By Latha Rajendra Kumar, MD, PhD and Robin Yurk, MD, MPH

Source: 1 The term Medical Tourism in healthcare is increasingly being associated with the business industry and, like every business; it needs excellent management to keep the business running effortlessly. The configuration and economics of healthcare are changing speedily. 2 Medical operators of Medical Tourism facilities require leadership and organizational management skills.3 Future medical and health services managers must be prepared to deal with the integration of healthcare delivery systems, technological innovations, an increasingly complex regulatory environment, restructuring of work, and an increased focus on preventive care. They will be called on to improve efficiency in healthcare facilities and the quality of the care provided.2 Health care managers initially begin their research program by analyzing data to improve the system. Quality of care is one area which managers can focus on to establish priorities in the areas of access, effectiveness, technical competence, and efficiency of the system. 4 JCI has developed Health care Organization Management Standards which are designed to improve patient safety by focusing on improving the processes. Medical tourism facilities can adopt the

JCI framework to build their programs. The framework of management standards include: 1) Quality Improvement and Patient safety, 2) Prevention and Control of Infections, 3) Governance, leadership and Direction, 4) Facility Management Safety, 5) Staff Qualifications and Education, 6) Management of Communication and Information.5 Patient Safety: Patient Safety is an International goal with several organizations promoting a culture of safety including JCI 5, ISQUA6, the Institute of Medicine,7 and the WHO.8 The JCI standards for Patient Safety and Quality improvement focus on developing the leadership for patient safety programs, design of clinical and management processes and standards for these programs, facilitate data collection, analyze the data and maintain improvements within the system.
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Many Medical

Tourism facilities are located in developing countries and require establishment of specific Patient Safety goals for developing countries as described in the WHO report.9 The WHO Quality improvement reports research priorities can be used to establish the standards for a Medical Tourism Patient Safety Program. These standards are 1) counterfeit and substandard drugs, 2) inadequate competence in training & skills, 3) healthcare associated infections, 4) unsafe infection practices and 5) unsafe blood practices.9 Prevention and Control of Infections The World Health Organization reports that Healthcare associated infections is a global problem which results in prolonged hospital stay, long term disability, increased resistance of microorganisms, increased costs, and increased mortality. 10 Prevention and Control of Infection is a JCI Standard 5 and also is a priority for Patient Safety in Developing Countries.9 The JCI program standards include having a program in place with leadership, policies, and processes to integrate with a current patient safety program. Other goals for the program include providing a focus for the program such as Prevention control measures. This includes instituting practices such as wearing protective equipment: gloves, masks, eye protection or isolation procedures.5 The WHO Hand Hygiene guidelines can be used to design, implement, and educate the staff on this standard.10 Governance and Leadership

International leadership is required for global healthcare facilities because of the diverse patient populations. China Medical University Hospital, Bangkok Hospital Medical Center, Soroka University Medical Center, Changi General Hospital, International Clinical Laboratory, Hospital Mexico Americano are examples of JCI accredited hospitals that have International leadership from Americas, Australia, Singapore, Thailand, and the United Kingdom.11 JCI promotes safe Healthcare facilities which should have an organizational structure and governance with an appropriate mission, policies and procedures, and budget to provide leadership. Other qualities of a leadership program include a plan for medical staff implementation, communication with the community, and organizational ethics. 5 Facility Management Safe healthcare facilities require leadership and staff education focused specifically on reducing adverse events. Guidelines exist in the area of security, hazardous materials, disaster preparedness, fire safety, medical equipment, and utility systems.5 An example of some of the unique programs needed for medical tourism facilities is illustrated in management team at Bangkok Hospital Phuket, where doctors, nurses, medical assistants meet the standards of medical facilities in the US. Bangkok Hospital Phuket is the first hospital in Phuket to receive the Joint Commission International (JCI) USA, the accreditation the gold-standard in hospital certifications worldwide.12 Staff Qualifications Each country has different standards required of its professionals. The Education Commission for Foreign Medical Education is an example of an organization that is established to certify whether International Medical Graduates are ready to enter US residency or fellowship training programs.13 Medical Tourism Facilitators have established their own process for verifying physician credentials by creating physician profiles from the International Hospitals which includes a CV, background on their education, residency, and certification. 14 International hospital healthcare management can improve upon credentialing by defining the appropriate education, skills, and knowledge of its staff in the following categories: orientation and education. 5 medical staff membership, nursing staff, other healthcare professionals. 5 It should also provide for appropriate

Management of Communication & Information Communication of medical information has a common structure in the form of a patient record. There are some aspects of the patient record which need standardization to protect patient rights using privacy standards as an example. Privacy standards are different amongst countries and may require informed consent in the transfer of records.15 The JCI recommendations for healthcare organizations include having a management team to communicates information appropriately through the community, patients and families, and practitioners. The leadership should have a system in place which establishes privacy, confidentiality, the patient record, and aggregate data.
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Risk Management teams are one leadership solution to promote patient

privacy. This still needs further development in some countries. 16 Conclusions: Creation of the management infrastructure in healthcare facilities can improve the quality of care through the reduction of adverse events and promotion of efficiency. More resources are needed for the institution of programs and patient safety research globally. They include a wide range of measures which include risk management, tracking medical device hazards, healthcare environmental safety, continuing care services, accident investigation, quality improvement and risk management consultancy services. Standardization and accreditation led by the international sector has played a key role in educating the healthcare system about risk management and patient safety but still needs further development. The development of management programs for patient safety is a step in the right direction to improve the quality of care whether a facility is located in a developed or developing country

References: 1. Saratoga Emergency Physicians. Retrieved on September 28, 2010. Available at URL:www.seppc.com/. 2. United States department of labor , Occupational Outlook handbook 2010-11 Edition, Retrieved on September 27, 2010. Available at URL: http://www.bls.gov/oco/ocos014.htm.

3. The CBS Interactive business network, Health Care Industry, Hospital administration, Retrieved on September 27, 2010. Available at URL: http://findarticles.com/p/articles/mi_gGENH/is_20050229/ai_2699003385/. 4. Lori DiPrete Brown et al. Quality Assurance of Healthcare in Developing Countries. Quality Assurance Project. 1990. Bethesda, MD. Retrieved on October 4, 2010. Available at URL: http://www.qaproject.org/pubs/PDFs/DEVCONT.pdf 5. JCI. Joint Commission International Standards for Hospitals. Standards List Version 4th Edition. Retrieved September 13, 2010. Available at URL: http:// www.jointcommissioninternational.org/common/pdfs/jcia/IAS400_Standards_Lists_Only.pdf. 6. About ISQUA, Vision & Mission Statement. Retrieved on October 26, 2010. Available at URL: http:// isqua.org/about-isqua/visionmission.htm. 7. IOM Report. To Err is Human: Building a Safer Health System. November 1999. RetrievedonOctober26,2010. Available at URL:http:// iom.edu/~/media/Files/Report%20Files/1999/To-Err-is Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf. 8. WHO Patient Safety. Retrieved on October 26, 2010. Available at URL: http:// www.who.int/patientsafety/information_centre/documents/en/index.html. 9. WHO. Global Priorities for Patient Safety Research. WHO Press: Geneva, Switzerland. ISBN 978 924 1598620. Retrieved on October 26, 2010. Available at URL: http:// whqlibdoc.who.int/publications/2009/9789241598620_eng.pdf. 10.WHO Patient Safety. WHO Guidelines on Hand Hygiene in Healthcare. 2009. WHO Press: Geneva Switzerland. ISBN 978 924 159790 6. Retrieved on October 26, 2010. Available at URL: http://

whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf. 11.JCI accredited organizations. Retrieved on December 7, 2010. Available at URL: http://www.jointcommissioninternational.org/jci-accredited-organizations/. 12.Bangakok Hospital, JCI. Retrieved on December 7, 2010. Available at URL: http://www.phukethospital.com/eng/Accreditation-Hospital-JCI.html. 13. ECFMG. About ECFMG. Retrieved on October 26, 2010. Available at URL: http://www.ecfmg.org/about.html. 14. Med Retreat. Procedures, Physicians. Retrieved on October 26, 2010. Available at URL: http://www.medretreat.com/procedures/physicians.html. 15. Kumar LR, Yurk RA. Legal Issues in Global Healthcare. IntHealthCert International. December2010. Available at URL: http://inthealthcert.com. 16. Express Health care, Mitigating risk in health care, Retrieved on December 1, 2010, Available at URL: http://www.expresshealthcare.in/201011/strategy01.shtml.