Going Global

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Kenneth Ouriel, MD, was ready to take his career to the next level. He aspired to become the chief executive officer of a large health system. After 15 years as the chairman of Cleveland Clinic's division of surgery, he felt it was time for a change but wondered where the next challenge would lead him.

About 8,000 miles east of Cleveland, as it turns out-in the capital city of Abu Dhabi in the United Arab Emirates. Ouriel took charge in June as CEO of Sheikh Khalifa Medical City following a deal with the Health Authority of Abu Dhabi. Cleveland Clinic agreed to manage the healthcare network that includes a 552-bed acute-care hospital, 121-bed behavioral sciences pavilion, an 88-bed rehabilitation center and more than 20 outpatient clinics and primary-care centers.

Now Ouriel is adjusting to the 106-degree heat and a cultural climate that calls for his personal attention in all phases of Sheikh Khalifa Medical City's operations. "Here everything is hands-on," he says after finishing an hour and a half of negotiations to get better housing for the system's employees. But with his staff of six C-suite executives-all veterans of the clinic-Ouriel is trying to create an empowering environment that more closely aligns with Cleveland Clinic's organizational model.

Sheikh Khalifa Medical City represents just one of several recent global projects that a handful of American academic medical centers are taking on. Now that entry into the United States is much more difficult than it was prior to Sept. 11, world-renowned U.S. health programs are seeing fewer international patients. But at the same time, emerging regions of the world are seeking ways to enhance the quality of healthcare by emulating many elements found in U.S. health systems.

Worldwide demand
Despite international criticism of the U.S. healthcare system-largely a byproduct of the nation's 46 million uninsured and underinsured-some of the best-known American health systems are getting requests to develop partnerships around the globe. "We have more inquiries right now than we can respond to," says Michael O'Boyle, chief operating officer of the Cleveland Clinic Foundation and Health System.

Much of what these developing nations want can be provided by U.S. healthcare executives who are willing to relocate and transfer their knowledge of management and quality techniques. "Many of the leading hospitals in Thailand, Singapore, Asia Pacific, as well as the Middle East are seeking information from American and United Kingdom-based hospital executives to understand how to better run a hospital that is profitable, of high quality, and inspires trust within their region of the world," says Maureen Potter, vice president of International Services for The Greeley Co. (Both The Greeley Co. and HealthLeaders Media are owned by HCPro Inc.)

Harris Benny, CEO of Johns Hopkins International, agrees that the demand for importing intellectual capital from U.S. health systems is at unprecedented levels. Like Cleveland Clinic, Johns Hopkins healthcare executives can be found in Abu Dhabi. Through an agreement sealed last year, Johns Hopkins retained oversight of the 469-bed Tawam Hospital. And the first step, says Benny, was to install a leadership team.

"By January 2007, we had the entire complement of C-suite there," says Benny. "They are responsible for everything, from hiring and planning to the operating budget to all of the strategic planning. It is really similar to a hospital we would run here in the United States."

But Tawam Hospital was not Johns Hopkins' first overseas venture. Its global efforts began with a 30-bed oncology hospital in Singapore, which was established in 1998. And both Johns Hopkins and Cleveland Clinic are exploring other global partnerships that do not require capital risks. "We are evaluating several other opportunities in other parts of the world-Europe, India and China," says O'Boyle.

What's in it for them?
It should come as no surprise that large academic medical centers are the first U.S. healthcare organizations to experiment with global projects; such AMCs had internationally recognized brands and overseas relationships to build upon. Additionally, a presence abroad offers department chairs research opportunities that might not be available stateside.

But don't discount the influence of financial incentives for U.S. systems. "Part of what all of us in the healthcare delivery world are dealing with are reduced margins and tighter and tighter constraints on payment," says O'Boyle. "And to support the type of organization and size and scale the Cleveland Clinic operates, we need to make sure that we have many sources of revenue so that we spread our economic risks among a number of different opportunities and enterprises."

Managing facilities abroad also helps U.S. health systems develop executive talent. In this way, a medical center can retain top leaders by offering new challenges and greater authority. The operation in Abu Dhabi, for instance, allowed Cleveland Clinic to give Ouriel his shot at running a system.

"Every industry is going global. The world is getting smaller because of a facilitation of communication," Ouriel says. "For the next decade or so, there's a real need for outside management teams."

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Readers: I hope you find these weekly installments educational and insightful. My columns are written for you, so please take an active role, and let me know by e-mailing me your comments, questions, or suggestions. My e-mail address can always be found on the bottom of each article I write. In addition, you can sign up to receive HealthLeaders Media Global, a free weekly e-newsletter that provides strategic information on the business of healthcare management from around the globe.
Rick Johnson is senior online editor of HealthLeaders Media. He may be reached at rjohnson@healthleadersmedia.com.
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