Letters to the Editor
I thank Dr. Williams for his thoughtful comments. The articulation of the four “development stages” was a framework that was not intended to characterize an organic maturation process for a particular institution. Rather, the intent was to reflect stages, or “levels,” of involvement that an organization can attain. While some organizations may evolve along a path that may be reflective of the stages, others can start immediately at the highest stage. The University of Pittsburgh Medical Center is a good example with their first international commitment to own and operate a joint-venture transplant hospital in Sicily. The framework recognizes distinct sets of activities with varying levels of commitment while also recognizing the fact that academic health centers can develop internationally along the three missions of education, research, and/or clinical care. The five points raised to reflect development components for a relationship or venture abroad are well articulated and critical for success.
Michael G. Merritt, Jr.
Executive director, international business development, NewYork-Presbyterian Hospital, 14 East 60th Street, Suite 1201, New York, NY 10022; (firstname.lastname@example.org).