Studies in progress: Leader reflects on a decade at HMI

This year marks the tenth anniversary of Harvard Medical International. Founded in 1994 by Daniel Tosteson, MD, then the dean of Harvard Medical School, HMI was created to extend the School’s mission internationally. In a decade, HMI has had more than 50 programs in over 40 countries.

In this HMI World feature, Robert K. Crone, MD, president and CEO of HMI, talks about HMI’s growth and progress, and discusses the challenges that lie ahead.

HMI WORLD: As we arrive at the end of HMI’s tenth year, where does Harvard Medical International fit in the context of global health?

Robert K. Crone, MD

CRONE: When many people think of global health, they think of, one, public health initiatives related to creating and carrying out policy, and two, grassroots efforts. At HMI we are positioned right in the middle, and this embodies the missions of Harvard University and Harvard Medical School, which both call for the creation of new knowledge and communities that continue to learn.

Our vision—that “No citizen of the world should need to leave their own community to access high quality health care”—has remained a constant throughout the decade. With the successful implementation of HMI’s programs in medical and health education and health systems development, we have striven to keep this vision foremost in our minds.

HMI WORLD: What are the major trends influencing the services and partnerships of HMI?

CRONE: Since the beginning of HMI, there has been a developing realization that government cannot provide all things to all people with regard to health care. Even in places where the government has traditionally held a monopoly, the private sector must play a role.

In China, India, and the United Arab Emirates, for the example, the governments, instead of continuing to provide all of the care, are fostering the development of alternatives in the private sector. The governments are transitioning to a stewardship role wherein they act as a regulator and arbitrator between the three points on the health care triangle: providers, patients, and payers. This frees the government to regulate hospital standards and serve as a steward for patient safety. The same trend can be seen in medical education. The impetus for curriculum reform in Germany was that the government put the universities in the position of having to compete with one another.

This shift to the private sector has underscored the need for health care management training. This is a concern felt both locally and internationally, but with our international partners in particular we are seeing a focus on helping physicians develop their capabilities as executives. Whereas in the past they mainly had a need to acquire and update their clinical knowledge, physicians are now focusing on cost-efficiency, patient safety, and consumer satisfaction, and how these metrics affect their bottom line. The programs of the Harvard Macy Institute have been very successful at addressing that, and these issues have also found a forum with Practi-Med.

The leadership of our partner institutions understand that, with today’s health care consumer more knowledgeable and discerning than ever before, quality will be the single most important differentiator of their services. Our partners in India, for example, are focused on quality and performance improvement initiatives that will help them to control costs, thereby making their services as affordable as possible for more people.

From left to right: Mehul Mehta, James White, and Norman MacLeod of HMI discuss strategy.

HMI WORLD: How do you trace HMI’s evolution over the past decade? In other words, what can you point to in order to show how HMI has moved from its startup phase to where we are now?

CRONE: The obvious measure that comes to mind is our growth as an organization. We now have a Boston-based staff of 46 people, plus a landed team of eight in Dubai.

Another way to look at the evolution of HMI is to look at how some of our partnerships have evolved. In the beginning, HMI’s relationship with Sri Ramachandra Medical College & Research Institute was focused mostly on creating student exchange opportunities. Today, we are working with SRMCRI through both our education and health systems divisions, have broadened the scope of our objectives, and share some fairly ambitious goals in the areas of curriculum development, quality management, HIV education and international hospital accreditation. And that expansion of the partnership reflects not only SRMCRI’s emergence as a leader in medical education and health care delivery in India, but also our own development in terms of what we can offer over the life of a partnership.

The depth and breadth of our strategic collaboration with Dubai Healthcare City is another indicator of our progress as an organization. This partnership touches every corner of HMI, and calls upon so much of our past experiences and areas of expertise. That we have been able to deliver on our objectives there to date, I think, speaks well of HMI’s versatility and capacity.

HMI WORLD: Going forward, how will the focus of HMI shift, if at all? What areas or challenges will receive more attention?

CRONE: Notwithstanding any shifts in the focus of our work, we must remember that we have arrived at this point, after ten years, because we have worked to learn from each project and experience. After more than 50 programs, our position is still the same—that we aren’t offering our partners the only approach to meeting their objectives; rather, we’re working with them to identify the approach or strategy that is most suitable for them. That philosophy has to stay in the foreground.

We always need to be thinking about how we can better understand and work with health care policymakers as well as those involved in grassroots efforts. It is in that milieu where we have the most potential to bring different resources together, to spark collaborations between key stakeholders, and make a contribution that creates sustainable progress.

HMI WORLD: How has HMI’s approach to developing program activity changed or evolved?

CRONE: One of our most important achievements over the past ten years has been to create replicable models that benefit our partners because they enable us to do our work less expensively. Tom Aretz (vice president for education) and Harvey Makadon (vice president of health systems) have codified what we do in education and health systems. In our alliances focused on reforming curricula and developing faculty, for example, we have learned to systematically approach a set of problems, and recognize standard approaches that translate in different areas. Over the years we have improved at learning from our experiences, and therefore been able to develop applicable modules and tools for our partners.

HMI WORLD: How has HMI evolved its capability to determine what our partners need and how best to help them?

CRONE: We have developed assessment tools that help us better identify our partners needs, which tend to be at the systems and administrative levels. Also, when structuring a partnership, we take the long-term view and impress upon them that they must create a strategic vision and overarching strategy in order to be successful.

Program coordinators like Michael Kavanagh, Ryan Wildes, and Kristen Mitchell play a critical part in HMI’s partnerships and programs.

HMI WORLD: What is it about the people at HMI that makes them suited to this kind of work?

CRONE: The people of HMI are curious by nature. They are all very accomplished at home but interested in the world outside of the Harvard community. They are comfortable challenging their own ideas, and see the value of learning from another place. This characterizes not only the senior staff who are working abroad, but also the program coordinators who are an important communications link between HMI, our partners, and the network of faculty with whom we collaborate.

HMI WORLD: What role has the relationship between HMI and Harvard Medical School played for both HMI and HMS?

CRONE: First of all, we could not have accomplished what we have without the unwavering support of, first, Dean Daniel Tosteson, and now, the past_issues/Nov_Dec_2004 dean of the Faculty of Medicine, Joseph Martin.

Obviously, the ability to tap into the faculty of not only Harvard Medical School, but the other schools in the Harvard University community as well, has given us an enormous amount of flexibility in responding to our partners’ needs. To date approximately 750 members of the Harvard faculty have participated in HMI programs.

But we hope that the benefit extends in both directions. It became clear very early that HMI could offer faculty at Harvard Medical School unique opportunities to go abroad, not only to teach, but to learn as well. By participating in HMI’s programs, these faculty help to broaden their own perspectives and the worldview of the faculty as a whole.

HMI WORLD: How can HMI be a resource for people in the academic community with an interest in global health care initiatives?

CRONE: One of our objectives going forward is to more rigorously study what we do to create new knowledge for ourselves and for the world. Part of this pursuit of our academic mission is the global health seminar that we organized through the Department of Social Medicine. That series of discussions is a way for us to bring together some of our experiences and knowledge.

There is great potential for us to contribute something unique on the academic front. HMI is a petri dish to test out academic ideas. Together with our partners, we teach, train, and develop strategies for delivering health care and education, and we implement these strategies, so we are not working at the theoretical level.

HMI WORLD: What are HMI’s greatest challenges going forward?

CRONE: Demand is growing for what we do and others are emulating us. We will be challenged to continue to expand what we’re doing and how we’re doing it, but at the same time, we must have the discipline to critically evaluate true measures of success, and remain true to the mission of Harvard Medical School: to create and nurture a community of the best people committed to leadership in alleviating human suffering caused by disease.

HMI World welcomes comments from readers. Please write to let us know what you think of this article.