Patient Experience Management as a Tool for Internationalization in Foundation Cardiovascular of Colombia

ABSTRACT


Introduction
Medical tourism, also known as healthcare tourism or medical travel, refers to traveling to a foreign country to receive medical treatment.Medical tourism has recently become increasingly popular, with millions yearly traveling abroad for healthcare services.One of the main reasons people choose medical tourism is the cost savings (Kurtulus & Cengiz, 2022).Medical procedures in some countries can be significantly cheaper than in others, even after accounting for the cost of travel and accommodation.In addition to cost savings, medical tourism can provide access to treatments that may not be available in a patient's home country or have extended waiting lists (Raharjo, et al., 2022).ISSN 1693-6590 Vol. 21, No. 2, 2023, pp. 120-128 Juan Leon Baccera (Patient Experience Management as a Tool for Internationalization in Fundacion Cardiovascular de Colombia)

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Healthcare providers in countries that are popular medical tourism destinations have recognized the potential of this industry and have invested in facilities and services to attract international patients.These providers often offer services such as airport pick-up, translation, and assistance with visas and travel arrangements (Kydd, 2008).However, medical tourism is not without its challenges.Patients need to carefully research and select healthcare providers and facilities, considering factors such as accreditation, quality of care, and patient safety (Ponsignon, et al, 2015).Patients may also face cultural and language barriers when seeking treatment in a foreign country.Despite these challenges, medical tourism is expected to grow in popularity in the coming years.Healthcare providers must adapt to international patients' needs and provide high-quality, patientcentered care to remain competitive in this industry (Raharjo, et al, 2016).As a result, patient experience management has emerged as a vital tool for hospitals to ensure successful internationalization (Taya, et al, 2015).The patient's experience concerning the provision of health services may vary according to the dependency (Abo-Hamad, W., & Arisha, A, 2013) to which reference is made or according to the factors that influence care; It is for this reason that describing patient experience management as a tool for internationalization is essential when seeking better quality standards and greater competitiveness in the international market (Bellio, E., & Buccoliero, L, 2021).Therefore, this work seeks that all the internal guidelines of the institution perceive the importance of considering the patient's experience as a critical instrument for a more significant market capture in the internationalization of services.
In the present work, the authors delve into patient experience management and its importance in internationalization, particularly in the hospital setting.Then, the authors explore how hospitals can utilize patient experience management to improve the satisfaction of their international patients and create a positive impression of their services.Additionally, we will examine the challenges that hospitals may face while implementing patient experience management in internationalization efforts and how they can overcome these obstacles.Furthermore, we will also discuss the role of technology in enhancing patient experience management and its potential benefits for internationalization. Lastly, we will summarize the key takeaways from the article and provide insights into the future of patient experience management as a tool for internationalization in the hospital industry The internationalization of health services, which aims to expand and diversify the potential market of a company, is characterized, to a large extent, by the so-called health tourism, through which thousands of patients become tourists who enjoy the innumerable attractions of the supplying countries (Chen, et al, 2021).Inquiring in depth regarding the current situation of the health cluster in the Santander region, which has been characterized in the last decade for being a pioneer at a national and international level in aspects of innovation and quality of health services through its two major references, Fundación Cardiovascular de Colombia and Foscal Internacional, it was possible to identify that in these, during the last 3 years the figures for sales of international services or the internationalization of these institutions have been decreasing by leaps and bounds, this as a consequence of the pandemic ( Covid 19) which, at its peak, in addition to causing the closure of borders, forced the Caribbean islands, the leading market for these IPS, to invest capital in the creation of Health Institutions specialized in medium and high complexity and to invest in international training for medical care personnel with the aim of meeting the health needs that arise at that time and additionally start the provision of health services that were not previously provided.This work investigates whether the patient's experience is an internationalization tool.However, for the experience during the hospital stay to be promising, it must correspond to the quality that users demand today, and that not all Healthcare Provider Institutions Health Services (IPS) seek to satisfy (Jones, K., & Griffiths, L. 2011).Given that the tendency of these is not linked over the years to offer something innovative or to strengthen and improve service benefits, but rather to increase the capture of national and international clients, and also International companies by reducing the cost of their services.The goal is to determine the management of the patient experience as a tool for internationalization in the IPS: First, the authors categorize the internationalization processes in the IPS: Fundación Cardiovascular de Colombia.Secondly, the authors identify the experience of international IPS patients: Fundación Cardiovascular de Colombia.Lastly, contrasting the processes of internationalization in the IPS: Fundación Cardiovascular de Colombia can see in Figure 1.

Approach, type of study, and methodological design
This work is based on a mixed research method, a non-experimental design, and a correlational scope.It seeks to collect information independently or jointly, allowing the characterization of the problem under study and the measurement with precision of the variables investigated.Data on these are collected quantitatively, exposed, cautiously summarized the information, and then analyzed very thoroughly in a qualitative way the results obtained, to extract in a general and significant way what contributes to knowledge.
The methodological design of the research will be descriptive, that is, in order to allow the researcher through descriptive research to discover details about "what is the pattern of use of the service of patients and their satisfaction", describe the nature of the demographic segment drawing concrete conclusions about the respondents, and finding respondents' traits, behaviors, attitudes, or opinions about the study in questions.

Participants and data collection sources and tools
The population that the project will study is all patients who receive health services at the Cardiovascular Foundation of Colombia.The method that decided to be used to collect the necessary information provided by the people who were the object of the study was the satisfaction survey carried out with patients of the Cardiovascular Foundation of Colombia, which has the advantage of collecting a large amount of data from each individual in the sample.In addition, it is versatile and applies to different contexts, considering this element as the leading choice.

Main indicators for measuring the international patient experience
The method used to know patient satisfaction is the Likert scale, which is used in market research to understand the opinions and attitudes of a consumer towards a brand, product or target market.For the realization of the survey the Cardiovascular Foundation of Colombia, had as reference the HCAHPS Survey, therefore, they are in the public domain and are NOT subject to the copyright laws of the United States.That is, it is a survey taken from a reference hospital in the United States, however it is important to take as a basis the IPS: Cardiovascular Foundation of Colombia for the realization of the survey, since although it covers a large part of the criteria necessary to measure satisfaction, as commented by the Director of Quality of the Cardiovascular Foundation of Colombia, "We must take as a starting point for the measurement of quality in services, the critical points that represent a rework for the institution and the fluctuation in services".

Internationalization in the IPS: Cardiovascular Foundation of Colombia
Among the main objectives of internationalization in IPS are: obtaining better revenues, reducing costs, and participating in new, more competitive markets.Presenting, for its achievement, several elements of an internal and external nature; in the case of internal ones, these are related to structural aspects which allow companies to compete in an ideal way in international markets; Among the most representative are: internal organization, technology, size and age of the business.Concerning the elements of external nature, which have an impact on the insertion of companies in the international market, the following can be identified as central: the characteristics of the market to which they are entering or intend to enter, the specific characteristics of the sector and the intervention of the government.

Results and Discussion
As previously stated, the IPS establishes within its commercial objectives internationally the propensity for a better service and patient experience, however, it is considered within a hierarchical order as the last, leaving aside the relevance that this can have as a market catcher and main focus of competitiveness at the international level.and as suggested by the Commercial Director of the Cardiovascular Foundation of Colombia, it is important to restructure the objectives so that their focus is directed to the continuous improvement of the patient experience and satisfaction, achieving the development and growth of the institution with patients as brand ambassadors, for instance, Figure 2 shows the admission process on a key service: ambulance plante transportation.
Other critical process is the international patient discharge process.The process established by the Cardiovascular Foundation of Colombia, with respect to the discharge of the patient, is simple and its orientation is not given to promote promotion and prevention mechanisms that complement the care received by the IPS, establish this in conjunction with other influential factors in the provision of the service, will allow an increase in patient satisfaction that consequently will give rise to the theory mentioned in (Astudillo Durán, S., & Briozzo, A. E, 2015) "A satisfied customer, comes back and repeats with the products or services".In general, from the first objective it is possible to deduce that despite having the internationalization processes already defined by the IPS: Cardiovascular Foundation of Colombia, it is key to complement each of these, with a general approach, which is oriented from the experience that the patient has when starting their process of admission and request for services, during your stay at IPS.

Fig. 2. Admission process of an ambulance plane by the international office staff
The internationalization objectives could not be accomplished without aggreements with International insurers, currently, the Cardiovascular Foundation of Colombia has 18 commercial agreements established with different international insurers, among which are: BMI Companies, Scientology, Axa Assistance, Bupa, AP Companies, Best Doctors, Cigna, Ennia, Fundacio( n Simo(n Bolivar, CBG Insurance, Global Medical Management, Jipa Network, Pan American Life, Vumi, Nagico Insurance, AZV, Penfield and SZF Stiching.However, of these 18, only a total of 3 insurers are a reference in the shipment (constant of patients).

Categorization of health and internationalization of the capital of the Santander region
Within the process of internationalization of health tourism in the Metropolitan Area of Bucaramanga, several projects developed in the region stand out, such as the treatment for children with congenital heart diseases.These patients arrive mainly from Ecuador, Venezuela, the United States and Canada.Another important project is offered by the Cardiovascular Foundation (FCV) which is a leading program worldwide, called the National Telemedicine Center that consists of a network of more than one hundred linked hospitals that are connected through a telecenter 24 hours a day to treat patients from remote populations.
It is worth mentioning that the health sector of the region has presented a boom with an entrepreneurial dynamic (Rathert & Boren, 2013), when talking about quality in service, innovation in medical and dental treatments and international recognition for the development of new procedures, the clinics and hospitals of Bucaramanga appear in the ranking of privilege.

Contrast of internationalization between the Cardiovascular Foundation and other institutions in the health sector
In order to compare the processes and characteristics that have allowed a successful process of internationalization of health care institutions (hospitals, clinics and medical centers), a search was made for various companies in the health sector that have expanded internationally through commercial presence.We identified 18 companies that offer different services in the health sector, such as emergencies, insurance, telemedicine, diagnostics, laboratories, medical tourism, among others.Also, from the data shown in Table 1 it is clear the excellent performance of the institution in terms of the patient experience survey, positioning it as an important actor in the regional and national panorama.They are evident, the consequences of what the covid-19 pandemic contracted for the health sector, the decrease that can be seen during the semester of 2022 is less than half of what was had for the year 2021.What analytically at first glance is defined as a decline in the income curve for the institution.This decline is rooted not only in the closure of the borders, but also in the needs represented by the pandemic, since it forced, among other things, the creation of specialized institutions in the Caribbean islands that were the main object of the IPS market: Cardiovascular Foundation of Colombia.The SWOT analysis in Table 2 complements the possible threats that the IPS have, showing also their opportunities, strengths and weaknesses.T3.International competitors such as India in which their medical staff are fluent in english O4.Implementation of strategic alliances with the hotel chain, transportation and health facilities network T4.Spas offer are focused on Europe, north America, and Asia, in number of spas and net income O5.Most if health tourist are Colombian expats that reside in Netherland Antilles, Venezuela, Aruba, Panama, Spain, and United States of America T5.Possible losses in health coverage care system for country of origin.Specially with tourist that have healthcare insecure in their country.It could be risky to perform health procedures outside their existential network, coming back to their country customers could lost coverage, or procedures being denied.

Conclusion
By investigating the classic theories that talk about the internationalization of companies, and additionally, analyzing studying two cases of institutions providing international health services, it was possible to identify the internationalization process.Furthermore, there is no algorithm that determines how an institution should venture into the internationalization process, the ways to penetrate the international market will always depend on its experience both in the national market, as international.The mode of internationalization must always be linked to gradual growth so that the company has to go through the different stages of an expansionist model.In addition, the analysis carried out allowed to identify as success factors in internationalization, physical and sociocultural distance.Such factors can be tackled with strategies such as: Increase the volume of international patients of the FCV through market diversification, ensure the effective execution of administrative processes associated with all international patient care, and provide the best medical care and experience to the patient and his family, during inpatient or outpatient care in the FCV, until the patient's return to his country of origin.Colombia can begin its internationalization process based on innovative capacities and resources, called intangible assets, that are focused on the continuous improvement of quality and patient experience.The latter, composed of physical and financial capital, materialize in competitive advantages.

Fig. 1 .
Fig. 1.Characterization of IPS in Colombia a) Number of IPS b) IPS per 100.000habitants Admission process / Ambulance plane Scenario 1: Accepted patients during workday ( 7 am to 5 pm Monday to Friday) and that enters healthcare facilities within the same

Table 2 .
SWOT Analysis for the internationalization of FCV Colombia