Medical Affairs: How to Establish Your Baseline

Missed Part 1? Read Medical Affairs: What's Your Baseline?

Last week, I wrote about the watermelon problem in Medical Affairs: every functional scorecard can be green while the underlying problems remain.

Publications delivered. Advisory boards completed. Scientific interactions increased. But what actually improved? Performance reviews and strategy updates tell us what we accomplished, but they don't always reveal why certain problems persist or what we're overlooking.

That’s what a baseline is for: a documented picture of where you stand today, what the evidence shows, and what remains uncertain, so you can make better 2027 decisions and measure progress afterward.

At a glance:

Not the tactic we planned to execute, but the underlying clinical, scientific, or organizational problem.

Medical Affairs work develops its own momentum. Teams, education plans, and engagement targets are in place, so we keep executing even as the market evolves.

But HCP needs aren't static. At launch, clinicians may be trying to understand the evidence and where a new therapy fits. A year or two later, their questions may be about applying that evidence to patients who don't look like the trial population. Meanwhile, guidelines, healthcare delivery, and access to scientific information continue to evolve, with resources ranging from Medical Information and peer networks to AI tools like OpenEvidence.

The KOLs we regularly engage may not reflect those changes across different healthcare settings.

Before carrying a priority forward, I'd ask whether we're still addressing today's scientific and clinical needs or continuing to execute yesterday's plan.

Did we have the right people, capabilities, processes, and resources? Were responsibilities and decision rights clear? And did our processes actually support the strategy?

Take medical engagement. If the field team isn't clear on what the organization needs to learn, MSLs may engage broadly and bring back scattered insights. Those insights then get categorized and summarized, sometimes losing the context that would make them useful.

Suppose several regional practices consolidate into a larger health system. HCPs who previously made treatment decisions independently may now work within system-level protocols. MSLs hear pieces of this in individual conversations, but the insights process may not connect those observations into a broader change in how clinical decisions are made.

Before asking the team to engage more, clarify what you're trying to learn and whether your processes can capture and act on that information.

This is where I’d spend considerable time. Beyond completed activities, what was delayed, changed, or abandoned? Where did the same problems keep appearing, and were they resolved or simply worked around?

Let’s stay with the engagement example. MSLs may have picked up changes in how treatment decisions are being made across health systems. The insights were submitted, categorized, and included in quarterly reports. From an operational standpoint, everything happened as planned.

But did anyone recognize the broader pattern? Did Medical Strategy revisit its assumptions about which stakeholders influence treatment decisions? Did field priorities change?

Not every insight warrants a change in strategy, but there should be a disciplined process for evaluating emerging patterns against an established baseline.

That’s why an assessment needs to trace what happened afterward. I’d talk to the people collecting the information, those analyzing it, and those responsible for acting on it, then compare their accounts with the decisions actually made.

Otherwise, we risk documenting the organization’s perception of itself rather than how it actually operates. There’s the process we intended to build, the process people believe exists, and the process that’s actually happening.

An assessment can have blind spots, too, particularly when it relies on the same reports and perspectives that shaped the original strategy.

Did a field insight inform an evidence-generation decision? Did an advisory board change our understanding of a scientific question? Did we identify an operational barrier that led to a change in strategy or execution?

This is where I distinguish contribution from attribution. Medical Affairs doesn't control every downstream outcome, and some results take years to materialize. But we should be able to trace what we identified, which decisions our work informed, and what happened next.

For example, if recurring field insights helped leadership recognize an evidence gap and prioritize additional research, that's a contribution worth documenting. The study may take years, but we don't have to wait for its completion to demonstrate that Medical Affairs informed the decision.

Of course, identifying a gap isn't the same as resolving it, and contribution isn't necessarily proof of ROI. The question is whether our work informed something meaningful, not simply whether we completed more of it.

What should we continue, change, or stop? Which problems remain unresolved, who's responsible for addressing them, and how do we close the loop?

I've sat through plenty of meetings where everyone understood the problem and agreed something needed to improve. Then another urgent deliverable came along, and six months later we were discussing the same issue.

Closing the loop means more than assigning an action item. It means making sure the findings reach the right people, decisions are made, and those who contributed the information know what happened. That includes explaining when no action is taken and why.

We tend to document what we decided, but rarely what we considered and rejected, what didn’t work, and why. That history matters when leadership changes. The goal isn’t to prevent old decisions from being reconsidered, but to preserve the reasoning so they can be revisited with context.

The five questions are a starting point. The goal is a documented picture of the organization's current situation, supporting evidence, unresolved gaps, and decisions requiring attention.

Consider a Field Medical team that continues hearing the same questions from KOLs or HCPs despite increasing scientific engagement and producing additional educational materials.

An assessment might reveal:

The finding might instead support more targeted education or reveal a practical implementation barrier. The point is to investigate before deciding where to invest.

A baseline should help leadership determine what needs more investment, what requires a different approach, and what should stop.

I see two situations where this is particularly valuable.

Annual strategy planning. Before finalizing 2027 priorities, establish what the available evidence tells you about how your organization is operating today. Which assumptions still hold? What has changed? Where are the constraints?

If you've never established a baseline, start with what you know and document what remains uncertain. That gives you a reference point for future evaluation.

When a new leader takes over. This one matters to me because I've been there.

When you inherit a team, you're also inheriting established processes, relationships, previous decisions, workarounds, and unresolved problems. Much of that history lives with the people who've been there, and everyone may have a different perspective on what's working.

An independently conducted assessment can help compare those perspectives, test assumptions, and identify what needs attention before making changes.

The value isn't simply having an outside perspective. It's having a structured way to examine information the organization may not routinely bring together.

Pick your most recent advisory board and ask:

1. What scientific or strategic question was it intended to answer?

2. What did the organization learn?

3. Who needed that learning, and what decision or action did it inform?

Compare those answers with the original objectives and what happened afterward.

You may discover a clear connection to an organizational decision. Or you may find that the meeting was completed, but nobody can explain what changed because of it.

Either way, you've learned something about how your organization operates.

Reply and tell me what you found. I'm curious whether the answers were consistent across the people involved.