Clinical trial protocols become overly complex because teams copy and paste from previous studies, accumulating unnecessary data points and criteria. Merck advocates for "protocol lean design," which starts from the core research question and rigorously challenges every data collection point to reduce site and patient burden.

Successful healthcare systems like Kaiser improve blood pressure control not through better individual doctors, but by implementing system-wide solutions: standardized treatment protocols, empowered care teams, and actionable data registries. This shifts the focus from individual effort to scalable processes.

The core of value-based care is a business model where preventing adverse events like strokes is more profitable than treating them. This fundamental financial alignment, not just quality measures, drives organizations like Kaiser to invest in team-based care and proactive protocols, a reality that clinicians within the system may not even perceive.

True effectiveness comes from focusing on outcomes—real-world results. Many people get trapped measuring inputs (e.g., hours worked) or outputs (e.g., emails sent), which creates a feeling of productivity without guaranteeing actual progress toward goals.

Relying on activity metrics like the number of meetings is a flawed way to gauge an MSL's effectiveness, as activity is just "noise." Real impact is measured by tangible changes in the healthcare system, such as improved diagnosis rates or better guideline adherence, requiring a shift away from activity-based KPIs.

The true value of a Medical Science Liaison (MSL) lies in preparing the entire healthcare system for better care, not just educating individual physicians. This means focusing on systemic changes like improving diagnostic pathways or guideline implementation. Science is only powerful when it moves systems, not just conversations.

Don't wage a direct war on familiar but flawed metrics. The politically savvy approach is to introduce new, more insightful KPIs alongside them. As the new metrics prove their superior value in driving decisions, the legacy ones will naturally become obsolete and be outgrown.

Setting rigid targets incentivizes employees to present favorable numbers, even subconsciously. This "performance theater" discourages them from investigating negative results, which are often the source of valuable learning. The muscle for detective work atrophies, and real problems remain hidden beneath good-looking metrics.

Companies waste resources on "orphaned activities" that don't contribute to core goals. To fix this, ensure every metric on your scorecard corresponds directly to a step in your business process map (e.g., acquisition). If an activity isn't on the map, it shouldn't have a metric and should probably be cut.