Redefining Quality within the Context of the International Patient Experience

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Wiping the sweat from his brow, John leans forward again trying to make eye contact with the receptionist in admissions. A momentary flicker of her eyes gives him cause for hope, but just as suddenly she returns to flirting with her cell phone.


He looks to his wife but she is engrossed with the latest best seller on her Kindle. In desperation John scans the room around him in search of a friendly face or someone who can help him. Instead he is greeted by a hospital admission area filled to the brim with a mix of patients, family members and hospital staff speaking exotic-sounding languages.

It was supposed to be so easy – at least that is what he was told by the medical travel facilitator…he’d be picked up at the airport and then taken to the hospital where he would be met by a staff member who would assist him with the admission process.  


Instead, he waited at the airport for nearly an hour before an apologetic tour guide found him in line at a pay phone.  Then another hour in bumper to bumper traffic brought him to the hospital.

“Mr. Yoness?” A tap on John’s shoulder brings him face to face with a petit young woman who identifies herself as a hospital representative. “I’m Mr. Jones, where have you people been?” “I apologize, there wuz a little problema wit our scheduling but all is guud now. I am here to helpe you with the admission procedure.”


Flicking off her Kindle John’s wife joins him as he takes a seat in admissions. “Mr. Yoness, you will need to feel out thees consent forms and waibers before we take your blud.” A stack of documents is dropped in front of him; as he scans them he quickly realizes that they are not in English.


“Do you have these in English? I don’t understand what they say.” “I’m very sorry, we are sapost to have dem in Ingles but dey are still not ready. But not a problema, I will helpe you to feel dem out.”

Thirty minutes later John is off to his pre-operative exams; as he registers in the lab area he is asked if he has fasted for the last twelve hours. Angry, John replies that he has just arrived from an eight hour flight and that no one had mentioned anything about fasting.  The hospital representative and lab receptionist both exchange puzzled glances, then apologetically he is rerouted to the x-ray department.

Along the way he notices that the hospital is spotless and modern, but all signs are in a foreign language and very few of the staff speak English.  Standing with his wife in the imaging department, John marvels at the high-tech equipment that would put his local hospital to shame. Yet he feels alone; no one is there to answer his questions or to explain what is going to happen next.

Later that afternoon he is taken to meet his surgeon. The doctor is delayed, so John and his wife are left alone outside his office for over an hour before he finally shows up. John understands that doctors are busy, but it would have been nice if someone had passed by occasionally and updated him on his arrival status.


The surgeon is nice and attentive – a dozen certificates splayed out above his head reassure John that he is in the hands of an experienced specialist. Yet his English language skills are moderate at best, making the communication process painfully slow.

As John leaves the doctor’s office he ponders the fact that he’s flown five thousand miles to a hospital in a strange land and culture, in search of renewed health for his ailing back. Yet he is starting to wonder if he has made the right decision.

The next morning he is wheeled into surgery; the last thing John remembers is the face of the anesthesiologist fading into never never land.  John wakes up to the beep beep of a heart monitor. His body is shaking slightly from the cold as he tries to focus on his surroundings.


Nearby, several nurses are chatting around a desk. One of them points at John and comes by to check his vital signs; she never looks him in the eye or asks how he is doing. When John asks how the surgery went, she shakes her head, “No talk Ingles.”

The next day John recovers in his room. His back is starting to feel better and he is grateful that the procedure was a success.  Unfortunately, the day has been filled with constant pain and communication problems.  It seems like pain is endured here rather than managed, and most of the nurses – though cordial – can barely communicate with him. Just asking for some crushed ice took ten minutes of hand gesturing.

After a couple days he is discharged to a hotel to recuperate.  To John’s surprise he finds himself on the second floor of a building with no elevators.  John’s room is cozy but very difficult to negotiate for someone just out of surgery – no shower, just a high rim bathtub that he is unable to use due to his limited mobility.  


The hotel staff is attentive but they have little or no experience attending to patients.  Due to a lack of follow-up care a post-surgical infection is left undiagnosed for several days, contributing to an additional night stay in the hospital.


Two weeks later John is on a flight back home. His back is healing nicely but he has no intention of recommending the hospital to friends and family as his medical trip was, for the most part, an unpleasant experience.

What we have witnessed is a fictional – yet all too common story for patients traveling across borders for medical care.

What can we learn from this patient’s experience?

International accreditations, cutting-edge technology and a focus on patient safety and positive outcomes do not automatically translate into a great international patient experience.  The reason is simple: medical quality is only part of the equation (though undoubtedly our primary concern).


When we consider Quality within the context of medical travel, it becomes clear that we must approach it from a broader perspective; one that encompasses not only outcomes and patient safety, but also the clinical and non-clinical needs and expectations of international patients along the entire medical travel process.  In short, we must focus on improving the international patient experience.

What does this mean to you? If you’re a hospital or clinic with an international accreditation and great outcomes you may still be falling short on the patient experience meter. In other words, patients may not be recommending you for any number of reasons that have nothing to do with medical quality:

  • Prospects are getting lost on your website
  • You are slow to respond to an inquiry
  • Your customer service representatives are responding incorrectly
  • There is a language barrier
  • You fail to understand your international patients’ expectations
  • There is a cultural issue or misunderstanding
  • You lack established care paths and protocols for international patients
  • You fail to follow-up with your patients

Defining the “patient experience”

The “patient experience” can be defined 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.”  That covers a lot of territory!  Don’t make the mistake of thinking that the “patient experience” starts at your hospital or even in your country. It is much much broader than that.

When does the international patient experience begin?

  • When patients land on your website
  • When patients see your doctors speaking on YouTube
  • When patients talk to a friend who had a treatment at your facility
  • When patients see your hospital’s information on a medical tourism facilitator website
  • When patients call your hospital and receive an answer in broken English (or the language of your international patients)

When does the international patient experience end?

Not until the patient tells you to get lost!

Hospitals must nurture and grow their patient relationships with emails, calls, and newsletters, providing valuable advice and information.  This can go on for years and even decades. There is a patient we have assisted over the years; he is an English gentleman who lives in the United States.  


Recently he told me, “If I were in a car accident, I’d drag myself to the nearest airport and hop on a flight to Costa Rica to be treated at your facility.” This type of reaction is the result of staying in touch with your patients.


Why should we focus on the international patient experience?

  • Because it is the right thing to do. International patients are traveling thousands of miles to seek care at your hospital. The least we can do is try to satisfy their needs and provide them with a positive experience.
  • Because an increasing number of traveling patients are expecting a VIP treatment experience that will make them say “Wow!” Quality accreditations such as Joint Commission International are no longer the only criteria patients are looking at when choosing a medical facility.
  • Companies are looking to implement and incentivize medical travel as a way to save hundreds of thousands of dollars off their employee healthcare costs. One of the keys to these programs gaining acceptance and traction at your hospital is to provide a high quality patient experience.
  • Highly satisfied patients drive more patients, thereby increasing your international patient volume and lowering your marketing costs.

How do we create a consistently outstanding international patient experience?

  1. Understand the needs and expectations of our international market
  2. Implement the necessary standards, services and protocols to address the needs and expectations of our target market
  3. Constantly gather feedback from your international patients in order to refine and improve your services

If you’re a hospital that delivers a consistently high quality medical travel experience then you should do everything possible to shout this fact out to international patients and companies sending patients.

International patients have a right to know which hospitals have the standards, services and protocols in place to address their needs and expectations. On the other hand, if your international patient services are deficient, or if you have no idea how to deliver a quality medical travel experience then you would do well to seek education and training. Fortunately, help is now available.

International Patient Services Certification

With the goal of improving international patient services at hospitals around the world, the Medical Tourism Association™ recently announced the launch of the International Patient Services Certification (IPSC).

The IPS Certification is granted to hospitals that have demonstrated that they have the necessary standards, services and protocols in place to adequately address international patient needs and to generate consistently high international patient satisfaction scores.  


Hospitals who apply for certification will undergo an application and evaluation process that includes an onsite inspection.

How does the IPS Certification help your hospital?

The IPS Certification shows the international market in a tangible way that you have implemented the highest standards and protocols for international patient care. In other words, it provides your facility with a clear distinguishing factor and a competitive edge.

Additional benefits:

  • The certification process educates your organization and increases your knowledge of processes and procedures
  • Puts the right processes and procedures in place, reduces the likelihood of errors and it promotes positive outcomes
  • Helps create “best practices” when dealing with international patients
  • Certification can help to improve overall patient safety and outcomes
  • Provides the “Excellence Certification” logo which you can proudly display on your website and marketing materials
  • Patients, Insurance Companies, and Employers will look to work with organizations that have been certified by the Medical Tourism Association™
  • Creates confidence, trust and credibility for your organization, helping to increase the flow of international patients
  • Helps reduce your organization’s risk and liability
  • IPS Certified facilities will be featured on the MTA’s network of websites, magazines, and social networks providing you with increased visibility in front of your target markets

Hospitals who are not ready to be certified or simply want to improve their international patient services can receive the International Patient Center Onsite Training. This 2-3 day onsite training program has been designed to fast-track hospitals in the implementation of international patient services best practices and to prepare for IPS Certification.  


The program is for hospitals that are serious about offering a consistently outstanding international patient experience and significantly increasing patient volume.

What are some of the standards, protocols, and services promoted in the International Patient Services Certification and Onsite Training?

  • Standards in transparency in quality of care
  • Standards in patient education and communication
  • Standards in cultural sensitivity
  • Standards in continuum of care
  • Protocols in place to coordinate the secure transfer of private medical information
  • Protocols for risk management
  • Having a pre-established Care path for international patients (pre-operative evaluation and exams, surgery, post surgery evaluation)
  • Protocols in place to monitor patient satisfaction
  • Protocols in place to ensure a high level of hygiene and cleanliness
  • Ability to coordinate international insurance billing
  • Ability to coordinate travel logistics such as passports, visas, and flights
  • Ability to coordinate patient friendly accommodation

As you can see, creating a high quality patient experience is not something that falls into place on its own; it requires serious planning and a well-thought-out implementation process.  Your hospital may be well regarded in terms of the medical care it provides, but if you fail to deliver a consistently high-quality patient experience then you are shooting yourself in the foot.


This is especially true if you are marketing to international patients who tend to be looking at multiple destination options for treatment. Remember, in a connected world, word of mouth travels as quickly as an email or a post on Facebook.

Without a doubt, improving patient safety and outcomes should be our number one priority. But regardless of how superlative our medical quality indicators are, we will fail in the medical travel market if our efforts are not complimented by a strong focus on the international patient experience.  It’s that simple.

About the Author:

Bill Cook is the operations and marketing manager for Hospital Clinica Biblica’s International Patient Department. A keen observer of the international patient process, Bill is continually striving to identify and remove roadblocks, pot holes and detours in order to improve the international patient experience. Bill is also involved with the development of information packages, analyzing trends and overseeing the hospital’s international staff. He is currently collaborating with the MTA on the International Patient Services Certification (IPSC) and Training program which was launched in March of 2012. The goal of the program is to train hospitals on the standards, services and protocols necessary to provide a high quality international patient services program.