Globalizing Medical Care With Hospital Collaboration

This past January, Houston’s Methodist Hospital and the American British Cowdray Medical Center (ABC) in Mexico City announced a formal, six-year affiliation agreement. Methodist International, the hospital’s international arm, had worked with the 120-year-old ABC hospital on a consulting basis for many years.

“It began with them referring patients for treatment here in Houston, and us referring patients back for follow-up,” said Ruthy Khawaja, Methodist’s vice president for international services. As ABC advanced its clinical care, staffing and training programs, the relationship grew. In 2004, when the hospital acquired a PET (positron emission tomography) CT scanner, they sought help from Methodist International in setting up their PET program. They were so pleased with the results that they asked Methodist to help them establish their new cancer center.

“Ultimately, it became clear that instead of doing one agreement at a time, our two organizations should pursue direct affiliation,” said Khawaja. Through that arrangement, Methodist International will help ABC establish a formal quality program and revamp its organizational structure to more closely resemble that of leading hospitals—like Methodist.

Although this is the first full-scale, comprehensive formal affiliation agreement between Methodist International—launched in 2005—and an overseas hospital, it’s far from the first medical collaborative effort, and it’s hardly likely to be the last. Hospitals such as Methodist, which have long had strong international patient care programs, are now looking not just to serve overseas patients here in the United States, but to build networks with other hospitals around the world to share resources, advance research, and promote best practices.

“We’re exporting our know-how in hospital operations internationally,” said Khawaja. “We find that communities around the world have great doctors, they can build good hospitals, and they can buy the technology, but they are still looking for the expertise that Western hospitals commonly have in processes and standards that help achieve desirable outcomes.”

These overseas hospitals could hire consulting companies to help them set up operations, but there would be one important X-factor missing: “They’re not a hospital. They don’t have a demo site where you can come and see and engage in practice,” said Khawaja. “That’s our advantage—not only can we assess the needs of our clients, give them solution options, and help them and train them how to do it, but we can also bring them back here to demonstrate these systems in action.”

To date, Methodist International has set up consulting relationships with hospitals in Brazil, Costa Rica, Mexico, Turkey, Saudi Arabia, Honduras and China. Khawaja reported that Methodist is currently in the exploratory stages of major projects in India and the United Arab Emirates.

“Our vision is to have a global network of hospitals that are independent yet commonly connected through Methodist International as a network. They will share best practices, they will benchmark, they will perhaps share resources, and will achieve a level of quality that we’re willing to put our name on,” she said.

That doesn’t mean Methodist will own these facilities. “We’re not talking about ownership—it’s a collaborative environment that is fee-for-service,” Khawaja explained. “It’s not cheap: We’re risking our reputation and opening our home here to our affiliates, giving them access to our intellectual property, our standards, our upgrades.”

In other words, a franchise? “I hate to use that word,” Khawaja said, “but for example, when you go to a Four Seasons anywhere in the world, you know what to expect. Not every Four Seasons is owned by one company, but they have their name on it. There’s no reason why health care cannot achieve the same level of consistency that has been achieved by many other industries around the world in globalizing.”

Johns Hopkins Medicine International, another leader in global hospital partnerships, opened its first major international affiliate in 2000. The Johns Hopkins Singapore International Medical Centre is a Hopkins-run oncology center under Singapore’s private health system. Since then, it has grown into a state-of-the-art service center with 30 in-patient beds. In 2005, it relocated from the National University Hospital to a larger facility at Tan Tock Seng Hospital, shortly after receiving accreditation from the Joint Commission International—a first for private health care in Singapore.

Since then, Hopkins International has further expanded its international affiliations. In 2006 alone, it opened the Clemenceau Medical Center in Lebanon and Hospital Punta Pacifica in Panama. Hopkins is also affiliated with India’s Apollo Hospitals Group (the largest hospital chain in Asia), Children’s Hospital of Fudan University in China, Japan’s Tokyo Midtown Medical Center, Ireland’s Beacon Medical Group, and the Trinidad and Tobago Health Sciences Initiative.

That same year, Hopkins announced a new international management services program, launched with a 10-year affiliation agreement with Abu Dhabi’s Ministry of Health. The agreement includes a provision for Hopkins to manage Abu Dhabi’s largest and most prestigious hospital, Tawam Hospital—including the hiring of top executives.

The most recent agreement, which was finalized in April 2007, is a collaboration with Clínica Las Condes in Santiago, Chile, considered one of the best multi-specialty hospitals in South America.

Hopkins Singapore is the only institution outside the United States that is technically a part of the Hopkins umbrella. All the other hospitals and health care facilities are either managed—as in the case of Tawam Hospital—or have consulting agreements with Hopkins International.

These agreements can take several forms, explained Claudia Costabile, international communications specialist with Hopkins International. “We usually partner with the best facilities in a certain country to improve the delivery of health services there,” she said. “Our affiliations range from consulting services in operations and human resources to actually being part of the construction of new health centers—what we call ‘institutional affiliations.’”

But even though they may advise affiliates on how to build a new medical center, Hopkins—like Methodist—has no ownership in the facilities. “The Tawam Hospital is the first hospital to actually be managed by Johns Hopkins employees,” Costabile said. “It is already regarded as one of the best in the Middle East, and we partnered with them to enhance the delivery of care to the population of the UAE.”

Competition to become a Johns Hopkins Medicine partner is fierce, with literally hundreds of hospitals and medical centers around the world approaching the program and looking for affiliations or consulting services. “One of our priorities when choosing a partner is whether they are regarded as being one of the best facilities in their country,” said Costabile. “We consider that of utmost importance, because we look for stable partners that can carry the affiliation forward and who have the international accreditations necessary to deliver quality health care.”

Another key element in choosing partners is a match with the threefold Hopkins mission of research, clinical care and medical education. “Most of our affiliates have close relationships with universities to facilitate research, and also include education programs for physicians, nurses and staff through the exchange of knowledge with Johns Hopkins physicians,” Costabile noted.

Like Methodist International, Johns Hopkins Medicine International places a premium on ensuring that the quality of care provided by affiliates matches what is available at Hopkins. To make sure that happens, Hopkins assigns a medical director for each affiliation—a Hopkins physician who visits the affiliate at least once every three months to ensure that all accreditations, education programs and clinical programs are up to Hopkins’ standards.

“We do not believe in just having a referring office in other countries,” said Costabile. “We want to improve the delivery of health care services in those countries, and that’s why we partner with facilities that are already considered the best in their country. Of course, there are conditions that those places will not be able to treat, and for those cases we facilitate visits to the hospital in Baltimore [Md.] to provide second opinions. But ultimately, we want the physicians of those facilities to have the education and capacity to treat their patients in their own hospitals.”

About the Author

Gina Shaw is the medical writer for The Washington Diplomat.