Situation
Eisai Canada is the Canadian subsidiary of the Japanese pharmaceutical company that developed Leqembi, the first anti-amyloid therapy approved to slow the progression of early Alzheimer's disease — the first therapy to demonstrably slow cognitive decline rather than merely manage symptoms. But Leqembi is not a pill. It is an intravenous infusion that requires serial MRI monitoring before and throughout treatment to detect a potentially serious side effect called ARIA. Without timely access to MRI, eligible patients cannot start treatment, and those already on it cannot safely continue.
Complication
Canada's MRI system was already at capacity before Leqembi arrived. Wait times for non-urgent MRI ranged from months to over a year in most provinces, driven by workforce shortages, outdated equipment, scheduling inefficiencies, and a funding model that had not kept pace with clinical demand. Leqembi would require multiple MRIs per patient per year — a volume the existing system had no plan to absorb, and no national protocol to manage. Patients with mild cognitive impairment had a narrow treatment window. Delay the MRI, miss the window. Eisai could not build MRI capacity, hire radiologists, or change provincial funding policy. Like Biogen before it, the company needed a coalition of system actors to solve a problem none of them could solve alone.
What They Tried — and Why It Wasn't Enough
The conventional response to a system readiness problem of this kind is to commission research, engage key opinion leaders individually, and brief health system stakeholders through one-on-one meetings or small advisory panels. Eisai had pursued these channels. They understood the problem technically. What they lacked was a shared diagnosis built by the people managing the MRI system on the ground — radiologists, MRI technologists, neurologists, health administrators, and provincial policy actors who each saw a different slice of the access failure and had never been asked to solve it as an integrated system.
Question
Eisai needed Canada's MRI system to absorb a significant new volume of scans for Alzheimer's patients — but couldn't build capacity, hire radiologists, or change provincial funding policy on its own. The radiologists, neurologists, health administrators, and policy experts who together controlled the bottlenecks had never been asked to solve the access problem as a single, integrated system.
Answer
MMG convened 28 participants over three days via Zoom and MURAL in October 2023: Eisai internal staff, neurologists, radiologists, MRI technologists, patient advocates, health system administrators, and policy experts. Six topics — Burning Platform, Workforce, Prioritization and Guidelines, Funding, Technology and Process Improvement, and Policy and Advocacy — ensured that the recommendations would address the full pipeline of MRI access barriers simultaneously rather than in isolation.
Output
Eisai Canada left the workshop with three things it could not have produced through internal planning alone:
- A system-wide diagnosis of MRI access failure — a candid, granular account of where the pipeline actually breaks down, built by the clinicians and administrators managing it daily: workforce bottlenecks, scheduling practices that deprioritize outpatient neurology, equipment utilization gaps, and the absence of any national guideline for Alzheimer's-related MRI monitoring.
- 19 prioritized recommendations — spanning immediate clinical guideline development; workforce strategies to expand MRI technologist capacity; funding advocacy to provincial governments and hospital systems; and technology and process improvements to increase throughput without adding machines or staff.
- A cross-sector coalition with a shared mandate — 28 participants from neurology, radiology, patient advocacy, and health administration who had built the strategy together and left with shared ownership of its execution, giving Eisai a network of credible, committed partners to carry the recommendations into health systems and policy channels where a pharma company cannot go alone.
Frequently Asked Questions
Why couldn't Eisai solve this through one-on-one meetings and key opinion leader engagement?
One-on-one meetings and KOL briefings give you a map of individual perspectives. They don't give you a shared diagnosis or a cross-sector action plan, because each conversation happens in isolation. The radiologist's view of the access problem is different from the neurologist's, which is different from the health administrator's — and none of them has visibility into the full system. What Eisai needed was a process that put all those views in the same room simultaneously, so that the recommendations would fit together as a coherent system rather than a set of unconnected asks.
Why does it matter that the 19 recommendations were built by the people who will have to execute them?
Because recommendations that come from outside — from a consultant's report or a pharma company's internal team — land as suggestions. Recommendations built by the neurologists, radiologists, technologists, and policy experts who manage the MRI system daily land as commitments those people made publicly, in front of their peers. That distinction is the difference between a well-received report and a strategy that actually moves.
How do you get radiologists, neurologists, administrators, and policy people aligned on something this complex in three days?
Through structure. MMG designed the engagement across six topics — workforce, prioritization and guidelines, funding, technology and process improvement, and policy and advocacy — so that every dimension of the access failure was examined simultaneously. The design ensures that the recommendations address the full pipeline rather than the slice of it that any one discipline controls. The three days are intensive, but the output is a coherent strategy, not a list of individual suggestions.
What would we use this kind of engagement for if we're not facing an MRI access problem?
The underlying pattern — a complex system problem that no single actor controls, where the people who hold the pieces have never been asked to solve it together — appears across sectors. MMG has run structurally identical engagements for federal government agencies, not-for-profits navigating post-pandemic service delivery, and commercial organizations trying to align fragmented business units. If your problem requires the willing participation of stakeholders you can't mandate, this is the model worth examining.