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Global Promise Home Clinical Program Development Hazards of Homogeneity

We agree on the benefits of health care globalization: more uniform standards of patient safety, growth of telemedicine, greater access to lifesaving treatments, immediate information about care and wellness.

But are we overlooking a possible drawback: the homogenization of health care?

You may like knowing you can get the same Starbucks coffee whether you’re in Seattle or Shanghai. But each country employs a medical model that reflects its social, political, historical and religious values, which means health care does not—and should not—conform to a one-latte-fits-all model.

For example, patients in some regions may reject medical interventions based on longstanding traditions or their personal perspectives. They may not adhere to treatment because they don’t believe it will change their fate—or they see illness as a sign of spiritual shortcomings.

Cultural beliefs may also dictate how we share or receive medical information. I worked for a number of years in the Middle East, where it’s common for a family member to act as a “buffer,” communicating directly with the physician and then relaying the information to the patient. In other cultures, patients prefer to have more than one reliable source for communication, such as a doctor, spiritual leader or family elder.

Tailored Approach
My colleagues and I understand that individuals around the world have different ideas about what constitutes quality health care, how it should be delivered and who should deliver it. Even though Johns Hopkins has a global reputation for excellence in health care, research and education, it would be wrongheaded to think that what we do in Baltimore would work well out of the box in any other place in the world.

When we forge collaborations, we respect the local culture and vision of our international colleagues. We adapt our strategy to each affiliate’s specific needs, resources and cultures—all as part of collaboration between our experts and theirs.

Johns Hopkins recently launched the very first Doctorate of Nursing Practice Program in Saudi Arabia. We worked with our partner Johns Hopkins Aramco Healthcare (JHAH) and the Johns Hopkins University School of Nursing to create an educational model that would allow the 13 students—all women—to spend most of their time studying at JHAH medical facilities. The program’s structure reduced logistics problems in a country where women aren’t permitted to drive, and it helped them strike an easier balance between their professional, family and educational responsibilities.

We bring together our affiliates in Latin America as part of an annual forum where they can share best practices on how to improve health care in ways that are unique to their region and home countries. It’s exciting to hear their discussions around integrating health systems to reduce access inequities. These health care providers are creating centers of excellence in heart disease, stroke and cancer that unduly affect local populations. Meanwhile, they’re also strengthening executive, medical and nursing leadership to create regionally leading health care institutions.

We have worked with our affiliate Al Rahba Hospital in the United Arab Emirates to improve its emergency preparedness by designing a drill that tested response efforts to a disaster scenario. The drill involved a rush-hour, multivehicle crash that injured 60 people. Physicians and nurses reacted to the scenario, putting critical areas to the test: mass casualty notification systems, triage assessments, inventory of resources and operating room capacity. It was excellent preparation for a hospital in a country that has been impacted by high traffic death rates. Fortunately, recent efforts by the Emirati government have been successful in reducing injury due to motor accidents.

In each of these examples, we listened to our affiliates’ challenges and provided an opportunity for cooperation and sharing information across our cultures. By respecting different perspectives, we ensure the results of our collaboration are both meaningful and sustainable long into the future.

Striking a Balance
These examples reflect certain aspects of health care that are fairly universal. Much of our international collaborative health care work—including promoting the importance of nursing, opening access to quality care and creating stronger clinical programs that address the most pressing medical needs—have proven applicable and even necessary in every country where we’ve worked.

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.

Our goal is not homogenizing health care, but creating comprehensive local programs that will thrive long after we finish our collaborative work. By respecting the richness and diversity of how medicine is practiced and received in local communities, we can have much more success in opening access to quality health care around the world—a core tenet of our mission.


John Ulatowski

Vice President, Medical Affairs | Vice President, Middle East Operations Dr. John Ulatowski is vice president of medical affairs and of Middle East operations for Johns Hopkins Medicine International. He is also the Mark C. Rogers Professor of Anesthesiology and Critical Care Medicine, director of the department and anesthesiologist-in-chief for The Johns Hopkins Hospital. Click here to learn more about John.

2 thoughts on “Hazards of Homogeneity”

  1. Well said John. Particularly liked your observation that, "each country employs a medical model that reflects its social, political, historical and religious values, which means health care does not—and should not—conform to a one-latte-fits-all model."

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