by Sharon Kleefield. Ph.D. I was fortunate to participate in the IMTJ Summit 2015. It was indeed an opportunity to share expertise and knowledge, and better understand the ongoing themes of patient involvement beyond borders. The stakeholders were well represented from around the globe: providers, travel companies, brokers/facilitators, national medical tourist groups, media, accreditors, business start-ups and patients. The medical tourism industry is a web of relationships among private and public, commerce and patient care (G. Cohen, Patients with Passports, 2015). It is growing and evolving while still in flux, but the welfare of patients is always front and center. The need for good quality of care was a theme throughout the Summit, both as a global and regional concern. The attendees echoed the importance of good health for human well-being and the quality of life. Assessing quality of care is still difficult to ascertain, but patients are willing to travel in order to fix a painful hip or knee, or to fix teeth that are in need of complex but yet affordable treatment. Patients make informed choices as best they can, based on limited information. But are we, as an industry, doing enough to help patients understand what ‘signals’ to look for when assessing quality of care, and compared to what? From the consumer/patient perspective, choice is typically based on word-of-mouth: How good are the physicians/surgeons? Where have they been trained? How many procedures in a particular specialty have been successful? What about facility accreditation? Data in the public domain is difficult to find, even for individual patient experiences, similar to a Tripadvisor. Other factors influencing choice have to do with the distance and ease of travel, familiarity with language, local culture, amenities of the facility and cost. When asked, patients tell me that they would not sacrifice quality for cost, but that they are unsure about what to ask regarding quality and safety of care oversees. Data regarding clinical outcomes is very limited, if available at all. What we do know is that medical travelers are subject to similar healthcare risks as other patients. (World Health Organization) Going Forward, IMTJ 2016 Promoting high standards for the medical traveler does not imply the need for regulation although there was a show of hands at the Summit when asked if regulation was necessary. With 15 years of healthcare quality experience across 15 different countries, I am suggesting an approach that provides signals for quality and safety that are defined and comparable across borders. More than 20 years of research in healthcare quality and safety allows for the identification of such signals, often referred to as metrics or indicators. The most recent report from The Lancet, “Global Surgery 2030,” is an example of research that identifies such signals for safe surgical and anesthesia care globally. Examples include: training/experience of the providers; decontamination and sterilization protocols; blood safety; prophylactic antibiotic use; availability of necessary medicines; nosocomial infection rates; available ICU services and adequate nursing care. I have added additional considerations: hospital accreditation(s), patient satisfaction rates, availability of medical subspecialties for unexpected complications; hand hygiene practice; universal precautions; isolation protocols; and unexpected mortality rates. Definitions and standardized rates would assist facilities as to how and what to measure. Competition to become Centers of Excellence would be driven by a clearer view of quality of care by facility. Promoting case studies from those facilities that promote high standards would be a giant step forward for the medical travel industry and consumer protection. An effort to share these best practices would promote competition and position this industry for participation in discussions of global quality and safety. It would bring the medical travel industry into the broader efforts to improve global care and safety for all patients. Suggested topics and presentations for the Summit 2016 should provide the stimulus for case studies and aid organizing a working group, whose mission would be to advocate transparency in cross-border quality of care. I would be eager to assist in working on case studies, to develop criteria and peer review of data, and to work with IMTJ 2016 in supporting leadership for quality and safety.