We speak to Zahid Hamid on the quality of care in medical tourism


There are as many definitions of quality of care as there are participants involved in the health tourism sector; each participant views quality from the own perspective. What is required, however, is a common understanding of the term from the patient’s perspective. Simply put, Quality of Care is “a measure of the Duty of Care owed to the patient at each stage of the Medical or Health Tourism Process”. This has implications for each participant in the process and calls for seamless transition from one stage to the next, until the service is delivered and the duty of care towards the patient discharged as due.

The First Response – a capability statement

A health travellers’ journey begins with the first response sent to the patient when an enquiry is made. This response contains or should contain information on the hospital or choice of hospitals, surgeon or physician information, outline diagnostic or treatment plan, approximate costs, etc.

This is in effect a ‘capability statement’ made to the patient looking for treatment saying, ‘”We have the facilities, skills and expertise at the price that you want in order to treat you”.

It may be healthcare facilitators who are making this capability statement or the international patients’ departments within the provider hospitals, or even information available on the web. This information must be credible and verifiable, made available by the hospital and not put across in marketing-speak, and it must be documented.

The Decision – based on a promise

An iterative process then takes place that results in the facilitator or the service provider making information available to the patient along multiple streams;

  •     Diagnostic assessment
  •     Confirmation of nature, scope and extent of treatment
  •     Price assurance
  •     Confidence building and clarity seeking
  •     Logistic support
  •     Recovery and post operative care processes
  •     Warranties as well as legal aspects.

We may then expect the patient to arrive at the decision, which marks the transition of the ‘capability statement’ to a ‘promise’.

There may be multiple parties that have provided this information whether through the facilitator or the hospitals’ patient liaison departments, or at times even third parties. Quality of care must be the motive force for this flow of information that delivers the ‘customer decision’ and not commercial considerations or a hyped sales pitch. For all parties concerned, this duty of care, and the manner in which it has been exercised, must be ‘demonstrable’.

Transition to Treatment – Continuity of care

So, with the decision taken and the ‘business’ delivered to the service provider, is the facilitator’s deed done and the onus then on the service provider? The short and simple answer to this is a “No”; the facilitator was the first point of contact for the patient, has provided most of the information and mediated a ‘contract’ between the patient and service provider. The facilitators’ role is central to the ‘delivery of service to the promise’ as an ‘independent agent’. The Duty of Care continues and so must the involvement of the mediator in ensuring that all that has been promised to the patient is actually made available.

Delivery of Promise - The litmus test

The patients then reach the destination and give themselves into the ‘care’ of the service provider. Medicine is all about ethics and the onus of living up to the promise ultimately rests here. For instance:

  •     Are the treatment plan and schedules, facilities and special needs, and all other elements of the package made available as stated?
  •     Are there any changes?
  •     If so, are they adequately explained by the responsible person?
  •     Is the outcome as anticipated or at a variance?
  •     Are aspects of clinical governance, as relevant to the patient, implemented?
  •     Does the price remain unchanged?

For duty of care to be seen as having been delivered, it must be visible and can then translate into as assessment of Quality of Care. It is, in essence, ‘a measure of the Value proposed against the Value delivered’.

Continuum of Care – Post operative phase

However, the Circle of Quality of Care is not complete as yet. Post operative care is a major concern and even when complications do not occur, concerns over healing, progress of recovery and being on the course to good health and well being remain in the balance. This is an aspect often cited by prospective patients as a concern and may only be satisfied with adequate cover being available in the Country of Origin of the patient. Post operative care must include:

  •     Accessibility to the service provider and specialists who provided treatment.
  •     Timely responses from the service provider and Specialists.
  •     Availability of attendance by Specialists in the Country of origin.
  •     Prompt access to all treatment related documentation to assist those undertaking post operative care.
  •     Recourse in the event that corrective or revision treatment is required.

The focus – not the onus; that never went away – is  now back on the facilitator who assumes the mantle of ‘patient advocacy’ towards ensuring the return of the patient to health and wellbeing (the promise) with minimum dislocation, prompt communication, maximum peace of mind and without the burden of additional expense – it is all about ethics!

Patient Testimony – The measure of quality of care

What does the patient think? The testimony from the Customer, “did I get the quality and care at the price promised to me?” Patient feedback must be institutionalised as part of the process to measure the perceived value and to continually remedy, refine and enhance the value proposition.
The Quality of Care Call

Therefore, what Quality of Care calls for is:

  •     a. To be demonstrable at every stage of the process.
  •     For the process to seamlessly make a transition from one stage to the next.
  •     Transparency of actions taken before during and after the treatment.
  •     Documentation of treatment outcomes and follow up.
  •     The Ability to audit the trial of events in the course of patient handling from start to finish.
  •     Account for patient feedback and perceived value.

Orchestrating Quality – Harmony of thought, deed and spirit

This literally means that all parties are so well linked, their actions coordinated, their processes visible to each other (to the extent consistent with HIPPA regulations, of course) and their communication with the patient from one unified script; clear, coherent and complete.

With ‘One promise and a matched expectation’, an ‘Indicator of Success’ and the ‘Ability to trail failure and remedy’, Medical Tourism cannot go wrong! This is possible only through the partners to the process being bound in thought, deed and spirit, which calls for a shared understanding, a unified workspace, integrated processes and connectivity making it one whole rather than a number of disparate bodies, walking in parallel but not together.


Lessons from a decade in medical tourism

Resources, 25 April, 2017

Zahid Hamid, Euromedical Tours, IMTJ Medical Travel Summit 2017

The onus of care

Articles, 10 August, 2012

Healthcare providers can not rely on certification to draw customers

Regulating facilitators

Articles, 27 July, 2012

Why regulation is needed in medical tourism

Redefining globalisation

Articles, 04 June, 2010

Is medical tourism really global, or is it a local industry?




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