Project Work Flows in the International Setting

By Genevieve Bautista

When I worked on a hospital construction project overseas, there were lengthy debates as to whether it would be easier and require less resources to replicate and transfer a care model and operational processes than to start from scratch. Naturally, there were many who were adamant that replicating and transferring a model that already existed should require much less effort. Of course it would – all you have to do is copy what is already being done elsewhere, right?

The common misconception is that there is a simple way to copy a care model and complex operational processes, implement them in a new facility (not to mention one that is being built in a completely different country) and end up with a replica of the parent organization. First of all, the vast majority of health care organizations, particularly ones that have been in existence for several decades, have not documented their operations and processes. Much of the institutional knowledge is passed down over the years through experience on the job, not through documenting operations and process flows. Second, it is never as simple as sitting down with subject matter experts of the parent organization and having them talk through what they do or how their processes work, as so many nuances exist that simply are not captured. Third, regardless of how you arrive at understanding and documenting the operational models and process flows, the next challenge becomes how to successfully transfer those to a new facility in another country.

Several factors need to be taken into consideration when attempting to develop and implement operating models and process flows in a different country, such as:

  • Culture – Are there religious laws that require certain processes to be handled differently? Are patient expectations of health care and service different? Are there certain cultural norms that would deem certain processes as inappropriate or offensive?
  • Laws and regulations – Are there local regulations that would require completely different processes or even new processes?
  • Healthcare infrastructure – Are the payment systems in the other country different? How do other systems work, such as emergency transportation, physician and nurse licensure, etc.?
  • Availability of employees with the same skill sets, training or work ethic – Are there enough individuals locally who are adequately trained or educated to implement your care model? Even if you decide to recruit regionally or internationally to obtain enough educated or trained staff, how do you manage differences in work ethic and culture?
  • Infrastructure of other sectors within the country – As an example, does the transportation infrastructure accommodate your processes for how patients will access the facility? Will the technology infrastructure of the country be able to accommodate and support the new, leading edge technology that you would like to implement?

Though our team knew from the beginning that some modifications would need to be made as a result of local culture and regulations, we did not anticipate the number and magnitude of changes. Many collaborative discussions took place with local authorities, health care organizations, and other companies to better understand what modifications were needed for successful implementation.

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