When a healthcare model succeeds in one country and is exported elsewhere, what is usually the first assumption that collapses, and why?
That’s a big and very common question, particularly in healthcare, though it applies to many industries. Over the past 20-30 years, globalisation pushed companies to design models that could be applied broadly across markets. However, think global, act local is still what ultimately makes the difference.
The first, and most common, assumption that collapses is the idea that the problem to be solved is the same everywhere. Many international healthcare expansions start from a model that worked well in one market and assume that patients, professionals and systems will respond similarly elsewhere. In reality, what breaks down first is not the product or the technology, but the context in which decisions are made.
The most underestimated “invisible factor” is how authority, trust and incentives are distributed locally. Who truly influences clinical decisions? Who carries reputational risk? Who pays, who prescribes and who ultimately decides on adoption? These answers vary dramatically by country.
Companies are often surprised not by patient behavior, but by how differently clinicians and institutions interpret value, risk and responsibility. When this invisible layer is overlooked, even strong models can struggle to gain traction, particularly in more complex or distinctive markets such as Japan or South Korea.
What do global healthcare companies consistently misunderstand about how the ecosystem actually works?
That’s one of my favorite topics, because it is something I have seen repeatedly. Japan is a very distinctive market across industries and global healthcare companies often misunderstand how it operates. Japan does not function like other markets, because alignment must come before execution.
Foreign leaders often assume that once a strategy is logically sound, it should move quickly into action. In Japan, however, decision-making follows a different logic. What may appear as slow progress is usually a deliberate process of internal validation and consensus-building. This is not resistance; it is better understood as culturally-based risk management.
Business etiquette and communication styles also differ significantly. Western leaders frequently misread politeness as agreement and silence as a lack of opinion, when in reality silence does not imply consent. Japanese teams and partners typically expect leaders to demonstrate a deep understanding of the local context before genuine commitment can be established.
When this dynamic is misunderstood, misalignment follows. What seems obvious at a local level, such as the importance of long-term credibility, internal harmony and indirect influence, is often overlooked by outsiders. When Western leadership styles push too hard and too fast, they tend to erode trust, which can be more damaging than delaying a launch. In Japan, forcing decisions simply does not work.
Where do rollouts most often fail when it comes to physicians, pharmacists, incentives and authority?
Rollouts often fail when companies misjudge who actually owns the decision. This is a subtle but critical point, particularly in Japan, where business culture is built on harmony and consensus.
In many markets, physicians are not autonomous decision-makers in the way global models often assume. Pharmacists, hospital administrators, procurement bodies and distributors can all play decisive roles, depending on the country. In Japan, and more broadly across parts of Asia, authority tends to be collective rather than individual.
Incentives are rarely purely financial. They are closely linked to professional reputation, peer acceptance and risk avoidance, which is especially important in Japan. When medical or commercial models assume levels of autonomy or incentive alignment that do not exist locally, adoption stalls - not because the solution is rejected, but because the model does not fit local reality.
This reinforces the principle of think global, act local: go-to-market approaches must be adapted to reflect Japan’s unique context.
If you were advising a healthcare or MedTech company before international expansion, what 3–5 tests would you run to judge whether the model is truly portable, and where it will break?
This reflects my day-to-day experience. Companies often wait for decisions to be made and then expect everything to move very fast - assuming international scaling and rollouts should happen immediately. In reality, before expanding internationally or launching new products, it is essential to prepare properly and do the homework.
I usually recommend five practical tests before entering a market:
First is the decision authority test: understanding who truly decides adoption at the local level - not on paper, but in practice.
Second is a risk and risk-sharing test: assessing the personal and professional risks that adoption creates for clinicians, pharmacies or other stakeholders, as this is often a key barrier.
Third is an incentive alignment test: verifying whether financial and non-financial incentives are aligned with local professional motivations, regulatory constraints and how value is distributed across the value chain.
Fourth is the operational reality test: evaluating how well the model fits local workflows, capacity and regulatory requirements. This is where companies often fail, particularly in highly regulated markets such as Japan.
Finally, there is a leadership adaptability test. Success depends on whether leaders are willing to adapt behaviours, not just strategies, to local environments. Cultural friction is often dismissed as temporary, but localisation is not about translating branding; it is about redesigning the operating model. A single global campaign will not work equally well across markets such as China, India, Japan and Korea.
These five areas should be assessed before, not after, entering a market.
From your experience, what leadership traits predict success when scaling healthcare/MedTech across countries, and what traits predict failure?
Finding the right leadership for markets like Japan is more complex than in other regions. Successful leaders in international healthcare expansion tend to share three core traits:
- Curiosity before conviction
Leaders must listen, observe, and learn before proposing solutions. In Japan, credibility comes from demonstrating a deep understanding of the details, not from authority. Humility and careful observation are essential before decisions are made. - Contextual intelligence
The ability to adapt leadership style to local realities without losing strategic focus. This is particularly challenging for foreign leaders under pressure to deliver short-term results while also needing to build trust and think long term. Strong leaders are able to balance both. - Patience with purpose
Japan values process, discipline, and details. Leaders must respect local ways of working while maintaining clear priorities and a long-term direction, without getting lost in the details.
Failure usually stems from the opposite behaviors: impatience, overconfidence, and the belief that strong execution alone can overcome contextual misalignment. In complex markets like Japan, successful leaders balance humility with authority, build trust first and understand that moving too fast often slows progress.
Finally, language fluency should not be confused with leadership adaptability. Effective leadership is not about speaking well, but about truly communicating in a way that resonates locally.
Summary
International healthcare expansion remains one of the most underestimated leadership challenges for global organisations. Success depends less on exporting proven models and more on recognising how differently markets function beneath the surface. Japan, in particular, highlights how deeply local context shapes outcomes, reminding global leaders that long-term success across borders is driven by understanding, patience and adaptation rather than speed or replication alone.
