Archive for category: Symposium 2019 reports

Keynote: Survival in the New Normal: the Impact of Digitisation on Customer Behaviour

Keynote speaker Nancy Rademaker, a partner in nexxworks, a digital consultancy, began her address with a question: “Do you know this object?” she asked the audience, showing them a picture of an old-fashioned rotary dial telephone. Every member of the audience agreed that, yes, they did know what the object was. She then asked: “Do you know how to operate this object?” When every member of the audience agreed that they knew how to operate the telephone, she said: “So all of us are ‘old normal’.”

“Whenever you come across a ‘new normal’ person and you present them with an ‘old normal’ object like this, you get a clash.”

The purpose of her questioning then became clear, as she showed a short film of two teenagers trying to work out how to use a rotary dial telephone within four minutes. After struggling for some time, they worked out how to dial a number, but could not work out how to use the receiver.

“We live in this new normal, and that basically means that we have gone from digital being a novelty to digital becoming the new norm,” she said.

Technology, whether that be computing power, networks, data, or the internet of things, has grown in an exponential manner in recent years. In animals, the market for wearable technology (“wearables”) is expected to be worth US $8 billion in five years’ time. “That’s huge,” she commented.

Looking at the extent of digitisation within different sectors, healthcare was close to the bottom; from a positive perspective this meant that there was ample opportunity for improvement.

Ms Rademaker outlined the different eras of digitisation, beginning with the personal computer in the 1980s, moving on to the internet in the 1990s, and to the cloud-based and mobile digital eras of the present. With each era, “we, as normal people, had to get used to it, we had to get used to a PC, or the internet…and we had to get used to smartphones as well.”

However, while technology and innovation developed in an exponential manner, leaders were used to more linear evolution. “If you have an exponential innovation, it starts a bit negatively at first. That’s why leaders fail to see it coming – I would call it ‘corporate myopia’. It starts a bit negative and then it goes ‘boom’.”

This led to disruption within an industry. Ms Rademaker predicted that there would be massive disruption in any sector of any industry in coming years, with new technologies leading to new competition within an industry, and higher expectations.

“The fact that we are so informed has led to the fact that our minds, our heads, are becoming too full with all of the options that we have. We have so many options that it is becoming increasingly difficult to choose. We have this tremendous stress of choice all the time.”

Nancy Rademaker

Leaders are faced with a dilemma: they know that they needed to innovate, but at the same time, they cannot let go of what they had done so far.

“You can’t just let go of the old normal and step full into the new normal,” she said.

Innovation has to take place on three levels – the now, the next, and the beyond. But what does this mean? “You have to improve the now – improve your current business models, your current practice. You have to create the next – think about new business models, new markets…and you have to imagine the beyond – basically daring to look ahead some 30 years, trying imagine what it would be like and work your way back from there to here,” she explained. “It’s not about extrapolating from the past anymore, it’s looking into the future and working your way back to now.”

Technology has changed businesses but, above all, it has changed human beings. She described what she called a “5i” model of human characteristics that were either new characteristics or ones that had become more dominant because of technology.

The first “I” characteristic was “informed” – people are more informed than ever before. Globally, more than four billion people have access to the internet, and this will only increase as projects to improve access came to fruition. Connectivity, and being informed, starts at a very young age, she said, showing a photograph of a five-year-old child’s letter to Father Christmas, in which the child had written out the internet link to the particular toy they had wanted.

People have also become much more mobile, with five billion people owning mobile phones – and a low battery level is now one of the current generation’s biggest fears.

This increased access to information is having an impact on people, she said. “The fact that we are so informed has led to the fact that our minds, our heads, are becoming too full with all of the options that we have. We have so many options that it is becoming increasingly difficult to choose. We have this tremendous stress of choice all the time.”

The second “I” characteristic discussed by Ms Rademaker was “individualistic”. People have put themselves at the centre of their own universes, she explained, and it is crucial that businesses are able to deal with this. In healthcare, people want to check and monitor themselves using technology, and they want to do the same for their pets.

The third characteristic was “impatient” – “We want everything, and we want it now,” she said. The average person’s attention span has decreased from 15 seconds in the 1970s to eight seconds now – and today’s younger generation has an attention span of five seconds. As people have become more impatient, new ways of delivering services have to be developed. In healthcare, this included systems for remote consultation and sending data to healthcare professionals. The same thing was being seen in animal care.

She said that one thing a business should never do was steal time from its customers by having too lengthy procedures or processes.

The next “I” was ‘influenced’ and this was associated with the rise of social media. Research had shown that 75 percent of customers did not believe companies any more, but they trusted their peers much more. “Communities of trust” are being created between people who shared something in common. “We have this urge to let ourselves be influenced by others, by our peers,” Ms Rademaker said.

The final “I” characteristic was “intuitive”. She explained that the brain is divided into rational and emotional/intuitive elements. As the rational brain is now being overloaded with information, people tend to revert to their intuitive brains much more quickly than in the past. Most decisions were made using the emotional brain – people used their rational brain to justify the decisions that they had made – and companies need to be aware that people are now using their intuitive brains much more.

“The next gen is the pet gen. Anyone who is working in this space needs to take this into account – that this next gen is typically a changed generation compared to the previous one.”

Nancy Rademaker

These five characteristics meant that customers have changed dramatically; they are now moving in unpredictable ways. The next generation is typical of this unpredictable behaviour and, she said, “The next gen is the pet gen. Anyone who is working in this space needs to take this into account – that this next gen is typically a changed generation compared to the previous one.”

Any sector that has to deal with this uncertain, complex, volatile combination needs to move fast and be agile to survive. The rate of change is accelerating and businesses need to ask themselves whether they are changing at the same pace as the world around them. Startup companies tend to be both fast and agile, but the thing that they really get right compared to other businesses is that they do not start from the product or service they are offering, they start with the customer that they were serving.

This also holds true for the veterinary industry, but the relationship with the customer is atypical in that the patient is not the one paying for the treatment. “You have to carefully align with the owner or keeper of the animal to decide together what’s best for the animal. That makes your profession a bit different from any other customer relationship that we have out there,” Ms Rademaker said.

By starting with the customer, disruptive companies put customer experience first. But what is customer experience? It is, she explained, the customer’s perception of an interaction with any part of an organisation. In human healthcare, for example, this means that there needs to be a shift from “just products and pills”, she said, to complete patient solutions.

The other thing that disruptive companies do well was making optimal use of all the emerging technologies, such as artificial intelligence (AI) and big data, to optimise the customer experience. In healthcare, such technology offers the opportunity to move from reactive to proactive healthcare, from treatment to prevention. Every possible health parameter that could be measured would now be measured by new technology, and there will be a move from episodic measurement to continuous measurement, not only through wearable technology such as wristbands or belts, but also by technologies such as ingestible capsules that could send data wirelessly from inside the body to be displayed on an app.

There is also a lot of research going on into wearable technology in animals and how it could be used to monitor and improve wellbeing. The limiting factor currently is the cost of the technology, which exceeds the value of the animals it was being used on.

However, in human healthcare, the dramatic decrease in the cost of sequencing a human genome has opened up an opportunity for companies to offer a genome sequencing and disease diagnosis service. Genome sequencing could also be used for precision medicine, helping to determine appropriate treatments or optimum doses.

Vast amounts of data were being collected, Ms Rademaker said, but it was how data were used and how algorithms were created that would impact a profession and its clients.

“In the medical profession, this has become the doctors’ data dilemma,” she said, adding that by 2020, the volume of medical data facing doctors will be 200 times greater than the volume the human mind could process. Doctors would therefore have to apply algorithms/machine learning to make sense of all the data that they had.

“You can fight diseases with machine learning,” she said. “You can use machine learning to find them, to medicate, and to continuously monitor them as well.”

Google has developed an algorithm that could diagnose eye disease with the same accuracy as a human being. An app has been developed for the Apple watch that could collect data on heart rate. Ms Rademaker explained that variation in heart rate may be a good predictor of diabetes, and that an algorithm could predict this with 85 percent accuracy.

It is time for every profession to embrace algorithms and AI, she said. AI will not replace doctors, but it will revolutionise healthcare once it was widely accepted, particularly in the area of preventative healthcare. Ultimately, AI will allow healthcare professionals more time to deal with their patients with real empathy and care.

Optimising the use of available data would be key – at present very little available data is being used and she suggested that healthcare would benefit from ‘co-petitive learning’. This means collaborating with competitors and sharing data to feed in to a model to improve its performance. An alternative form of learning is ‘federated learning’, in which it is not the data that are shared, but the models that have been derived from the data.

Ms Rademaker then turned to new horizons – developments in healthcare that would arise as a result of the new technology. In-home digital devices such as Alexa are being used in healthcare, for instance with patients who need to log their health status on a daily basis. They are also being used by pet owners to discuss concerns about the health of their pet.

“Convenience is the new loyalty… you need to make it simpler on your customer.”

Nancy Rademaker

She discussed virtual and augmented reality, and 3D printing, and how all three had applications in the healthcare space. 3D bio-printing was in the “beyond” space in some instances but corneas had already been bio-printed and used in people with sight problems.

Embracing such technology would offer huge opportunities, she said, and AI would change jobs massively.

Businesses have to be prepared to deal with the new consumer, who expect extreme transparency in areas such as data security, privacy and pricing. They expect personalisation, too, whether that was in fashion, food or precision medicine. Consumers also expect convenience: “Convenience is the new loyalty,” she said, “you need to make it simpler on your customer.” She discussed a number of examples of new technology that offer greater convenience to its users.

While most things are going to digitise, not everything will, and there will always be a need for a human being. AI will help people augment their own intelligence: “It’s not man versus machine, it’s man with machine,” she said. “We have to embrace this technology and it will eventually get us to a higher level.”

Traditional hierarchies within companies could prevent change happening, or could lead to change happening only slowly. Companies have to move to a structure that encourages collaboration between all levels, and this is something that will take time to achieve.

She saw five major barriers to innovation – too many processes and procedures, too many policies and regulations, too many unnecessary gatekeepers, a culture that did not support innovation, and a lack of tolerance of failure.

“You need to dare to make a big leap every now and then. After all, the electric light did not come from the continuous improvement of candles.”

Concluding, Ms Rademaker encouraged her audience to “think in opportunities, instead of boundaries or limits”.

The changing role of the veterinary professional

How will the role of vets have to evolve in a precision medicine future? That was the question considered by Guen Bradbury, of Innovia Technology. She began with the following definition of precision medicine: “An approach to medicine where we consider an animal’s genetic, environmental and lifestyle factors in our diagnosis, management and prognosis of disease.”

However, she said, what actually needs to be considered is personalised treatment – how to be sure that an individual was being given the right care.

Breaking down a vet’s role into three main elements – skills, knowledge and relationship building – she discussed how each might have to evolve for vets to find the value in precision medicine.

Thinking about skills – how vets acquire information from an animal or a client, whether directly or through technology – she said that whatever the future looked like, there would undoubtedly be a lot more data to deal with. Vets therefore had to become comfortable learning about new software, and looking at and considering data from multiple sensors, new imaging modalities, genetic reports and black box algorithms. They would also have to be able to filter data and identify what was important and useful.

Turning to knowledge – how vets analyse the information they acquire – Dr Bradbury said that the amount of new knowledge being generated was “far too much for any one individual to keep on top of”. Clients and farmers are also accessing vast amounts of data about their own animals that vets did not have access to. This means that vets could no longer be seen as the source of all knowledge, and the value that vets delivered to their clients had to change. “We can think of it as moving from knowing data to knowing what to do with data,” she said.

Vets will find themselves out of their comfort zone in dealing with all the data available, and will need to know where to seek help. At present, the specialists that they seek help from are typically within the profession, but this will change and, in future, vets will be seeking help from a wide range of outside specialists too.

When it came to relationship building – how vets translate the output of their skills and knowledge into a bespoke treatment plan for an animal – Dr Bradbury argued that vets need to move from being late service providers to being early advisers. “If we’re going to realise the value of precision medicine, we need to be seeing animals early in a disease’s progress. If we get the data early enough, we can intervene and we can change the course of that disease. If we don’t see them at the right time, no matter how good, how amazing our new-found abilities are, we cannot use them to give value.”

Vets have been used to having animals that were “basically sick” and animals that were “basically healthy”, but as technology develops there would be an increasing number of “patients in waiting” – animals that have risk factors for a disease, but it was not known when, or even whether, they would develop that disease. Vets, therefore, would have an increasing role in helping their clients to navigate this new, uncertain world.

However, Dr Bradbury concluded, despite all the changes ahead, society would still need vets to ensure the health and welfare of the animals under their care.

Application of precision medicine, AI, genomics and the use of data for animal health and welfare

Dr Jasmeet Kaler, of the School of Veterinary Medicine and Science at the University of Nottingham, discussed how information derived from sensors and other sources can be used to develop machine learning algorithms and artificial intelligence (AI) that can be applied across animal health, welfare and production.

She began by describing some of the challenges facing livestock production at the present time, including increasing global food demand and the need to produce more food with limited resources and zero net emissions. Key societal challenges, such as antimicrobial use and resistance, also influence farming methods and food production.

She then described current ways of monitoring livestock health and welfare – based on visual observations, behavioural signs and subjective assessment against the Five Freedoms – and suggested that precision livestock farming could positively benefit the assessment of health and welfare.

Understanding disease, she said, relies on reporting and recording information. Such information is usually collected manually and intermittently, and can be biased. Is data collected this way really valid, she asked, and do vets really predict and prevent disease on farms?

In contrast, precision livestock farming refers to managing livestock by collecting data continuously, automatically and in real time across areas of production, health and welfare. “This then gives us a great opportunity to use various machine learning tools, AI, and different platforms where we can start to make more sense of that data,” she said.

So what is driving the increasing use of technology for precision livestock farming? There are three main factors – the decreasing cost of the technology required, increasing computational power and an increase in the parameters that can be measured.

She went on to discuss potential applications of precision livestock farming. These include ensuring efficient use of resources, such as precision feeding or precision grazing to ensure that pasture is used in an optimal way. “That’s been happening,” she said. Another application is diagnosing disease and using sensors to predict disease occurrence early and provide objective information on animal health and welfare. Sensors can also be used to inform the management of animals to prevent disease, for example, by helping to monitor stocking density.

Other potential uses include reducing the workload of animal keepers, certification and traceability, and phenotyping.

She also suggested that using sensors to collect information could help strengthen the relationship between farmers and vets by providing data that would help vets add value to farms.

She then described various pieces of research that had used sensor data to help understand animal health and welfare. For example, she had been interested in whether it was possible to use sensors to detect behaviour in sheep that was characteristic of lameness. “One peculiar thing about lame sheep is a head nod; they have this head nod as they are walking. And I was thinking, okay, we could really pick that up with a sensor,” she said.

“The concept was very simple,” she added. “We collect the data, we pre-process it, we develop a machine learning algorithm, we then implement on the chip…we validate it and if we need further testing, we do it.”

However, there had been a number of technical challenges to overcome, including where a sensor should be placed on a sheep to detect the head nod, the battery life of the sensor, and making it suitable for use in an extensive environment.

She had used a pattern matching engine (PME) to classify data collected from the sensor into different categories of activity. To do this, the data from the accelerometer had been matched to what the sheep was doing and then an algorithm had been built to classify different types of behaviour, such as standing, walking, lying, etc. Initially, she had thought that it would only be possible to detect lameness when a sheep was walking, but the algorithm was ultimately able to classify lame sheep even when they were standing still or lying down.

This study had used only one sensor, but it is also possible to use data from multiple sensors and fuse it together. In another study, she was trying to pool data from multiple sources to a central hub to make it easier for farmers to predict events such as calving or disease. One algorithm could now predict calving up to five days in advance.

Technology could give novel insights too, she said. There is a tendency to think about groups of animals rather than individuals, and to think of variability within a group as “noise”. But this variability could be very important – for example, there is a lot of variability in the amount of time lame and non-lame sheep spend grazing, so it is not possible to look at data from one single time period and identify which sheep are lame. “This is an exciting field in terms of insights,” she said.

A new project is looking at linking data from multiple sensors on health, behaviour, social networks, physiology, pathogens and immune function to detect positive measures of welfare. Another new project is using machine learning and AI to look for biomarkers of antimicrobial resistance.

There are, however, barriers to the adoption of such technology, including concerns about the reliability of technology, the ownership of data and data security, and concerns that farmers will become less skilled as a result of technology. There is also a lot of information being generated, but sometimes it is not usable. Systems that are currently being used focus on alerting users to problems and do not offer suggestions for potential treatments. Data are being kept in silos, and more interconnected systems are needed. Finally, she said, there are societal concerns about whether precision livestock management might result in greater intensification of farming.

Driving positive change – communicating to a changing demographic

“As businesses, we have to be seen to act with purpose and drive positive change,” began Collette Philip, founder of the brand and strategy agency Brand By Me. She explained that, in the past, organisations had been divided into those responsible for driving social change and “doing good”, and those responsible for driving profit. Now, these two things are “one and the same”.

Driving positive change means creating “win, win, win” situations – for customers, for the business in terms of profitability and sustainability, and for the wider world in terms of looking at ways a business could inspire change. “That’s what we mean by positive change. It’s about our ability to drive all three – wins for our customers, wins for our businesses and ourselves, and wins for the world around us,” she said.

The win for the wider world could be anything from looking at how an organisation contributes to the wider environment, to the community around it, or how it could do business in a way that delivered positive impact. Giving an example, she described how Ikea was now looking at options such as recycling and repair programmes for its furniture and at furniture rental; it had also made a commitment that, by 2020, its factories would be powered by clean energy. “It’s an example of how they are delivering positive change through their business,” she said.

As well as aiming to achieve these win, win, wins, businesses also have to communicate what they are doing. However, population demographics are changing – the population wis ageing, it is becoming increasingly ethnically diverse and the number of single person households is rising, for example. These wider demographic changes have massive impacts on businesses.

“In a world where the profile of our audience is changing rapidly, how can we make sure that we are able to communicate with them, that we are able to understand their needs?” she asked.

The answer, she said, was to stop focusing on demographics and instead look at a broader way of targeting and understanding different audiences.

She described three tools used by her brand consultancy to help its clients drive positive change within different spheres, and to understand, engage with, and communicate to different audiences.

The first tool helps businesses and individuals understand themselves. It asks them to evaluate their purpose (why they existed), their personality (how they did things in a unique way), their values (their non-negotiable principles) and their vision (how the future would look if they were delivering on their purpose). By understanding themselves, businesses can then work out the change they are best placed to make and which audiences would benefit.

The second tool helps businesses focus in on their specific audience. “Ultimately, understanding your audiences beyond demographics is a really useful way of focusing on who you can help and why,” she explained. The tool encourages businesses to think about the most urgent needs of their customers, what the biggest hopes of their customers might be, and also “what keeps them up at night” – basically what their major concerns were.

“If we ask these three key questions about our audiences, they can really help us get under the skin of how to communicate with people in a way that is relevant to them,” she said.

The final tool helps businesses understand the stages of the typical customer journey so that they can bring together what they had determined using the first two tools and work out how to build a relationship with their customers at each stage. Ms Philip explained that a typical journey began with customer awareness of a product or service and then moved through the phases of understanding the product, considering its purchase, actually acquiring it and finally retaining customers, so that they came back to the business again.

The process is not always linear and customers jump between stages. However, at each stage, a business needs to work out the implications for itself; for example, how customers found the business, how they found out more information, and what encouraged them to come back. A business also has to work out what its customers require at each stage; for example, what information they need to move them through the journey. Finally, a business needs to work out how it could demonstrate its values at every stage.

“Communication is not a one off,” Ms Philip said, “and it’s not just about us broadcasting out information that we want to tell people. It’s about understanding the needs and priorities of our audiences at the different stages they engage with us.”

Summing up, she said: “If we’re looking at how we drive positive change and our ability to communicate to changing demographics, there are three things that we need to do. We need to understand who we are, because that helps us understand who we are best placed to help; what the changes are that we’re best placed to serve; and also who we might need to communicate to with to deliver that change.

“We need to understand our audiences beyond demographics so that even if the profile of what they look like changes, their needs and motivations don’t, and we understand that. And then we need to create journeys that build a relationship with them over time so people understand who we are and our audiences understand how we can help.”

Changing customer attitudes and preventative veterinary medicine

“Pets are truly part of our family,” said Kathy Turner, Corporate Vice-President and General Manager for Idexx Laboratories, describing how attitudes to pet ownership have changed in recent decades. While the data she cited to support her presentation originated in the USA, she explained that similar trends are being seen elsewhere in the western world.

The benefits of pets to mental health and physical wellbeing have been reported by multiple studies and surveys, but she showed some self-reported data indicating that younger generations were placing increasing emphasis on the importance of their pets to their mental wellbeing. For instance, 76 percent of “generation X” individuals questioned thought their pet had a positive impact on their mental health; this rose to 83 percent of “millennials” and 86 percent of “generation Z” individuals.

“This is really important, because millennials and gen Z are going to be nearly 60 percent of all pet owners by 2025,” she said. “If we think about how we have to look at businesses and veterinary practices in just the next five or six years, that’s a really important clientele that we have to make sure we can address, and address properly, and think about how they want to be treated as consumers.”

This younger generation, more than any other, believe that their pets have “special health needs” she added. “Forty-two percent of those surveyed say ‘my pet’s different, my pet’s special, and she or he has very special needs’.” But, encouragingly, 75 percent of the respondents rely on their veterinarian for advice. “This is the digital, social media generation that goes to Dr Google but they still want to hear from a real live veterinarian about what’s best for their pet.”

The younger generation is also willing to spend more money on their pets and is willing to make more financial trade offs to afford pet products and services. Contrary to popular belief, data suggest that pet owners are willing to pay for things that they see value in; for example, pet owners in Europe spend five times more on pet food than owners in the USA. “That’s because across Europe pet food tends to be more organic – people go for more organic and natural ingredients,” she said.

Underlying owners’ willingness to spend money is a desire to understand the health and welfare of their pets. However, while the younger generation still looks to veterinarians for advice, there is emerging evidence that they are seeking out alternatives to traditional practices for more routine or preventative care. This has a great deal to do with convenience – they still want to talk to a vet, but they want to do so on their own terms. She suggested that traditional veterinary practices and facilities need to address this to attract this growing clientele: “Even just opening hours and the way we communicate with the pet owner is a way to bring them in and keep them loyal to the clinic.”

She then described how Idexx is innovating around diagnostics with the aim of making it easier for vets and owners to provide the best care to animals. Idexx believes strongly in investing in innovation research and development, she said, and in 2019, its investment will be close to US $150 million. She described two ways in which this investment is used to bring value to the veterinary clinic.

The first is the development of in-clinic diagnostic products. She mentioned a urine sediment analyser, which uses artificial intelligence and facial recognition technology to analyse urine. “What’s fascinating about that and the way we’ve used artificial intelligence is that instrument gets smarter and smarter every time urine is run in it. So the more patients it sees, the smarter it gets,” she said.

She also described how Idexx uses innovation to expand the utility of in-clinic instruments and of Idexx’s reference laboratory. The in-clinic instruments and reference laboratory use proprietary software, which allows data collected from various sources to be integrated. This helps vets provide owners with a wide variety of information. There is evidence to show that clinics that adopt the integrated technology grow faster than those that do not and, in fact, clinics that are not integrated are showing evidence of decline year-on-year.

In the UK, there has been extraordinary growth in innovative specialist chemistry and these new tools help vets provide better care.

The final area she discussed was preventative care or wellness testing. Idexx has collated data from multiple countries to develop a preventative healthcare protocol that includes blood tests – evidence indicates that adding blood tests to a routine wellness visit helps find potential health problems earlier in a pet’s life. Running the protocol on more than 30,000 apparently healthy dogs revealed that one in four senior and adult dogs had three or more clinically significant findings.

This shows the value of running the protocol on healthy pets, and also provides the sort of information owners are seeking. “Pet owners want to understand the health status of their pets,” she said, pointing out that only veterinarians are allowed to take blood samples from pets, and wellness visits are ideal opportunities to do this. However, even in the USA, where there is more diagnostic testing, only 17 percent of clinical visits include blood work. Internationally, the figure is 4 to 8 percent.

“Consumers are putting [smart] collars on their dogs, trying to understand their health status, yet that’s actually more expensive than coming to you and getting a holistic visit. It’s important that we think about that, and think about how we can use blood work and diagnostics and the innovation and technology that’s available to address the changing needs and the rapidly evolving needs of the millennial pet owners,” she said.

Concluding, she commented: “We have a 25-year generational macro trend ahead of us that we can do a lot collectively to address by working together to provide and use the technology that’s available and that’s coming down the road to really take care of our pets and our pet owners.”