How does a company work towards achieving compliance with the Foreign Corrupt Practices Act (FCPA) in a Joint Venture (JV) or other business relationship where it holds less that 50% of the control? That question is often faced by US companies when they enter into a JV in many countries which require a majority of local ownership or even a 50-50 split in ownership. Some tactics that the compliance practitioner might employ were discussed in an article in the June issue of the Harvard Business Review, entitled, "The Perils of Partnering in Developing Markets", in which Johns Hopkins (Hopkins) Medicine International Chief Executive Officer (CEO) Steven J. Thompson wrote about his company's experience in partnering with a charity in Turkey to build and operate a "state-of-the-art medical facility."
While not directly discussed in the article it is certainly worth noting that in partnering to create hospitals overseas, Hopkins is always dealing with the FCPA as health care services generally and hospitals particularly are run by the foreign government in which the hospital is located. However, the problems Hopkins encountered and some of the solutions provide excellent insight into compliance challenges that a company might well face when it moves into a developing market. Thompson began by noting that as a non-profit Hopkins always takes a minority interest or none at all. This requires Hopkins to operate not as typical JV or other type of partner but "more like consultants with a broad range of responsibility and high level of authority." The other thing that I found quite interesting was that as a non-profit, the most important thing to Hopkins is its good name; in other words it is far more concerned about reputational damage than financial loss. Some of the key lessons learned were as follows.
Filling the Local Talent Gap
Even if the country's laws do not require that local persons be the entity's managers, most local partners insist upon it. Thompson has learned that fighting this "rarely pays out." Instead Hopkins seeks to team its advisors with the local executives, so that the advisors will have the ability to influence both "process and culture." Overtime, Hopkins has found that the top local managers cannot push as hard or as strongly for innovation and culture change so that the Hopkins team can begin to take over the top management functions.
A key component for long term success is training. This includes local training in all aspects of hospital management and financial operations. Additionally, Hopkins establishes a strong recruiting pipeline for bringing back to Baltimore, the home of Hopkins, so that they can be trained at and see how the facilities are run in the US.
When Best Practices Collide with Culture
In most medical treatment outside the US, the culture is such that a Doctors judgment is never questioned. This is quite different from the Hopkins experience in the US, where other providers of health care are empowered to challenge the decisions of senior physicians where a patient's health may be at risk. The Hopkins approach when "confronted with a culture clash is to determine whether we really need to challenge the culture." With this approach, Hopkins found that it could accomplish its goals, "within the cultural constraints" in which it operated. When it could not do so, it "seeded the staff with professionals who could lead by example" so that in the case of the culture of deference to Doctors whose authority was not challenged, senior nurses were brought in from countries where such a tradition did not exist. Once others saw that patient outcomes were steadily improved, "they began to come around and the culture of deference receded."
In many ways, I found the Hopkins experience in mitigating risk to be the most interesting. Here Thompson said that the pre-agreement due diligence process, which he termed "choosing the right partner and learning to read the signs from up-front negotiations are critical", were two of the most critical factors. He identified factors such as foreign institutions which only desired short-term profit or were trying to capitalize on the Hopkins name as "anathema to success." He wrote that these factors can be ascertained through long conversations with potential partners about goals such as sustainable quality and commitment rather than on financial returns alone. Mimicking the requirements under the US Department of Justice's (DOJ's) minimum best practices compliance program, Hopkins requires strong contract language regarding the commitments made by any foreign partner. Lastly, if a relationship begins to sour or otherwise have problems, Hopkins is not afraid to rethink its position or even end the relationship after appropriate consideration. To help facilitate this from the legal perspective, Hopkins requires a "termination for convenience clause" in its contracts.
Another interesting aspect of the Hopkins approach was in the implicit use of risk assessment. Thompson included the below chart to illustrate "How Johns Hopkins Sizes Up International Risk". I found that these concepts speak to an on-going approach to risk assessment so that the process is continuous and therefore allows for continuous improvement.
Evaluating the Opportunity
Getting up to Speed
Operating Over Time
Assess the potential partner's willingness to commit resources.
Engage experts to hire key personnel and to design processes.
Stabilize processes and create feedback loops.
Assess regional constraints.
Establish training and mentoring programs for local managers and professionals.
Transfer more responsibilities to local managers.
Work with your local partner on a project plan and a business plan.
Set up clinical, operations and financial performance metrics.
Establish local education and recruitment pipelines.
Ensure that your local partner has a clear understanding of, and realistic expectations for the project.
Establish quality, safety and efficiency processes.
Establish regional marketing programs.
Set up a time for accreditation.
Consider new initiatives and expansion.
If Trouble Arises
Thompson concluded is article with a list of action items that you can perform if there are signs of trouble. So, following McNulty's Maxim No. 3 of "What did you do to remedy it?", I list the following actions steps your company can take at three different stages of a JV relationship.
1. In the Evaluation Phase
2. In the Start-Up Phase
3. As the Relationship Matures
Many US companies have struggled with how influence partners to comply with the FCPA in JV relationships. The Hopkins experience has some excellent steps that your company can take in the pre-formation stage, during contract negotiation, in post-execution contract management and then as the relationship matures. The process that Hopkins follows is one that clearly allows you to use influence, rather than the brute force of the majority right of control. It is a very good road map for you to consider and one that management should take a close look at when managing any overseas relationship.
Visit the FCPA Compliance and Ethics Blog, hosted by Thomas Fox, for more commentary on FCPA compliance, indemnities and other forms of risk management for a worldwide energy practice, tax issues faced by multi-national US companies, insurance coverage issues and protection of trade secrets.
This publication contains general information only and is based on the experiences and research of the author. The author is not, by means of this publication, rendering business, legal advice, or other professional advice or services. This publication is not a substitute for such legal advice or services, nor should it be used as a basis for any decision or action that may affect your business. Before making any decision or taking any action that may affect your business, you should consult a qualified legal advisor. The author, his affiliates, and related entities shall not be responsible for any loss sustained by any person or entity that relies on this publication. The Author gives his permission to link, post, distribute, or reference this article for any lawful purpose, provided attribution is made to the author. The author can be reached at firstname.lastname@example.org.
© Thomas R. Fox, 2012
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