Destination Evaluation for Medical Travel: A Checklist for Facilitators (Part I – Airport and Hotel Arrival)

Much has been posted in press releases, directories, brochures, and other content when a new “place” decides to enter Medical Tourism. Some of it is very superficial and doesn’t address what a medical tourism facilitator needs to know about a place they will recommend to their clients.

This lack of detail is frequently exacerbated by the prevalence of many medical tourism event B2B meetings and internet transactions, where medical tourism facilitators contract with health facilities and physicians – in a place they’ve never personally laid eyes on, and then begin making recommendations. Is the real objective of their “professional” services client safety and a delightful destination experience? or a commission payment and revenues?

This author would like to believe that revenues are earned by meeting the client’s needs and objectives: unbiased guidance, advocacy for safety and quality and a hassle free experience, and a delightful and productive destination experience.

The takeaways from this article

In this article, I will share with you a few of the lessons learned after over 35 years of experience examining destinations eager to welcome medical travelers to avail themselves of medical, dental, rehabilitation, diagnostic and wellness services around the world.

Below you see a map of the places I’ve examined. I have shared this – not to show off – but instead, to give you a feel for the decades of experience that go into the creation and improvement of the checklist that I’ve shared with you.

My intention is that you grow in your professionalism and gain an understanding of the importance of direct observation of the destination where your healthcare trading partners are situated.

When you arrive at a destination that wants you to recommend and refer clients for medical, dental, rehabilitation, diagnostic or wellness services, your eyes begin scanning the terrain from just before landing.

Prior to landing

You fly over the terrain near where you will land and from about ten minutes before landing (about 10,000 feet), you can begin to make out areas of dense population and undeveloped areas (forests, mountains, farmlands, etc.) This bird’s eye view is your first glimpse of where you are headed. In most cases, commercial aircraft fly between 400-600 miles per hour, so at 10 minutes from landing, you are looking at the view that is 60-70 miles away from the airport where you are scheduled to land. How far is the airport from the area where your host hospital, clinic or healthcare facility is located? How far is the hotel? What’s in between and enroute. You should be making notes of these first impressions as that’s what your client will be doing when they arrive.

On arrival

Upon landing, is a jet bridge used or stairs? Is a shuttle bus required? Are the passengers exposed to the elements (rain, cold, heat, wind) to access the terminal? Might your clients be mobility challenged? What arrangements will “someone” need to make to ensure they have adequate assistance and accessibility on arrival? These details should be added to your notes so that you can create a custom checklist for each destination. The details must include contact information for whom to call to make arrangements. In Europe, these arrangements are required to be made and entered in the PNR (passenger name record) at least 48 hours in advance, unlike the USA where the services must be available “on demand”. What about in the country where you are visiting? What official authority will offer you this guidance? How can you obtain a contact details for “station managers” for each airline that lands there? How can you get in touch with lost baggage offices, first aid if your client feels unwell on arrival? How can you expedite your client’s immigration process so that they don’t have to wait in long queues if they don’t have standing or walking tolerance?

In the destinations I’ve visited on the map above, I’ve recommend to airport and aviation and tourism authorities that this information should be readily available as part of their medical tourism entry preparation. How many have actually implemented my recommendations? Very few. Most just want to jump right into to attracting medical travelers and their companions and making money. Few have allocated adequate time, capital or staff to undertake the development necessary to prepare to receive medical travel and wellness travel visitors and delight them to make referrals and return for additional care.  For the general public who uses a “professional” medical travel facilitator or coordinator, they are paying a fee for a professional service. When they don’t get this, it is the facilitator’s fault and responsibility, plain and simple.  If you don’t provide a professional service, then the client is merely paying you a referral kickback, no matter from whom the check is paid.

From your entry into the terminal, study your environment: the temperature, cleanliness, wayfinding signs, security levels, shops, bathrooms, seating areas, power receptacles to plug in an recharge electronic devices, food and beverage outlets, etc.  It matters not if your stop is an intermediate connection hub airport or your final destination.  Chances are, you’ll either have lots of time to spend or you’ll be in a rush and distracted trying to make it to a short connection.

Every commercial airport in the world has what’s known as a minimum connection time (MCT). MCT is the amount of time the airport has determined is the absolute least amount of time an able-bodied person needs to make a connection to a continuing flight.  What if your client or their companion require assistance and are not able-bodied?  How will you know what time is required to make that connection and how can you connect with the right parties to arrange assistance?  In Istanbul, at Attaturk, I had one hell of a time getting assistance from an international flight to a domestic flight.  No one would help. People I stopped in Turkish Airlines uniforms ignored me and did not make eye contact when I spoke to them. A total of 14 people did this. No wheelchair was at the gate when we disembarked. When someone did acknowledge that I was speaking to them, their body language and hand gestures and tone of voice were indicative of annoyance. That I was bothering them. Some actually had the audacity to articulate that what I was asking was “not their job.” But they made no attempt whatsoever to solve the problem. They just walked away. They did not call a manager or a supervisor who could help. Some literally barked “No English!” at me and kept walking.

Eventually, I found my way to an “Assistance Desk”. They took my passport from me, and my subsequent flight boarding card, and pointed to a row of chairs and instructed me to “sit there.”  I did as I was told. 30 minutes passed. Nothing happened, nobody came to help. Nobody updated me as to what was planned, what to expect. I needed to use the toilet. Could I leave? Where was the toilet? I still needed to emigrate into Turkey, and then continue on to my final destination from a different terminal more than a mile away.  I can tell you that I did not feel like an invited guest to Turkey. Instead, I felt like an unwelcome, homeless, helpless person in a crowded bus station in a foreign land unprepared for international visitors.

When I got up to use the toilet, I stopped by the desk to tell them my plan. The man yelled at me saying, “You cannot leave.” I asked when I could expect someone to come for me. He again raised his voice at me to say “Go and sit down. Someone will come.”  I did as I was told. Another 30 minutes passed. Nobody came for me.  When someone finally arrived 75 minutes after I entered the terminal, they arrived with a pediatric-size wheelchair with a broken wobbly wheel, a torn seat and filthy dirty. When the person pushing the wheelchair realized that their equipment was inadequate for the task, they went to the Assistance Desk and then left.  After 10 minutes, I approached the Assistance Desk attendant to inquire about what was the plan. I still needed to use the toilet. I was thirsty, I had not yet passed through immigration and visa, and my connecting flight was now less than one hour from departure.  Again he barked at me. “Someone is coming. Sit. Wait.” At this point, my bladder was ready to burst. I was near tears. I asked to speak with a supervisor or manager. Again he barked at me. “Someone is coming. Sit. Wait.”  Another 15 minutes passed before anyone came for me. From there, our first stop was the bathroom.

TIPS:

Instruct your clients to say “toilet” not “bathroom” outside the USA. Otherwise, people will assume they wish to have a shower or bath.

Provide them with a basic phrase list in the language spoken at the destination that they can use to point to the word and get their needs met. Another option is to send them pictures of things like “toilet” “water” “coffee” “sandwich” “passport” “visa” “wheelchair” “police officer” “doctor” “nurse” “hotel” “bed” “chair” “pillow” “taxi” “cash machine” that they can load on their phone and just point to communicate.

So continuing on through the airport terminal:

• Where are the bathrooms? Are they clean? Well marked? Accessible to the mobility challenged?
• How far is it to the immigration and customs area?
• In what condition are wheelchairs or electric carts? Will they transport a person of large stature?
• How far is it to the next flight or to baggage claim? Are moving sidewalks, escalators, and elevators available? Do they work? What is the backup plan if they are out of service? In most Mexican airports, escalators, and elevators existed but were not functional.  Alternatives were not convenient for a mobility challenged person with a purse, tote bag and a rollaboard suitcase in hand.
• Do they announce gate changes? In Turkey and in several other countries, these changes are only announced on a screen. So if you aren’t watching, your departing flight gate could be changed to someplace a mile or more away on short notice. If you then happen to miss that flight, and it is the last flight of the day… too bad; so sad.  You may be scolded, penalized with a surcharge and on your own for your overnight arrangements, and your ticket (including your return) may be totally cancelled.
• Will they accept credit or debit cards for visa and immigration or departure fees? If not, how will you get local currency to pay the fees if the ATMs are outside the controlled area?
• Do wheelchair pushers and assistance personnel expect to be tipped for their service? In the USA and many places yes. In Japan, you risk offending the wheelchair pusher or assistant if you even so much as offer.
• In the visa and immigration area, there may be forms to complete, items your client might not realize must be declared, additional inspections one might not expect as part of the immigration process, and very personal questions to answer. Certain patient-administered medications, such as pain medications, legal where they live, may not be permitted in the destination country.  These unexpected challenges can give rise to long waits standing in lines that also can affect your minimum connecting time windows if you must pass through immigration and visa before connecting to a domestic flight at another in-country airport. They can also be uncomfortable if your client has limited standing tolerance. And at worst, intimidating, owing to a miserable arrival experience. If you cannot describe all this and guide and set expectations for your clients, because you’ve never experienced travel into the subject airport as a foreigner with special needs and language constraints, why would you refer a patient there? And yet this happens again and again. That’s not professionalism, it isn’t safe, there’s no delight, and it does not deserve a fee for providing a professional service.

Once the client passes through immigration and visa and collect the remainder of their luggage,  they arrive at an arrivals hall.

• What if their luggage does not arrive as expected? Will it be delivered by a secure and reputable service? Larceny happens all the time in both developed and developing nations.
• What if the luggage has been damaged or belongings are missing? How do they obtain assistance?

In developing nations where poverty is rampant, people with people view medical travelers as elite, rich people capable of paying for costly private healthcare. Many developing countries are plagued not just by ordinary crimes such as larceny, pickpockets, and petty theft, but also by culturally-sanctioned violence against women and gays and serious forms of transnational crime such as sex trafficking, drug trafficking. What if someone puts contraband IN their luggage instead of taking things out?

How will you guide your client to be safe. If you haven’t vetted and performed background checks on arrival and departure coordinators, how do you know that they are safe enough for your clients’ well-being?

In the arrivals hall, currency exchange desks and ATMs may be available. Which should they use?

There will also be many people offering rides to hotels and other places. Will you have an official arrival coordinator for them to meet?

• How will they recognize them? Where will they find them? Will they be in a uniform? Do you have a picture of the person assigned to coordinate their arrival? Will they have a sign?
• Has this coordinator been vetted for safety and security? If they are the driver, has their driving record and insurance been verified by you or your company?
• Do they speak the language of your client? If not, how will the two communicate?
• Do they expect a gratuity? Will they manage luggage or is a porter going to handle luggage and will the porter expect a tip and if so, how much per bag?
• What kind of vehicle will be used for ground transfer?
• How long is the ride to the hotel? Does your client have a marked map that sets expectations as to the route they should expect to travel? What if they feel uneasy about the driver, the vehicle or the route of travel? How can they get help? Will their phone work to call for help?

At the hotel

• Will they merely drop them off at a hotel or hospital? Will they accompany them inside? Will they remain to accompany your client to their hotel room to ensure the right hotel accommodation is assigned, consistent with what was reserved?
• What contingency is in place if the hotel “walks” your client for some reason?  Sometimes, hotels are overbooked. This can occur because of inclement weather that causes flight cancellations, overstays, or an emergency condition at a hotel that takes a block of rooms off market for some reason. Because of the highly competitive markets, the goal of the front desk managers is to have zero room vacant in order to maximize revenue generated from room and also to achieve full occupancy. Rooms are like perishable items because if the opportunity to earn revenue from that room is gone forever every time it goes vacant. So if after a reasonable period of time, even through rooms are reserved, if a flight delay or misconnection causes an unexpected late arrival, the hotel may give away a reserved room as part of their tactics to compensate for noshows, cancellations and early departures. That often translates to a hotel accepting a certain percentage of reservations beyond capacity. They overbook more than the hotel can accommodate, based on historical noshow, cancellation  and early departure statistics. Also when an unanticipated number guest stayovers occur and the hotel is not able to accommodate all the guest expected to arrival that day then that result in a walk situation. And those guests who had been shifted to other hotels is known as ‘Walked Guests’. Does your hotel contract stipulate to a “no walk” agreement? Do you have a hotel contract? If not, in whose contract does the no-walk policy exist? What is the backup contingency if it happens anyway? What if the room type reserved is not available on arrival and the guest is assigned to an inappropriate room? How will you overcome this sudden unexpected turn of events?
• If your client is walked, how will they be accommodated there on arrival? Who will arrange transportation if their arrival coordination driver has departed? It is customary that the reserved hotel will pay for room and tax at the alternate hotel for one night, one long distance phone call, and local phone calls if it is necessary for the guest to notify home and/or business associates of his new location. How will the accounting be sorted out? What if they don’t cover the usual amenities?
• What if the alternative property room is not of similar standard and doesn’t meet your clients’ special needs criteria?
• Who briefs the telephone operator at the original hotel about what happened and how to contact the client?
• How will the client be returned to the originally reserved, inspected and approved hotel?
• What happens if the client decides they don’t want to move to the originally booked hotel? How are prepayments and refunds arranged?
• If you are due a hotel commission, it should be paid in full regardless of the walk situation.

How to use this information and new knowledge

1. Begin creating a checklist prior to your next familiarization tour or site inspection. Start with pre-landing observations and notes.
2. Then create a checklist that spans from the time the door of the aircraft is open until the client has cleared immigration and visa with luggage in hand.
3. Then create a checklist for entry into the arrival hall, and arrival coordination and ground transportation and the route to the accommodation and the clinic.
4. Then create a checklist for hotel check-in and arrival. This checklist will be different than any checklist you use to inspect the hotel for appropriateness, furniture, services, amenities, location, etc.  That checklist would have been completed prior to ever selecting the hotel and referring a client there in the first place.
5. Next, begin creating your “client trip planning” and “briefing” materials that set expectations.
6. All of these materials will form component parts of your quality program, and will be useful if you decide to attempt certification under ISO-9001:2015. They will also prove useful if you should choose to arrange for professional liability insurance because they will be requested and reviewed by underwriters to determine if you are a “good” risk or a may be too inexperienced and unprepared for them to extend coverage.

If you need assistance or on medical tourism facilitation skills and business preparedness:

• I offer personalized training. I’ve helped many new and experienced facilitators through this program.
• I consult via Skype or telephone for a set fee per 15 minute increment. Call +1.800.727.4160 for an appointment or to learn more about this service.
• I’ve authored internationally-published instructional books you can purchase on Amazon.com or from the publisher in print or digital format.
• I write many articles like this one that are published several times each week. Text MEDICALTRAVL to 43506 to receive SMS notifications when new content is published that you can read and learn from. Reply STOP any time you want to discontinue the notifications.  You can also click this link to sign up from your computer or tablet.
• I teach Master Classes, seminars, webinars, and conduct workshops at select medical tourism and wellness industry events you can attend. Text ASKMARIATODD to 43506 to receive SMS notifications when new training programs and workshops are announced. SMS subscribers receive valuable discounts not available to the public. You won’t get any notices other than education notifications at this address so if you want both training and new articles, you’ll need to subscribe to both notification groups. Replay STOP to either group notification any time you want to discontinue the notifications. You can also click this link to sign up from your computer or tablet.