit, now part of Google, have also pivoted to tailored healthcare. AliveCor’s  KardiaMobile provides at-home ECGs and shares data for customised treatment plans, while Fitbit offers devices with advanced health monitoring features and personalised wellness programmes. Dexcom's G6 CGM System provides real-time glucose tracking integrated with health data platforms. Roche has shifted towards customised healthcare with digital health solutions like the Roche Diabetes Care platform and the NAVIFY Tumor Board for personalised cancer treatments. 23andMe, initially known for genetic testing, now partners with pharmaceutical companies for drug discovery and develops tailored treatment plans based on genetic data.
Transforming MedTech in the Era of Personalised Care

The healthcare industry is undergoing a transformation marked by a shift towards patient-centric care and the adoption of value-based healthcare models. This shift is driving increased collaboration among traditional MedTech firms, healthcare providers, and emerging players, all united in their goal to innovate and tackle the complex challenges facing healthcare today. Regulatory changes and technological advancements also are playing roles in reshaping the competitive landscape, guiding the industry towards more patient-centred, value-driven, and collaborative approaches. In response to these evolving dynamics, MedTech companies are transforming their product development strategies by embracing agile and interdisciplinary approaches. Leveraging digital technologies, they are adapting to changing demands through virtual testing, data-driven design optimisation, and rapid prototyping.
The move towards personalised care is not only transforming product development strategies but also reshaping business models within the MedTech industry. There is a growing emphasis on outcome-based pricing and service-oriented solutions, reflecting the industry's focus on delivering measurable results and comprehensive care experiences. Digital health platforms and software-as-a-service (SaaS) offerings are emerging as key drivers of revenue, highlighting the importance of innovation and customer engagement in staying competitive and relevant.
Amid these transformations, regulatory and compliance considerations are crucial. Regulatory frameworks are becoming more stringent, emphasising product safety, efficacy, and data privacy. Compliance with varying standards across geographies is essential for market access, requiring companies to navigate these landscapes skilfully to sustain growth. Regulatory bodies are also evolving to tackle emerging challenges like cybersecurity and interoperability, highlighting the need for effective regulatory management in today's MedTech ecosystem. Addressing these challenges demands collaboration among stakeholders to build trust, promote standards, and ease the adoption of innovative technologies. Only through concerted efforts can the industry overcome these obstacles and fully realise the potential of customised care in transforming healthcare delivery.
Adaptation Strategies for Traditional MedTech Companies

To strengthen their alignment with personalised healthcare, traditional MedTechs can adopt several strategies. One effective approach, which, in a previous Commentary, we referred to as the Third Way, involves forming partnerships and collaborations with start-ups, research institutions, or other industry players. Through these partnerships, corporations can gain access to novel technologies, broaden their market reach, and expedite the pace of innovation. Additionally, diversification emerges as another adaptation strategy, enabling companies to venture into adjacent markets or therapeutic areas. This not only helps in mitigating risks but also enables them to capitalise on emerging opportunities within the healthcare landscape. Furthermore, many traditional corporations opt for M&A to bolster their market position, acquire specialised capabilities, or tap into new customer segments. Collectively, these strategies empower traditional corporations to navigate industry transitions towards customised care, foster sustained growth, and uphold their competitive edge.
This Commentary highlights the need for companies to re-evaluate their strategies in response to the industry's shift toward personalised care, a force shaping the future of healthcare delivery. It suggests traditional enterprises should proactively address challenges such as regulatory compliance, data security, and technological adoption barriers. Yet, within these challenges lie significant opportunities for growth and innovation. By pursuing strategic partnerships, investing in R&D, diversifying, and engaging in M&A, corporations can lead in the era of customised care, influencing healthcare's trajectory. Despite obstacles, the outlook for traditional enterprises is promising, driven by technological advancements and global healthcare demands. Success, however, depends on their agility, resilience, and proactive adaptation to the evolving landscape. By leveraging innovation and fostering collaboration, traditional MedTechs can navigate complexity and continue to drive positive transformation within the industry.
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  • MedTechs traditionally prioritise M&A over in-house R&D yielding size without always improving quality
  • Amidst healthcare's rapid evolution, companies must explore new avenues for growth and staying competitive
  • Embracing a Third Way, MedTechs can invest in start-ups to access disruptive technologies, mitigate risks, foster growth, and competitive advantage
A Third Way Growth Strategy for MedTechs
MedTech industry leaders must welcome fresh ideas to maintain their competitive edge and ensure ongoing growth. However, the conventional avenues of development, such as merger and acquisitions (M&A) and in-house research and development (R&D), often encounter obstacles that diminish their effectiveness. As the industry advances, companies face the dual challenge of adopting new technologies while breaking down entrenched organisational barriers. In an era marked by transformative breakthroughs and turbulent market forces, adaptability and innovation are indispensable drivers of success.
The line separating established enterprises from agile newcomers has blurred, paving the way for potential collaboration and strategic investment. To excel in this environment, traditional MedTechs should consider recalibrating their conventional growth strategies. Rather than solely relying on M&A or low-risk tweaks to in-house R&D, they should explore a Third Way: investing in and collaborating with a range of innovative start-ups. Giant MedTech have been doing this for decades and reaping the benefits of nascent enterprises, fuelled by high-energy talent, leveraging novel technologies, and offering a fresh approach to growth and value creation.
Collaborating with early-stage entities empowers traditional firms to foster a culture of innovation and adaptability, thereby improving patient outcomes and strengthening healthcare systems to thrive in an era of unprecedented change. Effectively managing inventiveness becomes imperative for traditional MedTech companies to successfully navigate the evolving healthcare ecosystem.

In this Commentary

This Commentary emphasises the importance for MedTechs to define a clear strategic path in response to the challenges posed by rapid technological advancements, geopolitical shifts, and advancing market dynamics. We propose a Third Way that moves beyond conventional strategies of M&A and internal R&D. We advocate for investment in a varied portfolio of innovative early-stage enterprises focused on developing disruptive healthcare solutions and services. This approach aims to avoid the drawbacks associated with conventional growth strategies and set up MedTechs for long-term growth and improved competitiveness.
Challenges of M&A

For more than four decades, the MedTech industry has predominantly relied on M&A as its primary growth strategy, which, over time led to the financialisaton of the industry. Larger conglomerates emerged, but their size does not always translate into enhanced patient outcomes or improved operational efficiency. This pattern emphasises a tendency where short-term financial objectives frequently overshadow longer-term strategies focused on quality systems, organisational structure, and talent within the acquired companies.
In many instances, early-stage enterprises have deficiencies in their operational and human resource systems. These weaknesses are frequently overlooked or insufficiently addressed during the integration phase. While the repercussions of such oversight might not be readily apparent, they tend to surface over time, potentially hindering growth.
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The fallout from prioritising financial integration strategies can jeopardise the long-term viability of the merged entity and hamper its ability to innovate and adapt to shifting market dynamics. Successfully merging disparate corporate cultures, technological platforms, and operational processes requires meticulous planning and execution across all facets of the integration process. Neglecting to allocate adequate time and resources to address these non-financial aspects can lead to disruptions in workflow, employee discontent, and diminished performance.
Moving forward, corporations might consider adopting a more balanced approach to growth, one that not only factors in financial gains but also prioritises the assimilation of quality systems, organisational coherence, and human capital to ensure sustained success. Strategic complacency seems to be present in many large entities, and associated with an excessive dependence on conventional M&A for growth can dampen internal innovation.
Challenges of In-House R&D

Traditional MedTechs encounter challenges when considering disruptive in-house R&D endeavours. The inherent risks, coupled with resource constraints, often dissuade many traditional companies from pursuing innovative avenues of development. Also, complex regulatory environments present hurdles that require expertise, investment, and stringent compliance measures. The infrastructural needs for integrating new technologies exacerbate the situation, necessitating updates to current manufacturing facilities, supply chains, and distribution networks. These conditions emphasise the demanding nature of pursuing innovative R&D in-house. 

The demands of sales and marketing add additional complexity to internal development initiatives. New offerings require educating healthcare providers and consumers regarding their benefits, alongside developing specialised sales teams and tailored marketing strategies aligned with the product's unique demands. Incentivising sales teams to prioritise new offerings over established ones can be testing, which reinforces the hesitation of traditional MedTechs to pursue disruptive R&D projects.

A culture of risk aversion often prevails within traditional firms, leading to a reluctance to depart from established business models and technologies. This is reinforced by corporate structures that highlight stability and predictability over innovation and agility. Executives may hesitate to invest in ground-breaking R&D projects, opting instead for incremental improvements to existing devices. The allure of legacy products, despite their age and slow growth rates, provides a sense of security that dissuades corporations from exploring new technologies.
A Third Way

A Third Way for achieving growth and competitiveness, involves investing in innovative early-stage enterprises. Start-up culture thrives on creativity, fuelled by agility, entrepreneurial spirit, and a focus on disruptive solutions. Unlike traditional MedTechs, new ventures are free from the constraints of legacy systems, which enables them to take bold risks and explore new ideas. The collaborative culture of emerging businesses frequently attracts top talent from diverse disciplines, promoting interdisciplinary cooperation and fresh perspectives. This convergence of talent, flexibility, and risk-taking propels start-ups to the forefront of progress, extending the boundaries of what is achievable and contributing to transformative change in healthcare delivery and patient outcomes.
Engagement with entrepreneurial businesses warrants larger companies access to cutting-edge technologies while mitigating risk across a portfolio of ventures. Investment in early-stage entities opens avenues for collaboration, partnership, and potential acquisitions, enabling traditional firms to capitalise on emerging trends to maintain and enhance their competitiveness. Overall, embracing a broad-based investment strategy in start-ups represents a prudent approach for traditional MedTechs aiming to reconcile progress with risk.
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Supporting a variety of new ventures that are developing novel products through off-balance sheet investments presents a strategic advantage for traditional corporations. This approach allows them to access advancements without immediately bearing the financial burden of traditional acquisitions, thereby preserving their financial flexibility, and safeguarding their core business. 
By providing tax benefits and mitigating the impact on financial ratios, these commitments contribute to the overall financial wellbeing of the company. Additionally, they facilitate low-risk incremental acquisitions. As start-ups mature and demonstrate success, traditional enterprises can acquire them, leveraging their initial investment and minimising the risk associated with unproven technologies. This model fosters an ecosystem where new entrepreneurial entities thrive with support from established players.
Investing in emerging businesses for MedTechs extends beyond financial contributions and can include injections of expertise and knowledge. Established firms possess the capability to offer invaluable guidance and mentorship, drawing on their experience in navigating complex regulations, executing successful clinical trials, and effectively scaling manufacturing operations. By sharing their expertise and knowhow, mature companies amplify the impact of their financial stakes and strengthen their ability and reputation to drive innovation. 

The Potential of Venture Arms for MedTechs

The creation of venture arms by leading MedTech companies has facilitated creativity and driven commercial success. Johnson & Johnson (J&J) and Medtronic, for example, have embraced this trend with positive outcomes. J&J's venture initiative, JLabs, was initiated in 2015 in San Francisco to nurture ~50 start-ups across a spectrum of healthcare sectors, including medical devices and digital health. Since then, it has burgeoned into a dynamic ecosystem with key incubation hubs worldwide, from New York to China.
While J&J typically refrains from immediate investments, its strategic commitments to enterprises like Mauna Kea Technologies, Protekt Therapeutics, Cara Care, Cala Health, and Sight Diagnostics demonstrate the company's interest in nurturing entrepreneurial solutions aligned with its strategic objectives. Similarly, Medtronic's venture arm has effectively made strategic investments in a diverse array of early-stage businesses, with Axonics as a notable example. Axonics' recent (January 2023) FDA approval for its fourth-generation rechargeable sacral neuromodulation system serves as a testament to the success that can arise from such collaborative endeavours.
Traditional MedTech companies can take valuable lessons from industry giants such as J&J and Medtronic, especially in establishing their own venture funds to invest in a range of start-ups. This strategic manoeuvre not only provides these companies access to cutting-edge technologies and disruptive innovations that might outstrip their internal development capacities but also allows them to diversify their product portfolio and helps mitigate risks associated with reliance on a narrow range of offerings.
Entrepreneurial ventures often boast agility, enabling them to swiftly bring products to market, surmount bureaucratic hurdles that larger corporations may face, cultivate a culture centred on innovation within their organisations, and inspire employees to explore fresh ideas and collaborate with external partners. 
However, this can only be achieved if the MedTech market offers realistic opportunities.
The MedTech Start-up Market

We have argued that the MedTech start-up market holds potential for traditional companies seeking to revitalise their portfolios to maintain and increase their competitiveness. However, what are the realities of this market? Recent studies shed light on its trends and opportunities, and from these, we can judge whether such investments strategies are a viable option for mature MedTechs.

A 2017 study by the Deloitte Center for Health Solutions and AdvaMed Accel suggested that venture capital investments in early-stage MedTechs were slowing because alongside lacklustre returns, investors showed reluctance towards unproven technologies, and were deterred by regulatory and reimbursement obstacles. However, findings of a similar study repeated in 2021 paint a more promising picture. Since 2017 and the onset of the Covid-19 pandemic in 2020, venture financing in early stage MedTechs surged by ~67%, suggesting a renewed investor confidence. Notably, the bulk of investments were towards late-stage diagnostic and digital companies, highlighting a shift in investor priorities towards more mature ventures. Furthermore, alternative financing avenues such as public markets and family offices have emerged as viable options, opening new pathways for entrepreneurial endeavours. Notwithstanding, amidst this surge, seed, and Series A funding continued to decline, which poses difficulties for fledgling MedTech entities.

For traditional MedTech companies contending with aging legacy products in slow-moving markets, bridging the funding gap presents an opportunity to enhance their growth prospects and strengthen their competitive position. As we have asserted, beyond financial backing, start-ups often seek guidance on regulatory navigation, clinical studies, intellectual property, and reimbursement procedures. Leveraging their wealth of experience and established networks, large firms are ideally situated to provide such valuable insights and support to emerging ventures. 


By strategically committing to a diverse range of start-ups, traditional firms bolster their capacity to navigate the complexities of the technology ecosystem. This proactive stance not only positions enterprises to shape the future of healthcare but also augments their prospects for sustained growth and competitiveness in an industry experiencing rapid evolution.
Collaborating with emerging businesses at the forefront of technological development empowers large corporations to respond adeptly to market dynamics and drive progress. Such strategic engagement reinforces their relevance in the market, fosters a culture of cooperation and improvement across the healthcare continuum, strengthens traditional enterprises' competitive edge and ensures their long-term viability.
The entrepreneurial spirit inherent in start-ups can rejuvenate the development pipelines of traditional MedTechs, enhancing their decision-making and cultivating an environment of creativity conducive to growth. Establishing a fund to invest in start-ups helps to reduce risk and maximise returns, thus protecting corporations against potential disruptions. Adaptation is crucial for survival, and the approach outlined in this Commentary provides traditional companies reliant on legacy offerings with an opportunity to adapt and thrive, reaffirming their relevance in an era characterised by constant change.
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  • Healthcare is flooded with diverse data from multiple sources, including imaging, genomic sequences, lifestyle factors, and clinical records
  • The volume and diversity of healthcare data pose challenges for medical practitioners and hinder the delivery of quality care
  • Relying solely on healthcare professionals to manage this diverse data is impractical
  • Multimodal AI can amalgamate, analyse, and utilise complex healthcare data, offering transformative potential across delivery systems
Transforming Healthcare with Multimodal AI

On April 1, 2024, Peter Arduini, President, and CEO of GE Healthcare, announced the acquisition of MIM Software, a leading provider of medical imaging analysis and artificial intelligence (AI) solutions in fields such as radiation oncology, molecular radiotherapy, diagnostic imaging, and urology, serving diverse healthcare settings worldwide. "We are excited to welcome MIM Software, recognised for its innovation in multimodal image analytics and workflow," said Arduini.
Multimodal AI

Multimodal AI is at the forefront of modern methodologies, synthesising diverse AI technologies to concurrently interpret various data types, a capability commonly referred to as handling multiple modalities. This approach has the potential to transform processes and enhance patient care. In today's healthcare environment, the emergence of multimodal AI signifies a leap forward, particularly within medical technology. The inundation of data from various sources such as imaging, time series, genomic sequences, lifestyle factors, and clinical records pose a challenge for individual healthcare professionals to merge and interpret. The expectation for clinicians to proficiently manage and utilise such diverse datasets alongside their primary medical specialisation is unrealistic. Multimodal AI offers a solution. Tailored for medical applications, it harnesses the power of sophisticated algorithms and machine learning techniques, to integrate and interpret disparate data streams. By doing so, the technology furnishes healthcare providers with insights and actionable intelligence, thus empowering them to make informed decisions and drive improved patient outcomes.
In this Commentary

This Commentary explores the complexities of healthcare data, encompassing a broad spectrum from imaging to clinical records. Multimodal AI emerges as a pragmatic solution, harmonising disparate data sources to provide insights and streamline healthcare delivery. The recent acquisition of MIM Software by GE Healthcare underscores the increasing significance of this approach. Through a historical lens, we examine the evolution of multimodal AI and its progress in deciphering various data formats. In healthcare contexts, multimodal AI has the potential to transform patient care by combining data to formulate personalised diagnoses and treatment strategies. In tackling data complexities, the technology equips healthcare professionals with efficient tools for managing intricate datasets. Furthermore, its adoption yields tangible benefits for MedTech companies by expediting innovation cycles and enhancing operational efficiency. Ultimately, multimodal AI instigates a shift in healthcare delivery and administration, fostering improved health outcomes.
A Brief History

Multimodal AI has evolved through advancements in AI, data science, and interdisciplinary research. The foundation of AI was established in the mid-20th century by pioneers like Alan Turing and John McCarthy, focusing on symbolic logic and rule-based reasoning. However, early AI systems had limited capabilities to process diverse data types. The 1980s witnessed the rise of machine learning as an area within AI research. Techniques such as neural networks, decision trees, and Bayesian methods emerged, enabling systems to learn from data and make predictions.
During the 1990s and early 2000s, progress was made in computer vision and natural language processing (NLP), laying the foundation for multimodal AI by enabling the processing and understanding of visual and textual data. The early 21st century saw a growing interest in integrating multiple data approaches within AI systems. Researchers explored techniques to combine information from sources such as text, images, audio, and sensor data to enhance analyses.
The advent of deep learning in the 2010s transformed AI, fuelled by advances in neural network architectures and computational resources. Deep learning techniques, including convolutional neural networks (CNNs) and recurrent neural networks (RNNs), enabled progress in processing multimodal data. In recent years, AI fusion technology has become increasingly prevalent across various domains, including healthcare, finance, autonomous vehicles, and multimedia analysis. These applications leverage sophisticated AI models capable of integrating and interpreting data from diverse sources to extract actionable insights.

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MedTechs Battle with AI for Sustainable Growth and Enhanced Value

The development of multimodal AI continues to be driven by interdisciplinary collaboration between researchers in AI, computer science, neuroscience, cognitive science, and other fields. This collective effort aims to advance the capabilities of AI systems to understand and interact with complex, poly modal environments more effectively.

Multimodal AI in a Healthcare Setting

To illustrate the application of multimodal AI in healthcare, envision a scenario where a patient communicates symptoms through a voice-to-text interface with a medical practitioner’s office. The text is then managed by a computer utilising natural language processing (NLP), empowering machines to understand and interpret human language. Simultaneously, the patient's recent medical images and electronic health records (EHR) are accessed and undergo examination by computer algorithms. Consider that these EHRs are derived from speech recognition processes, transcribing spoken notes from prior examinations conducted by healthcare professionals. These disparate data sources are amalgamated to construct a health profile, offering insights into the patient's medical history and current condition. By harnessing machine learning algorithms, this profile, developed in split seconds, lays the groundwork for crafting personalised diagnoses and treatment plans that surpass the limitations of singular modal approaches. Moreover, the system remains dynamic, evolving alongside the patient's treatment journey. It continuously learns and adapts, aligning with the patient's status to ensure the delivery of optimal therapies. The insights obtained from this multimodal AI approach can be shared with healthcare providers to facilitate informed decision-making and encourage collaborative patient care. In an era marked by vast and rapidly growing healthcare demands, escalating healthcare costs and constrained resources, the significance of this approach cannot be overstated. By encapsulating the complexities inherent in medical diagnoses and treatment plans, multimodal AI offers a superior alternative to traditional singular methods.
Healthcare's Data Challenges and Multimodal AI

Let us examine the current situation in a little more detail. In today's digital age, the healthcare industry is a prolific generator of data, contributing ~30% of the world's data volume. This figure is projected to surge further, with a compound annual growth rate (CAGR) of ~36% expected by 2025. Such growth outpaces key sectors like manufacturing, financial services, and media & entertainment by significant margins, emphasising the pace of data expansion within healthcare.
The challenges inherent in managing vast amounts of data are not solely due to their abundance; difficulties also arise from their diverse formats, ranging from structured data to unstructured datasets encompassing text, images, graphs, videos, and more. Despite the potential held within such data, significant portions remain untapped. The primary reason for this underutilisation is the inadequacy of conventional tools to unlock the latent insights embedded within diverse data types. Traditional technologies falter in efficiently searching, processing, and analysing these massive and heterogeneous datasets. As a result, there is a need for specialised methodologies and advanced technologies capable of extracting actionable intelligence from this wealth of information.
Enter multimodal AI: a transformative solution poised to unlock the value in unstructured datasets. By synthesising advanced algorithms with diverse data modalities, this technology offers a comprehensive approach to data analysis, transcending the limitations of traditional tools. Through techniques like natural language processing, computer vision, and deep learning, multimodal AI empowers healthcare professionals to navigate the complexities of data with unprecedented precision and efficiency. By leveraging this technology, healthcare providers can overcome the challenges of data and pave the way for innovative advancements in patient care, research, and beyond.
Navigating the Data Deluge

Medical practitioners encounter obstacles in their efforts to provide optimal care, improve patient outcomes, and manage costs effectively through data amalgamation and analysis.

Real-time data generation intensifies the pressure on healthcare professionals, demanding rapid analysis to extract actionable insights. However, ensuring data quality and reliability remains an issue due to the prevalence of errors, inconsistencies, and missing values, which can compromise both analytical validity and clinical outcomes.

Interoperability problems further exacerbate the situation, as disparate healthcare systems often employ incompatible technologies and standards, hindering data exchange. The absence of standardised formats and protocols impedes integration and sharing across platforms and organisations, thwarting efforts to leverage data for comprehensive patient care.
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Leaning-in on digital and AI

Moreover, privacy and security regulations, such as the American Health Insurance Portability and Accountability Act (HIPAA) and the EU’s General Data Protection Regulation (GDPR), necessitate a balance between safeguarding patient privacy and facilitating data access and sharing. The digital transformation of healthcare increases these concerns, underscoring the urgency of compliance with regulatory standards and robust data protection measures.
Multimodal AI solutions have the capabilities to address these challenges by leveraging advanced encryption techniques, anomaly detection algorithms, and robust audit trails, which strengthen data security and prevent unauthorised access. These AI-powered systems also play a role in ensuring regulatory compliance by identifying potential violations and monitoring adherence to guidelines, thus mitigating compliance risks within healthcare organisations.

Furthermore, effective data interpretation hinges upon domain-specific expertise and a nuanced understanding of clinical contexts. Healthcare professionals must contextualise data within individual patient characteristics, medical histories, and clinical guidelines to make informed decisions, thereby optimising patient care. However, biases inherent in healthcare data pose an obstacle, potentially skewing AI models and predictions. Mitigating biases and promoting equitable healthcare outcomes require a concerted effort towards fairness, transparency, and generalisability in AI model development and deployment.

Addressing these challenges necessitates collaborative efforts among healthcare professionals, data scientists, policymakers, and technology providers. Implementing strategies such as data standardisation, interoperability frameworks, advanced analytics techniques, and robust data governance policies are imperative for overcoming obstacles and unlocking the full potential of healthcare data to enhance patient care and outcomes.

Multimodal AI and MedTech Innovation

Multimodal AI extends beyond traditional healthcare practices and has the potential to reshape how MedTech companies tackle healthcare challenges and develop solutions and services for patients. The technology holds promise to accelerate innovation cycles by expediting the development and refinement of novel medical devices and technologies. By integrating various data modalities, including imaging, genomic, and clinical data, it enables firms to uncover insights, leading to the creation of more effective diagnostic tools and treatment solutions. This not only improves the competitive edge of enterprises but also translates into tangible benefits for healthcare providers and patients by offering faster, more accurate diagnostics and therapies.
Furthermore, in the realm of personalised care, multimodal AI empowers corporations to tailor interventions to individual patient profiles, encompassing genetic predispositions, lifestyle factors, and treatment responses. Such tailored approaches improve patient outcomes and have the potential to drive market differentiation for MedTech products, which cater to the growing demand for customised healthcare solutions.

Moreover, the integration of multimodal AI into MedTech solutions and services fosters interoperability and connectivity across various healthcare systems and devices. This boosts the efficiency of remote patient monitoring and telemedicine platforms, allowing enterprises to reach underserved populations and geographies more effectively. By leveraging data from wearables, sensors, and remote monitoring platforms, the technology enables proactive healthcare interventions, detecting early warning signs of deterioration, facilitating timely interventions, thus improving patient outcomes, and reducing healthcare disparities.

In addition to driving innovation in product development, multimodal AI contributes to optimising operational efficiency and resource allocation within enterprises. By automating administrative tasks, streamlining work, and analysing data on patient flow and resource utilisation, the technology empowers MedTechs to allocate resources more effectively, reduce costs, and strengthen overall operational performance. This not only translates into improved bottom-line results but also enhances resource allocation for healthcare providers, which ultimately benefits patient care delivery.

The integration of multimodal AI into the medical technology sector catalyses a shift in how healthcare is delivered and managed, paving the way for more efficient, personalised, and accessible healthcare solutions. As corporations continue to harness the power of this technology, the potential for transformative innovation in healthcare delivery and management becomes increasingly possible, promoting better health outcomes and experiences for individuals and populations worldwide.


GE Healthcare's acquisition of MIM Software highlights the company's strategic foresight in leveraging MIM's extensive product portfolio, utilised by >3,000 institutions worldwide. Also, it exemplifies Peter Arduini's astuteness in navigating the evolving healthcare technology landscape and emphasises the importance of integrating multimodal AI tools to achieve sustainable growth and gain a competitive edge in today's dynamic healthcare ecosystem. As technology progresses and data complexity increases, multimodal AI's importance is poised to escalate, transforming healthcare's trajectory. The technology’s integration optimises diagnostic and treatment procedures, streamlines administrative functions, and enhances operational efficiency within healthcare systems. Despite challenges such as data complexity and privacy concerns, the ability of multimodal AI to synthesise data and provide actionable insights empowers healthcare professionals, leading to improved patient outcomes. As this technology evolves, it promises to reshape the delivery and management of medical services globally. Multimodal AI has the capacity to reinforce GE Healthcare's leadership in innovation and enhance its competitive position.
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  • Amidst rapid technological advancements, shifting demographics, volatile markets, and geopolitical turbulence, corporate boards grapple with multifaceted responsibilities to steer their enterprises towards sustainable, long-term growth
  • The relentless pace of change demands directors to be adaptable and strategic 
  • Given these dynamics, traditional approaches to board effectiveness should be re-evaluated and enhanced to equip directors with the essential tools for enduring success in today's business environment
Reimagining Boards
The role of boards of directors has been transformed since their inception in the late 18th or early 19th century. Initially tasked with safeguarding shareholder interests during nascent industrialisation and within smaller-scale enterprises, boards now face additional challenges. The 21st century is marked by rapid technological advancements, significant demographic shifts, volatile global markets, and geopolitical turbulence, all of which converge to test organisational resilience and innovation. Despite this evolving landscape, boards continue to have a fundamental duty of protecting shareholder interests. Directors are elected by shareholders to provide guidance, set strategy and oversee management. Thus, they shoulder the responsibility of ensuring sustained growth and vitality for the entities they govern. However, the accelerating pace of change on many fronts requires boards to manage with agility. Effective communication between executive and non-executive directors, as well as among the latter, is crucial in this endeavour. Notwithstanding, the perception of harmony among corporate colleagues may mask underlying areas for improvement that tend to surface during moments of crisis. Against this backdrop of increasing complexity and the pervasive influence of advancing technologies across all sectors, complacency in communication poses a threat to governance effectiveness. Thus, there is a need to reimagine board strategies to align with the demands of a rapidly changing business ecosystem. Cultivating a culture of mutual respect, agility, and innovation is essential for directors to effectively manage uncertainty and foster sustainable growth. Such a proactive approach not only shields directors against unforeseen obstacles but also positions them to seize emerging opportunities, thereby enhancing their resilience in the face of volatility, and promoting enduring prosperity for the organisations they represent.

In this Commentary

This Commentary explores the role that public company boards play in corporate governance. It delves into the obstacles facing directors in today's evolving business terrain, emphasising the need for adaptability and innovative governance practices. It suggests strategies to strengthen boards, including education initiatives, diverse board compositions, and strategic planning retreats. It sheds light on the limitations imposed by directors' time constraints and board meeting schedules, highlighting the potential impediments to gaining a comprehensive understanding of crucial enterprise dynamics. Furthermore, the Commentary examines the implications of aging boards and advocates for the integration of digital natives, suggesting a blend of seasoned experience and technological fluency in governance structures. Through analysis and actionable insights, we endeavour to provide boards with suggestions to help navigate contemporary business ecosystems.
21st Century Boards of Directors

Today, corporate leadership is characterised by a complex interplay of various factors, including technological advancements, demographic shifts, market dynamics, geopolitical intricacies, and evolving societal expectations. Compounded by the relatively short tenures of large company CEOs and C-suite executives, averaging ~5 and ~4.5 years respectively, the challenge for directors and boards becomes even more pronounced. The turnover in leadership underscores the need for agility and foresight in governance and strategic planning processes. Entrusted with the task of charting a course for their companies' future prosperity and sustainability, boards must adeptly manage these hurdles. To succeed in this endeavour, non-executive directors must possess a deep understanding of the forces shaping the business environment and possess the flexibility to adapt to emerging trends and challenges. By doing so, boards can ensure that their organisations remain resilient and responsive among the ever-changing milieu of the modern corporate environment.
At the forefront of this task is the speed and extent of technological disruption. Numerous 21st-century technologies have reshaped societies, economies, and everyday life. Smartphones and mobile telephony have transformed communications, entertainment, commerce, and productivity, becoming indispensable tools globally. Social media platforms like Facebook, X, (formerly Twitter), Instagram, and TikTok have radically changed communication patterns, influenced consumer behaviour, and shaped political discourse. Cloud computing services such as AWS and Azure have disrupted data storage and software access, driving efficiency and innovation in businesses. E-commerce platforms like Amazon and Alibaba have radically changed traditional retail models, offering convenience and global reach. Artificial intelligence (AI) technologies automate tasks, analyse data, and power innovations from virtual assistants to medical diagnostics. The Internet of Things (IoT) enables interconnected devices to optimise processes in healthcare, manufacturing, and transportation. Big data analytics unlock insights from vast amounts of information, driving innovation and enhancing competitiveness. These technologies present opportunities and risks. Corporate boards must fully comprehend their implications, urging companies to harness them for innovation while fortifying defences against emerging threats such as cybersecurity breaches.
Geopolitical uncertainty presents another substantial challenge for leaders. With trade tensions and regulatory hurdles, directors must possess a nuanced understanding of global markets and exhibit agility in adapting to shifts in international relations. Navigating such volatility demands strategic prowess and capabilities to react swiftly. Moreover, addressing evolving consumer preferences requires cultivating diversity within corporate governance structures. By developing leadership teams that encompass a range of perspectives and expertise, organisations are better positioned to drive innovation and ensure well-informed decision-making processes that connect with stakeholders. 
Equally crucial are environmental, social, and governance (ESG) considerations, which have surged to the forefront of corporate agendas. Rather than treating sustainability and ethical practices as add-ons, leaders must integrate them into strategic planning and risk management to safeguard long-term value and reputation.
In the digital age, cybersecurity and data privacy pose threats to businesses. Boards must exercise decisive oversight to protect critical assets and uphold stakeholder trust amidst escalating cyber threats. Collaborative efforts between directors and management are essential to assess risks, implement policies, and integrate cybersecurity into broader strategic initiatives. Proactive measures can mitigate challenges, preserve customer trust, and ensure sustainable growth.
In today's business environment, the responsibilities of board directors extend beyond attending meetings and responding to market fluctuations. While these short-term considerations are essential, directors must also recognise the importance of enhancing their comprehension of factors that influence longer-term strategies pivotal for sustainable growth. The traditional format of board meetings, and the competing interests of non-executive directors, may inadvertently foster a superficial approach to governance and the formulation of long-term strategies. Directors play a crucial role in steering their organisations towards sustainable growth and competitive advantage. This necessitates a comprehensive exploration of all facets of the corporation and its industry, coupled with a continuous awareness of emerging technologies and the growing influence of emerging economies.
To adeptly address both short-term pressures and foster sustainable growth, boards must reassess the regularity and structure of their meetings. Increasing their frequency facilitates prompt decision-making, encourages deeper engagement and strengthens problem-solving capabilities among directors. Furthermore, aligning the frequency of meetings with strategic priorities ensures that time is allocated effectively, laying a robust foundation for long-term success.
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The Power of Corporate Culture

Directors must balance oversight and intervention while fostering adaptability, innovation, and embracing change as an opportunity for growth, instilling forward-thinking mindsets, and empowering management. Expertise, vigilance, and adaptability are indispensable traits for effective board leadership.
Communication challenges

Effective communication is a cornerstone for boardroom success. Nonetheless, nurturing relationships is a task that demands both time and resources. Disregarding such endeavours can lead to issues, ranging from ineffective management practices to organisational breakdowns.

Executive-Non-Executive Communications
One main obstacle to effective communication is the inherent information asymmetry between executives and board directors. The former often possess more detailed knowledge about the organisation's day-to-day operations and challenges, leaving directors at a disadvantage. This information gap can result in misunderstandings or misinterpretations during board iterations. Executives may withhold information due to concerns about reputation or personal interests, while directors may lack the depth of understanding to fully comprehend the implications of certain decisions.
Further, communication between executives and non-executive directors is susceptible to confirmation bias and groupthink. Executives may present information in a way that aligns with their preferred course of action, while directors may feel pressured to conform to the consensus within the boardroom. This can stifle dissenting opinions and critical evaluation, leading to suboptimal decision-making. A lack of accountability compounds these challenges. Without transparent communication, directors struggle to hold executives accountable, which can encourage a culture of complacency, allowing misconduct to go unchecked.

Overreliance on PowerPoint Presentations
Personality conflicts, power struggles, and divergent communication styles present barriers to the flow of information within organisations, hampering problem-solving efforts and eroding trust among stakeholders. Moreover, an excessive reliance on PowerPoint Presentations (PPPs) can exacerbate these challenges, as they often fail to stimulate meaningful dialogue. Executives must engage in frank discussions with their board colleagues to tackle complex issues, fostering an environment of openness and transparency. Effective communication between executives and board directors demands strategies that encourage genuine engagement and facilitate transparent dialogue. This not only strengthens relationships but also fosters a culture of trust, collaboration, and collective problem-solving. Jeff Bezos, known for his emphasis on effective communication and decision-making within Amazon, has notably instituted a practice in company meetings where executives must read and internalise a memo, which serves as the basis for discussion, rather than relying on PPPs. This approach is thought to encourage more thoughtful analysis and in-depth understanding.

Kingdom Building Among Middle Managers
Boards across industries might draw on the strategic manoeuvres of tech giants like Meta and Google, who are simplifying their organisational structures by eliminating layers of middle management. It is at these levels where internal kingdom building occurs, leading to bureaucratic hurdles and siloed operations. By flattening their hierarchies, these tech firms aim to boost transparency, agility, and collaboration. Boards representing other industries might take note of the potential inefficiencies and communication bottlenecks stemming from excessive middle management layers and consider similar initiatives to bolster organisational efficiency. A more streamlined and agile enterprise can help boards to drive innovation, adapt swiftly to market changes, and sustain growth.

Communication Among Board Directors
Effective communication among board colleagues is essential for fostering mutual respect and a shared commitment to the company's vision, mission, and strategy. When directors comprehend and endorse the organisation's goals and purpose, they can utilise their diverse expertise to collaboratively drive strategy. This alignment encourages unity within the board, ensuring decisions are made in the best interest of the company's long-term success. Through exchanging insights, providing feedback, and engaging in constructive dialogue, directors can identify trends, assess risks, and make informed decisions that contribute to sustainable success. Conversely, inadequate communication among directors can lead to conflicts and impede the board's ability to make timely decisions. Disagreements and misunderstandings can undermine trust and cohesion, ultimately jeopardising the company's competitive position.

                   Strengthening Boards for Dynamic Governance

Directors juggling competing interests often face heightened demands, which may compromise their effectiveness, particularly when they hold multiple board positions. While enriching their experience and expertise, multitasking can strain their time and focus, hindering their ability to prioritise effective communication within individual affiliate boards. To address this challenge, implementing limits on the number of boards directors can serve on becomes essential to ensure that their attention remains focused and their commitment undivided. In the US, institutional investors have voiced their opposition to the appointment of directors sitting on >5 boards. Notably, BlackRock, an investment management firm, cast dissenting votes against 163 directors across 149 companies between July 2020 and June 2021 due to concerns of over-boarding. 
Continuous education and training programmes for executives and board directors are essential for improving their grasp of roles, and responsibilities. These instil a culture of constant learning and flexibility, equipping participants with the skills needed to tackle modern challenges. Additionally, by promoting diversity of thought within the board, discussions and decision-making become more vibrant, and encourage innovative solutions to current problems. Evaluating executives' performance, particularly their communication abilities, enhances accountability and contributes to ongoing progress.
Careful structuring of board committees ensures oversight and dynamic discussions. Regular rotation of committee members safeguards against complacency and brings in fresh perspectives, invigorating the board's decision-making processes. While organising retreats involving both executives and board directors may disrupt the usual rhythm of board meetings, such initiatives are instrumental in reinforcing alignment with corporate goals and strengthening communication channels. By incorporating workshops, inviting guest speakers, and facilitating open forums during board meetings, the focus shifts towards promoting creativity and embracing diverse viewpoints, rather than perpetuating conventional thinking. Such initiatives help to shape and reshape the mindsets of executives and directors, stimulate innovation, and facilitate active engagement.
Beyond Boardrooms

Sticking strictly to the traditional approach of holding board meetings exclusively at the company's headquarters could inadvertently limit directors' understanding of the operations they oversee. In an era marked by interconnectedness and diversity, it is crucial for directors to move beyond these physical confines and actively involve themselves in the varied operational landscapes of their enterprises. This fosters a deeper understanding of the challenges and opportunities encountered by the company, cultivating a more nuanced perspective essential for informed and effective decision-making.
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Forging a path for digital excellence in the MedTech Industry

When board directors acquaint themselves with facilities and locales crucial to operations, they gain insights into quality control protocols, potential bottlenecks, and opportunities. Armed with such knowledge, they are better positioned to identify avenues for improvement. An understanding of supply chain dynamics is also essential for effective risk management and protection against disruptions. By increasing their knowledge of key suppliers, directors strengthen their ability to navigate challenges and cultivate agility and adaptability.
Furthermore, the operational footprint of international corporations often spans diverse regions characterised by unique cultural, economic, and regulatory frameworks. Venturing beyond the headquarters helps board members gain first-hand exposure to these varied geographies, enhancing their ability to contribute to strategies tailored to local contexts. Such knowhow proves invaluable in understanding key customers, navigating complex regulatory spheres, and seizing market opportunities.
Embarking on exploratory journeys into potential regions and markets equips directors with insights necessary to make more informed strategic decisions regarding expansion initiatives, mergers, or acquisitions. Through experiences in new regions, directors develop the ability to assess market potential, recognise competitive dynamics, and determine the viability of investment ventures, thereby mitigating risks inherent in moving into unfamiliar territories.
In the late 20th and early 21st centuries, a significant shift occurred, with ~80% of the global population transitioning from poverty to middle-class status and from ignorance to enlightenment. This period witnessed the transformation of once nascent markets into economic powerhouses. Despite comprising >75% of the world's population in 2000, developing economies were responsible for only ~40% of global GDP. By 2010, this share had risen to ~50%, and projections indicate it will reach ~60% by 2025. No longer low-margin commodity exporters, emerging markets now serve as growth opportunities for Western corporations, with tech giants like Apple and Microsoft also leveraging them for innovative R&D. In today's setting, it is essential for directors of Western enterprises to broaden their horizons beyond their advanced home economies and gain exposure to the conditions, economies, business practices, and opportunities of emerging markets, where an increasing percentage of future global business and innovations lie.
Board Demographics

The median age of public company directors, which is ~65, holds significance for the effectiveness of corporate boards, particularly within fast-paced technology sectors. This demographic influences decision-making, strategic planning, and governance, thereby shaping the path of organisations. While the expertise of older directors contributes valuable experience and institutional insight necessary for understanding industry shifts and overcoming obstacles, it also presents constraints.
One important advantage derived from senior board members is the depth of experience and institutional memory they inject into boardroom deliberations. They serve as custodians of industry dynamics and historical perspectives, illuminating pathways for informed decision-making and strategic foresight. Their tenure promotes stability and continuity within the board, instilling confidence in shareholders and stakeholders regarding consistent leadership aligned with the enterprise's long-term objectives. Also, age does not necessarily correlate with either a lack of mental agility or technological acumen; many senior directors remain actively engaged, continuously updating their knowledge base, and contributing meaningfully to board discussions on market trends and technological advancements.
However, some seniors may lean towards a cautious approach to risk, potentially reducing innovation, and adaptability. While this approach may mitigate immediate risks, it could impede agility in responding to emerging business opportunities. A technology and innovation gap among seasoned directors may also hinder their ability to grasp evolving trends critical in today's competitive ecosystem, such as social media's influence. Boards lacking expertise in this area may struggle to manage online reputation and engage stakeholders effectively. Knowledge gaps could dilute the board's evaluation of risks and opportunities, affecting the company's competitiveness. This is especially critical in rapidly changing industries like agriculture and healthcare, where failure to leverage developing technologies can result in missed growth opportunities and loss of market relevance.
Digital Natives

Large company boards are comprised predominantly of digital immigrants, individuals who have been shaped in an era preceding the transformative influence of the internet on communication and information dissemination. We have suggested how this demographic has implications for how boards confront the challenges presented by an ever-evolving business ecosystem. Given the rapid pace of technological advancement, boards must not only draw upon the wisdom and stability offered by senior directors but also recognise the importance of integrating digital fluency into their ranks.
The integration of digital natives - individuals who have grown up in the information age - onto boards seems a strategic necessity. Their presence offers fresh perspectives and technological expertise essential for navigating the complexities of today's digital era. By broadening the scope of diversity beyond factors like ethnicity and gender to encompass age, boards can ensure they possess the skill set needed to thrive in a rapidly and perpetually evolving business environment. Actively recruiting individuals steeped in the information age can infuse boards with innovative thinking and technological prowess.
Moreover, embracing age diversity supports a collaborative environment wherein insights from both digital immigrants and digital natives are leveraged to maximum effect. This synergy between different generational mindsets encourages a deeper understanding of emerging technologies and market trends and thereby supports more nuanced and informed decision-making processes. Harnessing the collective wisdom of both cohorts amplifies the board's capacity to anticipate disruptions, identify opportunities, and devise strategies that resonate across diverse consumer demographics.
However, the integration of digital natives necessitates a commitment to foster an inclusive culture that values and empowers their contributions. Boards must provide opportunities for digital natives to express their perspectives freely and actively seek their input. Encouraging cross-generational mentorship and knowledge exchange initiatives can further enhance collaboration and facilitate the integration of digital fluency into boardroom discussions and decision-making processes.
In essence, bridging potential technology gaps within corporate boards through the inclusion of digital natives enhances the board's capacity to navigate the complexities of the modern era and reinforces its relevance and competitiveness in an increasingly dynamic marketplace. It seems reasonable to suggest that embracing diversity in age and thought is a pathway to sustained innovation, resilience, and long-term success in an ever-evolving business ecosystem.

The evolving landscape of corporate governance demands a re-evaluation of traditional board practices in the face of the rapid changes in technology, demographics, markets, and geopolitics. As guardians of corporate strategy and sustainability, boards must possess adaptability and strategic insight to navigate these complexities effectively. In this context, reimagining the role of boards extends to innovative approaches, including enhanced communication strategies, continuous education initiatives, and promoting age diversity. Furthermore, expanding board activities beyond the confines of corporate headquarters offers invaluable insights into operational realities and diverse markets, facilitating informed decision-making. By fostering collaboration, embracing digital fluency, and leveraging the collective wisdom of diverse generations, boards can navigate uncertainty, drive innovation, and ensure enduring success in today's dynamic business environment. Implementing these principles positions boards as architects of their own evolution, empowering them to lead organisations towards resilience and sustainable growth amidst the relentless pace of change.
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  • Corporate culture shapes the identity and values of MedTech companies, influencing their approach to innovation, patient care, and business ethics
  • It encourages robust employee engagement, collaboration, and commitment, crucial for driving advancements in medical technology and enhancing patient outcomes 
  • The alignment of corporate culture with regulatory standards and industry best practices is essential for enterprises to maintain compliance and trust among stakeholders
  • Ethical decision-making and integrity are cornerstones of a positive corporate culture in the MedTech sector, impacting public perception and investor confidence
  • Embracing a supportive and inclusive ethos attracts top talent, nurtures development, and sharpens competitive edge in healthcare's dynamic landscape
The Power of Corporate Culture
In the ever-evolving environment of the medical technology industry, where innovation and precision are essential, an often underestimated yet indispensable element stands out: corporate culture. It serves as the foundation upon which organisational cohesion and effectiveness are built, encompassing the shared values, beliefs, attitudes, and behaviours that guide employee interactions and shape decision-making processes. A unified corporate environment fosters collaboration, streamlines operations, and boosts productivity, optimising resource allocation and reducing waste. Conversely, fragmented cultures breed discord, hampering communication, impeding progress, and depleting valuable resources in the process. An integrated corporate ethos that empowers individuals and aligns them with the company’s strategic vision can unlock their full potential, nurturing sustainable growth and gaining a competitive edge. 

As the medical technology sector continues its pursuit of innovations and personalised solutions, the role of a robust corporate culture becomes indispensable. It acts as the crucial element for success, helping companies manage challenges effectively while also empowering them to seize opportunities with agility and foresight. Furthermore, a unified corporate ethos strengthens companies to achieve important results that connect with patients and stakeholders, solidifying their leadership role in advancing healthcare and shaping the industry's future.
The sustained success of Medtronic, Siemens Healthineers and Boston Scientific in the global MedTech industry partly can be attributed to their distinctive corporate cultures, which serve as a competitive advantage. These companies have strategically cultivated cultures that set them apart from competitors and strike a chord with their stakeholders. For instance, Medtronic's emphasis on innovation and patient-centricity encourages advancements and instils trust among patients and healthcare professionals. Similarly, Siemens Healthineers' commitment to quality and continuous improvement not only drives advancements in medical technology but also ensures reliability and excellence in their products and services. Boston Scientific's focus on integrity, inclusion, and accountability strengthens internal cohesion and enhances customer trust and loyalty. By prioritising values such as collaboration, excellence, integrity, and customer satisfaction, these corporations differentiate themselves within the industry and contribute positively to healthcare outcomes worldwide.
In this Commentary

This Commentary highlights the pivotal role of corporate culture in the MedTech industry, advocating for strategies to maximise its impact. It shows how culture can drive success through innovation, employee engagement, and performance. The discussion describes actionable approaches, such as leadership commitment, clear vision, open communication, empowerment, diversity, inclusion, and continuous learning. By implementing these, companies can benefit from culture's potential for sustained growth and innovation, thereby significantly improving healthcare delivery. We present a brief case study of MedCo, a lesser-known UK MedTech, which has gained a reputation for proactive innovation. We illustrate how the company purposefully developed a distinct corporate culture. This differentiated it in an increasingly competitive market, exemplifying the transformative influence of a carefully crafted and implemented corporate culture. Furthermore, the Commentary tackles challenges and provides practical insights to assist enterprises in overcoming these obstacles, directing them toward a culture that promotes innovation, engages employees, and ensures long-term success.
Culture a Catalyst for MedTech Success

At its core, corporate culture in MedTechs fuels an environment where employees are inspired to push boundaries, collaborate, and engage in continuous improvement, encouraging creativity and empowering individuals to challenge the status quo. These dynamics facilitate the creation of innovative technologies and solutions poised to improve healthcare delivery. Simultaneously, it nurtures a sense of purpose and belonging within employees, aligning their endeavours with the organisation's mission to advance patient outcomes and elevate quality of life. Corporate ethos can help shape an environment where innovation flourishes, employees excel, and enterprises differentiate themselves. It stimulates collaboration, inspires creativity, encourages quality processes, and promotes continuous improvement, ultimately driving success, and impacting healthcare while building trust, attracting top talent, and strengthening a company's reputation.

Enhanced Employee Engagement and Productivity
When employees feel valued, supported, and appreciated within a positive work environment, they are motivated to contribute their best efforts. Clear communication channels, recognition programmes, and opportunities for professional growth further bolster engagement. A strong corporate culture promotes collaboration, teamwork, and a shared commitment to excellence, leading to increased efficiency and quality output. 

Fostering Innovation and Adaptability
Corporate culture is a catalyst for innovation and adaptability by nurturing an environment that values creativity, experimentation, and continuous learning. Employees who are encouraged to think outside the box and challenge conventional norms often generate new ideas and breakthrough solutions.
An ethos that embraces change and risk-taking enables teams to adapt swiftly to evolving market dynamics and technological advancements. Open communication channels and collaboration across departments and functions facilitate the exchange of diverse perspectives and insights, supporting a culture of innovation. Furthermore, an emphasis on learning and development ensures that people remain agile and equipped to manage challenges effectively, driving creativity and adaptability.
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Optimising MedTechs’ People Operations for AI and Market Changes

Building Trust and Reputation
By embedding values such as integrity, transparency, and accountability throughout every facet of an enterprise's operations, corporate culture becomes instrumental in promoting trust and shaping reputation, positioning the organisation as a dependable industry partner. When employees observe ethical behaviours and fair treatment they can foster a sense of trust and loyalty. Upholding high standards of conduct and fulfilling commitments enables MedTechs to solidify their reputation as reliable, ethical, and trustworthy entities.
Cultivating an Effective Corporate Culture
Corporate culture begins at the top and hinges upon the unwavering commitment and alignment of leaders, who serve as the catalysts for its development. Central to this process is the relentless communication of the company's vision, mission, and values, coupled with the demonstration of these principles through leaders' actions. Collaborative goal setting, the establishment of clear objectives, and the implementation of receptive feedback mechanisms all serve to strengthen alignment with organisational objectives and bolster accountability throughout the entire workforce.
Open communication channels are essential for promoting transparency and trust. Establishing platforms for candid dialogue, such as regular team meetings and anonymous feedback systems, encourages active participation and fosters an inclusive culture. Leaders play a crucial role by modelling open communication, actively soliciting, and responding to feedback, thus supporting a culture of mutual respect and trust.
Employee empowerment lies at the heart of this process. MedTechs can enhance their people by delegating decision-making authority, granting autonomy in tasks, and developing an environment that champions innovation and encourages risk-taking. Recognition programmes that celebrate individual and collective achievements reinforce a culture of appreciation and motivate employees to pursue excellence. Additionally, offering opportunities for career development elevates people to map out their professional growth within the organisation.

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The Silent Obstacle to MedTech Growth and Value Creation

Embracing diversity and inclusion stimulates innovation and enhances employee satisfaction and retention. Corporations can implement initiatives such as diverse hiring practices, unconscious bias training, and affinity groups to nurture an inclusive culture where all voices are valued. Mentorship programmes and promoting diverse leadership representation further emphasises an enterprise’s commitment to creating an environment where everyone can excel.
Continuous learning and development are vital for maintaining a culture of growth and improvement. Providing access to training programmes, workshops, and educational resources encourages people to pursue professional development opportunities. Furthermore, cross-functional collaboration and mentorship programmes facilitate the sharing of knowledge, drive innovation, and support continuous professional development.
Overcoming Challenges in Developing Corporate Culture

Successfully navigating the complexities of corporate culture development demands a multifaceted approach and steadfast commitment from leaders. Proactively tackling challenges entails more than just addressing them; it requires a strategic orchestration of efforts. Initially, overcoming resistance to change necessitates transparent communication elucidating the rationale behind cultural shifts, while actively involving employees to advance their buy-in and acceptance. Further, dismantling siloed departments and hierarchical structures mandates fostering cross-functional collaboration and flattening organisational hierarchies to promote inclusivity and teamwork. Facilitating an inclusive environment acknowledges and respects cultural differences within diverse teams, promoting a sense of belonging and empowerment. Also, ensuring the longevity and efficacy of cultural initiatives demands consistent reinforcement and alignment with company objectives. And, overcoming resource constraints mandates judicious prioritisation of cultural investments and the efficient utilisation of available resources. By adroitly addressing these challenges and implementing tailored strategies, MedTechs can forge robust corporate cultures that drive success and foster sustainable growth.
MedCo: A Case Study

Traditional MedTech enterprises seeking transformative strategies for growth and value enhancement can glean valuable insights from the journey of MedCo. Positioned as a leader in personalised healthcare solutions, the company has forged a successful path by integrating data analytics, genetics, and artificial intelligence (AI) to significantly enhance medical treatments with tailored solutions. However, what distinguishes MedCo is the emphasis its leaders place on corporate culture. Unlike many traditional players who prioritise financial and technological advancements, the company leaders recognise the importance of fostering a dynamic corporate culture that encourages experimentation, embraces diversity, and champions agility. This strategic alignment between technological innovation and a progressive corporate culture has propelled the corporation to the forefront of the industry and enabled it to continuously adapt and prosper in an ever-evolving healthcare ecosystem. Thus, for traditional MedTech enterprises aspiring for transformative growth and value enhancement, the journey of MedCo serves as a testament to the influence of corporate culture in driving innovation and strategic success.
With unwavering determination, MedCo's leaders refused to confine themselves to the status quo of conventional healthcare provision. Recognising the transformative potential of corporate culture, they embarked on a journey, fully cognisant that the foundation of such culture rests with leaders, encapsulated by a well-defined vision, mission, and values. Their resolve was to carve out a reputation synonymous with excellence, offering innovative products alongside exceptional service and after-sale support. With a focus on enhancing usability, saving healthcare professionals time and resources, and prioritising patient comfort and emotional wellbeing, the leaders pursued their objectives. They developed a culture characterised by innovation, quality, and employee engagement, which was aligned with the enterprise’s strategic vision.

Recognising that corporate culture starts from the highest levels, leaders outlined the company’s vision, mission, and values. Then, through proactive involvement with employees, these principles were collaboratively honed to align with strategic imperatives. Their goal? To forge a legacy characterised by unmatched product excellence, innovation, and comprehensive service: a pledge to substantially enhance usability, mitigate healthcare expenditures, and improve patient outcomes.
Establishing open channels of communication emerged as a cornerstone of its cultural blueprint. Town hall meetings, feedback sessions, and online forums became conduits for transparent dialogue, promoting collaboration and encouraging employees to contribute to strategic initiatives. Embracing employee empowerment and recognition, MedCo delegated decision-making authority and celebrated achievements, engendering a culture where every individual felt valued and motivated to take ownership of their contributions. In tandem with strengthening their employees, the company prioritised continuous learning and development, offering comprehensive training programmes, workshops, and mentorship opportunities. This bolstered employee satisfaction and retention and ensured the corporation's continued innovation in a fast-moving sector.
The tangible outcomes of MedCo's corporate culture are manifested in elevated levels of employee engagement, heightened productivity, and pioneering innovation. This culture serves as an advantage, attracting top talent, enhancing the company's reputation, and driving technological advancements. This case study is a testament to the transformative potential of corporate culture: a narrative from which traditional MedTechs can glean valuable insights to help in their strategic evolution.

Corporate culture is pivotal for MedTech companies, fuelling innovation, engaging employees, and establishing a competitive edge. A cohesive culture, rooted in shared values and collaboration, unleashes companies' full potential for sustained quality growth. Prioritising initiatives like open communication, employee empowerment, and ongoing learning enables firms to tackle challenges, adapt to market shifts, and deliver cutting-edge solutions that improve patient outcomes. A robust corporate culture not only attracts top talent and bolsters reputation but also positions companies as industry leaders. As MedTechs innovate and personalise healthcare, developing and nurturing a vibrant corporate culture remains essential to their mission of transforming healthcare delivery. By embracing corporate culture's power, enterprises can chart a path to sustained success, innovation, and excellence in creating a healthier future.
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  • Traditional MedTechs should swiftly upgrade their human capital if they wish to keep pace with rapidly advancing technologies and changing markets
  • Priority lies in aligning in-house capabilities with technology-driven strategies and the progression of healthcare systems
  • Emerging technologies like AI-driven big data solutions and services are set to transform MedTech offerings
  • Enterprises need to adjust to decentralised care models within evolving healthcare ecosystems 
  • To flourish in the next decade, MedTechs must cultivate a culture of continuous enhancement to bolster their innovation capabilities
Optimising MedTechs’ People Operations for AI and Market Changes
In today's dynamic healthcare landscape characterised by rapid technological advancements and shifting market trends, traditional MedTechs find themselves at a turning point. Maintaining competitiveness demands a proactive stance to manage change through strategic investment in human capital development. Prioritising the rejuvenation of a company’s workforce is important, as an organisation's future sustainability and success hinge on its ability to adapt and innovate. This need for transformation is driven by factors influencing healthcare, including the rise of disruptive technologies and the continuous evolution of market conditions.
In this Commentary

This Commentary stresses the need for traditional MedTech firms to modernise their people operations amid the growing influence of AI, automation, and market dynamics. It stresses aligning human capital capabilities with organisational strategies to effectively leverage technological advancements, market shifts, and evolving healthcare systems. By showcasing the transformative potential of AI-powered big data-driven solutions and services, it draws attention to the importance of empowering people to manage challenges and drive innovation that provide access to new revenue streams. Furthermore, it highlights the shift towards decentralised care, prioritising prevention, and patient-centricity, prompting enterprises to realign their internal capabilities accordingly. Addressing challenges posed by off-patent products, the Commentary advocates a proactive approach in equipping workforces with essential skills and a mindset conducive to excelling in an era of heightened automation and efficiency. Lastly, it underscores refocusing company operations on value creation while fostering a culture of continuous improvement and innovation, guiding MedTechs to maintain their competitive edge in the evolving healthcare ecosystem.
Technological Advancements and Market Dynamics
The healthcare industry is undergoing a transformation fuelled by rapid technological advancements and market changes. Emerging automation technologies are disrupting traditional workflows and processes, promising heightened efficiency, accuracy, and improved patient outcomes. Concurrently, there is a notable surge in the adoption of digital health solutions, preventive measures, diagnostics, and value-based care. Digital health platforms offer opportunities for remote patient monitoring, personalised interventions, and data-driven decision-making, while preventive healthcare, driven by wearable devices and predictive analytics, aims to anticipate and mitigate illnesses before they escalate, thus promoting wellbeing and alleviating strain on healthcare systems. Moreover, diagnostics are evolving with greater sophistication, incorporating technologies like genomics and molecular imaging to enable earlier detection and targeted treatment strategies. In this changing technological terrain, traditional MedTech companies must shift their people towards a tech-savvy, forward-thinking mindset. Employees must be adept at leveraging disruptive technologies to develop and deliver innovative solutions and services that align with the evolving needs of patients, thereby providing access to new revenue streams. Achieving this necessitates a concerted effort to upskill existing talent, recruit individuals with expertise in AI, data analytics, and digital health, and cultivate a culture of continuous learning and adaptation. While the allure of seeking external expertise from consulting firms may be strong, the most sustainable approach is to invest in enhancing in-house capabilities, empowering the workforce to adeptly navigate transitions and foster innovation and sustainable growth from within.
Changing Healthcare Systems

Healthcare worldwide is shifting towards decentralised care, preventive measures, and patient-centricity and is characterised by innovative care delivery models, heightened emphasis on patient outcomes, value, and stringent regulatory standards. Decentralised care models, such as telemedicine, home healthcare, and community-health, are gaining traction. Such models prioritise accessibility, convenience, and cost-effectiveness, necessitating companies to develop solutions and services tailored to support remote monitoring, virtual consultations, and effective data exchange between healthcare providers and patients.
The growing recognition of the importance of preventive healthcare in reducing disease burdens and rising healthcare costs is likely to oblige MedTechs to adapt by shifting some of their focus towards developing technologies that enable early detection, personalised interventions, and health promotion initiatives. This requires people equipped with the expertise to manage complex healthcare ecosystems, collaborate with diverse stakeholders, and leverage data analytics to drive actionable insights. Further, patient-centricity has emerged as a guiding principle shaping healthcare delivery and product development strategies. Traditional enterprises, mostly focused on health professionals in hospitals, must enhance their understanding of patient needs, preferences, and experiences to design offerings that empower individuals to actively participate in their care journeys. This demands a workforce with an understanding of individual-centred design principles, empathy, and the ability to co-create solutions with patients and caregivers. MedTechs must increase investments to bolster cross-functional collaboration, nurture entrepreneurial mindsets, and deepen comprehension of regulatory compliance, quality production, value-based care, and market dynamics. These efforts are crucial for businesses to position themselves as catalysts of innovation and value creation within evolving healthcare ecosystems.
Impact of Off-Patent Products

As we approach 2030, numerous corporations are on the verge of encountering patent expirations that currently safeguard revenues of a substantial portion of their product offerings, including pacemakers, implantable defibrillators, insulin pumps, and certain stents. This impending wave of expirations suggests an imminent surge in competition from generic and biosimilar alternatives, posing a challenge to the established dominance of traditional firms. These enterprises, often hesitant to invest in innovative R&D initiatives, now face a critical decision point where they must evolve or risk losing their competitive edge. To effectively manage this impending challenge, companies need to revamp their people operations and talent management strategies.
In the race to swiftly bring new products to market, speed is critical. Traditional firms that have been slow to adapt must streamline their processes, remove bureaucratic bottlenecks, and cultivate a culture of rapid prototyping and iteration. This necessitates a workforce characterised by adaptability, resilience, and a commitment to excellence. Individuals must be empowered to foster innovation, embrace ambiguity, and view failure as an aspect of the innovation journey. Essentially, the impact of off-patent products suggests a new era of heightened competition and significant challenges for some traditional businesses. To excel in this environment, they should consider restructuring their people operations to foster innovation, differentiation, and agility. Only through such a culture can MedTechs hope to maintain their leading position amidst the evolving healthcare landscape.
Enhanced Efficiency through Automation

Projections from the Organisation for Economic Co-operation and Development (OECD) paint a concerning picture of the transformative impact of technology on the global workforce, with the healthcare sector positioned at the forefront of this anticipated evolution. As technological advancements become more prevalent, traditional roles within healthcare are likely to undergo transformations. Repetitive tasks, which have historically defined many healthcare professions, are progressively being assigned to automated systems. This shift liberates professionals to focus on tasks that necessitate human expertise and empathy.
For conventional firms, embracing this shift is not just a suggestion but a necessity for survival and prosperity. They must proactively equip their people with the necessary skills and proficiencies. This goes beyond technical competence and requires a shift in mindset and approach. Human capital strategies should foster a culture of collaboration with intelligent systems, leveraging individual talents to fuel innovation and boost productivity. Traditional enterprises must enhance their operations and services through advanced technologies. By integrating smart solutions throughout manufacturing, supply chain management, and product development workflows, MedTechs can unlock significant degrees of efficiency, scalability, and adaptability. Moreover, this integration can enhance the performance and functionalities of services, delivering added value to healthcare providers and patients. However, the rise of intelligent systems presents both challenges and opportunities for corporations. Embracing these advancements and investing in the necessary skills and technologies allow organisations to broaden their horizons and generate additional value, which is essential for sustained growth.
Cost Pressures and Value-Based Care

The significant rise in global healthcare spending, now exceeding an annual sum of US$8trn, has catalysed a transformative shift towards value-based care. This innovative approach prioritises the improvement of patient outcomes together with efforts to contain costs, marking a departure from the traditional reimbursement model, which is based on the provision of medical services. Within the framework of value-based care, conventional measures of success, like procedure volumes or sales figures, give way to more comprehensive evaluations that encompass patient wellbeing, enhancements in quality of life, and the effective reduction of expenses.
For traditional corporations, adapting to this new reality necessitates a reorientation of their people towards value creation. This goes beyond innovating products and requires a fresh approach that integrates considerations of efficacy, efficiency, and patient-centeredness into all operational facets. Employees must be empowered to transcend conventional boundaries and collaborate across functions to develop solutions that meet the needs of patients and healthcare providers. Additionally, MedTechs should invest in their human capital to enable all staff to illustrate the value proposition of the company’s products in tangible terms. This may involve employing data analytics to quantify the impact of products on patient outcomes, conducting real-world studies to validate effectiveness across various clinical settings, and adopting transparent pricing practices aligned with the value delivered. Moreover, fostering a culture of continuous improvement and innovation is important, where employees are encouraged to challenge conventions, experiment with new methods, and learn from both successes and setbacks. By embracing this mindset, companies are better positioned to drive sustained value creation, ensuring their relevance and competitiveness in an increasingly value-driven healthcare landscape.

With technological advancements and market shifts, the need for traditional MedTech companies to upgrade their capabilities cannot be emphasised enough. The convergence of automation technologies, evolving healthcare systems, patent expirations, and the transition to value-based care present both challenges and opportunities. Failure to adapt quickly to such shifts puts these companies at risk of being relegated to obscurity in an increasingly competitive market. The rapid pace of technological advancement, exemplified by emerging automation tools driven by AI and big data, requires people capable of harnessing these technologies to drive forward efficiencies and innovations. Furthermore, as healthcare systems evolve towards decentralised care, preventative measures, and patient-centric approaches, a deep understanding of new care paradigms and patient requirements becomes increasingly necessary. The expiration of patents emphasises the urgency for companies to cultivate innovation, differentiation, and adaptability. This entails empowering all employees to take ownership of change, think disruptively, and accelerate product development cycles. Moreover, the transition to value-based care necessitates a pivot towards outcome-driven, cost-effective, and patient-centric models. Traditional success metrics should be replaced with more nuanced measures of value, with people equipped with the necessary skills to demonstrate tangible value propositions. In essence, the transformation of traditional human capital policies is not just strategic, but a requirement for survival. By investing in people operations focused on innovation, collaboration, and value creation, enterprises can position themselves as leaders in the healthcare systems of tomorrow. Only by fully embracing this transformative journey can MedTechs succeed amidst the disruptive forces reshaping the industry.
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  • Over the past two decades, neurosurgery has been transformed by technological advancements, interdisciplinary collaboration, and a deeper understanding of the brain
  • Breakthroughs like functional magnetic resonance imaging and minimally invasive surgery have enhanced diagnostics and treatments, steering the field away from its conventional practices 
  • By 2040, such changes will continue and accelerate as neurosurgery embraces augmented reality interfaces, robotics, and artificial intelligence, facilitating personalised interventions based on individual genetic profiles
  • The future of neurosurgery will not only showcase technological excellence but also a heightened commitment to ethical principles prioritising patient welfare and societal wellbeing
Neurosurgery 2040
Over the past two decades, neurosurgery has undergone a transformation, marked by increased precision, less invasive procedures, and swifter recovery, all driven by technological advances, interdisciplinary collaboration, and an enhanced comprehension of the brain. Progress ranges from neuroimaging technologies to refined surgical techniques. This Commentary briefly describes the milestones and ethical considerations of neurosurgery up to ~2040.
Since 2000, the convergence of technologies such as functional magnetic resonance imaging (fMRI) and minimally invasive surgery has improved diagnostic approaches and treatment methodologies. Departing from conventional norms, the advent of personalised medicine and the rise of neurostimulation hold the promise of advancing our comprehension and treatment of neurological disorders.
Looking forward to ~2040, we foresee these trends intensifying, with operating rooms (OR) equipped with state-of-the-art technologies like augmented reality interfaces, robotics, and artificial intelligence (AI), synergising with human expertise. Envisage progress in targeted medicine to also continue and further disrupt neurosurgical treatments by customising interventions according to individuals' distinctive genetic profiles and incorporating developments in gene therapies. As these technologies augment cognitive capabilities, addressing ethical concerns to increase in importance will become more relevant. Prioritising moral considerations will be essential to ensure responsible and compassionate utilisation of these tools.
Furthermore, the upcoming collaboration spanning various fields is positioned to speed up, playing a crucial role in driving neurosurgery to unprecedented levels. This cooperative endeavour is expected to break down traditional barriers and enhance our understanding of the complexities of the brain. Looking forward to 2040, an intensified sense of purpose among healthcare providers is predicted, highlighted by heightened global awareness and strategic initiatives aimed at reducing healthcare disparities by broadening access to neurosurgical expertise worldwide. Underscoring the increasing significance of robust ethical guidelines and ongoing dialogues, we highlight the importance of steering the path of neurosurgery beyond technical innovations. Contemplate a growing focus on ethical principles that prioritise patient welfare and societal wellbeing, indicating that the future of neurosurgery will be characterised by a blend of technological expertise and a more pronounced commitment to human values and purpose.
In this Commentary

This Commentary has two parts. Its overall aim is to nudge neurosurgeons and providers to reflect on their current modus operandi and strategically prepare for the future. Part 1, Neurosurgery since 2000, briefly describes technological developments and interdisciplinary collaboration, which have improved diagnostics, treatments, and our understanding of the complexities of the brain. Part 2, Neurosurgery 2040, anticipates integrated operating rooms where augmented reality, robotics, and AI merge with human expertise. This forward-looking approach stresses interdisciplinary collaboration and a purpose-driven mindset to enhance access to efficacious therapies.
Part 1
Neurosurgery since 2000
Over the past two decades, neurosurgery has evolved at a pace unparalleled in its history. From advancements that have improved diagnosis to the refinement of surgical techniques, the field, since the turn of the millennium, has been a testament to the determined pursuit of knowledge and the inventive spirit within the medical community. We briefly describe aspects of this transformative journey, shedding light on a few key milestones, ethical considerations, and the promising trajectory that lies ahead.
Technologies such as fMRI, diffusion tensor imaging (DTI), and positron emission tomography (PET) have become essential tools to improve diagnostics. Concurrently, minimally invasive surgical approaches, guided by real-time imaging, have not only reduced invasiveness but have also improved patient outcomes. The collaboration between advanced neuroimaging and refined surgical methods marks a shift in neurological care, by facilitating more precise and effective interventions. Indeed, a hallmark of neurosurgery's evolution since 2000 has been the increased use of precision medicine. Departing from the traditional one-size-fits-all approach, the field has shifted towards tailoring treatments based on individual genetic, molecular, and physiological characteristics. Genetic profiling, biomarker identification, and targeted therapies have emerged as effective tools to enhance diagnostic accuracy and pave the way for the expansion of personalised therapies. This departure from conventional approaches suggests a future where neurosurgical treatments are as unique as the individuals they seek to assist.
Empowered by technological progress, surgeons can now probe the brain with newfound precision and safety. Minimally invasive approaches, including endoscopic and stereotactic procedures, have minimised trauma, accelerated recovery times, and expanded the scope of what is surgically achievable. Neuron-navigation systems and robotic-assisted surgeries have further enhanced neurosurgical practice, redefined possibilities, and improved outcomes. The rise of minimally invasive procedures has not only reshaped neurosurgery but has also facilitated patient-friendly approaches over traditional open surgeries. Techniques such as endoscopic and laparoscopic procedures significantly reduce physical tolls on patients, improve recovery times, and minimise complications. Equipped with specialised tools and advanced imaging, neurosurgeons can navigate through the brain's structures with minimal disruption, and not only provide medical advantages but also cosmetic benefits and faster postoperative rehabilitation.
Since 2000, neurostimulation has introduced novel therapeutics for various neurological disorders. Technologies such as deep brain stimulation (DBS) and spinal cord stimulation (SCS) have brought relief to conditions such as Parkinson's disease and chronic pain. The integration of adaptive neurostimulation guided by real-time feedback, represents a shift towards personalised and adaptive treatments, offering hope for an improved quality of life.
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Brain disorders and the changing nature of neurosurgery
The burgeoning field of neurogenetics investigates the interplay between genes and complex neural networks. Personalised therapies, which have evolved from unravelling unique genetic signatures, hold promise for conditions such as Alzheimer's, Parkinson’s, and epilepsy. Neurogenetics not only carries the potential for targeted interventions but also provides insights into the individuality of our minds, suggesting a new era where the enigmas of cognition are elucidated.
Interdisciplinary approaches drive breakthroughs in neurosurgery that go beyond traditional boundaries. The fusion of neuroscience with engineering, computer science, and genetics enhances our understanding of the brain, leading to creative solutions. Whether neurosurgeons collaborate with engineers or data scientists, these partnerships redefine possibilities within the field, pointing towards a future where the complexities of the brain are unravelled through a range of capabilities. Translational research in neurological disorders provides additional hope by linking theoretical breakthroughs to tangible results. The combined efforts of researchers, clinicians, and pharmaceutical experts expedite the development of innovative therapies, bringing optimism to those affected by neurosurgical disorders.
Neurosurgical progress brings hope, yet finding a balance between technological development and ethical challenges is essential. While innovations hold promise, the ethical considerations associated with interventions related to the brain, including matters such as informed consent and privacy, become increasingly complex. Thus, it is crucial to reconcile the progress in neurosurgery with an awareness of ethical responsibilities, ensuring the utmost respect for the human mind.

Part 2
Neurosurgery 2040
Neurosurgery 2040 envisions a future shaped by ongoing developments since 2000, described in Part 1. Though predicting specifics is challenging, key trends are gaining momentum and set to rapidly redefine the field over the next two decades. The integration of AI and novel technologies, collaborative efforts across disciplines, a shift towards patient-focused precision care, improved accessibility to neurosurgical interventions, and a heightened focus on ethical considerations collectively signal the nature of forthcoming transformation. While these trends have been evolving since 2000, it is important to note the accelerated pace at which they are expected. This underscores the need for clinicians and providers to proactively prepare for imminent paradigm shifts. This section offers a partial glimpse into potential aspects of neurosurgery in 2040, emphasising the urgency for adaptation and innovation.
In January 2024, Neuralink, founded by Elon Musk in 2016, achieved a significant milestone by successfully implanting its inaugural device into a human patient. This marked progress towards realising Musk's visionary goal of helping individuals grappling with paralysis and diverse neurological conditions. Concurrently, Jaguar Gene Therapy secured FDA approval for its gene therapy designed to address genetic manifestations of autism spectrum disorder and Phelan-McDermid syndrome, instilling hope in thousands of individuals who have lacked effective treatment options.
While traumatic brain injury (TBI) continues to be a pervasive global health concern, affecting millions annually, (in the US ~2m cases each year), the resultant annual global burden on healthcare, patients, families, and society amounts to ~US$400bn. The current gold standard management of severe TBI involves an invasive procedure, which entails drilling a hole in the skull to insert a catheter for monitoring intracranial pressure (ICP). However, the evolution of neurosurgical techniques suggests that this invasive process will become obsolete by 2040. Emerging innovations are poised to replace it with a non-invasive method for monitoring ICP.
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Healthcare 2040

Such breakthroughs provide a glimpse into the future landscape of neuro-trauma and neuro-disorders expected by 2040, highlighting the rapid pace of progress in the field. It seems plausible to posit that, as neurosurgery undergoes these, and other, changes, clinicians and healthcare providers will witness a paradigm shift, fostering an evolution in patient outcomes and reshaping neurological care.
Expect the continued development and increasing adoption of minimally invasive techniques, neuroimaging, nanotechnology, and targeted therapies. These advancements are poised to replace standard surgical approaches in neurosurgery, leading to a significant improvement in the overall patient experience and making interventions more accessible. The future of neurosurgery envisions the use of microscopic robotics for intricate procedures, steering away from invasive surgeries and embracing non-invasive alternatives. AI techniques are set to play a crucial role, serving as co-pilots by analysing real-time data. Additionally, genetic insights will inform tailored interventions in this collaborative environment, blurring interdisciplinary boundaries and signalling a departure from conventional approaches. The focal point of this shift is personalised care.

Within this evolving ecosystem, genetic profiling empowers neurosurgeons to design custom neural implants and gene therapies. This has the potential to significantly reduce the need for invasive procedures. These changes highlight the urgency for adaptation and innovation in the field, underscoring the importance of staying at the forefront of these technological and medical advancements.
By 2040, a confluence of neurogenetics, personalised neurosurgical therapies, and genetic engineering is anticipated to surpass conventional medical norms. Novel technologies will unravel the intricate interplay between genetics and neurological disorders, delivering custom-made solutions, significantly reducing risks, and optimising therapeutic outcomes. In the approaching years leading up to 2040, Western providers are positioned to align themselves with a defined 'purpose' and actively participate in initiatives aimed at enhancing access to high-quality healthcare. While these pursuits complement the traditional focus on maximising returns for investors, they are increasingly becoming an intrinsic part of the worldview and demands of Generation Z. The imperative for traditional providers to adopt a purpose-driven ethos and acknowledge their global responsibilities is important, and encouraged by a growing call for greater inclusivity. Foresee a surge in global awareness regarding healthcare disparities, prompting a commitment to leveraging technology for the advancement of worldwide healthcare accessibility. A socially responsible approach, incorporating ethical business practices and community engagement, is not only a moral imperative but is also foreseen to contribute significantly to the enduring sustainability of the MedTech industry.
As we approach 2040, Western neurosurgical providers will be expected to adopt a sharper 'ethical' focus, particularly in response to the escalating utilisation of neural implants and genetic therapies. While many MedTechs currently profess ethical awareness, the impending changes in neurosurgery underscore the necessity for a significant revaluation and augmentation of ethical strategies.
As neurosurgery advances with the further introduction of disruptive technologies and heightened cognitive capabilities, ethical considerations are projected to take centre stage. Deliberations on fairness, consent, and the definition of "normal" cognitive function converge with the emergence of neuroenhancement techniques and the integration of brain-computer interfaces. Ethical frameworks will be indispensable to mitigate and prevent biases in AI algorithms, address privacy concerns, and ensure the judicious utilisation of genetic information.
Effectively navigating these moral complexities demands not only technical innovation but also a robust moral compass to align enhanced cognition with human values. The evolving interplay between ethical considerations and technical progress underscores the imperative for ongoing dialogues among neuroscientists, ethicists, and policymakers. The overall objective is to shape the future of neurosurgery not solely through technological advancements but by integrating ethical principles that prioritise patient welfare and contribute to societal wellbeing.
We have described the transformative journey that neurosurgery has undertaken over the past two decades and provided a glimpse into its future. From the integration of breakthrough neuroimaging technologies to the emergence of precision medicine, neurosurgery has evolved, promising enhanced diagnostics and personalised therapies.
As we cast our gaze forward to 2040, a future unfolds where operating rooms are integrated with augmented reality interfaces, robotics, and AI, working in tandem with human expertise. Precision medicine takes centre stage, tailoring neurosurgical interventions to individual genetic profiles. However, the progress is not without its ethical challenges. The heightened cognitive abilities brought about by innovative technologies demand an appreciation for morality to ensure responsible and compassionate use. We stress the increasing significance of interdisciplinary collaboration, transcending traditional boundaries to foster a deeper understanding of the brain, and suggest a future where medical technology providers embrace a heightened sense of purpose, addressing global healthcare disparities by expanding access to neurosurgical expertise worldwide. Emphasising the critical role of robust ethical frameworks and ongoing dialogues, the Commentary suggests the future of neurosurgery should not only be defined by technical prowess but must also prioritise ethical principles that safeguard patient welfare and societal wellbeing.
Overall, the Commentary is a nudge for neurosurgery clinicians and providers to reflect on their current positions and prepare for a different future as the field is developing fast. Our two-part exploration, spanning the past two decades and projecting into Neurosurgery 2040, encourages a forward-looking approach marked by interdisciplinary collaboration and a purpose-driven mindset. The vision presented suggests that the future of neurosurgery will be characterised by a blend of technological expertise and a commitment to human values, ensuring that the field continues to develop ethically and deliver impactful, accessible, and compassionate care to individuals worldwide.
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  • Up to ~5% of American and British citizens grapple with narcissism, which is characterised by self-centeredness and a lack of empathy
  • Narcissists disrupt organisations and relationships through hindering collaboration, discouraging teamwork, exploiting others, and displaying an exaggerated sense of self-worth, all while lacking empathy
  • Narcissists are drawn to healthcare for admiration, control and validation, which can pose a threat to the delivery of quality care
  • Narcissism's impact on efficiency and productivity often goes unnoticed by many healthcare leaders, despite the underlying harm it causes
  • Vigilance in identifying and effectively managing narcissistic traits within healthcare settings is necessary to preserve the integrity of patient-centred care and collaboration among healthcare professionals
Narcissism: Impeding Healthcare Quality and Organisational Effectiveness

In the landscape of 2024, where the healthcare sector is strained by the aftermath of the Covid-19 pandemic, the challenges faced by healthcare executives are multifaceted. The surge in demand for care, driven by aging and chronically ill populations, collides with a diminishing supply of health professionals, creating a significant imbalance. Amidst this, many healthcare organisations grapple with declining workplace productivity and escalating gross margins. Such issues are further complicated by the struggle of human resource executives to foster collaboration, enhance teamwork, and improve employee satisfaction in the face of weak corporate cultures. A critical and often overlooked aspect contributing to the complexity of healthcare delivery is narcissism: a silent force that permeates the industry. The warning from Rob Behrens, the UK's Parliamentary and NHS ombudsman, sheds light on the impact of narcissistic tendencies among health professionals. The revelation of daily failings linked to narcissism raises concerns, supported by data indicating ~11,000 avoidable deaths in NHS England annually. An investigation conducted by the UK's Times Health Commission in 2023 emphasises the urgency of addressing narcissism within the healthcare system. As the Commission examined the future of health and social care, it uncovered a landscape fraught with challenges such as the aftermath of the Covid-19 pandemic, budget constraints, an A&E crisis, mounting waiting lists, health inequalities, obesity, and the challenges posed by an aging population. The extensive evidence sessions with diverse stakeholders, including senior doctors, nurses, midwives, hospital managers, scientists, business leaders, politicians, and health experts, provided a comprehensive understanding of the issues at play. Narcissists are attracted to healthcare, and narcissism, is identified as a rising concern with suggestions of a potential "narcissism epidemic" in Western economies. The prevalence of narcissistic personality disorder (NPD) in up to ~5% of the US and UK populations is alarming, with important implications for healthcare providers and the delivery of care. Early recognition and mitigation of narcissistic tendencies are critical to safeguard both care providers and patients. In the face of unprecedented challenges within the healthcare sector, recognising and actively addressing narcissism becomes necessary to strengthen the resilience of healthcare delivery. Unveiling the subtle yet impactful consequences of narcissistic tendencies and integrating targeted mitigation strategies into healthcare management are central to our suggestions. This proactive approach not only ensures a more robust operational framework but also paves the way for a patient-centric future, where the wellbeing of individuals takes centre stage in the evolving landscape of healthcare.
In this Commentary

This Commentary has three sections. Part 1: Decoding Narcissism, describes the condition, highlights some early warning signs, points to its incidence rates in the US and UK, and draws attention to the impact of narcissism on individuals and relationships. Part 2: Narcissism in Healthcare, discusses the prevalence and challenges of narcissism in healthcare settings, examining its impact on team dynamics, and patient-provider relationships. Part 3: Mitigating the Negative Effects of Narcissism, describes early warning signs and suggests key human resource strategies to alleviate the adverse effects of the disorder and considers some ethical implications of NPD for healthcare delivery. Takeaways emphasise: (i) early recognition of NPD and a proactive approach to its mitigation, (ii) professional help, and (iii) continuous learning and empathy development.  
Part 1
Decoding Narcissism
In recent years, the spotlight on narcissism has intensified, prompting discussions within the healthcare community. Narcissistic Personality Disorder (NPD) is a mental health condition characterised by a pervasive pattern of self-importance, a constant need for admiration, and a lack of empathy for others. More specifically, characteristics of the condition include: (i) a grandiose sense of self-importance and an exaggeration of one's talents and achievements, (ii) a preoccupation with fantasies of success, power, brilliance, beauty, or ideal love, (iii) an excessive need for admiration and a constant seeking of validation from others, (iv) a lack of empathy, (v) a sense of entitlement, (vi) a tendency to take advantage of others to achieve personal goals, often without regard for their wellbeing, (vii) a pervasive sense of envy toward others and a belief that others are envious of oneself, and (viii) arrogance.
People with the condition often engage in a behaviour referred to as gaslighting. This is a manipulative tactic that makes others doubt their own perceptions, memories, or sanity. Narcissists subtly or overtly distort facts, deny events, or present alternative narratives to undermine the confidence and reality of their victims. This can lead the person being gaslit to question their own judgment and feel confused, ultimately reinforcing the narcissist's control over them. Gaslighting is a harmful behaviour that undermines trust and can have enduring effects on the mental wellbeing of the individual experiencing it. The term gaslighting comes from a 1944 American movie, Gaslight, which is based on a 1938 play by Patrick Hamilton and stars Ingrid Bergman. The movie tells the story of a narcissist that drives his wife insane.
It is important to note that while everyone may exhibit some narcissistic traits at times, which are characterised by expressions of pride, egotism, and vanity, it does not mean that a person is a narcissist.  Individuals with the disorder display these traits consistently and to a degree that manifests as antisocial behaviour expressing callousness, remorselessness, and selfishness, with little empathy, and the condition impairs their functioning in various professional and personal aspects of life.

Narcissism casts a significant shadow over the psychological landscape. The condition affects up to ~5% of the American (~17m) and British (~3.4m) populations. The overwhelming majority of people with the disorder are males (~75%). Despite a prevalence among Afro-Americans (~12.5%) and Hispanics (~7.5%), ~87% of diagnosed Americans are Caucasian. However, such disparities could reflect access to therapy and treatment. A demographic breakdown reveals a higher incidence of the condition among young adults aged 20 to 34, with declining rates in those aged ≥50. Challenges in relationships are evidenced in the US statistics, with ~9.6% of narcissists being single, ~7.3% divorced or separated, and ~4.9% married. A higher percentage of narcissism is observed among mental health patients (~6%), forensic analysts (~6%), military personnel (~20%), and first-year medical students (~17%). These trends invite reflection on the socio-cultural factors contributing to the manifestation of narcissistic traits and emphasises the importance of tailored interventions across diverse demographics.

The causes of the disorder are rooted in a complex interplay of inherited traits, distinct personality characteristics, neurobiological influences, and environmental factors, all of which remain elusive. Notably, parent-child relationships marked by excessive adoration or criticism are believed to be contributory factors. The contemporary shift towards individualism, amplified by the omnipresence of social media, is also implicated in the increase of the disorder. A study published in the May 2021 edition of Personality Neuroscience suggests a connection between narcissism and heightened sensitivity to ego threats and emphasises social and emotional processing challenges and alterations in the brain's salience network as factors influencing the interpersonal dynamics of individuals with the condition. As society, organisations, families, and individuals grapple with these shifts, comprehending the ramifications of NPD's rise and impact becomes important. Here we discuss the negative influence of the condition on healthcare.

Part 2
Narcissism in Healthcare

In healthcare, the interplay between narcissism and health professionals is a complex and much debated subject. While quantifying the prevalence of narcissistic traits within healthcare institutions is challenging, studies suggest an affinity between narcissists and professions offering authority, recognition, and control: qualities inherent in certain healthcare roles. This proclivity can manifest in behaviours with potential repercussions on workplace dynamics and the delivery of care. John Banja's 2005 publication, Medical Errors and Medical Narcissism, illustrates how healthcare professionals, driven by a need to preserve their self-esteem, might hesitate to acknowledge and disclose medical errors.
The manifestation of narcissistic traits in healthcare professionals can divert their focus towards personal recognition, hindering collaboration with colleagues and impeding empathetic connections with patients. Identifying and addressing narcissistic traits in healthcare settings becomes imperative to cultivate a positive and collaborative environment. The inclination of narcissists to prioritise self-promotion over collaboration adds complexity to patient care, where emotional understanding and connection are necessary.
NPD casts a shadow on the dynamics between healthcare providers and their patients or collaborators, leaving an indelible mark on the relationships within the healthcare landscape, be it the collaboration and innovation-driven realm of MedTechs or the intricate doctor-patient connections. Healthcare professionals navigating narcissistic traits may find it challenging to comprehend and empathise with the emotions and experiences of colleagues and patients. This difficulty can create a perceived lack of compassion, posing a threat to trustworthy collaborative relationships within healthcare teams and compromising the balance in patient-provider connections.

The influence of narcissism on healthcare delivery is multifaceted, creating various disruptions. Providers swayed by narcissistic tendencies may prioritise personal validation over patient-centred care, challenging the importance of focusing on the patient's wellbeing in decision-making processes. Effective communication and empathy, critical elements in healthcare, may become casualties of narcissistic traits, impacting the informed consent process, and necessitating heightened ethical considerations to ensure respectful and informed patient consent. Maintaining appropriate boundaries becomes a struggle, giving rise to ethical concerns related to potential exploitation or invasion of patient privacy.
Beyond individual interactions, narcissism can also permeate collaborative efforts and teamwork, with ethical dilemmas emerging when personal interests overshadow collective goals. This compromises patient care and safety as collaboration and synergy take a back seat to self-centred motives. A culture of openness and accountability, vital for addressing concerns and errors in healthcare, faces hindrance, impacting care quality and the ability to rectify issues. Additionally, the prioritisation of personal recognition over equitable resource distribution raises ethical concerns regarding the fair and just use of healthcare resources. Thus, the ripple effect of narcissistic traits extends across a wide range of healthcare relationships and collaborations, demanding a nuanced approach to ensure the wellbeing of both providers and patients.

Part 3
Mitigating the Negative Effects of Narcissism

Early intervention plays an important role in addressing NPD and preventing its potentially harmful behaviours. Identifying early signs within oneself requires careful attention to behavioural patterns and interpersonal dynamics. Key indicators include feelings of grandeur, an inflated sense of achievements, and an incessant need for admiration. Additionally, individuals should assess their ability to understand and connect with the emotions and experiences of others, scrutinise their excessive need for praise and validation, and be cognisant of defensiveness or emotional reactions to feedback.
Similarly, recognising early signs in colleagues involves observing their interactions with others, noting potential signs such as a lack of genuine connection, self-promotion, and difficulties collaborating. Communication styles, domination in conversations, and reluctance to listen are red flags. Assessing their teamwork, prioritisation of personal goals over team goals, and conflicts with colleagues can provide further insights. Observing consistent patterns over time is important due to the enduring nature of the disorder's traits.
It is essential to emphasise that occasional narcissistic traits do not equate to NPD. However, if concerns persist, seeking professional help early enhances the likelihood of positive outcomes. Professional intervention fosters self-awareness and serves as a foundation for positive change. Therapy guides individuals through self-exploration, offering tools to navigate challenges, manage stress, and improve relationships. Early intervention is critical in mitigating the potential harm narcissistic traits can inflict on relationships.
Creating a positive work environment involves open communication, clear goals, and team-building activities. Acknowledging and appreciating team efforts, empowering members, embracing diversity, and establishing effective conflict resolution mechanisms contribute to a positive workplace. Leaders play a crucial role by exemplifying positive behaviour and encouraging constructive feedback, promoting collaboration, employee satisfaction, and increased productivity.
Addressing NPD in healthcare delivery raises ethical concerns, requiring a focus on patient-centred care, effective communication, professional boundaries, and a collaborative, ethical healthcare culture. Healthcare professionals and organisations must embrace these challenges, guided by ethical principles to ensure quality patient care. Human resources play a crucial role in fostering psychological safety: a culture where team members freely express ideas, admit mistakes, and contribute without fear. This openness supports innovation, risk reduction, and inclusivity, serving as a game-changer for team dynamics and performance. Properly managed, psychological safety leads to fewer mistakes, increased creativity, enhanced team performance, improved diversity, and greater organisational resilience. It is not a luxury but a necessity for thriving teams, encouraging open communication, building trust, and emphasising team dynamics over individual skills.

Successfully addressing the challenges posed by NPD requires a comprehensive and proactive strategy. Recognising the early signs and intervening promptly is essential to mitigate the negative impacts on personal relationships, work environments, and healthcare delivery. Seeking professional help, fostering self-awareness, and developing effective coping mechanisms serve as foundational pillars for cultivating healthier interpersonal dynamics. Building resilience against narcissistic challenges necessitates a commitment to continuous learning, empathy development, and the establishment of robust boundaries. Organisations, too, can benefit by promoting awareness, education, and proactive management of narcissism, thereby reducing associated stigma, and fostering open conversations about mental health. Education is a key component, targeting healthcare professionals to recognise early signs of the disorder and understand its impact on individuals, relationships, and healthcare delivery. Proactive management involves creating supportive environments, implementing interventions, and cultivating a culture of empathy and collaboration. Prioritising mental health, advocating for accessible resources, and adopting a compassionate and informed approach can collectively address the challenges associated with NPD, contributing to a more empathetic and understanding society.
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The HealthPad Team would like to extend our thanks for your continued support. As we celebrate another year together, we sincerely hope you've found our Commentaries interesting and helpful and we look forward sharing more thought-provoking content with you in 2024.

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