The Translation Problem
Consider a familiar story, a composite drawn from dozens of similar ventures. A Series B diagnostics company, battle-tested across tier-2 Indian cities, enters the UK market. The technology is proven. The clinical outcomes are strong. The team has scaled through regulatory complexity before. Within eighteen months, they've burned through their expansion runway and retreated to their home market.
The product worked. The market existed. What failed was translation.
This pattern repeats with troubling regularity. Companies that have solved genuinely hard problems, from diagnostic AI that works on low-resolution smartphone images to care pathways that navigate fragmented health systems, stumble when they attempt to export these solutions. The failure is rarely technical. It's contextual.
Friedrich Hayek identified the core problem decades ago when writing about economic coordination[1]: practical knowledge is dispersed, contextual, and often impossible to articulate. Healthcare systems are vast accumulations of exactly this kind of local knowledge, encoded not in policy documents but in daily practice. The referral patterns between GPs and specialists. The unwritten rules of hospital procurement. The workarounds that frontline staff have developed over years. None of this appears in market research reports, yet all of it determines whether an innovation can take root.
The innovation that succeeds in India has learned to work within Indian local knowledge. It has adapted to how decisions actually get made, how trust is actually built, how value is actually demonstrated. This adaptation is often so deeply embedded that the innovators themselves may not recognise it. When they attempt to export the solution, they discover that what felt like universal product-market fit was actually a deep alignment with context-specific conditions.
"What works here and now rarely works there and then without deliberate translation."
The four contexts
Every (healthcare) innovation exists within four contexts that shape its viability. Understanding these contexts is the first step toward successful translation, and the research on cross-border innovation consistently points to failures in one or more of these domains.
How healthcare is organised
United Kingdom
NHS as dominant provider. Free at point of care. GP gatekeeping to specialist access. Centralised procurement. Integrated digital infrastructure.
India
Mixed public-private. Out-of-pocket dominant (62% of expenditure[2]). Direct specialist access. State-level variation. Fragmented systems.
Khanna and Palepu's work on institutional voids[3] explains the challenge: Indian innovations succeed precisely by filling infrastructure gaps. When exported to contexts where institutions already exist, they may solve problems that don't exist, or compete with embedded state-supported solutions.
Translation requires: Redesigning the patient journey from consumer-facing to system-facing. Evidence shifts from clinical outcomes to health economics. Strategic accupuncturing is preferred to casting a wide net.
The four gateway principles
Understanding why translation is hard and what specifically must be translated leads to principles for navigating the challenge successfully. These are not abstract guidelines but practical orientations drawn from both academic research and observed patterns in successful cross-border healthcare ventures.
"Translation is not localisation. Localisation assumes the core stays intact. Translation accepts that the core itself may need to transform."
The gateway ahead
A gateway is not just an opening. It is a structured passage that requires preparation, navigation, and adaptation. The companies that successfully translate healthcare innovation between contexts do not simply walk through; they are strategic.
The next article examines these failure archetypes: the recurring patterns that doom cross-context translation before it begins, and the warning signs that suggest a venture is heading toward one.
Continue in The Gateway
Related reading:
- The Systems Paradigm - Understanding context-dependent worldviews
- Move Fast and Break Things? Not in Healthcare - Why healthcare operates by different rules
- UK Health Tech Compliance: See the System - Mapping the UK regulatory landscape
- Why Health Tech Companies Should Set Up in the UK - The strategic case for UK expansion