Top global businesses appear to be less healthy than their locally focused counterparts. That's the finding of McKinsey researchers Martin Dewhurst , Jonathan Harris , and Suzanne Heywood , who matched organizational health scores--from McKinsey's own organizational-health index database--with top performing multinationals and top local companies. And they found this: The authors write, in the McKinsey Quarterly : To understand what lies beneath these findings, we interviewed executives at 50 global companies. Those interviews, while hardly dispositive, suggested a relationship between organizational health and a familiar challenge: balancing local adaption against global scale, scope, and coordination. Almost everyone we interviewed seemed to struggle with this tension, which often plays out in heated internal debates. Which organizational elements should be standardized? To what extent does managing high-potential emerging markets on a country-by-country basis make sense? When is it better, in those markets, to leverage scale and synergies across business units in managing governments, regulators, partners, and talent? One global company, hoping to realize the benefits of scale and, simultaneously, of focusing intently on India and China, recently started deploying business unit “CEOs,” whose responsibilities cut across both of those high-growth markets. Complicating matters further, our interviews suggested that, for most companies, about 30 to 40 percent of existing internal networks and linkages are ineffective for managing global–local trade-offs and instead just add costs and complexity. Many companies, for example, can’t identify transferable lessons about low-income consumers in one high-growth emerging market and apply them in another. Some struggle to coalesce rapidly around market-specific responses when local entrants undermine traditional business models and disrupt previously successful strategies. Read Understanding your ‘globalization penalty’ here .