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Marketing & Business Development

Will the Circle be Unbroken? Effectively Marketing your International Department

Marketing & Business Development

Imagine the following scenario:

As someone in urgent need of knee replacement surgery, you have been in contact with a foreign hospital’s international department for several weeks. A long string of emails have been exchanged, and you’re starting to feel pretty comfortable with the idea of traveling abroad for your surgery. Why shouldn’t you? The price is right, the international staff has been friendly, and your every email has been answered promptly and to the tee. They even sent you some glossy brochures with hospital photos worthy of any U.S. institution. Hey, in your mind this hospital is the perfect choice to rid you of your constant knee pain, so you quickly settle upon a surgery date.

A few weeks later after a tiring flight, you arrive in a foreign country only to find that no one is there to greet you. When you call the hospital you’re put on hold and then passed along to a host of non-English speaking brethren until, seemingly by chance, you end up with your international department contact. She quickly pulls things together and twenty minutes later a van screeches to a halt in front of you. A somewhat disheveled driver greets you with an effusive “que tal amigo?” and then apologizes to you in broken English for his tardiness. To your chagrin, he goes on to inform you that he must wait a few minutes for another passenger. A “few minutes” eventually turns into twenty-five, before you’re finally off to your hotel.

Things have not started out well, but you chalk it up to a little bad luck. Fortunately, the hotel looks nice and the desk clerk, if not particularly friendly, seems to speak your language. You’re surprised that no one shows you to your room, but, after some hand signals and pointing, you eventually find your way. The room’s okay; however the bed is small and the bathroom, although spacious, was not designed for a knee surgery patient. There are no support bars, and there is a high-rim bathtub instead of a shower. Though adequate, the hotel lacks a personal touch and many of the amenities you feel medical patients might require.

The following day you’re taken to the hospital – a modern building that boasts the latest in technology and style. Soon however, you begin to notice cracks in the facade. Your international department host is warm and welcoming but never tells you where you’re going or what is happening next. Doe-eyed and drenched in sweat, he seems almost as confused as you are. Your pre-operative tests take forever, seemingly because of a lack of coordination and timing with the lab and diagnostic departments. Worse yet, you’ve received countless dirty glares from hospital employees and patients each time your host tries to “cut” you to the front of the line.

Your doctor’s appointment starts off well, but little by little you get a sinking feeling that “fluent in English” has a very broad meaning here. Fortunately, through the use of an interpreter, you get most of your questions answered and then you’re whisked off to the surgery ward.

I could go on but I think you get the picture.

Even though nothing terrible has happened, this string of events is not something you want any of your patients experiencing. On the contrary, as a hospital administrator or international department head, you want to do everything in your power to make sure your patient is not only happy with the surgery or treatment, but also has the best all-around experience possible.

But what, do you say?  Does any of the above have anything to do with marketing?

Before I answer that question we’ll take a quick look at some traditional definitions for marketing. Webster’s online dictionary defines marketing as “The commercial processes involved in promoting and selling and distributing a product or service.”

Then there’s the oft-quoted “four Ps”: product, pricing, promotion, place.

Still scratching your head? Well I don’t blame you, as marketing is usually thought of as something you do to promote your product or services to your customers. However, as you can see from the illustration above, all the marketing in the world will not make your international program successful for the long term until you have learned how to market/promote/sell your international department to your hospital administration, internal departments, physicians, and even your third party providers (hotel, transport services etc…).

Moreover, your hospital’s international department is not an island, and no matter how hard you work to please your patients, or how hard you paint a pretty picture to the world, your efforts will be mediocre at best, unless you sell the rest of your hospital on your mission ~ which is to provide international patients with a positive outcome and experience. And make no mistake about it, each one of these “components” is part of the same machine and all must be moving in sync to successfully achieve this goal.

Against the wind

It may sound strange to some people that you would actually have to “sell the rest of your hospital on your mission.” I mean, doesn’t every hospital want to provide their patients with the best experience possible? And if so, won’t they also put the necessary systems in place to make this happen?

The answer to the first question is an unqualified “yes.” The answer to the second question is probably affirmative as well. However, systems are one thing, getting people to work seamlessly together is quite another ~ and always a work in progress.

As a hospital administrator or international department manager, you may feel that all is fine and dandy with your international patient program. Your international patients seem to be doing fine and complaints are few and far between. If that’s the case, then don’t waste your time reading any further.

For everyone else, I would urge you to take a closer look under the hood and take time to determine if the needs and expectations of your international patients are truly being met. You may be surprised to learn that all is not working as seamlessly as you had imagined, and that there is still some room for improvement.

What are these “needs and expectations”? Well for one, chances are most of your international patient clientele will be coming from first world regions such as the United States, Canada and Europe. They have been touted first-class services and may not take kindly to long waits for admission, dealing with “cumbersome” protocols or hospital staff they can’t understand (to name but a few).

Your goal then is to make your international patient experience the best that it can be. The challenge, however, is to achieve this goal within the natural limitations and “constraints” placed upon you by hospital systems and processes that were probably designed to cater to the customs and needs of your local patient population (and rightly so).
Let’s face it.  Unless your hospital was built with the express purpose of treating international patients, then it is likely that you will meet some resistance along the way to “making your international patient experience the best that it can be.”

Suspicious Minds

With the rapid rise of medical tourism over the last five years, hospitals have often been in a rush to put together an office or department to cater to the expected influx of international patients, if only as signal to the rest of the world that their hospital is a serious player in the global health travel arena.

Unfortunately, sometimes little thought or planning has gone into this venture and it has too often been like hammering a square peg into a round hole. In other words, your international department may not always fit snugly with the rest of your hospital’s culture, leading to your department being perceived as somewhat of a fifth wheel or crazy uncle, the one you politely greet but quietly wish would go away.

Of course, it doesn’t help that in your zeal to provide your international patients with an outstanding experience, you have probably stepped on quite a few toes, possibly even engendering a few “enemies.”

Building a Circle of Trust

You may recall a popular movie from some years back called “Meet the Parents,” where a slew of oddball situations and hilarious antics revolve around Ben Stiller’s character Greg Focker, trying to get into (and stay in) the “Byrne’s family circle of trust.” No matter what he did, or how hard he tried, he never seemed to be able to get in on Jack Byrnes’ (a.k.a. Robert De Niro) good side.

Although, as portrayed in the movie, the circle of trust concept may be going a little too far, it is vital that you build strong relationships between your international department and the rest of the hospital (and key third party providers), in effect creating a circle of trust. This means physically getting to know and even bonding with department heads, supervisors and frontline employees; key people who can assist you with providing an outstanding experience for your international patients.

And no, it’s not necessary to stroll shoulder to shoulder amidst the hospital rose garden with Sanjay from diagnostics. A warm greeting and a smile is a good place to start. Later, perhaps, you might have the opportunity to send a receptionist a thank you note for her help during a difficult situation, or even for routine assistance, with a copy to her supervisor. This will go a long way towards building trust and goodwill.

Let’s go back to the “Meet the Parents” movie for a moment. Remember Robert De Niro’s famous line, “I keep nothing from you, you keep nothing from me… and round and round we go”? In the same way, the circle of trust is like a chain, and if there is any weak or broken link in this chain, you can be sure that it will negatively affect your international patient’s overall experience at your hospital, and cause you a lot of unnecessary stress as well.

Now let’s take a look at some key areas in your hospital and how to go about building your own “circle of trust”:

Hospital Administration

There is little doubt that this should be the first stop on your crusade to build your circle of trust. They are, after all, the ones that first saw a need for your existence, brought you forth into this world, and nurtured you along to where you are today.

And continuing with this analogy, whether you are a toddler, teenager, or full-grown adult (I would guess most likely one of the former two as this industry is still in its infancy), it is critical that you maintain close and frequent contact with your hospital administration. They will ultimately set the guidelines to be followed by the rest of the hospital, in effect running interference for your international program and thereby making your job much easier.

It is also important to let the administration know when certain established systems or procedures may be interfering with your ability to better serve your international patients, and then work together to find solutions that are agreeable to everyone involved.

Periodic meetings are essential to maintaining mama and papa in the loop, to hear their feedback and to set goals that are in harmony with the rest of the hospital’s strategic agenda. This may sound like a no-brainer, but you’d be surprised how easy it is to get lost in the day to day activities of running your department and to forget about the big picture.
This will be your first task but it’s not enough – not by a long shot…

Internal Departments

You must also make time to meet with each department to introduce your international office staff and explain a little about the program. Nursing is particularly important. Make sure nurses (as well as the rest of the internal departments) understand the particular needs of international patients (cultural issues, language, fear of the unknown) and how to address these needs. You should also listen to their side of the story and encourage them to offer suggestions and advice. A receptive attitude on your part will help smooth out any future misunderstandings.

Take a hospital’s laboratory for instance, one of the first stops for international patients getting their pre-operative tests done. In a perfect world, Yolanda, the lab attendant, will be sitting there with a radiant smile as she contemplates the glorious beginning of the new workweek. The waiting area is deserted, and she’s got nothing else to do as she counts down the minutes to your patient’s arrival.

In reality though, the waiting area is overflowing and Yolanda is upset at her husband for forgetting their anniversary the night before. If that weren’t enough, she is also stressed out because her supervisor is hovering over her like a hen while she attempts to resolve a patient’s complaint. The last thing she wants to see now is your international department assistant seeking preferential treatment for a patient – and you really can’t blame her.

One possible solution would be to coordinate with the lab beforehand to make sure they know the international patient is coming and that they have all the necessary information to process the patient on arrival, without the need for any furtive glances and awkward hand signals to get the lab attendant’s attention. Another option may be to set up a separate area for international patients where tests can be performed out of sight of other patients.

The best solution will depend on your particular hospital; the important thing here is to reach out to each department and discuss how to better serve the needs of all your patients, both local and international.


As human beings we tend to be a pretty loyal bunch, especially when it comes to our medical practitioners. We find one we like and then we never let go. Therefore it is hardly surprising that a good group of doctors is the keystone of any successful international patient program.

When choosing your international program physicians, start with the same criteria you would use to find any good doctor: experience, skill, education and a specialist in his or her field. Your physicians must also speak and understand English (or other languages popular with your patients) and ideally possess a charismatic personality that will easily connect or empathize with your patients. Although possibly underrated, this last element can make the difference between a good outcome and a memorable-tell-all-your-friends-and-family kind of trip.

Having said that, you will find doctors to be a diverse group, requiring a multifarious approach laced with tact and understanding in order for you to really get your message across. Open and frequent communication with regard to procedure details and pricing is a must in order to avoid mistakes and hard feelings…“Ah doc, I could’ve sworn the rhinoplasty procedure was included in the lower body lift…”

You will also need to take into account a doctor’s availability and desire to cater to international patients. Some doctors may enthusiastically sign up for the program only to find they are unable or unwilling to dedicate the time necessary to gain a patient’s trust. Doctors need to be aware that in general, international patients require a lot of prep time and back and forth follow-up to bring them to the point where they are comfortable with the idea of traveling to a foreign country for their surgery.

Doctors also need to understand that this is a global marketplace and that, in many instances, whether they like it or not, they will be competing with other physicians from around the world for a patient’s favor (however flippant this may sound). To make an informed decision, patients will want as much information as possible. Therefore, doctors catering to international patients should be especially forthcoming with information about their background, education and experience.

Don’t underestimate the importance of establishing a close working relationship with a good group of physicians, as this will save you much heartache later on.

Third party providers

When I say providers, this will in most cases refer to the lodging and transportation options you provide to your international patients. It is possible that your hospital will have its own lodging and transportation services in house. Most likely though, you will be outsourcing these services to other companies, which means potentially losing control of an important part of your patients’ experience.

Naturally, outside providers will usually be your weakest link, so to avoid having your circle of trust snap like a twig.  It is critical that providers understand the type of customers they are dealing with and what you expect from them.

In the case of transportation services, you must be adamant that the personnel should be easily identified by their uniforms, be personable and posses good English speaking skills. In many instances, representatives from these companies will be the first face your patient actually sees, so an impeccable presentation and warm welcome is of the utmost importance. You should also survey your patients for feedback regarding their experience with your transportation.

It goes without saying that any hotels you recommend for recuperation purposes should possess infrastructure and services suitable for people who have recently undergone surgery: rooms equipped for handicap patients, wheelchair access and flexibility with dietary needs to name but a few. Beyond that, make sure professional medical care is readily available and that the staff is informed about the particular needs of each of your patients. For example, patients who have undergone weight loss surgery will require a strict diet that must be made available at regular intervals. For others, bandages need to be changed, drains emptied and medications administered.

Don’t make the mistake of taking your provider’s word that they are “patient friendly.” To be certain that your patients are safe as well as comfortable means holding people accountable. This can only be accomplished, in a real way, once you have established a close rapport with your third party providers.

Step by step to success

As you have seen by now, building a circle of trust is a high maintenance endeavor and not a one time job. No matter the quality of your international department, don’t be fooled into thinking that all will fall into place on its own. All the great staff and technology in the world will do precious little if not tethered to a carefully nurtured support network. Yes, being a lone ranger sounds romantic but it will only get you so far.

To effectively market your international department you must ultimately begin with a mindset that focuses on relationship building with anyone and everyone that can influence your international patient’s experience. Be it a chauffeur, a nurse, or even your hospital director, all must be engaged, stone by stone so to speak, setting a solid foundation that will eventually underpin and then propel your traditional marketing efforts for the long haul.

As Patient Coordinator for Hospital Clinica Biblica International Department in Costa Rica, Bill Cook oversees operations and customer relationship management initiatives aimed at increasing customer loyalty and satisfaction. Bill also overseas web content development and marketing strategy for Medical Tours Costa Rica, a locally based medical tourism operator. Bill can be reached at

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