Signposts from the Future - scenario planning at BMJ

In this guest blog, Katy Alexander, Head of Strategic Marketing for Journals at BMJ takes a fascinating look into the future.....

It’s 2037, the fourth industrial revolution has come and gone. The medical research landscape is highly automated and cloud based. Medical researchers are required to combine scientific qualifications with advanced programming and policy/communications expertise, patients are driving the healthcare research agenda and the very nature of disease is disrupted by technology. While some of this may seem implausible, I’ll bet that a number of us would have said the same in late 1990s when the scenarios of the time were pointing towards a potential future when the publishing industry would become a technology industry, prey to small disruptive innovations companies.

As with many industries, the publishing and healthcare industries operate within a complex, rapidly and consistently changing environment. In the past five years alone, the medical research and healthcare space has been influenced by a range of disruptions brought on by digital technologies, political and social unrest, and shifts in customer behaviour.  Wearable patient-monitoring devices and apps like Sea Hero Quest  have started to offer access to unprecedented data sets, often in real time. This period of rapid change has presented wide-ranging uncertainties.

While scenario planning is far from a new discipline, companies are increasingly incorporating scenarios practice into strategy processes as a means of surfacing and managing these uncertainties more systematically.  The process pushes us to think more expansively about potential futures in order to inform today’s strategic choices and the signals and underlying trends we may see in the future that could indicate which scenarios are playing out and how we should adjust to them. Practically scenarios are a structured way for companies to paint divergent versions of the future, they offer possible views of the world in the form of a narrative or “story”.

In November 2016, BMJ embarked on a scenario planning process based on the Saïd Business School’s Oxford Scenarios Programme (OSP).  We didn’t set out to predict the future; I think we can all agree that isn’t possible. However, we did want to think more systematically about the future, strengthen our abilities to cope with unpredictable shifts in the landscape and plan for innovation. Led by our Competitive Intelligence team and Director of Strategy, the process took just over eight months. During this time, we identified our two critical uncertainties - (Technology Adoption / Dominant Funding Model) - and defined a set of forces that could influence the direction of medical research. We carried out over 50 interviews with internal and external stakeholders as well as global thought-leaders from a wide-ranging list of industries, hosted three workshops and developed four varied and plausible scenarios describing the range for the future of Medical Research.  An overview of our four scenarios is provided below:

Techtopia: The fourth industrial revolution has rid the need for entire medical disciplines and many roles previously carried out by medical researchers are now done by machines. Researchers are required to develop expertise in programming, engineering, and software & informatics. While a small private ecosphere, driven by philanthropic organisations, is paying for research to be undertaken in neglected areas private technology corporations monopolize all elements of medical research. Medicine is highly personalised, health wearables are abundant, patients are triaged in the cloud and medical facilities are small and owned by large corporations.

Sustainable health 2037: Governments have come together to address the big, global issues. A combination of regulation and taxation has encouraged a diverse and highly collaborative research ecosystem. Medical researchers progress in their careers by producing high-quality data sets in areas prioritised by governments. Machine learning provides real-time analysis and interpretation of datasets, and technology is making lifestyles healthier, even in once-remote regions. However, the replacement of human-to-human interaction by technology is exacerbating mental health problems associated with social isolation and loneliness.

Post West power shift: Economic and social instability and volatility in the West have curtailed international movement, and political agendas now focus narrowly on issues of national security and economic health. The West no longer dominates the medical research landscape, Easternisation and the rise of the Global South is causing a geographic shift. Medical researchers are employed by public research and healthcare facilities.

Neighbourhood science: The voice of the people drives the setting of medical research priorities. There is increasing investment in medical research at the boundaries of health and social care, and the data comes from mostly from social networks and community apps that share personal health information. Clinical research is a niche interest collected by crowd-funding and pockets of small investors, and are driven by public appeals.

 Aside from informing our strategy process, as a company we have benefited from scenario planning in three main areas:

1. Scenario planning has widened the conversation at BMJ. It has stretched teams at all levels and in all departments, bringing us together and enriching conversations, leveraging expertise and knowledge from across the business and challenging everyone’s assumptions. 
2. Our thought process has collectively moved further away from a linear, preordained and operational path to understanding that linear concepts are not the only way to think about time. We are setting up early warning indicators that can be monitored and contingency plans implemented. This means we can revisit the scenarios and if necessary, revise them.
3. Scenario planning draws on a wide range of disciplines and interests, including economics, psychology, politics and demographics, it has engaged us all to think outside of our industry and to remember that even modest environmental changes can have enormous impact

We don’t know exactly what 2037 will look like; it may have some aspects of these scenarios or possibly none. However, we can and should be asking ourselves how key uncertainties and broader trends affect our industry and business. Through this process, we should constantly be looking for ways to innovate and shape the future that we wish to see.

If you want to read more about the scenario planning narratives and the key forces we believe are impacting and shaping medical research  please visit our site www.bmj.com/company/scenarioplanning

If you are interested in learning more about our process and the thinking behind our scenarios, keep your eyes open for “The​ ​future​ ​of​ ​global​ ​research​ ​-​ ​a​ ​case​ ​study​ ​on​ ​the​ ​use​ ​of​ ​scenario planning​ ​in​ ​the​ ​publishing​ ​industry​” in a future Issue of the Learned-Publishing.

Katy Alexander is Head of Strategic Marketing for Journals at BMJ and has over 15 years experience in the publishing industry, serving in a variety of marketing and strategy positions. She is always happy to discuss anything related to publishing or disruptive technologies so reach out on twitter @kla2010

Website: www.bmj.com/company
Twitter: @bmj_company
Facebook: https://en-gb.facebook.com/bmjcompany
LinkedIn:https://www.linkedin.com/company/28437/

ALPSP Awards: Where are they now? BMJ Case Reports

With the 2016 ALPSP Awards for Innovation in Publishing now open for submissions, we spoke to Janet O'Flaherty, Publisher at BMJ, to find out how BMJ Case Reports has faired since winning in 2010.

1. You won the ALPSP Award for Best New Journal. What was that like?

It was a super evening and we were all thrilled to win. The trophy sits proudly in our boardroom. I enjoyed the submission process, even doing the presentation to the panel. It was particularly gratifying that one of the reasons we won was the business model - only people with a personal or institutional Fellowship (subscription) can submit case reports - but there are no additional publication fees if the case is accepted.

2. How have you developed BMJ Case Reports since then?

We have grown immensely with nearly 13,000 cases live. The developments have been editorial rather than technical - we now have some subject specialist editors and a Global Health section with an accompanying Student Elective competition new for 2016. We have a group of medical student editors that blog for us. We've expanded into dentistry and have plans for a pharmacy section. The Editors do a lot of outreach and workshops on writing cases and getting them published which are always very well received. We have also copied the model for one of our societies with Veterinary Record Case Reports.

3. What have been the highlights?

The rapid growth and acceptance by medical schools that this is an important resource for students and trainees - and truly international as we have case reports from more than 70 countries. Adding the student board and having a workshop on getting published at the BMJ Careers fair in 2015 were personal highlights. Publishing our 5,000th and then 10,000th case reports were great milestones and we did some print mini-journals to celebrate. The journal has outperformed it's original business plan which is also gratifying.

4. What are the challenges you’ve faced?

The sheer volume of submissions and keeping turnaround times down is probably the most difficult. We also don't have an automatic way of checking that authors have the rights to submit (ie, that they or their institution has a Fellowship) so that's done manually (we do outsource that bit).
The journal is on a standard journal platform and so perhaps not optimal for discovery of the content. Also the publishing model means we don't currently have a mobile optimised site.

5. How did winning the Award help with BMJ Case Reports' development? 

It was great for marketing - in fact it's still used on our website and in our user guides/training materials.

6. What are your plans for the future?

We're exploring some technical enhancements - making the content more discoverable, e.g. if you are interested in this case then here are others that you should read. Hopefully some integration with other BMJ products that are used by medical students and junior doctors. We do hope to have a new user interface and design by 2017. As mentioned before - expansion outside medicine. We're looking at adding some interactive questions - starting with pathology and pharmacology cases. As we now have so much content - and there's no sign of it slowing down - we may offer a "read only" subscription once we have enhanced the journal's website.

Janet O'Flaherty is Publisher at BMJ. Information about BMJ Case Reports is available on their website.

Submissions for the 2016 ALPSP Awards for Innovation in Publishing are being accepted until Thursday 9 June. Full details available on the ALPSP website.

BMJ's acquisition of the British Veterinary Association Journals

Janet O'Flaherty from the BMJ

In a session designed to consider divestment as a strategy, Janet O'Flaherty, Publisher at BMJ, outlined how the British Veterinary Society chose to work with BMJ as their preferred partner and how the journals have fared in the past six years.

The BVA has been publishing in house since 1888. they were very traditional and conservative, had seen spiralling costs with declining revenues and lost contract publishing business over several years. There was a technology deficit and were struggling to keep up to date. They chose the BMJ due to a good natural fit: both are the 'go-to' Associations for their professions.

BMJ inherited a weekly magazine, large backlog of content and lots of historical legacy systems. First of all, they moved the staff across to the BMJ, built a new jobs site, reviewed roles and processes, integrated workflows and upgraded hardware. It was important to reassure the staff that they were investing for the future.

They moved print production to BMJ suppliers and renegotiated supplier contract for hosting. They introduced right-priced subscriptions and tweaked the business model. They didn't have any vets working on the editorial board so they advertised for a Veterinary Editor-in-Chief. They also set up customer focus groups. They refreshed cover and page layout, bearing in mind the conservative nature of the audience.

Other editorial developments included:

• Appointed veterinary research editor and clinical editor
• Refreshed international advisory board to improve reach
• Improved workflows and author services - online first
• Research published as one page summary in print for practitioners
• Editorial to accompany original articles
• OA hybrid option
• Boosted social media.

There is a successful and ongoing relationship with the BVA which is profitable for both parties. Online usage has increased 60% from 2011 to 2014. They have had positive feedback from readership surveys. They've looked at new revenue streams such as supplements, round tables, webinars. The jobs site has changed and even more successful with revenue growing. Editorial turnaround times now 12 days from receipt to acceptance. They have a stable editorial team and have launched two new journals.

And the lessons learned? These include:

• Timing to avoid disrupting weekly schedule
• Poor inherited data especially for subscribers (importance of TRANSFER)
• Staff getting used to BMJ (letting go of some responsibilities)
• Transition to new systems and processes
• Online hosting transfer slow
• Recruiting first Veterinary Editor-in-Chief
• Communications are key

Janet O'Flaherty spoke at the ALPSP seminar Disruption, development and divestment held in London on Tuesday 17 March 2015.

Tim Brooks Keynote: Drowning - or Waving?

We are delighted to welcome delegates to our annual International Conference and Awards. This year we will provide coverage of the event on Twitter so follow the #alpsp13 hash tag. We'll also provide summaries here on the blog.

The day kicked off with a keynote from Tim Brooks, CEO of BMJ who reflected on the struggle that every organisation has with technology driving change.

Who am I to talk?
Brooks is a journalist by training, but has experience of working at The Guardian, IPC Media, Time Inc and Emap amongst others. He was a Visiting Fellow at London Business School before joining BMJ, which provided a different perspective of how people learn. He has seen first hand the challenges traditional media companies face. At BMJ, they have over 60% of revenue now derived from digital, up from 10% in just a few years, and they are seeing growth from international markets.

Modern life: bloody complicated
Brooks observed that it is impossible to talk to anyone who is not facing an increase in the speed of activity, greater need for flexibility, an increasing number of variables, ever more complex interdependencies and an increasing range of novel - or unpredictable - phenomena. Fast is the new slow. Being a manager today is a lot like ongoing agile development.

'Doubt is not a pleasant state: but certainty is a ridiculous one.' - Voltaire

Why is change so hard?
There are cultural obstacles that are easy to overlook. Good news culture can be corrosive: issues that are causing difficulty get filtered out as it goes up the organisation, so that those with senior, strategic responsibility aren't getting the full picture.

Skills and decision making are key, but corporate leadership were/are not digital natives. Leadership by definition has vested interest in the status quo. And digital natives are not naturally drawn to legacy environments. Marrying digital skills to an enterprise's established skills or vice versa challenging and time consuming.

Do those who know have a voice?
Brooks drew on the example of Emap in the 80s. They noticed that classified regional newspaper sales were falling across the board. Rather than fire the sales team, they talked to them - as highly skills professionals - to find out why. The message was clear: local radio was taking sales. The solution? They sold their regional titles and bought into local radio.

There are a number of structural options an organisation can adopt. The prevailing wisdom is if you are going to make a transition to the new you have to keep it separate. But there are a lot of different options for company structures and it is difficult to predict which is the right one.

Make sure you use the right metrics. Don't get trapped by your own perception of what your business is: the customers' perception is more important.

Looking for answers: the newspaper industry
The UK has the most competitive newspaper market in the world because it was the first into the market in Victorian times. Shrinking, dying industries start doing strange things, but when you look at The Times and The Guardian, they have strong readership and there is healthy rivalry.

Agility, agility, agility
Sky has been brilliantly agile. They have portfolio agility and strategic agility. When LoveFilm came along they untethered their content so it can be watched on mobile devices.  This was a massive change to their business model and one that was full of risk. They structure their businesses for different markets - keeping film and print differently.

'There are always two parties, the party of the past and the party of the future; the establishment and the movement.' Strategy as Revolution - Gary Hamel

What's in it for me?
While Brooks was at The Guardian, they opened up weekly open meetings for all staff to come along to discuss a digital related issue. It was amazing how they gained fresh insight into issues from unlikely sources. He stressed the importance of remembering what's in it for the people you work with. Treat staff as volunteers. Talk and listen. Honour the rule of 5 (in marriages if there are five or more positives to every negative the marriage will last). Treat your staff the same way. Look after your team. Tell people what you want them to do, why you want them to and thank them for it. And don't forget you. The balance between self, loved ones and work crucial.

ASA 2013: Fiona Godlee on Who is an author and why does it matter?

In the first session at the Association of Subscription Agents and Intermediaries conference in London, Fiona Godlee, Editor-in-Chief of the British Medical Journal discussed the challenges of authorship credit and the move towards contributorship. Who is an author and why does it matter?

Life and research is far more complicated than it was. We now have multi-centre/author/function research going on. There are questions around who did text, the statistics and the lab work. Research has always been, but is even more so today, competitive with researchers fighting for first author place. Then there is the commercial interest, use of journals for marketing by medical/pharmacy industry

The International Committee of Medical Journal Editors has guidelines on authorship credit and have added to these to try and tackle some of the emergent issues. The idea of contributorship revolves around credit and responsibility, being explicit about roles and contributions and revisiting responsibility for complex studies with guarantor role.

The things that bother editors are:

• bias
• data manipulation or suppression
• dupliate publication or salami publication
• fabriation of data
• falsification of data
• gift authorship
• plagiarism
• self delusion
• undeclared conflict of interest
• wrong observations, analysis or references.

Source: Stephen Lock, BMJ

You can map these across to what constitutes errors in good faith, 'trimming and cooking' or fraud. Stephen Lock at the BMJ mapped these issues (see Fiona's slide, right).

The reality is that the lack of open data is creating major problems with verifying research. Questions around Tamiflu are a case in point, with contradictory statements confusing the picture, which was compounded by the lack of data available for checking.

Concealment of data is a very serious offence. In the US you have to register your trial and publish data within a year of the end of the trial by law. Yet a large proportion do not. The BMJ are trying to do their bit by insisting that clinical trial data must be available to be published alongside the article. 

With the BMJ open data campaign, Tamiflu is the test case. However, industry funded trials are not the only transgressors. Non-commerical trials are just as guilty. But there are signs of compliance. The UK HTA programme is an exemplar - they badger authors, withhold funding and publish on an open access website. This approach has resulted in near 100% compliance.