WelDest Health and Well-being in Tourism Destination

WelDest project has been funded with support from the European Commission.
Thisreportreflectstheviewsonlyoftheauthor,andtheCommissioncannotbeheld
responsible for any use which may be made of the information contained therein.
Lead by FH-Prof. Dr. Kai T. Illing,
FH JOANNEUM University of Applied Sciences
WelDest
Research
Report 2014
Health and
Well-Being in Tourism Destination
527775-LLP-1-2012-1-FI-ERASMUS-ECUE
http://weldest.blogspot.com

WelDest Research Report 2014

ABSTRACT
WelDest is an Erasmus/LLP funded project (2012 – 2014). The aim of the project is to create a
development framework to be used by public bodies, destination management organizations and private
companies when developing holistic health and well‐being (H&WB) tourism destinations. WelDest also
aims to identify the current knowledge and competence needs in managing and developing health and
well‐being tourism destinations. The project combines the expertise of 5 Higher Education Institutes, 10
industry and 15 associate partners from Austria, the Czech Republic, Finland, Germany, and the UK.
The main research question is: “How can a destination be developed into a health and well‐being
destination”? This research report consists of results from both primary and secondary research. The
primary research comprises of 52 stakeholder interviews (qualitative interviews with a structured
questionnaire that were analysed quantitatively). Furthermore some 784 persons answered the customer
survey which was available in English, German, Finnish, Russian and Czech languages. The survey was
distributed in paper form and fully digitally (in Finland) and was also available as a link at the WelDest
blog. Respondents were those who had spent time and used the facilities in a particular H&WB
destination or a potential H&WB destination.
This WelDest research report focuses on health and well‐being tourism, destination development, and
destination management and has brought the following results: As for the implications for the
management of wellness and spa hotels, public spa centers, health spa villages, and DMOs, they all should
pay more attention to the many features and elements guests expect when coming to a H&WB
destination. The many things destination managers and their stakeholders have to have in mind when
developing a region/destination under the auspices of health and well‐being refer to challenges on
different management levels, as destination development takes place not only on a company level, but
also on a destination level, and on a political level, with regional or national dimensions when it comes to
things such as environmental protection or health insurance which is asked to pay for medical treatments.
The dichotomy between health and wellness can also be seen in the quantitative part of the stakeholder
interviews. The results reveal a strong emphasis on wellness issues and a weaker emphasis on health
related issues, although the latter ones play an important role, too. The stakeholders did not attach too
much importance to “outdoor and indoor sport”, although active holidays might not necessarily be the
same as “outdoor and indoor sport”. As the consumers attach as much importance to “indoor and
outdoor sport” as to “enjoying natural scenery and nature”, an active holiday in the outdoors is among
the highly demanded activities. Nonetheless, pampering and indulging spa procedures belong to the most
important ones. Furthermore, the stakeholders stress the importance of proper communication among
the players of the destination and the use of regular and personal contacts.
A health and well‐being destination needs to dispose of both nature and skilled staff working in certain
facilities. Hotels with a wide range of spa services are complemented with well‐ maintained nature
offering the opportunity for various activities. Thus, a critical mass must be reached satisfying the clients’
needs in the field of relaxation and healthy activities. Various professions have to work together closely to
provide a seamless chain of services. The destination is to be managed and marketed professionally as a
unit and disposes of a strong brand image.


ZUSAMMENFASSUNG
WelDest ist ein Erasmus/LLP‐ gefördertes Projekt (2012‐2014). Das Ziel des Projektes ist es, einen
Entwicklungsrahmen zu erschaffen, der von öffentlichen Einrichtungen, Standort Management
Organisationen und privaten Unternehmen genutzt werden kann, um ganzheitliche gesundheits‐ und
wohlbefindensorientierte Tourismusstandorte zu entwickeln. WelDest zielt auch darauf ab, den aktuellen
Wissensstand und die Kompetenzen, die für das Management und die Entwicklung von gesundheits‐ und
wohlbefindensorientierten Tourismusstandorten benötigt werden, zu identifizieren. Das Projekt
kombiniert die Expertise von 5 Hochschulinstituten, 10 Industrie‐ und 15 assoziierte Partner aus
Österreich, der Tschechischen Republik, Finnland, Deutschland und Großbritannien.
Die Hauptforschungsfrage lautet: „Wie kann ein Standort sich zu einen gesundheits‐ und
wohlbefindensorientierten Standort entwickeln?“ Dieser Report beinhaltet die Resultate aus Primär‐ und
Sekundärforschung. Die Primärforschung besteht aus 52 Interviews mit Interessenvertretern (qualitative
Interviews mit einem strukturierten Fragebogen, der quantitativ analysiert wurde). Weiterhin
beantworteten 784 Personen die Kundenbefragung, die in Deutsch, Englisch, Finnisch, Russisch und
Tschechisch zur Verfügung stand. Die Umfrage wurde in Papierform verteilt und voll digitalisiert (in
Finnland) und war auch als Link auf dem WelDest Blog verfügbar. Befragt wurden diejenigen, die Zeit an
verschiedenen oder potentiellen gesundheits‐ und wohlbefindensorientierten Standorten verbrachten
und die Einrichtungen nutzten.
Dieser WelDest Forschungsbericht konzentriert sich auf den gesundheits‐ und wohlbefindensorientierten
Tourismus, Standortentwicklung und Standortmanagement und hat folgende Ergebnisse gebracht: das
Management von Wellness‐ und Spa Hotels, öffentliche Thermen, Kur‐Dörfer und DMOs (Destination
Management Organisationen) sollten den vielen Funktionen und Elementen, die die Gäste erwarten,
mehr Aufmerksamkeit widmen. Die vielen Dinge, die Standortmanager und ihre Akteure bei der
Entwicklung einer Region/eines Standortes unter der Schirmherrschaft von Gesundheit und Wohlbefinden
im Kopf haben müssen, stehen im Zusammenhang mit Herausforderungen auf unterschiedlichen
Managementebenen, da die Standortentwicklung nicht nur auf Unternehmensebene ein Faktor, sondern
auch auf Standortebene, politischer Ebene mit regionalen oder nationalen Dimension, wenn es zu Dingen
wie Umweltschutz oder Krankenversicherung, welche für medizinische Behandlungen aufkommen muss,
kommt.
Die Dichotomie zwischen Gesundheit und Wellness kann auch im quantitativen Teil der
Interessenvertreter‐Interviews erkannt werden. Die Ergebnisse zeigen einen starken Schwerpunkt auf
Wellness‐Fragen und einem schwächeren Wert auf gesundheitsbezogenen Themen, obwohl die letzteren
ebenso eine wichtige Rolle spielen. Die Akteure messen "Outdoor‐und Indoor‐Sport" nicht zu viel
Bedeutung zu, auch wenn aktiver Urlaub nicht unbedingt das gleiche wie "Outdoor‐und Indoor‐Sport" ist.
Da die Verbraucher genauso viel Wert auf " Indoor‐und Outdoor‐Sport" als auch auf das "genießen
natürlicher Landschaften und Natur" legen, ein aktiver Urlaub in der Natur gehört zu den stark
nachgefragten Aktivitäten. Dennoch gehören verwöhnende Anwendungen zu den wichtigsten Angeboten.
Darüber hinaus betonen die Interessenvertreter, wie wichtig die richtige Kommunikation unter den
Hauptakteuren der Standorte und die Verwendung von regulären und persönlichen Kontakten sind.
Ein gesundheits‐ und wohlbefindensorientierter Standort muss sowohl von der Natur als auch von
qualifizierten Mitarbeitern profitieren. Hotels mit einer breiten Palette an Wellness‐Dienstleistungen, die
durch eine gepflegte Natur ergänzt sind, bieten die Möglichkeit für verschiedenste Aktivitäten. So kann
eine kritische Masse erreicht werden, um die Bedürfnisse der Kunden im Bereich der Entspannung und
gesunde Aktivitäten zu befriedigen. Verschiedene Berufe müssen eng zusammenarbeiten, um eine
nahtlose Kette von Dienstleistungen zu gewährleisten. Der Standort muss professionell verwaltet werden
und als Einheit über ein starkes Markenimage auftreten.


ABSTRAKT
Projekt WelDest je řešen v období 2012 – 2014 a je finančně podporován ze strany Evropské komise, a to
konkrétně programem Erasmus v rámci Programu celoživotního vzdělávání. Cílem projektu je vytvoření
rozvojového rámce, který bude využíván veřejnými subjekty, organizacemi destinačního managementu a
soukromými firmami při komplexním rozvoji destinací zaměřených na zdraví a well‐being (H&WB).
WelDest se také zaměřuje na identifikaci současných potřeb v oblasti znalostí a kompetencí v procesu
řízení a podpory rozvoje H&WB destinací cestovního ruchu. Na projektu spolupracují odborníci z pěti
vysokých škol, deset partnerů z podnikatelské sféry a patnáct přidružených partnerů z Rakouska, České
republiky, Finska, Německa a Spojeného království.
Předkládaná výzkumná zpráva odpovídá na hlavní otázku, a to: “Jak může být destinace rozvíjena směrem
k destinaci podporující zdraví a pohodu svých návštěvníků neboli health and well‐being destinaci?“. Zpráva
obsahuje výsledky jak z primární tak i sekundární části průzkumu. Primárního průzkumu se zúčastnilo 52
důležitých aktérů cestovního ruchu ve zkoumaných destinacích. Byli to zejména manažeři destinací na
národní, regionální a lokální úrovni, dále významní podnikatelé v oblasti hotelnictví a manažeři
zdravotnických zařízení či lázeňských společností. Jako výzkumná metoda byl použit strukturovaný
rozhovor. Dále byl proveden průzkum u 784 respondentů pomocí dotazníkového šetření na území všech
zúčastněných států ve všech příslušných jazykových mutacích, a navíc byl dotazník dostupný i v ruském
jazyce. Dotazník byl distribuován jak v tištěné, tak i elektronické podobě a navíc bylo možné ho vyplnit
přes link na blogu projektu WelDest. Oslovení respondenti byli lidé, kteří strávili čas v současné H&WB
destinaci nebo v potenciální H&WB destinaci.
Výzkumná zpráva z oblasti rozvoje destinací podporujících zdraví a pohodu a jejich destinačního
managementu přináší následující výsledky: Ukázalo se, že vedení lázeňských a wellness hotelů, lázeňských
center, lázeňských míst a organizace destinačního managementu by měly věnovat více pozornosti
základním rysům a prvkům očekávání hostů, kteří do H&WB destinací přijíždějí. Manažeři a všichni
významní aktéři podílející se na rozvoji destinací musejí mít na paměti, že rozvoj destinací směrem ke
zdraví a well‐being s sebou přináší potřebu řízení na různých úrovních, a to podnikové, destinační a
politické úrovni v regionální i národní dimenzi, právě pokud řízení zasahuje do takových oblastí jakou je
například ochrana životního prostředí nebo zdravotní pojištění.
Dichotomie neboli rozpor mezi zdravotním cestovním ruchem a wellness je patrný z kvantitativní části
strukturovaného rozhovoru prováděného mezi aktéry. Výsledky odhalily silný důraz na oblast wellness a
menší důraz pak na zdravotní cestovní ruch, ačkoliv ten samozřejmě hraje také významnou roli. Aktéři
nepřikládají příliš velký důraz sportovním aktivitám ve vnitřním i vnějším prostředí, ačkoliv aktivní
dovolená nemusí být nutně totéž a je důležitým elementem H&WB destinací. Hosté H&WB destinací
nepřikládají tak silný důraz sportovním aktivitám ve vnitřním i vnějším prostředí jako takovým, ale spíše
možnosti užít si okolní přírodu, a aktivní dovolená v přírodě patří pak mezi nejžádanější atributy H&WB
dovolené. Nicméně využívání lázeňských procedur patří mezi nejdůležitější z nich. Kromě toho aktéři
pokládají za velmi důležitou vlastní komunikaci mezi partnery v destinaci s využitím běžných a osobních
kontaktů.
H&WB destinace potřebuje mít k dispozici jak přírodu, tak zkušený personál v příslušných zařízeních
cestovního ruchu. Hotely, které disponují širokou škálou lázeňských služeb, doplňují své nabídky dobře
udržovanými přírodními podmínkami, které nabízejí možnosti k různým aktivitám. Skutečnou nezbytností
je uspokojení potřeb klientů z hlediska odpočinku a zdraví. Různé profese musí úzce spolupracovat, aby
mohly poskytovat zdánlivě nekonečný řetěz služeb. Destinace musí být řízena a nabízena profesionálně
jako celek se silnou značkou.


TIIVISTELMÄ
WelDest on EU:n Elinikäisen oppimisen ohjelman (LLP) vuosina  2012 ‐2014 rahoittama projekti, jonka
tavoitteena on luoda kokonaisvaltainen terveys‐ ja hyvinvointimatkailukohteen kehittämismalli matkailun
julkisen sektorin toimijoiden, matkailukohteiden johtamisesta vastaavien organisaatioiden sekä alan
yksityisten yritysten käyttöön. WelDest ‐projektissa selvitetään myös, millaista tietoa ja osaamista
terveys‐ ja hyvinvointimatkailukohteiden johtamisessa ja kehittämisessä tarvitaan tällä hetkellä.
Projektiin osallistuu 5 korkeakoulua, 10 yrityspartneria sekä 15 verkostopartneria Itävallasta, Tsekin
tasavallasta, Suomesta, Saksasta ja Isosta Britanniasta.
Projektin tavoitteena on selvittää, miten matkailukohteesta voidaan kehittää terveys‐ ja
hyvinvointimatkailukohde. Projektin aikana on tehty asiaa selvittävä tutkimus sekä yhteenveto aiempien
tutkimusten tuloksista. Tutkimuksessa haastateltiin 52 eri sidosryhmien edustajaa. Haastattelut olivat
laadullisia ja niissä käytettiin lisäksi strukturoitua kyselylomaketta, jonka tulokset analysoitiin
kvantitatiivisesti. Haastattelujen lisäksi tehtiin asiakaskysely englanniksi, saksaksi, suomeksi, venäjäksi ja
tsekiksi. Kyselyyn vastasi yhteensä 784 henkilöä. Useimmissa tutkimukseen osallistuneissa maissa kysely
toteutettiin jakamalla paperille tulostettuja kyselylomakkeita, Suomessa kysely tehtiin sähköisenä ja lisäksi
siihen pääsi vastaamaan myös WelDest ‐blogissa olleen linkin kautta. Vastaajat olivat vierailleet terveys‐ ja
hyvinvointimatkailukohteissa tai sellaisissa matkailukohteissa, joilla on potentiaalia kehittyä sellaisiksi.
Tämä tutkimusraportti keskittyy terveys‐ ja hyvinvointimatkailuun, matkailukohteen kehittämiseen sekä
johtamiseen. Tutkimuksen tulokset osoittivat, että kylpylähotellien, terveyskylpylöiden ja
hyvinvointimatkailukohteiden johtamisessa tulisi kiinnittää enemmän huomiota asiakkaiden niihin
kohdistamiin odotuksiin. Terveys‐ ja hyvinvointimatkailukohteen kehittäminen ei ole vain yritystasolla
tapahtuvaa toimintaa, se liittyy myös alueellisen, kansallisen ja poliittisen tason kysymyksiin kuten
ympäristönsuojeluun tai sairausvakuutusjärjestelmiin, joiden odotetaan kattavan lääketieteellisestä
hoidosta aiheutuneita kustannuksia.
Asiantuntijahaastattelujen kvantitatiivinen analyysi osoitti terveys‐ ja hyvinvointikäsitteiden jakautuvan
kahteen osa‐alueeseen: sekä hyvinvointiin että terveyteen liittyvät tekijät ovat yhtä tärkeitä, vaikka
edelliset painottuivatkin haastatteluissa jälkimmäisten kustannuksella. Luonnosta ja sen tarjoamista
virkistysmahdollisuuksista nauttimisen lisäksi kuluttajat pitävät yhtä tärkeinä myös monipuolisia sisä‐ ja
ulkoliikuntamahdollisuuksia. Aktiiviloman viettäminen ja ulkoilumahdollisuuksien hyödyntäminen on
kuluttajan näkökulmasta tärkeää, mutta lisäksi tarjolla on oltava myös mahdollisuuksia hemmottelevien
hoitojen ja palvelujen hyödyntämiseen. Asiantuntijat puolestaan korostivat eri toimijoiden välisen
viestinnän sekä säännöllisten henkilökohtaisten kontaktien ylläpitämisen merkitystä.
Terveys‐ ja hyvinvointimatkailukohteen on tarjottava sekä luontoelämyksiä että ammattitaitoisen
henkilökunnan palveluja. Varsinaisten kylpyläpalvelujen lisäksi kylpylähotellien odotetaan tarjoavan myös
mahdollisuuksia monenlaisiin aktiviteetteihin luonnonläheisessä ja hyvin hoidetussa ympäristössä.
Tarjonnan kriittinen massa onkin edellytys asiakkaiden rentoutumiseen ja terveyttä edistäviin
aktiviteetteihin liittyvien tarpeiden tyydyttämiseksi. Asiakkaalle on voitava tarjota saumaton palveluketju,
jossa eri alojen ammattilaiset toimivat tiiviissä yhteistyössä. Tämän lisäksi hyvinvointimatkailukohdetta
pitää johtaa ja markkinoida ammattimaisesti yhtenä kokonaisuutena ja sen pitää luoda itselleen vahva
brändi.


Contents
1 RESEARCH REPORT – INTRODUCTION ............................................................................. 9
1.1 Terms and abbreviations ............................................................................................................ 10
1.1.1 Terms ......................................................................................................................................... 10
1.1.2 Abbreviations ............................................................................................................................. 11
2 STAKEHOLDER INTERVIEWS PART A – A QUANTITATIVE APPROACH .....................12
2.1 Methodology .............................................................................................................................. 12
2.2 Research results ......................................................................................................................... 13
2.2.1 Which of the following options best describe the role of health and well‐being in your
destination now and by 2020? ................................................................................................................. 13
2.2.2 What do you think are the most important reasons customers come to your destination? .... 14
2.2.3 Which elements prevent your guests from recognizing your destination as health and
wellbeing destination? ............................................................................................................................. 16
2.2.4 How important are the following competencies for you regarding the management of your
destination? .............................................................................................................................................. 17
2.2.5 What is your personal need for further training regarding the following competencies? ........ 19
2.2.6 Please evaluate the present performance of your destination regarding the following specific
points 22
2.2.7 How important are the following specific points regarding the development of a HW&B‐
destination? .............................................................................................................................................. 24
2.2.8 Please define the level of your current job ................................................................................ 27
2.2.9 What is the highest level of education you have completed so far? ......................................... 27
2.2.10 How many years of experience do you have in the following categories? ........................... 28

3 STAKEHOLDER INTERVIEWS PART B – A QUALITATIVE APPROACH .........................29
3.1 Methodology .............................................................................................................................. 29
3.2.1 Definition of a H&WB destination .............................................................................................. 31
3.2.2 Key service supply, resources, staff competencies and elements of H&WB destinations......... 33
3.2.3 SWOT Analysis of H&WB‐destinations ....................................................................................... 36
3.2.4 Importance of nature/sustainability in H&WB destinations now and in the future .................. 38
3.2.5 Role of national/regional health policy in H&WB destinations now and in the future ............. 39
3.2.6 Destination development now and in the future ...................................................................... 41
3.2.7 Resources in destination development ...................................................................................... 43
3.2.8 Processes in destination development now and in the future .................................................. 44
3.2.9 Balance between needs of tourists and needs of locals ............................................................ 45
3.2.10 Competencies needed in the destination ............................................................................. 46
3.2.11 Core business of the destination in the future ...................................................................... 47
3.3 Discussion .................................................................................................................................. 48
4 CONSUMER RESEARCH .....................................................................................................51
4.1 Methodology .............................................................................................................................. 51
4.2.1 In which country are you right now while filling in this questionnaire? .................................... 52
4.2.2 Please write down some key words, which come into your mind if you think of a H&WB‐
destination ............................................................................................................................................... 52
4.2.3 What kind of services, staff competences and elements attract / did attract you to come to a
destination like this? ................................................................................................................................ 54
4.2.4 How did you come to the idea to visit this destination you are currently staying at / you have
stayed at? ................................................................................................................................................. 57
4.2.5 What was the overall reason for you to come to this destination? ........................................... 58
4.2.6 Which services, activities, and elements do you value the most in this destination? ............... 60

4.2.7 Which of the following options best describe your needs when choosing a health and well‐
being holiday? .......................................................................................................................................... 61
4.2.8 To which extent does/did the destination as a whole meet your expectations regarding the
health and well‐being related offering during your stay? ........................................................................ 62
4.2.9 How would you score the destination’s services in general? .................................................... 65
4.2.10 To which extent were/are you able to use the variety of services offered in the H&WB‐
destination? .............................................................................................................................................. 67
4.2.11 How do/ did you check the influence of your current holiday on your health at the end or
after the stay? .......................................................................................................................................... 68
4.2.12 Which of the following alternatives best describe your expectation of the price level of an
H&WB holiday compared to a standard holiday of the same length? ..................................................... 69
4.2.13 Which are the elements which prevent you from recognizing a destination as a health and
well‐being destination? ............................................................................................................................ 70
4.2.14 What is the highest level of education you have completed so far? .................................... 71
4.2.15 Sex ......................................................................................................................................... 71
4.2.16 Your age ................................................................................................................................. 72
4.2.17 Origin ..................................................................................................................................... 73
5 DISCUSSION OF THE RESULTS: STAKEHOLDER AND CONSUMER RESEARCH ..........74
5.1 The term health and related meanings ........................................................................................ 74
5.2 Elements which prevent guests from recognizing a destination as a H&WB destination ............... 75
5.3 The quality of services ................................................................................................................ 77
5.4 Country‐specific analysis 1: What people do for their health ....................................................... 77
5.5 Country‐specific analysis 2: Price level ........................................................................................ 79
5.6 Specific analysis: Health activities and education ........................................................................ 80
5.7 H&WB destination: Characteristics and definition ....................................................................... 82
6 SUMMARY AND MANAGERIAL IMPLICATIONS ............................................................83
7 LIMITATIONS ......................................................................................................................86

7.1 Qualitative stakeholder analysis ................................................................................................. 86
7.2 Consumer Research .................................................................................................................... 86
7.3 Limitations in general ................................................................................................................. 86
8 APPENDIX ............................................................................................................................87
8.1 Stakeholder questionnaire – part A ............................................................................................. 87
8.2 Stakeholder questionnaire – part B ............................................................................................. 94
8.3 Consumer questionnaire ............................................................................................................. 97
8.4 Literature ................................................................................................................................. 102
8.5 List of charts ............................................................................................................................. 103

p. 9 weldest.blogspot.com

1 Research report – Introduction
This WelDest research report focuses on health tourism, wellness tourism, and
destination management. The aim of WelDest is to create a development framework to
be used by public bodies, destination management organizations and private companies
when developing holistic health and well‐being destinations (H&WB). The project
“Health and Well‐being in Tourism Destination” (WelDest) combines the expertise of 5
Higher Education Institutes, 10 industry and 15 associate partners from Austria, the
Czech Republic, Finland, Germany, and the UK.
The purpose of the research is to conduct research that is relevant to the health and
well‐being tourism industry and destinations. The goal is to create a development
framework to be used by public bodies, DMOs and private companies at tourism
destinations willing to strengthen the elements influencing the well‐being level of
tourists and locals alike.
One of the objectives of the research is to identify the current knowledge and
competence needs in managing and developing health and well‐being destinations
(needs analyses to be conducted among core partner target groups: industry partners,
associated partners and HEI‐partners, and outside the partnership: representative
sample of managers, developers, experts and policy makers responsible for destination
development).
The WelDest research consists of both primary and secondary research. The report at
hand is the primary research paper which comprises two different approaches. The first
is based on stakeholder interviews and the second on consumer research. The
stakeholders were interviewed on the basis of two different approaches, quantitative
(questionnaire part A) and qualitative (questionnaire part B):


Chart 1: Structure of the WelDest‐research

1.1 Terms and abbreviations
1.1.1 Terms
Facilities: Something which is built for a special purpose. The term infrastructure is
rarely used in this report as it means basic equipment such as roads and bridges.
This report uses the word destination instead of region as it deals with tourism. If the
word region is used, the report refers to regions in general without referring to tourism
specifically.
Consumers or guests are visitors to a destination.
Positioning: To endow a destination with a clear brand identity in order to distinguish it
from its competitors.
Healthy activities: This report uses phrases such as “healthy activities” or “to do
something for one’s health” to comprise all things done to improve the guests’ health.
Thus, certain terms as for example “health promotion” can be avoided as they are
confined to strict definitions.

WelDest research
Primary research Secondary research
Stakeholder interviews Consumer interviews
Part A Part B


1.1.2 Abbreviations
H&WB Health & well‐being
USP Unique Selling Proposition
DMO Destination Management Organization


2 Stakeholder interviews part A –
A quantitative approach
2.1 Methodology
Methodology for the stakeholder needs analysis concerning health and well‐being
destinations (part A) was developed, beginning in October 2012, by the university
partners and the industry partner CHC. There were three feedback loops, involving all
project partners, regarding further improvement of the questionnaire. The final version
was created in April 2013.The questionnaire comprises two parts: The first part uses a
quantitative approach (see chapter 8.1), the second part has open questions (qualitative
approach, interviews, see Chapter 8.2). The latter part was done on the basis of an
interview guideline either face to face or via telephone. Ten to eleven standardized
interviews were conducted by each of the WelDest partners in their own countries and
then uploaded to Webropol1
. The data were transferred into MS Excel and analysed
descriptively by FHJ. Frequency analyses were chosen, with the results shown in graphs.
The choice of the interviewees was conducted according to the following suggestions
ensuring a broad sample of different professions and management levels:
 Regional developers (e.g. LEADER managers, staff of regional management authorities).
 Hospitality managers from wellness‐hotels, spas/medical spas, and fitness clubs.
 Health managers such as health promoters, medical doctors, nutrition experts, or sport
scientists.
 Local tourism managers, such as authorities from destination tourism boards.
 A policy‐maker holding a relevant job with national importance (e.g. federal tourism board).
All project partners were asked to choose at least one of their interviewees from each
the above mentioned groups.

1
Webropol is an online solution for conducting surveys, gathering data, managing feedback, and reporting
data (http://www.webropol.com/)


2.2 Research results
The following chapters present the results of the survey with the sequence of questions
corresponding with the questionnaire (chapter 8.1).

2.2.1 Which of the following options best describe the role of health and
well‐being in your destination now and by 2020?

Chart 2: What describes the role of H&WB now and in future?
How to read the chart: 21 responses stress that H&WB will play "an essential part of the tourism
offering alongside other services" in the future.

5
9
10
15
10
3
4
21
H&WB will be/is the core tourism offering of our
destination
H&WB will be/is a minor offering
1. H&WB will be a part of the destination strategy
but not yet implemented at the destination level
2. H&WB is already a part of the destination
strategy
H&WB will be/is an essential part of the tourism
offering alongside other services
for the future now
38/39 responses


The chart clearly shows that the idea of health and well‐being serves as a promising
approach for further destination development. Conversely, health and well‐being as a
"minor offering" plays a less important role in future.

2.2.2 What do you think are the most important reasons customers come
to your destination?

Chart 3: Reasons for coming to the destination

9 respondents selected "other reasons, please specify" listing ideas such as "major
events”, “regional cuisine”, and “wine." According to this chart, "suitable
accommodation" and "visiting friends and relatives" play a minor role. Interestingly, the
stakeholders attach more importance to “health” than the guests do themselves (see
chart 20).
Those, who ticked "doing something for health", could fill in a subsequent question, the
analysis of which is presented in the next chart:
5
5
8
9
11
19
24
24
Suitable accommodation
Visiting friends and relatives
Price level
Others, such as major events,
regional cuisine and wine
Culture
Reputation / image of destination
Doing something for health
Natural scenery
40 responses
Multiple answers


Chart 4: Specifications from those who ticked „to do something for his or her health“

Interestingly, the two most important items deal with approaches which are aimed at
reducing stress. Obviously, health in a more medical sense plays a less important role.
The responses may give deep insight into the clients’ needs and the situation of the
societies they live in.

2
9
10
11
19
21
25
Other reasons, such as fun, sport, outdoor
events…
Clinical/medical services
Natural healing resources
Outdoor and indoor sport
Enjoying natural scenery and its nature
Pampering spa services
Relaxation
36 responses
Multiple answers


2.2.3 Which elements prevent your guests from recognizing your
destination as health and wellbeing destination?

Chart 5: Reasons which prevent guests from recognizing a destination as H&WB destination

Interestingly, it is not the industry and traffic which disturb according to the
stakeholders. They believe it is the "lack of medical services" and the "lack of wellness
and spa facilities" which prevent guests from recognizing a destination as a H&WB
destination. These results show a contradiction of what was stated in the previous
question (chart 4), with medical services playing a less important role (9 responses). It
seems that stakeholders are confused as to what is meant by a H&WB destination.

2
2
2
3
4
6
6
8
8
11
14
15
Too much traffic
Too expensive
Too many tourists
Too many disturbing industries
Lack of natural environment
Bad quality of services, such as signage of
walking trails,…
Outdated health‐promoting facilities,
such as old‐fashioned baths, gyms, etc.
No medical staff available
Sprawling cities, villages and industrial areas
Others, such as lack of overall concept,
lack of willingness on the part of service…
Lack of wellness and spa services /
infrastructure
Lack of medical services/infrastructure
40 responses
Multiple answers


2.2.4 How important are the following competencies for you regarding
the management of your destination?


Chart 6: Importance of certain competencies

1
7
10
13
13
13
15
15
15
16
16
17
18
19
20
20
21
22
25
27
29
29
33
17
17
11
21
21
16
19
18
21
16
15
19
17
17
17
12
15
13
13
11
11
6
13
10
12
5
5
9
5
6
1
7
5
2
3
3
2
4
3
1
3
2
4
1
1
2
1
1
3
1
1
Others
Intercultural communication & foreign language
Business law
Employment law
Understanding the benefits of applied research
IT skills and e‐Business
Recruiting process
Knowledge management
Innovation management
Responsible management (sustainable issues)
Understanding of H&WB related concepts/…
Self‐management
Team leading
Process‐ & project management
Quality management
Problem solving within the organisation
Complaint management
HRM
Networking skills to contribute to destination d.
Sales & Marketing know‐how
Rhetoric /Presentation / Communication
Recognition of service gaps
Recognition of customer expectations
not important at all not very important quite important very important
40 responses
Multiple answers


The chart reveals the importance of the “recognition of customer expectations” as one
of the core competencies with respect to the management of a H&WB destination. The
next three items include communication in the form of rhetoric and presentation,
marketing, and networking.
In this chart, "quality management" plays quite an important role in comparison to
other questions in which it is assigned less importance..
"Others" was ticked up just one time and mentions "appraisals, HR‐procedures, health
and safety".

2.2.5 What is your personal need for further training regarding the
following competencies?
Charts no. 6 and no. 7(previous and next) belong together as they are part of an
importance‐performance‐analysis. This approach compares the importance of defined
services and their present performance by the interviewee, assuming that a high need
for training reveals an insufficient performance at present or an increasing demand for
this capability in future. Chart no. 7 and its blue bars combines the previous chart with
the result of the performance analysis (red bars),, taking only “very important and quite
important” (blue) and ”high and some need for further training” (red) into account.
If there are differences between importance and performance, a gap arises indicating a
need for action. The need for action arises if both bars (blue and red) are particularly
long, as is the case with respect to “recognition of customer expectations”. Another
example: “Quality management” is rather important too (blue bar, 37 votes), but the
necessity for training seems to be comparatively low (red bar, only 17 votes).


Chart 7: Need for further training compared to the importance of the competence in question

It appears that those competencies which get the most points with regard to “very
important” (chart 6, upper part) seem to have the highest need for further training.
Example: The “recognition of customer expectations” gets a high ranking with respect to
a need for the training (chart no. 7, first red bar).
24
27
24
34
34
31
34
33
37
32
32
37
36
37
37
33
37
38
40
40
40
39
23
16
16
20
22
19
22
24
22
24
20
23
23
17
20
19
24
23
23
23
24
27
Intercultural communication & foreign language
Business law
Employment law
Understanding the benefits of applied research
IT skills and e‐Business
Recruiting process
Knowledge management
Innovation management
Responsible management (sustainable issues)
Understanding of H&WB related concepts/…
Self‐management
Team leading
Process‐ & project management
Quality management
Problem solving within the organisation
Complaint management
HRM
Networking skills to contribute to destination d.
Sales & Marketing know‐how
Rhetoric /Presentation / Communication
Recognition of service gaps
Recognition of customer expectations
performance ("high and some need for further training")
importance ("very important and quite important")
35 responses
Multiple answers


The first two items in chart no. 7 deal with the customers and their expectations and
related service gaps.
The second group of training needs comprise communicative issues such as
“rhetoric/presentation”, “sales/marketing”, and “networking skills”. Legal subjects such
as "employment law" and “business law" play a minor role, as is the case with
"intercultural communication & foreign languages”.


2.2.6 Please evaluate the present performance of your destination
regarding the following specific points

Chart 8: Evaluation of the present performance of the destination
1
2
2
3
7
7
7
8
8
9
9
11
13
12
15
20
24
15
13
18
17
19
14
19
15
15
18
15
16
11
14
12
13
12
13
10
11
8
7
2
2
3
8
2
3
3
3
2
3
2
We use a quality management system (e.g. ISO,
EFQM,…)
There is a feeling of togetherness and common
goals amongst the actors
There is transparency in communication
processes
There is an adequate development process‐ &
project management in place
We follow joint sales & marketing strategies
There is a commitment and co‐operation of all
actors (private and public)
We have an effective destination management
organization
We are involved in destination‐wide decision
making processes
Aspects of sustainability will be considered in
decision making processes
We collect and utilize destination level data
systematically (knowledge management)
We provide an innovation friendly environment
We follow a destination brand identity
There is an understanding of the importance of
strategic destination development
I strongly disagree I disagree I agree I strongly agree
65 responses
Multiple answers


Interestingly, the statement concerning the "commitment and co‐operation of all
actors" gets quite a critical evaluation as eight interviewees "strongly disagree". This
corresponds to other questions in this research the responses to which high importance
was attached to inter‐regional communication and networking in general.


2.2.7 How important are the following specific points regarding the
development of a HW&B‐destination?

Chart 9: Importance of certain points for the destination development
11
14
17
18
19
21
22
23
26
27
28
30
33
14
23
17
18
14
17
17
13
11
9
11
8
4
15
3
5
3
6
2
1
4
3
2
1
1
1
2
Use of a quality management system (e.g. ISO,
EFQM,…)
Process‐ & project management with regard to
destination development
Providing an innovation friendly environment
Transparency in communication processes
Consideration of sustainability in decision
making processes
Joint sales & marketing strategies
Systematic collection and utilization of
destination level data
Involvement in destination‐wide decision
making processes
A destination management organization
Common understanding of the importance of
Commitment and co‐operation of all actors
(private and public)
Feeling of togetherness and common goals
amongst the actors
Destination brand identity
not important Quite important important very important
40 responses
Multiple answers


Many of the above mentioned items deal with communication and cooperation.
If "very important" and "important" are taken together many items have more or less
the same number of responses. So, we propose to differentiate between "important"
and "very important".
The "use of quality management system" and certifiable quality seals such as ISO 9001
and EFQM seem to be of less importance, at least in this question.

The next chart deals with the same data while trying to present the outcome in another
way. There are points given to each category:
 „not important“ 0 points
 „quite important“ 1 point
 „important“ 2 points
 „very important“ 3 points.
If calculated together, one gets a result in the middle of the next chart which delivers
deeper insight into the outcomes:


Chart 10: Interpretation of the previous questions
11
14
17
18
19
21
22
23
26
27
28
30
33
14
23
17
18
14
17
17
13
11
9
11
8
4
15
3
5
3
6
2
1
4
3
2
1
1
1
2
72
91
90
93
91
99
101
99
103
101
109
107
108
Use of a quality management system (e.g. ISO,
EFQM,…)
Process‐ & project management with regard to
destination development
Providing an innovation friendly environment
Transparency in communication processes
Consideration of sustainability in decision
making processes
Joint sales & marketing strategies
Systematic collection and utilization of
destination level data
Involvement in destination‐wide decision
making processes
A destination management organization
Common understanding of the importance of
Commitment and co‐operation of all actors
(private and public)
Feeling of togetherness and common goals
amongst the actors
Destination brand identity
points not important
0 points
Quite important
1 point
important
2 points
very important
3 points
Linear (points)


2.2.8 Please define the level of your current job

Chart 11: Level of the current job

2.2.9 What is the highest level of education you have completed so far?

Chart 12: Highest level of education

The comparatively high number of doctoral degrees results from the fact that quite a lot
of medical doctors were among the interviewees, as experts from the health industry
were part of this survey.

7
8
11
14
Owner/entrepreneur
Others, such as director of customer
operations, mayor, academic university
professor, senior manager, resort…
Executive Manager (e.g. CEO)
Mid‐management (e.g. department head)
1
6
7
8
17
Basic education
Doctoral degree
Secondary school
Bachelor's degree or similar
Master's degree or similar
40 responses
39 responses


2.2.10 How many years of experience do you have in the following
categories?

Chart 13: Years of experience

The chart delivers insight into the job experience of the interviewees. The majority of
them have more than 6 six years of job experience in tourism, health, or destination
management.

5
1
4
11
1
8
5
17
2
4
2
14
Less than 1 year
1to 3 years
4 to 6 years
more than 6 years
Working in hotels / restaurants
Destination management or regional authority
Health related services such as (thermal) spa, public / private health care, etc.
39 responses


3 Stakeholder interviews part B – A qualitative
approach
3.1 Methodology
The development of the stakeholder needs analysis (qualitative questionnaire, part B)
was developed, beginning in October2012, by the university partners. There were three
feedback loops, involving all university partners and the industry partner CHC, for
ensuring the quality of the questionnaire. The final version was created in April 2013.
Part B was developed as a semi‐structured interview guideline consisting of 12
questions. The topics of the semi‐structured questions were:
 Terms and Definitions
 SWOT
 Role of nature
 Role of national / regional health policy
 Current situation in destination development
 Internal versus external resources in destination development
 Instruments to be applied for destination development
 Locals versus tourists
 Training and education on a destination level
 Future Markets

Through the development of a guideline which described the implementation and
analysis of the interviews in detail, standardization was ensured. In that way it was
ensured the method for conducting the interviews was the same in all partner countries.
This document “Notes for qualitative stakeholder needs analysis” was divided into three
sections:


 1. Conducting the interviews
 Preparation for the interview
 The interview itself
 How to get the data in analyzable form
 Data selection and analysis
 2. Interview Guideline
 3. Template for interview protocols (a form into which the transcription of an interview was
to be filled in).

Ten to eleven interviews were conducted by each WelDest partner. The interviews were
either done face to face or via telephone. The selection of interviewees was conducted
by every project partner (see chapter 2.1). The interviewees, chosen as experts in their
field, were first contacted via telephone or e‐mail to make an appointment for the
interview. Therefore, the experts selected comprised regional developers, hospitality
managers, health managers, local tourism managers, and policy makers on a national
level. The confidentiality and the anonymity of the data were assured to the
interviewees. Before the interview started the interviewees were asked to get
permission to audiotape the interview.
An interview guideline was used during each interview in which it was recommended to
use open questions and to avoid closed questions in order to keep the interviewee
talking.
The face to face interviews were recorded, transcribed and then translated into English
when needed. One protocol for each interview was compiled in English or German. It
was recommended to use an audiotape for writing the protocol to avoid a loss of
information. Furthermore, some basic information had to be gathered before the
interview started, such as the interview number, the interviewee (first name, last
name), his/her function, interviewee initial number (partner country, interview number;
e.g. AT1), date of interview, length of interview, and name of the interviewer. All teams
fed their interview protocols into Webropol to make them available to FHJ for analyzing.
The interviews were transcribed according to Froschauer & Lueger, 2003. Afterwards,
the categorizing of the data was done with aid of MaxQDA 2007 to ensure a professional
categorizing system. The Austrian transcripts were used to validate the categories of the
interview. This was to ensure a comprehensive system of categories (word‐clusters). In
other words: The Austrian transcripts were used as kind of a pretest. Additionally, the


categorization was discussed in a team meeting with all partner countries, with almost
all suggestions for improvement being taken into account. Then, the interviews from all
partners were categorized according to the same categorizing system.
Most of the interviews took about one hour. The shortest interview time was 30
minutes, and the longest interview took 2 hours.

3.2 Research results
Overall, 52 interviews were conducted (10 in Finland, Germany, and the United
Kingdom, and 11 in Austria and the Czech Republic) comprising 15 regional developers,
15 hospitality managers, 12 health managers, 8 local tourism managers, and 2 policy
makers.

3.2.1 Definition of a H&WB destination
The first question deals with the definition of a H&WB destination. About half of the
interviewees think that health and wellness are two different things. The term health is
attached more with sick people as medical issues, whereas wellness has a more holistic
view of the person, and comprises the body, mind, and soul. This holistic view is,
according to the interviewees, very important for H&WB destinations. Nevertheless,
most interviewees stated that expertise in medicine and health are core factors:
“If you talk about health tourism or well‐being tourism then there should be
evidence, something that “tastes” right, not only pampering as such. Well‐being
can be many things but in this, especially when discussing rehabilitation it has to
be real and true.” (FIN10, 7)

Core factors for the definition of a H&WB destination are wellness offers, possibilities to
relax, spa facilities, and well‐being. These are as important as expertise in medicine and
health. There can be a negative association with the term wellness because it is not
defined properly and almost all hotels use the term to market themselves.
When it comes to nature and environment, interviewees stressed the importance of a
sound, beautiful, clean nature and the use of local natural resources such as thermal
water for thermal baths, because they distinguish destinations from one another.


“Why should a guest even go to a thermal spa, because almost each higher
categorized hotel has all offerings that thermal spas have, too? And you get to
the point what a thermal spa is all about: It is the thermal water, which is simply
not available everywhere.” (AUT04, 9)

Another distinctive feature can be a unique offering of services, providing different
types of services and also a wide range of services. In order to be able to offer these
services, sufficient facilities are necessary. This also involves indoor and outdoor
activities like hiking, biking, going for walks or going to the gym, etc. Another important
aspect is to provide healthy food and also organic/regional healthy products. Not only
physical goods, but also the service attitude and the friendliness of the staff contribute
to an enhanced experience during a holiday in a H&WB destination. Qualified staff plays
an important role in the perception of the delivery of services for guests.
“Personally I can forgive small shortcomings in accommodation, but the way
people treat you, the cleanliness and the friendliness, the presence of flowers
etc. not really. Inner feelings and emotions are definitely decisive for clients, they
are absolutely essential.” (CZK08, 7)

Destinations should also take into consideration their historical values and culture which
they can identify with authenticity. Some interviewees stated that homogenous offers in
the destination help the guests to become oriented, and they function as a positioning
statement. The whole destination should offer a chain of services for the guests so that
they can experience their holiday as a complete package. Interdisciplinary co‐ordination
is necessary to achieve this goal.
Differences between the countries of the interviewees could be especially seen in the
following points: It seems that the Finns have a very holistic approach to wellness.
According to them, it should involve the body, mind, and soul of individuals, whereas
they associate health with medical services and recovering from an illness. For the other
countries this holistic approach is important as well, but Finns put a very high
importance on it. So there should be a distinction between the two terms „wellness“
and „medical,“ which the Austrian interviewees also put a focus on. As for the Austrians
and the Finns, the term wellness is quite imprecise and overused and should therefore
not be part of a definition of a H&WB‐destination. The British stressed that the term
H&WB is not understood in the UK as there is the term spa tourism, which is not directly


linked to health. Travelers normally have no associations with the term H&WB, but
understand the term spa tourism well.
If we look at the answers from the point of view of the various professions of our
interviewees, health managers put a strong focus on natural resources, nature, and
environment of H&WB destinations as well as medical expertise and wellness offers.
Hospitality managers are more service‐oriented and focus on well‐being offers. Regional
developers, on the other hand, emphasized the importance of a homogenous offer and
health‐promoting expertise. The chain of services is crucial to them. Local tourism
managers put a focus on well‐being and a holistic approach.

Summary
It seems that health and wellness are seen as two different things. Health is associated with
medical issues and wellness has a more holistic approach, at least for the interviewees. This
holistic approach is important for H&WB destinations, and competencies in health and
medicine are core factors for H&WB destinations. Other core factors mentioned include
wellness services, possibilities to relax, spa facilities, and well‐being.
The interviewees stressed the importance of a sound, beautiful, and clean nature as well as
capitalizing on local (authentic) resources. It seems to be necessary to offer different types
of services, and appropriate facilities are necessary, too. Service quality and friendliness
were also emphasized, as was the need for qualification.

3.2.2 Key service supply, resources, staff competencies and elements of
H&WB destinations
The second question is about the key service supply, resources, staff competencies, and
elements of a H&WB destination.
As far as the service supply is concerned, interviewees agreed that the offered services
have to be of high quality in order to satisfy the customer. There should be a broad
range of offers. According to the interviewees, a H&WB destination must provide well‐
being offers such as services for relaxation, beauty treatments, and spa procedures.
However, the same importance is attached to medical offers like rehabilitation,
prevention, and education in achieving a healthier lifestyle. Additionally, outdoor and
indoor sport activities were mentioned as key services of a H&WB destination. Another
issue is tailor‐made services for special interest groups. Extremely important for H&WB


destinations is the way the services are offered. There should be a network that
provides supporting products and services, so customers feel that the offer in the region
is homogenous and comprising. The chain of services is crucially important for the
experiences of the guests. As one Czech interviewee summarized:
“At the end of the day, health and well‐being are all about the services (…).”
(CZK09, 13)

The key resources of H&WB destinations evolve around the big topics of nature,
environment and landscape. These factors are seen as being very important to the
overall impression of the destination. Furthermore, natural resources available in
destinations should be used in tourism, for example thermal water for spa treatments or
regional and healthy products in restaurants. The other big topic for the interviewees in
this category is the facilities. Interviewees agreed that a minimum level of facilities in
H&WB destinations is necessary in order to deliver appropriate services. Most important
in this field are the facilities for well‐being, and spa facilities like pools, saunas, gyms,
relaxation, and treatment rooms.
“Definitely for me it’s the nature and natural conditions, for example forest,
river, clean mountain water and healing climate, and of course the landscape and
of course the facilities for doing activities, like hiking trails and trails for biking, in
the winter for cross‐country and other winter sports. In the same time the place
should be able to offer spa services starting from the bath and massages to spa
centers.” (CZK09, 10)

Crucial to H&WB destinations are the staff competencies. The offered services must be
delivered in a professional manner. Also very important is the qualification, training,
education and knowledge which they have obtained. All these things enable the staff to
be capable of delivering services of high quality. Almost all interviewees agreed on the
fact that social skills and the direct interaction with the guests are the key factors that
enhance the guests’ well‐being as well.
“I think that the human factor is crucial, I mean service standards, staff standards
and their ability to be affable. The education of people working in the field of
tourism is essential as well.” (CZK08, 7)


Another important aspect is the public transport system, which should be sufficient so
that guests can easily reach the destination and places of interest within the region. The
culture and heritage of the destination should not be left out, but rather included in the
packages, as guests are interested in the history and traditions of the locals. When it
comes to the positioning of the H&WB destination, it is very important to communicate
a clear USP. Guests want to know what they can expect from the destination and choose
the appropriate offering for themselves. This is explained in the statement below:
“If we talk about a USP, for example we are the health destination for weight
reduction; appropriate services like exercise should be coordinated. In other
words: specific joint‐friendly sports or also the facilities for example a lake or a
therapeutic bath where these things can be offered. The whole offer should be a
smooth concept, adjusted to the hotels with their programs, all factors that
influence the medical indications of diseases. (…) Target‐group‐specific offers
with target‐group‐specific staff in all areas.” (AUT08, 13)

Viewed from the point of view of the country and profession, there are some
differences. For the Austrian interviewees qualified staff is the most important key
competency of a H&WB destination. On the other hand, for the English, complementary
services (which do not belong to the core competencies) seem to be very important.
Hospitality managers put a clear focus on the quality of staff and customer service.

Summary
According to the interviewees the key service supply of a H&WB destination should be of
high quality and combine medical services with well‐being, relaxation, and spa offers. There
should be a network that provides supporting services and products to the guests.
Interviewees think that the key resource for H&WB destinations is nature and environment.
Natural resources like thermal water also play an important role. Sufficient facilities have to
be available to deliver the desired services to the consumers.
Professionally trained staff has to get adequate training and education in the core areas.
Most important to the interviewees are social skills.


3.2.3 SWOT Analysis of H&WB‐destinations
The third question dealt with a SWOT‐analysis of the interviewees’ own H&WB
destinations. Interviewees were asked to name the strengths (S), weaknesses (W),
opportunities (O) and threats (T) of their HW&B‐destinations. Many factors were
identified by the interviewees with the answers matching partly with the key
competencies of H&WB destinations.
The most important strength for H&WB destinations mentioned is a beautiful and sound
nature and environment, which have to be maintained as they can become a weakness
if they are not taken care of. The history, culture, and traditions of H&WB destinations
should be included in the tourism offers as it underlines authenticity. Good facilities
combined with accessibility and public transport are very important factors. Other
factors mentioned are the reputation of a H&WB destination, professional staff and the
preparation of relaxation offers.
“Strengths are the tradition, the location, the natural curative resources, the
human resources, their language skills somewhat, and the demand for the type
of service that we supply. Also the natural environment, which is relatively clean
(…)“ (CZK10, 13)

The weaknesses largely correspond with the strengths, which mean that if the strengths
of H&WB destinations are not taken care of, they can quickly turn into weaknesses. A
further point mentioned in the weaknesses is the positioning and marketing of a USP.
There was general agreement that too many destinations market themselves in the
same way, thus not being distinguishable from others. In part, this can be traced back to
a low level of co‐operation in the destination as well as to low financial resources.
“The weakness is the co‐operation between public, state, and local authorities.
Even among business units we are speaking different languages and we are not
setting the same goals. And every four years the authorities are changing their
priorities according to the political situation. It is kind of difficult. And I would say
that this is the obstacle to growth.” (CZK09, 13)

Regarding the opportunities of H&WB destinations, the biggest potential according to
the interviewees can be seen in attracting new target groups. Often, H&WB destinations
focus on strictly defined target groups which do not have enough potential. Also the


improvement of networking and co‐operation in the destination is seen as an
opportunity.
“(…) attract more people in a broader age range, but that is not easy because of
the competitors in the market and so on the other hand because of the
expanding number of people, because of the expanding part that is older in the
long run, a spa has this association with people who are older because this is
becoming such a growing part of the market.” (AUT05, 9)

The biggest threat for H&WB destinations according to the interviewees is the high level
of competition. Many destinations and companies link themselves with H&WB, which
could potentially also lead to an oversupply in the near future. For the interviewees
uncertainty is also associated with potential political friction or economic recessions.
The withdrawal of public financing for H&WB destinations, especially for health
tourism2
, is seen as big hazard because it is not clear whether consumers will be willing
to pay for health activities themselves.
“(…) potentially in a certain segment of H&WB tourism there is already a little bit
of an oversupply (…)” (AUT01, 13)

Austrian interviewees advance the view that prevention and medical services belong to
the biggest opportunities for the future development of H&WB destinations. Czech
interviewees think that the biggest weaknesses of their H&WB destinations are the low
service quality which results from a lack of qualified staff. For the British heritage,
history, and reputation are key strengths of H&WB destinations. Hospitality managers
think that qualified staff is the biggest strength of H&WB destinations.

Summary
This chart presents the SWOT Analysis of H&WB‐destinations from the interviewees.
Strengths Weaknesses

2
The treatments of which can be paid by the health insurance as it can be part of the health care
legislation.


sound nature / landscape / environment
history / culture / tradition
good facilities
reputation / image / brand
professional / qualified staff
accessibility / public transport
location
relaxation / health / retreat offers
unqualified staff
no positioning / marketing of a USP
weak facilities
weak public transport / accessibility
no networking in the destination
Unclean environment
low financial resources
Opportunities
enlargement of target groups / segments
networking / co‐operation in the destination
nature / natural attractions
differentiation / positioning
facilities and infrastructure (renewal, expansion
of both roads and public transport as well as spa
resorts)
Threats
high competition
political friction
economic / financial crisis or recession
withdrawal of state / public financing

3.2.4 Importance of nature/sustainability in H&WB destinations now and
in the future
The fourth question is about the importance of nature at present and in the future
(2020).
Generally, interviewees stressed that nature and sustainability are very important
aspects for H&WB destinations. The protection of the environment is a crucial topic
which should be pursued in the future. In general, interviewees think that H&WB
destinations are to make use of their local natural resources such as thermal water and
marshland for swimming pools and spa treatments (wrappings). According to the
interviewees, nature is one of the core reasons to travel to H&WB destinations and their
unique selling proposition (USP). Nature can also be used for outdoor activities like
hiking, biking and so on.
“(…) It’s extremely important to take care of ecology and nature now and it will
be even more important within ten years. Because if we’re not going to take care
of the nature (…) even within seven to ten years we will have nothing to offer. So
the more we take care of it now, the more we will be able to offer in 2020.”
(CZK09, 16)
On the subject of sustainability there was agreement that it is very important for H&WB
destinations in order to maintain the scenery and natural resources, although there is
mostly no sustainability codex applied in the destinations so far. Some interviewees put
a focus on local networks and the marketing of regional products.


“Sustainability is interpreted locally (…) as developing local partnerships and
supporting the rural economy. It is about developing links between wellness and
other products. It is about retaining a distinct local mix of shops and other
businesses. It is about integrating local products, especially local food to the
wider tourism offering.” (UK01, 16)

When asked about the future importance of nature and sustainability in H&WB
destinations, most interviewees said that the importance of these topics will increase.
Others stated that they will have the same importance in the future because these are
already now very important topics.

Summary
Nature and sustainability are both very important elements for H&WB destinations. They
can act as USP for destinations and core reasons for guests to travel to certain destinations.
Interviewees think that the protection of the environment is crucial in order to be able to
offer outdoor activities. This should be underlined even more in the future. Natural
resources such as marshland can be used for spa treatments in tourism offers.
The importance of these two elements is already very high in H&WB destinations and
interviewees think that this will probably increase even more in the future.

3.2.5 Role of national/regional health policy in H&WB destinations now
and in the future
The fifth question is about the role of national / regional health policy in H&WB
destinations at the moment and in the future (2020).
Interviewees think that the political influence on H&WB destinations largely depends on
the services available. Destinations concerned with offering cures3
and medical

3
The Central European concept of „Kur“ (nowadays called ambulant prevention) is part of the preventive
health care at least in the German speaking countries which aims at subsidizing treatments in health spa
centers to maintain the ability of employees to work. Thus, “Kur” does not mean curing from a surgical
and clinical point of view but is based on treatments using natural remedies such as healing water or
healing climate.


treatments for example have bigger connections with health policy than destinations
operating with well‐being services. About half of the interviewees stated that politics
play no significant role in their destination, but almost the same number said that health
policy has a big influence on the development of their destination. Some also agreed
that politics does have some impact on them, if not largely.
“Health policy, of course there is a connection, that is without question (…)“.
(AUT11, 42)

On the contrary, a Finn and an English interviewee said:
“I cannot say more to regional health politics – we are not that medical, that it
would reflect on us. (…).” (FIN09, 19)
“There has been no contact between tourism and the health authority, no
mention of tourism in the (…) health strategy.” (UK05, 19)

Most destinations are familiar with some sort of subsidies, financial aid or co‐payments
by the government or health insurance companies, which have just as large an influence
on the type of guests as on the treatments and the qualifications of the staff. For the
future, interviewees think that health policy will have a big influence on cuts in
subsidies. More prevention offers in the future are desired, but it is unclear whether
politics will support these services or not. Generally, interviewees wish to have more co‐
operations with health policy in the future.
“(…) so the key here, it seems to me, is that national and regional health policies
become more orientated to prevention that’s to be driven by economics. It won’t
be possible anymore to focus on treatment. There is much too little emphasis
upon Austria’s health policy now, and the same for regional policy in the
location, and they are directly connected with one another (…).” (AUT05, 17)

Again, there are some differences between the countries concerning the importance of
health policy. The Finns and Austrians largely agreed that health policy influences their
H&WB destinations while Czech and British interviewees think that it doesn’t influence
their destinations a lot.


Summary
The influence of health policy on H&WB destinations depends largely upon the offered
services. Destinations focusing on medical procedures or cures have more connections with
health politics than destinations with well‐being offers. Nevertheless, almost all H&WB
destinations are familiar with some sort of financing through the state or health insurance
companies.
For the future, interviewees think that politics will have a bigger influence on H&WB
destinations and hope that more preventive services are offered. Interviewees also seek
more cooperation between the public and private sectors.

3.2.6 Destination development now and in the future
This question deals with the topic of destination development in general. It has a focus
on the current situation and future development of H&WB destinations.
Most interviewees think that co‐operation, partnerships, and networks support
destination development in a positive way. Common destination planning and
development are seen as improving the performance of destination for tourists and
politicians, if the latter ones officiate in a fluently communicating and conflict‐free
destination. According to the interviewees, many of their H&WB destinations have
developed their tourism product recently. Infrastructure and facilities are another issue
for H&WB destinations as they should satisfy customer needs. Interviewees also stated
that a focus was put on the marketing and positioning of the destinations. Regular
meetings are held to ensure co‐operation and planning.
“(…) health and wellness is clearly being seen as an important development
opportunity for destinations. (…).” (UK04, 22)

The interviewees also had some negative associations with the current destination
development. The biggest limiting factors for H&WB‐destinations at the moment seem
to be financial factors. Many wish for more financial support from government and feel
a big influence from the current recession. Some regions also miss co‐operation from all
stakeholders and feel that there is a lack of networking. Other negative factors


mentioned are political frictions and a lack of time for appropriate destination
development.
“(…) in this recession the development of the destination is pretty small, so
basically we just try to survive the competition and the recession.”(FIN05, 22)

In the future, interviewees stated that their H&WB destinations plan to invest in their
facilities both on maintenance and construction. Many of the interviewees also hope
that co‐operation and networking become bigger topics in all regions in order to
enhance destination development. A focus will be put on H&WB offers and, generally,
services will be diversified in order to attract more market segments. For some the
protection of the local environment is the most important aspect in the future
development.
“As an example every company is trying to understand how to attract more
foreign visitors, instead they should do it together and they could offer bigger
entities that would attract more than a single company offering.” (FIN03, 22)

Looking at the question from the point of view of different countries, a difference can be
seen concerning the Czech interviewees. For the Czech interviewees the presence of a
destination management organization (DMO) is a very important aspect in destination
development, and should be further enhanced in the future. Other countries did not put
a special focus on this subject.

Summary
Common regional planning and acting is seen as improving the performance of destinations
for both tourists and politics. Many destinations have recently developed their facilities and
the range of services offered to attract more consumers. According to the interviewees,
marketing and positioning are both attached with the utmost importance.
Interviewees think that the biggest limiting factors for current destination development are
financial issues, mostly due to recession.
Future development is aimed at improving facilities and the co‐operation and networking in
the destinations. The range of services will be diversified.


3.2.7 Resources in destination development
This question discusses whether internal (endogenous) or external (exogenous)
resources should be exploited for destination development. The general agreement of
interviewees is that a mix of external and internal resources is vital to destination
development. It is very important to make use of external resources, too, such as
consultants or market research data. This also includes the monitoring of tourism trends
and an examination of science and current research. Interviewees think that the
government and public sector have a large influence on destination development
because they predetermine many aspects of H&WB destinations, for example certain
regulation about hotel categories or health offers.
“(…) there needs to be a mixture of both, active participation of the locals but at
the same time external experts, that means a combination of both (…).” (AUT08,
38)

From the internal point of view, interviewees think that it is very important to gain ideas
for development internally and also make decisions internally, but with the help of
external consultants. Local co‐operation and partnerships can also foster development
and help to work towards a common goal. In this context, stakeholder management
plays a central role. Some H&WB‐destinations are guided by a DMO and feel that this
guidance is very helpful for the development.
“We work with a destination management organization very closely; we have
representation on the board. We take advantage of what the DMO is doing. We
communicate, offer proposals to their strategies, we meet. They do it well, and
they‘re interested in opinions from the field.” (CZK06, 25)

Concerning external resources, most interviewees stated that they have used external
consultants in their destination development process so far to get an outside view. The
examination of best practice examples and benchmarking is very common and provides
them with new ideas. The interviewees stress that memberships in different
associations and organizations also contribute to the conflux of external knowledge
which has to be exchanged systematically within the destination. Most interviewees said
that their H&WB destinations are familiar with external investments.


“(…) we try to get the influence from elsewhere because otherwise we have the
cave effect; we only see the shadows but do not see what is happening out
there.” (FIN05, 22)

Summary
According to the interviewees, a mix of external and internal resources is vital for the
development of H&WB‐destinations. Current tourism trends, research, and science should
be monitored to be able to react to changes in customer behavior etc. Interviewees think
that government and the public sector have a big influence on their H&WB destinations as
they predetermine certain regulations.
Interviewees feel that internal ideas should be supported by external guidance and local co‐
operations and partnerships. The presence of a DMO facilitates the development of a
H&WB destination.
The H&WB destinations are familiar with the use of external consultants and external
investments for the development of their region. Examination of best practice examples
and benchmarking is a common feature as well as membership in organizations.

3.2.8 Processes in destination development now and in the future
Question number eight is about the processes used for destination development now
and in the future.
Currently, most interviewees said that they use regular and personal communication in
meetings to develop their destination. Also the co‐operation of stakeholders is a
common tool used for the development of H&WB‐destinations, and co‐operation
between the public and private sectors is vital as well. Interviewees develop their
destinations with the aid of various platforms such as forums, membership
organizations, and associations. Other points mentioned are on‐going research and the
monitoring of tourism trends, as well as promotion and marketing of their H&WB‐
destinations.
“Attend exhibitions, conferences, networking events, trade publications. Discuss
new product development with other companies. Owners travel abroad for ideas
regarding key and emerging trends.” (UK09, 32)


For the future, interviewees think that local guidelines for co‐operation will be the most
important instruments for destination development. This includes the continuous
involvement of locals in the decision‐making processes. Important points that will
remain in the future, according to interviewees, are market‐research, trend analyses,
and also the marketing of H&WB destinations.
“Developing local partnerships is the key to any future success. There is a close
working relationship with local businesses (…).” (UK01, 28)
Summary
Most interviewees said they use regular, personal communication to develop their
destination. Another common tool for destination development mentioned by the
interviewees is the co‐operation of stakeholders and the public and private sectors.
According to the interviewees, various platforms as well as market‐research and
marketing are used for destination development.
Interviewees think that in the future co‐operation on a destination level will be the most
important process for destination development. This also involves the participation of
local inhabitants. Research and marketing will remain important in the future.

3.2.9 Balance between needs of tourists and needs of locals
This question deals with the balance between the needs of tourists and the needs of
locals.
The interviewees’ opinions vary largely on this topic. About half of the interviewees
think that the relationship between tourists and locals is problematic, but the other half
thinks that there are no conflicts between tourists and locals.
“Finding the balance is very challenging! I feel however, that the local inhabitants
are positive about this; what is good for tourism is good for the locals, too. But
we would need to give them more information about what we do and use them
in the development and raise their status, increase their role in the
development.” (FIN01, 34)

There is general agreement that the facilities and the range of services should be for
both groups and that facilities are improved regularly. Locals should participate in
tourism development, being able to advance their opinions. Furthermore, interviewees

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