Caring for Out-of-Town Patients ~ Lessons Learned

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Since medical tourism became an industry buzzword many private hospitals around the globe want to get a piece of the business and start attracting more out-of-town patients. But as many are learning now the business of coordinating safe quality care for patients traveling long distances is not an easy one.


For decades patients from all over the world have come to our institution The Johns Hopkins Hospital in Baltimore Maryland in search of the latest diagnostic services and treatments. It was not until 1999 that the efforts of coordinating care for out-of-town patients were better structured and formalized. Since then we have learned a lot. And we would like to share with our colleagues in other hospitals around the globe some of the lessons we have learned.


These lessons I believe go beyond international patient programs. What I have learned in this journey is to expand my own notions about clinical quality and marketing to include in our strategic priorities the need for outstanding services and impeccable non-clinical patient coordination for patients from home and abroad.

OUR INSTITUTION OUR CHALLENGE

The Johns Hopkins Health System is now an enterprise that includes four acute care hospitals with a total of 1897 beds. Our School of Medicine employs 2590 faculty members.Our flagship hospital is The Johns Hopkins Hospital. This hospital is within a cluster called Johns Hopkins Medical Institutions a campus with more than 25 interconnected buildings that include not only the hospital but also our Schools of Medicine Nursing and Public Health.


As you can imagine this environment could be very challenging to navigate for our-of-town visitors.Hopkins has been ranked the number one hospital in the US for 20 years in a row. But the truth is that good customers and non-clinical patient services have never been our strength. Until the late 1990s many accused Hopkins of being a narcissistic enterprise the type that at times would treat its patients as you're lucky were taking care of you.


We were painfully aware that our service did not match the excellence of our science. We knew things had to change.According to McKinsey Quarterly More and more patients are likely to base their choice for hospital on non-clinical aspects of the visit-like convenience or amenities.


Most patients perceive their experience not through the science of the encounter but by the human touch of each encounter during their hospital visit. No wonder research after research shows that the key factor for a patient to choose a hospital is the perception that Staff is caring and supportive. Non-clinical services are usually the areas where with the lowest investment we can have the highest impact on the way a patient perceives his or her hospital experience.


With more than 300 hospitals around the globe certified by JCI hospitals who aim at attracting patients from other cities will have to offer an outstanding level of service and have that service be a differentiator in an increasingly competitive global market where good physicians facilities and international accreditations will become the norm.

TEN LESSONS LEARNED

These are the ten lessons I would like to discuss today:

1. Hospitals Need a Sound Loyalty Plan

In an increasingly competitive healthcare market patient loyalty has become the keystone of a sound branding strategy for any hospital. Loyal patients are those who are the most likely to return to your hospital and most importantly are the most likely to recommend your facility to friends and family. Since 2004 Johns Hopkins Medicine International has worked in a comprehensive strategic approach to improve all the operational aspects of coordinating care for out-of-town patients.


We call our loyalty program CRM (Customer Relationship Management).Evidence shows loyal patients are the most cost-effective marketing a hospital may have in place. Especially when trying to reach out to an array of distant markets.


Because of the increasing choices that patients have when deciding where to go for their medical care and all the logistics inherent in traveling for healthcare impeccable non-clinical services are a make-it or break-it business requirement for any facility or cluster of hospitals who want to increase their reach to attract patients from other cities or countries.


CRM is not just a type of software you buy to track your patients experience. CRM is a shift in the culture of how we do business. It is comprehensive measurable and systematic. This is not your typical service excellence program. CRM goes well beyond service excellence to involve your patient safety quality billing and finance marketing and human resources departments.

2. It Is All About the People Our People.

In a hospital your human capital is your best asset. Without satisfied employees you cannot have satisfied patients or clients. Therefore any sound strategy must include tactics to engage the frontline employees.CRM cannot be something imposed from the top. You cannot mandate good attitude. Rather make your staff part of the solution engage them into how to make things easier for themselves in their daily lives.


Chances are those things that make your employees life difficult is what is preventing your patients from getting the best service possible.Additionally in order to have satisfied engaged employees who are part of the solution and not part of the problem you will require a committed human resources department that will support your CRM initiative with strategies for career development for hiring evaluating and placing employees in the correct positions.


Human capital requires also investment: on training tools and ways to work more efficiently. Long gone are the days where a hospital can only afford training for the top management.

3. Focus On Your Advocates

Loyalty programs divide the market following a pyramid model. The bottom of the pyramid is where the unknown potential patients are. It is large. Above the unknown we have the target. Those populations we want to reach. Above the target we have the prospects. Those are the patients who have shown an interest in coming to your institution. Above prospects we have clients those patients who visit once.


We are now getting close to the narrower top of the pyramid. We have two more segments the two most important from a marketing perspective: customers those who visit your institution more than once and finally at the very top of the pyramid sit the advocates. Advocates are your most important champions. Those are the patients who are so loyal to your institution that they will recommend everybody to come to you.

4. Map the Experience of Your Patients

What are we putting our patients through? From the moment they contact us to request an appointment to the moment they go back home there will be dozens of touch points places where you will have the opportunity to get it right or wrong delight them or frustrate them. Do we really know what all the steps a patient has to take before during and after their appointments are?


You should look at the experience form the patients perspective. It teaches you about your redundancies your deficiencies. It helps you understand what improvements can be made to become easy to do business with.After we developed our map we created tools checklists processes and service standards for each touch-point with the patient.

5. Secure the Continuity of Care

In large hospitals with many decentralized services there is always a risk to lose track of the continuity of care. This happens because our processes were not developed from the point of view of a patient but rather from the different competing and redundant needs of each of the silos that touch the patient.This is why in quality and patient safety we strive to come back to a patient-centered model of care.


Through CRM we pay special attention to continuity through two processes: one more clinical considering care management and another one non-clinical involving the figure of the patient coordinator.The clinical team assists in-patients and families with education discharge and follow-up care. Additionally the team serves as clinical liaison with international insurance companies.


This care management takes the traditional US care management process one step further taking into consideration the specific needs of international patients.We also improved the figure of the non-clinical patient coordinator. This is one call full service concept that allows our patients to have only one contact point for everything related to their Hopkins experience.


When needed the navigators are certified medical interpreters who are familiar not only with the linguistic needs of the patient but also with the cultural nuisances and issues. These navigators act in fact as cultural brokers making sure that all aspects of the experience are culturally competent.

6. Use Technology to Support Processes

In our case the CRM technological solution was not expensive software but rather a fairly simple database that allows us to have the whole picture of a patients interaction with our institution.We called our solution UTOPIA because our employees were so exhausted of having to input the same information over and over again in different databases that when we offered them the opportunity to have everything in one place they thought it was too good to be true.


This solution allows us to understand each patient as a unique individual; we can track his or her personal preferences as well as understand the referral pattern where did they hear about us and why they did decide to come to Hopkins.

7. Involve the Marketing Department

One of the key success factors was to recognize the fact that our best marketing was good service.Therefore we structured our marketing department under our operational leadership and we engaged their expertise on how to communicate to create extensive plans on how to communicate with our customers and advocates before during and after their visit to Hopkins.

8. Measure Results

The functional units that piloted this loyalty program within Johns Hopkins Medicine were able to double their number of patients in only four years. Patient satisfaction for these units was up to 95 percent.Your CRM program should include a clear list of indicators that you can track and report. Some ideas include: Unique Number of Patients Patient Discharges Downstream Revenue (Financial Impact) Number of New Patients vs. Number of Repeat Patients Word of Mouth Impact Patient Satisfaction Likelihood to Recommend Employee Satisfaction as well as any ad-hoc ROI (Return On Investment) for specific initiatives such as loyalty events the original social networking.

9. Celebrate Success

Pamela Paulk our VP for Human Resources once told me: When somebody does something wrong tell them. When somebody does something right tell everybody. Employee recognition can be a great learning and teaching opportunity for all when we establish through awards for example who are the leading employees those who we as leaders believe are the best of the best those who impresses us inspires us those who we want to emulate.

10. Practice Continuous Improvement

The key of any great quality intervention is to secure its continuity and momentum. Improvement must be part of your hospitals DNA. Every time we improve we must think about what is next what is the next best thing that we can do for our patients.


This is why changing our corporate culture should be the most important and maybe is the most difficult aspect of any quality intervention.I hope this article has provided you with some ideas on how to make everlasting changes to the way you coordinate your out-of-town patients. Trust me. It pays.

About thr Author

Emilio M. Williams is Managing Director at Johns Hopkins Medicine International since 2001. In the last 10 years Williams has led several high-profile innovative projects within Johns Hopkins Medicine in Baltimore. In this capacity he lectures and offers consulting services to healthcare organizations around the globe in the areas of strategic marketing customer loyalty and cultural competence.


As a Director at JHI Williams was in charge of using traditional and new ways of communication to expand around the globe the mission of Hopkins in patient care biomedical research and education. (www.jhintl.net) As part of a comprehensive marketing strategy Williams conceived and launched the first formal Customer Relationship Management (CRM) initiative within Johns Hopkins Medicine a program aimed at securing the loyalty of Hopkins' customer base.


Additionally he supervised the communications and marketing efforts of affiliated Hopkins entities around the globe.Before joining Hopkins in July of 2001 Williams had accumulated extensive experience as an entrepreneur and journalist in the global communications arena. In September of 2000 Williams co-founded GD Solutions a multimedia communications company dedicated to develop culturally sensitive health information for the Spanish and Portuguese speaking communities.


During his tenure as CEO of GD Solutions he was a consultant with the private and public sectors on how to develop meaningful health messages for a new millennium. Clients included NIH Johns Hopkins Medicine Dupont Pharmaceuticals Glaxo Welcome among others.Williams has also held several important positions inside Cable News Network (CNN). In Washington he produced international talk shows and political breaking news.


In CNN's headquarters in Atlanta Williams served as assignment editor managing the daily coverage of bureaus and reporters around the world. He also acted as news reporter for CNN en Español CNN Radio Noticias and several media outlets property of the Tribune Co. including ¡Exito! And the groundbreaking Internet project Metromix.Williams holds degrees in journalism from CEU San Pablo Madrid and in film and video from Georgia State University.


As a healthcare executive he has visited and collaborated with projects in Argentina Bahamas Bermuda Brazil Canada Chile Colombia Dominican Republic Japan Lebanon Mexico Singapore South Korea Spain Panama Peru the Philippines the United Arab Emirates the United States of America Venezuela and Vietnam.His email is
ewilli24@jhmi.edu