Openly collaborative, organized, and functional service process ecosystem paving the way to success in Finnish medical tourism

Keywords: medical tourism, ecosystem, tourism supply chain, tourism service process, service process ecosystem, collaboration in tourism.

Medical tourism- tourism or just a health care intervention abroad?

Medical tourism is originally derived from health tourism that include travelling outside one’s native health care administrative region for the reconstruction or strengthening of personal health by the means of medical interventions and wellness ¹. The distinction between the terms health tourism, medical tourism and wellness tourism, are many times misleadingly used synonymously, by specifying that health tourism can be divided to two branches: medical tourism and wellness tourism ². Still, a medical tourist may include elements from wellness tourism into their experience.

Phenomenon of traveling outside own home country for medical care has been existing long in history and during the last few centuries affluent individuals from less developed regions have travelled to more developed countries to get treatments in more advanced facilities by skilful and well-trained medical staff ³. Although the patient movement across borders is not a new phenomenon, social and economic changes of the recent years have accelerated the transnational demand and supply of health care bringing medical tourism at the crossroad of tourism and medical care activities ⁴. Along with globalization, the growing numbers of patients and medical professionals travelling across borders, enhancements in health technology, funding and governmental regimes across country borders has brought about unforeseen forms of consumption as well as production of medical services. Seeking medical treatment abroad is preferred by people who attempt to integrate treatment with a touristic holiday with activities and attractions ^4,5.

Customer personas- from functionally healthy to terminally ill

Depending on the health status, it is likely that for some medical tourists the holiday and recuperative functions are less topical while for other medical tourists the leisure aspect could have a more important impact on how the medical service purchasing decision is made. Still, the majority of people traveling for medical purposes need at least the basic hospitality services such as accommodation, transportation and restaurant services. Also, accompanying family members may be interested in different services provided by tourism industry.

When a potential medical tourist is searching and selecting providers the most important factors are their personal networks, recommendations from acquaintances, and online search engines. Hence, medical travel incorporates the development towards more individualized health culture with tailor-made service offerings. Therefore, it is important to acknowledge customer motivations and needs in the customer process when developing service processes in medical tourism. The customer, the medical tourist, is in the center focus when these processes and collaboration is planned and aligned.

In general, receiving medical care and being treated at home by carers speaking their own language, being close to relatives, in a system that is recognizable is preferred. Therefore, proximity to home, geographically and/or culturally, is seen as an important factor but there is a willingness, ability, and preparedness to travel longer distances for medical care if it offers some advantages ^{5, 6}. Common factors contributing to seeking medical care abroad are affordable costs, shorter or non-existing waiting times, availability of treatments, i.e. accessibility with issues regarding bioethical legality and insurance coverage, modern medical facilities, equipment and technology, perceived quality of care, including reputation of superior and more advanced skill level of medical personnel and methods, and familiarity, including feeling comfortable with the system, trusting the carers and importantly being able to communicate in own language ^3,5,6,7,8,9.

The image of the destination country may have a major impact on the decision-making process. Here Finland has an advantage with its unique set of qualities that can only be found in the Nordic countries. It is emphasized that trustworthiness is a key element, also reflected in transparency in pricing and humane values that are important and prevalent qualities in Finnish medical tourism. Finland should be able to communicate its offering and the good qualities the medical tourism field has to offer compared to global competition.

Glimpse of the Finnish market

Global estimates of the annual amount of people travelling outside their domiciles for medical interventions and the global market evaluation vary; Medical Tourism Association (MTA), a global non-profit organization that advocates on behalf of the industry, has evaluated the number of people to around 14 million with a global market size to USD 4 billion in 2021 ^10,11. In Finland, treating foreign patients is still small scale and medical tourism as an industry is still in its infancy. Medical tourism growth potential is significant, and Finland as a technologically advanced country, along with long established health technology export, is well prepared to meet growing demand by offering high quality medical services in clean and safe environment ⁸. A vision set for 2023 by the Medical Tourism Association of Finland is that Finland would be a leading medical tourism destination in the Nordic countries and one of the most popular in Europe with 100 MEUR turnover and 5 MEUR investment ¹². In 2022 the total turnover produced by medical tourists in Finnish market was EUR 8,3 million whilst the corresponding annual turnover before the Covid-19 pandemic was ca. EUR 10-15 million and the annual number of medical tourists between the years 2019 and 2022 has been 630 to 3800¹³. There are medical services offered from different medical fields, e.g., oncology, orthopaedics, neurology, and other specialized medical fields such as vascular diseases and obstetrics, as well as rehabilitation and medical check-ups.

Competition in the global market is fierce, which emphasizes the need for more close collaboration among stakeholders, a variety of actors such as hospitals and clinics, medical tourism facilitators, also called patient broker agencies or butler service providers, travel agencies, hotels, airlines, restaurants, and transport companies. At the moment there are only a few companies operating within the medical tourism field in Finland which collaborate with each other, and most are organized in an association. Medical tourism as an industry in Finland is in a phase of a new beginning where the focal actors, the medical service providers, and the facilitators, are starting to mould their operations, push forward the niche market and align their collaborative ecosystems accordingly. Recognizing and bringing together various stakeholders and investing in establishing good relations among the stakeholders is imperative. Agreeing and abiding to the individual roles and tasks in a long-term basis is a mission for all the stakeholders in the ecosystem and a premise for its successful implementation.

Medical tourism ecosystem – a platform for collaboration

Collaborative business ecosystems are characterized by information sharing and joint action among complementors ¹⁴. Ecosystem value chain thinking has evolved from supply chain management, which is the practice of coordinating the flow of goods, services, information, and finances as they move from raw materials to parts, supplier to manufacturer, to wholesaler to retailer to consumer ¹⁵. Coordination is a decision-making procedure that aims to perform functions to accomplish supply chain targets through predetermined arrangements. However, coordination is considered to be decision-making that does not extensively take into consideration the impact of these decisions to the other stakeholders and the relationship is not considered to be fully integrated with common objectives ¹⁶. Whereas an ecosystem approach takes into consideration the stakeholders and the environment in a more thorough, dynamic, less hierarchical and broader manner serving today ´s industry needs better. The ecosystem term is aimed at capturing the connection linking the core service/product, its main elements, and its complementary services/products, which together increase value for customers¹⁷.

As with any business field, there are socio-economic opportunities, risks, and concerns regarding medical tourism. However, the main critical concern about the financial benefit and general feasibility and success of medical tourism is how the foreign patient service process chain regarding the treatment and the whole customer process is organized ^{18, 19}. Businesses design and create their own service process ecosystems and may then expand collaborative targets within the industry specific service process ecosystem. Through organizing collaboration and service process functions in the medical tourism service process ecosystem, created specifically to suit the needs of medical tourism businesses in Finland, the ultimate goal of medical tourism, medical tourist satisfaction, can be achieved.

Collaboration, collaboration, collaboration

There are over twenty different identified stakeholders connected to Finnish medical tourism. This indicates unique diversity in the collaborative business environment in medical tourism industry as it is a totally different service industry compared to tourism and leisure since there are stakeholders involved from tourism, health, medical and public sectors. The multitude of stakeholders means the existing collaboration in medical tourism is intricate and complex.

The extent and forms of collaboration among medical tourism actors in Finland vary considerably, and they are connected to the business strategy and mirror the states and operational aims of the companies. Some have established extensive collaborative networks while others have more sporadic collaboration patterns. Some uncertainty can be seen as to with whom to collaborate with, and what sort of collaboration would be useful and needed. However, there is a common disposition among the stakeholders to harmonize the collaboration so that Finnish inbound medical tourism could be increased.

The prerequisites, in terms of collaboration, for Finland to become a well-known medical tourism destination is the understanding and open-mindedness at governmental level that the whole nation must be invested in it. As a result, the common mission and elevated brand awareness would open more collaboration and business opportunities. In medical tourism collaboration, one stumbling block may in fact be a certain inability or disinclination on behalf of the medical service provider to look at the customer not only as a patient having the medical procedure but also at the same time an oversees tourist possibly willing to purchase other tourism related experiences. This would deepen and diversify the customer experience and strengthen the economic impact of an individual customer by activating various stakeholders in the medical tourism service process ecosystem. On the other hand, medical tourism might be looked at only as a part of tourism industry in the mind sets of public medical service providers and not seeing it as their task to promote a separate private industry that is experienced burdening and/or irrelevant to theirs. The institutional characteristics and sentiments of the public health care sector largely define the frames for possible collaboration and the extent to which these can be influenced may be limited.

If the nationwide economic potential and benefits brought by medical tourism are recognized it would most likely mean that there would be more collaboration, hence more business opportunities, between the medical tourism facilitators and medical service providers in both private and public health care sectors. The feasibility with a socio-economic harm-benefit analysis of treating medical tourists should be looked at of course critically but most importantly with an open mind looking at it as an opportunity. This would also alleviate the lack of (mis)information regarding the possible impacts of medical tourism. If a well-thought process for medical tourism is executed correctly the potential revenue earned by treating foreign patients in the public arena would increase the effectiveness of the public health care sector in the long run. The revenue could be used to invest in public sector facilities and resources such as staff and this way medical tourism could be harnessed to bring positive effects to public health care sector and, in larger scale, the national economy. In a situation where the public sector medical service providers simply do not have will or resources to treat foreign patients the medical tourism industry must function within the private sector. After all, for collaboration to happen one must seek collaboration with the ones who are willing and able to collaborate.

Recommendations to actors in medical tourism industry in Finland

-Improving market status by increasing understanding of the importance of nationwide collaboration. Active networking, building, and looking for possible partnerships locally and globally.

-Tailoring services into more purposeful, unique, and unforgettable experiences, towards gaining a competitive edge in competitive international markets.

– Joining forces with key stakeholders to create country specific medical tourism ecosystem with a customer path that enables that experience and promotes Finland as one of the leading medical tourism destinations.

This blog text is based on the Master´s thesis of the author: The role of collaboration in the development of tourism service process ecosystem- case Finnish medical tourism. Salminen, Ulla E.

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How a starting tourism business creates customer value by adopting digital marketing technology?

How a new tourism business creates customer value by adopting digital marketing technology?

Everybody is online today and everybody is expecting all the noteworthy and legitimate running businesses to be there as well. If the consumer can not find your online presence the chances are your business goes unnoticed. Even worse it builds an image of untrustworthiness in the minds of the consumers. The potential customer may presume the business can not deliver what the customer is expecting. If the business fails in the first customer touch point the game is over before it even began, no matter how good the service or a product in reality is.

Where to start when you´re starting- the do´s and don’t´s

Alford and Page state in their study of technology adoption in marketing that SMEs who have a strong Web presence grow twice as quickly as those who have no or minimal presence¹. It is essential to seriously think about implementing technology from the very beginning. As a starting business owner, you should start by thinking about what you want to achieve and who you want to reach. Once the business plan is ready, the goals, strategy and the understanding of the desired customer is clear it is time to use this knowledge as a basis in creating a suitable digital marketing plan. The plan should not be a separate aspect but rather intertwined with all that is in the very core of the business.

Dredge et al. examined the challenges and opportunities of digitalisation in tourism listing the needs of tourism businesses when taking up new technology². They identified five topics: skills, mentoring support, finance, policy support, and infrastructure.

Skills.

The digital competencies of your business will play a key role in the successful uptake of digital technologies. Often tourism businesses lack the necessary technical resources in their workforce to fully realise digital potentials. This can be due to a number of factors such as a lack of knowledge in identifying required digital skills to limited staffing issues. These restrict the time and effort which can be applied to learning new digital processes. You should map your knowledge and see if you already have knowledgeable personnel in the company. Or think do you want to outsource completely or partly.

Mentoring support

One option is to use mentoring initiatives. Mentoring can boost innovation, enhance creativity and ideation and assist with capacity building. It may improve connectivity between tourism enterprises, technology companies, the arts and cultural sector, and other start-ups. Mentoring reduces the distance and improves the timeliness, of advice between those that have the expertise and those that need to learn. It can be a prolific co-operation between two or more companies where all parties deliver something the other needs helping their businesses thrive. It is smart to keep in mind to not to bite off more than you can chew and here the importance of networking stands out.

Finance

Lack of finance is identified as the number one obstacle preventing the implementation of digital technologies in tourism businesses. There is a significant concern amongst tourism businesses that the cost of implementing new digital technologies will be more than the gains. Analyse what technology your business can benefit from and make a decision. You can start by taking up a few platforms and expanding from there according to the set budget. It is important to remember to build digital marketing around your customers and choose channels accordingly. Thinking which technology to choose to reach the specific customers and which technology brings the most value to the customer in return. Starting smaller and smart saves time and assets.

Policy support

You need policy initiatives and actions to support business awareness of new technologies. They make clear the benefits of their implementation. Your business requires support in business planning and decision-making with regards to new technologies to ensure efficient utilisation. Do research on the available technologies and find what best suits your needs and what serves your customers best. Find out what is out there, any new innovations that would suit you and your customers´, needs. Choose only appropriate, functional and effective technologies.

Infrastructure

The geographic location of tourism enterprises greatly affects their access to adequate digital infrastructures. In developed countries, connections tend to already be adequate even in more remote areas. Still, businesses in urban settings benefit from modern wireless and fibre broadband connections. The infrastructure in rural or more remote areas can be less developed. Getting your software and connections up-to-date is important so that the basic tools at hand are functional.

Are you (all) motivated enough?

Different personal motivations, corporate culture and managers attitude affect the willingness to adopt technology, which is traditionally explained by the technology acceptance model (TAM). Ritz et al. studied the combination of TAM and the do-it-yourself (DIY) behaviour model in adopting new technologies. They stated that small businesses are less likely to participate in digital marketing than larger businesses³. TAM evaluates the ease of use and perceived usefulness of the technology. DIY motivators are economic benefits and lack of quality in existing services. In other words, managers should make the use of technology easy and the economic advantages and other benefits that come with technology apparent. This applies to themselves and communicating this to the whole team.

Alford and Page found out that small business owner-managers have a positive attitude and a real appetite for adopting technology for marketing¹. If you can channel this attitude successfully to motivate your employees you may be able to get staff involved in creating more innovative marketing content. This may serve a wider spectrum of customer expectations that exist towards your business.

So what is customer value and how it is created using technology?

According to Holbrook customer value is the basic foundation for everything in marketing. It can be defined as a preference, experience, interactive and relativistic, that is comparative, personal, and situational⁴. Komppula and Gartner talk further about desired value, which refers to the value that customers want to receive from products or services and their providers. Received value refers to the value customers have actually experienced through specific customer interactions⁵. Zeithaml encapsulates the definition by stating that value represents “a trade-off of the salient give and get components”⁶. All the definitions explain what exactly is the customer value that is created when a business can answer to the needs and wants of their customers.

The product of tourism business is a service that can be thought of as an intangible object which is more difficult to define and label. The service involves emotions, hopes and dreams and the pursuit of satisfaction. As Neuhofer et al. state in their study experiences constitute the essence of the tourism industry⁷. Holbrook continues that therefore customer value resides neither in the product purchased, in the brand chosen, nor the object possessed but rather in the consumption experiences outcome. People desire not simply the product but rather what is behind the product or service; the satisfaction the experience brings through activity⁸.

It is all about the experience

It is important to understand the consumer´s journey. How they experience it throughout all the phases of tourism experience which happens before, during and after the service situation as stated by Opute et al⁹. For a business aiming to achieve improved customer experiential value at a profit, the focus should be to leverage digital technology. This is to fundamentally optimise customer satisfaction. That is why the focus should not be limited to leveraging digital technology to ensure more effective service design and implementation. It should also be about leveraging such technology to drive an integrated implementation strategy. The strategy should recognise the importance of reaching out to customers. This involves engaging actively with them to access customer ideas and suggesting cues for improving their overall experience.

Opute et al. studied the role digital technologies play in tourism customer service experience. They continue by stating and summing up that tourism service providers can leverage digital technologies to drive a customer engagement focus. Doing this higher customer experiential value is reached. At the same time, customer retention and organisational performance improve. Achieving these targets requires the business to interactively engage with customers. By leveraging customer-generated information to fine-tune tourism service design and delivery leave an indelible and memorable impression in the mind of the customers. Customers may attach a high experiential value to a tourism service episode. When this happens they are motivated to undertake a repurchase or re-endorsement of the service. In addition, they want to share their positive service experience afterward⁹. This reminds the business to put emphasis on the follow-up of the customer visit on the marketing plan.

Ready, engage, interact!

Interaction is what consumers want. They want to be recognized and treated personally. Businesses have to keep in mind that consumers are not completely dependent on communication with the business. They also want to communicate with other consumers and a smart business creates these opportunities. This brings great value to the customer. Customers want honesty and transparency and they go where they can get it. As Prahalad and Ramaswamy ¹⁰found out the consumers can choose the firms they want to have a relationship with. The consumer base this on their own views of how value should be created for them. This reminds the starting tourism business to be humble and how important it is to engage and answer to the customers’ expectations.

Technology adoption has been successful when your business uses technology that is suitable for your strategy. If the technology produces measurable customer value it can be said your business has been very successful. Tapping your digital marketing efforts on all the stages of the tourism experience you maximise the effect and benefit of technology. This way your business ends up creating superb value for the customer.

Acknowledgements

This blog post was written as a part of the Information Technology in Tourism Business course at the International Master’s Degree Programme in Tourism Marketing and Management (University of Eastern Finland Business School). Read more about the programme at https://www.uef.fi/tmm

References

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²Dredge, D., Phi, G., Mahadevan, R., Meehan, E. & Popescu, E.S. 2018. Digitalisation in Tourism: In-depth analysis of challenges and opportunities. Low Value procedure GRO-SME-17-C-091-A for Executive Agency for Small and Medium-sized Enterprises (EASME) Virtual Tourism Observatory. Aalborg University, Copenhagen. © European Union, 1995-2019. Available at: https://ec.europa.eu/growth/tools-databases/vto/documents?page=1. Retrieved 25.10.2020.

⁸Holbrook M.B. (Ed.). 1999. Consumer value: A framework for analysis and research. London (UK): Routledge.

⁴Holbrook, M. B. 2005. Customer value and autoethnography: subjective personal introspection and the meanings of a photograph collection. Journal of Business Research, 2005-01, Vol. 58 (1), p. 45-61. ISSN: 0148-2963, DOI: 10.1016/s0148-2963(03)00079-1

⁵Komppula, R., & Gartner, W. C. 2013. Hunting as a travel experience: An auto-ethnographic study of hunting tourism in Finland and the USA. Tourism Management (1982), 2013-04, Vol.35, p. 168-180.35. ISSN: 0261-5177, DOI: 10.1016/j.tourman.2012.06.014

⁷Neuhofer, B., Buhalis, D., & Ladkin, A. 2014. A typology of technology‐enhanced tourism experiences. International Journal of Tourism Research, 2014-07, Vol. 16 (4), p.340-350. ISSN: 1099-2340, DOI: 10.1002/jtr.1958

⁹Opute, A. P., Irene, B. & Iwu, C. G. 2020. Tourism Service and Digital Technologies: A Value Creation Perspective. African Journal of Hospitality, Tourism and Leisure, 2020-03-01, Vol. 9 (2). EISNN:2223-814X

¹⁰Prahalad, C. K., & Ramaswamy, V. 2004. Co-creation experiences: The next practice in value creation. Journal of interactive marketing, 2004-01, Vol. 18 (3), p.5-14. ISSN:1094-9968, DOI: 10.1002/dir.20015

³Ritz, Wendy, Wolf, Marco & McQuitty, Shaun. 2019. Digital marketing adoption and success for small businesses: The application of the do-it-yourself and technology acceptance models. Journal of Research in Interactive Marketing.2019-06-16, Vol.13(2), p.179-203. ISSN:2040-7122. DOI: 10.1108/JRIM-04-2018-0062

⁶Zeithaml, V. A. 1988. Consumer perceptions of price, quality, and value: a means-end model and synthesis of evidence. Journal of Marketing, 1988-07-01, vol. 52 (3), p.2-22. ISSN:0022-2429.DOI:10.1177/002224298805200302