Guest Column | April 12, 2018

How To Effectively Work Across Cultures In Global Clinical Trials

By Lynn Doerr, 3Sixty Pharma Solutions, LLC

How To Effectively Work Across Cultures In Global Clinical Trials

Most of us have spoken to someone and struggled to understand an accent or word choice. Even within a country like the United States, different regions can have unique language, which can be confusing to an outsider. It can be as subtle as the difference between “soda” in the East and “pop” in the Midwest. But what happens when you try to coordinate complex projects across countries and regions? How do you work successfully, accounting for the differences in culture and honoring common objectives?

In our global economy, where goods and services cross boundaries daily, we can be more effective if we think about what we want to accomplish and how our actions can be perceived. Let’s take a closer look at understanding how to communicate and coordinate with multiple nationalities.

Evaluating Cultural Context And Communicating Effectively Within Clinical Project Teams

A distinction many of us are unaware of is the concept of “low-context” and “high-context” cultures. Consider this example: “I need you to research these three facilities and determine which is best for our project.” In a low-context environment, the burden is on the speaker, and communicators tend to be very specific about what they need. But in a high-context environment, the request may become, “We are looking for the best facility for this project. We know of three we could consider.” In a high-context exchange, the burden is on the listener to translate this statement as a request to research the institutions. You can see where a low-context listener might miss the request to do the research. But think about the first request. A high-context listener might be insulted by the directness. Cultures such as the United States tend to be very low-context, and it makes sense when you think about the mix of backgrounds and cultures in the country. People err on the side of being very specific to eliminate confusion. But in a more homogenous culture such as Japan, where high-context communication is well-understood, this is unnecessary and might be interpreted as condescending and rude.

Knowing these differences can be helpful when managing a multi-country project. Discuss differences and establish that it is OK to ask questions for clarification. Be aware that your own culture can be confusing to others, and explain your style to the group. Clarify what is normal, and be open to others doing the same.

Suggestion: Consider setting up a low-context approach as a ground rule for communicating within a multi-country project, and ask clarifying questions to make sure you understand the intent of requests and assignments. Remember different is not wrong. You might even find that a new technique from outside your own culture works best in your multi-country project environment.

Persuading And Developing Trust In Cross-Cultural Teams

We often find it disturbing or confusing when someone communicates differently than we do, especially when it comes to convincing others to do something. Project management is largely dependent on managing without authority, and when leading projects across countries, this can be problematic if information is not delivered in an appropriate context.

For instance, many countries expect to see the background and foundation of an argument before you can ask for support. Even if your culture normally prefers to cut to the chase, others need to understand the reason and want to see the fact summary for the proposal before you can legitimately ask for needed support. I encountered this when working with my Korean counterpart on developing a workshop. I didn’t understand the need for so much background information, as I wanted to make the best use of our time. She explained to me why the big picture was so important. We needed to set the context for the strategy before persuading the teams to integrate the new concepts. Once I understood that need, we made adjustments to the agenda that allowed for both our objectives — building the context more thoroughly and still meeting time demands. It’s important to listen and understand the preferences of your audience before you try to persuade them to change behavior.

Another element that’s important when persuading audiences is trust. In Asian cultures, trust is a necessary part of the relationship; you must build it before you start to do business. My counterpart and I had already developed a basis of trust in our personal relationship that carried over to the business side. Therefore, it was much easier to work out an agenda and be up front with each other about our individual concerns. And we trusted each other to honor our mutual concerns. This trust carried over to the workshop teams — they trusted me and the content I delivered because they trusted her. In some cultures, such as the U.S., business trust seems to rest more on our accomplishments than our individual traits. So, I might expect someone to let me run things my way because I have conducted several successful workshops in the past. In fact, I might find it insulting that someone would question my judgment on the appropriate content, wondering why they don’t trust my expertise. This is what makes communication across cultures so tricky — we speak different languages when it comes to what is accepted as a basis for trust. Until that is understood and we can each accommodate each other, we can create more mistrust.

Suggestion: When in doubt, don’t be afraid to ask what will work best for a specific country. It’s as simple as asking, “What is the best approach for your group?”

Leading Projects In A Cross-Cultural Context

The concept of power distance, a continuum from high to low power distances, can be useful in explaining how to lead groups from one country to the next. Countries with a high power distance tend to have a more hierarchical culture, and they see their leaders as the ultimate power and authority. Many Asian cultures and even countries such as Italy tend to work this way, with the leader being distanced from the group. Countries such as Sweden and Australia have a low power distance and see their leader as a more equal team member. The U.S. is somewhere in the middle, so the power distance is something that is often embedded and influenced by a specific company culture, which may also be dependent on where a company was founded. Trying to approach a low power distance country with high power distance tactics can quickly leave you unsuccessful as the group is confused as to why the leader isn’t rolling up his sleeves to do the work with the team rather than just giving the orders.

Suggestion: Try to familiarize yourself with the business etiquette so you don’t make a mistake such as sitting in the chairman’s seat at a meeting with a high power distance protocol. And when working with the team, discuss leadership and partnership roles so everyone understands expectations.

Making Decisions In Cross-Cultural Teams

Understanding how decisions are made from one country to another can save you time and frustration when projects need to move forward. Some countries don’t like being put on the spot in meetings or interactions, and being pushed to make decisions within the time frame of a meeting can make some cultures uncomfortable. I learned this while working closely with a company in Japan. They always requested my presentations several days before the meeting. Since I usually liked to do final edits on my 12-hour flight to Tokyo, I didn’t understand why I had to finish everything so early. One of my colleagues in Japan shared the reason: they simply wanted time to review everything in advance, discuss amongst themselves, and prepare any questions. Countries such as Japan, Sweden, and Germany have a more consensual approach to decision making and will take time for discussion. Because everyone is involved, it helps with implementation, which tends to move quickly. Countries such as China tend to have a top-down approach to decision making. I found I had no traction in China unless the top-level executives had agreed to an initiative. Reaching the right level for decision making can make the process run smoothly.

Suggestion: Understand the comfort level for decision making on an individual versus group basis and include all relevant individuals. If the group leans toward a consensual approach, be sure to send materials prior to a meeting so they have ample time to discuss and prepare.

Handling Disagreements While Considering Cultural Viewpoints

What happens when you are working with a team of individuals from multiple countries and there is a disagreement? Some cultures engage in lively debate, while others avoid confrontation. Imagine mixing the two! One side is appalled at the challenging dialogue while the other side wonders why their counterpart is so quiet, mistaking the lack of engagement for a lack of interest. If you’ve worked with Asian cultures, you probably know about “saving face.” Even if someone disagrees with you, they will find a non-confrontational way to address a concern, preserving the relationship as they see a person and their ideas to be very closely tied. In a country such as France, they may openly debate or challenge ideas, not pinning them to the individual. It can be quite confusing to be caught in the middle and see the damage to relationships when both sides have different styles.

Suggestion: One way to handle this is to separate people from their ideas by using a flip chart or sticky notes when discussing ideas in a meeting; another is to send information in advance so everyone can review and pre-submit comments that can be aggregated and not attributed. Another tactic is to respond to comments with “Tell me more” rather than attaching a positive or negative assessment to each one.

Scheduling Meetings For Optimal Effectiveness

We all know someone who is perpetually late. But are they late in the context of their culture? In the U.S., we tend to schedule in one-hour increments and when a meeting is supposed to start at 10 a.m., we expect it to start at 10 a.m. That is not the case all over the world. Some countries find it acceptable to be a little late, while others even accept being quite late. Train schedules can run precisely on the minute in one country, such as Japan, while you need to be prepared to wait in another country such as India. I witnessed what seemed to be airport mayhem in India as everyone crowded the ticket counter while I searched in vain for what resembled a line. I quickly gave up and joined the crowd. Although it seemed unlikely, everyone was taken care of and soon I was on my way. I didn’t understand until much later that this was common in India and, despite what seems to be unscheduled confusion, it’s just another way of handling a crowd. Remember it is more a matter of what you are used to than what you think will work best.

Suggestion: When managing a project, set the standard. As a ground rule, request that everyone be on time.


If working across cultures is new to you or even confusing, Erin Meyer wrote a book titled “The Culture Map” that gives insight into working across cultures successfully. Even with my experience of working across various countries, I found her approach helpful in distilling differences into meaningful categories — the concept of naming something and then “owning” it in practice.

Keep in mind that we all have a desire to be understood, and taking the time to ask questions or think through a different viewpoint can ensure you are more successful. Think about the communication culture in the country of the person you are interacting with, and make appropriate adjustments. Understanding your audience can mean more than just making a valuable business connection — it can lead to strong and lasting relationships.

About The Author:

Lynn Doerr has more than 25 years of experience in the pharmaceutical and global health environment, primarily focused in brand/product management, market research, disease management, and key opinion leader strategy. Her expertise includes a deep understanding of influence networks in the physician, scientific, access, and policy areas — at both the strategic and tactical levels. Doerr’s therapeutic knowledge includes cardiovascular, respiratory, women’s health, oncology, and vaccines, and she has worked with countries in Asia Pacific, Europe, and South America to maximize inline and launch product planning. Currently, Doerr consults with pharma/biotech companies conducting market research, managing projects, and translating the complex into strategy-based marketing and communications plans. You can reach her at or connect with her on LinkedIn.