Quality policy in creating organizational maturity in a medical tourism enterprise

Introduction

The management of an enterprise1 requires operational efficiency, which results from managers’ decisions, conducted analyses, assessments, and communication relations. In the theory of management, efficiency is a criterion that is used to assess both the functioning of an organization (legal entity) and management (process approach) (Masiurkewicz 2017). Zieleniewski (1981, p 235), discussing the concept of efficiency, indicated its three basic dimensions — efficiency, profitability and economy. In simple terms, as emphasized by Urbanowska-Sojkin (2021, pp 267–268), the efficiency of an enterprise is a variable condition of that enterprise, influenced by external and internal factors, presenting (with the use of various methods and corresponding tools) its condition in real time and in the future, as well as its competitive potential in the strategic perspective.

The factor that determines the attractiveness of the internal conditions of strategic efficiency of a company is people — company staff with knowledge and skills, equipped with resources, co-creating key and distinguishing competences. This is important in the context of the levels of organizational capacity analysis and reflects the role of actors, their reflectiveness and participation in organizational skills, and not just an enigmatically defined group of managers (Urbanowska-Sojkin, 2021, p. 133). The importance of the quality of human resources in an enterprise is a key element, but a much more important issue is their skilful use and development of interpersonal relations in the direction of creating a constructive dialogue to achieve the goals set.

The aim of this theoretical-empirical article is to address the problem of the concept of organizational maturity, with particular emphasis on the importance that it has or can play in a medical tourism enterprise. After first presenting a critical review of some of the existing Polish and the international literature on the crucial concepts, it next presents selected results of a qualitative study conducted among selected private medical institutions specializing in medical tourism.

Theoretical background

While focusing on efficiency, effectiveness and the related mechanism of coordinating the company’s activities, it is impossible to ignore the important factors highlighted by Kowal (2015) . He emphasizes that the identification of the essence of efficiency and effectiveness is based on the analysis of both complementary and individual (selective) approaches in the interpretation of these categories. In complementary terms, there are two approaches to the interpretation of the concepts: recognition of effectiveness and efficiency as assessments made in the context of measuring the results of an organization or activities, and recognition of effectiveness and efficiency as managerial tasks related to the enterprise. Efficiency considered individually allows for the identification of assessments regarding: the state of the market.2 Taking into account the wide range of views on the definition of efficiency and effectiveness, it is possible to see a platform for discussion on the unequivocal interpretation of the aspect of enterprise evaluation. The point of reference is, on the one hand, the goal or the cost, and on the other hand, the approach to the enterprise from the perspective of multifaceted considerations in terms of assessing its capabilities and coordinating activities. Kałowski (2010) notes that the legitimacy of the organization, defined in terms of its effectiveness, economy and profitability, must reach the highest level if the enterprise intends to make it the source of its own success. At the same time, emphasizing that in order to survive enterprises must strive to gain competitive advantages, which make it easier for them to achieve success. On the other hand, the sources of competitive advantages should be sought inside the enterprise, especially in the organization itself. According to Nowicka (2016, p. 9), contemporary enterprises are focused on the implementation of processes that work through various functions in the organization. The process itself is a repetitive sequence of cause-and-effect actions performed using the resources available, and its purpose is to deliver specific values at an indicated time. As a result, the competitive position is built in relation to the value resulting from the processes implemented, in which, depending on the level of transaction costs, internal or external resources are used. In addition to the concept of “organizational efficiency”, the emphasis mentioned by Wiśniewska (2020, p. 141) regarding the question of agility, as the ability to react quickly and adapt to new conditions in response to continuous and unpredictable changes in the environments of competitive markets deserves attention. A rapid and successful response requires an agile enterprise to adapt all its components, such as enterprise goals, organization and people, to unexpected changes (Kidd, 1994, pp 2–14; as cited in Wiśniewska, 2020). Wiśńiewska relates her considerations to a company operating in the medical tourism sub-market. With the subject of an agile organization focused on knowledge, the search for outstanding solutions is emphasized in the literature by many researchers with emphasis on the fact that it is the basis of a competitive strategy.3

Today’s business environment can be described as turbulent, which means that enterprises face enormous challenges. Tracking the changing conditions of the economic, social and cultural environment requires constant monitoring and making strategic decisions. At the same time, the unfavorable conditions for enterprises resulting from the pandemic situation evoke a feeling of uncertainty and force them to prepare solutions enabling them to operate in crisis, and thus high risk, conditions. This is important in the case of medical tourism enterprises. Meanwhile, the stability of the environment has a significant impact on the level of effectiveness and efficiency of the organization’s functioning and the related market advantage. Urbanowicz-Sojkin (2021, pp. 17–18), considering the efficiency of enterprises in conditions of uncertainty, points out that enterprises focus their efforts on determining what the future will be in order to adapt to the changing environment. Attempts to shape the future have an impact on the future activities of the company, on its further organizational, market and social development. Urbanek (2021, pp. 35–36) rightly notes that regardless of the views on the primary determinants of the company’s success, there is a consensus among management theoreticians and practitioners that the ultimate key to success is the customer (…) at the same time emphasizing that having better relations with the customer, the company has a better chance of keeping them and selling additional products, which directly translates into value. From the customer’s point of view, as Rust, Zeitham and Lemon (2000, pp. 56–57) point out, three main groups of factors build their capital, that is, they determine the value that they assign to a given offer: value capital, brand capital, and relationship capital. Value capital refers to the customer’s assessment of product parameters, functionality and availability, with an emphasis on rational and objective aspects of the offering, such as: quality assessment, functionality and amenities. Brand equity refers to the subjective assessment of primarily intangible benefits provided by a product brand. This assessment is shaped by the company’s marketing efforts, customer experience, and brand associations. Brand capital concerns associations related to the emotions, lifestyle and feelings that accompany brand consumption. We notice that brand strength is an important image element and may be subject to an evolutionary process depending on different consumer reactions. Therefore, it can be said that high brand awareness in the eyes of the consumer builds its capital. Therefore, the aim of the organization should be to build a brand image in which the examination of the needs and views of consumers on their purchasing decisions was previously shaped on the basis of the expectations identified. Significance can be attached to the flexible adaptation of the organization’s strategy to the dynamically changing conditions of the environment.

In a competitive environment, organizations need flexibility to meet customer demands by offering high quality goods and customized services to the needs and expectations of customers. Kotler and Keller (2021, pp. 613) emphasize that a product is considered to be something tangible, but in fact a product is anything that can be offered on the market to satisfy a desire or need, including: a physical good (commodity), service, experience, event, person, place, real estate, organization, information or idea, while noting that the customer will assess the offer taking into account three basic elements: product availability and quality, service portfolio, and quality and price.

In conclusion, in order to create a competitive, attractive offer, all three of the above-mentioned elements must constitute a whole and interlock with each other, remaining in mutual symbiosis. Their identification plays an important role in the process of shaping new products, but above all, cooperation between all departments at every stage of work on a new product is required. As noted by Kotler and Keller, among organizational solutions many companies also use consumer aided design to create new products taking into account customer preferences regarding the final shape of the project, and some even to create better new products, and implement changes within the enterprise. An important factor in success, as emphasized by Tellis, Prabhu and Chandy (2009, pp. 3–23), is also the correct corporate culture — the company must be ready to reduce existing products, tolerate risk and maintain orientation to the future market. It is also becoming important to accept the globalization processes of the environment, which, as Urbanowska-Sojkin (2011, p. 5) states, are characterized by hidden, difficult-to-identify relationships between individual events and trends and their combined impact. In a dynamically changing environment, organizational efficiency is a dominant element and contributes to following the path of pro-quality activities, which are aimed at shaping high quality in each management area of the organization. The organization, by setting its own goals, strives for effectiveness in them, and this is associated with the satisfaction of the consumer using a given good or service.

In this article, reference is made to the organizational excellence of the enterprise in medical tourism. Pro-quality issues play an important role in medical tourism, specifically those relating to the importance of building organizational maturity.

The concept of organization in theoretical terms

The concept of organization appears in the literature in various fields of science, including: economics, sociology, technical sciences, psychology, physiology and anthropology, and especially their sub-disciplines, and is therefore an interdisciplinary concept. In the Polish literature, the developing interdisciplinary movement in science was taken up by Koźmiński (1983, pp. 69–96) as the basis of a systemic approach in the sciences of organization and management. Peszko (2002, p. 23) lists five research trends that set the tone for contemporary management theory and practice, as shown in Figure 1.

The interdisciplinary movement in science in relation to the concept of organization presented in Figure 1 indicates the multidimensional nature of its application in various scientific disciplines. Its universality indicates how widely this term is interpreted in the literature on the subject by many researchers. Individual sciences and sub-sciences deal with various issues related to the functioning of the organization, and so the natural sciences (e.g. organizational balance), ergonomics (e.g. tools and working conditions), physiology (e.g. working time), psychology (e.g. the individual in the organization), sociology (e.g. group functioning), economics (e.g. the impact of an organization on the economy), management sciences (e.g. maximizing effectiveness and efficiency), computer science (e.g. using knowledge resources), cybernetics (e.g. self-steering through information exchange), and operational research.

 

The concept of organization occurs very often in the field of economics, and also refers to a social system that was created to achieve a specific purpose. An organization is a team of people cooperating with each other on the basis of established, coordinated and formalized rules aimed at achieving pre-set strategic goals. According to Kotarbiński (1965), an organization is a whole system because of its relationship with its own elements, all of which contribute to its success. In Leavitt’s approach (1965), an organization is a structured, i.e., ordered system (whole) comprising four basic elements (subsystems):

1. Goals and tasks — i.e., functions that the organization performs for the environment (in complex organizations they can be divided into operationally important detailed tasks);

2. Formal structure — this is the communication system, hierarchy, scope of activities, organizational chart and work system;

3. Devices and technology — these are tools for solving problems (computers, machines, software);

4. People — these are the attitudes, qualifications, skills, motivations and all interpersonal relations (Figure 2).

 

It can be said that human resources are one of the elements determining the strategic efficiency of a company. The company’s staff having the knowledge and skills to use it effectively and competently in order to implement plans is a superior good, influencing organizational abilities. Various definitions dealing with the subject of organizational capabilities of the enterprise are summed up in Table 1 by Matwiejczuk (2014).

 

 

 

An interesting approach was presented by Parsons (1956, p. 64), who also applied himself to the theory of organization and was the author of articles published in the first two issues of the first specialized scientific journal to be published in this area — Administrative Science Quarterly. He believed that organizations can be identified by orientation towards achieving specific goal. According to Barnard (1968), an organization is a system of consciously coordinated actions or forces by two or more people.4 Taking into account services and their specificity, the definition of an organization by Griffin (1996, p.35) deserves attention: “An organization is a group of people who cooperate with each other in an orderly and coordinated manner to achieve a certain set of goals”.

The essence of the organization is contributing to the success of the whole and the whole to the success of the part, the organization must be characterized by a certain level of consistency and mutual alignment of parts (Staff, 1983, p. 12). An organization is an internally ordered and interconnected set of elements separated from the environment. Therefore, the issue of ordering and connection is important, as it determines the structure of an organization created and developed by people. They do this to ensure the achievement of the assumed goals, tasks and functions (Koźmiński & Piotrowski, 2002, pp 30–31). The human factor plays a very important role in a service organization, due to their immateriality, integrity and heterogeneity (Dąbrowska, 2013, p. 12–13). By noticing, assessing, designing and improving individual elements of the organization, we can systematically create a system of related vessels in order to implement the intended strategic activities. According to Bielski (2004, p. 35), an organization is a socio-technical system, oriented on purpose and having a specific structure (way of ordering). It can be concluded that an organization is a complex system aimed at achieving the desired objectives using a combination of the resources at its disposal and a specific type of activities. Organization is the degree of internal harmony and adjustment on various levels of its everyday functioning. In everyday life, we use the names of well-organized organizations, i.e., internally “harmonious” organizations, efficiently achieving their goals, effective or, on the contrary, poorly organized organizations, where individual activities are organized incorrectly or not very effectively, which ultimately translates into achieving the assumed goals in an inefficient manner, if at all. Looking at the organization in an attributive way allows us to activate the synergy mechanism and stimulate creativity. We can then evaluate its structure, quality of activities and results, evaluate its construction, and establish development plans. An interesting definition of organization is presented by Rogoziński (2016, p. 38), who believes that it is “a structure filled from the inside with service phenomena that mediate in the service relationship (…) as an announcement of an opportunity to overcome mechanistic and technocratic monism, according to which the whole is determined by a fragment, but there is also greater benefit”. The same author emphasizes that services are a key factor in formulating judgments about the reality around us, especially its social dimension; they are a condition for appropriately thinking about the world created by people and in line with their self-understanding. In conclusion, “Thinking in services” is something different than thinking about services.

Organizational maturity

Systematic improvement of an organization’s skills, as well as the processes it implements, in order to obtain higher efficiency in a given time, is referred to as the maturity of the organization (Hammer, 2010, pp. 111–123). The growing importance of organizational maturity in terms of quality, process, design, knowledge, technology and customer service is becoming increasingly important. It becomes a fundamental concept in which the center of gravity of the organization should also be transferred to, and certainly included in the considerations of, the maturity of the people who make up the organization. Maturity also means understanding the need to prepare for functioning in conditions of uncertainty, when it is rational to distinguish opportunities and risks (the possibility of determining the probability of occurrence and impact on the tested object) as well as potentials and threats (the inability to determine the probability and impact on the tested object) (Głodziński, 2014, pp 34–40). Organizational maturity is the pursuit of organizational management through the use of modern management methods, e.g., quality, processes, human resources, outsourcing, and sales. The use of modern management methods is an expression of the growing maturity of the organization. It highlights the essence of achieving a certain level of professionalization in key areas of the organization’s operations, as well as being a factor influencing the possibility of success in building value for customers. Skrzypek (2013, p. 5) emphasizes that the maturity of the organization is primarily related to the high level of various forms of management efficiency and effectiveness. The effectiveness of actions is related to the readiness to implement the projects implemented. A mature organization is a system of related vessels, where indicators identifying the quality of management, the course of processes, and the ability of the product (good or service) to meet the consumer’s needs have been clearly defined. A qualitatively mature organization is capable of continuous improvement, improvement of achieved results, and adaptation to changes. It has implemented information systems that allow it to recognize its weaknesses and strengths as well as opportunities and threats resulting from the environment (Stocki 2003, p. 295). According to Szczepańska (2010, p. 8), pro-quality management should lead to an increase in the level of maturity of the organization, and thus to perfection understood as the highest level of quality in relation to the functioning of the organization, the course of identified processes, the structure of system components and relations affecting it, leading to the creation of a product expected by society.

Organization and excellence

The concept of quality management in the enterprise indicates continuous improvement, where all employees are constantly looking for the possibility of eliminating the causes of imperfections in the functioning of the organization (Al-Jawazneh & Smadi, 2011, p. 8). The European Foundation for Quality Management (EFQM) has developed the EFQM model of excellence, which is a comprehensive tool for improving organizations in the most important areas of their operation, along with the requirements that they should meet. According to Buchacz (2005, p. 33–35), the EFQM model serves as a self-assessment tool and, at the same time, a model of excellence to be pursued by taking appropriate actions in each of the distinguished areas. The EFQM model is based on eight principles of excellence that lay the foundation necessary for any organization: creating customer value, ensuring a sustainable future, developing the organization’s capacity, using creativity and innovation, leadership based on vision, inspiration and integrity, flexible management, achieving success through talent of employees, maintaining excellent results. The principles of excellence in the EFQM Model are presented in Figure 3.

It can be concluded that the EFQM Excellence Model does not impose ready-made solutions, but provides many choices to achieve permanent excellence in key aspects of the organization’s operations. The application of the principles of excellence through predefined guidelines for the implementation of a specific principle increases the chance of the organization’s management bringing it closer to the state of excellence. The principles of excellence proposed by the European Foundation for Quality Management are primarily characterized by a richer scope of implementation of the pro-quality concept of quality management. The principles of excellence in the EFQM Model in terms of the undertaken and applicable actions are presented in Table 2.

 

Summarizing the theoretical part, we can say that for companies/organizations to be successful in today’s global business competition, it is imperative that they provide a high standard of services. Basically, the purpose of maturity models is to provide a framework for improving an organization’s business performance by assessing strengths and weaknesses, enabling comparisons with similar organizations, and measuring correlations between organizations (Combe, 1998). By contrast, Levin and Skulmoski (2000) indicate that maturity models provide a framework that helps organizations increase their ability to deliver projects on schedule, within budget and in accordance with desired technical specifications. A different view is given by Argyris (1957), who believes that an organization is mature when its processes, systems and people (leaders, teams and individual employees) mature.

 

Medical tourism in organizational excellence

Quality management directs the organization towards excellence. This applies in particular to service organizations. Therefore, it can be said that excellent service organizations are entities that implement pro-quality management in all areas of operation and subject them to constant checking. This shows the relevance of the approach to quality Borys (2012, pp. 7–23), who stated that “quality is everywhere”.

In recent years, we have noticed the growing importance of medical tourism. The interest among medical institutions in servicing foreign patients traveling for medical purposes results, inter alia, from the fact that this area of activity is an attractive aspect of extending the package of services, gives the opportunity to attract new customers, which translates into economic aspects of the functioning of the facilities. The concept of medical tourism has not been clearly defined; therefore it remains in the area of research.5

Medical tourism is defined not only as a spatial structure, but also as the range of medical services sought and offered. The development of medical tourism is influenced by social expectations, the development of technology, and the availability of certain medical procedures. Medical tourism services are provided by very different entities: from small clinics and hospitals to huge hospital complexes or medical centers.

Results IDI research among medical clinics in Poland and Croatia

Kędra and Chudak (2011) emphasize that improvements in quality ensure the efficient and effective functioning of the healthcare system, which leads to patient satisfaction with the services provided, employee satisfaction with the work performed, reduction of the costs of the activity conducted, better and more effective use of material resources, and human, financial, and market share growth.

The aim of the qualitative research conducted among medical facilities (clinics) serving foreign tourists operating in Poland and Croatia (three in each country) was to obtain knowledge on pro-quality management. The interview participants were people responsible, inter alia, for product management, human resources, marketing, quality in the broad sense, and management of medical areas.

The content-related issues included the following areas: the medical offer addressed to medical tourists, outsourcing, human resources management, customer service, activities undertaken by company managers, and activities related to the company’s marketing policy. The study was conducted to answer the main research question, how are the intra-organizational processes shaped that can lead to organizational completeness in each of the clinics studied?

Due to the complexity of the research problem and the multithreaded areas of the company’s activities included in the interview scenario, this article presents two key areas that significantly affect the perception of quality by the consumer/foreign medical tourist:

1) activities in the area of the product offer;

2) activities in the field of human resource management.

At the outset, it should be noted that the inflow of foreign medical tourists in the case of the clinics studied operating on the Polish market are mainly patients from: Belarus, Belgium, Canada, Germany, Iceland, Ireland, Italy, the Netherlands, Norway, Russia, Spain, Sweden, Switzerland, Ukraine, the UK, and the United States. In the case of Croatia, the core is made up of medical tourists from: Austria, the Czech Republic, Germany, Hungary, Italy, Slovenia, and Switzerland.

The information obtained allows us to conclude that in the Polish institutions serving foreign medical tourists, the offers included the following services: surgical treatment of obesity (laparoscopic gastric resection, intragastric balloon), abdominoplasty (abdominoplasty), breast surgery, face lifting, pediatric orthopedics (birth defects, correction of congenital defects), orthopedics for adults (hip atroscopy, hip replacement, knee atroscopy, knee replacement), neurosurgery (disc herniation removal), gynecology (childbirth).

The clinics operating in Croatia offered primarily the following services: dental — prosthetics, aesthetic dentistry, conservative dentistry, dental laboratory, implantology, oral surgery, orthodontics, as well as diagnostic tests, physiotherapy, inhalations, and massages.

This article focuses on the product offer, which is defined as a certain set of goods or services serving the satisfaction of a need. As emphasized by Kotler and Keller (2021), a product is something tangible, but in fact a product is anything that can be offered on the market to satisfy a desire or need, including: a physical good (commodity), service, experience, event, person, place, real estate, organization, information and idea. Creating a product offer tailored to the needs and expectations of consumers is a basic aspect of every business activity. A well-structured product offer becomes an asset for a medical facility and is an element of its image.

The choice of a medical facility by a foreign tourist, apart from the service offer, may also be influenced by the attractiveness of the region / / city / country, which can be treated as an element of building a complementary service. In the case of the Polish clinics surveyed, in the opinion of the interviewees, this factor was not important for building the image of the product or the image of the entity. The interviewees representing the Croatian clinics studied were of a different opinion. For all 3 Croatian clinics, the tourist attractiveness of the region / city / country contributes to the choices of medical tourists, in addition to which the tourist attributes of the region / city / country are used by Croatian clinics to build a promotion strategy and build a product offer for medical tourists.

The issues related to the product, apart from the type of the most frequently provided services for a foreign medical tourist, the importance of tourist attributes being an element supporting the product, included questions related to the availability of medical procedures, the uniqueness of the offer, the quality of medical services, medical authorities, and the availability of innovative technologies necessary for the provision of the service. The present article only presents selected elements due to space limitations.

When analyzing the factors that determine the choice of the service offer of a given clinic, one factor constituting a separate marketing instrument was also taken into account — the price, since it is very important for the client in making a purchasing decision.

Table 3 and Table 4 summarize the factors influencing the selection of clinics by foreign medical tourists according to importance. The results are presented separately for Poland and Croatia.

 

It can be concluded that the classification of the influence of factors on the interest in medical services by medical patients, according to the opinions of the representatives of the clinics studied, is varied. The importance of factors for clinics is an individual matter, resulting from their experience in working with foreign medical tourists, as well as internal, multifaceted analyzes before, during and after the medical procedure.

As one might expect, price is a very important as a selection factor. Only an interviewee from one clinic operating in Poland assigned this factor “rather important”. This can be explained by the fact that patients who decide to provide services in this clinic appreciate the highest quality and the effect obtained after the service has been rendered.

 

The quality of medical services was considered to be a very important factor, in addition to the price. As noted by Gruca-Wójtowicz (2009), it is difficult to define quality in health care, because it is connected with the specific properties of these services, which include, among others, its social nature, separation of the functions of the service recipient and payer (although this is not always the case), forced (due to illness, health condition) receipt of services and difficulties in assessing the effectiveness of the services provided. The features of services also have a significant impact — immateriality, non-resolution, impermanence, and diversity. The following factors were also considered very important or rather important in clinics operating in both countries, such as: medical authority, matching the offer to an individual patient, safety, and the uniqueness of the offer (with a predominance of rather important). These are elements of building value for the client. Dobiegała-Korona (2015, p. 84) defines this construct as “a surplus of subjective benefits perceived by the customer over the subjectively perceived costs associated with the purchase and use of a given product. Benefits include the satisfaction of needs by the products used (provision of the service), while costs are defined as their monetary dimension and lost time, inconvenience, efforts made and negative emotions”.

There were quite divergent weights assigned by interlocutors representing Polish clinics in the case of nomedical technologies and innovative solutions. In two clinics, these factors were considered rather important, and in the third of the studied clinics as rather unimportant. It seems that the pursuit of excellence in the scope of the product offer should force the implementation of innovative solutions also based on new medical technologies. The observed progress in this area, especially in commercial clinics, is an element that attracts the interest of customers. However, it should be borne in mind that modern solutions entail higher prices. It should be emphasized that in crisis conditions, including those in the pandemic, household budgets are usually lowered, which in turn may have a significant impact on the expressed interest of customers in the medical services offered. One more point cannot be omitted. The clinics studied were varied in terms of the services provided, which means that the possibility of introducing innovative solutions is not equally possible in each of them.

The intimacy factor also received quite divergent ratings. It seems that medical services should be provided in conditions that create a certain psychological comfort for the patient, and this applies to all types of services.

In the case of clinics operating in Croatia, the discrepancies in the rank of these factors are even more pronounced. New medical technologies and innovative solutions have ranged from very important to neither important nor unimportant to rather unimportant. The intimacy was also assessed as a rather unimportant and unimportant factor, only in the case of one clinic the interlocutor considered it to be a rather important factor.

In order for the medical tourism activities offered by clinics to meet market expectations, another important issue that arose in the qualitative research was activities in the area of human resource management.

All intra-organizational activities can be implemented with the participation and participation of the human factor. Research in this area made it possible to look at the standards prevailing within the organization and the procedures that are consistently implemented in order to strive for the company’s excellence in medical tourism. The aspects that Polish and Croatian clinics implement to make the structure orderly and focused on pro-quality activities at the highest level in the field of providing services to foreign medical tourists constitute a wide range of well-thought-out procedures developed over the years of working with foreign patients.

The importance of selecting medical and non-medical personnel to serve a medical tourist should be emphasized. The criteria and personality traits taken into account by Polish and Croatian clinics in the selection of medical personnel (doctors, nurses, midwives, laboratory diagnostics staff, paramedics) and non-medical personnel (reception staff, middle and lower management, administrative staff) are presented in the tables 5–7. In the case of Polish clinics, the list of medical and non-medical personnel was prepared in one table, because the indications of personality criteria and characteristics did not differ — Table 5. In the case of Croatian clinics, the indications obtained were different — see Table 6 and Table 7.

 

Tables 5–7 include criteria and personality traits such as: empathy, education, fluency in foreign languages, professional experience, professional achievements, appearance, ease of building relationships with customers, speed of service, ease of communicating with other employees, and personal culture. In the case of one of the clinics, aspects such as: life stability, place of residence close to the clinic, and family situation were also important. And in the case of others, additionally: entrepreneurship, ethics, passion for quality.

In the case of clinics from Poland, all features were considered important for their managers and taken into account when building a team, be it medical or non-medical workers. In services, these are very important features due to the very nature of services defined as activities performed by one party (service provider) to the other party (recipient). These features are also important in terms of shaping internal marketing (relations between employees) and interactive marketing (concerns relations with service recipients).

Croatian clinics responded to the above factors in various ways. The criteria and personality traits taken into account in the selection of medical and non-medical personnel for one of the clinics reflected the characteristics that Polish clinics mention. One of the clinics limited its requirements in the case of medical personnel to: fluent knowledge of foreign languages, work experience, appearance and ease of communication with other employees. In the case of non-medical personnel, the dominant factors were: empathy, education, professional experience, as well as the ease of communicating with other employees. Another clinic declared, however, in the case of medical personnel: education, work experience, professional achievements, ease of communication with other employees and personal culture.

The essence of the issue in both Polish and Croatian clinics are the developed and implemented cooperation procedures between individual workplaces as well as departments. These procedures enable the facility to function efficiently at all organizational levels. Each new employee hired to work is introduced into the current work system, and often undergoes a multi-stage preparation, and then, as one of the clinics pointed out, the skills acquired in the implementation process are verified. After that, the final decision on further cooperation is made. It should also be noted that the structured implementation system depends on the experience of the clinic. In very extensive structures, highly specialized, with high traffic in the area of medical tourists, the implementation procedures operate at a very high level of advancement and each element of the activity is serviced by specialized cells. In the case of smaller entities operating on the Croatian market, but very experienced and advanced in serving medical tourists, emphasis on interdepartmental cooperation (marketing, sales, research and development, analysis) is an element of constant monitoring, emphasizing its importance in the patient service process. One of the clinics recognizes the cooperation in question as an inseparable element and constantly raises the standards in this area. However, two sites showed a greater tendency to operate between departments than between workstations, albeit with a tendency to broaden the optics in this area. In order for the structure to function properly, an inherent element influencing the quality of services provided, apart from qualified personnel, is the issue of permanent improvement of professional qualifications. This is done through planned activities in the context of the training schedule at each level of the organization’s hierarchy. Unambiguously, all clinics, except one, participating in the qualitative research — Polish and Croatian — confirmed the participation of medical and non-medical personnel in both external and internal training to improve professional qualifications (specialization, new technologies, practical, managerial, language, sales, customer service, knowledge of cultural differences, motivational, competence, IT). Through systematic activities aimed at improving professional qualifications, clinics gain knowledge and more effective competences in serving medical tourists. By noticing the need for training by the managers of the institutions, the employees are oriented towards the client and their needs and problems in their activities, which was pointed out by interviewees. As emphasized, the main goal is to care for the customer in the “best possible way”.

The complexity of the management processes of a medical facility constitutes a wide spectrum of possibilities of multi-faceted presentation of the operation of intra-organizational structures. The presented results of an individual in-depth interview within the adopted areas of operation of the medical clinics studied indicate individual approaches, although there are also many common points. These differences in the pursuit of high quality, whether in the field of product shaping or in the field of personnel shaping, will result from the complexity of the services provided, the approach to image building strategy and building relations between the service provider and recipient, as well as the development strategy adopted.

These issues will be the subject of further analysis and investigation as part of the doctoral dissertation being prepared.

Conclusion

The review of the Polish and international literature conducted herein indicated the importance of quality management in building organizational maturity, especially in a service enterprise. Improving quality ensures smooth and effective functioning.

The companies surveyed, both in Poland and in Croatia, differentiate the importance of factors influencing the choice of a medical clinic, although each of the factors can and should play a significant role. It can be assessed that the assigned rank of importance of factors for clinics results from experience in working with foreign medical tourists, but also from the assigned importance of evaluation and analysis of the service provision process. The quality of medical services was considered to be a very important factor.

The services examined are often characterized by a high price, and therefore this is crucial as a selection factor.

Intra-organizational activities can be implemented with the participation and participation of the human factor. Through marketing activities undertaken in the area of personnel, adopting certain important criteria and characteristics, personalities in the selection of medical and non-medical personnel result in the quality of services provided, building positive experiences. The common features of the studied clinics are education and ease of communicating with other employees.

It can therefore be said that the process of improving the organization in terms of the services provided is a process that includes many activities, taking into account stimulating factors towards the development of such functioning mechanisms that will be a motivating factor for medical tourists in terms of choosing a specific destination and medical facility. As noted by Dąbrowska (2008, p. 138), consumer behavior is determined by many factors of an economic, socio-demographic, cultural and psychological nature. According to Johann (2019, p. 30), the globalization of markets is also of great importance, and applies to both production/service and consumption. The effects of market globalization are visible in the area of changing consumer needs and preferences as well as expectations towards the goods and services offered. Global consumers are demanding, expect a wide product offer, and pay attention to the quality, appearance and features of products. By looking at changing environmental conditions, organizations face major challenges in meeting customer needs. Achieving a competitive advantage should be dictated by care for the development of internal organizational procedures focused on customer service, as well as tracking external changes contributing to meeting the growing needs of buyers.

In the field of medical tourism, the ability and willingness to make decisions about choosing a destination that is of interest to a medical tourist is undoubtedly related to their preferences, often dictated by the opinion-forming environment experiencing the value of the service after the medical procedure.

The increase in revenues from foreign medical tourism causes a tendency to implement new technologies, introduce innovative products, and greater openness to the needs and expectations of medical tourists, while taking into account the needs and lifestyle of potential consumers, and thus striving for excellence.

In conclusion, the essence of organizational maturity lies in the multidimensional approach to the client, taking into account their expectations, and often the requirements in such a sensitive environment as medical services. The growing requirements force a change in the perception of the consumer through the prism of the current trends and existing quality standards, while at the same time using, as Johann (2019, p. 32) notes, “communication and information technologies enabling the improvement of sales systems and communication with buyers, and new management methods allow costs to be reduced and better use of resources”.

An equally important issue worth mentioning, in addition to ensuring that an organization is technologically advanced, is the increasingly growing awareness of environmental care in the aspect of sustainable tourism. Emphasizing this value will probably in the long run become an important element influencing consumer decisions and a measure proving that organizations meet quality standards, as well as strengthen and shape future relationships. As emphasized by Urbanek (2021, p. 71) in a competitive economic environment, the condition for the long-term success of a company is the development and consistent implementation of a strategy that leads to an increase in its value.

Many of the quoted aspects of an efficient organization affect its success, but the success of the enterprise, as emphasized by Nowicka (2016, p. 8), is determined by its strategic potential in the form of appropriately selected resources in the processes implemented and their ability to create a competitive advantage and the organization’s ability to use them in an innovative and effective way. The ability to identify the customer’s needs and expectations is a key aspect of business in the case of medical facilities providing services for medical tourists and is a reference point for configuring the service in a way that reflects the organization’s potential and ability to be competitive.

Endnotes

¹ For the purposes of this article, the terms organization and enterprise will be used interchangeably. The author realizes that these concepts are not necessarily synonymous, as not every organization is an enterprise.

² For more on the theoretical considerations on the definition of effectiveness and efficiency, see e.g. Kowal (2015), Kotarbiński (2003), Jackson J. (1991), Haimann, Scott, and Connor (1985), Raines (1966), Barnard (1968).

³ For more about the “agile enterprise” concept see e.g. Kim and Lui (2015), Olesiński, Rzepka, and Olak (2017), Stenbeck and Mix (2019), Sajdak (2019), Trzcieliński (2011).

⁴ see also Zieleniewski (1978, pp. 71–77), as cited in Puchalski (2008, p. 11).

⁵ More on the different approaches to the definition of “medical tourism” in: Biernat et al (2020), Lubowiecki-Vikuk (2012), Rab-Przybyłowicz, J. (2014, p. 27), Prochorowicz, M. (2008, p. 133), Białk-Wolf (2010), inter alia.

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