Q&A: Karen Timmons

Karen Timmons, CEO of the Global Healthcare Accreditation (GHA) programme, discusses the evolution of international healthcare, the challenges facing medical travel and how the organisation works to enhance the patient experience

Can you discuss some of your career milestones?
My career focuses on accreditation and building systems and solutions that assist healthcare organisations in their mission to improve the quality, safety, and patient experience of care.
During my tenure as CEO and executive vice-president of The Joint Commission and as CEO of Joint Commission International, I was able to understand the unique role of an accreditation body in convening diverse expert stakeholders to review and forge consensus on challenging issues facing healthcare, such as public disclosure and measurement.
Also, in developing international standards, the importance of setting standards that would be achievable in different types and sizes of healthcare organisations as well as varying countries and cultures, was an important lesson. It was essential to be sensitive to cultural differences and how standards might need to be adapted while maintaining consistency in compliance for quality and safety issues. What is imperative is ensuring that ‘international or global standards’ are developed with the input of experts from around the globe with an understanding of local practice.
Another profound influence on my career and values was serving as chair of the WHO Collaborating Center for Patient Safety Solutions and working with WHO’s World Alliance for Patient Safety. With the growing awareness of patient safety as a major challenge, many national patient safety agencies and accrediting bodies established national campaigns and priorities that consumed much effort and resources. Through the WHO collaborative effort, we were able to reduce redundancies, use scarce resources much more efficiently and share efforts and results in the development of solutions that were disseminated to Ministries of Health around the globe.
Additionally, the importance of attending not just to the development and dissemination of solutions, but how solutions could be implemented, was an essential lesson. Healthcare organisations wanted to do the right thing and were very motivated to apply the solutions, but needed more understanding and assistance with implementation. It is important for Ministries and governmental agencies to forge private/public partnerships to work with organisations in building capacity or testing pilots to understand how best practices can be implemented well within various types of organisations.

Most existing accreditation organisations focus on traditional aspects of quality and safety … but do not take into account the unique aspects of medical travel or the entire continuum of care that medical travel encompasses

What led you to move to Global Healthcare Accreditation (GHA)?
Healthcare is one of the late industries to globalisation. While patients have travelled for thousands of years seeking restorative therapies, most often it was the wealthy who could afford visits to restorative spas and other healing and wellness sites. More recently, we see various trends impacting the patient who travels for their care. These might be patients from developed countries seeking more affordable care in developing countries due to lack of insurance or being underinsured. It may be an employer or insurer who is incentivising an enrollee to travel to a Center of Excellence or Institute of Quality or organisation that they have contracted with for value-based purchasing. It might be governments, such as the European Union (EU), encouraging cross-border care. It might be a self-paying patient who is seeking better quality of care, or care or treatment that is not offered within their country, or may be seeking quicker access to that care, especially in national systems that may have long waiting periods for certain procedures. I am convinced that this trend will continue to grow, as countries face huge budget constraints.
Working with GHA provides a unique opportunity to conduct a deep dive into global/international patient service units and an opportunity to have an impact on improving the quality, safety and experience for all patients who travel for care. Additionally, because GHA focuses on the entire continuum, those business practices within an organisation that impact the medical travel programme, such as marketing, finance and IT, are included. Many leaders of organisations have shared that this component is very important to them, and GHA strives to ensure a GHA-accredited organisation receives solutions that impact not just patient outcomes, but business performance as well.

How do you think international healthcare has evolved over the years?
Healthcare has traditionally been local. With a more digitalised world, and one where information is readily available, patients are more informed and actively engaged in their care, seeking treatments and options on their own, and often looking for more affordable, timely care. Both international and national regulatory and oversight bodies, such as WHO, CDC and NHS, as well as accreditation bodies, have propelled more standardisation across the globe in the practice of care.
There is more shared decision making with the patient, as well as more focus on person-centered care. Additionally, rather than a sole focus on individual treatments and care for a patient, international healthcare is engaged in the management of population health, and efforts are made to prioritise the management of major chronic diseases within a population.
Additionally, healthcare is beginning to see systems and networks spanning countries and continents, with brand expansion of major institutions, although this trend is still lagging other industries.
And with more standardisation, there are still local adaptations for culture and language, something I refer to as ‘Glocalisation’.

What are some of the challenges facing medical travel?
There are unique challenges in medical travel that still have not been addressed. There are challenges in understanding the exact number of medical travel patients due to lack of common definitions. Little is known about the outcomes of care provided to patients who travel, or the clinical effectiveness of particular procedures, institutions or clinicians. For example, while data may be collected from a hospital respecting key safety or outcome data (such as readmissions or infections), it normally pertains to the overall population and may not include any patients who travel for their care. There is little sharing of best practices respecting medical care. There are issues regarding transparency about risk and pricing, and whether treatments are evidence based, and countries having differing laws regarding confidentiality as well as legal liability and accountability. And most existing accreditation organisations focus on traditional aspects of quality and safety (which is very important), but do not take into account the unique aspects of medical travel or the entire continuum of care that medical travel encompasses. As an accreditation organisation, working in collaboration with other credible organisations, there is an opportunity for GHA to try to bring resolution to these issues.

How is GHA seeking to do this?
Ensuring that all touchpoints across the entire Medical Travel Care Continuum are seamless is imperative, starting from the moment the patient first views an organisation’s website, through to aftercare at home. Our standards promote proactive risk assessment of vulnerabilities in processes as well as a focus on transparency.
Additionally, as there is little real data about medical travel patients, even within organisations with sophisticated IT data collection, it usually does not segregate out performance on medical travel patients. We require submission of key performance indicators so organisations also focus within their improvement plans on this unique sector of patients and are thus able to benchmark with other organisations over time.
We believe that medical travel offers much more than trickle down economic growth in the health sector. Theoretically, medical travel can help reverse brain drain within countries that have placed a priority on medical travel. The positive impact on the economy (encompassing ground and air transportation, hospitality, tourism and medical) can facilitate improved quality and safety throughout the country by the sharing of best practices and health authorities having additional funds to purchase medical equipment and technology for all patients. In the long term, GHA would like to contribute to the data analysis of the long-term impact of medical travel on local populations.

What are the benefits of focusing on the patient experience in medical travel, besides happier patients?
Around the world, healthcare consumers are becoming savvier, payers are demanding high-quality care, and research groups have found more and more convincing evidence as to why the ability to prioritise and manage the patient experience is so important to a positive overall healthcare experience. Dr Thomas Lee, through the Harvard Business Review, highlights ‘How U.S. Health Care Got Safer by Focusing on the Patient Experience’. This article raises the point that performance outcomes are correlated – the organisations that have better performance with patient experience also have better performance financially and with patient safety.
The Institute for Healthcare Improvement (IHI) also emphasises the link between patient engagement and making care safer and more reliable in their white paper Patient Family Experience of Hospital Care (www.ihi.org/resources/Pages/IHIWhitePapers/default.aspx).
A strong and growing evidence base shows that patient- and family-centred care is integral to the improvement of clinical, financial, and satisfaction outcomes. Evidence also demonstrates that patient involvement positively impacts their ability to manage chronic care, for example.
What can the industry - specifically, individual organisations - do to improve the patient experience in medical travel and make it more of a priority?
There are many ways organisations can improve and focus on the patient experience, and the GHA standards can provide a guidepost. First, it is important to view patient experience not as a separate entity, but integrated with clinical processes, an organisation’s Medical Travel Care Continuum, and even business processes. All of the touchpoints a patient encounters need to be seamless. This means if an organisation contracts with a third party for transportation or hospitality, for example, it needs to set expectations for the service provided and monitor that. It needs to consider how its business policies respecting IT, marketing and finance may impact a patient. And of course, issues such as being able to communicate with a patient and be respectful are a given. Most of these issues can be explored through a review of each organisation’s Medical Travel Care Continuum, with a focus on vulnerabilities, training, and putting in place mitigation strategies to facilitate a positive experience for patients.

Can you tell us about your proudest achievement to date?
My proudest achievement is my family: my husband and three daughters and more recently two granddaughters! It has been a blessing and joy to have their support and I have especially enjoyed raising daughters, all three of whom are now successfully working in their own careers and balancing the needs of family and work.

There are many ways organisations can improve and focus on the patient experience, and the GHA standards can provide a guidepost

What long-term plans, both professional and personal, do you have?
Professionally, I am very excited about the potential to work with organisations to impact positively on the care provided to medical travel patients. This is an underserved niche that is growing in volume each year. Another part of our vision is to facilitate more data, facts, and research about medical travel. I believe strongly in collaboration and look forward to establishing appropriate strategic partnerships that will help to raise awareness about, reach consensus on and mitigate some of the challenges patients who travel for their care now face. Additionally, GHA is undergoing technical review of its standards by ISQua currently and we look forward to ISQua accreditation.
Personally, I look forward to spending more time with my family, especially my granddaughters, as well as travelling with friends and family. While I have been fortunate to travel to many countries, I have not had the opportunity to explore at leisure and intend to do some of that, as well as some good reading, walking and talking with friends and family.

If you could spend time in any country in the world, where would you visit and why?
There is not a country I have visited that I would not want to return to! There are many national parks here that I have not visited and would like to. My husband would love to visit Singapore, and go on a safari – and we hope to make these trips together in the coming years.

How has working internationally affected you?
Working internationally has profoundly impacted my life. It is always a two-way learning experience, and I have gleaned so much from visiting many hospitals and organisations throughout the years. I have been fortunate to meet so many dedicated professionals whom I now call friends and colleagues.
By nature, I believe in lifelong learning and the need for collaboration, consensus building, trust, sharing of best practices, adaptation, and respect. Working in an international environment provides a broad foundation for all of these.