Financial Burdens, Language Barriers and Hospital Gowns – 3 Takeaways on Improving the Patient Experience

This past week we were gratified to read three news articles highlighting different activities or issues that impact the patient experience. While none of the articles dealt specifically with medical travel, all focused on values that GHA promotes in its standards. Below we provide a brief synopsis of each article and some key takeaways for healthcare providers treating traveling patients.

In the first article titled: “The case for standardizing best practices in discussing a patient’s financial obligation,” the author advocates for standardizing processes and protocols related to provider-patient financial interactions as a way to improve the patient experience. According to the author, “The road to patient satisfaction is paved with all things that start from an accurate preauthorization, a thorough financial counseling session or estimate, a courteous front of house service through the medical care itself, all the way to getting the bill that you expect and the billing department’s previous projections holding true.” Standardizing best practices for communicating with patients is key to achieving these objectives. These recommendations are even more critical when we apply them to medical travel patients and the unique challenges they face during provider-patient financial interactions. There is the increased risk of miscommunication, misrepresentation or lack of trust stemming from distance, cultural/language differences, the variances of currencies between countries, and the frequent use of intermediaries. Healthcare providers treating medical travelers should communicate in advance to ensure patients are aware of payment options, price validity, and cancelation and refund policies.

The second article: How Cultural, Language Barriers Impact Positive Patient Experience focuses on recent research which demonstrates how culture and language barriers negatively impact the patient experience. Researches sought to identify key trends that both “build up and detract from the patient experience.” According to the article, patients indicated that language barriers “added another layer of complexity and difficulty regarding basic interaction with doctors and staff,” and “a general concern as to whether doctors and patients fully understood each other when having to work through an interpreter.” Some of the patients surveyed stated that providers who attempted to speak their language and used non-verbal clues were viewed more favorably.  While this particular research dealt specifically with local patient populations from different culture and language backgrounds, many of the same challenges apply to traveling patients.  For healthcare providers, strategies to reduce cultural and language barriers include:

  • Employing a diverse, culturally, and linguistically competent workforce.
  • Providing new staff orientation, ongoing in-service training and professional development activities for all staff.
  • Hiring on-site interpreters or using bilingual clinical and non-clinical staff.
  • Using multilingual wayfinding and signage.

While it may not always be realistic for a healthcare provider’s staff to speak all the languages of medical travelers receiving treatment, GHA encourages healthcare providers to design and support cultural appropriate services and processes that meet the identified needs of the target population groups served by the medical travel program.

The final article: Why do hospitals bare butts when there are better gowns around?” literally exposes the bare facts about hospital gowns and how they impact the patient experience. While the traditional tie-in-the-back gown is still a dominant presence in most hospitals, the trend towards patient-centric care has motivated a growing number of providers to look at gowns that provide more privacy and comfort. One such gown mentioned in the article was developed by Bridget Duffy, Cleveland Clinic’s first and former Chief Experience Officer. During her time at the Cleveland Clinic, Duffy developed a more patient-centric hospital gown which she has since refined and helped launch as a line of hospital gowns for the health apparel company Care+Wear.  According to the article:

“The gown resembles a kimono, wrapping the patient and tying in the front. At the back, the gown splits just below the patient’s buttocks, and the fabric overlaps broadly to prevent accidental exposure.”

Duffy states, “The first thing hospitals do is strip patients of their dignity…but hospitals are increasingly paying attention to patients’ experience, and that includes what they wear.” Also quoted in the article is research physician Harlan Krumholz of Yale University who states, “It’s time to truly treat patients with the respect they deserve and not put them in a dependent, submissive position — starting with a gown that can be a symbol of becoming a faceless patient rather than an individual with a name and a history and a specific need.”

Better hospital gowns are a benefit to all patients. However, hospital gowns that offer better comfort and more privacy are especially valued by patients (particularly women) whose religious and/or cultural backgrounds place a strong emphasis on modesty. Healthcare providers with traveling patient populations that fit this profile should consider how their gowns and any other practices impact patient satisfaction.

Perhaps the lesson we can take home from these three articles is this: every detail, no matter how insignificant it may appear from the provider’s perspective, impacts the patient experience in one way or another. Whether it is a staff member discussing the hospital’s financial policies with a traveling patient, an airport pick-up driver who may not be fluent in the patient’s language, or the type of gowns a hospital provides to its patients, all of these elements influence the patient experience and have a cumulative impact (good or bad) on a patient’s perception of your organization.


*Medical travel is also known as medical tourism or health tourism.

Mobile App Used to Enhance the Patient Experience

Getting lost on a hospital’s sprawling campus or labyrinth of hallways may soon be a thing of the past. A healthcare provider in New York State recently implemented a wayfinding app that allows patients to quickly navigate to any area of the hospital or hospital campus. The app works similar to mobile applications such as Waze, used for navigating in automobiles. The patient is able to access a map with the layout of the hospital facilities, view nearby amenities and even see the estimated time to reach the desired location. In addition to these helpful features, the app can be used to schedule appointments, educate patients about different phases of the treatment process and elicit feedback. Healthcare providers caring for traveling patients would benefit from an app like this or similar tools (particularly if they are adapted to different languages and cultures) as they can facilitate orientation inside the hospital physical environment, help with communication and education, and ultimately improve patient engagement. To read the entire article click here.

Airports, Planes and Patients: Don’t let what you can’t control, negatively impact patient satisfaction

For someone who is ill or suffers from a serious medical condition, the act of preparing for surgery or treatment can be debilitating both mentally and physically. In the best of cases the person may face multiple doctor appointments, medical exams, financial burdens, and perhaps even doubts about the ultimate success of the treatment, all while attempting to balance work and family commitments.

When we talk about medical travelers, one must also add the stress and anxiety of travel to the mix. We know that healthcare providers are experts at supporting patients while they are within the walls of the hospital or clinic, however, not all are prepared to do the same while patients are traveling to and from their facility. Airports and flying can be especially challenging for any patient, particularly those with special needs or who have never travelled before. What can healthcare providers do to promote safety, increase comfort and ultimately ease the stress of travel?

Patients with special needs

Some of the individuals traveling to your hospital or clinic will be patients with special needs. They may have to travel with wheelchairs or oxygen tanks, or possibly require the assistance of a nurse or family member. While most persons with special needs do not require medical clearance before travelling, some airlines may ask for evidence of fitness to travel in order to ensure the patient is able to attend to his or her personal needs. In these cases, it is helpful for healthcare providers to provide patients with a ‘travelling letter’ that gives a brief description of their condition, disability or physical limitations and what type of assistance they might need.

Important information to convey to patients with special needs

Prior to travel, inform patients that they should inquire with their airline about:

  • Available assistance at check-in, while moving around the terminal, during boarding and disembarking. Most airlines will provide assistance to passengers during these three phases including providing wheelchair assistance, mobility assistance – getting in and out of the plane, and assistance with battery-powered medical devices. Patients who require a wheelchair or other mobility assistance should advise the airline of their need during booking and no later than 48 hours prior to the flight.
  • Airline policy on taking equipment such as wheelchairs, portable machines, batteries, respirators or oxygen. Some carriers require that travellers contact the airline to confirm if a given medical device is approved for travel. In the U.S., for example, passengers can only board with portable oxygen concentrators (POC’s) that are approved by the Federal Aviation Administration (FAA).[1] Restrictions for other devices can vary depending on the airline. Patients should advise the airline in advance if they plan to take their own wheelchair or other mobility aid as most commercial airplanes only have room in the cargo hold for one folding wheelchair. [2]
  • Special meals. Most airlines can provide a wide variety of meals including vegetarian, Kosher, Muslim, diabetic, and low sodium. However, these should be requested at least 24 hours prior to take-off.


Traveling patients are apt to carry medications to and/or from the medical travel destination. However, patients may not be aware that medications are subject to special screening protocols or that some types of medications may even be restricted in certain countries.

International laws

Drugs available as a prescription in one country may be illegal or highly regulated in other countries. It goes without saying that the patient experience will be seriously compromised if the patient faces drug charges on your watch.

  • Patients should be advised to inform the destination healthcare provider of the names of any medications they will be bringing into the country.
  • Additionally, healthcare providers should ensure that any medications prescribed to the patient after treatment (prior to departure) are legal in the patient’s country of origin and the countries they may pass through in transit.
  • It is also recommended that the treating physician provide each patient with a letter stating what medical conditions he or she has and what medications were prescribed, including their generic names.

Packing and security screening

Flight delays and lost luggage are not an uncommon occurrence. Patients should be advised to stow their medications and prescriptions in their carry-on luggage to ensure quick access and reduce the possibility of losing items. Medications should also be labeled and placed in a separate zip lock bag for security screening.[3]

Airport security

Passing through airport security can be daunting even for seasoned travelers. There are the seemingly interminable lines, the shouts and instructions from stone-faced security personnel, the frantic struggle to pull off shoes and discard water bottles, and finally the hulking machines that scan our bodies. To make this process less intimidating for patients, let them know in advance what to expect and what actions they can take to reduce chances for delays or additional screenings. This includes:

  • Informing security officers prior to screening if they have metal implants, such as artificial knees or hips.
  • Informing security officers prior to screening if they using a prosthetic limb or other medical device such as an insulin pump or ostomy bag.
  • Packing medications separately in a zip lock bag and declaring them prior to screening. Note that medically necessary liquids are allowed through a checkpoint in any amount once they have been screened.

Airline seating

Does it seem like your legs have grown several inches every time you settle into a seat in economy class? Actually you are not that far off. Airlines are continually looking for ways to squeeze more passengers onto each aircraft. One way to do this is to shorten the space between rows. According to reports, over the last several years the space between seats (between your seat and the seat in front of you) has decreased on average from 35 inches to 31 inches and on some airlines even to 28 inches. [4] For patients with limited mobility or who have just undergone surgery, this phenomenon is not only uncomfortable but potentially dangerous. Conditions such Deep Vein Thrombosis (DVT) – a potentially fatal condition where a blood clot forms in one or more of the deep veins in your body[5], can occur if passengers sit too long without moving their legs. To reduce these risks and increase passenger comfort, high risk patients should be advised to book one of the following options (in addition to taking any medications prescribed by their physician):

  • Business or premium economy class
  • Bulkhead seats
  • Aisle seats with lifting arm rests

The first two options offer more leg room and ease of mobility, while the third option offers patients more opportunities for stretching their legs and ease of access and exit. Note that morbidly obese patients should be informed that they may require two seats.

Arrival at destination

These days some large airports almost resemble small cities with their array of restaurants, shops and even hotels. Patients disembarking from their flights can easily get lost or disoriented as they attempt to navigate the ongoing rush of passengers heading to immigration and customs. Late night and early morning arrivals can be especially challenging as information kiosks and other services may be closed. It is also important to keep in mind that traveling patients may not be familiar with the language and culture of the destination; this, couple with exhaustion from the flight can make patients feel even more disoriented. What can you as a hospital do to help?

  • Depending on the size and complexity of your city’s airport, it can be helpful to provide patients in advance with a map and detailed wayfinding information to help expedite their exit from the airport and ensure they quickly locate appropriate transportation options or the prescribed meet and greet location.
  • Ask an employee from your organization who is already traveling, to pay careful attention to the airport arrival process and to watch out for any challenges patients may experience.
  • Ask traveling patients if they are experiencing any challenges.

Remember, it’s all about reducing obstacles and making the process easier for your patients. The more data you gather, the better decisions you can make to improve the traveling patient’s arrival experience.

Don’t let what you can’t control become a barrier to achieving patient satisfaction

GHA advocates for improving the patient experience at all stages of the medical travel care continuum both within and outside the clinical environment. And while it is acknowledged that healthcare providers cannot control all activities or interactions that occur during the travel process, they do have the ability and responsibility to 1. Identify situations that have the potential to negatively impact patient safety and the patient experience and 2. Proactively educate traveling patients to better prepare and deal with these situations. Ultimately the travel process is an important component of the medical traveler’s experience and, as such, should be rigorously monitored to ensure it does not become a barrier to achieving patient satisfaction with a hospital’s medical travel services.

[1] Wattles, J,. Judges Order FAA to Review Airplane Seat Sizes. CNN Money 2017. Retrieved from on January 23, 2018.

[2] Mayo Clinic Retrieved from on January 23, 2018.

[3] USA Today, Rules for Flying with Prescription Drugs. Retrieved at on January 23, 2018.

[4] American Airlines – Mobility and Medical Devices. Retrieved from  on January 23, 2018.

[5] Ibid.


*Medical travel is also known as medical tourism or health tourism.

The Patient Experience Starts on Your Website

6 Strategies to improve the website user experience for medical travelers

First impressions can make or break a potential relationship. For medical travelers, their first impression of your organization often occurs on your website. Consequently, any interactions on your website have the potential to positively or negatively impact the patient experience. Potential challenges for medical travelers include finding or obtaining desired information, navigating and orienting themselves throughout the website and understanding what is being communicated.

The following recommendations are designed to help healthcare providers improve the effectiveness of their website by ensuring its content and functionality is aligned with the needs of medical travelers.

  1. Content and functionality should be relevant to the needs and expectations of medical travelers

This may sound obvious, but you would be surprised at how many healthcare providers are falling short of reaching this goal. Oftentimes a website may have not been created with medical travelers in mind, or management simply does not have a clear idea of the needs and expectations of the different traveling patient populations they are serving. As a general rule, self-pay medical travelers typically go through several different stages in the decision and planning process that require website or other online support. Among these are:

  1. Research;
  2. initiating contact with the provider (which can also be part of the research stage and may or may not lead to a purchase decision); and
  3. trip planning.

Each of these stages should be supported with the appropriate information and website functionality.

Research: During this phase medical travelers are seeking information that will help them determine if a particular medical facility is the right one for their needs. For instance:

  • Detailed information about the medical procedures and treatments being offered including potential risks and complications.
  • Detailed information about physicians including qualifications, experience, education and language proficiency.
  • Quality and safety related information including accreditation of the organization, healthcare indicators and technology.
  • Estimated pricing for treatments and who is responsible for medical complications should they occur
  • Payment methods and cancellation and refund policies.
  • What to expect during their trip.
  • Testimonials from previous patients.

It is important to note that all claims on an organization’s website should be supported by hard data and this data should be available to the patient if requested.

Initiating contact with the provider: If patients are interested, they will want an easy way to communicate with the healthcare provider. To facilitate this it is advisable to include multiple contact methods and interactive functionality that is highly visible and easy to use. For example:

  • Phone numbers (ideally a toll-free or local number in the country where the patient resides)
  • Emails
  • Chat boxes
  • Web forms
  • Social media

Keep in mind that if patients are uploading or sending private health information via your website or a web portal, you should implement the necessary security protocols to protect patients’ private health information (PHI). For instance, a privacy policy, high-level encryption, and password protection are just some examples of strategies used to protect a patients PHI as well as to ensure you are compliant with privacy laws in your country and the patient’s country of residence.

Trip planning: Once the treatment has been confirmed, traveling patients will require information to plan their trip, such as:

  • Destination information including travel alerts, visa information and required vaccines
  • Lab work or tests that need to be done prior to admission
  • Information about appointment including date/time and location
  • Ground transportation options
  • Hotel recommendations and amenities
  • Tourist attractions

It is important to note that potential patients may be looking at multiple hospital websites to compare quality, price and convenience. So the more informative and relevant your content is, the higher the likelihood that a patient will engage with your organization. It is also important to mention that these stages are not always sequential. Patients may prefer to review trip planning information before making a decision or may contact the organization before doing any research. However, these stages have been included as they are a logical and convenient way to visualize the user experience and are helpful in understanding what information or functionality needs to be available for patients. For a better understanding of the needs of traveling patients, take a look at the following article.

2. Ensure your website is adapted to the language and cultural needs of your patients

Over the past decade a growing number of healthcare providers have begun to translate their websites into the language or languages of their international patients and/or traveling patient populations. While this is a good first step, much more needs to be done to ensure your website is “localized” for your target patient populations.

Website localization is the process of adapting an existing website to the local language and culture in the target market. It goes beyond translation to adapt the original (source) language and other site elements to appeal to the customer’s cultural preferences in their own (target) language. [1] According to Nitish Singh, Ph.D, an expert in localization strategies, “Localization takes into account the inherent diversity that exists in international markets and treats individuals as ‘cultural beings’ whose values and behaviors are shaped by the unique culture in which they live.”[2] Localization impacts all website content including text, imagery, color and layout. For example:


Art, photographs, icons and symbols are often subjective. Designs that seem attractive to Westerners may be offensive to other cultures. Images of hands positioned using certain gestures, religious symbols and animals can be offensive in some cultures. When including images in your website it is important to do your research.[3]


How color is interpreted can also vary from culture to culture. In Japan, yellow traditionally signifies bravery and wealth. In Thailand it is considered a “lucky” color and was associated with the beloved and recently deceased King Bhumibol Adulyadej. In China, on the other hand, the color yellow has negative connotations and is often associated with pornography. [4] Therefore, it is important to research colors and potential conflicts if you are not sure of cultural implications.


People in the West usually scan a website from left to right. However, people from Arabic countries read from right to left. If this is one of you target markets, you will need to change the layout of the section that includes the Arabic translation.  [5]

Additionally, there are legal considerations that should be taken into account when localizing your website. Countries around the world have their own regulations regarding privacy, terms of service, taxes, and data protection. To protect your organization, it is important to ensure that the content you translate is in line with local law.

Finally, few things degrade the quality and professionalism of a website more than misspellings and grammar errors. Take the time to double and triple check your content before putting anything up live.

3. Make it simple

All of us, at one time or another, have visited websites that take forever to load or seemed disorganized and difficult to navigate. Perhaps you click on what looks like a link and nothing happens, or the main navigation menu seems to disappear or change locations.

Don’t make your visitors think. By this I mean that the function or purpose of every element on your website should be obvious to the user. Visitors want to know what they should do immediately and then do it.  They should not have to ask themselves “is this a link?” Or “what’s this button for?” Make links/buttons clear and distinct; keep language clear and simple; don’t use jargon (especially if you are targeting medical travelers) and give examples and support when asking people to provide information. [6]  If your visitors are forced to continually ask themselves questions, then eventually this leads to confusion, and ultimately they are more likely to leave your site.

4. Make your layout and navigation consistent

Layout determines where the text content, navigation, graphic images and other elements are placed on the web pages. If these common website elements are in the same place on every page it means your visitors spend less time trying to use your website and more time engaging with your content. [7] Visitors don’t always land on your home page; the truth is every page on your website is a potential landing page. Therefore, it is important to keep your navigation, typography and the general layout of your site the same from page to page. Don’t make your visitors wonder where they are. If your main navigation menu is on the left then keep it there throughout the site. If you use a certain font to highlight important elements then do so consistently. Doing so will ensure that your layout looks aesthetically pleasing and is convenient and easy for patients to use.

5. Make your website easy to scan

After spending weeks and months carefully crafting the content for your website, it may be tempting to imagine visitors hanging on your every word. The truth is most people will rarely read through all your carefully crafted text. Instead they are much more likely to scan your content looking for relevant pieces of information. Long blocks of text can be intimidating. According to one study, on the average Web page, users have time to read at most 28% of the words during an average visit; 20% is more likely. [8]  Make your content easier to digest by:

  • Breaking up content into shorter paragraphs with clear headings
  • Distinguishing headings by using bold text
  • Adding relevant and helpful links to more comprehensive content (when it makes sense)
  • Using bulleted lists
  • Highlighting keywords
  • Use white space. What’s not on a webpage is sometimes as important as what is not there. Readers don’t always want to fight through a wall of words. [9]

6. Make your website mobile-friendly

In this day and age practically everyone is using mobile phones in one way or another. Google is prioritizing mobile-friendly websites. [10] Increasing numbers of healthcare providers and physicians are communicating with patients via mobile apps. [11] In fact, I am aware of hospitals who receive most of their medical travel patient inquires via mobile platforms such as WhatsApp or WeChat. So if you want to make your customers happy, remain relevant and reach more patients, it makes sense to ensure your website can be easily accessed via mobile phones.

Patient experience needs to expand beyond the walls of the hospital

GHA advocates for a high-quality patient experience across the entire medical travel care continuum. This includes interactions within and outside of the clinical setting. Healthcare providers who are serious about improving the patient experience for medical travelers should not ignore their website; making it user-friendly and adapted to the needs of their traveling patient populations. It is the welcoming face of your organization; a tool for educating and communicating with traveling patients. As such, it impacts patient perceptions and the patient experience at the very start of the patient journey.


[1] The Definitive Guide to Website Translation. Lionbridge. 1/8/18

[2]  Nitish Singh, Ph.D, Localization Strategies for Global E-Business, Copyright © Nitish Singh, 2012, Cambridge University Press.

[3]  The Definitive Guide to Website Translation. Lionbridge. Retrieved 1/8/18

[4] What Colors Mean in Other Cultures. Huffington Post, Jan. 26, 2016. Retrieved 1/8/18

[5]  How to Conduct Website Localization – Don’t Get Lost in Translation. Retrieved 1/8/18.

[6] The Basics of User Experience Design. Interaction Design Foundation.

[7] Why is Consistency Important in Web Design? 2017. Retrieved 01/09/18

[8] Nielsen Norman Group. Retrieved 1/4/18

[9] Scanners Vs. Readers: How To Create Web Content That Engages Both Reader Styles. Retrieved 01/05/18

[10] A. Woloszyn. 10 Reasons to Make Your Website Mobile Friendly. Retrieved 1/7/18

[11] 30 Facts and Statistics on Social Media and Healthcare. Retrieved 1/9/18.

*Medical travel is also known as medical tourism or health tourism.

Clues for Identifying Medical Travelers’ Unique Needs

Recognizing and responding to the needs of an individual is critical to the development of a responsive service that is truly patient-centered. Patients experience needs on several different levels: medical, psychological, related to attitudes and beliefs and even concerning information and communication preferences. [1] Individuals may also experience needs as a result of the unique circumstances or characteristics common to a specific patient population. This is true of medical travel patients.

While the circumstances and characteristics of medical travelers can vary based on factors such as geographic proximity to the medical travel destination, cultural and language affinity, economic circumstances of the individual, domestic healthcare policy, and insurance portability, among others, there are certain elements that are generally applicable to many if not most traveling patients.

Circumstances and characteristics shared by many medical travelers

  • They must travel to access medical services.
  • They will often look at and compare several different medical providers before making a final decision (unless the treatment is covered within a defined network).
  • Diagnosis or corroboration of the diagnosis is often performed remotely.
  • They may be more susceptible to bringing or contracting infectious diseases.
  • They may not be familiar with the medical travel destination, its laws, language(s), customs and culture.
  • Orientation at the destination and inside the hospital may be difficult for them.
  • They may be traveling on a limited budget (particularly if the main motivator is lower cost)
  • They may not be familiar with the details of the medical travel process.
  • They may arrive overly stressed and fearful simply because this is a strange situation to them.
  • They will often undergo a shortened in-country recovery process after surgery or treatment.
  • They may spend part of their recovery time in a hotel setting.
  • They may have to travel long distances within a relatively short time after surgery.
  • They may need additional care or monitoring after they return home.

Use these clues to design an appropriate pathway for medical travelers

How can healthcare providers use this information for the benefit of the medical travel patients they serve? Taking these elements (or clues) as a starting point, hospitals and clinics can begin to design the appropriate services, policies and protocols to satisfy the particular needs of traveling patients.

For example, if “diagnosis or corroboration of the diagnosis must be performed remotely,” medical staff will need to gather critical information in advance of accepting the patient to ensure he or she is a candidate for a specific procedure and fit to travel. This may necessitate the implementation of new policies or the adaptation of existing policies to address this challenge.

The fact that medical travelers “may not be familiar with the medical travel destination, its laws, language(s), customs and culture,” may require healthcare providers to develop new educational content and begin staff training and orientation to ensure patients’ expectations are met and to reduce the risk of language and cultural barriers.

If medical travelers are prone to looking at multiple provider options for their healthcare needs, healthcare providers will likely be motivated to offer multiple contact options, provide quick and comprehensive responses and implement better customer service.

Drilling down even deeper, patients of certain religious or cultural backgrounds may have very specific dietary needs and customs that would necessitate adapting certain services or even treatment plans. For instance, some people of the Jewish faith may request kosher food (prepared according to the kosher dietary law), while some women of the Muslim faith may not want to be treated by a male physician.

It bears repeating that this is only a starting point. The list of elements highlighted above is generally applicable to traveling patients and, more importantly, does not take into account all individual patient needs or preferences. However, these elements do provide a framework to reference – and to fill in the blanks with more specific details – when healthcare providers are beginning to develop a medical travel program.

The bottom line is the more healthcare providers know about the unique circumstances and characteristics of medical travel patients, the better prepared they will be to identify relevant needs, customize protocols to address these needs, and ultimately provide a higher quality patient experience.

[1] K. Dudgeon. Understand the Whole Patient. A Model for Holistic Patient Care.‎

The Silent Patient – What you don’t know can hurt you

As the head of a hospital or hospital department you are probably not in the habit of waking up each morning thinking: “Wow, the sun is shining, the coffee is percolating, and I just can’t wait to see all the new patient complaints we’ll receive today!” Obviously, the fewer complaints coming your way, the greater the likelihood that your patients are happy or at least satisfied with your organization’s services. However, a lack of patient complaints is not always a good thing.

Patients don’t always complain or make their concerns known to healthcare providers unless they are prompted. There is even evidence that some patients or companions may be reluctant to complain out of fear of retribution.[1] [2] The “silent patient” type will rarely complain and may even put on a happy face saying “everything is fine.” Yet under the surface he or she may be upset at a certain situation or even brimming with anger over a perceived infraction on the part of your staff. “Silent patients” have the potential to generate some of the most damaging complaints as healthcare providers are given no opportunity to resolve the issue. A patient’s dissatisfaction can just fester and lead to negative comments to friends and family or a broadside on a social media site three months down the road: “Don’t ever use ABC Hospital, the nurses are terrible and don’t speak English. I had terrible pain and they just ignored me…”

Observe and proactively seek out dissatisfied patients (and companions)

Hospital staff should always be on the lookout for dissatisfied patients. Train employees (particularly those on the frontlines) how to spot patients who may be dissatisfied but who have not expressed a complaint and about the proper way to handle complaints. The best way to spot a silent complainer is to cordially ask specific questions: How was our food? Are you okay with the pain medication? Is there anything I can do to make your stay more pleasant? Eventually, even the most reticent patient will usually open up about a perceived issue.


Once you have observed a problem that seems to happen repeatedly, you must then get down to the root of why the problem is occurring in the first place. Are the pre-op exams taking longer than normal? Is the package price you have set for the procedure package unrealistic? Talk to patients, ask questions, and keep track of suggestions and comments gathered through surveys or testimonials. Many complaints are due to uncertainties or a lack of information…”nobody told me,” “I didn’t know.”

Dealing with complaints promptly at the point where they arise should be seen as a priority throughout the organization. The basic principles for managing patient complaints are the same regardless of whether a patient is local or a medical traveler. However, healthcare providers should be aware that the unique circumstances of the medical travel experience can sometimes exacerbate certain situations and lead to misunderstandings. For example:

  • International patients are in the midst of a new culture and unfamiliar language which can lead to misunderstandings or misperceptions.
  • They may be alone and without the support of family members
  • The entire medical travel process is new to them which causes stress due to the unknown

Therefore, healthcare providers should:

  • Communicate clearly and often so there are no opportunities for misunderstandings
  • Lead patients by the hand and assume they know nothing about the medical travel process
  • Be particularly sensitive medical traveler patient needs and expectations
  • Let them know you are there to support them at all times

Global Healthcare Accreditation (GHA) standards recommend that traveling patients have access to a patient advocate who is responsible for maintaining communication between the patient, in their chosen language, and their healthcare provider to ensure patient understanding of procedures. This will reduce the risk for misunderstandings and also ensure patients have a go-to person they can trust if they have any problems.

Take action

When you see the same problem popping up again and again, this is usually a clear sign that you do not have a process set up to deal with it. The obvious solution is to create a process to eliminate the problem. In some cases you may not need to set up a new process but, instead, simply change a single step in your standard process. Using the previous examples, this may mean bringing patients in for pre-operative exams at a different time, or reassessing the costs of your medical procedure package so that they are in accord with reality.

What are the benefits of successful complaint handling?

So, what’s the upside to successfully resolving patient complaints? There are many. The Guide to Complaint Handling in Healthcare Services[3] states:

  • Prompt and speedy resolution of complaints
  • Reduced costs (direct and indirect) involved with complaint handling
  • Better risk management, potentially limiting the number of complaints that may become formal legal claims
  • Promotion of better health care outcomes
  • Better quality assurance, by providing feedback on service delivery
  • More satisfied consumers

Healthcare providers should not fear patient complaints; on the contrary, organizations should look at patient complaints, or any other feedback, as an opportunity to improve their processes and services. After all, your customers are providing you with golden nuggets of information that you may have not been aware of, and that if left unchecked, could continue to negatively impact other patients and ultimately your hospital’s financial bottom line.

[1] Ann Clwyd MP, Professor Tricia Hart. A Review of the NHS Hospitals Complaints System Putting Patients Back in the Picture. 2013. Retrieved 12/16/17 .

[2] ‘Silent majority’ of older people do not complain about substandard care. The Guardian. Retrieved 12/16/17.

[3] “The Guide to Complaint Handling in Healthcare Services.” Health Services Review Council 2005, Victoria, Australia. Retrieved at‎

GHA Consultants Travel to Thailand

On December 1st, GHA Interim Chief Quality Officer, Ann Jacobson and Director of Business Development, Bill Cook will travel to Bangkok, Thailand to provide training and advisory services for a well-known hospital in the region that is preparing for accreditation by GHA. During the trip, Ann and Bill will also meet with representatives of Thailand’s Ministry of Tourism and a local university to discuss collaboration opportunities. Over the past few months Thailand has seen several visits by the GHA leadership team, most recently in September when GHA consultants presented a workshop to members of the Private Hospital Association and engaged in the accreditation survey at Bumrungrad International Hospital. GHA wishes Ann and Bill a safe and productive trip!

Pre-screening Traveling Patients: 4 Things You Must Know

Authors: Karen Timmons, Erik Fleischman M.D., Bill Cook

Medical travel can offer patients many benefits such as rapid access to care and improved quality, service and savings, but, not all patients can or should travel for treatment. There are many elements – some obvious, some not so obvious – that should be evaluated in advance to determine if a patient is a good candidate for medical travel. To ensure patients are safe and fit for medical travel it is important for healthcare providers to implement a pre-travel risk assessment protocol that considers the following four factors:

Health of the traveler & appropriateness of treatment being sought
LIKE local patients, medical travelers may have pre-existing illnesses such as diabetes, cardiovascular disease, hypertension or other co-morbid conditions.  When uncontrolled these conditions can make medical travel dangerous and potentially fatal.  UNLIKE local patients, healthcare providers must identify these conditions remotely prior to travel. Equally important, healthcare providers must assess whether the requested or recommended treatment will benefit the patient or place them at further medical risk.  The recommendations for treatment abroad for elective or semi-elective treatments tend to come from their primary care physician, the destination physician or sometimes even from the patients themselves.

Recommendations: To ensure a patient will benefit from treatment being sought and will be healthy enough to travel and undergo a procedure or treatment, it is recommended that healthcare providers:

  • Send potential patients a medical history questionnaire to gather data about their health history including previous surgeries, illnesses, co-morbidities, unhealthy habits or medications that they may be taking.
  • Request and review medical records and diagnostic tests, especially x-rays and scans.
  • When possible, communicate with the referring physician or primary care practitioner to gather information and identify any red flags that may have not been apparent in the medical history questionnaire and exams.
  • When possible, schedule a conference call between the patient and the treating physician. A conversation between the treating physician and patient prior to confirmation of a procedure is one of the most effective ways to screen potential medical travelers. With the patient´s medical information in hand, the physician can ask more specific questions regarding chronic illnesses, allergies and current medications; information that will help determine if the patient is an appropriate candidate for the treatment. It is also a great opportunity for the patient to ask questions and establish a trusting relationship with the treating physician.

Risks related to travel
Travel creates increased stress on the body’s physiologic systems–early morning wake-up calls, crowded airport shuttles, long waiting times, and then a long flight home cramped in a narrow cylinder packed with people. Patients can minimize the discomfort by flying in business class or choosing bulkhead seats, but there are still potential risks involved, especially with long flights after surgery. One of the most dangerous conditions is deep vein thrombosis (DVT) and pulmonary embolism.[1] Another risk factor for traveling patients is exposure to people with infectious diseases not found in their own country of residence. Some nations, due to geographic environments and/or socioeconomic factors, have a higher incidence of infectious diseases including tuberculosis, Hepatitis A & B, amoebic dysentery and other diseases rarely found in most so-called developed first-world nations.[2] These pathogens present a real threat to a person following a major surgical procedure when the immune system is unaccustomed to this exposure. There may also be similar risks related to tourist sightseeing activities and even the type of accommodation chosen by the patient.


  • To ensure travel related risks are addressed and monitored, healthcare providers should review existing clinical guidelines to ensure they encompass potential risks related to medical travel such as infectious diseases and DVT. Readily available guides specific to infectious disease risks and precautions are readily available on the internet and via government embassies and international security websites.
  • Patients may want to consider the benefits of travel insurance information and Medical Assistance companies to help prepare for potential local hazards, infectious diseases and security issues.

Patient expectations
Patients may have unrealistic expectations regarding their treatment or procedure outcome as well as the medical travel experience. A patient traveling for a facelift, for example, may have unrealistic expectations regarding outcomes including expected aesthetics, improvements and recovery. When the bandages come off a few days later and reality sets in, he or she may have anger, anxiety and emotional issues with the surgeon or healthcare provider. Another patient may expect everyone in the hospital to speak his or her primary language fluently. When he or she arrives at admissions and observes hospital staff struggling to communicate or using interpreters there is often increased anxiety about the upcoming procedure.

Recommendations: To reduce patient dissatisfaction it is important to:

  • Properly educate patients in advance of their trip. This can be accomplished via links to website content, email communication and calls.
  • Set reasonable expectations that can be clearly understood and conform to the level of understanding and intelligence of the individual patient. Ask patients to confirm they understand these expectations.  This should be documented.
  • When talking to potential patients, healthcare providers should use open-ended questions that encourage potential patients to elaborate as opposed to simply answering “yes” or “no.” Allowing potential patients to “open up” and expand on their expectations regarding the treatment and medical travel experience will give physicians and case managers a better chance of spotting potentially risky patients. These efforts can provide insight toward a patient’s capacity to tolerate travel  to an unfamiliar country or city.
  • Healthcare providers should be crystal clear about all aspects of the treatment plan; travel itinerary and inclusions and exclusions in the price estimate provided. Making available FAQs or a “What can I expect” page on the organization’s website is a great way to educate potential patients in advance about the medical travel experience.

Setting proper expectations from the beginning will minimize the possibility of problems and dissatisfaction down the line.

The patient’s financial circumstances
Some self-pay patients may also pose a financial risk to themselves and the healthcare provider if they do not have sufficient funds to cover medical complications if they occur. According to the Kaiser Family Foundation, almost half of Americans said they would have difficulty paying an unexpected $500 dollar medical bill.[3]

Recommendations: While this may be a sensitive topic, it cannot be ignored when healthcare providers are seeking the patient’s best interests and trying to ensure a sustainable medical travel program.

  • Transparency about costs, potential complications and those persons responsible for extra medical expenses should be clarified with the patient in advance his/her trip.
  • Asking key questions such as “How are you going to pay for the procedure?” and “Do you have complication insurance or funds to cover the costs of medical complications if these were to occur?” will help identify patients who may not have the financial means to cover unexpected expenses. It also offers healthcare providers the opportunity to guide patients to additional options such as financial assistance or medical complication insurance.

Benefits of Pre-travel Risk Assessment

The value and benefits of a comprehensive pre-travel risk assessment protocol are many:

  • Ensure the traveling patient’s wellbeing
  • Improve treatment outcomes
  • Reduce costs
  • Shorten hospital stays
  • Reduce patient cancellations
  • Increase patient satisfaction

Finally, the pre-travel screening process is critical for giving a good first impression of a healthcare organization. A positive patient experience starting prior to travel can set the tone for the entire care encounter.

[1] Ethical and legal implications of the risks of medical tourism for patients: a qualitative study of Canadian health and safety representatives’ perspectives. Retrieved 11/02/17

[2] Ibid.

[3] Ballooning bills: More U.S. hospitals pushing patients to pay before care. 11/5/17

Selecting the Right Hotel for Your Medical Travelers’ Needs

It is easy to think of hotels as relatively unimportant players in the context of a patient’s medical trip. Typically the patient (and often a companion) books a night or two in a hotel before treatment and then returns for several days of rest prior to his or her departure home. The “heavy lifting,” after all, is performed by healthcare providers who are responsible for a myriad of details including the treatment plan and the delivery of high-tech medical interventions.

While there is no denying that the stars of most medical trips are the doctors, hospitals and clinics, a poor patient experience and even a bad procedure outcome can occur if healthcare providers recommend hotels that are not appropriate to the patient’s needs. Depending on the type of procedure or treatment, some traveling patients may actually spend more time in the hotel than they will in a clinical setting. Being cognizant of this, healthcare providers should carefully evaluate all accommodation options that are recommended to medical travelers.

Consider the following factors when choosing appropriate hotels for medical travelers:

• Location and surroundings

• Budget

• Infrastructure, services and amenities

• Capability of hotel staff to cater to the needs of medical travelers

• Balancing patient needs verses preferences

Location and surroundings
In an ideal world, healthcare providers should strive to offer hotel options located relatively close to the healthcare facility. Apart from the convenience of quick transfers to and from the hospital, the proximity to the hospital can literally be life-saving if the patient suffers a medical emergency or treatment complication. Of course, real-world scenarios are not always ideal. There are many mitigating circumstances related to the hotel itself and its surroundings (which we will look at below) that may necessitate choosing accommodation options located farther away.

As far as surroundings go, healthcare providers should recommend accommodation options in areas that are safe, quiet and located close to restaurants and shopping venues. This is not always easy, but patients and their companions will be grateful for the peace and convenience this affords. Even a two-week stay at a nice hotel can feel like a prison sentence if there are no opportunities for entertainment.

Not everyone is looking for a luxurious 5-star resort; in fact, more often than not, patients will be seeking more affordable options. A good practice is to recommend accommodation options at different price points so that patients can choose hotels that fit their budget and preferences.

Infrastructure, services and amenities
As can be expected, some hotels will be better suited to the needs of medical travelers than others, while other hotels may be more appropriate for traveling patients undergoing certain treatments or procedures. Almost any hotel will do for patients undergoing dental or non-invasive treatments. However, not every hotel is suited for patients undergoing more invasive procedures such as joint replacements or weight loss surgeries. In the first example, patients will require little or no aftercare. In the second example, patients may require medical supervision, physical therapy, special diets and facilities that are adequate for guests with limited mobility. Therefore, it is important to evaluate each hotel’s infrastructure, services and amenities prior to recommending them to patients.


While most hotels were not built with the purpose of catering to medical travelers, many larger hotels have been designed to accommodate guests with disabilities. If a hotel is located in the U.S., then it must comply with the ADA (Americans with Disabilities ACT). ADA mandates strict guidelines [1]regarding accessibility to entryways, rooms, bathrooms, and public spaces such as pools and gyms. Hotels in other countries, however, may be subject to less stringent government regulation with regard to being accessible for guests with disabilities. Each hotel should be assessed by healthcare providers to ensure it offers the types of services required by patients depending on the medical procedure. If a hospital will be referring a large number of patients to a hotel, the hotel may be willing to meet the specifications of the hospital respecting food plans, special accommodations for safety such as rails, and bars. Wheelchair accessibility is a must for hotels catering to most medical travel guests. Reducing hindrances to getting around the property also needs to be a consideration for facilities not previously prepared to accommodate wheelchairs or other mobility assistance equipment. In the event that elevators are not present in the hotel, it may be necessary to use the first floor rooms for those with such needs. [2]

Room considerations: [3]

• A universal remote at bedside allows guests to open and close curtains, operate the television, adjust room lighting, and can provide an emergency button that calls for help if needed.

• The availability of wireless Internet makes use of the laptop from the bed possible, and nightstand-height electrical outlets allow for easy connection.

• If only one telephone is available in the room, it is recommended it be on the nightstand so it is accessible from the bed.

• Although unusual for hotels, a bed with a footboard allows a handle for stability as the guest walks around the room.

• A round table removes sharp corners to prevent bruising, but it needs to have a stable base that will support a person who leans on its edge.

• If a guest has limited mobility or requires the use of a wheelchair, the furnishings need to provide adequate maneuverable space.


• Roll-in shower with grab bars.

• A handheld shower and a seat within the shower or tub area is a convenience if somebody has a specific body area that must remain dry.

• A full-length mirror on the bathroom door provides service to those in wheelchairs.

• Phone service in the bathroom gives the option of calling for assistance in the event of a fall.
• Toilet safety frames and rails can assist patients having difficulty standing up.

Services & amenities for medical travelers:

Medical travelers will often require one or more of the following services or amenities:

• Airport pick-up/drop-off.

• Expedited check-in service as might be provided to business executives. After surgery, the guest is likely to be in a physically weakened condition, so routine processes such as waiting in a short front-desk line can be tiring.

• Scheduled transportation service to nearby restaurants and shopping venues.

• Providing frequent linen and towel changes.

• Food service. Patients may require special dietary considerations, so room service may need to accommodate customized specifications. Additionally, hotels may wish to ensure that the offerings are aligned culturally with patients so that “comfort” food is available that is aligned to patient nationality or religious preference.

• Flexible transportation service to hospitals/clinics for doctor appointments and treatments.

• Transportation vans equipped with hydraulic lifts for wheelchairs.

In some cases, hotels that receive a high volume of medical travel guests may provide nursing support either directly or through contracted third party providers. Healthcare providers should verify the qualifications and experience of such personnel and ensure they follow the discharge instructions and care protocols prescribed by the treating physician. Additionally, hotels that wish to cater to medical travel guests should understand that their main mission is not to provide medical care, but instead, to create a healing environment for patients while monitoring their recovery.

Capability of hotel staff to cater to the needs of medical travelers
Hotel staff should be sensitized to the medical traveler’s unique needs and expectations. As we have seen, depending on the procedure or treatment, medical travel guests may require more hands-on care than regular guests. They may require frequent linen and towel changes due to their wounds; they may have special dietary requirements; they may require flexible transportation options or have special mobility requirements. Hotel managers, front desk supervisors and staff, housekeeping, room service, and food & beverage personnel should all be educated to anticipate these needs and any safety do’s and don’ts (such as what to do and who to call in an emergency) when serving or aiding medical travelers.

Balancing patient needs verses preferences
Oftentimes, patients will be tempted to choose one hotel over another based on budget or lifestyle preferences. This is not a problem for patients seeking dental treatments or minor cosmetic surgery. However, as indicated previously, patients traveling for more invasive procedures will need accommodation conditions that are suitable for the type of care or supervision they will require after their treatment. As medical experts, healthcare providers are in the best position to advise the patient as to the appropriate accommodation options. In instances when patients wish to choose a hotel or another accommodation option not appropriate to their needs as specified by the treating physician, healthcare providers must tactfully but firmly advise the patient to select a more appropriate option and explain why doing so will benefit their recovery.

The patient experience is not the sole domain of the healthcare provider
For healthcare providers treating traveling patients, accepting that the “patient experience” is not the sole domain of the healthcare provider is the first step in the quest to facilitate an optimal patient experience across the medical travel care continuum. The second step is to educate, empower and collaborate with other stakeholders – such as hotels – to ensure the traveling patient not only has a great experience, but also a successful recovery and treatment outcome.

[1] Retrieved 11/16/17.

[2] The Physical Innovation of Hotels in Medical Tourism. Dan Cormany. Medical Tourism Magazine. April 1st, 2009. Retrieved at

[3]  Roberts GW. Nurse/patient communication within a bilingual health care setting. Br J Nurs. 1994;3(2):60–7.


*Medical travel is also known as medical tourism or health tourism.

Choose Your Companion Wisely

Patients’ companions represent an important source of potential support for patients undergoing treatment. The physical and emotional support they can provide is especially beneficial during the recovery process when patients are at their most vulnerable. In fact, research consistently shows that companion participation in care is associated with positive patient and physician experiences.[1] [2] [3]

The support of a companion or informal caregiver is important in any healthcare setting but is especially critical in the context of medical travel where patients may face additional challenges such as travel, an unfamiliar physical environment, a different culture and potential language barriers.

However, not everyone is ideally suited to being a medical travel companion. While a competent caregiver may improve a patient’s health, one who is less prepared and supported may be detrimental to it.[4] Some spouses or friends may look at the trip as a chance for a free vacation and spend their time sightseeing instead of assisting the patient.[5] Others may nitpick and complain about insignificant details, causing the patient additional stress and worry, possibly even hindering the patient’s recovery.

To avoid these types of situations, which can impact the patient’s experience as well as his or her wellbeing, healthcare providers should take time to educate patients and companions about the role of the latter during the medical trip.

Knowledge broker and advocate

In a study analyzing the roles of informal caregivers in medical travel, the authors identified “knowledge broker” as one of the companions’ key roles.[6] The facilitation of knowledge transfer from medical tourism facility staff to the patient by caregivers is typically done in four ways: inquiry, clarification, translation, and retention.[7] For example, caregivers may inquire about travel logistics or clinical concerns such as prescriptions or care options. Next they may seek to ensure the patient understands the information. In some cases the caregiver may be more familiar with the local language and will serve as an interpreter or translator for the patient. Finally, caregivers will seek to retain information that has been conveyed by facility staff to the patients. For example, being aware of any known allergies the patient may have, carrying a list of the patient’s medications, and being willing to ask questions and take notes on care instructions.

Ultimately, companions should understand that their primary purpose during the trip will be to care for the patient and to advocate for his or her needs. They should be willing to put the patient’s needs ahead of their own and assist and support the patient during the pre-op, treatment and post-op process. In practice this may mean bringing up a grievance to the healthcare provider on behalf of the patient, helping the patient get to different tests or appointments, watching over the patient after surgery or simply offering a shoulder for the patient to cry on. Additionally, and with the patient’s consent, companions should be encouraged to learn about the patient’s condition, the procedure or treatment, and especially aspects related to the patient’s anticipated convalescence and recovery.

All of the above does not mean companions cannot have some leisure time to enjoy the local culture and attractions, however, the companion’s primary job should be to support the patient and look out for his or her wellbeing. GHA believes that educating both patients and companions about the care process is fundamental for providing a safe and positive medical travel experience.


[1] Roseland, Ann-Marie. “Family and Friend Participation in Primary Care Visits of Patients with Diabetes or Heart Failure: Patient and Physician Determinants and Experiences”


[2] Molloy GJ, Johnston DW, Witham MD: Family caregiving and congestive heart failure: Review and analysis. Eur J Heart Fail. 2005, 7: 592-603. 10.1016/j.ejheart.2004.07.008.


[3] Bevan JL, Pecchioni LL: Understanding the impact of family caregiver cancer literacy on patient health outcomes. Patient Educ Couns. 2008, 71: 356-364. 10.1016/j.pec.2008.02.022.


[4] Crooks, Valorie. “You’re dealing with an emotionally charged individual…”: an industry perspective on the challenges posed by medical tourists’ informal caregiver-companions. Globalization and Health.


[5] Ibid.

[6] V. Casey, V. Crooks, J. Snyder and L. Turner. Knowledge brokers, companions, and navigators: a qualitative examination of informal caregivers’ roles in medical tourism.


[7] Ibid.