Medical tourism is on the rise and well respected globally active healthcare institutions reaching out internationally, to transfer their knowledge based on decades of experience in administration, delivery of care and innovation. It is not primarily financial interest; it is the overall goal to deliver excellent care to regions which for many reasons have not yet established an appropriate level of quaternary care. While at first it might be straight forward to plan a health care facility, nothing is more complex than establishing a functional surgical service, especially a skull base unit, which relies on numerous factors to deliver successful outcomes. Recruiting the right interdisciplinary team, educating and training upfront to achieve common standards, creating a culture of safety with mock and simulation center scenarios, are crucial steps before the first patient. The lecture gives an overview of the difficulties encountered, the challenges mastered, and the setbacks analyzed by exemplary case presentations and a formula for how to make it better next time.
