The Tavistock and Portman: Delivering virtual education in China

Overview

The Tavistock and Portman NHS Foundation Trust has been at the forefront of the development of mental health practice throughout its 100-year history.  It has always enjoyed a strong international reputation and been open to the world, with overseas collaborations present from the trust’s inception. 

More recently, the trust has sought to be increasingly strategic and commercial in developing international work, aiming to widen reach and impact, increase financial sustainability and underpin UK service delivery, which would in turn contribute to the trust’s overall vision and mission. This was initiated by the trust’s participation in the 2017 Healthcare UK trade mission, led by the trust’s director of education and training and dean of postgraduate studies, Brian Rock.

What the organisation faced

Before the COVID-19 pandemic, the majority of the Tavistock’s international work was focused on welcoming groups of international visitors for tailored short education programmes.  These were in the leadership and management domain and also for practitioners, and were largely centred on the Chinese market. 
However, when international travel was stopped early in 2020, it became necessary to amend the strategy to provide services in a virtual form and protect this valuable revenue stream.

What the organisation did

The trust decided to explore the virtual option in a limited way in the first instance, and chose to develop one of its existing e-CPD programmes that focused on addressing the issues of adolescence through the prism of psychodynamic approaches.

Unfortunately, despite already being an online course, adapting it wasn’t a straightforward task, as in China a foreign entity cannot hold an Internet Content Provider (ICP) licence. With China’s ‘Great Firewall’ making access to foreign websites inconsistent, the only way to access the Chinese online education market is via partnership. 

Though the Tavistock already had a potentially interested partner with its own web platform, concerns about intellectual property (IP), trademarking and the repatriation of funds created a level of reticence within the trust to take the steps required to develop a tailored programme. 

However, the trust did have some existing online CPD materials that could be shared with its Chinese counterparts, if the right arrangements could be put in place. 

When exploring these commercial opportunities, the primary focus was to ensure the trust was not exposed to any unexpected risks. In order to do this, a number of actions were taken to create the confidence to obtain a consensus within the trust’s internal sign-off procedures:

• A thorough due diligence report was commissioned on the potential partner.
• The trademark was registered in China.
• Spent sufficient time in contract negotiations in order to reach a partial payment upfront model, which allowed confidence in the operating and business model to grow.
• Ensured a legally binding contract in both English and Chinese with provision for well-recognised arbitration in case of a dispute. 

Results and benefits

When the product launched, no one knew quite what the appetite would be for a course addressing the issues of adolescence through the prism of psychodynamic approaches. The trust predicted 500 subscriptions and received over 4,000 in the first three months. This course was adapted from one of the Tavistock’s existing e-CPD programmes and achieved income levels almost equivalent to the those achieved in the UK’s product lifecycle of around three years.

Overall, the pursuit of this partnership has enabled the Tavistock to continue providing the education programmes to Chinese healthcare market. By exploring the virtual option in a limited way in the first instance, the trust was able to test both its capacity to deliver and the required commercial processes, without incurring unmanageable risk.

And the benefits of international engagement are not exclusively financial. In addition to the pre-recorded material, the Tavistock also ran some live sessions to enable students to ask questions and have the opportunity to interact with experts. 

Challenges

While teachers enjoyed these virtual sessions, they found that having more than 400 students on a Zoom call was quite disorientating given that much of the UK-based delivery is conducted through smaller seminar and supervision groups.

There are also key cultural differences in Chinese students’ expectations of education. Broadly, the teacher in China is the expert and expected to provide the answer, rather than the more participative reflective approach in the west.

Though this may initially sound like barrier, if the Tavistock is to remain relevant for the next 100 years we regard engaging with and learning from other cultures as a key competency in an increasingly global world. 

Tips for other organisations

In terms of getting paid, it is important to note that Chinese banks are worried about currency flight and are therefore extremely scrutinous of remittance to foreign entities. In practise, this means that all contractual and invoicing paperwork needs to be in order.

It is also worth noting that there is tax to pay (16.72 per cent) on any monies due.

Rather than get into the complexities of the Chinese tax system, it is better that this is handled by the Chinese partner and this responsibility is clearly stated in the contract.

There was also clear additional value added by using a local partner in terms of:

• using their existing platforms with 5 million subscribers interested in mental health
• understanding of the local market conditions
• marketing expertise in China, which may look different to what might be produced in the UK
• translation and video editing into Chinese.

In terms of delivering the virtual programmes, both students and teachers need to accept cultural differences and not assume one side will adapt to the other.

Truly collaborative learning experiences are created whilst working within cultural tensions, not only when everything is easy. 

Next steps

The Tavistock and Portman now has plans to roll out more of this type of product to the Chinese market.