The Future
of medical care on cruise ships
Summary
Seven years ago, the quality concerning cruise medicine, in particular on
American ships was described in a publication as being pretty bad, even
live-threatening. Despite there were some improvements in the meantime
by attaining a better quality management, there's no satisfying situation
achieved yet. This is surely exaggerated for German ships, but also here is
backlog demand existing, specifically in aspects of personnel and
organisation. Increasing specialisations in cruise market require equal
specialisations and adjustments of demand in medical care. This is why one
has to count on clear change of needs in the future.
In the foreground, there is the choice of personnel. "Classic cruise
doctors" and "classic nurses" cannot cope with the requirements any
longer. The job description contains beside basic qualifications also special
abilities, which are specific to particular ship and passenger types.
Also stockpiling of medicaments and material go beyond the standards of
"MSN" and is depending on passenger structure. Related to family cruises,
the children have to be considered particularly.
The increasing complexity in medical care on board requires a specialised and compact organisation, which can be instituted within the company itself or be outsourced to extern operators. Only that way, it's possible to avoid overstocking and the choice of wrong personnel and to guarantee a favourable cost structure despite the high demands. Doctors with a wide base education and extra abilities are going to be in demand concerning personnel choice. Furthermore, they should be able to prove continued advanced training in line with a quality management. The support personnel are going to be less and less recruited out of nursing staff. A better basis is to be found in the German education structure regarding paramedics, the German "Rettungsassistent". This kind of job training, combined with administrative qualifications is meeting the future demands at sea in a much better way.
There is a huge growth potential contained in the health care market. It
should be as a matter of course, to take advantage of this potential on a
way, which is effective in advertising and within the already existing
medical supply structure on board. There, the hospital and the medical
crew are in demand as "health provider" and not as "invalid's caretaker".
Not only expert knowledge, but also experience is required and it's not
sufficient to copy offers on shore identical to life on board. Just to try out
new possibilities is creating unnecessary costs, which can be avoided by
"purchasing" experience.
A smooth, health technical and marketing orientated procedure of
medicine on board can be transferred in a favourable till self-financing way
to extern operators. The installation of an own structure should be
calculated accurately -probably it does only come into question for bigger
company structures.
Present situation:
About seven years ago, an American medical publication described the condition of the so called "cruise ship medicine" as disastrously. The use of medical services on board was rated as being life-threatening! Meanwhile, this situation eased off in consequence of clearly improving regulating guide-lines.
However, a satisfying condition was not achieved yet. The only reason why serious damage is occurring that rarely is that the duration of cruises in the USA is restricted to approximately one week and the routes are always lying in reachable nearness to land. This is surely exaggerated for ships being laid out for German passengers. Anyhow, one has to wonder if the present situation has to be accepted tacitly or if there isn't any room for improvement left, which could be filled with new and secure ties to steady customers. As a reason for the "American situation" the following aspects are of importance: Due to high cost and inevitable familiar problems with separation, it's only possible to find physicians for cruise ship workings, which hasn't succeeded in the normal medicine environment out of different causes.
Ethnic background, lack of professional capacity, social incompatibility or even longer time-out concerning work may well be responsible. With other words: it's quite difficult to find qualified and successful physicians, which are furthermore possessing sufficient time resources to work on a cruise ship.
On "German ships", this problem is tackled in a multitude of different ways. Partially, foreign physicians are employed by the shipping companies. These mostly from Eastern Europe states originated doctors do often bring along good skills and the earning situation is very appealing to them, but quite often there are serious communication problems arising. Moreover, they stop participating in possibilities of retraining during this long-term activity. Concerning a half-life of medical knowledge given at three years, this negligence may be of detrimental nature within a short time span. Alternative short-term contracts of three to six months are offered.
For
such undertakings, physicians who are already receiving pension, such who
use transition between two employments or drop-outs are being hired to fill
such contracts. It's only too understandable that in isolated cases a
successful physician will not engage under such a situation.
Additionally a possibility is given as an offer to exchange holidays against
activity. Thus, usually competent and better qualified physicians are to be
employed and normal medical care is guaranteed in most cases. However,
a market strategic motivation is lacking. Primarily, the physician is to enjoy
his vacation on board and is not to participate in "CID commitments", nor
is he to engage in additional time consuming marketing realization.
Future situation:
Inside cruise ship market there are more and more "specialisations" to be found. While on the one hand sportive and leisure-time orientated journeys are booming, you can find a niche within the area of classic cruises, which rather older clientele take advantage of. Additionally, there is the new cruise ship generation, which mostly stands for the ship itself defining the vacation.
Countries and harbours take more and more a back seat. The increase of the numbers of beds entails also a decline in prices so that partially cruises can already be offered more favourable than classic package tours ashore. As a result, the number of families with children on board is rising. This has to be taken into account also what medical care is concerned! According to public needs also the doctor has to provide extra qualifications and specialisations. On board of entertainment ships, knowledge of sports medicine and orthopaedics is increasingly offered.
Family cruises ask for knowledge of paediatrics and especially parents are very critical what this is concerned. Classic cruises ask for accessory knowledge of internal and orthopaedic medicine. In particular the lapse of chronic diseases is often leading to severe complications, which increase with the length of the cruise. But not only is the medical qualification in demand, also the accommodation of the stock of medicaments is of importance. It's not sufficient to be geared just to the partially antiquated "MSN-lists". According to the clientele, there are to be added for example medicaments for children and for patients with chronic diseases. If you leave the stockpiling to single doctors or pharmacists, stocks will rocket high unnecessarily. Stock ground is wasted. The abundance of "the unnecessary" is constraining the administration of material, so it gets more and more difficult to cope with the requirements of authorities and the risk of higher penalty is rising. Also the medical support personnel are exposed to a change. So far, only nurses were employed, but until now it's not considered that an education based on care and nursing doesn't make sense. Of course there are sickbeds on board, but they are very rarely used for patients in need of care.
They conduce exclusively to the observation, intensive care medicine
and stabilisation until the patient is able to be debarked at the next medical
competence centre. Thus, nurses for intensive care medicine are required
at best. Nurses without any education in intensive care medicine or
emergency medical aid are out of place on board! The biggest part of this
medical activity on board is incumbent upon administrative duties:
handling with electronic files, accounting, electronic way of maintaining
medicaments, preparing and developing of lists needed by authorities and
surveillance of hygiene on board together with the doctor and the
superintendence. Outraging computer literacy, organising ability and
captious management ability are required aside to the medical basics. Such
a wide spectrum of skills has to be developed other several years. Finally,
this should also be reflected in the composition of ranking. Personnel with
this kind of education belong in the median officer's rank!
It appeared that trained paramedics with the additionally needed
administrative abilities are in conformity with these requirements -better
than classic nursing staff.
In the future, there will be claimed a rethinking, already beginning with the
tendering of personnel.
Future prospects and solution:
Likewise catering, shops and other scopes are outsourced to an extern operator; also the increasing complexity of medical on-board systems is demanding a compact and specialised organisation. This one can be instituted within the company itself or in a similar manner be outsourced to extern operators. Essentially for a smooth process is without fail the "complete mentoring".
If there is only personnel administration, material administration or other parts outsourced, the chaos will become norm. As this sensitive area is reaching from hotel management and on-board leadership to extern legislative surveillance and without a proper working the whole cruise ship company is malfunctioning, everything needs to be administrated in a single organisations structure. If this is taking place company-internal or -external is finally just a question of cost. Up to a medium-sized business, an extern placing is surely more competitive.
Exemplifying this, we can take the outsourcing of the entire hospital operation by a German travel company, an English Holding or a Greek shipping company into consideration. Here, the hospital with all its functions was transferred to a German operator (concessionaire), which could grant the personnel and administrative "basics" mentioned above. A 6-year-period of experiences is able to show a positive result.
Medicine on board as a marketing tool:
"Health" as service is one of the mostly growing markets. The demand is increasing all over the world. This also flashed over to the cruise market. Accretive requests prior the booking of a journey for special offers or activities on board is confirming this movement. The medical care is especially on classic cruises an important argument for booking. Pure "healthiness-cruises" are even promoted by health insurances. Dialysis-supervision on journeys is successfully applied.
But you're not allowed to cherish the illusion that the journeys can only be sold via medical offers. There is no such a demand existing as offers of that ilk can be realized much better ashore. Aesthetic surgery, special wellness etc. has unfortunately to be discounted as advertising stunt. In the front, there's the journey, living on board and the ship! All the other medical offers have to be seen as an additional, gladly adapted marketing tool. The medical-functional mentoring concerning board sporting, the medical- functional company concerning special trips ashore and the approachable presence of the medical personnel amidst the passengers; this all is accepted with good grace. Out of this, additional therapeutic offers can be developed. As a condition for this, there has to be a willingness and ability of the operator to develop and offer new "health concepts" beyond the basic medicine.
But also the motivation to be integrated into the marketing
political concept and to put it into practice is quite important. The ship
hospital is awakened out of a sleeping beauty situation and is offering in
addition to its normal necessary functions a variety of health inducing
programs. Not only help and healing in case of sickness is offered, but also
healthiness and confidence is added to the existing health concept. This is
the only way to face the ever growing health consciousness of the
customer and to attract also insecure, health critical and fearful customers.
**„MS-Astoria", MS-Astor
*** Delphin-Renaissance-Holding
**** Global Maritime Service