Situation
When Biogen Canada needed to move a fragmented, underprepared healthcare system toward readiness for the first-ever disease-modifying Alzheimer's therapy, they faced two problems simultaneously: a structural one and a logistical one. The structural problem was that no single actor controlled the solution — neurologists, patient advocates, health administrators, and provincial policy actors each held a piece of it, and they'd never been asked to solve it together. The logistical problem was that it was November 2020. Bringing 27 people into a room wasn't an option. Making 27 people do meaningful collaborative work online — not just listen, but actually build something together — was a different kind of challenge altogether.
Complication
The Canadian healthcare system was completely unprepared — and the timing could not have been worse. The workshop took place in November 2020, eight months into a pandemic that was actively making everything harder: dementia care was being deferred across the country, memory clinics had shifted to virtual models that weren't designed for this population, and governments at every level were consumed with COVID-19 response. Layered on top of that was a structural problem that predated the pandemic entirely: no standardized diagnostic pathway, no sufficient PET or MRI imaging capacity, and deep stigma around dementia that suppressed early help-seeking even in normal times. Biogen could not mandate any of this to change. It is a pharma company — it cannot force provinces to fund PET scans, compel physicians to adopt new protocols, or direct patient advocacy groups to shift their priorities. And yet neurologists, patient advocates, homecare providers, health administrators, and provincial policy actors would all need to move, together, in the same direction. They had never been in the same room.
What They Tried — and Why It Wasn't Enough
The conventional pharma playbook for situations like this is the advisory board: invite a handful of experts, brief them on the therapy, gather their input, and synthesize the feedback internally. Biogen had done this. The team had also commissioned a significant body of research on Canada's readiness for Alzheimer's DMTs. They understood the problem in detail. But data and advisory input pointed to the same ceiling. Advisory boards put a pharma company at the centre, asking external stakeholders to react to the company's framing, one at a time, in separate conversations. They generate opinions, not ownership. They produce a report, not a coalition.
Question
Biogen needed to know how to move a fragmented, underprepared Canadian healthcare system toward readiness for a new class of Alzheimer's therapies — in the middle of a pandemic, without the authority to mandate any of it. The neurologists, patient advocates, health administrators, and provincial policy actors who each held a piece of the solution had never been asked to solve the problem together.
Answer
MMG convened 27 participants over three days via Zoom and MURAL on November 12–14, 2020: 9 internal Biogen participants and 18 external stakeholders including neurologists, Alzheimer Society representatives, a homecare provider, a healthcare consultant, a former Ontario Health CEO, and one patient. Six topics — Awareness, Activation and Screening; Referral and Diagnosis; Treatment; Patient Experience; Burning Platform; and COVID and Other Scenarios — were designed to surface the full system's barriers simultaneously, so that the recommendations would fit together as a coherent strategy rather than a series of unconnected asks.
MMG designed the three-day engagement specifically for distributed collaboration — using Zoom breakout rooms for structured small-group work and MURAL to replicate the synthesis process that would normally happen around a physical wall: clustering ideas, surfacing patterns, building toward shared conclusions. The format was new; the rigor was not.
Output
Biogen Canada left the workshop with three things a pharma company cannot buy or commission:
- A candid system diagnosis — a shared, ground-level account of where the Alzheimer's diagnostic and care pathway actually breaks down, surfaced by the clinicians, advocates, and administrators living those breakdowns rather than inferred from secondary research.
- A cross-sector action plan — 18 integrated action items spanning awareness and stigma reduction; referral and diagnostic pathway improvement; treatment readiness; and patient and caregiver experience, built by the people who would have to execute each part.
- A coalition ready to engage — 18 external stakeholders who had stress-tested the strategy together, endorsed its recommendations, and left with a shared understanding of the problem that no advisory board process could have produced — giving Biogen a network of informed, aligned partners rather than a roster of separately-briefed contacts.
Frequently Asked Questions
Why aren't advisory boards enough for complex life sciences challenges?
Advisory boards put the pharma company at the centre and ask external stakeholders to react to the company's framing, one at a time, in separate conversations. They generate opinions, not ownership. What Biogen needed wasn't more input — it was a coalition of neurologists, patient advocates, administrators, and policy actors who had built a strategy together and left with a shared stake in executing it. That's a different output entirely, and it requires a different process to produce it.
How do you get 27 people to do real collaborative work over Zoom?
The short answer is that you design for it from the start rather than adapting an in-person format. MMG used Zoom breakout rooms for structured small-group work and MURAL to replicate the synthesis process that would normally happen around a physical wall — clustering ideas, surfacing patterns, building toward shared conclusions. The distributed format was new; the rigor wasn't. Participants weren't listening to presentations. They were actively building the strategy together.
How did this engagement produce 18 action items when a pharma company can't mandate any of them?
Because the 18 commitments weren't Biogen's recommendations handed to stakeholders — they were built by the stakeholders themselves. Neurologists, patient advocates, homecare providers, and provincial policy actors each held a piece of the problem, and the engagement was designed to surface all of it simultaneously. When the people who will have to execute each part of a strategy are the ones who built it, the ownership question largely answers itself.
Could this approach work if we're not a pharma company with a specific therapy to launch?
Yes. The underlying challenge — getting a fragmented group of actors, none of whom controls the full solution, to build and commit to a shared strategy — appears across sectors. MMG has run similar multi-stakeholder engagements for government agencies, not-for-profits, and commercial organizations facing the same structural dynamic: the people who need to move are not the people who hired us.