Karen Timmons is an internationally known expert in accreditation and healthcare quality and safety processes. She currently serves as CEO of Global Healthcare Accreditation (GHA), a U.S.-based company that provides accreditation for organizations that offer medical travel, medical tourism and international patient services. Prior to joining GHA, she served as President and CEO of Joint Commission International (JCI), Chief Operating Officer of The Joint Commission, and Global Patient Safety Officer for Det Norske Veritas (DNV), as well as served as chairperson on several WHO committees.
What is the vision guiding your new company, Global Healthcare Accreditation (GHA)?
As an independent accrediting organization, our goal is to improve the patient experience and care received by patients who travel for their medical care and treatment, whether within their own country or internationally. In medical travel, the patient experience extends beyond the care delivered in the actual healthcare facility — it starts from the point of inquiry through the ongoing communication after service has been provided. That means organizations need to measure and pay a lot of attention to the satisfaction of patients outside their own delivery of care within a hospital; to what is communicated on their website with respect to transparency of risk and pricing; to information about outcomes and possible complications that may arise; to information about travel, ground transportation and hospitality managed and delivered; and to management of medical records that can be read by home doctors in their primary language after the patient leaves.
Another part of our vision is to facilitate more data, facts and research about medical travel. Currently there is no universally accepted definition of a medical traveler: whether this term refers only to those patients seeking care outside of one’s home country, whether it includes patients who may need emergency care while on vacation or business travel, and whether it includes patients who undergo procedures such as cosmetic or dental surgery. Unless you have a universal definition, you have no useable data.
Additionally, little is known about the outcomes of care provided to patients who travel or the clinical effectiveness of particular procedures, institutions or clinicians overseas. For example, while data may be collected from a hospital respecting key safety or outcome data, such as readmissions and infections, it normally pertains to the local population and may not include any patients who travel for medical care. Also, little is known in the aggregate about the patient experience or the satisfaction of patients traveling for care, nor about the quality of life or “back to work” data that may be significant in measuring success for medical travel.
How would the role of a global accreditation body be different than that of local accreditations?
Well, let’s look at the role of accreditation bodies in general: They develop standards that are state of-the-art and evidence-based, bring together diverse stakeholder groups that could be held accountable to the industry, and can bring consumer voices and important issues to the table. They play a critical role in facilitating safe and quality care.
Medical travel is here to stay, it’s not just a fad. Medical travel brings a degree of complexity and involves governmental bodies that normally may not be involved in healthcare oversight, such as ministries like Tourism and Finance, departments responsible for medical and travel visas, and other national industries that work with ground transportation and hospitality. Additionally, insurers and employers are increasingly offering medical travel as a way to provide high value to their enrollees, by negotiating a discount bundled rate with facilities for high volume procedures — such as hip and knee replacements and cardiac and spine procedures — with organizations having good outcome data. Patients within these networks normally do not have a deductible for care and may even share some of the savings as an incentive. So GHA must have relationships with all of these key stakeholders and can facilitate the delivery of professional norms for this unique niche.
The GHA program complements existing national and international clinical accreditation programs, and offers an Accreditation with Excellence designation to those organizations having accreditation from an ISQua (International Society for Quality in Healthcare) approved accrediting body. While these programs traditionally focus on the clinical aspects of care for the entire organization, GHA conducts a deep review of the International or Global Patient Services program, or the entity within an organization that serves the medical travel patient — like the American College of Surgeon’s Breast Oncology Accreditation Program, which complements national accreditation — by conducting a rigorous evaluation of the program treating breast oncology patients.
In addition to quality and safety, our standards focus on issues such as confidentiality of patient records; ethics and transparency; cultural competency; infection control, which is especially pertinent in medical travel with the risks of transmission; and sustainable business practices and business health. We also require the collection of key indicators from accredited hospitals regarding medical travel outcomes, and medical travel patients specifically.
GHA is less than a year old — what has the company been able to accomplish so far in its first year?
It has been a very busy, successful and rewarding time since we launched in late September. As I have spent my career in accreditation, one of my lessons along the way is that infrastructure and process do matter. So we have established a great advisory board with diverse expert representation from key stakeholder groups around the globe. We have leaders of the International Programs from leading organizations around the globe, including the Cleveland Clinic in the U.S., Apollo in India, Bumrungrad International in Thailand, and Johns Hopkins Aramco in Saudi Arabia.
We are also in the process of having our standards undergo technical review by ISQua, which is the accreditor of accreditation programs. It is important for accrediting bodies to walk in the shoes of their customers and ensure their standards and survey processes are robust and state of the art. Additionally, we are conducting a formal field review of our standards to ensure feedback and input from key stakeholder groups. And we have recruited and trained two outstanding classes of surveyors, who are internationally known for their expertise in healthcare quality and safety as well as medical travel.
And we have surveys scheduled in the U.S., Europe, Mexico, British Virgin Islands, and Brazil. One of our first clients was Mercy Hospital here in the U.S., accredited last fall, which is known as an Institute of Quality and Center of Excellence for patients seeking spinal surgery in their provider network. Patients in this network have no deductible if they travel to a center of excellence, so there’s no cost to them for traveling. Finally, we have recruited local agents that give us local feet on the ground in Europe, the Middle East, South America, and Thailand in Asia so far.
There are some challenges. There’s very little oversight regarding medical travel, legal liability, accountability and transparency with regards to patients. Working with these stakeholders, we might be able to create awareness for needs for some of the gaps, such as for medical complications insurances, or we might be able to raise awareness or attention to an issue without having to start it themselves.
The CDC has estimated that over 750,000 patients travel overseas, and WHO has noted over 9 million patients traveling outside the country for medical care; the data available isn’t very accurate. Different sources will quote different figures, but the common theme is that this is an expanding market with lots of potential for growth.
What are some challenges that come with running a global healthcare operation?
One of the lessons I’ve learned over my career is that you really need to understand implementation. It’s not as easy as just developing and distributing standards and expect organizations to implement them easily. We need to understand local practices and cultures, and what it means for organizations to implement them and provide practical strategies — which may be different in different countries due to cultural differences. Successful implementation requires thinking through how a standard would be understood within a cultural perspective; having input and feedback in a structured way, such as from global boards, regional advisory councils, and local representatives; and, most importantly, sustaining collaboration and cooperation with ministries and key professional organizations from major regions of the world.
What do you think the global healthcare landscape will look like in 5, 10, 20 years?
Healthcare has lagged behind other industries in becoming a global industry. First, more patients will travel for their care due to cost and access issues, ease of travel and stronger local infrastructures. More digitized communications will make this easier, and telemedicine will bring access to care in new ways. But patients will be smarter and more demanding, and will want to make informed decisions about where to go, so there will need to be better data about clinical and satisfaction outcomes relating to specific procedures, clinicians, organizations, costs, and risks overseas.
There will be more global brands in healthcare, with major systems extending their brand presence in multiple regions of the world. We will have a global, consumer driven portal for patients to post their ratings of organizations, much like TripAdvisor. And patient experience will count. Just look at the examples of the airline industry these past few months. The outrage over how passengers were treated and their experience while aboard the flight matters — even as the airline delivered on its main goal to have a safe arrival for passengers. Patients, like passengers, want to be respected and understood, and have as good an experience as possible.
We used to say healthcare is local: not anymore. People are willing to travel to access high quality care.
— Ali Greatsinger
Ali Greatsinger is the senior editor at GHCi.