Safe and Sound Part 1:
Road to Safety:
CMOs' Tips and Insights
for Business Travel
Episode #31 of NAVIGATE CMO Dr Joel Lockwood shares healthcare best practices for business travellers.
Dr. Joel Lockwood, Claire Johnson
Claire Johnson 00:04
Welcome to NAVIGATE by World Travel Protection. I’m Claire Johnson, your host for this episode and today we’ll be exploring the medical assistance side of travel risk management. This is the first of a three part series and I’m speaking with Dr. Joel Lockwood, Regional Chief Medical Officer of the Americas region, operating out of our Command Centre in Toronto, Canada. It’s a pleasure to have you join us today Dr. Lockwood.
Dr. Joel Lockwood 00:27
Thanks for having me.
Claire Johnson 00:29
Could you begin by telling our listeners about your experience in the medical field?
Dr. Joel Lockwood 00:33
I’ve got about 10 years of experience in emergency medicine and aeromedical medicine. With WTP, I’m the Regional Chief Medical Officer of the Americas reason. But in addition to that, I’m a staff physician in emergency medicine, and a trauma team leader at an academic Trauma Center in Toronto, Canada. I also work as a transport medicine physician with our large Ontario air ambulance system. At WTP I manage a team of medical staff, which includes nurses and physicians. What we do is ensure that millions of travellers are able to have safe and enjoyable trips each year. We handle approximately 40,000 medical assistance cases each year. And of those about 400 need urgent repatriations. In addition to that, I’m a fellow of the Royal College of Surgeons of Canada. And I hold an academic position of assistant professor in the Department of Medicine at University of Toronto.
Claire Johnson 01:22
You’re one of three regional chief medical officers across the globe for World Travel Protection. Can you share with us how you all work together?
Dr. Joel Lockwood 01:30
Definitely. At World Travel Protection, we have identified that really, it’s a committee of medical professionals that makes the best decisions. So we have three regions, Europe and Africa, Australia, as well as the Americas each with Regional Chief Medical Officer who has experience in critical care, and acute medicine as well as aeromedical medicine. All three of us currently work as practicing physicians – we’ve identified that it’s important to have leaders and decision makers who are the most up to date physicians, because if you’re travelling, let’s be honest, you want someone that has been in the trenches and knows a thing or two about modern day medicine rather than someone who hadn’t seen the inside of a hospital for 10 or 15 years. The other thing that this allows us to do is really to provide thought leadership, and to ensure that we’re providing best practices within World Travel Protection. We have a process for Chief Medical Officer escalation, where we really run cases off each other. And this is analogous to hallway talks that happened in hospitals where a cardiologist might speak to a surgeon about a particular case. And we wanted to have the benefits of healthcare facilities in the medical assistance world. And the process by having chief medical officers with regions I think certainly has allowed us to do just that.
Claire Johnson 02:44
Absolutely. And with the experience you mentioned earlier of having 10 years in emergency and air medical medicine, how is that prepared you for your role as the Chief Medical Officer over the Americas region?
Dr. Joel Lockwood 02:56
I think that the past experience I have is really done a lot to provide the experience base and skill. So I need to accelerate this rule. The first thing is that I’ve worked in a number of different continents. And I think I understand health systems in different parts of the world really well. I’ve also cared for patients and transport patients for very long distances – in helicopters, in planes in the back of ambulances as well. And I think that those experiences are very valuable in this type of setting. Because I think that I, along with my colleagues, kind of know what to expect. And we can provide advice and get a good feel of the medical situation, regardless of where you are, or what your medical need is.
Claire Johnson 03:35
And diving into your transport, medicine and evacuation experience, which as you said, is very valuable and quite critical, especially for travellers in all sorts of weird and wonderful places. Can we jump into what you and your team do on a regular basis with an example of a medical assistance case and how it was handled?
Dr. Joel Lockwood 03:58
Sure. So first of all, I just want to say that I’m going to change a few details about this case to make it non identifiable. But in the COVID pandemic, there were terrible supply chain issues, as we’re all aware. One of the things that came up was a traveler that was in Southeast Asia and had a fall and broke their spine. Now thankfully, they were neurologically intact me that there was no evidence of a spinal cord injury, but their spine was injured in such a way that they were very precarious and any real sudden movements could have caused complete and irreversible paralysis. They were at a facility that had an appropriate spine surgeon. But because of these logistical issues, they didn’t have the surgical equipment – things like screws and rods – to be able to fix the spine appropriately. And what they recommended was that we transport the patient a few 100 kilometers away to their sister facility, which had both the facility of the staff and also the equipment to do the surgery. However, these were over Southeast Asian roads that are very bumpy and as you can imagine, this was quite a concern for us, and a risk that frankly, we weren’t willing to take. So sometimes the best transport is one that does doesn’t occur because we came up with an outside of the box idea. And what we did was we overnight couriered the appropriate equipment that was needed to be able to do the surgery in the first facility, which then was done safely, effectively, and the customer had a great outcome.
Claire Johnson 05:15
Perfect, thanks for that example. Now, there’s so much to coordinate and think of in a high pressure and time critical situation like that, like in a surgery or in an evacuation. And you mentioned earlier the importance of continual learning or work to ensure current best practice. How do you effectively work with your team and provider network across the world to ensure everyone makes the right decisions for the patient?
Dr. Joel Lockwood 05:42
One of our strategies for education and continuing medical education is to really bring some of the best aspects of traditional health care based or hospital based medicine to the assistance world. What I mean by that is, sometimes we run things somewhat similar to the way a hospital is. We have regular rounds, where we go through cases, and we have case presentations, where some of our medical team will present a case that they have, oftentimes, it’ll be led by me, and we’ll bring everyone together and kind of ask what they would do in the situation, kind of their thoughts and feelings. And I think what that does is, it’s a good way to bring everyone’s skill up. So it allows us to introduce best practices very efficiently. And I think it’s a great way to have our staff continually learning. Another thing is we have standard operating procedures, particularly with high risk cases. So one example that I can bring up, that maybe isn’t immediately thought is, a lot of times travellers travel to relatively resource limited settings, and suffer animal bites, like a dog bite in Mexico, for example, something that we quite commonly see in the Americas region. Most dog bites are relatively minor, most will get better with antibiotics. But something that can be a problem and can be quite severe. If it is there is rabies. Now, that’s not always thought of in these smaller facilities for rabies vaccine isn’t always available. But with our standard operating procedures built right in, we’re able to ensure that everyone gets the appropriate management, and that we hold ourselves to a very high level of that. And that’s something that we’re very proud of.
Claire Johnson 07:09
Yeah, absolutely. And along with introducing that best practice of having a standard operating procedure, over the past year at World Travel Protection, we’ve implemented our own clinical governance framework. Now I know that’s a little bit different. So can you say more about what that is, and what that looks like?
Dr. Joel Lockwood 07:30
Certainly, at WTP, we really do see ourselves as a healthcare related company, except that our patients or our customers are really travellers anywhere in the world. Now to be effective clinically, one of the things that we’ve identified that we need to initiate is a clinical governance framework. What that is, is really a set of guidelines and principles that we use to ensure that we’re constantly improving and optimising the success of the medical advice we provide, or that our partners provide. So what we’ve done really, as we’ve borrowed from hospitals, that have employed clinical governance frameworks in the past, and we’ve installed these pillars into WTP, to ensure that we’re learning from our cases, we’re flagging cases, and that we’re constantly improving. So far, it’s been a great success. We’ve seen dividends immediately. And I think that it’s something that our customers are gonna continue to benefit from for years to come.
Claire Johnson 08:22
Yeah, definitely. And for those who aren’t familiar with healthcare and don’t have a healthcare background, could you say more on what that framework looks like in practice, and what that means to review flagged cases?
Dr. Joel Lockwood 08:36
Well, one of the things we’ve implemented is a global clinical case review, which we do monthly. Now, it’s something that’s kind of akin to medical shows, you may have seen where it’s at a boardroom, and everyone kind of talks about cases. Now, it’s not usually the types of cases that we want to pat ourselves on the back for it’s really things that we want to examine in minut detail of how we can improve. So oftentimes, there’ll be cases where even though things may have not gone badly, there were opportunities to improve the we can incorporate that into the learnings we have for the future. So what we do is we have all of our medical leads from all three regions, each present a case from their region every month, and we kind of interrogate it and go through it, looking for ways to improve, or getting each other’s perspectives on how things may have gone a bit different.
Claire Johnson 09:23
And this collaboration across the regions that ties into the hallway talks that you mentioned earlier, and the value that comes from communicating and working together. So it not only helps us to be more efficient, but more importantly, it helps to provide the best outcomes for our patients and our customers, right?
Dr. Joel Lockwood 09:42
That’s right. And I think it’s another example of how we want to bring the best parts of healthcare to the insurance world and this is one of the ways that I think we really can raise the bar for assistance companies everywhere.
Claire Johnson 09:54
Yeah, definitely. And another correlation or connection between health care and insurance and assistance is being able to provide 24/7 service. So to address that and ensure a true around the clock care for our travellers, we’ve implemented our World Travel Protection, what we call a ‘follow the sun’ model. Could you say a bit more about that, and why that impacts the care that we’re able to provide for our travellers?
Dr. Joel Lockwood 10:22
Certainly. While we do three teams in three different locations across the globe, we’re definitely all part of the same WTP family. We’ve also identified that it’s important for us to have people that are as energetic and alert is possible. And that’s one of the reasons why we’ve developed our ‘follow the sun’ model. The idea with this is that we’ll have a Command Centre, taking in all the calls from across the globe, at their daytime hours and handing it subsequently over to the other Command Centres. What this does is extremely beneficial to our customers. The first thing is that it avoids night shifts, which obviously we know from a variety of settings, especially in the healthcare where mistakes and errors tend to happen. It also allows us to have people at their absolute best, you know, awake in the morning, at their preferred hours, not alone in a Command Centre at night. And I think that that is something that’s going to contribute to the success of our company and the success of our relationships with our clients.
Claire Johnson 11:20
Great. Thank you. Now, shifting gears to focus on the travellers we support. What are some of the most common medical issues business travellers face? And how can they be managed or even prevented?
Dr. Joel Lockwood 11:34
Well, there’s a lot of things that do come up, sometimes there’s a very common thing, sometimes there’s critical things that are thankfully a lot less common. One of the most common things is people not bring enough of their medications. They’ve either extended their trip and didn’t consider that they might need more medications, or they just didn’t quite pack enough to take them the whole time through. That can be a challenge, because first of all drugs that they may have may not be available, where they’re travelling. Or they may have different names, and other interesting challenges that, you know, pharmacies that you may come across in Belize or Nicaragua aren’t going to be the same as what you’re used to back home. And certainly there’s a lot of problems with counterfeit drugs, particularly in Latin America. One of the things that we WTP can do to help out is to help find you pharmacies that are safe and reliable. And if you need a prescription, we can access physicians that have local prescribing rights, no matter where you are in the world to ensure that these types of problems that do occasionally happen, minimise your trip as little as possible.
Claire Johnson 12:32
And I’m glad you brought that one up because that ability to prescribe local medication, it’s a factor most travellers don’t consider, because it’s not an issue that they face at home, wherever that is, because they’re visiting their local doctor, and realising that that prescription that they have, even if it’s current isn’t going to help them if they need to refill it overseas. So now for business and leisure travellers with other long-term or pre-existing health conditions, how can you and your team support and enable their travel?
Dr. Joel Lockwood 13:06
One of the largest suggestions I would give is really to get our team involved as early as possible in any medical assistance case. We can help direct people, particularly vulnerable people, safe ways to access healthcare, no matter where they are – that could either be virtually or even at a hotel room. And again, we could help manage medications, simple prescriptions, oftentimes, without even visiting a hospital. If the need arises to go to a hospital, we have a Global Care Network, which is essentially a very large database of all of our experiences of every healthcare facility in the world. It truly is unique and invaluable. What that does is it really removes any of the guesswork as far as going to a safe, clean, hospitable healthcare facility, regardless of what your medical need is. And that’s something that again, I would really encourage people, particularly vulnerable travelers to access through us as early as possible.
Claire Johnson 14:01
Great, thank you. Now, for our last question, what is the final takeaway or tip that you want to share with listeners based on your experience on the supporting end, on how to stay safe and healthy when travelling?
Dr. Joel Lockwood 14:16
Well, the biggest thing is preparation. I think that it’s important to ensure that you’ve got your medications, that you’re ready for your trip, that you remain well hydrated, but some things you can’t really prepare for. And I think that that’s where WTP comes in. We can help you regardless of where you are in the world, or regardless of what exact type of emergency you’re having. We can ensure that you get the safe and efficient medical care that you need, regardless of where you are. It’s something that we’re open 24 hours a day for, and we get great joy of helping people out in times of need.
Claire Johnson 14:47 – 15:18
Dr. Lockwood, it’s been a pleasure having you on NAVIGATE today. Thanks so much for your time discussing the importance of communication and collaboration in medical assistance. Thanks so much. That’s all from us today. Thanks for listening. Be sure to follow NAVIGATE and subscribe wherever you listen to podcasts for the latest travel inspiration and travel risk management insights. Visit worldtravelprotection.com for past episodes and transcripts and to hear more from our experts. Until next time, goodbye and safe travels.
Part 1 of 3 in the Safe and Sound Series is with Dr Joel Lockwood, Regional Chief Medical Officer – Americas for World Travel Protection (WTP). In this episode we discuss multiple healthcare best practice frameworks that have inspired WTP’s medical assistance model. From senior doctors continuing to work in hospitals to creating an environment for hallway talks and structuring shifts in a way that minimises human error – we hear what that looks like and why it matters for travellers.
At the end of the episode, Dr Lockwood shares one of the most common issues travellers face – and an easy way to prevent it happening to you.
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