The Fight Is Inside the Building

In healthcare, the hardest thing to move is never the technology. It is the institutions and the conventions around it.

I put that claim to four leaders on a panel I moderated at the French Chamber’s Healthcare Business Leaders Symposium last week. Each is changing how medicine is delivered in Japan: where it happens, who controls the information, whether a patient needs a transplant at all, and whether some patients get treated at all. None of them is running an efficiency play. If they succeed, each one takes something away from an established interest.

Japan needs them to succeed. The population is ageing and shrinking, and every year fewer clinicians care for more patients. The country cannot keep practicing medicine the way it always has. So I didn’t ask them about their products. I asked what it takes to lead the change.

The session ran under the Chatham House Rule, so what follows is what I took away, not who said it.

1. The first “no” comes from your own people

One panelist ran a campaign that lifted adoption of an under-used therapy several-fold. His own staff told him it broke the rules and opposed it. He didn’t fight them internally. He went straight to the regulator and asked. The regulator’s response, in effect: what exactly is the problem?

Another moved from the lab into corporate strategy at a large Japanese pharmaceutical company. Her seniors told her there was no path and no precedent, and declined to support her. She built relationships with the strategy side on her own, applied internally, and made the move anyway.

In every story I heard, the first objection came from inside: their own people, their own profession, their own seniors. Not regulators. Not competitors. Leading change in Japan is mostly an internal fight.

The leaders who win it do one thing consistently. They carry the risk personally. “If something goes wrong, I take responsibility” is what psychological safety actually means. It is not a workshop. It is a leader absorbing the downside so the team can move.

2. Stop trying to convert the unconvinced

For three decades, one company had tried to persuade thousands of specialists to adopt its therapy. Most never did. But roughly one in five already had.

So the new leader stopped persuading. He told patients directly that they had a choice, and that getting it depended on which hospital they chose. Then he pointed them to the hospitals whose doctors were already convinced.

He was precise about one detail. His team wanted the television campaign. He refused to run it without a way for patients to find the right hospitals. Awareness alone would have sent patients to doctors who would never offer the option. Reach without a call to action is money spent on nothing.

Many change programs pour their energy into the resisters. The leverage sits with the people who already agree. Direct the demand to them, and the holdouts become irrelevant.

3. Lead with their interest, not your mission

Going around the gatekeeper only works when someone on the other side can choose. In emergency care, nobody can. The patient arriving by ambulance is in no state to weigh options, and in Japan most patients defer to the doctor anyway.

So one founder had to win the institutions. His challenge was hard. Japanese hospitals guard their data, each one gains little from sharing it, and the value appears only at national scale.

He didn’t pitch the national platform, and he didn’t lead with patient outcomes. He solved the hospital’s own problem first. A large share of a hospital’s inpatients arrive through the emergency department, so its operations matter enormously to administrators. Fix that, and permission to use the data follows. It worked, at scale.

A mission inspires your team. Self-interest moves an institution. Know which one you are talking to.

4. Stay close to the work

One founder now runs a company of more than a hundred people and still works clinical shifts on weekends. He uses his own product on the floor. In the office, it works well. In a crowded critical care unit, the network drops, the app slows, and the data comes in wrong. He learns things there that no report would tell him.

Another left the lab for the CEO’s chair, and the science still shapes her strategy. Her lesson from her research years: good technology needs good strategy, and good strategy needs good technology. Leaders who speak only one of those languages end up talking past half their organization.

The further you move from where the work happens, the weaker the signal. Find a way back to it.

5. What to stop accepting

I closed by asking each panelist what leaders in the room should stop accepting as the way things are done in Japan. Four answers, each worth taking home:

• Stop keeping the “nice to have” out of fear. Teams preserve outdated practices because of a 1% chance something might go wrong. Tell them you will back them. Usually, nothing happens.
• Stop being vague. Japanese teams often hesitate to voice a clear opinion, which is exactly why they need one from the leader. Make the vision vivid.
• Stop losing to resistance. When people tell you it can’t be done, strong conviction and curiosity are reason enough to keep going.
• Stop merely criticizing. Pointing out what is wrong drains a team. Ask what we will do to solve it, and put their energy into the next challenge.

The real obstacle is rarely the market

One panelist leads the Japan arm of a European group that recently decided to build its own business here rather than license its products out. That fits a pattern I see across industries. For all the talk of a shrinking, ageing population, many global companies now see Japan as their last great growth opportunity, because their share here still trails what they hold everywhere else.

The opportunity is real. But listen to where these four leaders actually met resistance. Their own staff. Their own seniors. Their own profession. Their own headquarters, asking why it should spend on a television campaign.

If you lead a company in Japan, the question is not whether Japan will change. It is whether your own organization will let you change it.