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The purpose of this paper is to ascertain the relative importance of sustainable tourism practices to medical tourists. Sustainable management practices have become the accepted and appropriate model for tourism. Medical tourists, those who visit a foreign country for a medical procedure unavailable at home due to high costs, timeliness or local laws and customs, are asked how important a set of sustainable management practices are in their experiences. Selected for this study are the Global Sustainable Tourism Criteria (GSTC). These criteria have been designed to be the minimum practices to ensure sustainability for the business as well as protect the natural and cultural resources.

An online survey was employed to gather the travel patterns, motivations and socio‐demographics of medical tourists and to test their ranking of the GSTC on a five‐point Likert scale.

Medical tourists who travelled to Costa Rica, a recognized ecotourism destination, are more likely to support some of the sustainable criteria designed to maximize social and economic benefits to the local community and minimize negative impacts, than those who travelled elsewhere.

While the sample size is modest, this is an exploratory assessment by medical tourists of sustainable management practices.

Research into sustainable medical tourism practices is timely given that hospitals are not traditionally in the tourism business, but are now rapidly seeking to provide this service to their foreign patients.

The paper presents what is believed to be the first investigation into medical tourists' preferences in sustainable tourism practices.

Although there are many quality measurement theories and models, all are imperfect; that is, each has its own advantages and disadvantages. Particularly, some models cannot indicate accurate improvement priorities. The purpose of this study is to develop an integrated performance model that improves service quality and acquires accurate improvement priorities that promote customer satisfaction and eliminate resource wastage.

This study applied a performance matrix and quality loss function (QLF) theory to determine priority items needing improvement. A questionnaire was designed to determine the priority of improvement objectives derived from certain questionnaire items that do not fall into the appropriate performance zone (APZ) of the performance matrix. Finally, the QLF was adopted to rank the improvement objectives in terms of priority. A large QLF area indicates customer satisfaction needs improvement.

This study utilized an employee satisfaction survey to demonstrate this matrix, and found that it reflects the improvement priorities of different items and avoids the shortcomings of other models. In this case study, 11 items must be improved; furthermore, five items with the greatest QLF areas became the priority items for improvement.

This performance matrix also considers the items of surplus resource investment, which can be included in improvements, thereby avoiding resource wastage.