Whenever you hire someone from a different culture / country, you need to start from the basics by explaining the very core of your society. An Americ

Whenever you hire someone from a different culture / country, you need to start from the basics by explaining the very core of your society. An American programmer might not be too concerned if a body temperature measurement returns 45 degrees Celcius. Similarly, a patient height of 95in probably wouldn't immediately raise alarm bells for a European developer. This is so key and has been overlooked for decades. In addition to what you wrote, I think it may actually go beyond that? There's a certain "team unity" that binds good teams together. It's that extra "something" that helps you get through those tough moments and really work together. I've worked on remote, international teams that HAVE had that kind of esprit de corps. And I've worked on local teams inside the same building that haven't. But, overall? In my experience that kind of unity and teamwork is MUCH harder to build across cultures and/or remote work arrangements. And the difficulty is often multiplied by the "mercenary" nature of consulting work in which consultants obviously aren't really incentivized to worry about that sort of thing - in fact you kind of need to form emotional armor and avoid it to an extent. It can be done, and is absolutely worth doing. (And, in my opinion, it's a form o institutional racism not to...) In my experience it's often as simple as giving employees some space to banter and chitchat and get to know each other. Can be as simple as a #random or a #chitchat IRC/Slack channel sometimes and/or a company culture that allows for some chitchat and getting-to-know-eachother during daily standups. And if you are working cross-culture, at an absolute bare minimum, do some homework to at least understand each others' holidays and intangibles like differences in etiquette and so forth. Thing is, in typical offshoring arrangements, much of this is impossible.