The strategic value of local expertise in delivering global strategy
in this article
Europe is often spoken about as a single market. In reality, it encompasses dozens of different healthcare systems, cultures and priorities, each with its own dynamics.
As regional president for Europe at Merz Therapeutics, I lead with this difference in mind. I take it as a starting point rather than a complication to be managed away.
Across Europe, market access, reimbursement environments, prescribing behaviors, stakeholder expectations and political priorities can vary significantly from one country to the next. What works in one market cannot simply be assumed to work in another.
For most global organizations, the natural response to this kind of complexity can be to seek greater consistency: more processes, more central oversight, more layers between strategy and execution. But I believe that approach can create a different problem. The further decision-making moves from the reality of the specific region, the greater the risk that we lose the context needed to make good decisions.
The role of a global organization is to provide a clear strategic ambition and the capabilities to support it. But strategy only creates value when it can be translated into the realities of individual markets. That requires trust in the people who understand those realities best and the accountability for them to act.
For me, this begins with a simple principle: the closer you are to the patient, the closer you should be to the decision. Once an organization’s strategic direction is clear, the people closest to the region should have the judgment and accountability to determine how best to deliver it.
What works in one market cannot simply be assumed to work in another.
Global strategy requires
local judgment
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One of the most important questions for an international organization is therefore not simply, “What should we do at a global level?” but, “At what level should this decision be made?”
When it comes to translating strategy into action, we should push decisions as much as possible toward the person who is closest to the patient. This is not decentralization for its own sake. It is about shortening the distance between understanding what is happening in a market and being able to act on it.
Local teams have a perspective that is difficult to replicate from a regional or global office. They can see how prescribers are responding to a change in their market, how a payer is approaching access or how stakeholder priorities are shifting. In healthcare, where the same strategic ambition can require very different approaches from one market to another, local judgment is essential.
Local expertise is therefore not the final step in implementing strategy. It is part of the strategy itself.
That does not mean every decision should be made locally, but it means we should give local leaders the confidence and accountability to make the decisions they are best equipped to make.
It also means recognizing, sometimes, that local judgment should not remain local. One of the advantages of operating across multiple regions in Europe is the ability to learn from one another. An idea developed in one country can challenge assumptions somewhere else. A new approach to customer engagement or omnichannel activity can become a model for others. We are already seeing this, for instance, through the way local teams experiment with how people are engaging with our products.
The role of leadership, then, is to create the conditions for those insights to travel.
When it comes to translating strategy into action, we should push decisions as much as possible toward the person who is closest to the patient.
My decision tree for
decentralization
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Once you accept that judgment needs to sit close to the market, a second question follows: how do you decide what should remain local, what should be coordinated regionally and what genuinely requires a global decision?
For me, one of the most useful considerations is how difficult a decision would be to reverse.
Some decisions are relatively contained. If the consequences remain within one country, we are generally better equipped to make that decision within that country. Other decisions carry implications across markets. If the consequences are shared across countries, that is when broader coordination becomes important… because mistakes can travel quickly. This is how I think practically about decentralization: it is not a choice between central control and local autonomy. Instead, I’m looking at where decision-making can be executed at the right level.
This philosophy also shapes how I think about agility. Moving quickly does not mean making a decision and then never looking back. It means having the confidence to make a decision, understand the outcome and change course when the evidence tells you to.
At Merz Therapeutics, we use pilots to test new approaches with a straightforward principle: learn quickly, or scale quickly. What we avoid is allowing an idea to remain in limbo because we are reluctant to decide whether it is creating sufficient value. How we do so is through accountability: people need to know what they own, what they are empowered to decide and what happens when the outcome is different from what they expected. In that sense, empowerment and accountability are not opposing ideas. They depend on each other. When people are given responsibility to make decisions, they also need the authority to act on them.
For me, this is where accountability and agility come together. My objective is not to contribute to an organization where every decision is made locally. It is to build one where decisions are made at the right level, by the right people, with the accountability to act and the flexibility to learn.
The region should
connect, not control
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If global leaders were to direct every regional launch in detail, we would lose the benefit of local judgment. But if every country operates entirely independently, we lose the ability to learn from the collective experience of the organization.
The role of regional leadership sits between these two extremes.
As European healthcare systems become increasingly interconnected, regional leaders have an important role in connecting markets, sharing expertise and identifying patterns across countries.
But connecting markets does not mean controlling them.
Regional leaders succeed by orchestrating and simplifying the complexity that Europe presents, without controlling it.
For me, that means creating the connections that help local teams execute more effectively, while preserving their ownership of the decisions that belong in their markets. It means recognizing when an issue is genuinely local and when it reflects a broader pattern. It means helping successful ideas travel and making sure that local insight can inform the wider organization.
This is where the regional layer can create real value: it can act as a bridge between local insight and global scale.
That distinction becomes increasingly important as organizations grow. More coordination can easily become more bureaucracy. Some friction is healthy; it can challenge assumptions and improve decisions. But when coordination starts to slow down execution, it stops creating value.
I therefore judge regional leadership less by the amount of activity it generates than by what it enables markets to do. It is not the input that matters, but the output: the decisions we unlock and how effectively we enable our regions to execute them.
That, ultimately, is the purpose of regional leadership: to simplify complexity so that the organization can move through it.
I therefore judge regional leadership less by the amount of activity it generates than by what it enables markets to do.
This is where the regional layer can create real value: it can act as a bridge between local insight and global scale.
The purpose of scale is
to accelerate execution
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This brings me to what I believe is the real test of any global organization: once its strategic direction is clear, how quickly can it turn insight into action?
There is a common assumption that the larger an organization grows, the slower it becomes. I do not believe size itself determines that. The way an organization makes decisions is far more important.
I have seen this multiple times throughout my career, working in smaller businesses that competed against organizations many times larger. Yet being smaller did not prevent us from having an impact. What mattered was the ability to make decisions through relevant, local expertise, take accountability and act with urgency.
Speed of decisions can beat the size of the budget.
That is why I believe small, accountable teams can often outperform much larger organizations. When you have the right people in the right roles, with a clear sense of ownership, you can move quickly without creating layers around every decision.
This is not an argument against scale. Scale gives us capabilities, reach and the ability to bring successful approaches to more people. But scale should not become weight.
That means protecting our agility. In areas where we are closest to market execution, we aim to operate like a speedboat, not a tanker: focused, responsive and able to change direction when the situation demands it.
It also means accepting that execution does not need to wait for perfect certainty. Once we have enough evidence to move, we should be prepared to act, learn from the outcome and adjust where necessary.
I would rather make a mistake and learn from it quickly than make the right decision too late.
