Leading With Patients in Mind: Cynthia Schwalm

Former critical care nurse Cynthia Schwalm, now executive vice president and president of North American commercial operations for Ipsen, shares her unique perspective on the pharma industry, her formula for successful team building internally, and the importance today of stepping out of the C-suite and into the world of the patient 

To say that Cynthia Schwalm’s ascension to the top wasn’t exactly traditional wouldn’t be too far of a stretch. Originally an engineering major, the now president of North America for Ipsen, a global specialty-driven biopharmaceutical group, was affected by her mom’s cancer diagnosis and switched her undergrad major to nursing. As a nurse, Schwalm was able to see the benefits of quality therapies. She also got to see what could be improved. 

Cynthia Schwalm (sitting left) is pictured with her leadership team at Ipsen's US headquarters in New Jersey. (Left to right) Jennifer Benenson, Ron Graybill, Donny Pearl, Paul Reider, Brad Bailey, and Marisol Peron. (Photo/John Halpern).

This first-hand knowledge stays with Schwalm to this day, and has not only shaped her leadership style, but is also a dynamic she tries to find in candidates looking to work on her team. 

Pharm Exec recently spoke with Schwalm about the current state of healthcare, her work at Ipsen, and how she managed a successful merger. With global headquarters in Paris, Ipsen markets more than 20 drugs and employs more than 5,100 people around the world. 

PE: Tell us a little bit about your current role at Ipsen?

Schwalm: I have two roles with Ipsen. I am president of North America-our definition of North America is the US and Canada-so I manage all the commercial operations. My team also delivers shared services to some of the global roles that are in the US, such as R&D, manufacturing, business development, regulatory, etc. 

I also serve on Ipsen’s worldwide executive committee, so that’s why I have a second title and act as executive vice president for the Ipsen Group, which is the worldwide family of companies.

PE: What’s a typical day like for you?

Schwalm: Instead of a day, because my days can swing greatly, it might be helpful to talk about how I think about my time. I think of my time in chunks. I work toward spending 30% of my time externally. By externally, I mean with patients, with healthcare providers in external settings where I am learning about the evolution of healthcare, etc. It’s a lot harder than it sounds, because when you’re managing a company there is always something that is pulling you into the home office or something going on with corporate. So I’m pretty rigorous about planning my time at least three to four months in advance.

Another 30% of my time I spend on people and people development, and working with some of our best talent to ensure we have the right team. We have the great fortune of being able to build a talent base from scratch in North America. I have been able to collect high-performing talent across the US and Canada, and we’re growing at such a fast rate-over 50% per year-so it’s very important that we help these executives come in, grow, and develop.

Another 30% I spend on being a member of my other team, which is the worldwide executive committee working on global projects, global initiatives, thinking through the strategy of the company moving forward, operations globally, mergers and acquisitions, etc. That takes me out of North America and to the global market.

And the final 10%, I try to keep open to just be able to think, because that’s where some of the best ideas come from-when I can just have some free time to either take in ideas, spend time with people I might not have normally spent time with, and just be able to think and reflect on the business.

PE: What do you enjoy most about your position and leadership role within Ipsen?

Schwalm: It’s going to sound a little clichéd, but what I really enjoy the most is the fact I have been able to build this business as an entrepreneur and fund it by an almost 90-year-old entity called Ipsen. I’ve been able to build this business, and by that I mean building a great high-performing team that actually has a tremendous team dynamic. The most enjoyable time for me is when I’m being with, watching, and enjoying the efforts of this group that I’ve put together. It really makes my professional life very enjoyable, and it feels very rewarding.

Keeping a strong team dynamic can be challenging. I’ve been in the industry for a long time, and people talk about it and I’ve grown weary of reading-I mean, how many coaching books can you read? There are dozens of publications per year on high-performing teams. When you have the good fortune of living through many experiences, at this point in my career, it’s a real blessing, and I don’t take it for granted.

PE: What’s the most challenging part of your job?

Schwalm: The most challenging part is managing the growth of this business and its contribution to Ipsen. When I was approached by the board at the end of 2013, Ipsen had not been successful in the US, despite investing a significant amount of money since 2009. Now, three years later, we became the major growth engine for Ipsen. We are the largest country, the number one affiliate; we are leading growth and profitability for the company. That challenge does keep me awake at night and it is also requiring all of us to learn how to embrace this level of change and responsibility within the company. The acceleration has been sort of extraordinary.

It’s about how you bring people along day-by-day, how you help shape the shift, how you think about resources, how you drive externally, which is now one of my big drivers. It is a very important responsibility.

I do find it challenging because you can become overwhelmed by it, or you can take it step-by-step. For example, I recently presented as part of a team at our annual investor day, where we showcased the growth of the company to our investors. Over the past three years, our investor base has changed: We now have more American investors, our stock price has increased on average by about 50% per year since early 2015, our return to our shareholders is up 150%-plus, and a lot of that has to do with the impact in North America. The expectation is that we continue to drive performance.

These are good problems to have.

PE: Your undergraduate degree is in nursing. Can you explain your career evolution from a critical care nurse to executive of a global pharma company?

Schwalm: I was actually an engineering major in college, and I’ve always been fluent  at math. During college, my mother was diagnosed with breast cancer, and I made the switch to nursing. I was a dual major for a period of time, and then I made the switch to nursing, because I really felt very passionately about it.

At that time, cancer was a death sentence. In the late ’70s, there was none of the innovation that we have today. In changing my major and moving into oncology and critical care nursing, I really decided that I was intrigued by what I was seeing happening to my mother, I was intrigued by the whole situation, and I really wanted to get into the clinical aspect of healthcare for a living versus the abstractness of engineering.

After several years as an oncology and critical care nurse, I was studying for my MCATs, because I wanted to continue being able to impact and influence. I was very drawn toward helping populations who were very sick or very challenged, and it was at that time that I was approached to join a device company as a trainer.

I decided to pursue the device role, and that led my career to what I call the manufacturing side. Once I started working my days and nights and working in medical schools all over the four-state area of New York, New Jersey, Pennsylvania, and Maryland, it was exciting to be able to influence at that level. I witnessed all the types of healthcare-and at the time, I was still very close to the patients-I knew that was my calling. It was very clear to me.

This concept has driven my career choice over the past 30 years. Being close to patients and the patient agenda drive my thoughts around strategy and has been what has made me successful, along with having the good fortune of getting my executive MBA at Wharton (University of Penn.) between 1997 and 1999. Business skills completed  what I would call the heart-mind connection; I learned the language of finance and use that language to drive the opportunities I see being so close to

 healthcare.

PE: How has the nursing background helped you in your corporate roles?

Schwalm: I have so many different colleagues who are leading in the industry, and we all come from different backgrounds, but I very clearly see the patient in my mind’s eye in every single conversation. That’s something that I think is very unique about executives from the nursing and allied healthcare professions. We have been so close physically to so many aspects of life and death with patients and their families. That agenda is front of mind.

It’s been very easy for me to see business opportunities where it might not look like an opportunity on paper or logically, but I can see the patient agenda. I think it’s also helped me in the evolving world of pharma, where being a compliant organization is so important. I can very easily see the ways to work with patients and providers in a very compliant fashion, and it’s not been what I would call a barrier to me, because that’s all about responsibility. 

PE: What’s the biggest change or shift in healthcare you’ve seen during your time in the industry?

Schwalm: The biggest change in oncology has been the absolute drive and focus now in oncology and rare diseases. These were areas that when I started, the industry wasn’t even interested in. There was one company, Bristol-Myers Squibb, that had worked with the government on Taxol; and now most companies, with a few exceptions, have a significant business model in oncology and are also working on subpopulations that are very small populations of people who are ill and need help. That is a dramatic change. Thirty years ago, it was about primary care and big, big patient populations-and oncology wasn’t on the agenda.

The other big change in terms of the industry is the influence of Wall Street and driving the behaviors of leaders and executives in our industry around deals, acquisitions, and pricing. I’m hoping that push has run its course, and that we are going to come back to some middle ground about focusing on strong innovation that is obviously profitable for companies, but also extremely effective for patients.

PE: What excites you most about the current state of the industry? 

Schwalm: What excites me is that we are moving to a new level of marrying communication with adherence and consistency. And, of course, technology is in the background. When I say communications, I mean the enabling-technologies.

There are still so many therapies where patients don’t adhere, because they don’t have the right resources, and then they don’t get the optimal outcome. This whole new world-that’s not totally complete yet around the patient’s ability to communicate, monitor, think through, deliver, and look at their own outcome-is just absolutely fascinating. I look forward to the day when we get a total integration of technology with therapy.

One example that I’m thinking about that we have is Increlex, a therapy for a rare condition called short stature, in which children do not grow, that helps about 500 children in the US. One thing that we noticed is that for some particular reason that we are sorting out, the parents and the children are not getting the injections that are required to help them grow-to help their organs, body, and mind grow. So having that continuous loop with these parents, the children, their doctors, and access to the medicine is something that is going to require a very integrated approach. If we can tackle that, it could profoundly affect many decades of life for children in this country with a rare disease.

That’s just one example where I really see an opportunity, if the industry can figure out a way to bring all of these technologies together for a better outcome.

PE: What do you think is the biggest challenge the healthcare industry will face in the next five to 10 years? 

Schwalm: In the US, it’s still disturbing that about 30 million people don’t get access to care, and we are one of the most affluent countries. Recently, there was an article in The New England Journal of Medicine that posted statistics that we have states in our country where the average mortality age is decreasing.

We have not tackled fundamental healthcare for our citizens and I think it’s a huge challenge-I don’t immediately see the way forward with the new administration. I think that we, as industry partners, have a role to play in that. I see that as a huge challenge for the US, and  I don’t see the absolute way forward, but I’m hopeful that various constituents will continue to partner.

In terms of access to global healthcare, I think access to care in some of the burgeoning countries where the middle class is moving forward and people have disposable incomes but not necessarily adequate access to care, is still an issue. I think about the time I spent in China, where there are also global access issues. In India and Brazil as well.

The biggest challenge for our industry is how we continue to truly innovate and drive value-based pricing, with pricing that meets the needs of the major global markets. The whole issue of pricing has obviously hit an all-time high in terms of being the lightning rod for our industry. It’s going to require global biotech and pharma companies to agree on finally developing value-based pricing in the US. We’ve talked about it, but we really haven’t done it and stuck to our convictions.

PE: You have a great deal of experience building successful leadership teams. What qualities do you look for in a candidate when you’re filling a position? 

Schwalm: There are some common themes that we look for, all the way from executives to emerging leaders. We look for people who have just as much of an interest in being as high-touch as we are regarding patient care, being focused, aligned, spending our time visualizing, and being with the patients and the people who care for them.

People talk about it, but I want to see that they have done it and that they have enjoyed that aspect of their work. If they have not had that opportunity, certainly there is the ability to be intensely curious about what we do from a patient and innovation agenda.

We look for people who have a real love of this game, of what we do-that we bring innovation to patients, and that are internally curious, whether they are in finance or HR. It doesn’t have to just be a field-facing position. You can sense when people have a real love of the game, the love of the industry that we are in, and a love of where they think they can contribute.

The bottom line for us, which we say at Ipsen, is this work is personal to us. So when you interview people, you can very quickly determine whether this work will be personal for them.

PE: Ipsen recently completed the acquisition of global oncology assets from Merrimack Pharmaceuticals. As a company leader, how do you prepare for a successful transition of bringing a new brand into your current portfolio?

Schwalm: The short answer is you don’t wait until the acquisition closes. As we went to the board and presented our proposal, we had already identified an integration process, an integration team, and we picked a high potential executive in our company to be that integration leader to make sure all the aspects went well-everything from regulatory, manufacturing, clinical development, and commercial. We actually started that process in December, announced the deal, and then closed the deal in April.

The short answer is you start way before Day One.

PE: You serve on a number of leadership boards. Why do you feel it’s important to volunteer your time in this way? 

Schwalm: I serve right now on the Wharton Executive Women’s Leadership Board and Harvard’s JFK School Leadership Board; those are two philanthropic boards. I feel most compelled to do that because it moves outside of just our industry, and we are actually engaging in very thoughtful research about women in leadership globally. The research is beginning to have traction and is beginning to be used not only by private interest, but by government and academic interest.

By thoughtfully engaging in the work of what it means to empower women to be at the table, be part of the conversation, and to deliver on that conversation, is extremely important to me. Also, I have two grown daughters, and I have mentored many people.

I also think it’s important for our young men coming up, because as our world evolves and we live longer, a career is longer. To be able to be a leader throughout life’s journey requires a different skill set for both men and women. It’s a more inclusionary skill set than ever before.

PE: What advice do you have for younger executives who aspire to a C-suite role?

Schwalm: I’m so excited to be here today, because when I started my career it was a bit of the land of “no.” I think there are opportunities to manage your career and find the environment where, for both young men and women, you can be highly performing, highly functional, and still have a committed relationship, manage a young family, manage respecting your elders, and moving homes at times. Being able to say, “you know what, I can’t move to take this job now, but I certainly can do it at another date.” That type of flexibility is what is going to make people successful in the long haul and I encourage people to seek out those environments.

I also encourage executives to get close to the line. I don’t believe in strategy alone, I don’t believe in operations alone. I think good strategy comes from people who have been close to the customers, been close to patients, and understand what it really takes to ensure that innovation moves forward.

It can be difficult when people get into what I would call classic corporate jobs, and have not had those frequent exposures to the patient agenda at the bedside. I really encourage people to do that. 

Michelle Maskaly is Pharm Exec’s Senior Editor. She can be reached at michelle.maskaly@ubm.com and on Twitter at @mmaskaly