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Understanding the TEMOS approach to quality and accreditation in medical tourism

Assessing quality and accreditation in medical tourism

Caroline Ratner of the IMTJ spoke to Dr. Claudia Mika, the Managing Director of TEMOS International. TEMOS officially launched last year and certifies the quality of the services and facilities at hospitals, clinics and dental clinics worldwide.  TEMOS provides a neutral, professional assessment which benefits insurance companies, patients and the facilities it certifies.

What is TEMOS currently working on?

We have our third conference in November and are currently working on the first and unique standard for international patient departments.  This means that in addition to the focus that we already have on our certification for international patients departments, we are now devising a module to check the whole process of how international patients are processed. 

How is what you do different from JCI and other accreditation organisations?

We are very different from the other accreditation organisations and we don’t compete with them on any level. We currently need to educate the industry about the difference between them and us and I am very aware that we have to explain that we are different because whenever I do explain what we do they are very interested.

At TEMOS we monitor and certify the quality of the services and facilities at hospitals, clinics and dental clinics.  We have developed a system which works on top of what JCI and other accreditation institutions provide.  TEMOS provides a neutral, professional assessment which benefits insurance companies, patients and the facilities it certifies and is established as a worldwide brand for certified quality in medical care.

How do you assess the quality of an institution?

What we do is assess the quality management systems that are currently in place in an institution. A precondition of getting certified is that you have an established quality management system already in place which we can assess and advise on. We provide a questionnaire which provides us with information that we need to know in order to make our assessment. Once we receive the questionnaire we don’t provide an audit plan but just fix a date and are flexible about when we carry out the inspection according to the hospital’s schedule. We basically want to see them in action, we want the patient’s and employee’s perspective, and it is important that we carry out our inspections on normal works days because we don’t want an artificial inspection.

Do you have to have accreditation before you can gain TEMOS certification?

Yes, we start from that, and additionally whatever you have as a basis of your quality system comes on top of the accreditation that you already have in place. 

So why would a dental practice or a hospital or facility need a TEMOS certificate?

If they have international patients or if they are in the field of medical tourism they need to have a set of standards in place to measure the quality of services that are not covered by other quality management systems, like the accreditation companies.

What kind of things are you looking for when you are assessing the quality of the services and facilities provided for international patients?

We send in a team of surveyors which is made up of doctors and quality management surveyors.  We are not looking for a rigid set of criteria, there is more than one way for a facility to reach the standards required to achieve certification and we are not focussed on there being only one way to have quality systems in place. 

So what are you looking for?

We start with the way a facility or institution communicates with insurance companies, and our criteria includes things like; do they provide translation services and speak a range of languages, do they have international patient services on site, and if they are serving international patients are they able to provide meals for patients and accommodation and meals for relatives.  Additionally they need to provide medical records in other languages other than the native language of the facility. We need to know that the equipment is up to date and in good working order and other essential information for patients and relatives. These are the types of criteria that are not covered with other quality management or accreditation services. We track and advise on how to provide and improve the quality of the systems in place and during an assessment there is a lot of on the spot consultancy work within the frame of the inspection visits.  So for example if we go into a radiation suite or operating theatre and notice that something is not right we will make on the spot recommendations as well as including them in our report.

How did you identify that this service was needed?

TEMOS came about in response to market demand and was originally developed for emergency overseas medical care but now includes medical travel as the industry is growing. Initially insurance companies came to use us because TEMOS is actually a spin off from the German aerospace industry which provides a similar quality assessment service for that industry. Travel insurance companies realised that they needed further information about where their clients were being treated, because there was a lack of information about the quality of patient care and the places they were being treated in and there was no overall international standard for patients.  

Do you approach facilities and institutions or do they approach you?

Insurers recommend places for TEMOS to approach and we approach hospitals and dental clinics directly but they also apply to us. We are currently discussing special projects with tour operators, especially ones which organise trips popular with older customers who may need medical treatment while travelling. We are working to ensure that there are quality hospitals available with TEMOS certification in the regions that these people are visiting.

Why do you grant certification not accreditation?

Our system is a living system which means we don’t have a frozen standard, so when we visit a hospital and learn things that could be of help to other hospitals or clinics we integrate it into our system and criteria. So our standards are fluid and constantly developing which is one of the advantages. This philosophy means that we can take what we’ve learned and can apply it to our existing hospitals.

How are patients finding out about this?

TEMOS is more or less business to business but we recognise that there is a need to transfer the knowledge to the patients. Patients can see our hospital guide online. We know that the public need to be made aware of the information we have and while we are a neutral platform and cannot recommend any facility we are currently looking into the best ways to raise public awareness of what we do.

How much you do charge for certification?

It really depends on the size and type of facility and organisation. Prices start from €5,000 for small institutions, going up to €30,000 plus travel and accommodation.

Do you make recommendations for changes or do you pass or fail a hospital, clinic or facility?

If we see something onsite that is not OK, we’ll immediately tell them and then discuss our findings in a final meeting with management.  We then send a report and we’ll put in the weak points and add recommendations including deadlines that they have to provide evidence that those changes have been made. We are not rigid about the time frames that changes need to be made and we discuss realistic time frames for changes and problem solving with the organisations.  Hospitals that are applying to TEMOS are aware that quality management is very important. They have an interest to improve themselves, because it makes them a better facility. This means that the insurance companies will want to use them more as they are TEMOS certified hospitals.

To what extent does quality vary throughout the world?

One size doesn’t always fit all when assessing quality management, and there is more than one way for an organisation to reach a high standard of quality. We know about the quality criterion which has to be fulfilled and are aware of the gaps that need to be reached to reach our criteria.

However, what we try and do is improve what already exists and be flexible when working with what systems are already in place. When inspecting a facility we need to keep in mind legal aspects, cultural difference, and different ways of reaching the same attainment of high quality services which can vary from country to country. As a result we need to strive for quality management systems that are appropriate for a particular country. For example, applying a European framework in India might not work.  There is of course a quality baseline but quality management should be useful for the hospital and if you try and impose an overall framework it might be helpful or might not be helpful, it depends you have decide once you are on site. We talk a lot with staff members who might not be satisfied with the current system they have because it’s not according to their culture. So as a team we have to be adaptable when we are inspecting and the experts in our team are there to optimise and improve the systems already in place.  This is why we have a Quality Management expert in the team that works alongside our doctors.


Date published: 7 April 2011

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