The following was originally published in the October 2019 special print edition of Medical Tourism Magazine, which was initially available at the 12th annual World Medical Tourism & Global Healthcare Congress in Abu Dhabi.
There’s nothing new about the need for medical care oversight. As long as there have been modern hospitals, there have also been safeguards in place to protect the quality and patient safety of the medical services provided. Many countries and national Ministries of Health require hospitals to meet standards and criteria designed to assure a minimum threshold of care, and many hospitals also seek to grade themselves against international standards.
Patients deserve a system that can protect and inform them. Moreover, the health sector is measuring patient experience and patient engagement as key performance indicators of the successful operational capacity of an organization and as factors that significantly contribute to the clinical outcomes for patients. Patients have the ability to make decisions based upon the quality of care of a facility, the clinical care of a physician, and the anticipated patient experience.
The growth of medical travel has opened up new opportunities for patients to seek treatments that may not be available, affordable, or of high-quality in their home countries.
However, widespread health travel has also brought its own set of unique challenges. How can patients be sure that a hospital or clinic, located half-way around the world, in a different regulatory and cultural environment, is right for their specific needs? How can travelers make sure they’ll receive a high-quality healthcare experience? After all, we are dealing with healthcare procedures that often carry certain risks. Additionally, when you add some combination of travel, poor or uninformed choices, and bad luck, there is always the potential for less-than-desirable outcomes to occur. Take, for example, a recent study from the University of York, which examined medical interventions by the UK’s National Health Service. It estimates that poor outcomes from cosmetic operations, which were originally conducted overseas, cost the British taxpayers £8 million per year.
In a popular and well-respected Central American medical travel destination, an anemic New Yorker suffered major blood loss during a tummy tuck procedure and needed emergency surgery. The doctor allegedly knew she was anemic and chose to operate anyway. After being told to return in a few months for reconstructive surgery, the patient returned to New York, where she was rushed back to an emergency room for a post-op infection that had developed in her stomach. While the clinical risks are obviously very important to consider as highlighted above, there are also risks related to the patient experience.
There are potential language and cultural barriers and issues that can occur with travel, such as missed pick-ups or patients being discharged to hotels that may not have the necessary infrastructure, services, and staff skills to adequately serve the patients’ needs. Recently there have even been stories in the media of foreign patients being kept against their will in hospitals due to confusion or misunderstandings regarding billing policies.
Incorporating Medical Travel Best Practices
The Global Healthcare Accreditation (GHA) Program was established in 2016 with international standards that advocate for traveling patients in important areas such as Care Management, Communication & Education, Patient Advocacy, Cultural Competency, Travel & Tourism, Business Ethics, Marketing, and more. It can be viewed as a new layer of consumer protection specifically targeted at medical travel.
"GHA does not compete with existing national and international clinical accreditation programs, but instead, complements them," said Karen Timmons, Chief Executive Officer of Global Healthcare Accreditation. "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."
Optimizing the Medical Travel Care Continuum
While the Global Healthcare Accreditation (GHA) Program reviews some clinical aspects of care (specifically as they impact medical travelers), its primary focus is on enhancing the patient experience (including pre- and post-care) and improving the performance of an organization’s medical travel program. At the heart of the Global Healthcare Accreditation’s standards is the Medical Travel Care ContinuumTM (MTCC); these are the touchpoints or stages of the medical travel experience, from first contact, all the way through medical follow-up back home. The MTCC depicts the entire care continuum that must be integrated and managed to ensure good clinical outcomes, good patient experience, and good business practices that positively impact an organization’s performance.
More Patients are Demanding a Great Patient Experience
Patients want and expect good quality outcomes, and in today’s world, they also expect a great patient experience. In fact, a growing body of evidence suggests that focusing on the patient experience also improves clinical outcomes. For example, 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 .
To deliver a high-quality patient experience, each touchpoint along the medical travel care continuum must be optimized to ensure a positive medical travel experience. “Consider some of the terrible airline passenger experiences that have gone viral on social media in recent years,” said Ms. Timmons. “In these cases, the passengers have arrived safely at their destination; however, they certainly did not have a great experience with the airline, and the wide publicity surrounding these events damaged the reputation of the airline. In medical travel, patients will often judge a hospital by their entire trip experience including the interactions on the website, remote communication with staff, airport pick-up, the hotel...all these details impact the patient’s perception of your organization.” But what actual value does GHA accreditation bring to a facility?
Accreditation is an external validation of an organizations’ commitment to quality. It demonstrates a hospital or clinic’s willingness to have an external third party conduct an on-site review of its compliance with recognized best practice standards. Accreditation builds trust and enhances the reputation for organizations, while strengthening the confidence of patients.
Additionally, GHA helps improve the patient experience for medical travelers and supports healthcare providers to increase visibility and implement a sustainable business model for medical travel.
Better Business Performance
While GHA cannot guarantee increased international patient flow to an organization, the results of the accreditation process will put the organization in a better position to attract and effectively serve medical travel patients. Specifically, we are referring to improved patient experience across the entire medical travel care continuum and better business performance of the medical travel program. Recent studies demonstrate that improving the patient experience correlates with stronger 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.” 
GHA also offers guidance within its standards and requires ongoing monitoring of Key Performance Indicators (KPI’s) unique to medical travel, ensuring that healthcare providers are continually and accurately measuring and improving the performance of their medical travel program. “In fact, Timmons said. “It has been gratifying to hear feedback from our accredited clients which highlights improved patient experience scores, an increase in patient volume and the ability and confidence to target new markets since becoming GHA accredited.”
Additionally, GHA is working so that more insurance companies and global payers adopt medical travel, helping them determine which hospitals have implemented best practices for medical travel patients. Our advisory board includes representatives from recognized insurers such as Cigna, Aetna, and Axa.
Addressing the Lack of Data in Medical Travel
GHA isn’t solely in the business of accreditation – it also provides training on the GHA standards and medical travel best practices and advisory services to help organizations enhance the medical travel care continuum or develop a medical travel program or destination brand. GHA is also pursuing the collection of data specific to medical travelers. According to Ms. Timmons, “For such a large industry, there is a lack of consensus on definitions and very little data regarding clinical and patient experience outcomes for medical travelers. Healthcare executives cannot make intelligent decisions for their organizations unless they truly understand the context in which they do business. GHA aims to promote consensus and clear definitions for the medical travel industry including, ‘How do we define medical traveler?’ and ‘What are meaningful key performance indicators in medical travel?’”
In other words, GHA believes that advocating for international best practices in medical travel will help encourage transparency, credibility, and sustainability in the industry.
“The GHA process – what I believe should be more accurately called ‘The GHA Experience’ – was an exercise in practical, pragmatic, necessary quality improvement," said Dr. Erik Fleischman, former International Medical Director of Thailand’s Bumrungrad International Hospital. "GHA was particularly fitting for our institution, as it is the only accreditation that helps assure quality care from the time a patient leaves their home to the time they return after medical care. We are a great hospital. We are even better after GHA.”
GHA reached a new milestone in 2019 with the accreditation of its standards by the International Society for Quality in Healthcare (ISQua), known as the accreditor of accreditors.
“This achievement provides assurance to patients, insurers, ministries of health, and other stakeholders that an organization’s medical travel services have undergone a rigorous evaluation against the highest international benchmarks for accreditation entities and are focused on both international best practices in medical travel and continuous improvement,” Ms. Timmons said.
As internationally recognized healthcare brands expand their global footprint, the global healthcare industry will become increasingly more competitive and defined as to consumer choice and preferences. As the medical travel industry continues to evolve, the question that remains is: will organizations reference the correct framework for medical travel? The Global Healthcare Accreditation (GHA) Program provides the ideal starting point to introduce international standards and professional norms that provide a measurable impact on patient experience, as well as the performance of the medical travel program.
 Jha, A., Orav, E., Zheng, J., Epstein, A. “Patients’ perception of hospital care in the United States.” New Eng J Med 359.18 (2008): 1921-1931 quoted in Luxford, K., Sutton, S., “How does patient experience fit into the overall healthcare picture?” Patient Experience Journal, Vol 1. (2014)
 Accenture: Patient Engagement: Happy Patients, Healthy Margins