國際醫療案例剖析

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Case Study for International Medical Services

蔣永孝

醫師

臺北醫學大學附設醫院

Taipei Medical University Hospital

2010.07.18

是否能達到國際病患的期望，那就是我們的outcome的展現。

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Agenda

• Introduction

• The Patient Journey

• Case Study

• Part I：A Start to Finish Process

1. Initial Contact Stage

2. Confirmation Stage

3. Pre-Surgery Stage

4. Post-Surgery Stage

• Part II：Patient-Centered

• Conclusion & Discussion

• Supposed questions to be asked

醫護人員可能不只扮演醫護角色，可能還有導遊、領隊的角色。最重要的是語言溝通。

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Introduction

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The Patient Journey

醫生轉介是重要客源。

病患透過媒體、朋友、搜尋等尋找醫療機構。

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1. Initial Contact Stage

2. Confirmation Stage

3. Pre-Surgery Stage

4. Post-Surgery Stage

略之定義

策略管理

策略類型之劃分

醫院策略管理相關研究

認知

醫院績效指標

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Case Study

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Stage 1. Contact

• From the patients , doctors,

insurance companies and agencies

• By telephone, fax , e-mail or post mail

▫

Fast reply

to patient is key factor

▫

Help them to confirm treatment options

▫

Sending material & information

about

Hospital

(annual report , leaflet)

right after the first contact

聯絡時要提供充足的資訊，反應要即時。

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Training/Education Program

at Your Place

• Since 1993, they have educated 530

spine specialists from over 60 Countries

• Sharing their long-time accumulated

knowledge with the world

▫ Wooridul Hospital Fellowship course

Spine Meetings/conference

▫ International Minimally

▫ Invasive Spinal Surgery(MISS) course Visiting and Surgery Observation

Establishing

Network System

Referring

Patients to WSH

要展現較高品質或者較低價格的服務。要建立自己的形象：醫療品質。 8

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Stage 2.

Collecting Patient Data

• Radiology data by online/off line

▫

X-ray , CT, and MRT

▫

No older than 3months

• Medical record/certificate from their

doctor/hospital

• Symptom Survey Form(SSF)

• Try collecting as much data as possible

病人不可能過來門診，一定是利用網路或電話接收病患資訊。由其疾病診斷需要詳盡的資訊。

與病人溝通，了解病人之需要。

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Stage 3.

Diagnoses

• Finding right doctor (Team)

▫ Most experienced doctor

▫ Depends on symptom position, e.g. cervical, thoracic and lumbar

▫ Depends on procedure, e . g. minimally invasive spine surgery and technique or endoscopes

• Team diagnosis and team surgery system:

the diagnosis and treatment plan will be made by the team

▫ Members (NS, OS, GS and AN)

▫ Friday Grand Conference (case review session)

▫ Providing information relating to the

▫ treatment/ surgery of the patient

•

Providing information relating to the

treatment /surgery of the patient including total number of cases and success rate

接下來成立團隊討論疾病診斷、團隊提供何種服務。可能需要跨科診斷。

在病人到達前就先計劃好。

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Stage 4.

Setting up a Visit Plan

& Cost Consultation

• Visit plan based on the patient’s

schedule

• Cost consultation: making it as

clear as possible

• Insurance company

▫

Contact insurance company call center

and verify the patient’s coverage

▫

Profile the estimated cost and

hospitalization period for treatment

▫

Require letter of guarantee

接洽完之後，要檢查價格與內容，與病患確認後簽約。規畫病人旅遊行程表、

與旅行社簽約時注意：費用、協定內容。

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Stage 5.

Assisting with Visas

• Provide an invitation letter

directly to the patient

▫ Collect patient’s personal and medical data

▫ Advance diagnosis required

▫ Advance deposit required

(50% to 70% of total medical fee)

▫ Send certified invitation letter

▫ Communicate with embassy

x medical purpose

• Keep good relationships with

• Embassies

旅行社簽約後，安排病人簽證、住宿等。

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Stage 6.

Reservations & Scheduling

• Final confirmation (Double check)

▫ Reservation ward, accommodation, and transportation

▫ Consultation appointment with MD

▫ Pre-surgery exam schedule with each department

• Triple Check –details and documents

排定醫療行程、醫療照護人員時間等

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Stage 7.

Airport Pickup

• Consider the patient’s conditions and requirements

▫ Ambulance (Driver + Medical Staff + Coordinator)

▫ Van (Driver + Coordinator)

▫ Car (Driver + Coordinator)

機場接待，如同外賓接待流程一樣。飛機落地開始，我們的服務就開始了。讓他們在到達台灣的第一分鐘就有好印象。

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• Emergency Case

▫ Hospital staff in the aircraft

▫ Providing essential documentation

▫ Cooperation with immigration office, airline company and airport

病患在落地時，了解是否要提供緊急醫療服務。

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Stage 8.

Hospitalizations

• Hospital tour

▫ Location of WIPC and Business Center

x Provide welcome kit & package

x Provide newspapers,

magazines

and cable TV in English

▫ Food

x Pre-order service system

x Provide Chinese, Western,

and

Vegetarian style…….

醫院硬體會影響到病患對往後行程的感覺。

從旅館住宿等，病患已經開始打分數，會影響病患心情等。

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Stage 9.

Medical Exams & Consulting

• Provide 1 escort service with the Nurse

Practitioner (NP)

• Short Waiting Periods

• One Stop Service

要有專人帶領做檢查，行程要非常順暢，不可等待太久。

陪伴病患的時候，對於病患提出的疑問以及檢查的目的行程要解釋清楚。陪同的護理人員給予病患協助。

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Stage 10.

Paperwork

• Patient understands and signs the informed

consent form for the surgery and anesthesia

手術同意書等文件，向病人說明文件簽定。

對於沒有醫療背景的人，要釐清其中內容比較困難，可能在解釋完之後還會有問題出現。

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Stage 11.

Treatment & Surgery as Scheduled

手術時間排定。

行程排好之後盡量不要更改。

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Stage 12.

Recovering

• Introduce recovery resorts,

surgical retreats,

rehabilitation and

recuperation hotels

• Assist setting up the vacation

plan only for less demanding

treatment (light cosmetics surgery,

non surgical dentistry)

手術完之後病患會有更多的問題，因為剛開完刀通常是不舒適的。手術前要先說明術後可能會遇到哪些症狀、風險或問題。

護理人員是病患和醫師間溝通的橋梁。

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Stage 13.

Discharges

• Medical Team

(physician and nurse practitioner)

▫ Medical certificate

▫ Medication

▫ Follow-up appointment

▫ Discharge education about the matters that require attention after

returning to their own country

• Administration Team

▫ Copy of medical record

▫ Copy of radiology data

▫ Provide English receipt

▫ Insurance claim form

出院時一定要交代出院的照護方式，以及一但出現問題的連絡窗口或處理方法為何。

協助備齊保險公司的文件。

出院後會整理病歷摘要(Medical summary)、診斷書等交付給病人。

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Stage 14.

Others

• Provide escort service,

• Provide interpretation service,

• Provide own required meal menu,

• Provide tour information,

• Introduce long term stay institution,

• Patient follow up back home

確認病患的感受及滿意度。病患滿意度：治療前後之想法是否有差異。口碑效應。

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策略之定義

策略管理

策略類型之劃分

醫院策略管理相關研究

認知

醫院績效指標

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Case Study

Part 2：

Patient-Centered

Take It for Example：

The Story of Alberto Zaffaroni

除了語言的隔閡之外，醫學知識如何清楚的傳遞也是問題。義大利病患：在臺灣受傷，在台就醫。

國外病患對於臺灣醫院無法接受：廁所。

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Conclusion& Discussion

• Supposed questions to be

asked

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Supposed questions to be asked include:

• Who will be carrying out my treatment and

what qualifications do you have?

• Will the medical team speak English?

• Are there any testimonials from previous patients?

• How many times have you carried out the procedures

I am having?

• What are the rates of success, complication,

re-admission and infection?

• Are you regulated by or registered with any

professional body?

• Is the work guaranteed?

如果能夠說些簡單的當地語言也很重要，因為病患不一定為英語系國家，此舉對病人的感受有正向幫助。國外：醫院手術數量高代表醫院品質好，病患會想了解醫師的手術服務量。回答數據一定要有依據。提供自己醫院的數據最好，也不容易出錯。 26