Dr Maria Todd, leader of the Mercury Advisory Group experts headquartered in Denver, Colorado is often called upon to provide an assessment of the medical tourism potential and current situation at a destination that desires to enter the medical tourism market.

Maria is often hired to assess and recommend ways to improve the functioning and potential impact of the ongoing medical tourism innovation partnerships and identify criteria for future development. To do this, she conducts desk and field research and meets with stakeholders and representatives of government authorities such as the health, tourism, economic development, education, foreign affairs, finance, and export associations.

Bringing together medical tourism actors into some integration architecture is often done at a medical tourism destination through the creation of “clusters”, developed by consultants who dabble in medical tourism between their other “regular jobs” as trade association presidents, and even moonlighting government employees where their experience includes an “n=1” expertise and track record.

In reality, most often these cluster formations have been declared complete when really the project is not much further along than a building shell created in accordance with a licensed architect’s blueprint. This is often the result of unethical practices by the consultants looking to make a “few extra bucks”, coupled with incompetence or inexperience. They don’t finish the job and their output deliverable is incomplete because often they haven’t the foggiest idea “how” or “why” it won’t work. The core issues is that they’ve never really been at the executive or managerial level of a hospital or clinic, have never personally be responsible to coordinate the continuity of care for a client/patient, and they only know about health tourism from the conference organizer point of view.  As such, if they are lucky, the clients are left at the end of the engagement with a large expenditure and an architecture that resembles integration of stakeholders but the cluster fails to produce results, has no way to conduct effective business and raise turnover, and suffers unsustainable systemic problems that the client is unable to overcome. Eventually, the cluster comes apart within 12-36 months. Sound familiar? It should. There are too many of these egregious failed clusters in the market today. The are on every continent except, perhaps Australia.

Criteria for Innovative Projects

Medical tourism innovation projects should demonstrate the existence of a clear need or prospects for: a)a unique breakthrough innovation and systemic solutions, b) wide-ranging partnering, c) public-private partnership actions, d) new destination or regional competitive advantages. Simply to sell off extra capacity in a hotel, spa, thermal resort or clinical setting does not qualify as the minimum criteria to start an innovation project.  Setting up exhibitor stands at conferences and congresses as a “precious metal” (gold, silver, platinum) or gem-level (diamond, sapphire, emerald) sponsor is also not a valid criteria to kickstart the project. That only meets the criteria for the conference organizers, and few others.

For medical tourism to thrive requires that the innovators create a management structure or collaborative architecture that can sustain and support systemic change. It depends on having a clearly articulated plan for “how” to move from the present fragmented system to the preferred system. Maria often helps guide innovators about what kinds of interventions are needed and in what manner by showing how linkages and interdependencies between elements of the system need to be reshaped or restructured. Consultants that have never done this, or have only studied it from afar are usually incapable of taking the innovators “through” this next step. As a consequence of their incompetence, they often stop just short of this and expect the client to sort it out themselves… which rarely happens. Obtaining some certification or accreditation (TEMOS, JCI, or something else) does not achieve this level of integrated alignment and support for business process on its own.

All clusters should not be created alike

to engage medical tourism actors for breakthrough innovation, an ecosystem approach to delivery should be followed focusing on mobilizing demand, experimentation, destination and individual stakeholder brand identity and diffusion. Instead of pitting actors against one another in the name of competition, the focus should be on creating a single market for innovation through demand side actions (relationship development with referral sources) and strengthening the diffusion of innovation. A skilled consultant knows how to build a level playing field before the project commences. This level playing field must ensure the open entry of new and relevant actors and prevent new silos and special interest power-hitters. The experienced consultant will also recommend clear indicators for success that can be adopted to monitor and evaluate success.  High-level leadership and effective governance models must be implemented as a priority of the local, regional and national government and designation as a core element of the work plan.

The architecture of the cluster is the first place where differentiation should be apparent.  Architecture refers to the structure of underlying principles that organizes many disparate parts of private health clinics, wellness, public health, tourism, travel, foreign affairs, education, public policy, tax regulations, immigration and more forms the cluster to operate as a coherent whole. The principles that structure the innovations within the cluster must be ecosystem-driven and mutually reinforcing. Otherwise, they soon unravel.  The objective of the framework architecture is to ensure that many innovations create a synergy and help move the challenge at hand in the direction to which the group has aspired. This shift, from current to preferred state is the systemic change. Without a clear architecture to guide the planning and delivery of medical tourism innovator actions, it is likely that many good initiatives will not create large scale change. This isn’t speculative – all one must do is examine any of the 10-20 medical tourism clusters developed over the past 7 years in Europe, Latin America, Northern Africa, CIS, Asia, and even the USA. Systemic change is about creating fundamental change that is achieved by engaging across aspects of a health or tourism system or groups of health systems and hotel resort chains. Systemic change is rarely, if ever, the result of a single innovative action. Rather it is generally the result of many innovation actions coordinated across a broad range of dimensions, which combined create change at scale. Understanding the mix and range of innovations necessary requires an architecture, or a structure, that guides intent. Commonly the range of innovations might include technological, social, and process innovations.  Conference organizers and government employees that work part time as consultants in the space often know the right words and have access to the politicians, but rarely do they possess the deep know how of technological, social and process to teach clients best practices or explain the “why and how” of their surface level recommendations.

The context of breakthrough innovation in medical tourism

The objective of any medical tourism innovation model is to create the conditions for future economic growth and social welfare in the destination. Typically, Maria finds that the government and stakeholders of the private sector seek to create new comparative advantages. These can rarely be achieved merely by emulating or extending models that didn’t work well in the past. Future medical tourism innovation and growth relies on the active design and development of new ecosystems of delivery. One such system is the Management Services Organization (MSO). It provides the supporting infrastructure needed to manage logistics, accounting, ensure continuity of care, collaborative destination marketing, statistical analysis, training and capacity development, and self governance of the cluster.  The innovative medical tourism destination’s promise lies in many factors including the size of its market, an educated labor force, and strong research and SME (small and medium-sized enterprises) communities, within a social welfare context. Clusters that are created to allow greater risk-taking and to challenge established market models in order to bridge the gap between invention promise and innovation delivery enable Blue Ocean Strategy thinking, by better leveraging a variety of local value chain assets. (If you are unfamiliar with Blue Ocean Strategy concepts, read the book by the same title by authors Renée Mauborgne, W. Chan Kim.) Today’s health and wellness tourism frontiers are increasingly on a systemic level, encompassing social, technological and market challenges. In fact, the recently released health tourism information system IT platform, developed by HiGoWell in Ireland is in lockstep with this trend. Innovation is likely to emerge at the points of intersection between different sectors and actors. In this context, the often challenging cultural alignment of private and public sector interaction, and the emerging third sector, can evolve as significant assets.

Innovative thinking

Innovation requires a new logic and approach to medical tourism at every level. The medical tourism innovators’ objectives are to integrate, harness and exploit a destination in a positive and potential way that creates a new ecosystem of innovation. Their original objective is to break down “silos” and bring together stakeholders across policies, sectors and borders, as well as capture new cross-sectoral value chains. Copying other models is like wearing last season’s party dress to the cotillion. It simply won’t work.  The medical tourism market innovation should therefore be focused on areas where new markets can be created or existing ones fundamentally transformed. This is the Blue Ocean Approach: value innovation and creation of new markets, rather than competing with others on the same old tired out approaches.

Innovators work across demand and supply. They then diffuse innovation through a better framework that supports their product, their stakeholders, and their competitive advantages like no other rival. The risk-reward matrix must be brought forward and nurtured. This is often a foreign concept in many parts of the world. Stakeholders must be encouraged and supported to experiment, venture into new markets, new ideas and new approaches. Otherwise, it is clearly not innovation, but instead merely a “knock off” of an existing model that may or may not be successful elsewhere. Who wants to claim “We’re just as good”?

Fast tracking innovation and accelerating breakthroughs takes courage, cash, and commitment. Projects Maria accepts often adopt ambitious targets and gain unequivocal commitment of a wide range of stakeholders, insurers, politicians and foreign investors.  She shepherds them to ensure that demonstration projects and pilots are transformed into real innovations. This is critical. For this to materialize, public and private actions must be well-coordinated, and the regulatory framework must be more open for the adoption of innovation. All to often the regulatory framework that exists is the square peg that tries to align somehow with the round hole. Those projects, if not open to systemic change are doomed. Collaboration is key. Changing regulations is not something entered into recklessly, because the touchpoints are often deep rooted in 7-12 different sets of existing laws that could be affected. Drafting new regulations sounds easier than it is and cannot be carried out by either the Ministry of Tourism or the Ministry of Health. No collaboration; no success.  In an era of scarce new funding arrangements, actors must drive the aligning of priorities, leveraging investments and forming future partnerships without big budgets.  Most large consulting firms lack the actual domain expertise in medical tourism, and they also lack the flexibility to work in an environment where lean approaches are the norm. They are accustomed to big invoices, big retainers and high hourly rates, generated by a plethora of consultants and interns, few of whom bring any added value to the project other than billable hours for the firm. Rarely are these firms about building new frontiers of innovation where blue ocean strategies can be created, or transforming existing ones. Generally, they validate and place their branded logo on the line for investor leverage. Rarely are they capable or do the offer coaching to drive large scale change, test ideas, generate feedback based on experience, or scale opportunities to address societal challenges.

Linking innovation and research to results

Medical tourism actors integrate different portfolios in in destinations and facilitate new collaborations between the public and the corporate sectors. This is where the creativity is the most exciting to watch. The often transfer knowledge to identify new synergies and they leverage capacity to map markets in order to identify new opportunities for innovation diffusion. They also work very hard to shape policy on removal of barriers to market access, if allowed to do so by regulators. If Maria doesn’t see indicators that the political authorities are not behind the initiative, she signs off the project rather than waste time and money trying to push a dead elephant lying in the road.  She carefully interviews hiring bodies to ascertain how the innovators intend to bring partners together with a view to aligning priorities, leveraging existing investments and forming future partnerships. If identified that this is not going to be possible or likely, she declines the engagement. That is how critical it is.  Another problem often encountered by Maria is that stakeholders often want to cover too much ground in one step. This shows lack of research, lack of understanding and lack of preparedness, and also lack of funding.

The linking of objectives and targets to current policy initiatives in the related areas has also been seen as positive and as a key tool in keeping the enthusiasm high in these innovation projects. If this is also absent in the discussions from the onset, Maria will not engage. She makes these decisions out of experience. No one likes to be the team leader or subject matter expert in a project doomed for failure from the onset. If there are too many niche agendas, the project ends up in cacophony without anticipated milestones and results. Experienced consultants see that from a mile away… and run, while neophytes “go with the flow” and get the small project paycheck…and ruin their brand – assuming they ever had one to begin with.

The best of projects share common characteristics: Some working groups have been extremely pro-active with excellent leadership and commitment of members. Their success has tended to be a function of a strong chain-of-command, with a clear division of responsibility and a collaborative goal for all concerned in the clusters. Others have imploded as the cluster was used and operated as a vehicle for its spokesperson to appear at events, congresses, and conferences to advance their personal brand as ring-leader, rather than  to advance the agenda of the cluster.

What Maria looks for in a project before accepting an engagement is that there is already some semblance of planned participation by all relevant stakeholders. The prerequisite of maintaining a balance between the different types of actors involved is critical to move ahead. This usually results in attracting strong interest from the side of individuals in positions of influence. Of the more than 400 physician hospital organizational clusters Maria has developed in the past 22 years, this delicate balance, team building, and leadership cultivation has proven far more valuable than big budgets and lofty objectives. The importance of ensuring that everyone understands and can function within their role is a critical success determinant. Moving forward without this understanding and commitment often leads to lackluster representation and poor outcomes overall. Another inhibitor is the lack of funding for travel reimbursement for SME participants. This really can be managed only so well with virtual meetings. Sometimes, it takes face-to-face collaboration that is impossible in the virtual meeting environment.

Implementation timelines

If there’s one thing that threatens innovation in medical tourism, it is changes in corporate or political administration in the middle of the project. Maria has found herself in the midst of projects in Thailand, Mexico, Spain, Greece and other medical tourism destinations over the past 11 years, that have rendered the projects that were in full swing to a state of complete demise. Most implementation plans span too long a time frame, attempt to take on too much, and don’t clearly elaborate the “how” road map of implementation. Sometimes this is a byproduct of attempting to slide “scope creep” into a project that should have been limited to a situation analysis but instead layered in a proposed strategy, an implementation framework that was too high level, and too short a time frame to produce the proper outputs. The demise of these projects is demoralizing for all the hard work of all the parties when the government changes or a corporate player is merged or acquired with a non-party that lacks the commitment of their predecessors. Too often, these strategies for medical tourism breakthrough innovation are written by “dreamers” and novice consultants that don’t know “how” to guide the implementation. As a result the stakeholders languish with a strategy that lacks proper implementation guidance and leaves participants wondering “what next?”  Do everything possible to ensure compartmentalized deliverable and outputs that don’t span over an election or threatened overthrow.

Measurement and evaluation 

When deciding the strategy and implementation, take time to develop and describe the metrics that will be used for measurement and evaluation at each step of the way. Data is the greatest shortcoming worldwide for medical tourism sector development. None of the destinations have yet agreed to agree on standards of measurement for reporting, volume, capacity, or price comparisons. As a result the entire system of measurement and evaluation is a circus. Start by standardizing metrics and defined terms within the cluster. Some day the clusters will come together and agree to agree at a higher international level. For now this is merely a pipe dream.

We cannot share data and grow together in the sector if at first we fail to pool forces, data, and exemplary practices into a system that achieves breakthroughs. Build a culture of cooperation across tourism, hospitality, and health and wellness silos to reach your cluster’s best potential. Seek to build medical tourism destination brands instead of personal ambitions of stakeholders. Next tease out the unique assets of the locality, the doctors, the therapists, the technology and build a recipe book for your sector-wide buffet, not a private dinner party with a flashy host. Seek to achieve balance at every level. Balance that acknowledges local citizen access to excellent health services, and builds destination brand recognition as a market leader in medical tourism. Identify demand-side influencers that can steer market share to trustable brands that perform with consistency and delight customers, and in turn create new brand ambassadors. Use social media tools to measure engagement with brands, brand messaging, and confidence points.

Fear not; Try new things

Try new things and don’t be afraid to experiment, but build in the analytics at the time you create the experiment as any scientist would. No scientist enters the lab and mixes chemicals together and turns on the heat without a well-developed hypothesis and emergency procedures in case the experiment blows up. The hypothesis is also critical in the determination of success. Ensure that your program and its metrics are sufficiently flexible to allow changes in direction when early indicators show that a change of directions could yield better results.  The cluster governance structure must be adequately entrepreneurial to ensure freedom to experiment, and courage to discontinue activities that do not bring convincing outcomes and take up new ones. Medical tourism clusters and cluster leadership must focus on creating new systemic solutions and markets and/or on transforming existing ones fundamentally. This is important not only in the surgery side of medical tourism, but also in the thermal springs and rehabilitation setting, where old mindsets, corruption, and underemployment are matched with lack of transparency and a mindset that often despises change.

As the new frontier of innovation lies in challenges that cut across sectors or domains of knowledge, health and wellness tourism clusters must create cross-cutting platforms and cross-sectoral value chains within a nation, a region or a city destination. Use the MSO to bolster and support innovation, data management, measurement and leadership. Start with a pilot project and expand instead of attempting to systemically change an entire sector at once. Go for quick measurable wins to produce proof of concept. Nurture the ecosystem of innovation as a crucial precondition in the process of getting solutions to market.

AskMariaTodd™ to help you structure your Terms of Reference, outputs, budget and project timelines and objectives that will help you to submit funding applications that specify light, flexible, results-oriented, convincing, measurable and sustainable building blocks and clear milestones to achieve your targets. 

How to get started:

Begin with a brief call (+1.303.823.4662) to Maria Todd to discuss your project. Projects of this type usually begin with a short term contract for an inception assessment mission. While on that mission, she helps you to form a steering group to undertake the initial scoping steps – in close co-operation with key stakeholders. The strategic implementation plan, containing specific actions and initiatives at different levels which must be taken to achieve the agreed objectives can be listed at that first encounter. There is no one-size-fits all: the exact composition of the steering group should of course be adapted to the specific situation of each health & wellness tourism innovation partnership. The initial inception assessment mission contract is customarily quoted as a flat fee inclusive of Maria’s travel and consulting services while at your location, as well as a 5-6 page mission report delivered within 10 days. From that point, project owners can decide from optional next steps that are dependent on the findings and recommendations of the inception assessment mission report.

Upon a commitment to continue working with Maria, the steering group will be expected to actively seek views and input from stakeholders which are not themselves represented in the steering group, but who can make a contribution to the achievement of the objectives. Maria can participate together with the steering group using virtual meetings and social network groups that include social innovation. The process of identifying bottlenecks, defining priorities and detailing the specific commitments, must be as open as possible. Maria will augment the steering group when necessary, to participate and lend guidance to ‘operational groups’ focusing on specific activities.  All steering groups and task forces are expected to have representation from public authorities, private sector leadership personalities, and other ad hoc members of the public, insurance plans, consumers and referral partner levels.

In the early phase of the partnership (the first six months) as it prepares the strategic implementation plan, the steering group would probably meet two to three times in person with Maria Todd in attendance. in person. The steering group must be supported by a secretariat, responsible for preparing the meetings, organizing stakeholder inputs and assisting the board and consultant experts in delivering on their respective tasks. Once the strategic implementation plan is finalized and the milestones defined, implementation of the plan begins. It is at that point that the role of the steering group transitions to monitoring and reviewing progress made and making slight changes in strategy as warranted.