Ichilov hospital and Sourasky Medical Centre in Tel Aviv..
(photo credit: WIKIMEDIA COMMONS/GELLERJ)
The significant improvement in the last three years – especially in 2015 – of 19 published health indicators in the country’s hospitals and other medical institutions proves informing the public of their performance gets them to do better.
This is a major conclusion that can be reached from perusing the 250-page Report on the National Program for Quality Indices in Israeli Hospitals released by the Health Ministry at a conference on Wednesday and due to be published soon (in Hebrew) on its website at www.health.gov.il. It also set down its official performance targets for all institutions.
The idea that hospitals’ performance – as reflected by how well their staff repair fractured hips after falls (to reduce deaths from complications); prevent infections by giving antibiotics to patients being operated on; perform CT/MRI scans soon after stroke patients arrive; do heart catheterization within 90 minutes of hospitalization for coronary infarction; and assess pain, among other things – was initiated by then-ministry director-general Prof. Ronni Gamzu, who is today director of Tel Aviv Sourasky Medical Center (which generally did very well in the comparison).
The indices project is headed by Dr. Anat Aka-Zohar, the ministry’s quality control director.
In carrying out catheterization within an hour-and-a-half of heart attack patients’ arrival, progress was clear, as 68 percent of all hospitals accomplished this in 2013, 79% in 2014 and 86% last year (compared to a 96% average in US hospitals).
High ratings in a small hospital, however, does not necessarily mean it generally performed better than large tertiary teaching hospitals, as the latter have heavier patient loads and deal with more complex cases.
Other indices measured whether doctors and nurses recommended taking low-dose aspirin to heart attack patients and gave anti-clotting (tPa) treatment after a stroke and deep-vein thrombosis.
A total of 117 medical institutions, including ambulance services and vaccinations in well-baby (tipat halav) centers, were included in the survey, and dozens of leading professionals around the country took part. The document also looked at differences in treatment between men and women (indices were generally lower in women).
Psychiatric hospitals were assessed for preparing a treatment program within five days of a patient’s arrival; assessing risk, setting follow-up appointments for the discharged, and handing them with detailed summaries of their condition.
Geriatric institutions were marked for carrying out assessments of patients’ nutrition, pain and functional independence measurement (FMI).
Before the assessment was first performed, hospitals preferred to keep their performance ratings secret, and the ministry did not require them to quantify and reveal them to the public. But this time, even before the 2015 report was officially published, various hospital spokesmen sent to health reporters press releases praising their institutions.
For example, Clalit Health Services’ Kaplan Medical Center in Rehovot boasted: “Do you live in the Coastal Plain or the South and think you have suffered a heart attack? Come to Kaplan! Don’t hesitate. We scored 93% on giving catheterization within 90 minutes, the highest on the Coastal Plain and the South and the second-highest of all general hospitals in the country.”
Clalit’s Meir Medical Center in Kfar Saba said for the second time in a row, it took first place among two dozen general hospitals for several health indices – not only in treating heart attacks but also in conducting nutritional assessments among all elderly patients it admitted.
The Hadassah Medical Organization maintained that its two Jerusalem hospitals “led” in targets of indices – “all of them above the national average.”
Shaare Zedek Medical Center in Jerusalem director-general Prof. Jonathan Halevy praised the indices project, saying that it is one of the most important changes in the history of Israeli medicine. It has had a major effect in improving hospital performance, and publication of the results pushes the institutions to improve. He added, however, that beyond the dozens of procedures that are quantifiable, there are hundreds more that can’t be measured, including compassion for the patient. But this, continued Halevy, “does not minimize the great accomplishment of the indices.”
The state-owned Tzrifin Assaf Harofeh Medical Center showed “outstanding” results in six indices and one of 100% in another index, topping the country.
The program was expanded to 19 parameters from the handful examined in 2014. In addition, said Health Minister Ya’acov Litzman and director- general Moshe Bar Siman Tov, it included the geriatric hospitals (four indices). The aim was to find weaknesses in the hospital system and make services more accessible and transparent, Litzman said.
The ministry reported that the medical institutions’ implementation of recommended procedures had risen significantly, as the assessment of indices in the US and Europe had previously pushed their hospitals – some of which receive financial bonuses – to improve.
Most Israeli hospitals scored high in some indices and lower in others. Sheba Medical Center’s geriatric institution at Tel Hashomer, for example, scored 99% in assessing pain, but only 27% in functional independence measurement.