A foreign office

What can managers learn from encountering leadership cultures from outside the UK? Emma Forrest talks to those who found working in overseas healthcare systems an invaluable experience

With foreign travel no longer commanding the awe it once did, overseas work experience is not always held in high esteem. Is spending some of your career in foreign climes just an excuse to get a good tan and spice up your CV, or can it be a true learning experience?

Royal Brompton and Harefield trust chief executive Dr Gareth Goodier is unequivocal in his praise of overseas experience. After training in the UK, he worked as a clinician in the UK and Saudi Arabia before taking a clinical post in Australia that led to his career in management.

'There is a great deal to be learned from other cultures. In Australia, there is always a belief that you have to travel to learn something other than what is in that country's boundaries, ' he says.

'The NHS can believe its own boundaries are the answer to everything and there is a danger in that perspective.'

His Australian experiences, latterly as chief executive of Royal Perth Hospital in western Australia, allowed Dr Goodier to witness a more competitive healthcare system, study the benefits of private healthcare and see advanced information systems used as standard.

Leading a World Bank project to introduce hospital accreditation to Lebanon convinced him there are things to learn even in the 'worst and most dangerous hospitals. Leadership is one of those things you can pick up anywhere, even in a refugee camp in Palestine'.

Australian Martin Fletcher, National Patient Safety Agency Northern czar, agrees being in a different culture can shed new light on the most routine of everyday issues. 'It is interesting and exciting to work in a new culture.

'When you work in a system for a long time, there are things you start to take for granted and they may not happen in other countries. It can help you to think outside the square.'

Even disparate circumstances can also have similarities. 'The language of health is the same the world over so long as you have a certain level of development, ' says Dr Goodier. 'It is hard to relate to a gulf of economies.

However with a relatively similar income on health expenditure there are a common set of problems we all face, such as nurse shortages, getting more value for money and clinical governance.'

A vast disparity in health expenditure was just one issue facing Kent and Medway strategic health authority director of workforce development Bryan Carpenter. Until he joined the authority in September, Mr Carpenter had spent seven years in South Africa, most recently as chief executive officer of Inkosi Albert Luthuli Central Hospital in the KwaZulu-Natal region, which includes very poor and remote rural areas.

'It is difficult to draw direct comparisons because of the state of development. People are grateful for what they can get and they expect long waits to get into hospital, ' says Mr Carpenter.

'The disease profile is vastly different; the largest cause of admissions and death were AIDS related. There are also a lot of diseases associated with abject poverty and a huge number of road accident related surgeries.

'Bed blocking resulted because patients had no method of getting home, as transport to their region would only run once a fortnight.'

In addition to tackling such alien issues, Mr Carpenter found South Africa's bureaucracy frustrating.

'It is very centralised. Across the whole of the public sector there is a lot of emphasis on process. I had the title of chief executive officer but had to delegate to the health authority for key decisions, ' he says.

Mr Carpenter adds that he is grateful for the political skills and awareness that the working environment forced him to learn.

Differing styles of management culture also took Peter Bradley, chief executive of the London Ambulance Service, by surprise during his 20 years in New Zealand. As chief ambulance officer of Auckland Ambulance Service, he tackled problems similar to those he saw in the UK, but believes management took less of a commandand-control role.

'It had taken time to get there but they were 10 years ahead; the relationships we have in the service now are like they were in New Zealand when I left seven years ago; it is more participative and relaxed.'

It has also left him a firm believer in cross-cultural workforces. 'You need to take risks in employing people from other countries.'

Time to indulge a taste for travel and enjoy an outdoor life in a warm climate are cited as reasons for working overseas. But the primary draw is the chance to take on jobs that may not be available in the UK.

'I would certainly have a different approach now if I had stayed in the UK, ' says Mr Carpenter. 'I have been exposed to a whole range of cultures and hope it has made me a better person.'