Global Leadership Development: Training and Cultural Intelligence

Paul Farmer: A Global Leadership Model

Examples of global leadership are easily found, but it is important to make distinctions based on criteria other than fiscal gain or corporate revenue. The example of global leadership discussed in this paper is Dr. Paul Farmer, the founder of Partners in Health. Dr. Farmer's innovations in global healthcare truly use Blue Ocean strategy and have altered the landscape of providing medicine to people in poverty. Farmer's primary attributes—in addition to his extraordinary intellect—are humility, compassion, and vision. Indeed, it is Farmer's vision and his ability to recruit followers and funds that have changed healthcare policy and practices around the world.

Dr. Farmer first came to Haiti in 1985, dividing each year into six months in Boston, where he earned the money to sustain his practice, and six months in Haiti serving patients. Farmer is on the faculty of Harvard Medical School and is known throughout the world for his innovative approaches to global health. Dr. Farmer estimates that roughly 10 million people die each year from preventable diseases. He and his colleagues in Partners in Health are determined to reduce those numbers. Farmer's fundamental belief is that everyone should have healthcare regardless of how much or how little money they have.

The models of healthcare that Farmer has integrated into the poorest locations in the world are partly based on his unique ideas and partly cobbled together from practices that originated in countries without the mature healthcare infrastructure and resources of the United States. Community health workers—an idea borrowed from Native Americans and rural Iranians, and probably many other cultures—are people living in their villages who have been trained to make daily house calls to patients to ensure they follow their healthcare regimens and take their medicines. When patients visit the clinics that Partners in Health have established, they find nurses and doctors who are native to the surrounding villages and have been trained by traditional institutional methods or through learning on the job under expert supervision. The system works and is sustainable.

Those who work for Partners in Health understand that the model of healthcare provided in Haiti, Rwanda, Russia, Mexico, Peru, and many other impoverished places around the world has been designed to endure long after Paul Farmer is gone. The clinics, hospitals, and systems of care are the vision manifest of Dr. Paul Farmer, but they are not dependent on him or on his celebrity. Few global leaders have such a clear-cut demonstration of the impact of their leadership as Dr. Paul Farmer has achieved.

"If you set your sights high, and you stick with it, you can make real progress," Dr. Paul Farmer told 60 Minutes reporter Byron Pitts while being interviewed in Haiti about Partners in Health. The competency that Dr. Paul Farmer displays in the 60 Minutes video is the ability to convey a vision to others and provide the leadership that ensures the vision will become a reality. Watching Dr. Farmer moving among the people of Haiti—in the villages, in their remote rural homes, and in the hospitals where they come desperately seeking treatment—reveals a man who perhaps did not set out to be a leader of people from many cultures, but who has certainly become one.

Recognizing and Training Global Leaders

One of the reasons that Dr. Farmer has been so successful in establishing Partners in Health and working with the World Health Organization is that he is equally comfortable in each of the places where his devotion to healthcare takes him. Farmer is a successful fundraiser of international scale; he is a skillful writer and researcher who brought the concept of structural violence to hospital boardrooms. With healthcare increasingly being privatized and focused on the bottom line, Farmer's ability to transform medical practices through innovation and attract skillful, highly educated people to his cause goes beyond remarkable. Categorically speaking, the early conceptualization conducted by Farmer and his colleagues was Blue Ocean innovation, as Partners in Health essentially established a new manner of practicing medicine for a niche population (Kim & Mauborgne, 2004).

Partners in Health brings hope to people that many medical practitioners would say are hopeless. But Farmer believes the right to give up hope does not belong to healthcare workers; hopelessness is the province of those who are sick and poor. Yet, as Farmer points out, many very ill poor people retain hope—despite being written off by traditional medicine—and this is the ideal, as hope can condition opportunity for healing. According to Farmer, when conventional medicine resorts to framing a situation as hopeless, it has co-opted something that belongs only to the patients. In their judgment that someone's situation is hopeless, the healthcare workers, policy makers, or funders have stolen something very important from people who are made vulnerable by their illness and their poverty. Hope is central to the vision that Paul Farmer brings to people wherever they are in the world. It is absolutely accurate to say that when Dr. Farmer interacts with people in a variety of cultures, he is completely comfortable in working with them and inspiring them, regardless of the setting.

Training executives to become competent global leaders requires a comprehensive plan. The Global Leadership Expertise Development model (GLED) provides a structured framework for such training. A cross-training model exists in the world of business that provides opportunity for candidates for executive positions to work for approximately one year in what is essentially a rotation incubator. The executive-level candidate is assigned to each of the major lines of business and to each of the operational departments on a yearlong rotation. The executive team in each rotation is charged with imparting critical knowledge and providing opportunities for the candidate to practice newly learned skills.

The extent of learning opportunities is bounded by time, since the objective is not to develop function-specific expertise in the candidates, but rather to ascertain their individual aptitudes for aspects of the overall work and to explore the candidate's cultural fit with the most significant teams. The program of global leader development described here is structured to function in much the same way as the rotation incubator.

The Global Leadership Development Program

Three main components of the development program are required of each trainee:

The antecedent training component resembles the sorts of training that the State Department gives Foreign Service officers. The training consists of lectures and seminars, role-playing and negotiation, reading and language study, and viewing instructional films. Classroom learning is the model for this component of the training. The curricula feature common approaches to learning about cultures, the influence of culture on business transactions, international finance, safety and corruption indices, and exploration of individual attributes and propensities. All activities in this portion of the training program fall within the Antecedents category of the GLED.

Once the Antecedent Training component has been completed, trainees are assigned to one of the foreign locations: Johannesburg, South Africa; Mumbai, India; or Bangkok, Thailand. The overseas placements will last three months, and the candidates will rotate through the firm's offices in those locations, essentially shadowing co-workers who service the accounts. If foreign branches of the firm are not established in a country, the candidate will shadow appropriate co-workers.

Global leadership and successful innovation are rooted in the capacity for creating new from diversity through "connecting things" (Dyer, Gregersen, & Christensen, 2009, p. 63). The cultural rotation will provide opportunity for practicing leadership and cultivating a beginner's mind within the rotating cultural contexts. Moreover, it is essential to reduce the potential for volatile relationships between innovators and those responsible for ongoing operations of the firm; for this to become a reality, the disparate groups and teams must learn to negotiate and cooperate rather than taking a position and holding fast (Govindarajan & Trimble, 2010). The activities in this section all fall within the Project/Job Novelty section of the Antecedents category of the GLED.

This portion of the training consists of a term assignment of approximately four months during which the candidates are placed with a department or division for which they have expressed interest and have demonstrated a robust degree of aptitude. International assignments are considered a robust and productive way to foster innovation (Dyer, Gregersen, & Christensen, 2009). For that reason, whenever possible, the placement will be in a foreign office; failing that, the placement will be with a team that experiences frequent and intense transactions with people from other cultures and countries. The focus of this placement is on flexibility, adaptability, and cultural competence. The activities in this section all fall within the Transformational Process category of the GLED.

Building Cultural Intelligence for International Assignments

Successful transition to a foreign workplace requires preparation and planning informed by cultural research. The location that is most unlike a current place of work is Johannesburg, South Africa. Research on doing business in South Africa has resulted in the following general guidelines and protocols.

By and large, business relationships are built in the office in Johannesburg. This is because South Africans tend to be transactional and do not need to establish long-standing personal relationships before conducting business. That said, long-term business success depends on networking and relationship building. Formal introductions may help a new person or new business get in the door to decision makers and avoid gatekeepers. South Africans tend to avoid confrontations and focus on maintaining harmonious working relationships. Face-to-face meetings are preferred over communication by email, telephone, and letters.

With regard to leadership, most South Africans respect senior executives and people who have attained their position through perseverance and hard work. Leadership styles that emphasize transparency, competence, and earned authority resonate strongly in the South African business context. Understanding these cultural norms and culturally accepted organizational behavior is essential for anyone transitioning to leadership roles in this region.