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Hospital Neo is a private clinic and hospital that provides general practitioner and specialist- level medical services in several medical fields, including for example neurosurgery, pediatrics, internal diseases, gastroenterology, dermatology, pulmonary diseases, otology, plastic surgery and dentistry. A particular specialization area and the biggest medical field of Hospital Neo is orthopedics and sports medicine: diagnosis and treatment of sports injuries and other musculoskeletal disorders. Hospital Neo is located in Turku, Finland, and it also has a branch in Salo, Finland. Hospital Neo was founded in 2011 and currently it has approximately 70 employees. (Hospital Neo 2015.)

Annually Hospital Neo receives around 100-150 patients from other countries than Finland. A special characteristic of Hospital Neo‟s foreign medical tourists is that a clear majority of them come for sports medicine and orthopedics, and currently Hospital Neo‟s foreign patients are most typically professional athletes from all over Europe. For example, orthopedist and surgeon Sakari Orava, who works for Hospital Neo, has been very popular among Italian and Spanish professional football players after operating many world-class athletes including

footballer David Beckham in Finland some years ago. Hospital Neo has also partnership agreements with some Finnish and foreign sports clubs which bring them foreign patients regularly.

“For a long time our foreign patients coming here has been based on our certain, quite famous doctors. But little by little patients, also from other countries, have started to know also Hospital Neo as such.” (CEO, Hospital Neo)

Hospital Neo has had foreign patients since its establishment, but Russian medical travellers are a relatively new focus area for it. The company has started actively marketing its services to Russian patients about one year ago and it is now taking its first steps focusing more on the Russian medical tourist segment. The number of Russian medical tourists is currently about 10 per year, but the number has been growing steadily. Their goal for the next few years is to have about 50-100 Russian patients per year.

“We believe Russian patients will become our biggest group of foreign patients.” (CEO, Hospital Neo)

Hospital Neo‟s interviewees also raised that medical tourists are not always desired patients for a small hospital and the process of receiving medical tourists must be well planned, otherwise foreign patients will complicate the hospital operations.

“Developing logistics for your foreign patients is important. -- If you have certain processes and you are following a certain logic with your patients, but you don‟t have a parallel process for your foreign patients, it may cause some interruption.”

(Project Director, Hospital Neo)

“Our processes are not optimized for foreign patients… I would say that if we have more than four foreign patients per week, it will complicate our processes.”

(Medical Director, Hospital Neo)

Communication and interaction with Russian medical tourists at Hospital Neo As majority of Hospital Neo‟s foreign patients are professional athletes, Coxa‟s personnel is

prepared to provide services in English and due to its various foreign patients, it expects sufficient English skills from its medical personnel. However, typically medical travellers without sufficient foreign language skills are not travelling alone, but they bring their own “interpreter” with them.

“Quite often Russian patients, who have no skills in Russian, have somebody escorting them. So it is quite seldom that a Russian patient with no skills in English travels alone.”

(CEO, Hospital Neo)

“Normally Russian athletes come here with their coach or somebody else from their team who speaks English. So they have solved the language issue already in advance. It is surprising how badly even Russian professional athletes can speak English. -- But in any case, we have to be able to communicate somehow with any patient also because of sufficient patient safety. ” (Medical Director, Hospital Neo)

“Once we had this situation that the patient came alone and he didn‟t speak English or Finnish or any language we speak here. And there was no interpreter. So it was absolutely body language… -- Somehow we managed and we sent the rehabilitation instruction afterwards, because they needed to be translated to Russian first.” (Nurse, Hospital Neo)

Due to Russian patients‟ limited skills in English, Hospital Neo has also hired some personnel who speak Russian: one doctor, one nurse and an outsourced service advisor. The service advisor is an outsourced Russian-speaking resource who answers all the requests by Russian patients and operates a phone service in Russian. Hospital Neo also provides services of a professional interpreter, if needed. Professional interpreter is used in situations the patient requests it or there is no other option due to lack of a common language. As professional interpreter is an outsourced resource and an extra service, patient is responsible for paying it himself/herself. Nevertheless, the interviewees at Hospital Neo have experienced some challenges with outsourced professional interpreters and in the future the plan is to use the newly hired Russian-speaking nurse as an interpreter.

“Sometimes we have to ask the interpreter here, because it is not possible and there is no point in an appointment with a doctor with absolute no common language with the patient. At

least some communication in some language between doctor and patient is a prerequisite for the whole meeting.” (CEO, Hospital Neo)

“We have had some interpreters who don‟t have specialization in medical language. They haven‟t been always able to brief the patient properly before an operation and there have been some other misunderstanding and mistakes as well.” (Nurse, Hospital Neo)

“Interpreter needs to understand our processes… That‟s why outsourced interpreters are a bit complicated. -- And it is hard to double-check, if the patient has understood for example rehabilitation instructions, when someone is interpreting your speech to a language you don‟t understand.” (Medical Director, Hospital Neo)

However, as Hospital Neo is still taking its first steps in the medical tourism sector and they are used to their foreign patients bringing their own interpreter, they still lack systematic approach in the language issues.

“We are solving these language issues, especially interpreting, on a case-by-case basis.” (Medical Director, Hospital Neo)