Finding purpose, motivation, and dealing with uncertainty

Sciana Fellow Andy Fischer reflects on Medgate, his “helicopter view” of healthcare, and leadership

A drive for efficiency, maximisation of resources, and potential led Swiss surgeon Andy Fischer to establish Medgate, a global company aiming to improve healthcare using digital health and advanced telemedicine solutions. Since Medgate's establishment in 1999, he has successfully grown the organisation to operate in regions worldwide. In 2021, Andy was announced as a member of Sciana's fourth cohort. 

As a surgeon and physician in the Swiss emergency helicopter service (REGA), he had a literal birds-eye view of the health system. "I really had, in a way, a helicopter view [of] the health care system. And the more I did this, the more I was convinced that we [could] do much better. 

"You see different types of hospitals. You see how they collaborate or how they do not. And it made me think about, 'How do we work in the health care system?' And I was really convinced [that] we can do much better as soon as we start collaborating. 

"Collaborating means we have to talk to each other and get instruments to talk to each other. And a very important thing is we have to enable patients to become part of our treatment journey. So, this is the whole idea. How do we empower patients towards an integrated healthcare system? 

"And it was really very clear even 20 years ago that digital instruments, computers with the power of calculation and identifying, and using data, [would] be the key to solve this problem. So that's actually how I stepped into the whole business. I was convinced that if we bring together digital instruments with our medical process, this is going to be an instrument of changing the way I treat patients."

Finding solutions meant revisiting some basics and looking beyond only medical instruments to solve health problems. "We started with a very simple digital process: with telemedicine. [...] telemedicine was really kind of a missing piece in getting started into an integrated health care because so far, we were treating patients 1:1 in a decentralised way, doing 15,000 times the same thing. This is extremely inefficient. 

"So, the first thing we did, we centralised more the most expensive resources, which is the doctor, and enabled doctors to deliver care [at] a distance. We were using digital instruments such as [the] telephone, internet, and video. So just this first step enabled us to come up with a remote treatment, which already resulted in about 40% efficiency gain. 

"[The] next step would be that we move from remote treatment into optimised treatment. So, we start in the authorising treatment process using artificial intelligence, using sensors that people use at home, using labs at home use, bringing the whole diagnostic experience to the place where people want to be if they're sick. If you start to think about new ways how [to] treat patients using new technologies and applying new technologies, it's a lot about health. It's a lot about treatment, and it's a lot about medicine. So, in this way, I'm still practising every day."

Medgate has grown in leaps and bounds, and Andy has learned many lessons about business along the way. "We started in Switzerland, and then, after a few years, we took telemedicine to Abu Dhabi. And then we had a project in Africa, in Ghana. We had another project in India also. Then, we also had an initiative in Australia. 

"But all of these initiatives have been quite opportunistic; there was no clear strategy and no clear international strategy. There was also not enough funding to have a clear strategy. We identified that if we want to be really professional and successful, we just have to get this proactively done and properly funded. And that's why we concentrated then on just two focus areas; that's why we are now really active in two areas, Europe and Asia, and we sold all the other businesses."

Leading an organisation means engaging a different mind- and skillset than being a working doctor. "Being a doctor, you just do what we have been doing in the past because there is evidence that if we do this, it's good. But there is a certain logic behind [the] good management of a hospital. It's like you have to do it how people do it. Right. And that's in a way the nature of how our medical organisation [and] what we did was [a] totally different thing. We started to change the way how we treat patients. So, then, you also have to change the way how you lead. You have to control. You have to make sure that there is quality assurance, stuff like that. And then you make people happy. 

"Leading a pioneering organisation needs totally different things. [In] my view, it needs two things that you have to really work on. One is [that] you have to create purpose for the people that work for you. They must feel this purpose. And this was already the fact 20 years ago. 

"The second thing you need is motivation because the problem if you lead an organisation like ours, which is pioneering, is honestly, most of the time, you also don't know where it's going. I mean, you just know I would like to go over here, but I can't tell you what the overhead really is. It might be far away, might be close, might be working, might not. 

"There is a lot of uncertainty. And this is exactly what medical professionals don't like because they're trained towards doing everything with zero error rate. And you have to move now to bring these people into a world where they have to live with it, and to do this, you need those two instruments: motivation and purpose. As you grow, you also have to realise that on certain levels in your organisation, you need different leadership skills."

For Andy, being part of Sciana means having access to a network of other growth-oriented professionals working in healthcare. "[I've known] Ilona for quite a while, and we did some work together in the past in Switzerland. And she actually had asked me whether I would be interested in joining the group. And since I do have friends [who] have been involved in former cohorts, I thought it would be quite interesting. 

"We are the so-called COVID cohort, and I'm really fascinated by the way everyone approaches things. Different views on really relevant topics in the health care system. I think it's a really interesting network in three countries and a very interesting playground for our own network. I think I would really like to profit more from the network within the group and potentially learn about different aspects of leadership. And honestly, I would like to see some younger people in Sciana."