I wanted to share a couple of interesting educational opportunities related to the subject of patient safety, an issue always at the top of our minds and those of our collaborators around the world.

One of the opportunities is an online class that starts today. I’ve written before (for example, here) about how important knowledge transfer, education and training are to our field. They’re key to medicine in general, and exploring new ways to deliver these services is critical to collaborating internationally to improve health care. Ideally, we could send an unending stream of Johns Hopkins faculty to wherever they’re needed in the world, for however long they’re needed, to personally train and mentor their counterparts abroad, or to bring all the clinicians and leaders here to Johns Hopkins for training. We do as much of this physical swapping as we can, but it could never be enough, and certainly isn’t always the most efficient way to exchange knowledge.

We have many solutions, as I’ve described, and one that’s increasing in importance is electronic delivery of educational content and interaction. That can vary from one-on-one videoconferences to live video lectures to YouTube-like clips. One option for digital knowledge transfer that’s becoming popular is the “MOOC,” or massive open online course. More colleges and universities are allowing anyone to take or at least “sit in” on courses via Web-based MOOCs. Johns Hopkins Medicine is now offering MOOCs, too, and a new, five-week MOOC on “The Science of Safety in Healthcare” starts today. From the official description:

The MOOC is open to anyone who is interested. It will explore fundamental topics such as patient safety culture, teamwork and communication, patient-centered care, and strategies for assessing and improving care. The five-week program will be led by Cheryl Dennison Himmelfarb of the Johns Hopkins University School of Nursing, and Peter Pronovost, director of Johns Hopkins’ Armstrong Institute for Patient Safety and Quality. The course workload is two to five hours per week, which includes up to two hours of video instruction, as well as readings and assignments. Previous MOOCs taught by Johns Hopkins have had as many as 100,000 students taking the course simultaneously from around the world. Students will receive a statement of accomplishment upon passing the course.

You can learn more about and sign up for the MOOC here.

The other patient safety-related educational opportunity I want to mention, one that’s in a more traditional vein, takes place September 23-25. It’s a forum—the in-person kind—to be held here in Baltimore, called “Emerging Topics in Patient Safety.” Here’s an excerpt from the online description:

The Armstrong Institute, in conjunction with the World Health Organization, will be convening patient safety experts and thought leaders from all sectors that influence health care at the inaugural Forum on Emerging Topics in Patient Safety, September 23 - 25 in Baltimore, Maryland. The event aims to discover new ways of thinking about how to meet key patient safety challenges of the next five to 10 years, as well as to identify untapped opportunities for collaboration that can speed improvement. We also hope to learn from the experiences of other high-risk fields, such as space travel and nuclear power, about how to hard wire safety into an organization.

I’d be curious to hear what you think about these sorts of educational opportunities. Are these effective ways of meeting your needs? Are there better ways? What topics would be of most interest and impact? We’re always looking for new ways to facilitate knowledge exchange, so please don’t hesitate to share.

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Most people who are at least vaguely aware of trends in the global economy have heard of the BRICs—Brazil, Russia, India and China—the four large countries whose economies have, on average, been growing over the past few decades at impressive paces. The result has been the generation of enormous middle classes with significant new purchasing power and access to the sort of information that leads them to be choosy in how they spend it.

But have you heard of the Next-11? Here’s how Goldman Sachs, which came up with the category, describes the group:

In 2005, Goldman Sachs identified the Next 11 (N-11) largest populations after BRIC, which—combined with economic and political conditions—could greatly impact the global economy. The N-11 countries include Bangladesh, Egypt, Indonesia, Iran, Korea, Mexico, Nigeria, Pakistan, Philippines, Turkey and Vietnam.

One might quibble about exactly which countries do or don’t belong on that list, but the concept is pretty solid. Most of these countries, too, are producing new and influential middle classes.

One of the things these emerging middle classes want is better access to good health care. And by and large their respective governments are responding. In many cases, governments, sometimes joined by strong private insurance markets, are providing the health care coverage to support improved access to care. But it’s not just a strong payor system that many of these countries have been lacking—it’s also the health care infrastructure itself. In many ways, upgrading that infrastructure to provide needed treatment can be a more daunting job than covering the costs of getting the care.

Governments often take on the job of building new hospitals and health care systems, or of significantly improving them. Johns Hopkins Medicine International collaborates with many governments around the world to do exactly that, as do others in the relatively small field of global collaborative health care.

We also work with private organizations, and have found that private investment in health care infrastructure projects can go just as far as, and perhaps sometimes even further than, government-financed infrastructure to improve health care for a population.

What’s more, the global financial community’s interest in health care investment in emerging markets was made clear at a recent international conference in Istanbul that Johns Hopkins Medicine International co-sponsored with the International Finance Corporation. The IFC, in its own words, is

....a member of the World Bank Group [and] the largest global development institution focused exclusively on the private sector. We help developing countries achieve sustainable growth by financing investment, mobilizing capital in international financial markets, and providing advisory services to businesses and governments. In FY12, our investments reached an all-time high of more than $20 billion....

So are billions in investment pouring into global collaborative health care? Not quite, or at least not yet. The problem isn’t that the finance community isn’t willing to invest in it. In fact, it could be argued that there’s more money out there than quality opportunities. One of the points that came out of the conference is that right now, top investors aren’t finding enough health care projects in emerging markets that they feel confident are likely to perform well in meeting both health and financial targets.

Today there are really only a handful of global collaborative infrastructure-builders capable of working to produce the kind of high-quality, high-performing projects that financial markets are looking for. We’re proud to be a leader in this small field, but we will need many more involved to support the emergence of good health care infrastructure in the many, many countries that today don’t have them. There just aren’t yet enough players to put up even a large fraction of those needed projects.

That’s the bottleneck right now—not investment. To be sure, it’s a tricky business, but it’s not a completely new one anymore, so I can only assume more organizations will come into the field and gain the right experience. That would bring new, better-designed and better-executed projects to deliver quality and value, and the money should be there to back them.

There aren’t all that many propositions in the global economy that are truly wins for everyone involved, but solid, high-performing hospitals that profitably deliver high-quality care to populations that never had it is surely one of them.

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A story broke recently about a run on baby formula in stores in Europe. The trigger for this unprecedented shortage, it turns out, was a drought in Australia and New Zealand—even though neither country has much to do with any part of the European baby-formula supply chain. But Australia happens to be a major supplier of milk for popular brands of baby formula imported by China, and the drought led to a cut-back in shipments into China.

China has plenty of local brands of baby formula, but many Chinese parents won’t use them, especially after a contaminated batch in 2008 left 300,000 infants ill, six of them fatally. So high is the preference of many Chinese parents for the foreign brands that they have gone online and enlisted overseas friends to ship in formula on their own, presumably at much higher cost, and in such large volumes that supplies have become scarce in several countries. Parents in these countries have in turn started stockpiling formula, exacerbating the shortage, and leading to higher prices. (Hong Kong was hit with shortages, too.)

The moral most people will take from this story—and the one that the Associated Press played up in its reporting—is that in our increasingly flat, wired, interlinked world, a problem in one region can have domino-like ramifications felt in other regions. True enough. Some might further be reminded that China’s vast economy, which is fast producing an enormous middle class with newly found purchasing power (and usually only one child to spend it on), as well as better access to information, can now create reverberations with every step.

But what came to my mind in reading this story is that in more and more countries, when people are concerned about their health, or the health of their loved ones, they can become acutely aware of the shortcomings of local health resources. That applies not only to baby formula in China, but also in many regions around the world to cardiac care, or cancer treatment, or even primary care.

Baby formula is easily shipped, at least for those who can afford it, and when supplies hold out. Most other forms of health care, unfortunately, are a great deal less portable. Certainly, people can travel for care they don’t think they can get locally, and many do— Johns Hopkins serves hundreds of patients from around the world and the U.S. every day, and we’re honored that they entrust their care to us, and doing everything we can to ease the challenges of getting treatment far from home.

But we’re also acutely aware that getting treatment can be challenging enough when the care is next door, and having to travel for it only adds to the burden. No matter how big a population is, nor how affluent it becomes, there is no perfect substitute for local care. Calling it “medical tourism” puts a cheery face on it, but people traveling for treatment are not tourists—they’re patients. What they really need (and deserve) is great local care that they can trust.

The world will get flatter and flatter, and more and more wired. And yes, health care will get more and more wired, too. But for much of the world, real progress in health care will arrive in a form that’s ever closer to home.

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A bipartisan team of three former U.S. senators and a former Congressional Budget Office director have come out with a report suggesting an approach to reeling in the high cost of health care in the U.S. What I really like about the effort is that the group decided early on that the problem of high health care costs isn’t really mostly about costs and payment—it’s about improving health and health care quality, while doing it at reasonable cost.

As the four members of the team write in an article on the report:

Too often we in Washington talk about health care as though it is little more than a line item on a budget table. Those of us who have experienced the best of health care know that is not how care should be delivered or policy crafted in this most personal of issues. Our country can achieve a higher-value health-care system....

This emphasis on value is key. In a nutshell, value in health care is about what the system costs compared to what we get out of the system—that is, the quality of care and the extent to which our health is improved. When we talk about health care costs by themselves, it’s like talking about “the cost of going out to eat” without considering whether we’re getting a fast-food burger or a three-course seafood feast out of the deal.

The result of health care discussions that focus on cost, without considering what we get for the cost, tends to be a zero-sum game that lowers the bill for some parties—typically for many consumers, employers and/or Medicare—while leaving others, usually providers and insurance companies, to shoulder the resulting drop in revenues. It’s not that such shifts are necessarily inappropriate or unhelpful. It’s that in and of themselves, they aren’t likely to leave us getting more or better or even the same level health care for less money on average, because they don’t address the whole system. As the team puts it:

Health-care cost drivers are complex and interwoven, but the most problematic ones we identified are the inefficiencies, misaligned incentives and fragmented care delivery in the current fee-for-service reimbursement system....In all our proposals, we sought to avoid simple cost-shifting as a means to generate federal budgetary savings....We also focused on reforms that will incite transformation across the health-care system.

That’s a much more ambitious goal, and one that is much more likely to give us more for our money, regardless of who is paying the bills. The full report offers more than 50 specific recommendations, but let me just quote summaries of three of them:

Empower patients by promoting transparency that is meaningful to consumers, families and businesses, and streamline quality reporting.

Advance the nation’s understanding of potential cost savings from prevention programs, through support for research and innovation on effective strategies to address costly chronic conditions.

Offer incentives to states to promote policies that will support a more organized, value-driven health-care delivery and payment system, such as supporting medical liability reform and strengthening their primary-care workforce.

These are the sort of goals that are going to make our system not just cheaper—the report reckons adopting the recommendations would lead to more than half a trillion dollars in savings over ten years—but better. Indeed, there isn’t a health care system in the world that wouldn’t be improved by adopting these principles, and they come up frequently in our conversations with government and private collaborators around the world as we work to build and improve health care infrastructure in different countries.

Yes, let’s figure out how to keep health care affordable, so that everyone can receive good care and maintain good health without going broke doing it. But let’s not forget that what we’re shooting for is value, not just lower bills.

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Many of us have become so dependent on our mobile phones for keeping up with the world that it’s easy to forget that it’s only been five or so years since the smartphone really caught on. The technology has advanced so quickly that it’s hardly even used as a traditional phone anymore. You have to wonder what we’ll be doing with these devices five years from now.

One real possibility is that we’ll be getting a chunk of our health care through our phones. We can already consult various medical-advice websites with our PCs—according to one study, 70 percent of Americans with Internet access have gone online through their PC to get health information. It’s not that big a leap to imagine we’ll start doing it with our phones.

The bigger leap would be using our PCs (“iHealth”) and inevitably our phones (“mHealth”) to access interactive, personalized health care services and information. Among the mHealth services that are already under development are those that provide access to test results and other personal health records; schedule appointments and tests; facilitate self-reporting of health data such as weight, diet, or medication side effects to the doctor’s office to help with patient monitoring; and consult clinicians via text message, chat or videoconference. There are even apps that show some promise in providing automated screening of symptoms. (Though not surprisingly, there are for now serious limitations to how much we can count on such apps.)

Much of the world seems amenable to jumping to these sorts of services, according to the results of a just-released survey. A brief excerpt of the findings:

Most consumers are comfortable with having all of their health records securely available on the cloud except for those in Germany and Japan. Nearly half of the consumers surveyed and two-thirds of the HCDMs surveyed would be comfortable sharing and receiving health information through social media channels. Most North American consumers – nearly eighty percent – are comfortable submitting a complete medical history and diagnostic information to help ensure they have all the information available to treat them and offer the most personal diagnosis possible. Ninety percent of Russian consumers expressed comfort, while fifty percent of Japanese customers expressed discomfort with the idea of submitting DNA....

Three quarters of consumers indicate they are comfortable with the idea of communicating with doctors using technology instead of seeing them in person. In China, Russia and Mexico, nearly three-quarters of consumers would be comfortable communicating with a specialist using virtual technology (e.g. video chatting, text messaging) for a health condition.

More than 60 percent of consumers from Germany, Japan and the U.S. indicate being comfortable with the idea of being treated by a specialist using virtual technology.

Note the survey results differed from country to country, which means we have to be careful about assuming that, for example, we can take an approach that might work well in the U.S. and simply implement it somewhere else in the world. Different mixes of services will win acceptance in different countries, and some countries will be ready for a given type of mobile service sooner than others.

In theory, at least, the opportunities to improve health care while simultaneously lowering costs are enormous. In some countries with large numbers of rural poor, such as India and many African nations, mobile phone-based health care services may be the only form of  health care accessible and affordable to those segments of the population.

Meanwhile, in the U.S. and other industrialized nations, the opportunity to provide some types of health care to people in their homes or workplaces—rather than forcing them to come to hospitals and clinics—may not only add convenience, it could also improve patient monitoring and lower the costs of some types of care.

That last point is critical, because the biggest challenge to health care around the world is now the management of heart disease, cancer, diabetes, Alzheimer’s, and other complex, chronic diseases. If mHealth helps make possible the sort of more-frequent monitoring of patients that clinicians need to catch and treat brewing problems and complications before they become acute and require hospitalization, the benefits to our health and to our health care systems’ efficiency could be large.

While mHealth may bring some real improvements, it isn’t likely to be a panacea. The quality of our health care will still be driven by access to highly trained, dedicated clinicians, in whatever form that access takes. It’s interesting to note that the survey I mentioned earlier also came up with this finding:

Patients and citizens will give up anything, including cost, convenience and travel, to be treated at a perceived leading health care provider to gain access to trusted care and expertise.

Patients aren’t going to be happy if mHealth brings them convenient access to second-rate care. That’s why it’s important we stay focused on the fundamentals as we work with our collaborators to build and improve health care systems. But mHealth will gradually become part of the mix, too, both here in Baltimore and at our affiliates' systems around the world.

(By the way, among the many efforts currently under way to build the mHealth platforms we’ll need to make these services fly, one is an ambitious start-up formed last year by a group of Johns Hopkins medical and graduate students. Check out this interview with on-leave Johns Hopkins medical student Ralph Massarella.)

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I ran across a post recently on The Health Care Blog that takes issue with the oft-heard notion that U.S. health care is not only the most costly in the world, it delivers poor outcomes compared to most other industrialized countries.

I myself, along with many others both inside and outside of health care, have also noted that the rankings suggesting U.S. health care delivers mediocre results are problematic. As the author of the post, statistics and policy expert Frank de Libero, notes, it’s not quite fair to measure the effectiveness of any health care delivery system strictly by outcomes, as reasonable as that might seem at first. Instead, outcomes ought to be viewed in the context of the population’s particular health status, and of the many, many factors that affect health outside of health care, such as what types of illness the system has to wrestle with (more complex illnesses in the case of the U.S.), or what the population’s health-related behavior is like (a big problem for the U.S., given on average our lack of exercise and the way we eat).

But having said that, I also think it would be an enormous mistake to discount the rankings, shrug, and just keep on doing what we’re doing. (Nor does de Libero suggest as much.) The real issue here is that the U.S. system is far from perfect, and can do much, much better. The health care industry, the insurance industry, medical academia, government, and all of us as individuals all need to work toward improvement in health status and health care.

Since I tend to focus on health care from an international point of view, I’m also reminded of the fact that when it comes to health care, every country has unique needs, challenges and opportunities. The U.S. arguably has the world’s best medical research infrastructure, the world’s best-trained doctors and nurses, and many of the world’s best-equipped and -run hospitals. We also have a health care payment system that allows most patients access to the best care available without having to worry about the cost. On the other hand, our system’s costs are extremely high, and our system isn’t sufficiently geared to making sure that patients get the ongoing primary care and other support they need to avoid becoming acutely ill down the road, among other shortcomings.

I could point to just about any country anywhere in the world and provide that sort of health care strength-and-weakness report card. Many countries offer universal health care access, but suffer from shortages of high-quality clinicians. Some have good hospitals, but don’t conduct the sort of medical research that points the way to new treatments aimed at the unique needs of the population. Some have good primary care coverage but lack quality specialty care. Some control costs effectively but don’t provide patients with all the health care services they may need.

I have yet to see the perfect system anywhere. That leads me to think we’re getting off track when we start paying too much attention to determining whose system is “better” or “worse.” Instead, our systems are just very different. Those differences offer us all opportunities to learn and improve. We may be able to improve our system here in the U.S., for example, by adopting pieces of other country’s systems. (And that’s a subject I’ll have more to say on.) We certainly can learn from other countries, just as they can and often do learn from us.

But in the end, every country has to confront its unique challenges and fashion its unique solution—and then whatever it comes up with, it ought to keep trying to do better. In my mind, that’s what a “good” health care system does, regardless of how others may rank it.

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Most experts concerned about obesity would argue that getting rid of humongous servings of heavily sugared beverages in restaurants and food retailers is a no-brainer, merely a tiny first step toward a sharper series of changes we need to make in our obesogenic environment. And yet the uproar over New York City Mayor Michael Bloomberg’s efforts to ban these absurd portions and unhealthy products makes it clear that when it comes to regulating food, much of the public isn’t ready to have its food options limited by government fiat. (Not to mention that most governments aren’t ready to try. New York City is nearly alone in even this small effort—check out Mississippi’s response—and even then the New York ban was blocked by a judge.)

Medicine has come to recognize that one of the most important paths to better health is getting people to adopt healthier habits, including eating right, exercising and not smoking. Regulation can be one way of promoting these changes, but tends not to fly with the American public. What other tools are available to governments to help people adopt new behaviors? Public education is the classic approach, and is well worth doing, but generally has a very limited effect. Taxing products that promote unhealthy or otherwise undesired behavior is another option, but is nearly as unpopular as regulation, isn’t always effective unless the tax is nearly draconian, and frequently ends up being a burden on the poor.

But what about incentives? Rewarding people for doing right thing is a kinder, gentler approach that fewer are likely to object to—though there is always the argument than any form of government intervention causes problems, especially in terms of spending. Studies have long suggested that most people respond better to rewards than punishments, especially when comes to changing habits. We overeat because it’s immediately and intensely rewarding. It’s much easier to plop down in front of the TV instead of getting out for a walk or some exercise. Maybe some cold, hard cash, to name one thing, would be enough of a reward to counter that.

The U.S. government, at least, doesn’t use incentives all that often to nudge people for changing their behavior. Tax credits for buying alternative-energy vehicles is one example, but it’s hard to find many more. There are now many calls within health care for incentives, both for patients in terms of lower insurance premium and for clinicians and hospitals in terms of higher reimbursement, and in fact the Affordable Care Act (alias “Obamacare”) will be trying to push the system in that direction. It could be a decade or more before we know for sure whether that can be done, and whether it works.

As it turns out, we’ll soon have a faster way to witness the results of a strong government-run incentive program aimed at health. We just have to look to the United Arab Emirates to see it. There, the government of Abu Dhabi has recently announced a “pay-for-health” scheme that will financially and otherwise reward citizens who achieve various health and wellness benchmarks, especially those related to diabetes. That may be the world’s first case of a government offering a cash reward for good health. In theory, people will feel it’s more worth their while to engage in healthier behavior, and if they do, the new behavior ought to pay off health-wise in measurable ways, which would serve as a nice validation of the incentive approach.

If the scheme works, it would likely slash health care costs—as studies and analysis have consistently indicated—which means this sort of pay-for-health scheme might not only improve health through behavior change, it might actually save the government money. Call it a bribe if you want, but by any name this sort of incentive could be a good idea.

I hope it does work, and if it does I hope governments at all levels all over the world, including in the U.S., take careful note. Even if a direct pay-for-health scheme isn’t feasible here in the U.S. (not that I think it isn’t), there certainly would be lots of ways of finding new, significant incentives to get people to do their share.

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I was just in Istanbul at the “Leading Change in Emerging Health Markets” conference that Johns Hopkins Medicine International co-sponsored with the International Finance Corporation, a subsidiary of the World Bank. One of the topics that was on a lot of people’s minds there—as it often is on mine and those of my colleagues and our collaborators—is what it takes to help a country develop a sufficiently large, skilled pool of clinicians (nurses and physicians). When building a hospital or health care system in emerging markets, project architects often rely too heavily on recruiting clinicians from other regions of the world.

Looking regionally or globally to find talent is often necessary, and can provide a workable solution to local shortages of clinicians. We do exactly that with many of our projects around the globe. But it’s neither a complete nor a long-term solution. A sustainable, high-quality, safe health care system requires access to home-grown clinicians. Countries that rely too heavily on importing those skills for too long will risk chronic shortages of talent, higher costs, and less-than-perfect matches between local culture and the sort of care provided by the system. This approach can cause us to miss out on meeting one of our main objectives—sustainability.

Ideally, every country would have good schools of medicine and nursing, as well as good opportunities for residency, fellowships, mentoring and ongoing education. We’re trying to help Malaysia establish exactly that sort of pipeline with our Perdana University project. In countries where academic medical centers aren’t yet fully developed, we enlist a variety of approaches to try to close the gap, including sending our faculty to our collaborations around the globe to participate in everything from grand rounds to workshops to teaching in a formal class setting. We supplement those efforts with videoconference education and meetings, and we bring clinicians from our affiliates to Baltimore for weeks or even months of exposure to our education and hospital practices.

But in the end, if we really want to do a good job, we have to go beyond educating clinicians. We have to help clinicians become educators who later help others become good clinicians. We have to train the future trainers, to ensure sustainable results and improvements. That’s one of the most important things we do, and that any health care system can do.

I think an article by Richard Gunderman in The Atlantic online a few months ago got at this issue very nicely. Gunderman, an astoundingly multi-credentialed physician-researcher at Indiana University, noted that even in the U.S. medical schools don’t always fully succeed in transmitting the necessary passion for education to doctors in the making. As he puts it:

A school can provide the perfect curriculum, state-of-the-art instructional methods, and unimpeachable testing, yet do a poor job of educating future physicians....One ingredient missing from this account is the creativity, commitment, and inspiration of medical educators....Like the practice of medicine itself, great education means establishing a relationship between human beings.

We try very hard to help our collaborators build health care cultures that foster these sorts of mentoring relationships between experienced clinicians and those who need training. It’s an ongoing challenge, and though I’m proud of what we’ve accomplished so far, I hope we keep getting better and better at it.

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From Baltimore to Guangzhou

by JHI Staff on March 13, 2013

For any organization like ours, that has a mission objective to collaborate with other institutions around the world, it’s hard to ignore China. Aside from China’s enormous population and immense, dynamic economy, the country has been seeing one of the most significant surges in middle-class growth in the history of the world. As outlined in this article from South Africa’s Business Day, there are reasons to think that the growth in China’s service sector will be especially strong in the coming years, and even more so within the health care industry:

National statistics show that the services sector accounted for 44.6% of China’s gross domestic product last year. According to the World Bank, this figure is very low compared to China’s peers, who typically have ratios of 55%-75%, with 63% as the world average....

The Chinese government has already begun to take steps at raising consumer confidence by expanding its public health insurance cover to almost all of its rural citizens. The state subsidy for health insurance is set to rise 18% from last year’s budget, equating to raising the reimbursement of hospital expenses from 50% to almost 70%.

Furthermore, in the first half of last year, 16 provinces raised the minimum wage by an average of 19.7%.... These initiatives, along with many more expected to follow, will begin to give Chinese consumers the confidence to spend more instead of saving (lowering their savings rate from the high of 42%).

On the other hand, as countless Western executives have noted, developing collaborations in China can be a challenging endeavor for a variety of cultural and structural reasons. With all of that as context, it’s gratifying to announce that Johns Hopkins Medicine International has signed a major, groundbreaking agreement with a superb academic medical partner in China—Sun Yat-sen University (SYSU) and its affiliated hospitals in Guangzhou.

Our collaborative agreement is primarily focused on supporting the growth of Sun Yat-sen’s clinical and translational research programs, and on establishing research programs between Sun Yat-sen and Johns Hopkins researchers. Sun Yat-sen is among several top-notch institutions in China that already have impressive biomedical research programs, thanks to a large number of dedicated researchers and the Chinese government’s commitment to research funding. But as relative newcomers to world-class biomedical research and the extraordinary demands of both publishing work in the field’s top journals and meeting the research standards of global pharmaceutical firms, these institutions are eager to continue to improve the quality and impact of their work.

This collaboration with Sun Yat-sen is structured to be a productive one for both sides. In the first phase, faculty from Johns Hopkins will spend time at SYSU teaching courses and running workshops for researchers there. SYSU investigators and junior faculty members will also have an opportunity to come to Johns Hopkins to collaborate on research for a year under a new fellowship program. A bit later on, the agreement will provide seed grants to collaborative clinical and translational pilot studies. It’s envisioned that these initial projects will be candidates for expansion into larger studies funded by industry or government sources in China and the U.S.

SYSU sees the agreement as a bolstering its position as one of the top institutions in China, and representing a big step toward earning a global research reputation. For our part, we’re thrilled to have a chance to establish a close connection with this impressive new pool of research talent and energy, and to have a stronger presence in China (whose largest city is, after all, in the title of my blog). And most importantly, from both parties’ perspectives, this relationship promises over the long term to have a real impact on the quality of medical education, research and patient care over a large—very large!—population.

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We’re very proud of the role we’ve played in helping to pioneer the relatively new field of global collaborative health care. But I frequently go out of my way to make it clear that Johns Hopkins Medicine is by no means the only player in this small but increasingly important segment of the health care world.

There are many well-regarded hospitals in the U.S. (most notably the Mayo Clinic), and elsewhere in the world, that do a good job of meeting the needs of patients who travel internationally to get complex care that may not be available to them at home. There are also a handful of hospital systems and academic medical centers, such as the Cleveland Clinic, that have collaborated to build, manage and improve health care facilities in other parts of the world.

It’s an honor to be in this league of prominent international health care players. And I’d be extremely pleased to see all of us continue to thrive in these challenging markets, both because of the positive impact that would have on health around the world, and because it would further strengthen this critical field that we’re dedicated to growing and improving. Sure, we’re competitors, but there’s more than enough work to be done here and throughout this “flattening” world for all of us.

But just because several of us address these same international challenges doesn’t mean we all do it in exactly the same way. I got thinking about this recently when I saw a quote in a recent article in a Minnesota newspaper. The quote mentioned Johns Hopkins as being among those institutions that have been “aggressively replicating the Mayo model” of international patient care. I took this quote with a grain of salt, knowing that hospital systems often have to campaign aggressively to drum up local support. But it also inspired me to consider how our model differs from those of other institutions.

We’ve had a considerable amount of time to formulate, learn from and tweak our model. Johns Hopkins has been a leader in academic medicine for more than a century, and we’ve actively focused on meeting the special needs of international patients for several decades.

Among our full-time team of 130 international patient services staff are more than 20 highly trained medical concierge professionals proficient in dozens of languages. Every family that comes here from abroad is assigned to one of 70 international care coordinators who understands the family’s local culture and expectations, knows the Johns Hopkins system well, is certified to provide medical translation and can answer any questions throughout their stay. We have a patient experience team that, among other things, provides thorough orientations for international families, to make sure they know what to expect and how to get whatever help and answers they need. Throughout their stay patients and families are supported by skilled language interpreters and translators. We ensure our patients and their families don’t feel alone or confused during the clinical care experience here.

We were also among the very first to collaborate on health care globally at an institutional level. Over more than a decade, we have learned (initially the hard way!) that just because certain clinical or administrative approaches work here doesn’t mean we can drop them into hospitals in other countries and expect them to produce the same results. Instead, it takes the exacting work of long-term collaboration to tailor our approaches to the local culture and vision of our international colleagues. In fact, we have come to realize that throughout this process, we learn as much as we teach.

There are clearly many top-notch institutions with their own models of international health care. They don’t have to imitate us, and, fortunately, we don’t have to imitate them. Best of all, it’s the patients who win.

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