The challenge in proton therapy is not complexity or expertise, it is lack of transparency

What was the inspiration for Trees with Character?

Today’s response to a world that continually changes, becomes ever more complex, and relies more and more on increasingly complex systems and expertise to achieve goals is to increase control, to demand guarantees and to manage through legal contracts.

The thinking is that it is not wise to simply ‘trust’ the experts to know what they are doing, when we no longer understand everything ourselves. So we step in, seeking out more and more information to cope with our uncertainty, trying to “get” what the experts are talking about and to try to stay on top of things. We end up telling the experts what it is we want, how they have to do it, how to report and which guidelines to follow. But in doing so we restrict the utilisation of the experts’ expertise. Both in how (using what product and services) they can best meet our challenges and in how they can deliver their solution against minimal resources.

This is also what happens in the field of proton therapy. Everybody sees risks everywhere, and instead of minimising this risk the impulse is to try to manage the experts — which increases cost. Which is exactly what the field doesn’t need. For a considerable group of patients proton therapy offers significant clinical benefits. To offer these benefits to patients both proton therapy vendors and proton therapy centers must have healthy operations: financially sound and optimally using the talents and expertise available to them.

But this is not what we find in proton therapy. The problem is not a lack of talent and expertise. The problem is not the complexity of the technology. The problem is only to a degree financial. The real problem is lack of transparency in the communication between vendors and clients. Vendors and clients are experts in their own fields each speaking their own language. To remedy the situation both vendors and clients must change the way they communicate with each other.

Clients don’t always know what their particular aims and challenges are. They need help. The established way forward is not to identify a vendor’s expertise but to select equipment. So they spend considerable amount of resources on gathering detailed technical information the relevance of which is often poorly understood. They then turn this information into a long list of requirements for vendors to fulfil. A list of requirements which is never “complete”, with relative weights which are impossible to define in isolation, with plenty of items which are not relevant to the project at hand and which may both intentionally and unintentionally exclude vendors with the right expertise.

Vendors tend to market and try to sell their equipment using technical information and a long list of features non-expert clients may not be able to assess whether they actually need them. Vendors also tend to highlight technical differences with competing products when the relevant differentiation for the client generally lies not in technology but in solutions. Vendors are asking their clients to become experts themselves or to “trust” the one vendor over the other.

In the field of proton therapy you must get many things right. There are many challenges to be met, and perhaps the biggest challenge of all is to establish a collaboration between vendor and client. What does the client need most? Which vendor has the right expertise to make the center a success? How can the vendor leverage their enormous expertise in engineering and software development to develop services their clients are — often unbeknownst — in great need of?

This conversation is not taking place. Everybody — both vendor and client — tends to automatically focus on equipment and the initial cost. This despite the fact that all vendors are able to accurately deliver identical protons with great precision in the target. Despite the fact that it is shown all too often that the success of a proton therapy center does not depend on the type of technology used, and only to a point on initial cost.

To make proton therapy a success — a healthy and innovating industry allowing healthy centers to offer clinical benefits to their patients — a different conversation has to take place. A conversation which begins with both vendors and clients bringing their respective expertise to the table to identify what the client is actually in need of in their particular situation. This will then become the starting point for vendors to communicate  how both their solution and their expertise is relevant for the client to make the center a success over its operational lifetime. The vendors have to communicate this in a transparent non-technical way, making use of data and past performances, so that the client will not be asked to simply “trust” the vendor.

There have been too many proton therapy centers who have failed or are failing to meet their often unrealistic financial targets. The industry must start to fully utilise the tremendous expertise that is available on both the vendor and the client side. By changing the nature of the conversation between vendors and clients, risk — both real and perceived — will go down. And so will cost.

The founder of Trees with Character not only has a lot of experience in proton therapy, he also developed the approach of Decision Free Solutions (DFS). DFS is an approach to achieve desired outcomes against minimal resources by optimally utilising expertise. DFS identifies decisions as unsubstantiated choices which need to be either avoided or treated as risks.

Trees with Character is passionate about utilising expertise to minimise risk in proton therapy as the way forward to establish a healthy industry and to increase the number of patients who have access to the significant clinical benefits of proton therapy.

What is driving us at Trees with Character?

At Trees with Character we are driven to connect inspiring places, to be a strong provider of solutions, acutely aware of the surroundings, to be a dedicated guide that transparently leads you and what you want to achieve from beautiful beginnings to an exciting end, be it your organisation, your project, personal challenges, or anything in between.

By means of Decision Free Solutions, by constantly building expertise, by not just ‘hearing’ people but by ‘listening’ to them. This way we ensure the required expertise to achieve — with minimal risk — the unambiguous aims of our client is identified, and a path is created that is so clear that during the entire journey decision making is no longer necessary.

This is how we make proton therapy a success

Patient selection and patient referral are pivotal.

Many proton therapy centers struggle because of unrealistic projections of patients being treated. But even when making a realistic projection, the challenges of patient selection and referral remain.

Read more

Don’t buy equipment, identify the right vendor.

Because of the vendor lock-in for the lifetime of the proton therapy center, the services and capacity for innovation a vendor offers are of much greater importance than current functionality of the equipment. Shift the focus.

Read more

You can start to minimise risk in proton therapy today.

A decision is a conclusion reached after careful consideration. If you have to think it means something is not transparent. Each decision increases risk. Risk is minimised by unambiguous aims and access to expertise. You find it here.

Read more

Proton therapy technology is the least of your worries.

There is too much risk in the field of proton therapy, but the problem is not the technology. Focussing on technology often results in underestimating the real challenges. Challenges a vendor may help you with.

Read more

Independent consultancy made the difference for us.

Proton therapy vendors have a lot of expertise and a need to sell equipment. They may not protest when unrealistic assumptions are made. Some consultants combine great expertise with ties to a vendor. Independent consultancy can make a difference.

Read more

Proton Therapy’s biggest problem is lack of transparency.

Proton Therapy's biggest problem is lack of transparency. Initiatives don't share their overall aims, vendors focus on technology. Everybody is blind to the other side's needs and capabilities. But there is another way.

Read more
The inspiration that became Trees with Character

In his 2012 TED talk high-wire walker Philippe Petit, famous for walking a wire between the two Twin Towers in 1974, talks about how he, as a 16-year old, decided to walk wires. In his talk he says about his first attempt: “I found two trees. But not any kind of trees. Trees with character. And then a very long rope and I put the rope around, and around and around, and around and around until I had no more rope.” In an interview for NPR’s TED Radio Hour in 2013 Philippe is asked the question why he mentioned that it were trees ‘with character’. He replies: “That is the difference between me and a regular wire walker who is able to move their mass from point A to point B. First I choose my point A and point B. And if they are not inspiring and beautiful, and have no artistry in them, I would go somewhere else.”

Trees with Character embraces Philippe’s spirit. It does not suffice to lead the client (A) to its aim (B). The client, the aim, and the journey: we embrace all that is inspiring, beautiful, exciting, and of value. Walking the high-wire is challenging and risky, but it is also exhilarating. To walk that wire is no small endeavor, and one is not to simply ‘try and see’ how it goes. Philippe Petit: “When I put one foot on the wire, I have the faith, the certitude, that I will actually perform the last step.” Another core value of Trees with Character: the commitment to the client, and the certitude that the client’s aim will be achieved by identifying and utilising expertise, or by ensuring that the client’s expertise will become transparent to those they are able to help achieve their aim.

Trees with Character is synonymous with expertise, its approach of Decision Free Solutions as unique as it is transparent: whomever is interested is invited to ask, to challenge, to learn, to join.

Patient selection and patient referral are pivotal.

Many proton therapy centers struggle because of an unrealistic projection of the number of patients that will be treated. In the past, and even in the present, the number of patients projected to be treated was simply the number that was required to make the business case look good. Today we know that the most successful centers treat, on average, no more than 300 patients per treatment room. But to achieve even this number takes great effort. There is the challenge of identifying the patients who will benefit from proton therapy, and there is the challenge of getting these people referred to the center.

Read more
Don’t buy equipment, identify the right vendor.

Initiatives who want to provide proton therapy treatments — often hospital organisations — are confronted with very complex and very capital intensive equipment they have never procured before. A proton therapy project is perceived as a major risk, and rightly so. Too many centers have failed or are failing. The risk lies not with the equipment, however. All vendors build reliable machinery delivering identical protons. Not all vendors, however, provide the same expertise and solutions. Initiatives should not focus on technology, but on identifying the vendor who is best able to meet their particular challenges.

Read more
You can start to minimise risk in proton therapy today.

A decision is a conclusion reached after careful consideration. If you have to think about something it means this something is not transparent. If you take a decision when something is not transparent risk increases. This risk is minimised by unambiguous aims and access to expertise. What is it that you need to achieve? Who is the expert that will help you achieve it? Trees with Character helps with both.

Read more
Proton therapy technology is the least of your worries.

Cyclotrons and synchrotrons alike are built to last for decades — as is shown by the early proton therapy centers who became operational in the previous millennium. To this day, however, the complexity of the equipment often is an initiative’s biggest concern and many resources are spent on trying to understand it. Meanwhile none of the proton therapy centers who failed failed because of the technology. There are other, much more relevant issues and challenges to be considered.

Read more
Independent consultancy made the difference for us.

Proton therapy vendors have a lot of expertise. They also need to sell their equipment and associated services and may not point out which of an initiative’s assumptions are unrealistic. Some consultants possess great expertise — as well as an agreement with a vendor. Independent consultancy can make a difference. Independent consultancy means that the only interest to consider is your interest. Trees with Character will help you to make the right choices.

Read more
Proton Therapy’s biggest problem is lack of transparency.

Initiatives don’t share their overall aims, vendors focus on technology. Everybody is blind to the other side’s needs and capabilities. Without transparency everything is a risk. Everybody is looking for safety and control. Many resources are spent on inspections, on meetings, on the contract. But there is another way.

Read more