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This chapter seeks to investigate the journey of breast and bowel cancer patients at the HMC Antoniushove. It zooms in on specific touch points and the possibilities for improvements. Furthermore, it elucidates the learning process and more particular the dissemination between the hospital (staff and medical students) and hospitality students and professionals and emphasizes that looking from different perspectives and various disciplines is beneficial for all the stakeholders involved in hospitals.

Diseases are increasingly chronic; patients are more demanding and competition between different hospitals is increasing. That is why, in addition to excellent medical treatment, excellent service (referred to here as hospitality) is becoming increasingly important in the healthcare sector, including in hospitals. What does it have to meet? What do patients appreciate, what needs to be improved and how can these improvements be designed and implemented with the involvement of both patients and hospital staff?

Medical and hospitality students collaborated in this project analysing and describing the journey of patients with breast and bowel cancer. They examined the patient journey and elucidated the touch points, which patients indicated as critical during their ‘journey’.

Most important finding resulted from the learning process of this collaboration and the insight gained, a greater awareness and understanding of the non-medical needs and wishes, i.e. hospitality, of patients. Furthermore, the mutual understanding between the evidence-based stance of thinking of medical students and hospital staff at the one side and the more on soft skills–focused attitude of hospitality students on the other hand increased.

Given the premise of de facto universal standards for FM, this paper aims to investigate development of facilities management (FM) at an Albanian and a Norwegian university hospital through examination of two hypotheses: the university hospital has recognised FM and established a designated FM organisation (H1) and the university hospital provides adequate food and catering services at ward kitchens and buffets (H2).

This is an exploratory and descriptive comparative case study based on a diverse cases’ designs.

There is limited and strong support for H1 at the Albanian and Norwegian university hospitals, respectively. Both the Albanian and the Norwegian university hospitals rely on in-house production of facilities services, but the Albanian university hospital has outsourced food and catering services. FM and provision of facilities services are deeply integrated within the Norwegian university hospital’s core activities. There is also limited and strong support for H2 at the Albanian and Norwegian university hospitals, respectively. Hence, the Albanian Ministry of Health and the Albanian university hospital’s top management have a comprehensive, but not impossible, task, if the aim is to catch up with the Norwegian university hospital concerning FM.

This is an exploratory and descriptive comparative case study. Large N studies should be carried out both in Albania and Norway and preferably also in other countries to corroborate and develop the findings.

This is the first comparative study of FM at an Albanian and a Norwegian university hospital.

The purpose of this paper is to investigate logistics activities in Singapore hospitals. It defines various types of activities handled by a logistics division. Inventory management policy and the use of information and communication technologies (ICT) for logistics purposes are also discussed. The study identifies the nature of strategic alliances in Singapore's health care industry.

This study was conducted by utilizing a framework for data collection, pre‐testing the questionnaire and conducting interviews. Various relevant literature was reviewed to design the questionnaire.

This study finds that logistics division carry out many related activities and some of them also provide engineering services. The hospitals make use of ICT. The hospitals are clustered under various groups to minimize the cost of operation, including the logistics related costs. However, hospitals do not see alliances with suppliers as a strategic option; rather they focus on outsourcing of logistics services. The findings also show that Singapore hospitals have a good stocking policy for both medical and non‐medical items so that changes in patient mix can be easily handled.

Singapore is continuously improving its health care industry and therefore, the findings will help hospitals in other regions to adopt some of the practices, like concentrating on local vendors, outsourcing, clustering, and maximum use of information technology as competitive factors that can improve the service and reduce the cost of operation. The paper suggests motivators and barriers to the use of ICT in logistics in the health care industry.

Health tourism is a relatively new branch of international tourism that has developed more rapidly than other tourism sectors in recent years. This study aimed to investigate the effect of government supports on health tourism development by considering the mediating role of internal and external infrastructures.

The study population consisted of all experts of two hospitals in Iran, which are frequently visited by foreign tourists (N = 151). A questionnaire, developed by combining standard and researcher-made questionnaires, was used to collect the data. The confirmatory factor analysis (CFA) model was developed in SmartPLS 3 to test the hypotheses.

The main hypothesis test results indicated that government supports positively affect the development of health tourism. Internal and external infrastructures were also found to mediate the relationship between government supports and health tourism development. In addition, the sub-hypothesis test results showed that internal and external infrastructures are positively affected by government supports, which puts forth the development of health tourism. As the results explained, the most important aspects of internal infrastructures affected by government support were health service quality, cost of health services and applying advanced medical technologies, respectively. Also, different aspects of external infrastructures affected by government supports are as follows: economic, infrastructures and cultural factors.

This study is the first of its kind to examine the impact of both medical and non-medical factors on health tourism and signifies the crucial role of governments in the development of health tourism.

The purpose of this paper is to explore the supply-side factors that determines the quality of global healthcare services from medical tourism healthcare providers’ (MTHP) perspective, which provide value-in-medical-travel to foreign patients/medical tourists, who travel to India for medical treatment/surgery.

The thematic content analysis of in-depth interviews with 15 senior MTHP, from 15 private hospitals in India was undertaken, to generate the themes, and identify the supply-side factors necessary for sustainable medical tourism management.

The findings conclude that MTHP ranked in ascending order, less waiting-time for surgery, healthcare quality and accreditation, staff/surgeon’s expertise, healthcare information, hospital facilities and services, patient-safety, travel-risk, surgical costs and holiday opportunity as essential factors for providing sustainable quality and value-in-medical-travel to patients.

Many private hospital spokespersons declined to be interviewed due to confidentiality and privacy policy

The findings are generalised in case of global private hospitals treating foreign patients. Policy implications suggest that private hospitals in developing countries need to focus on providing value-in-medical-travel, such as accreditation quality of healthcare, no waiting-time, patient-safety, qualified and experienced medical and non-medical staff, hospital facilities and post-surgery care with positive healthcare outcomes.

Medical-tour facilitators, hotels and tourism sites need to collaborate with agencies to provide inclusive built environment, first-aid and wheelchair access, to medical tourists, having financial and legal implications for business.

There is little qualitative empirical research on the views of MTHP, regarding management of essential supply-side factors that provide value-in-medical-travel to attract medical tourists to India.

医疗保健提供者对印度医疗旅行价值的看法

本文的目的是从医疗旅游医疗保健提供者的角度探讨决定全球医疗服务质量的供应方因素, 这些因素可为前往印度求医的外国患者/医疗游客提供医疗旅行的价值治疗/手术.

对印度15家私立医院的15家高级医疗旅游保健提供者（MTHP）进行了深度访谈, 对主题内容进行了分析, 以生成主题并确定可持续医疗旅游管理所必需的供应方因素。

研究结果得出结论, MTHP以升序排列的顺序是：手术等待时间, 医疗质量和认证, 工作人员/外科医生的专业知识, 医疗保健信息, 医院设施和服务, 患者安全, 旅行风险, 手术费用和度假时间机会是为患者提供医疗旅行可持续质量和价值的重要因素。

由于医院的机密性和隐私权政策, 许多私立医院发言人拒绝接受采访。

如果全球私立医院为外国医疗游客提供治疗, 那么研究结果将得到概括。政策含义表明, 发展中国家的私立医院需要集中精力提供医疗旅行价值, 例如无需等待时间的医疗保健认证质量和患者安全, 合格和经验丰富的医务人员和非医务人员, 医院设施和后期医疗服务。具有积极医疗效果的手术护理。

旅馆, 医疗旅行促进者和旅游景点需要与机构合作, 为医疗游客提供紧急急救和轮椅通道, 这对企业有财务和法律影响。

关于MTHP观点的定性实证研究很少, 涉及对提供医疗旅行价值以吸引医疗游客前往印度的基本供应方因素的管理。

印度, 医疗旅游, 全球化 等待时间, 患者安全, 认证质量

研究论文

Perspectiva del valor de los proveedores del cuidado de la salud en viajes con propositos medicos a la India

El propósito de esta investigación es explorar los factores que del lado de la oferta determinan la calidad de los servicios globales de salud desde el punto de vista del proveedor, el cual agrega valor al viaje con propósitos médicos a pacientes/turistas médicos quienes viajan a la India para tratamientos médicos ó cirugía.

El análisis de contenido temático de las detalladas entrevistas, con-15 proveedores experimentados de asistencia sanitaria de turismo medico, en-15 hospitales de la India, fué realizado para generar los temas é identificar los factores que del lado de la oferta son necesarios para la gestión sostenible del turismo médico.

Los hallazgos concluyen que proveedores experimentados de turismo ranquearon en orden ascendente la reducción en tiempos de espera para cirugías, acreditación de la calidad del cuidado de la salud, experticia del personal no médico y de cirugía, información del cuidado de la salud, servicios é instalaciones de los hospitales, seguridad del paciente, riesgos de viaje, costos de cirugías, y oportunidades vacacionales, como factores esenciales para proveer calidad sostenible y valor en los viajes con propósitos médicos a los pacientes.

Muchos representates de los hospitales privados se rehusaron a ser entrevistados debido las políticas de privacidad y confidencialidad del hospitales.

Los hallazgos son generalizables en el caso de hospitales privados globales que tratan a turistas médicos extranjeros. Las implicaciones políticas sugieren que los hospitales privados en los países en vía de desarrollo necesitan enfocarse en agregar valor al viaje médico, por medios como la calidad de acreditación de la atención médica, reduccion de tiempos de espera y la seguridad del paciente, personal médico y no médico calificado y experimentado, instalaciones hospitalarias y servicios posoperatorios con resultados sanitarios positivos.

Los hoteles, los facilitadores de toures médicos y los sitios de turismo necesitan colaborar con las agencias para proveer primeros auxilios de emergencia y acceso en silla de ruedas a los turistas médicos, teniendo esto implicaciones financieras y legales para los negocios.

Existe poca investigación empírica cualitativa sobre los puntos-de vista-de (MTHP) proveedores de asistencia sanitaria de turismo médico con respecto a la gestión de los factores esenciales del lado de la oferta que agregan valor al turismo con fiines médicos para atraer turistas médicos a la India.

India, globalización, turismo médico, tiempo-de-espera, calidad, seguridad-del- paciente

Trabajo de investigación

Hospital responsiveness to the patient expectations of non-medical aspect of care can lead to patient satisfaction. The purpose of this paper is to investigate the relationship between the eight dimensions of responsiveness and overall patient satisfaction in public and private hospitals in Tehran, Iran.

This cross-sectional study was conducted in 2015. In all, 500 patients were selected by the convenient sampling method from two public and three private hospitals. All data were collected using a valid and reliable questionnaire consisted of 32 items to assess the responsiveness of hospitals across eight dimensions and four items to assess the level of overall patient satisfaction. Data analysis was performed using descriptive statistics and multivariate regression was performed by SPSS 18.

The mean score of hospital responsiveness and patient satisfaction was 3.48±0.69 and 3.54±0.97 out of 5, respectively. Based on the regression analysis, around 65 percent of the variance in overall satisfaction can be explained by dimensions of responsiveness. Seven independent variables had a positive impact on patient satisfaction; the quality of basic amenities and respect for human dignity were the most powerful factors influencing overall patient satisfaction.

Hospital responsiveness had a strong effect on overall patient satisfaction. Health care facilities should consider including efforts to responsiveness improvement in their strategic plans. It is recommended that patients should be involved in their treatment processes and have the right to choose their physician.

The concept of organisational culture (also referred to later as OC) is one of the approaches in modern organisational analysis exploring the values, attitudes and beliefs behind human behaviour in the workplace. OC as a social phenomenon is considered to be important for the sustainability of every organisation. In the service sector, OC may affect the nature and quality of the services provided. The aim of this paper is twofold: on the one hand, to highlight the patterns of OC in a hospital; and, on the other hand, to outline relationships between OC and patient satisfaction. The study was conducted in Tartu University Hospital, one of the most influential health care organisations in Estonia. This paper has original value by presenting an insight into organisational culture in the Estonian health care sector, and the findings of the study will expand knowledge of OC in the health care sector in general.

The OC instrument applied in a quantitative cross‐sectional study was earlier developed according to the Competing Values Framework (CVF). Data from 456 medical and non‐medical professionals were analysed using non‐parametric tests of descriptive statistics. A factor analysis was performed to assess the instrument's compatibility for analysing the OC pattern in the health care sector.

The dominant culture type in all the groups investigated was the Internal Processes type, mainly followed by the Rational Goal type, while different cultural patterns were observed in professional groups. The factor analysis yielded a three‐subscale solution. Clinics with high patient satisfaction did not score more than clinics with low patient satisfaction in terms of the Human Relations type.

In future studies a random sample design and a multidisciplinary approach to OC research should be followed in order to further explore OC patterns in hospitals and their consequences for different aspects of hospital performance.

The purpose of this paper is to introduce and discuss the concepts of service convergence and service integration, illustrate them in the context of the medical tourism industry, and link them to factors that contributed to the success of a medical tourism firm.

The basis for the conceptual development of service convergence and service integration is an in-depth case study of Bumrungrad International Hospital (BIH) in Thailand. Based on semi-structured interviews and archival data, BIH's business model is analyzed and factors are identified that led to its success in the industry.

BIH's success can be attributed to nine key initiatives that enhanced customer focus, operational efficiency, and service quality. These initiatives supported BIH's twofold business model of product differentiation and globally competitive prices. The firm's activities led to the integration of medical and hospitality services resulting in a new, enhanced product. Competitors adopted BIH's service integration approach, which started the service convergence trend in the medical tourism industry.

The conceptual foundations for service convergence and service integration are laid in this paper and can serve as the basis for future research.

Insights from BIH's business model can guide firms in medical tourism and related industries on how to innovate and how to successfully implement their service products.

This paper introduces the term service convergence and discusses its mechanisms. Furthermore, it identifies success factors of a leading firm in the medical tourism industry and links them to service integration.

This paper aims to explore the role of tramadol in pain management and the impact of regulatory measures on supply and medical access in Ghana and other African countries.

The study adopted an exploratory design and qualitative methods to explore the perspectives of different actors, including officials of regulatory agencies, law enforcement agents, health-care providers and non-medical tramadol users. Data were collected through individual and group interviews, and transcripts were subjected to thematic analysis.

Findings show that tramadol fills a critical gap in treating pain across Ghana in areas with an acute shortage of opioid analgesics due to scheduling-related barriers. This was partly due to porous borders allowing for an influx of tramadol into the countries. The study further found that most tramadol purchases in Ghana and other West African countries were made from market traders rather than from health-care settings and were mainly generic medicines categorised as “substandard/spurious/falsely-labelled/falsified/counterfeit medical products” within the World Health Organization standards.

Although the findings are instructive, there were some limitations worth noting. The study encountered several limitations, especially with the non-medical users, because the environment is highly criminalised, People who use drugs were unwilling to avail themselves for fear of law enforcement officers’ harassment. Obtaining ethical clearance had its own bureaucracy – challenges that delayed the study time frame.

Placing tramadol under the list of internationally controlled substances would create barriers to access to effective pain medications, particularly by the poor, and encourage victimisation of users by law enforcement authorities.

The study is based on empirical research on tramadol use and regulation in African countries, contributing to knowledge in an under-researched subject area on the continent. The comparative approach further adds value to the research.

The Role of the Administrator In looking at the role of the administrator, it is first necessary to look briefly at some of the recent trends in administration, particularly hospital administration. The most significant development affecting the administrative process is the increased size and complexity of the hospital organisation and the bureaucratisation of all sectors of modern industrial society. Related to these developments are such other changes as the advances in science and technology with increased specialisation, extended lines of communication, and new language, related to growth and specialisation. In addition, the presence of unions, the progress in transporting methods, and finally, new discoveries and innovations in science and technology resulting in new material, plus new techniques and equipment to improve functions, have all had their impact on the process.