Tom Krohn is the Business Lead for the Lilly Clinical Open Innovation Team. Tom’s career began as a practicing pharmacist.
His experiences in building and eventually serving as GM of the largest healthcare organization in Madagascar shaped his frame of reference, as he realized that healthcare was not only about delivering much-needed treatment and medicine, but also about logistics, business models, and the accessibility of information.
In this interview, Tom tells us the story of how his “personal passion and commitment to use my talents to serve the marginalized of society” was shaped over time – and how this passion can be realized through his work in clinical open innovation.
You have a varied and interesting background: You’ve been a pharmacist, a CFO then GM for the largest healthcare organization in Madagascar, you have experience in an IT organization… How did that evolution happen?
The experience in Madagascar showed me a lot about what information systems and appropriate uses of technology could do for healthcare – both to help get things done and, especially, to empower the people doing the work.
My pharmacy degree gave me context, background – and we were successful in doing a number of things there, from local pharmaceutical production to computerized G&A functions and supply chain. But the main challenge of healthcare in the third world, in my opinion, is not primarily innovation or new medicines. There are many diseases there that are quite treatable, quite preventable. The real challenge is an administrative, logistic challenge – an organizational design challenge.
An example of a logistical problem: Traditionally, in Madagascar – this was before email was widespread – you had to go through someone to send a fax. It was $10 a minute to send the fax, half the time it didn’t get through to Europe, and it was just crazy.
So I worked with a French association and put in the first email server in the country outside of the U.S. Embassy. The goal was to put the ability into the hands of people on the ground – in this case, the people managing the supply chain – and allow them to interact directly with the suppliers in Europe and throughout the world. And what happened was that instead of having to go through the expatriates or someone at the top of the organization, they were empowered to do it themselves.
That autonomy changed the way they felt about their work, and it changed the way we worked in the business. There was this blending of management and technology for healthcare business. So, I stepped into the management role, initially out of necessity, but found that my gifts were as much, if not more, in administration as they were in pharmacy. I became convinced that my experience and background, over time, should be a combination of business in healthcare, using information.
How does this story inform your current role on the Lilly Clinical Open Innovation team – and your passion for serving marginalized people?
In Madagascar the challenge might have been the logistics of getting a box of supplies that needed a cold-chain to get from one place to another without getting hit by the heat of the tropics.The same idea can be applied to allowing people to speak into the operational dimensions of clinical trials. There are marginalized people even in clinical development.
In 10 years of working in the pharmaceutical industry, I’ve experienced watching us design and plan research for the sake of patients. But often that research is planned through the lens of subject-matter experts, the senior consultant advisors, and we marginalize or take out of the equation the patients, the people on the ground – often not by intent, but by how the research is designed.
And so, I am very interested in allowing and enabling the people affected by pharmaceutical research to be part of the process. Because, in the end, that’s where the healthcare happens: It happens on the ground.
So, how does empowering people work into a business model for clinical development?
In clinical research, we make significant investments in our late-stage – mainly Phase II and Phase III – portfolio. As we move to scaling and efficacy and continued safety observations, we make assumptions, based on our best judgments, of how trials will fit into clinical practice – how patients get treated, how they connect into their support groups, and so on.
The challenge is that we’re making these decisions and investments a long way away from the ground truth – away from the experience of the patient and the people who are treating them. We make huge investments – hundreds of millions of dollars – and, unfortunately, if you look at the track record, it’s not unusual that a Phase III program does not go as we desire.
That’s because the operational aspects – projections about patients’ willingness and availability, the design of inclusion/exclusion criteria (who can and cannot participate in the trial) – are off from the ground truth. So, what we’ll have is an investigator coming back to us downstream and telling us, “I can’t enroll patients because your I/E criteria is too strict” or “I can’t get them to come because you’re asking them to spend eight hours per week in this treatment protocol, and that’s unrealistic” and “Even if the treatment goes to market, we’d struggle to offer it as a valid option to patients because of the impact to them.”
Now, how do we listen to the people on the ground so that the probability of operational success on the trials is improved?
I would say that our approach is more of a hypothesis than it is a given truth at this moment. We find ourselves at the start of open innovation techniques in clinical development, not having proven models. In other words, we’re early on this. We have a series of plans to apply open innovation techniques to clinical development. We don’t have a proven case study yet.
So the question then becomes: How do we appropriately embrace and engage people outside our company walls in trial design and in clinical trials? I think there’s a lot of opportunity, and we’re going to go after some of those.
Why Lilly? How did you see Lilly as feeding this passion of yours to empower people?
When I left Madagascar after 10 years of service and came back to the States, I went back into pharmaceutical practice while I was getting my MBA at the University of Texas. (Go Longhorns!) I intentionally targeted the pharmaceutical industry. I had multiple offers and even interned at Pfizer. But I really connected with Lilly because they’re a values-centric company.
The other thing I would say about Lilly is that I joined in 2002, and the dot-com bubble was still strong, and Lilly made a commitment to innovation – through eLilly at the time – and that led to a number of innovative models of work. That got my attention. Probably the most well-known is Innocentive. The ability to change the way we do business – Innocentive’s Seeker-Solver model, for instance – is attuned to my mindset.
So, here is a company that endorses as part of its portfolio and investment not only in the pipeline but also in changing the way we do the business. That was attractive.
(And it’s been a great 10 years; I hope it’s many more.)