As global economies grow and standards of living increase around the world, the East-West cultural divide in quality healthcare is becoming smaller. Longer lifespans, changing demographics and the rising rates of chronic health conditions spur greater demand for better, more efficient, less costly healthcare services, propelling healthcare companies around the globe, and in local communities, to expand across Asia Pacific at an unprecedented pace. It’s growth that’s welcome and needed, but there is an acute talent shortage of those who can successfully lead these companies through the region’s complex landscape of diverse demographics, regulatory environments and unique cultural distinctions. As the world battles to contain the Covid-19 outbreak alongside China and other hard-hit countries, it only highlights the intensifying need for quality healthcare and experienced healthcare professionals. Even as countries with highly developed healthcare systems struggle to find leaders with the appropriate skill sets, emerging and high-growth countries are finding the task even more difficult — and many healthcare organisations have resorted to importing talent as a means to inject international experience, deep knowledge about the healthcare industry and best practices from around the world.
Roughly one in every four executives holding leadership positions across Asia Pacific’s leading healthcare businesses are expats. They hold integral roles and bring critical skill sets that help round out their respective leadership teams. We talked with 18 of these seasoned leaders who have been imported into the Asian healthcare industry for both clinical and administrative roles. They told us about their boots-on-the-ground experiences leading healthcare companies across Asia Pacific. In this article, we explore the key skill sets and competencies international executives need; and how organisations can create the conditions that enable these leaders to successfully land and have a positive impact in Asia.
An international mindset and the ability to be diplomatic and culturally adaptable
Asia Pacific is not a homogenous region; with more than half of the world’s population, it is richly multicultural and diverse. You don’t have to travel far within the region to discover that everything — from language and ethnicity to religion and food — changes drastically and quickly. China alone, for example, is home to dozens of different contrasting markets in terms of population, literacy rates, income levels and cultures.
Because of this multiplicity, leaders cannot bring a cut-and-paste strategy to their role. A solution that may have worked well in Shanghai may be disastrous in Vietnam; a communications approach that is successful in Tokyo might need to be revamped in Mumbai. In addition, there is a high level of diplomacy needed to navigate the complex and always-changing governmental policies and regulations. Unlike other industries that span the globe and operate under international standards or guidelines, like banking or pharmaceutical manufacturing, healthcare services lacks unified international standards, and yet it requires a vast and comprehensive array of leadership disciplines — from understanding emerging technologies and foreign capital to human psychology and social behaviors — that can adapt to the historical distinctions and cultural norms of a specific country.
“Understanding history and culture is part of the to-do list for a professional who's entering into a new geography, said Harish Pillai, CEO of Aster DM Healthcare in India. “Otherwise, your interpretation of verbal and nonverbal signals may be totally off the radar.”
Top 10 characteristics of successful expat leaders
- Adventurous: Inspired by entrepreneurs, respect agility and collaboration over hierarchical organisations and process-driven structure
- In tune with customers: Focused on loving and listening to customers, with a deep understanding of how digitisation improves personalisation and customisation
- Focused beyond product: Possessing a holistic view of the entire brand that reaches beyond individual products
- Data-minded: Enthusiastic about learning from data in every realm of the business
- Inspiring: Adept at fostering collaboration, collective thinking and an inclusive approach that energises people and teams
- Flexible: Giving employees options for how they work and not being constrained by an attachment to conventional paradigms
- Transparent: Able to construct a space where people feel comfortable sharing opinions openly and where information is shared throughout the company
- Curious: Adopting an agile approach to try new things, with a sense of curiosity about what new tactics and strategies might bring
- Courageous: Willing to fail, encourage failure in other, and learn from failure
- Low-ego: Trusting others throughout the organisation to make decisions, willing to focus on problem-solving rather than role-playing
Flexibility and patience
It takes an enormous amount of time for an international operator to fully understand the dynamic of a country, its culture and the way information and ideas are communicated. Subtext in communication is often a stumbling block for expats, as they have to exercise the patience to listen not to just what is being said, but the undercurrent message as well. The leader who possesses the flexibility to be nimble with the unexpected and the patience with delays or lingering timelines will be the leader who will often drive the best results within their organisation. This means pulling the best from a personal toolkit of successful techniques, systems and processes — and having the dexterity to marry them within the context of where they are geographically located. It enables leaders to become very effective at bridging the gap between orders from HQ and the local operations.
“I think what has helped me to be effective is being patient, but also consistent and persistent,” said Jeff Staples, group COO of Beijing United Family Hospital. “I try to play a supportive role where I recognise that the general managers know their hospitals better than I do and I recognise that the VPs know their functions better than I do. I try to align them, get obstacles out of their way and empower them.”
Humility and open-mindedness
Many Asia Pacific countries have inherently humble cultures, and several of the leaders we spoke with told us that it would be a mistake to believe that they’re bringing the gold standard of healthcare to the region. While expats often bring a depth of leadership and experience to the organisation, there still exists a learning curve to catch up with the locals, as they almost always know and understand their organisations, people and functions better. Approaching the role with a balance of proficiency and a willingness to step back and allow local leaders to steer the ship empowers them to successfully do their job and helps to align organisational priorities with clear, quantifiable KPIs.
“You’re in a very privileged position of working in somebody else’s country,” said Paul Gregerson, former CEO of Parkway Pentai in China. “You always have to remember that you’re a guest in their country and you generally only have the rights to be there because an employer has asked you to go there.”
Coaching mentality and willingness to be hands-on
Building and leading a successful healthcare organisation requires starting at the foundation: culture and a motivated team working together. It’s more than yearly performance reviews; it’s building of an integrated healthcare culture, sustained by a patient-centered philosophy, a constant feedback loop and a “hands-on” approach. Knowing how to communicate well to every level of the organisation helps to build a consensus about the way people should practice medicine.
“You need to recognise that you need to support the people,” said Grant R. Muddle ML, acting chief executive officer of Morobe Provincial Health Authority, Papua New Guinea, “Transformational and servant leadership is really important when you go across cultures.”
Remember why you are there: the people
Nearly every expat leader we spoke with talked about the importance of remembering the people — both healthcare employees and patients — at the center of every healthcare venture. If you’re building a competitive edge with a powerful marketing campaign in your target customer demographic, the patients must come first. It’s about focusing on the people, satisfying their needs and treating them in a way that shows you value them.
“The opportunity for the healthcare industry today is to build a model based on the patient and, by virtue of that, we can create a patient-centric environment,” said Bhavdeep Singh, former CEO of Fortis Healthcare in India. “Retail industries call it the customer — in healthcare, we call it the patient. Quite honestly, the ecosystem we build around is similar in many ways: so, if you focus on the customer, you will never have to worry about the financials.”
If your mission is to lead a successful healthcare company that employs both international and local talent, those employees must possess motivation and a sense of being valued.
“If you take the employees out of the hospital, all you’ve got is an empty building,” said David Wood, CEO of Suzhou New Century Children’s Hospital in China, and president & senior partner of The ChinaCare Group. “Bring that philosophy and good financial management — and those are the keys.”
Once you’ve zeroed in on the global healthcare leader with the experiences and capabilities required by your organisation, what can you do to ensure you provide the right support to enable their success?
Help the expats and their families to embrace their new home
A strong theme that came out of our conversations with these leaders is about ensuring not only the expat but also their accompanying family are properly settled and set up for their new life. The support companies can provide goes beyond concierge services and includes helping expats and their families to understand and embrace the differences in culture, life style and social environments so they can thrive in their new country and city of residence.
Partner expats with local resources
Partnering your leader with local experts, who understand the language, the culture and the local market, is the best way to address the challenges of operating in a foreign country. Language teachers — even if the expat fluently speaks the language — can be the right-hand person who can help read between the lines and translate the subtext of a situation. Programs like cross-cultural coaching with a local expert can help ensure a seamless transition and integration into a new healthcare leadership role.
“Having a culture mentor to help with local orientation would be important,” said Vincent Borg, former CEO of VAMED Middle East Healthcare Management and Consultancy Services. “Just someone to mentor through the keys at work and culture of the region.”
Be absolutely transparent about the issues
If the value of bringing in an expat is their ability to make an impact and leave a legacy for the healthcare organisation, companies must do more than hire an experienced leader and set expectations. To deliver the anticipated ROI, expat leaders need to understand the challenges that must be solved during their tenure, rather than becoming lost in a labyrinth of veiled problems.
“Sometimes organisations are reticent to provide an unvarnished and completely true account of what the issues are,” said A. Clancey Houston, managing partner of Empirik Health and a principal with The China Healthcare Advisory Group. “They don’t want to scare off potential talent, particularly not a leader they really need — but must be able to say, ‘Here are the issues we’re dealing with that need to be addressed, and we’re looking to you to do it.”
The demand for high quality and more comprehensive healthcare will continue to rise across Asia Pacific in the years to come. This growth will only intensify the need for capable leaders who are able to navigate the complex and evolving regulatory, social and economic dynamics in these countries so their company can capitalise the increased demand for healthcare services. Expat leaders bringing extensive experience and expertise from other markets can play a critical role in Asia Pacific, but they will need to come with a key set of leadership traits, adapt to the complex Asia context and adopt practices that are most effective in these emerging markets. At the same time, companies should put in place support measures to help these expats and their families successfully transition in their personal lives and this new adventure on their professional journey.
More takeaways from healthcare leaders
One of the objectives of creating a template for the future is to identify early what needs to be integrated and what needs to left alone; it is a fine balance.
Group Head of Operations & Integration, IHH Healthcare Berhad
You have to be respectful of the local culture, invest time and efforts to establish credibility and build trust with the local employees before you think about making changes and bringing impact to the business.
Chief Medical Officer, Shanghai Jiahui International Hospital
Healthcare and facility management is a rather sophisticated operation which requires years and years of training and hands-on experiences in order to feel comfortable and be good at it.
Ex - Founder & CEO, Delta Health China
From a human capital side, attract the best talent from both locally and overseas and somehow get all these people to make an effective culture together to be a truly different kind of health organisation.
Managing Partner, Asia Growth Solutions
You’re not only immersing into the hospital’s culture, but also the culture of the country — and that can change the way you think and behave so that you often become more local than the locals. [Expats} have to remind themselves of the fundamentals, the framework and successful practices within the hospital they’ve come from.
Former Group CEO Asia, Ramsay, Malaysia
It’s important to keep a good balance of listening to people and strong positioning to show leadership.
President, Novartis Oncology
You have to remember that you’re not only immersing yourself into the hospital’s culture. You’re also immersing yourself into the culture of the country.
Former Group CEO Asia, Ramsay, Malaysia
Having patience is key. Anyone who sees the move to Asia as a short-term opportunity will not do well. This person needs to make a commitment to spend at least four to five years in the region.
Group Head of Operations & Integration, IHH Healthcare Berhad
Hospitals are collegial, consensus-based institutions. As an executive, it isn’t enough to simply know the right thing to do, you must be able to convince your management team that it’s the right thing to do.
CEO of Suzhou New Century Children’s Hospital, President & Senior Partner of The ChinaCare Group
In Japan, there is a very high work ethic, high performing culture — but [there is also a] lack of encouragement in expressing own opinions, so you must create a trusted environment that is culturally sensitive. People were surprised when I said, ‘I made a mistake.’ So admit a mistake, share it and learn from it. It is okay to make mistakes but unacceptable not to learn from them.
President & Representative Director, GlaxoSmithKline
Be open, be transparent, do what you speak and build trust.
President, The Janssen Pharmaceutical Companies of Johnson & Johnson
Forming relationships is the foremost function, or chance, of making a difference in your organisation.
Deputy CEO, OMNI Hospital
Find the right doctors, with the right motivation, and you can ensure the stability of your team.
CEO, Shanghai Artemed Hospital