Re-thinking the patient journey

COVID-19 has changed patient expectations, as well as healthcare itself. The “new normal” in healthcare requires governments, hospitals, clinics, and other service providers to rethink the patient journey and patient experience. Elizabeth Ziemba, President of Medical Tourism Training shares her thoughts.

Dr. Donald Berwick’s JAMA article, “Choices for the New Normal” offers six characteristics that define the changes in the delivery of healthcare services in this time of COVID-19:

  • Virtual Care
  • Speed of learning
  • The Value of Standards
  • Protecting the Workforce
  • Preparedness for Threats
  • Inequity

I have added a seventh factor – sustainability – to these six points. Each of these factors is changing patients’ expectations about their experiences interacting with healthcare providers.

1. Virtual Care – Remote and Touchless

Much has been written about the explosive demand in telehealth/telemedicine virtual solutions which, prior to COVID-19, had met with slow uptake in most of the world. Insurance companies and third-party payers did not want to reimburse for virtual consultations. Licensing and regulatory bodies were bottlenecks for doctors to get licensed to offer virtual services in other jurisdictions. During the pandemic, regulatory waivers were liberally given out to make virtual care easy to access. Telemedicine is now here to stay.

Doctors and patients have discovered the virtues of virtual care. Pre-COVID-19, Geisinger Health System averaged 40 telehealth visits per day; now the number is between 4,000 to 5,000 per day. Patients and providers love the convenience and time saving factors. People do not have to make appointments and travel to see providers, potentially exposing themselves to the virus. Triage is able to take place more rapidly and, hopefully, more effectively.

Hospitals, clinics, and other healthcare service providers need to move beyond telehealth visits to expand touchless technology into the consumer/patient experience. People want to book appointments online. Waiting rooms are a thing of the past – individuals enter the place of service when the provider is ready to see them. Payment will be made either online in advance or with touchless, tap and go payment at the point of service. Hand sanitisers will be pedal operated or touchless. All providers will be wearing some type of personal protective equipment (PPE) appropriate to the services being delivered for the foreseeable future or at least until a vaccine is developed and widely available.

Virtual, fast, safe, convenient, and touchless define new patient expectations that hospitals and clinics must be prepared to deliver as part of an excellent patient experience.

2. Speed of Learning

People expect a quick vaccine or medicine to prevent or treat COVID-19. After a few months of lockdown, people are impatient to “return to normal” as the virus continues to spread around the globe. The re-imposition of lockdowns and other restrictions will not be welcomed, and further lack of compliance with restrictions may result.

Messages from the media, politicians, and others suggest there is a quick route to a vaccine while scientists are sounding a note of caution about the timeframe needed to produce a safe and effective vaccine. Failing to manage expectations may lead to problems down the road including continued spread of the virus, protests, violence, and civil unrest.

Providers are certainly learning and adapting quickly. Patients are enjoying the benefits, as telehealth and telemedicine deliver faster access, convenience, and, sometimes, cost savings.

These examples and others that are emerging from the pandemic demonstrate that medicine can and should do things faster, better, and less expensively than before. Patients now expect it.

3. The Value of Standards

Only a few months ago, many people had never heard of or understood the role of the World Health Organization, the Centers for Disease Control and Prevention, or the Johns Hopkins Bloomberg School of Public Health. Now these and other organisations are relied upon to provide guidance, standards, and protocols for almost every aspect of the treatment of SARS-CoV-2.

Because of the media coverage of the pandemic, people know far more and expect that healthcare providers will manage the diagnosis and treatment of the disease according to uniform, established best practices. For example, patients expect to see healthcare professionals at hospitals dressed in PPE, and may not accept anything less.

Prior to the pandemic, health insurance and travel assurance companies were looking to accreditation programs to ensure consistency of protocols to better predict outcomes. COVID-19 is demonstrating the value of standards. This trend will surely continue as COVID-19 continues to circle the globe.

Patients demand conditions that are safe, hygienic, and as free from risk as possible. A recent survey of consumers in the beauty and wellness sectors identified what is most important to them. “Rigorous sanitation guidelines” was identified as the most important factor in consumer confidence. By extension, it is arguably safe to assume that all healthcare patients will now demand high standards and nothing less, now and in the future.


4. Protecting the Workforce

Ensuring the health and safety of healthcare workers is a top priority for employers. The pandemic has exposed many failures by healthcare systems around the world to provide safe work environments. The prominent example is the lack of PPEs, exposing employees to disease and death on the job. This topic is covered in more detail in the first two parts of this series.

Effective management, standardised systems and policies, resources (including mental health services), security, and clear communications by healthcare leaders about protecting healthcare workers, are essential. Without healthcare professionals with a secure workplace, and appropriate tools to do their jobs effectively, patients are more likely to receive inappropriate care and have a poorer patient experience.

Failure to protect the healthcare workforce will have long-term consequences by discouraging people from pursuing careers in healthcare. Healthcare professionals are already leaving their jobs. It seems clear that patients expect healthcare workers to be safe in order for patients to feel safe.

5. Preparing for Threats

Globally, hospitals are required to have crisis management plans in place to maintain licensure. Clinics do not have this same requirement. While the possibility of a pandemic has been discussed in the public health sector for decades, with few exceptions, governments and providers were unprepared for the magnitude of this crisis.

Patient trust and confidence are essential. How well this crisis was handled will impact consumer decisions in the future in terms of expectations, need for improvement, ability to meet medical needs, and other critical factors that build trust and confidence in the providers’ abilities to deliver needed services.

Reputations and the brands of providers and destinations have been damaged (Italy, United States) as a result of the pandemic while others have been enhanced (New Zealand, Germany). Health travellers will remember the good and bad headlines about destinations and providers. Their decisions will be influenced accordingly about where to seek wellness, health, and medical treatment, in part based on how well-prepared providers and destinations were for this crisis.

Patients expect providers to be prepared for any circumstances affecting the care they receive. If your organisation and/or location performed poorly, reputation and brand rebuilding is needed to convince patients of an excellent patient experience.

6. Inequality

The toll of the pandemic has been uneven, with some segments of the populations hit harder than others. At the same time, the death of George Floyd has reverberated around the world and touched off protests in support of Black Lives Matter.

According to the United Nations High Commissioner for Human Rights’ Michele Bachelet, people of colour are disproportionately impacted by COVID-19. “For example, in Brazil’s São Paulo state, people of colour are 62% more likely to die from COVID-19 than their white counterparts. Higher mortality rates have also been reported in the Seine Saint-Denis department in France, home to many minorities….data from the United States shows that the COVID-19 death rate for African Americans is more than double that of other racial groups. The situation is practically mirrored in England and Wales, where the death rate for black, Pakistani and Bangladeshi people is nearly double that of white people, even when class and some health factors are taken into account.”

COVID death by race per 100,000 people in the United States paint a disturbing picture.


Everyone must have access to healthcare services that are affordable and available. People of color, ethnic minorities, and other groups who are underserved by local healthcare systems lose confidence in those services, causing people to completely forego or delay seeking medical attention. Overuse or inappropriate use of emergency room services, sicker patients, and other negative impacts are felt by individuals and society as a whole.

Inequalities in the delivery of healthcare services not only impose hardships on groups denied the same access as others but also impose costs on society as a whole that should be corrected to strive for access, affordability, and appropriate care for all individuals.

7. Sustainability

Pandemic lockdowns have shown the world that nature will heal itself when humans change their behavior. The skies are clear again in Tehran, Beijing, and other cities which were formerly the most polluted in the world. Wildlife is returning to places previously abandoned because they were too crowded or polluted.

Will people be content to resume prior behaviors that have clearly damaged the environment?

The answer depends in part upon whom you ask. A group of Millennials travelling for wellness services will most likely be more concerned about sustainability issues than parents seeking complex medical care for a child. While organisations may be motivated to engage in sustainability efforts to meet or exceed patient expectations, the results of such programs can deliver additional bonuses.

Sustainability programs benefit individual organizations, staff, and patients. Temos International Healthcare Accreditation offers ISQua/IEEA accredited sustainability standards focused on seven points : Engaged leadership; reduced carbon footprints; safer chemicals; smarter purchasing including buying from local sources; healthy food for patients, staff, and visitors; corporate social responsibility; and effective communication.

Clients report numerous benefits from these accreditation standards such as: reduced expenses; stronger relationships with local partners; compliments about food options, and overall appreciation about caring for the environment. Marketing campaigns about these benefits resonate throughout the organisation with staff, patients, and the broader community.

Smart providers and governments will look at ways to promote their services and destinations while doing good things for the environment. Employees like it and patients like it. Sustainability delivers a better patient experience.


COVID-19 has changed patient expectations, as well as healthcare itself. The “new normal” in healthcare requires governments, hospitals, clinics, and other service providers to rethink the patient journey and patient experience. Patients are now looking for virtual clinical and nonclinical services, faster learning implemented quickly and safely, high standards of care based on international and national best practices, strong measures to protect healthcare workers, preparedness to face COVID-19 and other threats measures to redress inequality, and environmental sustainability.

Are you ready to deliver patient experiences to meet these new expectations?