Why Health Care Solutions Aren’t Global

by JHI Staff on June 6, 2013

I saw an interesting article in the journal Foreign Affairs recently that traces the rise in popularity of a programming language called Lua for building webpages and software interfaces. To summarize, the language was developed by three relatively obscure researchers in Rio de Janeiro, Brazil, and ended up being enlisted by the developers of World of Warcraft and Wikipedia, two of the best-known software and online services in the world.

Normally I would quickly glance over the story of a programming language, and I wouldn’t know World of Warcraft if I woke up inside it. But this story caught my eye because it touches on a theme that we think about here at Johns Hopkins Medicine International quite a bit—namely, the push and pull between local and global approaches to building and upgrading health care infrastructure.

The term “global” is a little misleading in this case. We’re definitely global, as in worldwide, and even call our emerging field global collaborative health care. The key issue here, rather, is that a solution can be specifically suited to the needs of a local environment, or it can be designed as a “one-size-fits-all,” or universal, solution.

In the case of a programming language, “global” and “universal” are more or less the same thing, because what makes a programming language globally popular is how universally it can be applied. As the Foreign Affairs article puts it:

The world of software is dominated by network effects: The more people use a piece of software, the more valuable it becomes. This is particularly true for programming languages. For engineers, going with widely used languages means access to more jobs that require knowledge of those languages and more ready-built modules in that language to repurpose. For employers, using a popular language makes it possible to hire from a larger pool of engineers.

Not so much in health care, it turns out. Johns Hopkins Medicine has a global reputation for excellence in health care, research and education. Many people from around the world, as well as the U.S., come to Baltimore to entrust their care to us and work alongside us. But that’s a very different thing from saying that what we do here in Baltimore is universal, in the sense that it would work well in any other place in the world. In a sense, we’ve developed a local solution that has won us a global reputation.

That what we do in Baltimore is not a universal solution is something we learned the hard way when we first started collaborating overseas in the 1990s. We had assumed that our practices and processes and even some of our people could be neatly transplanted to other countries in order to create Johns Hopkins-like hospitals in those places. Since global collaborative health care didn’t fully exist yet, there was little evidence to suggest that wouldn’t be the case.

We quickly learned that wasn’t the case. Different countries, and even different parts of the same country, typically have different ideas about what makes great health care, how it should be delivered, and who should be delivering it. It seems obvious now, but at the time it was a bit of rude awakening. In the early days we had to struggle to learn how to adapt what we do here in Baltimore to others’ specific needs, resources and cultures—all in collaboration with our partners, of course. And now we go into each new project assuming that we’re going to have to rethink much of what we’ve done elsewhere in order to be successful. Knowledge transfer is very much a two-way business for us.

Software, in fact, may be the exception more than the rule when it comes to the global appeal of universal solutions. The network effect doesn’t much apply to food, entertainment, or cars—a Volkswagen isn’t more useful or appealing to a U.S. consumer because identical models are popular elsewhere in the world. Most products and services are more successful when they’re tailored to local needs and preferences, and that’s very true of health care.

Of course, that doesn’t mean there aren’t aspects of health care that are fairly universal. If we had to completely reinvent health care every time we came into a new project, global collaborative health care wouldn’t be much of an industry. Many of our practices, such as improving patient safety, mentoring younger clinicians, and promoting the importance of nursing, have all so far proven applicable and even necessary in every country we’ve worked in. As with so many things, the best solutions come from finding the right balance between two opposing approaches—in this case, providing the aspects of health care that make sense to just about everyone, and those aspects that might vary from region to region.


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Why Health Care Solutions Aren’t Global | jhublogs
June 6, 2013 at 10:19 am

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Dr. Nitsa Kiliari June 20, 2013 at 4:03 am

Dear Mr Thomson

I read your article with great interest and fully agree on non-universal character of healthcare and the low applicability of 'one-size fits all' solutions. Adapting healthcare on the particular circumstances of communities, and even individual people, has been a fundamental principle of scientific medicine since its birth around the 5th century B.C . In his treatise 'Air, Waters, Places' Hippocrates, the Father of scientific medicine, teaches doctors of his time to visit the place where patients live and carefully examine all the conditions to which they are exposed, including the effects of each season in their area, the quality of waters, the direction and temperature of the winds, the methods of production of food, etc

Dr Nitsa Kiliari
Nutritional Medicine Practitioner


Steve Thompson June 20, 2013 at 11:20 am

Thanks very much for pointing out there is indeed a long history to the importance of tailoring medicine to local conditions and needs. Maybe if we here at Johns Hopkins Medicine International had more carefully studied up on our Hippocrates before embarking on our first projects it would have saved us some tough lessons!


Matthew Kesinger June 6, 2013 at 1:56 pm

Great topic! Does JHI have any public resourses outlining methods on finding the balance between "providing the aspects of health care that make sense to just about everyone, and those aspects that might vary from region to region."?

I'm working to establish international relationships in surgery focusing on quality improvement, research, and education. But I'm working in a department with little experience in these endeavors.


Steve Thompson June 9, 2013 at 8:08 pm

Thank you for you comments and question. We do not have any public resources on this. It really is the result of years of experience that guides us. Having a "guidebook" for this sort of work would be helpful. We will need to get to that. In the meantime, please take a look at some of the other articles I have written on this topic. It may give you more insights. Thanks.



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