Patient-Centered Care Runs More than Skin Deep

A flutter of the drapes causes you to stir, bringing into focus a rippling of light and shadow along a mahogany paneled wall.  Your eyes drift across the lavish décor of your suite and slowly come to rest on a crumpled mass of pale green sheets lying on a futon couch nearby. Almost immediately the cheerful hum of Vivaldi’s Four Seasons fills the room, followed by the soft patter of footsteps.  “How are you feeling this morning Mr. Banks?” A familiar voice intones. “I’ve brought you the Sunday Times; shall I put it on the night table?” “I’m feeling much better this morning Tanya, thank you for asking. Ah, yes, on the table is fine.” “Are you ready for your breakfast? We have fresh fruit and Yogurt parfait for you and a ricotta and tomato breakfast burrito for Mrs. Banks…she went out for a short walk in the gardens you know.”

As you reach for the newspaper a jolt of pain strafes your left leg, a vivid reminder of what you went through just twelve hours earlier.  “Mr. Banks, it’s good to see you’re awake.  Dr. Smith strides through the room holding a clip board and surveying your bandaged leg.  Your knee replacement surgery went just as planned.  As long as you do your exercises and follow Tanya’s instructions you’ll be out of here in no time.”

From Hospital to 5-Star Hospitality

If the previous scenario sounds to you like a bizarre episode of The Suite Life of Zack and Cody meets General Hospital, you are not far off. While some of the best hospitals in the world are utilitarian in their design – often for very important reasons such as infection control or large patient volume, a growing number1 of hospitals are shedding their cold impersonal aura to compete for consumers with amenities and services more akin to a Four Seasons Resort than a typical hospital.

The Apollo Hospitals Group in India2, for instance, in addition to their regular hospital rooms, also feature lavish suites that can house wealthier patients in luxury with personal attendants, interpreters, a well-stocked pantry and dining table. Hospital rooms in Dubai will soon come with touch-screen entertainment and communication systems that allow patients and companions to watch TV, play games, order meals, request extra pillows and even call for an interpreter.3  At a Medical Center in Denver, delivery rooms have private bathrooms with Jacuzzi tubs, birth balls, rocking chairs, squat bars, and flat-screen TVs. After giving birth, mothers can enter one of facilities six luxury suites, where they’re offered the services of a private chef.4

Defining Patient-Centered Care

But while all these perks and amenities are nice – and patients certainly like them, are they a true reflection of patient-centered care?

Patient-centered care can be defined as a healthcare setting in which patients are encouraged to be actively involved in their care, with a physical environment that promotes patient comfort and staff who are dedicated to meeting the physical, emotional, and spiritual needs of patients.5

In other words, patient-centered care goes far deeper than aesthetics, perks and amenities, nor is it characterized by individual programs or initiatives. Instead, it is driven by the core values and attitudes behind the implementation of such programs. According to Planetree, the global leader in advancing patient centered care, “Patient-centered care is about engaging the hearts and minds of those you work with and those you care for. It is about reconnecting staff with their passion for serving others. It is about examining all aspects of the patient experience and considering them from the perspective of patients versus the convenience of providers. Ultimately, it is about a collective commitment to a set of beliefs about the way patients will be cared for, how family will be treated, how leadership will support staff, and how staff will nurture each other and themselves”6

The benefits of patient-centered care

The basic premise that patient centered care is integral to the overall quality of care received by patients has been established for quite some time. But can positive patient experiences lead to better clinical outcomes?

Several recent studies suggest they do:

  • A review of over 306 hospital referral regions indicated that hospitals with lower overall ratings by their patients also tended to have lower technical quality measures 7
  • An article published in the New England Journal of Medicine suggested that hospitals with high levels of patient reported ‘care experience’ provide higher quality clinical care across a range of conditions.8
  • According to an article in the Health Services Research Journal, higher patient ratings of experience of care have been associated with lower mortality in patients with acute myocardial infarction.9
  • In a study of 927 US hospitals, strong relationships between patient experiences and technical measures of quality and safety were noted including better patient experiences being associated with lower infections due to medical care.10

There is also a growing body of evidence that patient-centered care improves financial performance. According to a recent report by Accenture, a well-known strategy and consulting organization: “A superior customer experience doesn’t just strengthen patient engagement — it also correlates to 50 percent higher hospital margins.”11 In 2016 Deloitte reported:

  • Hospitals with “excellent” HCAHPS patient ratings between 2008 and 2014 had a net margin of 4.7 percent, on average, as compared to just 1.8 percent for hospitals with “low” ratings.12
  • Hospitals with better patient ratings earn disproportionately more revenue per patient day than those with low ratings13

Studies such as these and others are slowly but surely opening the collective eyes of the healthcare industry to the health and financial benefits of focusing on patient-centered care.

What is the takeaway for healthcare providers targeting medical travelers?

There is nothing wrong with offering traveling patients and companions lavish hospital suites and gourmet cuisine – if you have the resources and that’s what your patients are asking for (you may also need to consider more affordable options for other patient groups), then more power to you. Glitzy facilities and 5-star pampering can certainly enhance the medical travel experience.

GHA Meets with Healthcare Leaders in Thailand

GHA’s Karen Timmons, Dr. Paul Van Ostenberg and Somporn Kumphong meeting with International Health Division at Thailand’s Ministry of Health (above). June 20th, 2017.

GHA meeting with Bumrungrad Hospital below:

GHA meeting with Bangkok International Dental Center below:

GHA meeting Bangkok International Dental Center
GHA meeting Bangkok International Dental Center

GHA meeting with Kamol Cosmetic Hospital below: GHA meeting Kamol Cosmetic Hospital

GHA Leadership meets with Malaysia Healthcare Travel Council

Karen Timmons, CEO of GHA and Dr. Paul Van Ostenberg, Chaiman of the Standards Committee and Esther Law of Excellence Medicare with Dolly Lim and Doreen Loh, of Malaysia Healthcare Travel Council. Kuala Lumpur, Malaysia. June 16th, 2017.

GHA Leadership in Malaysia

Karen Timmons, CEO of GHA and Dr. Paul Van Ostenberg, Chaiman of the Standards Committee with Noor Hafizan Moad Noor, Corporate Manager, KPJ Hospital, Rafeah Ariffin, Senior general Manager, KPJ Hospital and Esther Law of Excellence Medicare in Kuala Lumpur, Malaysia. June 16th, 2017.

GHA Leadership Off To Asia

Karen Timmons, CEO of Global Healthcare Accreditation and Dr. Paul Van Ostenberg, Chairman of the Standards Committee departed June 13th for a 10 day whirlwind business tour of several APAC countries including Thailand, Malaysia and Singapore. During the trip, they will be meeting with top hospitals in the region as well as government leaders to introduce the GHA program focused on medical travel services. In the photo, Karen and Dr. Ostenberg are standing in front of Taylor’s University in Kuala Lumpur, Malaysia with Dr. Chin, Dr. Thomas and Esther Law of Excellence Medical Care. We wish you safe travels and much success!

The Secret to Managing Patient Expectations in Medical Travel

Picture yourself arriving at the Four Seasons Resort in Maui. The sun is dipping beneath a flaming horizon as you hand the valet your car keys and step into plush hotel lobby framed by a majestic turquoise sea. As you stroll across a terracotta tile floor towards the reception area you can’t help but feel invigorated by the sights, scents, and sounds of this luxurious tropical paradise.

At the reception desk the manager is lost in conversation with a co-worker. Both whisper back and forth in hushed tones without acknowledging your arrival. After clearing your throat – for a third time, the visibly annoyed manager finally looks in your direction. With a practiced smile that doesn’t quite reach his eyes, he ambles over in your direction and manages a: “Yeah? Can I help you with something buddy?”

Is this the type of reception you expect from a Four Seasons Resort? Of course not. At an accommodation of this caliber you expect to be lavished upon from head to toe. Instead, your expectations have been shattered and you will probably think twice about ever booking at this property again*.

“To wish was to hope, and to hope was to expect” Jane Austen, Sense and Sensibility

Webster’s dictionary defines an expectation as “the act or state of expecting or looking forward to an event as about to happen.” 1 We have expectations associated to almost everything we do. When we sit in a chair we expect it to stay in one piece. When we drive down the street we expect to get from point A to point B without bumping into a bunch of tripod-shaped robots that have suddenly sprung-up from the ground. And if we jump off the edge of the Grand Canyon we can reasonably be sure that we will not make it to tomorrow’s luncheon meeting.

Medical travelers also have expectations about your organization. In fact, at this very moment your prospects and patients are forming a mental picture of their trip to your hospital or clinic and will have at least some expectations based on the information you have provided, interactions they have had with your staff and their assumptions about the process based on what they’ve seen or heard from others or the media. Granted, they may not be expecting a Four Seasons Resort, but they are expecting to be treated with respect, empathy, and cultural sensibility. All these qualities should be reflected at each stage of the Medical Travel Care Continuum – from your website, to the call center representative, to the email correspondence they receive, to their pick-up at the airport, the hotel, during treatment and even once they return home.

What did you say?

Expectation management begins and ends with good communication. In medical travel, clear and frequent communication is especially important due to the many touch points that must be managed both inside and outside the healthcare environment. Is the hotel staff aware of the specific needs of the patient? Has the patient been informed of all relevant details regarding his trip and treatment? Was the patient aware that she should stop taking aspirin a week before surgery? If a patient is anticipating no language barriers but ends up using pantomime and Google Translate to communicate with his/her nurses after surgery, you can be sure he/she will have no problem communicating his/her experience to the world through Twitter or Facebook. It is critical then that we make an effort to understand what is important to medical travelers and what their expectations are regarding their treatment and medical trip. Ask relevant questions such as, “What do you think of the plan we have discussed today? Is this what you thought would happen?”

Without a doubt, a patient’s chief concern will be regarding their treatment and treatment outcome. Ensuring that patients understand the reasons for your proposed management of their condition and what to expect from any treatment will go a long way towards allaying their worries or anxieties. For physicians, it is particularly important to ask questions such as, “Is there anything that you do not understand; have I explained everything clearly?” If required, the presence of interpreters or multilingual staff is vital to ensure compliance and avoid misunderstandings. Finally, don’t let patients assume anything as assumptions often lead to discontent and frustration when others do not share the same understanding of the Medical Travel Care Continuum that you do.

Why is managing patient expectations important?

Understanding and managing patients’ expectations will pave the way for a higher quality medical travel experience. If we are attentive to medical travelers’ values and expressed needs – throughout the medical travel care continuum – our patients will be grateful. They will sense we have a better understanding of their circumstances (be it a hotel or healthcare facility) because our responses are aligned with their expectations. Moreover, by engaging in effective communication, we are promoting improved outcomes, mitigating risk, and ensuring better educated and equipped patients.2 Also, keep in mind that the way patients view your organization greatly affects whether they will return or recommend others, impacting your bottom line. Ultimately your goal should be to exceed patients’ expectations by delivering more than you promised: improved outcomes, better services and more compassion and kindness.

5 Resources for Improving the Patient Experience for Medical Travelers

Patients face unique challenges when seeking care in a different country or region. There may be fear of the unknown, long flights, cultural and language barriers, and being away from friends and family – all while preparing for a major surgery or treatment. Healthcare providers treating medical travelers have the difficult yet rewarding responsibility of ensuring a positive patient experience across a Medical Travel Care Continuum™ that includes arrival at the destination, pre and post-operative stages, billing, medical record transfer and aftercare.

Here are 5 resources that any medical travel program can use to improve or enhance the patient experience for medical travelers. Several resources have been created by internationally recognized organizations whom advocate for patient-centered care, patient safety and continuous quality improvement.

1. Planetree Patient Centered Care Environmental Audit. The tool provided by Planetree, the global leader in advancing person-centered care, was created to evaluate how the physical environment of a healthcare delivery organization supports or interferes with the delivery of patient-centered care, with a particular focus on barriers and/or facilitators of:
• Compassionate human interactions
• Access to information
• Patient and family engagement
• Patient privacy, dignity and modesty
• A supportive staff environment

2. Achieving an Exceptional Patient and Family Experience of Inpatient Hospital Care. This white paper, created by the Institute of Healthcare Improvement, provides insight into a project that identified the five primary drivers of exceptional patient and family inpatient hospital experience of care: leadership, staff hearts and minds, respectful partnership, reliable care; and evidence-based care.

*Source: Balik B, Conway J, Zipperer L, Watson J. Achieving an Exceptional Patient and Family Experience of Inpatient Hospital Care. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2011. (Available on

3. Picker Institute’s Always Events® Creating an Optimal Patient Experience. Picker Institute adopted an organizing principle focused on the concept of Always Events®. Always Events® are defined as “those aspects of the patient and family experience that should always occur when patients interact with healthcare professionals and the delivery system.” The Institute for Healthcare Improvement is honored to have been chosen by The Picker Institute to assume the work of Always Events® when The Picker Institute closed its doors at the end of 2012. Picker transferred their Always Events® trademark and programmatic goals to IHI, effective January 1, 2013.

4. Cultural Assessment Tool. The American Nursing Association via published a paper authored by Joyceen S. Boyle and Margaret M. Andrews that provided a cultural assessment tool for healthcare organizations or professionals when considering the patient experience.

5. Patient Experience Toolkit. The Nursing Executive Center’s holistic strategy for improving the patient experience has three parts: cultivating caregiver empathy, overcoming universal process barriers to a patient- and family-centered experience, and diagnosing institution-specific process barriers. This toolkit provides seven tools that equip nurse leaders to bring the holistic strategy to life within their institutions.


Global Healthcare Accreditation Announces Inaugural Advisory Board

The Global Health Accreditation® (GHA) Program, the first independent accrediting body focused on medical travel services and the medical travel patient experience, today announces an inaugural advisory board that will help guide the organization as it seeks to improve the patient experience and excellence of care received by patients who travel for their medical care and treatment, whether within their own country or internationally.

The GHA program complements existing national and international clinical accreditation programs and offers an Accreditation with Excellence designation to those organizations having accreditation from an ISQua approved accrediting body. While these programs traditionally focus on the clinical aspects of care for the entire organization, GHA conducts a deep review of the International or Global Patient Services program or the entity within an organization that serves the medical travel patient.

According to Karen Timmons, CEO of GHA, “Global Healthcare Accreditation optimizes the Medical Travel Care Continuum™ and supports healthcare providers in validating quality and patient experience, increasing visibility, and implementing sustainable business practices for medical travel. An important value-added component of our accreditation services is the inclusion of embedded business solutions designed to help an organization improve its performance, thus providing an immediate return on investment. The advisory board that we have assembled is truly exemplary in their individual and combined expertise in a wide-range of healthcare fields that impact the medical traveler’s experience. We are pleased to welcome such experienced and capable professionals to the GHA Advisory Board.”

The Global Healthcare Accreditation Advisory Board consists of fourteen leaders representing a diverse group of stakeholders, including healthcare providers, insurance companies, population health management, patient advocacy, employee benefits risk management, and medical travel facilitation:

Dr. Nizar Zein, Chairman, Global Patient Services, Cleveland Clinic
Dr. Erik Fleischman, International Medical Director, Bumrungrad International Hospital
Aileen R. Killen RN, PHD, CPPS, Global Head of Healthcare Risk Consulting, American International Group (AIG)
Larry Boress, President & CEO, Midwest Business Group on Health
Dr. Jose Quesada, Chief Medical Officer for Global Health Benefits, Cigna
Dr. Omar Shalabi, Division Head for the Central & Western Regions, Management Population Health Division, Johns Hopkins Aramco Healthcare
Noam Baruch, Head of Passport to Healthcare, AETNA International
Prof. Anupam Sibal, Group Medical Director, Apollo Hospitals Group
Chip Burgett, Managing Director, Quandry Healthcare Solutions
Susan Frampton, PhD, President, Planetree International
Laurent Pochat-Cottilloux, Global Head of Health Reinsurance Partnerships, AXA
Joseph Zhao, Deputy General Manager, Beijing Saint Lucia Consulting Pty Ltd
Muna Almuallen, Sr. Manager International Benefits, Fluor
Amy Villalobos, General Manager, NIB Options

According to Dr. Nizar Zein, Chairman of Global Patient Services, Cleveland Clinic, “As medical travel continues to grow, it is incumbent on healthcare providers to consistently implement professional norms that promote a safe and high quality patient experience throughout the entire care continuum. I welcome the opportunity to be a part of the Global Healthcare Accreditation’s distinguished advisory board and I look forward to supporting its efforts to enhance the quality of care and patient experience for medical travel patients.”

Laurant Pochat-Cottillox, Global Head of Health Reinsurance Partnerships, AXA stated, “Having developed and managed cross-border healthcare products in the insurance industry for many years, I understand first-hand the challenges faced by medical travelers. There are cultural and language barriers, concerns about the quality of care, as well as navigating all the details that go into planning a trip. I commend the Global Healthcare Accreditation program for its focus on enhancing and validating the quality of care provided by hospitals and clinics in the medical travel industry, as well the patient experience along the entire medical travel care continuum and I’m excited to participate on its advisory board in support of its unique mission.”

The Advisory Board will advise Global Healthcare Accreditation on current trends and challenges in the industry, ongoing standards development, service offerings, and launch markets.