"Coordinated Care: What Hospitals Around the Globe Can Learn from the Experience of US Hospitals"

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Healthcare in the United States, and in many other places around the globe, is living a watershed moment: the advent of Accountable Healthcare, or pay-for-performance. This trend describes the increase pressure by payers (both governments and private insurances) for healthcare providers to show better clinical outcomes efficiency and patient satisfaction, proportionally correlating payments to specific measurements on those fields.

With the increase in consumer and patient empowerment, and the growth in choices that patients have for quality healthcare in local, regional and international markets, patient satisfaction is a priority for all hospitals, independently of when (and not if), pay-for-performance will be coming to a particular market.


Clinical Care Service Coordinators will have an important effect on how institutions prepare for Accountable Healthcare because they are helping to increase patient satisfaction, and are also freeing time from nurses so they can spend more time coordinating the clinical aspects of their visits and therefore having a more positive clinical impact on the patient.

Meet the Clinical Care Service Coordinators

In the last year, Johns Hopkins has hired over twenty CCSCs, and the number will be increasing. Each coordinator is assigned to a nurse unit, or specific floor. Although these coordinators do not have formal clinical training, they’re neither nurses nor physicians; their main function is not to be underestimated.


A CCSC establishes a direct relationship with inpatients and their family members. They get to know patients and relatives in a more personal way. Hopefully that emotional rapport will increase feedback from patients and will give hospitals a chance to get things right CCSCs are highly trained in all aspects of customer service and patient satisfaction, with a special focus on service recovery.


Service recovery is the strategy that allows hospital employees to turn a bad situation into a positive experience for our patients and their families. Service recovery is the best training that we can give to all our staff members, it should be mandatory, because it offers our troops the empowerment and skills to be ahead of the curve and prevent any bad situation from escalating into a full-blown patient complain.

World-Class Coordinators

Years ago at Hopkins, the buzz word was “Service Excellence”. The institution had come to the realization that the service was not on the same level as the science. Many of the leaders and employees felt that it had fell into the narcissistic trap of treating patients as “you’re lucky we’re saving your life”. Things had to change, especially if the institution wanted to become a national and international destination for patients.

Around that time, Hopkins started investing heavily in new units that will serve as change agents in the journey to deliver world class services. Those units were staffed with patient coordinators, or navigators, that helped patients coming to Hopkins from overseas (Johns Hopkins International), or from out-side the state of Maryland (Hopkins USA).

Contrary to CCSC who are based in one unit or floor, international and national patient coordinators are a one call full service, contact person for all aspects of a visit to the institution.

These units demonstrated that coordinated care has a huge, measurable impact on patient, physician, and payer satisfaction. Most importantly, the units became very rapidly not just self-sufficient from a financial perspective, but very lucrative for the institution, and for the many institutions in the United States that developed national and international patient programs.

Coordinated care, a service provided by patient navigators, resulted into highly satisfied patients, who, in turn, became very loyal advocates for the institution; a de-facto marketing department that would recommend the institution to friends and family members around the world. In many instances, that loyalty turned even into monetary contributions, or philanthropic gifts, to the development of the not-for-profit mission of Johns Hopkins.

Hospitals around the globe interested in the medical travel segment should carefully look at the lessons learned from the in-bound medical travel segment in the United States.

Global Centers of Excellence

Leading U.S. Medical Centers are a great case on best practices when it comes to the coordination of out-of-town patients. These centers learned very early into their out-of-town growth that non-clinical services are key for a successful play in the national and international arena.

According to a study published in McKinsey Quarterly in November of 2007: “More and more patients are likely to base their choice for hospital on non-clinical aspects of the visit-like convenience or amenities.”

Why is that?

As quality of care increases in the U.S. and abroad, as more and more hospitals acquire the stamp of approval of an international accrediting body, patients take clinical quality for granted.

On top of that, for most of us, the clinical aspects of the encounter are a mystery. Our first impression about the quality of a physician, a nurse, or a whole hospital, is not based on medical aspects of the encounter. Rather, our first and lasting impressions of a hospital are based, research shows, on “how well staff communicated with me”, or “the overall cheerfulness of the institution”, or “how quickly my concerns were addressed.”

Coordinated care is especially important for out-of-town patients. We need to offer patients traveling from other locations a complete experience that will include all aspects of service before, during and after their appointments and visits to our hospitals.

Proper continuity of care continues to be the thorn in the side of the international medical travel industry. It threatens the credibility of our whole industry and, most importantly, the safety of our patients.

To secure the proper continuity of care, many U.S. medical centers also employ one or two full time case managers, or clinical nurses who interact with clinical and non-clinical personnel to secure the proper continuity of care.

Still the larger piece of investment will have to be on navigators and non-clinical coordinators.

Hospitals will have to invest on those coordinators, our human capital, to secure the proper training and to make sure that those coordinators are happy and well engaged in their role. It has been demonstrated, over and over again, that without satisfied employees we can’t have satisfied patients.


The right processes, implemented by the right people will have to be supported by some simple technology solutions, tools that will allow the institution to track all aspects of a patient visits, his or her preferences, and will allow us to follow up properly and at the right times with the patients (birthdays, maybe, or time to schedule follow up appointments).

Processes, people and technology, will be the three legged stool in which we can rest our Customer Relationship Management (CRM) strategy.

CRM will result in loyal patients, and loyal employees, which in term will result in increased volumes, from our target markets, and revenues.

Cultural and Linguistic Services

One of the areas that U.S. centers have excelled at is cultural and linguistic services. The natural cultural and linguistic diversity of the United States, has given these centers a competitive advantage over other locations around the globe.

The need for cultural and linguistic competence is fundamentally important from our websites and marketing materials, to our actual in-person services. For example, how can a hospital outside the U.S. create a sense of quality and credibility to attract U.S. patients if their communications in English are not impeccable?

And most importantly, are our physicians and nurses ready to handle the challenges of taking care of patients from a very different culture?

Coordinators can also be a cultural broker between our institution and our patients. Most U.S. centers with international programs employ native, certified interpreters that can be assigned to patients from the same country, with the same languages, and in cases with the same religious background.

At the end of the day, hospitals will have to invest in human capital, and culturally competent coordinated care, if they are serious about becoming an international player. Good pricing will not suffice to compete in the international arena unless it comes along with quality. Non-clinical coordination, as we have seen, is a tool we can use to easily improve the satisfaction of our patients traveling for healthcare.

About the Author

E.M. Williams-Lopez is a former Managing Director and Strategic Advisor for Johns Hopkins Medicine International. He has traveled around the globe giving talks and seminars on patient experience, service excellence and cultural competency. He currently works as a consultant helping hospitals develop and implement strategies to build up new domestic, regional and international markets and coordinated patient programs. He can be reached at williams@strateghealth.com