IHHR 6 - February 2019 by International Hospitals & Healthcare Review

Interview: ISQua Dr Peter Lachman, CEO

Big data for better patient care

Dr Sapan S. Desai, Northwest Community Hospital

THE ATTRACTION FACTOR: TARGETING THE INTERNATIONAL MARKET What hospitals can do to attract more international patients – and their insurers Issue 6 · February 2019

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Hello! If you hadn’t heard, it’s now 2019! Happy New Year to you, dear reader! Allow me to present to you the ﬁrst International Hospitals & Healthcare Review of the year. In this issue, Dr Peter Lachman, CEO of The International Society for Quality in Health Care, gives an insight into his organisation, which works to inspire and drive improvement in the quality and safety of healthcare on a global scale, and discusses how ISQua is developing innovative ways to improve quality and safety networks. We also bring you a feature on virtual health, which explores the rise of asynchronous health and examines potential beneﬁts and concerns as the phenomenon gains traction. In addition, with a focus on Hong Kong, we look at what hospitals can do to attract international patients, with insight from Danny Quaeyhaegens, Head of the international insurance department at Bangkok Hospital Pattaya, Thailand, and Lynne Fung, Executive Director, Business Development, Matilda International

4-7. News

A snapshot of industry happenings

Hospital. Finally, Dr Sapan S. Desai lends his expert opinion on how healthcare organisations can harness big data and machine learning to improve healthcare quality. If you or your organisation would like to feature in the International Hospitals & Healthcare Review please drop me an email. It would be great to hear from you. Wishing you health and happiness for the year ahead.

Lauren Haigh Editor editor@ihhr.global @Medical_Editor

08. Industry voice: Big data for better patient care Dr Sapan S. Desai, Northwest Community Hospital

12. Q&A: The International Society for Quality in Health Care (ISQua)

16. The attraction factor

Targeting international patients: Hong Kong

Dr Peter Lachman, CEO

Editor-in-chief: Ian Cameron

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NEWS Caribbean hospital expands ICU for international patients Health City Cayman has expanded its intensive care unit capabilities, now operating a Level 3 trauma centre. This follows the commissioning of its newly expanded Medical Intensive Care Unit (MICU) in early December 2018. The unit officially opened on 10 December following a nine-month expansion project that increased the ICU’s trauma and triage capabilities. Dr Devi Shetty, Chairman of Narayana Health and Founder of Health City Cayman Islands, highlighted the hospital’s

commitment to providing worldclass medical care to patients in the Americas: “We built Health City with the idea of transforming healthcare in the Western Hemisphere. The core of our vision is to make high-level healthcare more accessible and affordable for more people, who may previously have not had this access. The expansion of our Intensive Care Unit at Health City is another step in the ongoing development of our services to benefit the people of the Cayman Islands, the surrounding region, and international patients from further afield.” Dr Shetty said that the hospital’s mission is to transform the delivery of healthcare in the Caribbean and beyond, and that it is committed to providing the highest level of medical care to local and international patients.

New fertility clinic open to international patients

International acclaim for new breast cancer treatment India-based healthtech company Niramai has received international acclaim at the recent San Antonio Breast Cancer Symposium (SABCS). It was the only Indian company to present at one of the largest breast cancer conferences in the world, which is well-attended by oncologists and cancer researchers. Niramai had the opportunity to speak about its work at the event, with Dr Geetha Manjunath, CEO and CTO, explaining that

its solution uses AI to detect early stage breast cancer with results comparable to standard modalities. The solution, Thermalytix, is an automated diagnostic tool that combines thermal imaging with AI. It is radiation-free, accurate, automated and works on all women irrespective of their breast density. “We were privileged to get an opportunity to present at SABCS 2018, a prestigious forum for interaction and learning for a broad spectrum of medical practitioners, researchers and health professionals with a special interest in breast cancer,” said Dr Geetha Manjunath. At the conference, Niramai presented results of a retrospective multisite comparative study of 247 patients across three reputed cancer hospitals in India. These demonstrated higher sensitivity and comparable specificity of the solution to mammography. US-based radiologists were receptive towards the solution, with, for example, Dr Sheldon Feldman, a New York-based expert in breast surgery and surgical oncology, saying: “I am very intrigued by this promising technology. It looks like a major advance in technology. I hope to collaborate and be helpful to further validate its efficacy”.

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Dr Jamie Massie

Fertility centre ORM Fertility is opening a new clinic in Bellevue, Washington, US; the first ORM Fertility location in the state. The clinic will be led by Dr Jamie Massie, who joined ORM fertility in May, and the centre said that it will ‘provide a convenient option for people in the greater Seattle area as well as international patients traveling to seek fertility care’. ORM Fertility said that the expansion further establishes ORM Fertility and the Pacific Northwest as a premier destination for people seeking fertility treatment. Treatments available include in vitro fertilisation, advanced genetic screening, egg donors and safe surrogacy. The expansion to Washington comas as compensated surrogacy just became legal in the state on 1 January. “This is an incredibly exciting time in fertility care in the state of Washington,” Dr Massie said. “I'm greatly looking forward to helping patients in Washington and beyond on

their path to parenthood.” “Northwest Surrogacy Center, LLC has partnered with ORM Fertility for over a decade, successfully assisting our shared clients in growing their families,” said John Chally, Northwest Surrogacy Center, LLC Co-Founder. “We are excited to see ORM Fertility bring its expertise, high-quality medicine and commitment to personalised care to the Bellevue/ Seattle area. We look forward to continuing our shared mission of providing exceptional service to families from the Pacific Northwest and around the world.”

New international hospital in China Singapore healthcare company Raffles Medical Group has opened its first hospital in China – Raffles Hospital Chongqing – which, as the name suggests, is located in Chongqing. The tertiary hospital, which comprises 700 beds, is fully owned by Raffles Medical Group. Executive Chairman of the Group Dr Loo Choon Yong said that China presents more opportunities for the Group to expand in other cities: “They are now more used to international hospitals operating. The rules are becoming clearer, and therefore it will be easier.” Raffles Hospital Chongqing hopes to attract international patients as well as locals and expats, meaning that fewer China-based patients will seek treatment elsewhere, with Dr Yong explaining: “Traditionally, you see that people go out of the country for treatment, those who want to choose treatment in the West.”

NEWS Mental health and prevention and care foci for NHS In the UK, National Health Service (NHS) bosses have said that a new 10-year plan could save up to 500,000 lives by focusing on prevention and early detection, and that GPs, mental health and community care will get the biggest funding increases to shift the focus away from hospitals. Richard Coe, Project Director at Kajima Partnerships, a PFI/PPP provider specialising in health and education, commented on the plan: “It is extremely refreshing to see mental health becoming a political priority under the NHS 10-year Long Term Plan as mental healthcare has traditionally come second to physical health services when distributing available NHS funding. Undoubtedly the extra £2.3bn allocated to mental healthcare is a very promising start to what could be a real transformation of mental health services in the UK. We are particularly supportive of the shift in focus away from hospitals to prevention and care in the community through new evidence-based NHS prevention programmes with specific action for people with longterm mental health problems. We also support the improvement around land usage, which is particularly relevant to Kajima Partnerships through our work with South West London and St George's Mental Health NHS Trust (SWLSTG) which, through its estate modernisation programme, is using surplus land receipts to deliver two new mental health hospitals to replace the original and now dilapidated facilities, opened in the 1840s. This aligns with a key aim of the plan to allow the NHS to improve the way it uses its land, buildings and equipment to improve quality and productivity, energy efficiency and dispose of unnecessary land to enable reinvestment while supporting the government’s target to build new homes. However, for this extra funding to have a genuine impact on how mental healthcare is delivered in the country, it must be matched by investment in the NHS estate so that effective care can take place consistently and in the community, to help identify and treat mental

healthcare earlier. While hospital care is crucial, the presence of supporting community-based facilities is critical in reducing the burden on busy NHS departments. Currently much of the NHS estate remains hidebound by decaying, old-fashioned and isolated facilities with little accompanying community support. The solution to this problem lies not just in promising funding but in changing how healthcare is physically accessed and delivered. It is absolutely critical that we have facilities purpose-designed to support the new resources, such as community crisis teams and school Mental Health Support Teams, outlined in the 10-Year Plan so that the NHS’ ability to actually deliver them is not compromised. Effectively treating mental health means not merely having adequate crisis care but an integrated system of rehabilitation and recovery supported by modern, communitycentred buildings, with hospitals no longer viewed merely as standalone treatment centres but as part of the wider community. Ultimately, if we are to provide modern mental healthcare we must have the modern infrastructure to match. Evidence suggests that demand for mental health services in the UK is only growing, however the current model for mental health care is unsustainable and to make improvements we must radically change our approach to overcome the constraints of tight budgets and to deliver the best possible outcomes for patients. One of our first and foremost responses to this challenge must be to modernise the mental health estate – a task that is long overdue and a scenario that is absolutely achievable before the NHS celebrates its 80th birthday.”

Healthtech to rise to prominence in 2019 Data and analytics company GlobalData has said that healthtech will rise to prominence in 2019, with big data and artificial intelligence (AI) becoming ‘a transformational force’ in healthcare. According to the company’s latest annual outlook report, The State of the Biopharmaceutical Industry – 2019, 38 per cent of global industry respondents believe that big data will have the greatest technology impact on the pharmaceutical industry in 2019. “Increasingly high volumes of data are required for all decisions and big data will not only alter the regulatory process as we know it, but payers will increasingly require this evidence as a pre-requisite for reimbursement,” said Dr Bonnie Bain, Global Head of Pharma

at GlobalData. The company said that, compared with other industries, healthcare adoption of big data has been slow but its use will increase dramatically in 2019 across a number of core functions, such as: drug discovery and design; clinical trials; electronic health records; healthcare intelligence; and hospitals and healthcare systems. AI was found to be the second biggest trend anticipated in 2019 as confirmed by 32 per cent of survey respondents. ‘‘Companies need to understand the specific benefits that technologies such as AI can offer and how it can help their organisation. Investing in AI and Big Data will not provide a cure for business problems so do not believe the hype and set realistic expectations for success,” said Dr Bain. “There are also a lot of AI solutions on the market and not all of them are right for every business objective. Choosing the right solution for your business need is key! Also partner for success.’”

Healthcare staff retention improved by December bonus New research by bonus and incentives provider One4all Rewards has found that December bonuses have a large impact on the retention of healthcare workers. A survey of 1,096 UK employees found that healthcare bosses who award bonuses in December are less likely to see staff being poached or looking for a new job. Almost half of workers (42 per cent) said that having received a bonus or gift from their boss recently would prevent them from looking for a new job, while 43 per cent said that they would be less likely to accept a new job if offered one

if the same had happened. The research found that a December bonus is welcomed better than a bonus at any other time of year. “It’s interesting to see just how far a token bonus can impact on the loyalty of those in the healthcare industry. Even if you just consider the amount of money that can be lost through recruitment costs when a member of staff resigns – never mind the softer negative impacts and knock-on effects that employees leaving can have, in terms of morale in the workplace – it is clearly something that is worth investing in,” said Alan Smith, UK Managing Director at One4all Rewards. 5

NEWS

HR intervention needed to assist employees abroad Healix International, which provides healthcare and risk management solutions to clients on a global scale, has highlighted that staff working abroad face very specific risks that HR managers need to address. It said that difficulties can be mitigated by HR professionals carrying out detailed assessment of suitability for the post and thorough preparation of the individual. “Living away from familiar people and places can be challenging for anyone, and the challenges can be exacerbated for workers with pre-existing psychological issues,” said Dr Simon Worrell, Head of Medical Communications at Healix International. “The negative aspects of working abroad can be more pronounced for anyone with mental health issues. However, HR professionals can do a lot to offer the support people need to make a successful move.”

The company said that a vital step to take before an employee is posted abroad is a medical assessment covering mental health and physical wellbeing. It said that a medical clearance process will ensure an employee’s suitability for the posting, while a pre-posting assessment will help identify

any medication requirements, enabling an employer to ensure the destination country is suitable for the placement, as some countries have restrictions on

with the employee before, during and after their posting, concerning work-related issues as well as life outside of work, to ensure overall wellbeing and increase the likelihood of a successful placement. Education programmes and preparatory training before departure can be invaluable. And if issues do arise, working with an international assistance company gives immediate access to the best, most suitable support, which can be very difficult for the employee, or even their HR, to obtain in another country. With effective HR intervention, the worker can not only be prepared for the difficulties that may occur, but also be supported should troubles arise.”

certain types of medication. “Working overseas can bring considerable rewards, but also

present significant challenges,” said Dr Worrell. “Effective HR intervention helps workers prepare for the difficulties that may occur and offers them the necessary support. It is vital that HR works

Trends driving the employee benefits sector

Health insurance changes in Kuwait The Kuwait Times has reported that the Kuwait National Assembly's legal and legislative committee has approved a draft law that would establish a mandatory health insurance scheme for expatriates living and working in Kuwait, moving the proposed health insurance scheme closer to implementation. The committee is also reported to have approved a proposal to impose charges on medical services

for expatriates opting to seek treatment at public hospitals. The present situation is that expatriates are required to pay only KWD50 (US$164) annually on renewal of their residence permits and also pay partial fees for most health services at public hospitals. A further new measure being debated will, when passed, impose a requirement for obligatory health insurance on foreigners who visit the country. It stipulates that before issuing a visit visa to a foreigner, the sponsor must attach a health insurance policy to the application.

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A new report from MAXIS GBN, the international employee benefits joint venture between MetLife and AXA, highlights four key digital and data developments that will increasingly determine the future of the global employee benefits sector. These are: the adoption of global benefits platforms to centralise employee benefits enrolment and management; data analytics generating increasingly sophisticated actionable insights; health and wellness technologies helping employers create targeted wellness programmes; insurtech innovations such as artificial intelligence, distributed ledger technologies and robotic process automation. “We are seeing a significant acceleration of ‘digital transformation’ type activity in the global employee benefits space,

which is, by definition, slower to innovate than more advanced local markets,” said Helga Viegas, Director, Digital Marketing & Innovation at MAXIS GBN. “We launched the MAXIS Data & Digital Innovation Lab in March this year to capitalise on these trends and have begun developing new digital products and services, as well as working with global platforms, insurtech companies and entrepreneurs to offer innovative solutions for our clients.” The report also found that expectations around distributed ledger technologies (DLTs) such as blockchain have accelerated over the past 12 months and it’s likely that DLTs will be increasingly used across key aspects of the insurance world >>

NEWS

Royal Philips awarded for commitment to health informatics

including employee benefits to deliver smarter, instant contracts, better transparency and claims management, as well as greater flexibility for all parties. “DLTs are one of the most exciting parts of a fast-digitising employee benefits industry even though it’s a change in the underlying IT infrastructure that will be fairly invisible to the end user. While a number of challenges remain for those looking to implement a blockchain solution, such as how to effectively exchange information between different systems, the business case is very strong. We have begun looking at how DLTs can be used and there is a clear sense that the concept could transform the insurance market within a few years,” Viegas said.

Health technology company Royal Philips has announced that it has won the 2018 College of Healthcare Information Management Executives (CHIME) Foundation Partner Award, which recognises the company's high level of commitment and accountability towards its health informatics customers. “Our healthcare informatics solutions play a vital role in

Reliq completes new hires Technology company Reliq Health Technologies Inc., which develops mobile health (mHealth) and telemedicine solutions for the community-based healthcare market, has announced that it has completed key new hires and engagements to support the company’s anticipated growth in 2019 and beyond. “We are thrilled to announce the addition of two new members of the Reliq Health leadership team and the engagement of two new key partners,” said Dr Lisa Crossley, CEO of Reliq Health Technologies, Inc. “Dr Bassma Ghali has accepted the role of CTO with the company, and Lucas Smithen will take on the position of VP Products and Professional Services. These two

supporting care providers to diagnose, treat and monitor their patients,” said Carla Kriwet, Chief Business Leader for Connected Care and Health Informatics at Philips. “Healthcare is always on. As an accountable business partner, we know our value is not just in providing technology, but to be there alongside our customers to provide continuous support to ensure consistent, seamless care. The CHIME Foundation is one of the most highly respected global organisations serving CIOs and CIMOs and we are honoured to receive such positive feedback from our customers.” Philips said that health systems face a number of challenges when it comes to running their organisations – such as natural disasters damaging critical technology and interrupting services, cybersecurity, and ensuring consistent connectivity to enable the transfer of patient monitoring data – and that hospitals need a partner who can customise technology to quickly identify and fix the problems they face.

highly educated, experienced individuals bring a new depth and breadth of knowledge to Reliq to allow us to continue to expand our platform’s capabilities and improve our Implementation and customer support services. The company has also engaged Paul McCulloch to manage Reliq’s cybersecurity, privacy and policy development. McCulloch has an impressive background as a technologist and attorney, and has previously served as the VP of Technology and Global CyberSecurity Chief of Compliance at JP Morgan, and Special Advisor in the office of the US Secretary of State. Reliq has also engaged Sonique Ltd to support the Company in marketing strategy, digital and social media and creative services. Sonique’s previous clients include Dynacare, Disney, BBC, Nintendo, ASUS, Sony, HP and many other notable global brands.”

HIMSS hires Chief Americas Officer Global advisor and health information and technology company HIMSS has announced that Dr Denise W. Hines, DHA, PMP, FHIMSS has joined its Executive Leadership Team as Chief Americas Officer (CAO). She brings nearly 25 years of experience to the role and is a nationally recognised expert in healthcare technology, with particular knowledge in the role of state government in health information exchanges (HIE). Dr Hines is currently CEO of health technology consulting firm eHealth Services Group and serves as the Executive Director of Georgia’s statewide HIE, the Georgia Health Information Network (GaHIN). She previously served as VicePresident of Government Solutions at HealthNovation and consulted for both AT&T and the Georgia Department of Community Health’s Office of Health Information Technology. In 2017, she won the prestigious Women of the Year in Technology – Small Enterprise Award from Women in Technology (WIT). “I am thrilled to have Denise join our Executive Leadership Team,” said Hal Wolf, President and CEO of HIMSS. “Having worked directly with Denise through the years, we are so honoured to have her operational experience and passion for HIMSS contributing every day to our mission of reforming the global health ecosystem by leveraging the power of information and technology.” Christopher Ross, Chief Information Officer at the Mayo Clinic and Chair of the HNA Board of Directors, said: “I am very excited that Denise Hines will join HIMSS as CAO. Her long involvement with HIMSS, tremendous accomplishments in Georgia and nationwide, and her service on the Board and as Chair Emeritus will make Denise a great leader for the future of the organisation.”

INDUSTRY VOICE

BIG DATA FOR BETTER PATIENT CARE T Dr Sapan S. Desai discusses how healthcare organisations can harness big data and machine learning to improve healthcare quality

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wo of the most significant trends in healthcare today are big data and machine learning. Together, they are improving the quality of care delivered to patients while successfully decreasing costs. New applications in imaging, diagnosis, treatment, and healthcare management are occurring on an almost daily basis as innovation accelerates in healthcare. Big data is more information than one healthcare system can reliably collect. Consisting of millions or billions of points of data for a single disease process, big data provides the most accurate view of the population of patients impacted by a particular disease process. Traditional

statistical analysis on this sort of information will typically identify dozens of statistically significant findings. Unfortunately, few of those results will be practically meaningful, and truly innovative findings will often be lost within the vast amount of data being collected. Machine learning applications have helped identify both practically significant and statistically significant findings. Tools such as neural networks, support vector machines, decision trees, k-means clustering, and deep adversarial networks excel at identifying signals within the noise. When mated with a lean six sigma performance improvement program and project management tools, a healthcare organisation can prioritise its opportunities for clinical and financial improvement and realise a meaningful return on its investment.

INDUSTRY VOICE

Big data and machine learning â&#x20AC;Ś are improving the quality of care delivered to patients while successfully decreasing costs Predictive models Our group recently presented several innovative examples of this work using the cloud-based QuartzClinical healthcare data analytics platform. At the American College of Surgeons meeting and the International Hospital Federation meeting in 2018, we presented machine learning applications using big data as a way to predict longevity in dialysis patients, reduce mortality from ruptured aneurysms, and decrease readmission to the hospital. Traditional statistical analysis will typically yield predictive models that are accurate approximately 20 per cent of the time. Our machine learning algorithms within QuartzClinical have an overall accuracy exceeding 80 per cent for most models. Some

models, such as those for dialysis patients, have an accuracy exceeding 90 per cent. The impact of this work is the ability to identify the patient, hospital and surgeon-specific factors that impact healthcare. These factors are individualised to the patient, thus delivering truly personalised medicine. When combined with a performance improvement program, it is possible to mitigate the risk factors that are

most likely to lead to an adverse outcome, thus using a targeted approach to improve healthcare. When measuring key outcomes variables such as length of stay, mortality, readmission and cost of care, these models offer the ability to quantifiably measure finite end points. Reducing costs As an example, our group developed a predictive model to identify vascular surgery patients most >>

INDUSTRY VOICE likely to be readmitted to the hospital. With over 100 million data points in the big data model, our machine learning algorithm was able to narrow the number of meaningful predictors of readmission to just a few dozen. The impact was a 57.3 per cent decrease in 30-day readmissions, leading to a projected US$290,400 decrease in cost of care. If such a model were to be implemented nationwide, the overall savings would be in the hundreds of millions of dollars. There are several issues associated with widespread adoption of these tools. The most significant issue is access to the billions of data points needed to understand a specific disease process. One of the key limitations is lack of insight into procedure-specific data points which are simply not recorded by an electronic medical record. The second deals with poor interoperability between a hospital’s various data sources – the electronic medical record, financial system, supply chain system, etc. Another key limitation is that a single hospital system will simply not have the scale necessary to achieve the number of data points needed for a successful machine learning algorithm. For these reasons, contracting with a vendor who specialises in data analytics and utilises sophisticated machine learning algorithms to help analyse this information can provide significant strategic advantage.

Healthcare organisations that are moving toward a valuebased framework with a focus on pay for performance will benefit from the business intelligence opportunities created by healthcare analytics platforms Healthcare organisations that are moving toward a value-based framework with a focus on pay for performance will benefit from the business intelligence opportunities created by healthcare analytics platforms. Improving both the quality and cost of healthcare can lead to a significant improvement in the operating margin, particularly in today’s challenging financial climate. ■

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QuartzClinical is a cloudbased healthcare data analytics platform that was recently awarded first place in a Frost & Sullivan healthcare report due to its sophisticated machine learning algorithms and access to big data resources in healthcare. Other options include Truven Health Analytics by IBM, HealthCatalyst, and Vizient. Dr Sapan Desai, a board-certified vascular surgeon and lean six sigma master black belt, has received international recognition for his work in healthcare quality, machine learning, and data analytics. He is the visionary behind QuartzClinical. In addition to his role as the CEO of the Surgisphere Corporation, Dr Desai’s experience as a healthcare executive includes a proven record of success in performance excellence, quality improvement, innovation in healthcare delivery, healthcare leadership and strategic management.

INTERVIEW

QUALITY IS KEY Dr Peter Lachman, CEO of ISQua, discusses how the Society works to drive continuous quality improvement in healthcare worldwide

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INTERVIEW

What is your background and what led you to the International Society for Quality in Health Care (ISQua)? I am a paediatrician who trained in South Africa and has worked in the UK for the past 25 years. My clinical interests are in children with long-term conditions starting with neuro developmental problems. As a paediatrician, I have worked both in the community and in hospitals. I became interested in patient safety early on, having managed large departments where safety issues came to the fore. I was a Health Foundation Quality Improvement Fellow at the Institute for Healthcare Improvement in Boston, US, and then Director of Patient Safety and Quality at Great Ormond Street Hospital, UK. This led me to my position at ISQua. Can you talk about the Societyâ&#x20AC;&#x2122;s work to inspire and drive improvement in the quality and safety of healthcare worldwide? ISQua was founded to introduce standards in healthcare back in the 1980s. Since then, we have expanded to become a unique accreditation service to health and social care external evaluation organisations and standards developing bodies worldwide; we hold the premier international conference on quality and patient safety; and we

management. The safety movement has been reactive, and we now need to move to a proactive and preventative phase where the focus is on safe, high-quality care in the community. If we could share what we know with all people, then the changes and improvements would be phenomenal. What would you say is the current state of healthcare worldwide? What are some of the most pressing issues? The three reports that came out this year from the World Bank / Organisation for Economic Co-operation and Development / World Health Organization (WHO), National Academies Press and the Lancet Commission are pessimistic and offer solutions that may not work. Basically, they note the gap that exists which could be due to malalignment of resources, political inertia or misguided priorities, a misuse or poor use of funding and the focus on hospital care. For example, public health measures and primary care interventions could make a real difference if they went beyond the health sector and included housing, nutrition, sanitation etc. We need to think differently and not replicate the old structures â&#x20AC;&#x201C; there are many good examples of the application of quality improvement methodology and safety science theory in practice to meet the standards that we need to achieve.

Public health measures and primary care interventions could make a real difference if they went beyond the health sector and included housing, nutrition, sanitation etc. have developed innovative education programmes with a focus on working with people in low income countries. Our current mission is to inspire and drive improvement in the quality and safety of healthcare worldwide through education and knowledge sharing, external evaluation, supporting health systems and connecting people through global networks. Does the Society encounter barriers in this work? I.e. What is impeding improvement in the quality and safety of healthcare on a global scale? The issue is culture and the way healthcare is planned, designed and financed. I believe that if we designed for safety and quality then issues such as universal health coverage and integrated care could become a more realistic possibility. However, health systems are based on hospitals, and most people do not have access to good healthcare, rather they have access to disease

With origins dating back to 1985, what are some of the Societyâ&#x20AC;&#x2122;s proudest achievements to date? ISQua is, at heart, a global community. For over 35 years we have evolved and adapted to circumstances. Our members continue to inspire and drive improvement. We have an extensive, vibrant and diverse community of members and experts who continually handle the constant moving targets of healthcare. It is through all of those connected with our extensive network and commitment to the mission of ISQua that our work is conducted, and positive results obtained. Our own achievements have been many; from the development of our health and social care standards, now in their 5th edition; to 35 successful annual conferences; our International Journal for Quality in Health Care (IJQHC), a leading international peerreviewed scholarly journal that addresses research, policy and >>

INTERVIEW

ISQua ISQua, the International Society for Quality in Health Care, was established in 1985 as an independent, membership-based, not-forproﬁt organisation with a vision to promote quality and safety in healthcare through international co-operation and collaboration. ISQua is dedicated to making this vision a reality. Its extensive network of healthcare professionals spans over 70 countries and six continents; and its members are at the forefront in developing and delivering solutions to improve quality and safety of care. ISQua has one of the most extensive international healthcare partnership networks in the world, including ofﬁcial relations with WHO. www.isqua.org

implementation in healthcare quality worldwide; and now our recent work across Africa and Latin America to spread the good practice. Can you talk about your work in assisting WHO with technical and policy advice? We have a strategic partnership with WHO as a non-state party that provides support for several key programmes, including national quality policy and strategy (NQPS), Patient Safety, Integrated Care, Maternal and Child Health. Our support involves sending experts to key meetings, reviewing and helping to develop policy and now to provide support to member states that need it to implement the frameworks to introduce high-quality and safe universal health coverage within the sustainable development goals. This collaboration is growing, and we will expand it going forward.

Peter Lachman M.D. MPH. M.B.B.Ch., FRCPCH, FCP (SA), FRCPI assumed the position of ISQua Chief Executive Officer on 1 May 2016. He has great experience as a clinician and leader in quality improvement and patient safety.

You are involved in the accreditation of national and regional healthcare facilities worldwide. Could you talk about the importance of this work? To have quality healthcare one needs standards that are evolving and continually becoming more person-centred and outcomes-focused. We offer an independent third-party assessment process to validate existing systems and drive continuous quality improvement. Our International Accreditation Programme (IAP) enables organisations to demonstrate their credibility and benchmark their performance on an international level. The accreditation process is an important element of achieving high-quality care. Our programme plays a large part in this process in many areas – yet it needs to be part of an overall change in culture and desire to change.

Dr Lachman was a Health Foundation Quality Improvement Fellow at IHI in 2005-06 and developed the quality improvement programme at Great Ormond Street Hospital where he was the Deputy Medical Director with the lead for Patient Safety. Prior to joining ISQua, he was also a Consultant Paediatrician at the Royal Free Hospital in London specialising in the challenge of long-term conditions for children. Dr Lachman has been the National Clinical Lead for SAFE, a Heath Foundation funded RCPCH programme which aims to improve situation awareness in clinical teams. In Ireland he is Lead International Faculty at the RCPI in Dublin, where he co-directs the Leadership and Quality programme to develop clinical leaders in quality improvement. He is CoFounder and Chairperson of PIPSQC, the Paediatric International Patient Safety and Quality Community.

14 International Hospitals & Healthcare Review

We in healthcare need to move from disease management to health promotion, and this is the real challenge What are ISQua’s key goals in the next five to 10 years? We intend to build on our current success and to move forward into supporting global regions with strategic alliances. We are looking towards developing innovative ways to improve quality and safety networks and will develop our existing programmes and expand our impact in all regions. There are many organisations working in QI and patient safety – we all need to work together to make a real difference. What are your own hopes for the future of the quality and safety of healthcare worldwide? We are now at a place where we know what works. We need to network together to ensure that every citizen, no matter where they live, has an equal chance to access high-quality care. We need to pay attention to the vulnerable and those living in fragile states, to those in war zones or failing economies. We in healthcare need to move from disease management to health promotion, and this is the real challenge. ■

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FEATURE

THE ATTRACTION FACTOR:

TARGETING THE INTERNATIONAL MARKET Danny Quaeyhaegens, Head of the International Insurance Department at Bangkok Hospital Pattaya, Thailand, spoke to the International Hospitals & Healthcare Review about what hospitals can do to attract more international patients – and their insurers

irst, we must define who or what ‘international patients’ are. By social status, one can distinguish four major categories: regular tourists, working expats, long-staying (or permanent) retirees and medical tourists. However, there’s a lot of grey areas and overlap between these groups, and hospitals need to identify which category they wish to attract before they implement a marketing process. Different needs, different approaches Tourists mostly need acute medical care due to injury or illness, and so will be choosing where to receive medical care in a different way than other groups. Without wanting to be prejudicial, we often see that the above is affected by nationality. For example, the Chinese tourist who travels in a group will ask his tour guide, the Russian tourist who has to follow insurance policy conditions will call his alarm centre, and the American who travels

16 International Hospitals & Healthcare Review

alone will check Google. To attract the gambler, it’s mostly about physical appearance and first impression. The building and staff must be visible and look reliable – a high building with the name in large letters on top, street signs, some ads in the tourist guides, marble, uniforms. To attract the Google searcher, it’s about social media, ad words and Google rankings (the percentage of patients that go to a provider on the 2nd page of the search results must be extremely low). For those advised by the hotel staff, tour guide, taxi driver, or waitress, while ideally it would be because they are locals and they know that provider X offers the best quality for a reasonable price, some medical providers may also accomplish this by financial kick-backs or commissions. To be advised by the respective insurance/assistance alarm centres, I hope (and believe in most cases) it’s all about price-quality equation and not so much

about discounts or commissions. To be top of an assistance company’s list, a hospital has to look for that price-quality equation, but also make direct billing agreements, update them when new services are launched, accept and accommodate ‘Guarantee of Payment’ letters, etc. Long-staying or permanent retirees know the local situation better so there’s the potential to offer

To attract the Google searcher, it’s about social media, ad words and Google rankings

FEATURE

satisfaction with the service provided (adjusted to the needs of the foreigner) to turn customers into returning customers. Word of mouth in local expat clubs and local internet forums, combined with ads in local foreign media, might be ways to attract them too. If they don’t know, they might ask the opinion of their neighbour, landlord or of another waitress; in these situations, public opinion (objective pricequality, PR, CSR, advertisements, promotions, loyalty programmes) will have some effect. Price (affordability) and quality will often be the deciding factors in elective cases or cases such as cancer, regarding whether they will stay and have the treatment in your facility or they return to their home country. Working expats are in some ways similar to the above retirees, but in this case, a hospital should also consider that the HR department of the company (and possible corporate agreements

between company and medical provider) kicks in. Here, health promotion programmes (about hygiene and safety in the workplace, CPR and first aid, yearly check-ups etc.) will be helpful to have them get to know and trust you as medical provider. We often see that this group is better insured and often relatively well paid. Thus, with money being a less important decision-making factor, service level becomes an even more important issue. Due to few financial worries and sufficient time available, we also often see them undergoing elective treatments as well; those that are higher quality and/or lower price and/or faster than in their country of origin. Typically, we see them having a ‘let’s do this before we have to go back’ attitude in the period towards the end of their expatriate assignment. For medical travellers, having the right products with high quality and at the right price is crucial. A

smooth process pre-, per- and post-treatment and availability when the patient wants it (not when it’s convenient for you) are also crucial. Here, a hospital’s competition is not just the clinic across the road and the other hospital three blocks away. Instead, you’re competing with the whole world. Even when you have all the above, you need to find ways to relay that info to potential customers all over the world. Agents and third-party administrators have a role here. Insurance companies could have a larger role than they currently do, but even after all these years, we still in reality see very little ‘global steering’ of insured customers for elective care due to the well-known challenges as distance, air travel, liability, follow-up care etc. Thus, a significant proportion of medical tourists are individuals looking for a solution that has a perfect price-quality level for them. To lead them to your hospital, to get them to know your >>

FEATURE hospital, worldwide advertising via the classic channels as magazines, newspapers, television … is extremely expensive and probably not too effective. This must be solved by having a digital presence with the following: • A good website, (multi-lingual if possible) • Easy, fast, clear answering and of course free contact channels for questions and enquiries, again where possible in the patients’ language, not necessarily in the hospital’s language • Social media accounts • Positive reviews, feedback and ratings on consumer websites • High Google search engine rankings External accreditations such as JCI (Joint Commission International), Temos, EURAMI, CAMTS, ISO, etc. can be helpful here as they will affect the trust from the patient. Challenge extended The International Hospitals & Healthcare Review asked what the main challenges are when hospitals provide care to international patients. Quaeyhaegens selected his top five, which are: • Obtaining accurate medical history • Being clear on what a procedure costs • A lack of trust in the healthcare being given • Stress around repatriation • Insurance company ignorance of what a local healthcare system can offer. Medical history (MH) MH is often incomplete and checking this with a patient may or may not result in

18 International Hospitals & Healthcare Review

accurate information. Only last week, I was doing a pre-operative assessment with a French patient and upon asking ‘Do you have or did you ever have a heart condition or do you take any medication for blood thinning’?, the patient’s answer was ‘No’. Upon asking what medication he was taking daily, he answered: ‘Aspirin, Plavix®, beta-blocker and diuretics’. So, we must be very careful, and if needed, contact overseas physicians. To assess coverage, also alarm centres / assistance companies often have to pass some processes to, for example, check for pre-existing conditions. Apart from the new and stricter rules of GDPR this brings with it, time is often an issue here as sometimes it takes them many days (sometimes even weeks) to contact the medical providers or GPs in the patient’s home country. Finance Some patients come from healthcare systems where they hardly ever see / realise the real cost of treatment or medications, as there is a free at the point of care national system, their insurance picks up the bill directly, and/or pharmacies sell the medications by only charging the patient’s excess. When they then come into a hospital and are quoted the full price

medical tourists are individuals looking for a solution that has a perfect pricequality level for them for a procedure, they get to see the full price for medications or they need to wait one or two days (or longer in some cases) to obtain some authorisation and coverage assessment from their insurer, they might be surprised and not understanding. Again here, native co-ordinators can give further explanation about this process and the reasons hereto. Emotions Often, patients are confident in their own country’s healthcare system and wary about an overseas healthcare system, especially if ‘overseas’ is a developing country such as Thailand. Then, when they get ill or injured, especially for tourists who don’t know the country very well, emotions of fear, (lack of ) trust, panic, may be much stronger for the patient and their relatives or friends. Once more, this is a task for >>

FEATURE our native co-ordinators to speak with the patients / relatives, explain our standards of care and build their trust. Staff from alarm centres / assistance companies also have an important role in this situation. Bangkok Hospital Pattaya also tries to ameliorate this situation by improving the information given. For this, we translated all the important documents, information leaflets, brochures, screening documents, patient information, consent forms, into the 12 most frequently used languages for the patient to be able to read and better understand the information in his/her own language. (note: signature for consent etc. still needs to be done on the original Thai and/or English forms for reasons of legality but at least the patient will know exactly what they are signing for). Repatriation This is not only an expensive issue (for the insurance company), but also usually a stressful event for a patient (who has probably never experienced anything similar in their life before). It’s very important to give the patient good and clear information. The better the patient is informed, the less likely they will worry, panic or feel uncomfortable so the more likely the repatriation process will be successful. Insurance companies Some insurance companies don’t always know the local situation in a particular area or country well enough and want to apply ‘home conditions’ in countries where this is not possible. They may ask to send the patient to a rehab centre, or home with a home healthcare service, but not every country has such services. They may suggest

It’s important, therefore, that insurance companies make themselves familiar with the local conditions OPD treatments in places where transport / accessibility of medical provider is not suitable for such a case. Some will only cover treatment in a government

facility but in some countries, government facilities are not appropriate to treat a foreigner, whether because of language barriers, lack of resources, lack of international standards, or no direct billing facility. It’s important, therefore, that insurance companies make themselves familiar with the local conditions or if lacking that, to use a local intermediary such as an assistance company. International accreditation – is it worth it? For some third parties (insurers / assistance companies / TPAs), the accreditation in itself is important as they may only send customers to accredited facilities, as it will give these clients the indication that a minimum of quality standards will be in place. It may be the same for some patients, but many (non-US) probably have no idea what JCI, for example, means. Showing them a seal may be helpful, but the main thing for any hospital will be to show quality and safety standards in daily practice, with each patient contact. I believe that, especially in underdeveloped or developing countries, accreditation is more necessary. If I were a tourist myself in Germany, France, Switzerland … and I needed to be admitted, I would (I may be wrong, I don’t know) not worry for a single second about the quality of the nearest hospital. However, if I needed to be admitted to a Thai hospital (or in a hospital in any other developing country) I’d possibly be more worried about the care I’m about to receive. In such a case, seeing some indications of international quality would probably increase my trust and peace of mind. Making a difference There are some key changes that a hospital can make that would make it more attractive to an international patient or insurance company. Transparent pricing structures, and demonstrations of quality (accreditation etc.) are without doubt vital components, but there are also language and cultural hurdles that must be overcome if a hospital is to truly cater to an international patient base. There should be an acceptable level of English >>

FEATURE

for all staff depending on position, tasks and responsibilities. If possible, do not employ ‘English translators’ as they will take away the need for all staff to improve their own level of English; they become dependent on these English translators. From language groups with sufficient patient volumes, native staff is preferable, so that they don’t just have language skills ‘as native’ but are in fact real natives. Alternatively, a hospital could employ those who have lived for a substantial period of time in the concerned country so that they aren’t limited to ‘language translation’, but are also experienced with ‘culture translation’ as well. Cultural training programmes for nurses and doctors are also very useful in this matter. Every culture has its own peculiarities. Below are just some of the incidences and differences we have noted when treating international patients. • Why does an Arabic translator use 10 sentences to translate one simple question? Why is this Dutch patient so loud and why does the Italian look so angry with all his arm gestures? • Europeans can leave a doctor’s office happily also

20 International Hospitals & Healthcare Review

if they don’t get three different medications in four different colours. • Why do we need to explain each step carefully to the European patient (where to some of the local patients the doctor is ‘the one who knows all’ and is blindly trusted)? • How to deal with Islamic patients? Can we give them porcine valve implants? Should we give blood to this traffic accident victim who’s a Jehovah’s Witness? Should we use male / female staff? • What about palliative and end-of life care? DNR, living will and euthanasia? Co-operation with third parties To make a patient’s journey through a hospital a smooth process, a facility should accept GOPs, and have an open and accepting attitude toward third party (credit) payers. To facilitate this, the provider must enable good co-operation with the insurance companies. A direct billing agreement is important, but perhaps more so is the daily communication that takes place. Mutual trust

is the first requisite, with providers trusting Guarantee of Payment letters from / giving credit to insurance / assistance companies, and the insurance / assistance companies trusting the provider that good and appropriate treatment is provided. Insurance companies also need to have fast and complete information on every case so that they can assess the coverage. Clear and detailed cost estimates must be provided prior to the treatment, clear and detailed invoices are needed to conclude the process. Medical information must be clear, detailed and in English; treatments must be administered according to international standards, with no under- or over-treatment, and should be of the highest quality. Updating each other regularly about the activities is important. Communication with customer pre- and posttreatment We are living in a digital era, with many and more and more online and offline communication

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FEATURE

BIOGRAPHY

Danny Quaeyhaegens is Head of the international insurance department at Bangkok Hospital Pattaya in Thailand.

tools, so patients will be able to shop around and make inquiries about treatments and costs. Patients then also expect fast, clear and complete answers, if the answer doesn’t satisfy them they may move on to the next potential provider in whom they have, based on the reply to their inquiry, more trust due to a ‘more professional style of communication’. And, as in any business, whether one sells cars or delivers any kind of service, the after-sale-service

is very important to ensure you have satisfied customers. Hospitals should also be prepared to learn from previous customer experience in order to be able to continuously improve the product which is delivered, so it is worth following-up with contacts to check-up on the patient’s condition, the patient’s satisfaction and to pro-actively manage any complaints or dissatisfactions the patient may have is more and more important. ■

Lynne Fung, Executive Director, Business Development, Matilda International Hospital, shares her insights on the international patient market with the International Hospitals & Healthcare Review The key challenges in serving an international community of patients are mainly rooted in their cultural differences in care expectations and communication, as well as the healthcare system, doctors’ practice and the charging methods. In terms of communication, challenges include language and terminology, classification of insurance coverage in different countries, the popularity of using e-communication channels and even the expected response time. The time difference in different countries may also pose a challenge for having direct communications sometimes. When it comes to communication with patients or insurers, it is always important to manage their expectations by learning more from them, being patient with them and clarifying with them where necessary. Before the patients are admitted for treatment, education (of patients, insurers and other third-party payers) via different channels is crucial. It’s essential to understand patients’ needs. International patients who travel and seek treatments outside their own countries may want more assistance separate from their medical needs while they are accompanied by their family members or friends; for example, hotel accommodation, local transport or visa extension. We have a dedicated patient service team with frontline experience, as well as knowledge in healthcare and handling health insurance matters. The Patient Service Centre personnel assist patients in admission, insurance matters, doctor referral, appointment booking as well as providing advice on the availability of nearby accommodation and booking of limousines. It takes effort to help staff to understand cultural differences, create an innovative approach to developing a strategy or improving the system to streamline processes. Collaboration among staff, doctors, and insurers are equally important for catering to cultural differences. Continuous improvement on IT systems and websites also enable patients to obtain hospital information faster, contact us more easily, and streamline enquiry handling for a faster response. Human resources planning can contribute to serving our client mix. Many of our staff come from overseas, studied abroad or have experience serving expat clients and are well aware of being sensitive to the service details and cultural differences.

Key changes that could attract patients: Sub-specialise We set up an Orthopaedic and Spine Centre in 2017 and a Referral Centre in 2018 to provide a single enquiry point. We have regular reviews and update the logistics and the services offered to patients. The Orthopaedic and Spine Centre focuses on handling enquiries and bookings in these specialities since treatment has become highly sub-specialised into hands and wrists, shoulders, hips knees, ankles, paediatric orthopaedic, and so on. Designated personnel at the Referral Centre can give patients faster responses regarding referral to appropriate specialists for further treatment or follow-up, including an ear, nose and throat specialist, general surgeon and plastic surgeon. The staff from these centres also help set up appointments, provide quotations, assist in insurance and logistical matters. Accreditation There are always some patients who arrive in Hong Kong and are not familiar with the local healthcare system and hospital choices. International accreditation enables us to align and benchmark our standards with international practices, so as to enable patients to get to know our standards better. Certain insurers also work with us for independent audits or questionnaires or visits so they get to know more about our services and care practice and give recommendation to their insured clients. • We believe the introduction of more useful IT systems and channels can enhance, streamline and facilitate internal and external communications. The use of data exchange systems between hospitals and insurers will also help improve efficiency and accuracy in billing and claims. • We have been adopting price transparency policies and best clinical practice, eg. shortening length of stay and minimising the chance of return to theatre, which are welcomed by both individual patients and insurers who pay the bills. In many cases, lower initial quotations (that prove attractive to many people) do not necessarily mean that their final bills are as low. Looking into the future, we will continue to increase price transparency of our services and educate patients for clinical service standards, reviewing hospital quotations and pricing, so as to enhance our mutual understanding in these areas. • Continuously expanding direct billing and cashless agreements enable easier access to our services. • Last but not least, patient care involves human interaction. We always identify any gaps in human skills and attract more talent to join our hospital.

22 International Hospitals & Healthcare Review

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26 International Hospitals & Healthcare Review

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Intermed Hospital

tel: (+976) 7701 11 11

website: intermed.mn

SOS Medica Mongolia UB International Clinic

tel: +351 213 138 260 RU

United Famili Intermed Hospital Chinggis Avenue 41, Khan-Uul District 15, Uildver 17040, Ulaanbaatar, MONGOLIA

Euromed Clinic

SINGAPORE

MONGOLIA

Tropicana Medical Centre

NETHERLANDS

Centro Hospitalar de Leiria, E.P.E.

Fullerton Healthcare @ Ocean Financial Centre

website: www.luzsaude.pt

Gleneagles Hospital - Parkway Hospitals Singapore Pte Ltd (Network)

UB Songdo Hospital

Infectious Disease Partners Pte Ltd (Farrer Park Medical Centre)

Acibadem International Medical Center

Infectious Disease Partners Pte Ltd (Mount Elizabeth Novena Specialist Centre)

Amphia Ziekenhuis

Institute of Mental Health

International Health Center The Hague

KK Women’s and Children’s Hospital

Isala

Mount Elizabeth Hospital - Parkway Hospitals Singapore Pte Ltd (Network)

Groteweg 5, 8191 JS Wapenveld, NETHERLANDS tel: (+31) 38 424 50 00 SGE International Healthcare Services

28 International Hospitals & Healthcare Review

website: isala.nl

National Cancer Centre of Singapore Pte Ltd National Healthcare Group Polyclinics National Heart Centre Singapore National Skin Centre National University Hospital

Parkway East Hospital - Parkway Hospitals Singapore Pte Ltd (Network) Rafﬂes Hospital

TURKEY

SINGAPORE

INTERNATIONAL HOSPITALS DIRECTORY

Acıbadem Healthcare Group Fahrettin Kerim Gökay Cad. No:49 34662 Altunizade İstanbul, TURKEY

Singapore General Hospital (SGH) SingHealth Polyclinics

tel: +90 530 976 8398

SPAIN

Tan Tock Seng Hospital

Hospital Clinica Biblica

Anatolia Hospital AVENIDA 14, CALLE 1 Y CENTRAL, SAN JOSÉ, SPAIN

tel: 506 2522 1000

Caybasi Mh 1352 Sk No 12 , 07100 Antalya, TURKEY

website: clinicabiblica.com

tel: +90 242 249 33 00

Best Doctors

tel: +34 91 308 56 22

Istanbul Florence Nightingale Hastanesi A._. Medipol Mega Hospitals Complex Memorial Ankara Hospital

Özel Medicabil Hastanesi

website: bestdoctors.com/spain

Medical Response International

Fethiye Mahallesi, 1/A Mudanya Yolu Küre Sok Fethiye Mahallesi, 16140 Nilüfer/Bursa TURKEY

Quironsalud Hospitales USP Hospital de Marbella

tel: (+90) 444 8 112

Hospital Clinica Benidorm UAE

Hospitales San Roque Maspalomas

THAILAND

Bangkok Dusit Medical Services 2 Soi Soonvijai 7, New Petchburi Rd., Bangkok 10310, THAILAND tel: +66(0)2-310-3000

Vejthani Hospital

website: medicabil.com

Al Amana Home Health Care LLC

Belhoul European Hospital

Vithas Xanit International Hopsital

Samitivej Sukhumvit Hospital

website: anatoliahospital.com

Gayrettepe Florence Nightingale Hastanesi

C/ Almagro, 36 1ª planta 28010 Madrid SPAIN

Bumrungrad International Hospital

website: acibademinternational.com

PO Box : 4674, Dubai, UAE tel: (+971) 4 345 4000

website: belhouleuropean.com

website: bangkokhospital.com

Want an enhanced listing? Contact the sales team now: sales@voyageur.co.uk

Vibhavadi Hospital >>

Sharjah International Holistic Health Center

USA

UAE

INTERNATIONAL HOSPITALS DIRECTORY

Broward Health International

Sheikh Khalifa General Hospital

1608 SE 3rd Avenue, Ste 503-B, Ft Lauderdale, FL 33316, USA

Sunny Specialty Medical Centre Tawam Hospital

tel: +1 954 767 5587

Thumbay Hospital Umm AlQaiwain - Primary Healthcare Centers in Umm Al Quwain-Ministr...

Bumrungrad International

Universal Hospital LLC - Abu Dhabi

Cancer Treatment Centers of America

University Hospital Sharjah

Children’s Health (Dallas)

York Diagnostic Laboratories, JLT

Children’s Hospital Colorado

HCA Healthcare

Children’s Hospital Los Angeles

242 Marylebone Road, London, NW1 6JL, UK tel: 020 37335966

website: www.hcahealthcare.co.uk

Imperial Private Healthcare

email: Sbaig@browardhealth.org

Children’s Hospital of Philadelphia, The Children’s Mercy Hospital Children’s National Medical Center Cincinnati Children’s Hospital Medical Center City of Hope Cleveland Clinic

London,

Cook Children’s Health System

UK tel: 020 3311 7700

Duke Medicine Global website: www.imperialprivatehealthcare.co.uk

Queen Square Hospital

Florida Hospital

8-11 Queen Square, London, WC1N 3AR, UK tel: ------

USA

Emory Clinic

website: www.qsprivatehealthcare.com

Ann & Robert H. Lurie ChildrenÕs Hospital of Chicago Atrium Health Baptist Health International Baylor St Lukes Medical Centre Boston Childrens Hospital Brigham and Women’s Hospital (Partners HealthCare International)

30 International Hospitals & Healthcare Review

Flywire Health Brand Group Hospital for Special Surgery Houston Methodist Global Indiana University Health

Jackson Memorial Hospital International 1500 NW 12th Avenue, Suite 829 East, Miami, FL 33136, USA tel: +1 305 355 1211

website: jmhi.org

James Cancer Hospital (OSU), The

USA

INTERNATIONAL HOSPITALS DIRECTORY

Sharp Global Patient Services

Johns Hopkins Medicine International

8695 Spectrum Center Blvd., San Diego, CA 92123, USA

Kennedy Krieger Institute Lahey Hospital & Medical Center

tel: +1 888 265 1513

Massachusetts General Hospital (Partners HealthCare International)

website: sharp.com

Mayo Clinic

St. Joseph’s Hospital and Medical Center/Barrow Neurological Institute

Medstar Georgetown University Hospital

Stanford Health Care

Memorial Hermann-Texas Medical Center and TIRR Memorial Hermann

Texas Children’s Hospital

Memorial Sloan-Kettering Cancer Center

UC San Diego Health System International Patient Program

Minnesota International Medicine

136 W. Dickinson Street, Suite 109, San Diego, CA 92103-8222, USA

Mofﬁtt Cancer Center Mount Sinai Medical Center

tel: +1 619 471 0466

Navigant Consulting Nemours Children’s Health System

Uchicago Medicine

Northwell Health

UCLA Health

Northwestern Medicine

UCSF Medical Center

NYU Langone Health

University Health System (San Antonio)

Ochsner Health System

University of Cincinnati Cancer Institute

Ohio State Uni Comprehensive Cancer Centre

University of Colorado Health

Penn Global Medicine

University of Michigan Health System

3400 Spruce Street Philadelphia PA 19104 USA website: pennmedicine.org Philadelphia International Medicine

website: health.ucsd.edu/internation

University of Pennsylvania Health System University of Southern California UPMC USCSF Health Yale International Medicine Program

Princeton HealthCare System Roswell Park Cancer Institute Rush University Medical Center Scripps Health

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Seattle Children’s

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IHHR 6 - February 2019

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International Hospitals & Healthcare Directory