Geoffrey Hamilton-Fairley, Operating Partner at GHO Capital, draws on decades of international healthcare experience to examine how regional players can successfully navigate the complexities of global expansion. As healthcare markets continue to evolve in 2026, he explores the critical capabilities, strategic considerations and operational disciplines that separate sustainable international growth from costly missteps.
The journey from regional healthcare provider to global leader is rarely straightforward. It requires more than just ambition and capital – it requires a fundamental understanding of what makes international expansion sustainable, and a willingness to confront uncomfortable truths about operational complexity, culture and risk.
Market Opportunity Before Operational Capability
When GHO Capital evaluates regional healthcare companies with aspirations to scale internationally, our first consideration is always the market opportunity. Does genuine demand exist? What does the competitive landscape reveal? Only after establishing that an opportunity is real do we turn our attention to operational capability, where the greatest risks typically lie. There is a persistent danger in assuming that success can be simply replicated across borders, and the consequences of such assumptions can be costly.
We invest considerable effort consulting with local operators and those who have built operations in target territories, whether in healthcare, manufacturing and adjacent sectors. This helps us to understand the potential pitfalls of introducing new businesses into new regions – some markets are much more resistant to new entrants than others. These barriers can manifest in numerous ways: entrenched relationships between existing providers and healthcare systems, regulatory environments that favour incumbent players, cultural preferences for established brands, or simply the practical difficulties of recruitment, logistics and establishing credibility in unfamiliar territory. What appears straightforward on paper – replicating a successful model in a new geography – often proves far more complex in practice. Learning from those who have navigated these challenges, even in adjacent industries, provides invaluable intelligence about what actually works versus what merely sounds plausible.
We also assess whether partnerships with distributors might offer a more sensible route to market than building from scratch. Whilst this approach may require sharing margin, it can materially reduce execution risk and often provides access to established distribution networks. In time, these relationships can lead to targeted acquisitions once we truly understand how the market operates.
The regulatory landscape presents its own evolving challenges. Whilst harmonisation exists in certain areas – with many territories adopting FDA regulations – the ground continues to shift. Some of GHO’s portfolio companies, such as CDMO RoslinCT, work alongside clients introducing new therapies through the lengthy journey from early-stage clinical trials to market authorisation. Recent changes, such as the US’ acceptance of phase 1 and 2 trial data from China (whilst still requiring phase 3 trials and FDA inspections of the manufacturer for market entry) have altered strategic calculations considerably. Strategies must be robust enough to withstand decades of regulatory evolution, not merely optimised for today’s tariff environment.
The question of where to manufacture is increasingly strategic. Whilst it remains possible to manufacture for the US market from facilities in Scotland, as Roslin does, proximity to patients matters enormously, particularly for autologous therapies where logistics are critical. Given current geopolitical uncertainties, most organisations now accept they must maintain both US and non-US manufacturing capabilities.
The Importance of Local Expertise
Local expertise is essential. Without it, companies are effectively navigating blind. The nuances in employment regulations, HR practices and recruitment carry enormous operational impact. Consulting with those who have recruited and built teams in target territories, even outside our immediate competitive sphere, provides insights that are difficult to obtain elsewhere.
At GHO, we support portfolio companies by surrounding them with experienced operating partners who have accumulated valuable lessons through previous experience and developed rigorous planning frameworks. We can also leverage specialist organisations within our network – ELIQUENT Life Sciences, for example, provides regulatory advice spanning the US, Europe and beyond. More broadly, GHO maintains an extensive network of healthcare specialists across every discipline, enabling us to access targeted expertise rapidly.
RoslinCT’s US acquisition illustrates both the opportunities and challenges. Building trust across territories requires patience, transparency and consistent demonstration of commitment. Objectives must be communicated far more frequently than may feel natural and reinforced through sustained action before they are broadly accepted by the workforce. When organisations are growing rapidly, these cultural challenges intensify – so you need more time, more energy, more expertise and more experience to support companies through these transitions. GHO is well positioned to provide this support.
Separating Strategy from Operations
Our approach to maintaining resilient growth strategies centres on a clear separation between strategy and operations. Operational teams need to remain focused on execution without distraction from market speculation or strategic pivots that may never materialise. At GHO, we shoulder the burden of monitoring market evolution and preparing contingencies, while shielding operational teams from this noise until changes become concrete realities. Focus is the scarcest resource in any growing organisation.
This extends to how we think about leadership. The challenge of integration across territories demands particular qualities: the ability to build trust across cultural boundaries, maintain consistent messaging whilst respecting territorial differences, and avoiding the temptation to impose change for its own sake. Many leaders, when joining growing organisations, feel compelled to put their stamp on the business through change, without fully appreciating the disruption this creates. Change can create a huge risk, and so unless something is genuinely broken, it’s important that management offer continuity in messaging. People often say that being a CEO is the loneliest position in the world, which it can be, for many leaders. One area where GHO adds distinctive value is by ensuring CEOs are not isolated. Through our board composition, non-executives and operating partners, we provide a breadth of perspectives and support that complements operational leadership. Our CEO forums create environments where leaders can discuss unexpected challenges openly and access confidential coaching from experienced practitioners.
Measuring Success: Operational Metrics That Matter
Our definition of success extends well beyond traditional financial metrics. We focus intensively on business-specific operational measures: cost per full-time employee, efficiency benchmarks against competition, and granular metrics around manufacturing, product development and client delivery. These indicators are clear, practical and actionable and when shared with operational teams, they provide precise direction on where to focus improvement efforts.
