It’s all about guanxi.

For 15 years orthopedic surgeon Christopher S. Mow has been traveling to Asia, establishing fellowships, lecturing, and sometimes treating patients from Asia on both sides of the Pacific.

“For some time now, the medical and political leadership in several countries have asked that I bring someone from the Stanford medical staff leadership to meet with them,” said Mow, an adjunct clinical faculty member in the Department of Orthopaedic Surgery.

So Mow asked Medical Staff Vice President Bryan D. Bohman, who practices with Associated Anesthesiologists, to work with him to implement a visit to Guangzhou, Hong Kong and Manila, April 13-21.

Trips to Asia or other nations by Stanford faculty or even hospital administrators are common. For example, in recent years, Orthopaedics Chair William J. Maloney and Chief Nursing Officer Cindy Day have accompanied Mow on educational trips, visiting hospitals and medical schools in China.

Bohman and Mow say their recent visit to hospitals, medical schools and government ministries in April had the usual trappings — media coverage, discussions about such topics as accreditation and worldwide epidemics, teaching, as well as formal dinners and photo opportunities. But both physicians said their visit was at least subtly distinct from most other trips, which usually have specific business, educational or clinical agendas. The April visit, said Bohman and Mow, was intended as a medical staff initiative as opposed to faculty or hospital presence, but more pointedly, the visit was, well, guanxi.

“Significantly, it’s about being culturally in tune. Throughout much of the world, particularly China and Asia, business follows good relationships and promotion of goodwill. People want to get to know and have a personal relationship with people whom they eventually may be doing business with, explained Mow. “It’s the art of guanxi.

“The Chinese and other Asians simply will work with those whom they know and whom they can trust. You must want and establish those relationships as a prelude not just for financial relationships, but for academic, clinical or humanitarian relationships as well,” Mow said.

Bohman, who in September begins his two-year term as SHC Medical Staff President, has traveled extensively on medical service trips throughout the world, particularly Latin America. In Asia, the pair did a few demonstration surgeries at hospitals they visited, and Mow saw a few longstanding and referral patients. But Bohman underscored how this trip was different:

“We made it clear on our trip that we were traveling on behalf of the Medical Staff, not the hospital, university or anyone else. Before leaving we did communicate with our own hospital administration and clinical leaders and are certainly continuing to do so, but this was a trip to foster connections in a world where such international relationships are increasingly important,” said Bohman. “We told our hosts that if they have questions about Stanford and its policies, we’d be happy to pass them on, but we’re here representing the medical staff, not the hospital per se.

“We were trying to look at the bigger picture. Contacts between physicians in Asia and our colleagues throughout America are growing. I’d hate to see people fly over Stanford to establish relationships in the Midwest or on the East Coast and leave us out,” said Bohman.

The trip was financed by the Pittsburgh-based Asian American Institute for Research and Education, a nonprofit foundation that supports medical exchange and education, including fellowships at Stanford. Mow is on the board.
Bohman and Mow met with dignitaries, including physician Grace Tang, the president of the Hong Kong Academy of Medicine, “who seemed quite relieved to learn that our visit was in the spirit of guanxi after she asked, ‘Why are you here?’” Bohman noted.

In Hong Kong, the pair also met with Anthony Wu, chairman of the 44-institution Hong Kong Hospital Authority, and P.C. Leung, the authority’s chief quality officer, “who was particularly interested in questioning us about the benefits of Joint Commission accreditation now that the JC has established an international arm, Joint Commission International (JCI).

“Many medical staff concerns in Asia are often similar to what we find here, including apprehension over pandemic flu,” Bohman added. For example in Hong Kong, following the SARS epidemic, visitors and staff entering Princess Margaret Hospital in Kowloon, must now wash their hands at sinks placed outside the building before entering.

At Princess Margaret, Bohman and Mow met with pediatrician Lily Chiu, CEO of the Kowloon 7 Hospital Cluster. Also in Hong Kong the pair toured Princess Margaret’s new state-of-the-art facility that offers 100 negative pressure rooms to shield and treat patients with highly infectious diseases. “That’s the kind of facility that clearly offers a two-way educational opportunity between Asian experts and infection control experts and policymakers at Stanford and elsewhere in the U.S.,” Bohman said.

At Zhongshan Sun Yat-sen University Hospital in Guangzhou, the visitors met with top physicians Li Meng-feng, dean of the Zhongshan University School of Medicine, several hospital CEOs, and the chancellor of Zhongshan University, Xu Ning-sheng, a professor of mathematics. “Meeting and engaging with the top officials of one of China’s oldest and most prestigious Western style medical schools and universities was a gratifying contact,” Bohman said.

In the Philippines, in addition to performing demonstration surgeries and visiting a few of Mow’s private patients, the pair met with leaders at St. Luke’s Medical Center. At that premier Manila hospital, CEO Joseph Ledesma and his colleagues noted that the JCI, while voluntary, is an important marketing tool for top hospitals in the Philippines, because the accreditation group applies the same rigorous standards demanded in the U.S. In Manila, Bohman and Mow also met with Romulo Buzon, president of the Philippine Society of Anesthesiologists. “Medical societies are a crucial ingredient in medical leadership throughout Asia,” Mow said.

“Physician visits with our Asian counterparts, including with their administrators, were really important, because unlike the trend in the United States, in Asia hospitals and in fact the entire health infrastructure are almost universally led by physicians,” Bohman said. “In China and Asia, the government health ministers are almost invariably physicians.”

As for the future, Mow pointed proudly to an invitation they received to return next year to lecture at a China/Hong Kong government sponsored, high profile international health care policy forum. It’s about building relationships [guanxi],” he said.

Both physicians noted that while the state of medicine in Asia, particularly in Hong Kong and Singapore, is at a very high level, “the leadership and practicing physicians are keen to learn of U.S. expertise from their physician colleagues and others. But they want this in the context of full spectrum relationships, including two-way fellowships, and the many personal contacts that we can and have established,” Mow said.