Industry Voice: Building a modern assistance network for a new generation of medical needs
Dr Simon Worrell, CMO and Founder of Chiron International, talks to ITIJ about how to determine if a partnership is right for your business
A dependable network of global providers is at the heart of what we offer in international assistance. With a trusted global network, patients are admitted to hospitals and treated quickly and reliably. Moreover, we transfer patients using professionals in our network who are experienced and ready to act should they need to, whatever their location on the globe.
Maintaining networks
How are networks maintained and grown to meet the needs of today’s traveller?
Firstly, the vetting procedure that occurs when onboarding a provider is an essential step in creating a credible network. Establishing what a facility is able to do, and, importantly, what the trigger points are for moving patients to a superior healthcare provider, is paramount.
Several tried and tested lines in the sand for establishing credibility are the presence of an international standard, such as the Joint Commission International (JCI); the ability of the hospital to perform advanced services, such as neurosurgery or neonatal intensive care; and the pedigree of the physicians. However, these are only part of the story. What is of vital importance is the nursing care of the hospital and the day-to-day experience of the staff in dealing with complex issues. It’s of little use having good facilities if there is no one who has treated our patient’s condition before. We don’t want a case of ‘all the gear but no idea’.
Vital site reviews
To get the truest impression of the capability of your network, what is needed are site reviews conducted by experienced staff.
Inspections in the field are invaluable because you can see firsthand the range of facilities that are present – and, importantly, their upkeep. I’ve found over the years that during inspections, hospital staff are often blushingly honest about what is available and what is not working. For example, a few years ago, it was very common for radiology staff in particular parts of the globe to admit during inspections that their CT scanner had a downtime (i.e. when it wasn’t working) of around 30% or more. Machines go wrong, of course. But the problem was that if your broken scanner is made by a German company and the German repairman was only due to travel to your country in three months’ time, then there would be no CTs in that hospital for the intervening three months.
I’m pleased to say that the situation has recently dramatically improved.
The busy, less smart hospital is usually the safer option
European manufacturers now often train local technicians, commonly situated in the country’s capital city, facilitating expert and prompt repairs. Downtimes are now kept to a minimum. This was evident when I surveyed the healthcare facilities in rural Uganda recently, where even fairly remote clinics would have functioning CT and even MRI scanners.
However, as has been long known in international assistance, a scan is only as good as the person reading it. Previously this has been a big problem, but it has also recently improved. Scans are electronically conveyed to larger healthcare facilities, where they are read and reported. In Uganda, images were assessed in good hospitals in Kampala and if further expertise was needed, they were sent to centres of excellence in India.
Seeing this process in person during an onsite review gives confidence that your network is valuable, even in traditionally challenging locations.
Site visits can also provide an assessment of the expertise of the type of surgery performed at hospitals.
Assessing the paperwork
It’s raised a few eyebrows in the past, but I’ve always asked to review the operative logs personally when inspecting a facility. The logs are the descriptions of the operations that have been performed over the past few months in a particular hospital.
They’re traditionally kept in handwritten books in the operating theatre, so you’ll need to ‘gown up’ if you want to see them. If the logs show little more than caesarean sections (many hospitals in Africa start out as mother and baby clinics), it becomes rapidly clear that, should your patient be admitted to that hospital with anything slightly involved, they should be quickly moved to a superior facility.
Hospital staff are often blushingly honest about what is available and what is not working
Even the number of patients that are evident during the inspection is important. It is a common finding that otherwise impressive and well-equipped hospitals are too expensive for the local market, allowing few patients to afford their services, and little clinical experience gained by the staff: a case of all the gear but no one here.
Avoid if possible. The busy, less smart hospital is usually the safer option.
Importantly, networks should have a range of cast-iron tertiary referral hospitals to which patients admitted to lesser facilities can be evacuated. Such hospitals are the Bumrungrads and the Aga Khans of the world: trusted institutions that have saved the lives of many complex patients over decades. When a patient has been in a serious road traffic accident, suffered a catastrophic heart attack, or developed a life-threatening chest infection (to name but a few important clinical conditions), safely transporting the patient to a trusted regional centre of medical excellence is crucial to the patient’s care.
What is the direction of travel for international networks now?
Many travellers are now seeking more of an adventurous global experience
The recent concentration on a patient’s mental as well as physical wellbeing has meant that networks are beginning to include specialist psychological support services. For those of us who have worked closely with the security industry or with humanitarian workers in the field, urgent access to mental health workers is imperative.
Such employees are sometimes subject to horrific situations that require prompt professional help. The psychological support network should include a capacity for initial emergency consultation (often by telemedicine) but may also require onsite face-to-face support, and the ability to provide ongoing therapy delivered over several weeks.
With the acknowledgement that many travellers are now recognised as being neurodivergent, particular psychological support may be required in some instances. For most neurodivergent people, no added help will be necessary. But if it is, networks should include therapists able to deliver understanding and knowledgeable support when needed.
As many travellers are now seeking more of an adventurous global experience – not just content with the occasional ‘bucket and spade’ break – assistance companies must be prepared to help even in remote and challenging locations.
Our networks should reflect this if we are to remain effective. Of course, the best preparation for the less usual itinerary is always foreknowledge of both the trip and the travellers. Medical evacuation response plans (MERPs) can then be designed that detail where a patient should be cared for, and how they would get there, at each stage of the journey.
Such planning is already occurring with VIP clients and companies that send employees into remote areas of the globe, such as film units. But when travellers suffer accidents on adventure holidays where no MERP has been prepared, any assistance company worth their salt will hit the ground running. Their medical team will immediately consult with the treating doctor in the remote clinic, assessing the situation from scratch and planning for urgent evacuation if needed.
A first-rate assistance company medical team can never be replaced by the most complete of global networks. However, with effective medical management, a good network will be a powerful tool to provide the best outcome for those ill abroad. Wherever they are in the world.