The dual-assessment approach, combining desk analysis and stakeholder research, revealed preliminary insights into stakeholder-specific needs and broader trends. Preliminary findings identified distinct roles and needs within these communities, shaping our analysis of trends specific to each group as well as transversal trends affecting the healthcare landscape. These findings serve as a foundation for guiding our MA department's evolving strategic engagement and decision-making priorities.

3.1 Desk Analysis and Stakeholder Selection

In our exploration of the healthcare ecosystem, a thorough analysis identified 16 pivotal stakeholders that play a critical role in healthcare decision making or policy, directly impacting patient care, clinical processes, or regulatory environments. Each stakeholder is strategically grouped into three main communities and seven archetypes (Table 2). A community is defined as a broad group of stakeholders that share common roles or responsibilities within the healthcare ecosystem, such as patients, clinicians, or institutions, and collectively influence healthcare outcomes. Archetype is a category within a community that represents specific functions that stakeholders perform, each playing a distinct role in the broader landscape and with an impact in our activities, both in a transversal view and in a longitudinal projection (e.g., the lifecycle of our products).

Table 2 Classification of the stakeholders identified in the Spanish healthcare ecosystem

The first community is made up of the patients, as they are the end recipients of healthcare services, and their influencers: individual patients, patient associations, caregivers & family members, and the press and social media.

The second community includes clinicians and key external experts (KEEs), consisting of frontline healthcare professionals (HCPs), that include physicians and nurses across primary care and specialties, pharmacists, and support experts (researchers and scientific organizations) who are integral to the application and dissemination of medical knowledge and practices.

The third community involves the institutions, encompassing the foundational regulatory and policy-making entities, including policy makers (national and regional administrations), influencers (patient associations and scientific societies), payers (regional and hospital payers), and evaluators/approvers, such as the European Medicines Agency (EMA), the Spanish Agency for Medicines and Medical Devices (AEMPS) and the Spanish Interministerial Medicinal Products Pricing Committee (CIPM).

This categorization not only underlines the multifaceted nature of the healthcare ecosystem but also emphasizes the interconnected roles these stakeholders play in enhancing patient care and outcomes. Through this classification, we aim to underscore the strategic importance of understanding these dynamics for the evolution of MA departments in navigating and provide value to the healthcare landscape effectively.

3.2 Synthesis of Outside Assessment and Identified Trends

The healthcare ecosystem involves trends at different levels of the community structure, with some being specific to each group of stakeholders (institutions, HCPs and patients), while others are transversal trends common to all stakeholders. On top of this, there are macrotrends in the pharmaceutical industry that should also be considered.

3.2.1 Specific Needs and Trends of the Communities Comprising the Healthcare Ecosystem3.2.1.1 Patient Community

The needs within the patient group of stakeholders are diverse and encompass a wide range of expectations and requirements, crucial for enhancing patient care and the overall healthcare experience throughout the patient’s journey (Table 3).

Table 3 Transversal trends in the healthcare landscape and specific trends by stakeholder

For individual patients, the primary need is to have access to the most effective medications for managing or curing their conditions, emphasizing disease prevention and the attainment of the highest quality of life. They request accessible and understandable information about their conditions, treatments, and the long-term effects of their therapy. Furthermore, there is a significant need for emotional support from their communities. Patient associations stress the importance of creating awareness about the diseases they represent, advocating for the development of more effective compounds. They aim to better meet patient needs by shaping public policies through information, education, and assistance programs, alongside securing financial resources to support these initiatives and ensuring equitable access to innovative treatments.

Caregivers and family members highlight their need to provide comprehensive support and ensure treatment adherence, requiring access to information and new technologies that help them understand and manage the patient's condition. They also emphasize the need for access to the digital tools that patients use, especially in managing chronic conditions or in scenarios involving dementia or elderly care. These stakeholders demand to be actively involved in the communication process between HCPs and the patients.

The press and social media stress the importance of informing the public about health-related issues accurately, keeping abreast of sector trends and the information needs of their audience. They recognize the need for updated and valuable content, and the utilization of effective communication channels to reach and engage their target audience. Addressing these needs is pivotal for fostering a healthcare ecosystem that is responsive to the challenges faced by patients, caregivers, and the broader community.

3.2.1.2 Clinicians and Key External Experts (KEEs)

Within the HCP community, the needs and expectations are distinct yet interconnected, underpinning the overarching goal of enhancing patient care and healthcare service quality (Table 3). Physicians, both in primary and specialized care, are committed to providing the best standards of care in the most effective manner. They require access to all necessary medications, medical equipment, and diagnostic tools, together with healthcare processes adapted to the digital environment and the Spanish healthcare system. Continuous education on specialty-specific novelties, integrated and interoperable information systems, and access to new technologies are crucial for facilitating their work and knowledge exchange. Nurses (likewise in primary and specialized care) also seek to stay informed about medical advancements relevant to their scope of practice to enhance their performance and specialization level. Understanding treatment guidelines and medical recommendations is essential for their role, which could be improved by integrated information systems easing collaboration with physicians and patients. They also demand more recognition of the nursing profession at social and healthcare levels, since they play a vital role in patient care, cure, and follow-up.

Retail pharmacies need to ensure the availability of necessary medications and treatments, demanding detailed knowledge about drug compositions, active ingredients, and possible adverse effects. They also identify a need for understanding the application of medical devices and diagnostic tests, essential for advising the patients effectively, alongside maintaining their business model and providing services such as home delivery to add value for their customers. Primary care pharmacists aim to be a reference in the appropriate use of medicinal products, underscoring the importance of access to updated, personalized evidence and adherence to therapeutic protocols. Their role extends to promoting innovation and research within pharmaceutical care, acting as a bridge between different healthcare settings.

Key external experts and researchers strive to be leading figures in their therapeutic areas or specific pathologies, aiming for broad action and visibility in their professional and societal circles, both nationally and internationally. They aim to participate in innovative projects that improve patient lives and healthcare service quality, staying updated with the latest developments, and securing funding for research projects and the dissemination of their findings. The main goal of their research centers is to manage research expectations effectively, contribute to health and quality-of-life improvements through their work, and enhance their networking and knowledge through integrated, multidisciplinary research. Scientific societies seek to influence public policy and equitable patient access, providing information, training, and development services to their members. They aim to gain recognition for their specialty, attract talent, raise awareness, and improve disease prevention and treatment. Increasing extra-hospital coordination and securing resources or funding for research continuity and compensation are also among their goals.

3.2.1.3 Institutions

In the contemporary healthcare landscape, the articulated needs of institutional stakeholders delineate a pathway for pharmaceutical companies to contribute meaningfully to healthcare improvement. Policymakers emphasize the necessity for enhancements in service quality and efficiency, advocating for the integration of therapeutic innovations within the framework of available resources (Table 3). This aligns with their objective to foster scientific leadership and facilitate knowledge transfer between public and private sectors, aiming to meet the growing demand for high-quality public health services and to develop and retain talent within the sector.

Regulatory agencies (EMA and AEMPS) highlight the requirement for robust information to support accurate drug evaluation and decision making. They aspire to keep leadership positions in drug and medical product safety knowledge, requiring early insight into therapeutic research to fulfill their evaluative and regulatory roles efficiently. These agencies also seek to engage in public outreach and continue to drive innovative programs. The EMA especially subscribes to the “triple A” policy of Access, Affordability and Availability [17].

Regional payers (Autonomous Communities) focus on sustainable integration of new medications, emphasizing the need for budget predictability in the face of therapeutic innovations. They advocate for a comprehensive understanding of the therapeutic and economic value of new advancements, healthcare digital transformation, efficient resource use, and continuous staff training. Hospital payers stress the importance of sustainable hospital access to therapeutic innovations, requiring efficient negotiation with the pharmaceutical industry and detailed information on new products to support decision-making processes. They also highlight the need for improvements in healthcare quality and infrastructure, alongside fostering research and continuous education.

3.2.2 Transversal Trends Common to all Identified Stakeholders

The healthcare ecosystem is currently experiencing a significant shift, driven by a common set of trends that affect patients, clinicians, and institutions alike (Table 3). At the forefront is the acceleration of medical innovation, highlighting a collective demand for cutting-edge treatments and healthcare solutions that leverage the latest scientific advancements. This innovation goes hand in hand with the growth of value-added services, which are increasingly sought after for their potential to enhance patient care and outcomes beyond traditional healthcare solutions.

Moreover, there is a noticeable trend in increasing public-private and inter-private collaborations. These partnerships are crucial for pooling resources, expertise, and technologies to tackle healthcare challenges more effectively than any single entity could do alone. Alongside these collaborative efforts, the healthcare sector is witnessing a surge in the use of digital tools to manage and share more efficiently the increasing volume of data. This trend underscores the necessity to extract meaningful insights from a vast amount of data to inform decisions and improve healthcare delivery.

Another pivotal trend is the growing importance of social media within the healthcare landscape, pointing to a changing dynamic of communication and engagement within the stakeholders. Social media platforms are not only channels for sharing and disseminating information, but also valuable community tools for fostering support among patients, clinicians, and institutions. However, this digital transformation brings to light the need for high-quality online information and highlights the varying affinity towards communication channels by stakeholder. This diversity in preferences underscores a gap between the content provided and the expectations of different stakeholders, signaling a critical area for improvement in aligning communication strategies and content with the needs and expectations of the healthcare community.

3.2.3 New Macrotrends of the Pharmaceutical Industry

Especially since the COVID-19 global health crisis, the pharmaceutical industry is navigating through a phase marked by significant macrotrends that are reshaping its landscape and dictating new directions for growth and adaptation (Table 4) [18]. The sustainability of healthcare systems in many countries is under strain due to the aging population and a historical focus on disease treatment rather than proactive prevention [19, 20]. This situation calls for a rigorous containment of healthcare spending and pushes for efficiency in the Spanish healthcare system, where funding is increasingly constrained. At the heart of these shifts is the focus on patient centricity, recognizing that a deeper understanding of patient needs allows for the design of more personalized and effective medicine. This trend goes hand in hand with the increasing influence of patients who are sustained by more information than ever before, and therefore have a stronger voice in medication inclusion and prescription decisions.

Table 4 Macrotrends of the pharmaceutical industry

The acceleration of digital transformation is another defining trend, with digital activities expanding across all health domains from research and information access to interactions with HCPs. This digital surge is closely linked to the exponential growth of health data, offering a myriad of benefits for diagnosis, integration, and the personalization of care [1]. Artificial intelligence is poised to take a pivotal role assisting MA departments (as well as other stakeholders of the health ecosystem) in navigating big volumes of data [21]. Advanced personalized diagnostics are emerging in response to the social and political pressure to shift from costly disease treatment to proactive prevention. This shift is part of a broader movement towards a new ecosystem of services where medication is just one component of a comprehensive service portfolio aimed at patients and other healthcare sector actors, such as telehealth services.

The emergence of new players with innovative business models poses a threat to the competitive positioning of established companies, something that is transforming the pharmaceutical industry. Alongside these external changes, the industry faces internal shifts with the demand for new skills and attitudes. Key roles now require new skills, such as data-driven decision making, cross-functional collaboration, digital mastery, trial-and-error mindset, and customer orientation, among others. To navigate this evolving landscape, pharmaceutical companies are adopting flexible organizational models. These models are less hierarchical, more collaborative, and project based, revolving around mobile teams and leveraging technology. This organizational flexibility is crucial for adapting to and capitalizing on the complex interplay of trends shaping the future of the healthcare sector.

3.3 Internal Information Collection and Organization Assessment

Although our internal analysis is not the main focus of this paper, a summary may provide some context in which this MA initiative developed internally to adapt to the changing landscape of the healthcare ecosystem. The results of our internal assessment revealed a necessity to adapt our team's expertise, aligning with the evolving demands of the stakeholders. This adaptation includes the integration of new skills and capabilities within our workforce. Concurrently, there is an identified need to adopt new tools and systems that underpin our business operations, enabling more efficient workflows and decision-making processes. The analysis also highlighted the importance of coordinating integrated lines of action to streamline objectives and priorities throughout our organization. This vision would aid the establishment of a more coherent approach to the lifecycle management of new drug launches, emphasizing systematization and complete process traceability from start to finish. Furthermore, resource allocation must be calibrated to better match market needs and trends, ensuring greater operational effectiveness and efficiency.

In conclusion, MA departments must transition to a model that aligns with the evolving priorities and requirements of our stakeholders. This shift involves adopting an integrated customer perspective, which will enable more personalized and effective stakeholder interactions. Our research established a foundation for strategic enhancements in our MA department, designed to create a more adaptive and proactive unit amidst the shifting dynamics of the healthcare sector. Transforming a MA department to meet current healthcare challenges and opportunities necessitates a significant undertaking, involving visionary planning and thorough reorganization. We have already initiated this transformation by enhancing field medical scientific engagement, introducing innovative solutions to the health system to transform care, forging strategic partnerships within the Spanish healthcare system (including key scientific societies), and incorporating both clinical and payer evidence. Further details of this transformation will be discussed in a forthcoming publication.