Turning Around Healthcare Organizations Isn't a Strategy Exercise—It's a Human One

A series on the hidden realities of cross-border healthcare leadership

Introduction: The 60% Problem

I've spent over two decades leading healthcare turnarounds across four continents—the U.S., Europe, the Middle East, and Latin America. And here's what the business school case studies won't tell you: most international healthcare turnarounds fail to meet their initial timelines or budgets.

Not because the leaders lack strategy. Not because the financial models are wrong. But because the realities of cross-border execution are far more complex than any PowerPoint plan can capture.

Running a healthcare organization is inherently demanding. Running one across borders—under different regulatory regimes, cultural expectations, labor structures, political systems, and partnership dynamics—multiplies that complexity exponentially.

I've stabilized distressed assets, navigated joint ventures with partners who had very different ideas about "partnership," negotiated with unions while governments watched from the sidelines, and managed situations where every stakeholder claimed to want the same thing—quality patient care—yet operated according to completely different agendas and timelines.

This series shares the lessons I've learned—and the scars I've earned—from that work.

Over the next several weeks, I'll walk you through the forces that shape US and especially international healthcare turnarounds: stakeholder misalignment, cultural complexity, political realities, partnership dynamics, and the personal toll of this work. These aren't theoretical frameworks and I neither qualified nor willing to be an academic. They're patterns I've seen play out repeatedly, in different markets, under different circumstances.

If you're leading an international healthcare operation—or thinking about it—I hope these insights save you some of the expensive lessons I had to learn firsthand.

Let's start with the most dangerous assumption leaders make: that everyone wants the same thing.

Part 1: The Alignment Illusion

Everyone Wants "Quality Healthcare," but Not in the Same Way

Here's what I learned the hard way: when everyone in the room nods at "quality healthcare," you haven't achieved alignment—you've just found the one phrase nobody can argue with in public.

I once walked into a turnaround situation where the investor presentation, the government MOU, the union reps, and the medical staff all used nearly identical language about "patient-centered excellence." Six months in, I was mediating a three-way standoff.

The investors wanted EBTIDA margin improvement and were questioning why we hadn't consolidated services and locations. The medical director was threatening resignation over what he saw as "cost-cutting disguised as efficiency." The union had leaked to local media that "foreign management" was prioritizing profits over people. And the government liaison was requesting a meeting to discuss why patient and service scores had barely improved.

Everyone wanted quality healthcare. Nobody agreed on what that meant, how to achieve it and the timelines.

The investors measured success in quarterly EBITDA. Corporate headquarters in another time zone expected visible wins they could report to shareholders - closed deals, signed contracts, cash in the bank. The local staff wanted to know their jobs were safe and that we weren't about to "Americanize" everything they'd built. The union wanted a veto power on decision made but no accountability for operational outcomes. The government cared about optics - would this make the health minister look good or create politcal headlines during a perpetual election cycle? And the trade creditors just wanted to know if their invoices would clear.

None of these agendas were unreasonable on their own. The problem was they operated on completely different clocks. What investors needed in months, culture change required in years. What governments needed to see publicly, operational reality demanded we do quietly. What kept the lights on today sometimes undermined what we needed for sustainability tomorrow.

I stopped expecting natural alignment. Instead, I started mapping stakeholders by their actual incentives—not their stated goals—and building coalitions around specific decisions rather than assuming everyone was on the same page just because we'd all signed the same vision statement.

The Hidden Cost of Misalignment

 Misalignment doesn't just slow you down—it creates resource drain that most leaders underestimate. You're not just executing a turnaround plan; you're constantly mediating between competing priorities, translating the same decision into different languages for different audiences, and managing the fallout when one stakeholder's "win" becomes another's "betrayal."

I've seen talented operators burn out not from the work itself, but from the exhausting cycle of building consensus, only to watch it dissolve when circumstances shift or a new player enters the conversation. In one market, we spent four months negotiating workforce changes with union leadership, only to have a government minister—facing an upcoming election—publicly oppose the plan we'd all agreed to privately.

That's when I realized: stakeholder management in international healthcare isn't a preliminary step before the "real work" begins. It *is* the real work. The strategy is almost the easy part. Getting everyone to execute it at the same time, in the same direction, for long enough to see results—that's where turnarounds are won or lost.

What I Wish I'd Known Earlier

Looking back, I would have:

Mapped power, not just positions. The org chart rarely tells you who actually makes decisions or whose opposition can kill an initiative. In one region, the CFO's administrative assistant had been there 20 years and controlled access, information flow, and meeting agendas. She had more influence than half the C-suite.

Started with the hardest conversation, not the easiest win. I used to build momentum with quick wins before tackling thorny issues. I learned that delaying difficult conversations just gives misalignment time to harden into active resistance.

Documented everything. When stakeholders operate on different timelines and incentives, memories become selective. Written agreements—even informal ones—create accountability and reduce the "I never agreed to that" problem.

Built smaller coalitions first. Trying to get everyone aligned at once is a fantasy. Find two or three stakeholders whose interests genuinely overlap on a specific issue, deliver results together, then expand the coalition.

The Lesson

"Quality patient healthcare" is where the conversation starts, not where it ends. Real alignment requires understanding what success looks like through each stakeholder's eyes, what their real constraints are, and which battles are worth fighting.

If you ignore that you'll spend your turnaround managing conflicts you thought you'd already resolved.

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Next in this series :

Why Your Turnaround Timeline is Wrong (And What to Do About It) -  I'll share why a "12-month turnaround plan" actually means 24-36 months, the forces that slow cross-border execution to a crawl, and the expensive lessons I learned about speed versus sustainability.