"We Don't Need No Education" How Untrained Staff Can Negatively Impact the Patient Experience and your Bottom Line

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Dialing the phone number on her screen, Naomi felt a surge of excitement as her mind raced with possibilities. Looks of wonder from her family, compliments from co-workers; actually enjoying the thought of passing in front of a mirror, and best of all, her health would improve and she could finally spend time outdoors with her two kids. She had been morbidly obese for nearly four years – ever since the birth of her second child – and dozens of failed diets later had left her frustrated and depressed.  Recently she had considered bariatric surgery but did not have insurance coverage or the funds to cover the cost – that is, until a friend mentioned “medical tourism” and gave her the name of an overseas hospital.


“Buenos días, este es el Hospital del Atlantico, como le puedo servir?” “Hmmm, do you speak English?” “Un momento por favor.” Beep…beep…beep.  “Departamento de Radiología…” “Yes, I’m trying to find someone who speaks English…” “One momento pleeze.” Beep…beep…beep. “Servicio de enfermería…” “Do you speak English?” “Marta, usted habla inglés? (muffled voice) “No, mandeló a admisión.”

Beep…beep…beep. “Admisión para servirle…” “Does anyone speak English here??? I need to talk to someone about your bariatric surgery program.” “Yes, I speak a litel Engles… wut do you need?” “Bariatric surgery…I hear you have very good outcomes.” “Si…eh…yes we do dis procedure…ahh…the doctor is not here now, cud you coll back anoder time?” Errr…yes, but can’t you give me an email or a more direct number?” “Sorry, cud you repeat again?” “Can you give me an email to contact?” “Oh, yes..yes….you can call info@hospitaldelatalantico.com…den dey will replay back to you.” Uhh…okay…do you know how long they will take to reply?” “No, but dey usually replay bery on time.” “Well, I may look somewhere else then.”

“Excellent! Gudbye, and tank you for choosing Hospital del Atlantico for your medical needs.”

While this scenario may make you chuckle, it is no laughing matter for frustrated patients seeking medical care abroad, or for the many hospitals losing patients, revenue – and their reputation – due to a lack of training and awareness about international patient needs.

The importance of the patient experience

The success of your international program hinges on the patient experience, it’s that simple. In a recent article in this magazine I defined the patient experience as: The patient’s perceptions and related feelings caused by the one-off and cumulative effect of interactions (both direct and indirect) with a hospital’s employees, services, products, customers and systems. In other words, any interaction a patient has with your hospital forms part of the “patient experience.”

Studies have shown that, for a patient, the effectiveness of the interaction with the health providers and coordinators—the experience—is equally important as the accuracy of the diagnosis, treatment and procedure.

Think about that for a moment.  What kind of experience have you created for your international patients?

  • Is your staff culturally competent?
  • Who’s picking patients up at the airport?
  • What type of accommodations are you recommending?
  • Are your staff pre-loading patients with the right information?
  • Are they looking after the needs of the companion?
  • Do your doctors and nurses understand the particular needs and expectations of international patients?
  • Are their language barriers across any of the patient touch points?
  • Are you obtaining feedback and acting on it?

Any one of these details can have a huge impact on the patient experience. Great patient experiences don’t just happen out of the blue!  They are the result of planning, training, and putting a structure in place that allows them to thrive.


Too many hospitals these days are talking the talk but not walking the walk. “Yes, we want to attract international patients.” “Of course we have a medical tourism program.” But when you ask what steps they are taking to increase their international patient flow it’s hard to get a straight answer.

The effect the patient experience has on your bottom line

Happy patients breed new patients, new patients breed newer patients and so on, increasing brand awareness, building your reputation and ultimately growing your bottom line.

According to a 2012 survey by Echo Research, three out of four consumers say they have spent more with an organization because of a history of positive customer service experiences.

More importantly, the survey showed that on average, consumers tell 15 people about their good experiences and nearly half of consumers tell someone about their good customer service experiences all of the time.

You may be thinking: Sure, that’s what surveys always say, but in the real world these stats rarely translate into real-life patients. Consider this:  If you can bring in just four additional international patients a month during the year you can generate approximately $336,000 USD* (assuming $7,000 avg. per procedure) in additional revenue.

With the addition of word of mouth advertising and effective marketing you can increase your revenue exponentially. At 50 patients a month you can increase your hospital’s revenue to approximately 4.2 million per year.

Let me also give you a real world example of the power of word of mouth advertising (one of many).

A few months ago we assisted a U.S. patient who came for metabolic surgery (a procedure similar to a gastric bypass that often resolves the symptoms of type 2 diabetes).  Jim (not his real name) had been in contact with our team for a couple weeks but had still not committed to the procedure.  


So we put him in touch with a couple of past patients who had undergone the same procedure and the day after talking to them he called and confirmed the dates for his surgery. A few weeks later he was in Costa Rica recuperating from a very successful surgery.  


Before he departed he expressed to us how happy he was with the results of the procedure, but how utterly amazed he was with the professionalism and warmth of the people who attended to and anticipated his every need.  


He told us how he felt genuinely cared for and not just a number on a computer screen. Within six weeks of his departure he had already referred two more patients to us. Happiness, my friend, is contagious; it spreads like germs on a doorknob! (Oops, wrong metaphor.)

Poor service leads to lost sales

Unfortunately, the opposite is also true.  The same Echo Research survey revealed that, on average, 24 consumers tell others about their bad experiences and 56 percent of consumers talk to people about them all the time.

According to these statistics, if just one international patient (or prospective patient) a month is having a poor experience, then there are at least 288 people a year who are hearing negative things about your hospital. In the real world, though, some of these people will post negative experiences on blogs or other social media and a percentage of them will tell others and so on.  


This can exponentially increase negative exposure to thousands of people – some of them are potential patients who will not choose you for their healthcare needs simply because twelve patients had a poor experience at your hospital.

Say you are losing just three patients a month due to bad patient experiences. At the end of the year you will have left approximately $250,000 USD (assuming $7,000 revenue per patient) on the table. Multiply this by five years and you get a real idea of the potential revenue you are losing.

Investing in your staff

I’ll let you in on a little secret. One of the most important steps you can take to improve the patient experience is to train your staff. Doctors study for years in order to diagnose and treat patients. Nurses undergo intensive training and certification. Even a hospital’s cleaning staff follows certain protocols to perform their job well.


But when it comes to international patient services, we often try to wing it. I’ve heard this one many times: “Juan from marketing can handle international patient requests…or we can move Susan from admissions, she speaks Spanish pretty well.”

If there is one thing I have learned over the years, it’s that patients (particularly overseas patients) do not connect emotionally with your ultra-modern facilities, cutting-edge technology or the fact that one of your doctors has performed 2,000 flawless hip surgeries.


These are important elements no doubt, but in the end they’re gravy. The real reason they’ll choose your hospital (in the vast majority of cases) is because they like and trust the person or persons with whom they are communicating with on a daily basis. In my experience this is typically the patient coordinator (a.k.a. case manager) or the primary physician.

Don’t underestimate the impact your staff has on the success of your international program, both positive and negative.

  • To ensure that it is the former, your staff should be trained to:
  • Anticipate international patient needs and expectations
  • Understand the necessary services, both clinical and non-clinical expected by patients
  • Use proper communication and sales techniques
  • Practice cultural and emotional sensibility
  • Manage facilitator, insurance and agency relationships
  • Implement risk management protocols when accepting and attending patients
  • Properly handle patient complaints
  • Properly manage the continuum of care process

Doctors, nurses and frontline staff should also be aware of their unique roles in improving the patient experience. Management must possess the knowledge to implement a care path specifically designed for international patients.

An empathetic patient coordinator, doctor or nurse that understands a patient’s cultural background, listens, connects emotionally, and knows what to say and how to say it, is worth his or her weight in gold. Put them in a hospital system with appropriate protocols and services for international patient care and you have all the ingredients for a successful international program.

About the Author

Bill Cook is a Medical Tourism Training Instructor – International Patient Services Certification Program for the Medical Tourism Association. He is an internationally recognized expert on medical tourism and international patient services, having built one of Latin America’s most successful international patient programs by focusing front and center on providing an outstanding international patient experience. During the past six years Bill and his team:

  • Managed offshore medical care for nearly 2,500 patients treated at Costa Rica’s three JCI accredited facilities
  • Created and managed Hospital Clinica Biblica’s international patient department, positioning Hospital Clinica Biblica as one of the world’s premier medical tourism destinations

He has coauthored four books: “Developing an International Patient Center,” “The Medical Tourism Facilitator,” “The Las Vegas Health and Wellness Guide” and “The Jordan Health and Wellness Guide” together with Renee Marie Stephano, president of the Medical Tourism Association.