.png)
A few days ago, I shared some thoughts on this topic on Faces of Digital Health Podcast with Tjaša Zajc. The following essay is a continuation on the same subject, with more flesh and in writing.
Consulting is a multifaceted profession that demands vision, skills, talent, field expertise, compassion, and a significant dose of emotional intelligence. Health and health tech consulting, in particular, stand out due to their rich human interactions across various stakeholder groups, mostly with conflicting agendas and the high stakes involved in saving lives and ensuring populations’ well-being.
The challenges in this field are immense, but addressing them is equally rewarding. One way to analyse these challenges is to start from the end (outcomes) and roll back to other problems by proxy. To better appreciate what follows, I need to highlight that most of our work is related to big scale, national and international government health and digital health transformation initiatives, sports performance and Med Tech innovation. Pharma and payers are excluded from this analysis.
The Challenges
Over the past two decades, our field observations have helped us better appreciate the complex dynamics underlying consulting practices in health and care. Because pinpointing the problem is always a big part of the solution, we started documenting these challenges so we can learn, grow and unlock the full value of our client interventions.
1. Failure is more Prevalent than Success
Transformation efforts are strategic by design. A stark indicator of the aforementioned industry shortfalls is the rise in unsatisfactory outcomes of transformation efforts. In a 10-year study by Bain (Fig. 1), although outright failures have decreased by 65%, the proportion of projects that achieved mediocre results has increased by 33%, while the percentage of projects meeting or exceeding expectations has remained unchanged. Although these figures have multifactorial causes, it is essential to remember that consulting firms bear significant responsibility for ensuring the success of every project. This is, after all, the primary reason they are engaged. However, over a period of 10 years, it remains unclear how some consulting firms still claim to have met their clients’ expectations in over 88% of the studied cases.
Moreover, the current engagement model having over 80% of the consulting market tangled in the claws of a handful big consulting firms is showing patent signs of cognitive fatigue. No wonder the outcomes of most transformation projects above look eerily similar. Innovation and impact being the biggest victims of these sterile interventions.
2. Intellectual Distraction
This is probably the most important and insidious variable in the big consulting equation. It takes different flavours and shapes too.
It is a common occurrence to see national health strategy-related projects awarded to big consulting firms. The usual suspects. Not least because of their capacity to readily deploy an army of consultants, the client often needs to navigate their own administrative streams, manage political risks and most of all, secure a much needed budget for the actual implementation of the strategy. Although an unwritten rule, in more countries than others, the brand on the ‘rubber stamp’ of the consulting firm who delivered the strategy plays a major role in securing that project budget. Big consulting companies offer that virtual safety blanket to governments. Virtual because, as periodically reported in the news, they’re not always immune to backlashes, undeclared conflicts of interest and other sorts of unethical and unprofessional behaviours.
Everything is ‘fair’, until one realises that a big part of the project deliverables is not implementable for lack of understanding local contexts and related due diligence. It is also common practice in consulting to use templates from previous projects and find paths of least resistance to literally copy-paste past practices and processes from under other skies into a very different client context. I’m not saying this is a wrong practice, until it really is when done blindly.
The problem with benchmarks is they come with the illusion of being replicable with the same effort and same outcome. Nothing is further from the truth, but for now, benchmarks are the most tangible anchor one can get to frame new projects. They just need to be understood and interpreted in the limits of their own context.
"The problem with benchmarks is they come with the illusion of being replicable with the same effort and same outcome."
The whole setup feels and looks like a scene from the movie ‘Inception’, with the intellectual dimension frozen in time before the start and after the end of the engagement, allowing business-as-usual transactions continue to take place.
I’m not sure to what degree this lapse in cognitive continence could ever be fixed, but it seems to be something we will have to deal with in foreseeable future. For now, I’d defer this great use case to the higher court of more competent business schools.
"Often enough, big transformation projects have budgets adjacent to those of a rocket launch — yet, the output often fails to pass the stratosphere, let alone reach orbit."
3. Competent Resource Scarcity
Despite shrinking client budgets, the demand for highly skilled health consultants still far exceeds the supply across all consulting service suppliers. Crucial elements of field competence include human relations, analytical skills, domain expertise, emotional intelligence and industry experience. Competence involves finding the most efficient path to accurately define a problem, and devising options to solve it. It also involves knowing when to advise against certain practices based on evidence and/or parallel contexts.
Knowing ‘what not to do’ is sometimes the cheapest and most effective action a competent consultant can advise with. It just averts mistakes, saves face and most of all, credibility. However, this is all easier said than done. Fact is, practicing at this professional level is a rare occurrence in health and care today. The scope of health advisory competence covers a whole spectrum ranging from art to a few scientific domains. I do not mean that a consultant should know everything, nor I’m insinuating that I do either. This is a statement to highlight the complexity of our job where a professional is at least expected to know what they don’t know, say so and act accordingly.
However, these ethical boundaries are still blur for many, and this blur is sometimes nurtured by clients who expect the consultant to know almost everything. Of course, Subject Matter Expertise is a thing in consulting — as much as name-dropping. But like in construction, offloading 20 workers in uniform on a whim doesn’t mean they’re all fit for purpose and competent to complete the building according to industry standards.
4. Cultural Literacy
Consulting in general and healthcare strategy consulting in particular is a truly global enterprise. Not least because I know of no other industry that is currently undergoing such a fundamental transformation, mobilising expertise from the four corners of the planet is not only critical, it is actually often expected by the client. And there lies another set of cultural challenges.
4.1. Decision-making is a major domain of cultural consideration:
Germany: Time to make important decisions is typically long. But when a consensus is reached, the germans go straight into implementation. No more questions asked.
USA: Time to decision making is much shorter, however, this only means that ‘we agree to start but reserve ourselves the right to change scope and directions along the way’.
Middle-East: Committees are the place where decisions are made. The process can be long or short, but the main hiccup is that committee decisions can be overturned by one person in a higher position at any point in time.
There’s no right or wrong in the above. It’s a statement of engrained cultural behaviours that a culturally-aware consultant needs to get their head around before engaging.
4.2. Giving and asking for feedback also sometimes comes with a decoding algorithm — both ways. The topic of ‘feedback’ remains by far the most mentally challenging, fascinating and entertaining topic to me and underscores the vast diversity and complexity of human nature when multiplied by the cultural factor.
4.3. Finally, the cornerstone of every successful transformation project are governance and leadership. More often than not, reality translates leadership to ‘hierarchical power’ and governance to ‘whatever the most powerful instance says’. This is unfortunately far from fiction. However there’s always a way to deal with this situation and this usually takes one’s whole cultural acumen, patience, a good dose of luck and a lot of frontal lobe numbing substances to overcome.
5. Consulting in the Age of AI
The consulting industry is showing signs of slowing down, with major firms like Bain, McKinsey, EY, and Deloitte reducing their workforce post-Covid. Revenue growth has halved to 5 percent according to the Kennedy Consulting Monitor. Moreover, AI is now capable of performing tasks traditionally done by junior consultants, such as creating slides, analysing documents, and proofreading reports, without incurring additional client costs. This indicates a shift toward a decline in the current consulting model. And this is just the beginning.
6. Local Expertise and Institutional Memory
One of the most complex challenges is the over-reliance on consulting firms for strategy, execution, and operational management. Without adequate knowledge transfer and capacity building, this practice contributes to the decline of the ‘client's institutional memory’, which benefits the consulting firms economically but ultimately harms the clients in the long run.
Moreover, it is common practice for consulting companies to poach clients’ best employees, which further exacerbates the problem. For obvious reasons, consulting firms are very unlikely to shift away from this practice, and it is therefore the client’s prerogative to break the cycle by explicitly demanding a knowledge transfer plan, dedicate full time resources from their side for this undertaking and develop a coherent talent retention programme. Only then, a sustainable path for bilateral growth and success can see the light.
Fig. 2 highlights our golden quadrant as a sine-qua-non principle to build a path for a more resilient client base.
A benchmark in efficient long-term government planning is Singapore: In 2008 when faced with the prospects of digitising its healthcare ecosystem and gearing up for the National Electronic Health Records (NEHR) project, a Government-owned private company was created — Ministry of Health Holdings (MOHH). MoHH then attracted, hired and retained experts from the four corners of the planet to build capacity. Most of these executives occupied C-Level roles — up to Minister-minus-two positions. After a successful trnasition, today, 99% of the MOHH workforce is Singaporean. A model to follow indeed.
"Beyond the classic deliverables, the unwritten golden rule of consulting is the moral obligation to work on leaving the client stronger and in a much better position they were in, before the engagement."
7. Health Technologies
Digital health holds the promise to boost healthcare outputs and indicators. However, our documented observations show that we still have a long way to go before that happens. The most salient reasons for that are:
Lack of Clinical Leadership: With extremely few exceptions, Technology-led initiatives almost all the time fail, because of lack of clinicians’ engagement. In low maturity settings, the risks of technology implementations being undertaken in spite of lack of related policies is worrisome. For example, implementing telemedicine services without policies, regulations, accreditations and technology certifications is closer to crime than it is to good medical practice. The other problem is, problems occurring through the delivery of telemedicine services are almost never reported.
Speed of Innovation: Technology evolves at a much higher pace than polices and clinicians can cope with.
Lack of Digital Competence: this goes beyond skills. Digital Competence is the ability for hospitals and governments to sort out their tech investment priorities in a way that is aligned with their business aspirations. The current AI frenzy is very disturbing because we always tend to overestimate the short-term potential of new technologies while underestimating their negative long term effects. Hint: look at Facebook!
"The current global rush on AI in healthcare should be considered as the biggest double-blind study in the history of medicine, at best!"
An accountable healthcare consulting company has the duty to flag these issues and help their client address the related technolgy risks in a timely, efficient and meaningful way.
A Possible Way to Overcome These Challenges
These challenges are elements we see every day, and they inspired us to rethink about the way we deliver our services. I thought to share some principles we have surrounded ourselves with, for reflection and informed feedback. These guiding tenets ensure that, beyond any contractual obligations, we as healthcare professionals, go the extra mile to deliver impactful, sustainable interventions that enhance the capacity and robustness of our clients’ base and serve the best interests of their main stakeholders: citizens and patients. These tenets are:
1. Competence Over Expertise
Exclusively engage seasoned healthcare and health tech experts and give them a cultural briefing before the engagement. Transformation projects are too important to engage junior staff. I stand to be proven wrong by means of evidence that engaging junior consultants in big projects delivers anything but frustration. By avoiding junior and cross-industry assignments, and engaging seasoned experts, we ensure the highest output quality, lower risks and nurture the trust our clients place in us. The economic argument to not do so is nothing but a lame, self-fulfilling excuse. Oh, and did I say to never take the word of sales person for granted. Sales people sell and most of them talk cheaply. If you need consulting services, don’t talk to sales, talk to those who will deliver.
2. Knowledge Transfer and Capacity Building
A consulting engagement’s mission shall always extend beyond contractual boundaries. Not by doing more for free, but doing the right thing to ensure success. Hence, the commitment to transferring knowledge to clients’ teams, empowering them to build capacity and reducing dependency burdens on external consultants should be the holy grail of every intervention. The goal is to leave their organisation stronger and more self-sufficient. That’s your true impact. And they’ll never forget it.
3. Tactical Quick-Wins and Strategic Guidance
We live in the NOW. Expectations start building up as soon as a national transformation project is publicly announced. Nobody wants to wait. You can’t change human nature, but you can always work on managing their expectations by means of effective communication and swift action. Identifying quick-wins and measurable, time-sensitive improvements — for example, within the first 60-90 days and at 6 months would be a sensible thing to do. This approach ensures that stakeholders see some immediate benefits, which helps anchoring them to long-term strategic plans by means of gained trust.
4. Accountability and Evidence-Based Advice
There’s a travesty in the consulting business: A consulting company’s typical first mission is to put the blame on someone else when things go wrong. To date, I’m yet to see any of the ‘big four’ taking accountability for negative outcomes following any advice given to clients. The burden of failure is always on the client. Unless things go really well and the client is elevated to the rank of global reference. Of course some clients are 100% to blame for failing to execute or not complying with the already agreed strategy. But in general, it takes two to tango and having skin in the game goes both ways.
5. Open Source Consulting
Most tools, assets and practices should be made available to clients to use without restrictions. This ensures more transparency and offers us an opportunity to receive external feedback to further enhance methods of work and hone approaches in a more scientific way.
6. Creativity and a Blue Ocean Mentality
The argument for creativity is simple: If your brain is what you’re being paid for as a consultant, then you have the moral obligation to use it. There is nothing more counterfeited, lazy and dull than seeing a consultant filling a template from another project. It’s borderline insulting.
In our business, being creative unlocks a realm of possibilities, transforming challenges into opportunities and fostering innovative solutions that drive success. As much as we all like frameworks and structured approaches (of course, they’re easy to follow), we advise to balance consulting interventions through new, creative ideas. This mindset empowers joint teams to think beyond conventional boundaries, offering fresh perspectives and unique strategies tailored to each client's needs. Ask unconventional, challenging questions, embrace agility, guided experimentation, and have a relentless drive for improvement — allowing your clients to uncover hidden potential, inspire groundbreaking ideas, and deliver impactful results.
7. Communities of Practice
We believe that focusing on healthcare practice and leveraging an open collaboration with a global network of smart and competent health and health tech professionals is the future. We believe in the power of collective leadership and its potential to deliver diverse, creative views and undeniably achieve much higher value.
We believe that these principles are essential in delivering value to clients while addressing some of the challenges we mentioned above. The principles help align our growth with the positive impact we create. It’s a win-win proposal. One that is based on trust and competence on both sides.
Our hope is to see more of these principles applied on the field these principles. As always, we openly share practices and lessons learned so they benefit everyone shaping the bigger picture of health and care wherever they are.
Our aim is not to point fingers, but to elevate the level of debate. Our aim is to redefine competition grounds that are based on substance, content and impact, and depart from hype, branding power and marketing jargon.
If you have ambitious goals and you are looking for a partner who truly understands how to address the complexities of healthcare, and is committed to making a lasting difference, we invite you to explore how our unique approach can benefit your organisation or your practice. We’re always looking for opportunities to learn and grow. Together!
Our purpose is to build resilient health ecosystems — and we cannot do it alone. This is an open invitation for anyone who wants to help us shape this exciting endeavour. And we’re literally just one click away!
Join us!
Mehdi is the Founder and Managing Partner of SEHA - a global, independent health and tech consulting company.
Comments