By Natalie Johnson
Multinational companies have spent a decade building global operating models and a shared digital stack, on the assumption that a good decision travels. In healthcare, it rarely does. A reimbursement pathway, a referral process, a budget cycle, and the question of who is trusted to tell a patient what to do next all change at the border, and an executive who misreads any of them will push a correct strategy into a system that cannot absorb it. Rolf Hoenger, Healthcare Leader and Co-Founder of Movement Health, argues that the ability to read those differences is not a soft complement to commercial judgment but a condition for it. “Executives who want to be at the cutting edge with all the globalization cannot avoid having deep knowledge about the local situations to be successful,” he says. The claim is sharper than it sounds, because it relocates cultural agility from the HR training catalog to the decision table.
Trust Is What Gets You The Information
Hoenger defines cultural agility as adapting how he leads while staying the same person doing it, and the distinction matters. What he adapts is method. “In one setting, taking a clear position early can give a team confidence. In another, people may want to see that I’ve taken the time to understand their context before I offer a view. I adapt to that.” What stays fixed is predictability. He wants people to know where he stands, to feel able to disagree with him, and to trust that he keeps his word. Those are not pleasantries. They are the conditions under which a regional leader finds out what is really happening in a market.
The payoff is informational. “In a role of leading leaders, that trust gives you access to the judgment of people who know their markets better than you do.” That judgment is the scarce asset, and seniority is the main thing that blocks it. Hoenger is explicit about managing his own gravitational pull in the room. With a team used to open argument, he puts his reasoning on the table and invites challenge. In most Latin American settings, where his position might cause people to defer, he asks the country leader or the responsible head to run the discussion and offers his own view only after hearing theirs. The sequencing is deliberate, and it is the difference between a room that confirms the boss and a room that informs him. His job, as he frames it, is to make trade-offs visible, challenge local thinking with international benchmarks, and establish who is accountable for what.
Where Technology Lands Depends On Who Patients Trust
Across Latin America, Hoenger watched very different health systems run into the same pressures. Funding was tight, healthcare professionals were stretched, and patients waited for tests, specialists, and treatment. The pressures rhymed; the causes did not. “A long waiting list might reflect a shortage of specialists in one place and a referral process that loses track of patients in another.” That observation changes where an executive starts. Diagnosing a symptom correctly across 20 markets and prescribing one remedy to all of them is how regional programs fail quietly and expensively.
So he gives country teams room to work with local partners, because they know how decisions get made and who has the standing to convene people. In one market the conversation opens with a health authority, in another with clinicians who already hold the community’s confidence, in another with non-government organizations that are decisive. Technology enters only once the problem is named. In Peru, the Movement Health Foundation, which Hoenger helped establish, has supported digital tools that help local teams coordinate referrals after cancer screening, and Roche’s LINK platform connects needs identified by health systems with innovators who can address them. Take a regional goal such as improving follow-up after a diagnosis: in one setting a clinic reminder moves patients to their next appointment, while in another the better use of the same technology is helping community health workers coordinate follow-up, because they already have relationships with patients and families. Same objective, same toolkit, different answer. His measure cuts through the complexity: whether more patients are getting the care they need sooner.
Trace The Patient And Trace The Money
For executives who want to build this capability before the market forces it on them, Hoenger prescribes something concrete rather than attitudinal. Spend time in the market with the country team and follow two threads through the health system. How does a patient move from a first consultation to treatment, and how does money reach the people providing that care? “I want to know who decides what’s covered, who controls the budget, and how and when providers get paid. Those details tell me where an executive decision can make a difference.” That is the useful test of cultural fluency, because it produces a map of real authority rather than an organizational chart.
The second discipline is triangulation. A payer, a clinician, and a patient will often give three different explanations for the same delay, and Hoenger treats the discrepancy as data. He compares what he is told against what he can verify, then asks local colleagues whose judgment carries weight in that system, how support for a decision gets built, and which assumptions he has imported from elsewhere. Crucially, he wants that built into strategy reviews before resources are committed, not after a launch underperforms. When something works in one country, he asks what made it work there, then asks the next team which parts they can use, what they must adapt, and how they will know it is helping patients. That is how a company turns 20 markets into a learning circle instead of 20 disconnected experiments.
Follow Rolf Hoenger on LinkedIn for more insights on cultural agility, patient access, and leading teams across global health systems.
