Facing the future with Jerusalem’s ultimate gift

No physician, nurse or hospital administrator in this country could deny that the Hadassah Medical Organization (HMO) is the wellspring of Israeli healthcare and that Henrietta Szold and the Hadassah Women’s Zionist Organization of America she founded 100 years ago were its trailblazer.

In pre-state Israel and for decades afterwards, Hadassah’s medical institutions were unique in the country’s healthcare system.

Last week, 1,500 of HWZOA’s 330,000 members and supporters (led by national president Marcie Natan) came to Jerusalem from all over the US to dedicate the magnificent, 19-story, $363-million Sarah Wetsman Davidson Hospital Tower, which is gradually replacing the Ein Kerem campus’s orange brick-faced inpatient facility. Overcrowded, inadequate and deteriorating, the old hospital building – which opened to much fanfare in 1961– is due eventually to be renovated and used for outpatient purposes. The new edifice was planned over a decade by the HWZOA and longtime HMO director-general (and now National Insurance Institute director-general) Prof. Shlomo Mor-Yosef to serve the public for at least five decades.

Ein Kerem’s tertiary Hadassah University Medical Center and its community hospital on Mount Scopus have a total of 1,000 beds in the capital, while the Ein Kerem campus also includes the Hebrew University-Hadassah Medical School and schools of nursing, public health, dentistry, physiotherapy and occupational therapy. As it is, more than a million people are treated annually in over 120 outpatient clinics and over 70 departments and specialized units.

“This new building is the HWZOA’s ultimate present to Jerusalem and the whole country,” said Prof. Ehud Kokia, an obstetrician and fertility specialist who succeeded Mor-Yosef at HMO almost a year ago. “I am very excited, looking at last week’s events with a perspective of Hadassah’s first century.”

He adds that due to Mor-Yosef’s devoted work bringing it into fruition, “the building is registered in his name.”

Every few weeks, a new unit or department moves into the tower, and all should be in place by 2014. The planning for the city-like structure, with tens of thousands coming every day, was “excellent. We have had very few problems with the new building.”

But even though the tower will be a boon for the medical center and HMO doctors and scientists conduct half of all medical research in the country, HMO is not now in a league of its own.

“I agree that Hadassah’s university hospitals are no longer unique,” concedes Kokia in an interview in his office with The Jerusalem Post.

Ein Kerem was the first medical center in the country to implant stimulators and pacemakers into the brain, perform brain catheterization, use a surgical robot, make pathfinding discoveries in the field field of human embryonic and adult stem cells and the experimental use of some stem cells to treat devastating diseases like ALS (amyotrophic lateral sclerosis).

“But we are among the top five, which also includes Tel Aviv Sourasky, Sheba, Rambam and Soroka Medical Centers,” says Kokia, who was previously director-general of Maccabi Health Services – the second largest health fund, responsible for providing healthcare to a quarter of all Israelis.

“Hadassah’s medical centers remain on top in numerous fields. Now that we have dedicated the hospitalization tower, our aim is to restore HMO to being unrivaled among the country’s medical centers. It can’t be done in a day or a year. We have to cultivate the younger generation of physicians.”

Thus, given the country’s shortage of physicians in a growing number of fields, the most promising medical residents – who study specialties in teaching hospitals – are eagerly sought by HMO.

“The most senior hospital department heads will leave within a decade, so when considering the future, we have to attract the best who are in their 30s or 40s,” the directorgeneral said. “When I came to Hadassah – and I really had little contact with the organization before – I heard that residents didn’t want to come here, and that some who were already here were not very satisfied.

Jerusalem was not attractive for most medical residents and nurses because they prefer the lifestyle and location in the Tel Aviv/Hasharon region.”

Most medical residents had never lived in Jerusalem. With half of them being women, they want a family life after work. For a resident to move to the capital, there has to be employment for the spouse, affordable housing and good schools for their children, explained Kokia, who now allows those who insist on it to live outside the city instead of close to the hospital and gives an allowance for car expenses.

After investigating the situation, Kokia created a team headed by HMO deputy directorgeneral Prof. Shmuel Shapira and a senior manpower official. On September 1, he initiated the Eitam Program, named in memory of the esteemed Hadassah pediatric oncological surgeon Dr. Eitan Gross, who died suddenly while at work a few months ago and is deeply mourned by his colleagues.

Every Hadassah medical resident is given a mentor to solve problems. New channels of communication and feedback, says Kokia, were establishment, and medical journal clubs to discuss the latest research were activated.

“I meet all the new residents on their first day at work and present each one with an iPad to help their work and show we want them.”

He invites every new resident into his office for a welcome.

THE HMO director-general was born in the old Jaffa Road building of Sha’are Zedek Medical Center (SZMC) and raised in the Mahaneh Yehuda market area, but he studied medicine at Tel Aviv University and left the capital for his military and medical careers. Kokia joined the academic service (Atuda) in the IDF, studying medicine at TAU’s Sackler Medical Faculty.

Later, he completed a two-year fellowship in fertility at the University of Maryland and graduated from the US Navy/Air Force’s rigorous aeronautical medicine course in Pensacola, Florida. “I took the advanced flight surgeon and survival course in 1990. For a Jerusalemite who didn’t know how to swim at 40, I had to swim a mile with my boots on. That I passed is one of the things in my life of which I am most proud.”

During his military service, he served as commander of the Israel Air Force’s aeronautical medicine center. In 1995, after returning to civilian life, he joined Sheba Medical Center at Tel Hashomer. Then Kokia was hired by Maccabi and served in a variety of positions, including head of the Negev district, director of the medical branch and, most recently, as head of the health division, which is the highest position below the director-general.

So when he arrived in Ein Kerem last fall, he really didn’t know Hadassah, and he still drives to work daily from his home in Yavne.

Kokia admits that he still gets lost when going to about 10 percent of the campus, but he’s learning.

“I had a good time at Maccabi,” he says, “There were many successes there.” But after 17 years in the health fund, which has some 6,000 employees, the now 62-year-old medical administrator thought he should try a new challenge. When offered the HMO post, “I asked for two weeks to think but I actually decided in two hours. I thought it would be worthwhile.”

Going from a major health fund to HMO, he found himself switching sides. Health insurers aim to provide the best care for their members while cutting cost to be more efficient and reduce deficits. One health fund competes with the other to get the highest discounts from the medical centers for treating members. But at Hadassah, Kokia must provide the best care for inpatients and outpatients and be responsible for research and teaching.

“In the hospitals, there are much more heroics and glory. You walk into our trauma unit and see lives being saved,” he says.

HMO has some 5,000 employees – 800 physicians, 2,200 nurses, 500 paramedical and 1,500 support staff. “It is more intimate than a health fund, where the responsibility is huge, nationwide and much broader. At Maccabi, daily work was more routine and bureaucratic and more distant from patients,” he says.

Now with experience on both sides of the divide, Kokia has an integrated viewpoint.

“There must be more cooperation between community health facilities and the hospitals, and I am glad,” he continues, “that Health Ministry director-general Prof. Ronni Gamzu has initiated a project to promote better communications between them about patient care.”

In recent years, some Hadassah senior physicians have had a reputation in the public and among doctors in other institutions of being more arrogant than compassionate.

“I know what has been said about Hadassah physicians,” says Kokia. “I have become familiar with them now. It was true in the past, when Hadassah-Ein Kerem was by far the hospital. It remained for a time after it was no longer absolutely unique. But in discussions with me, young new directors are more modest. Being a mensch is a key factor in being hired now. We all have to work hard to say we are the best.”

HMO’S FINANCIAL problems has been in newspapers for months, as the HWZOA transfer of funds from New York to Jerusalem has been significantly reduced and a NIS 200 million deficit has piled up.

“The whole healthcare system in Israel,” Kokia responds, “is in deficit. We have extra responsibilities here, as we run with the medical school the Hebrew University, and there is an academic agreement that gives special benefits to senior doctors. The lack of attractiveness of Jerusalem to doctors and nurses weighs down on us. We have the only neurosurgery department and transplant center, the only tertiary trauma center in the city. All of these cost money.”

In addition, HWZOA is coming out from under the world economic crisis and the Madoff affair, in which it lost $90 million.

But it still covered the bulk of the cost of the hospitalization tower, with – for the first time for the voluntary medical center not owned by the government – $15 million in state aid.

Kokia says: “We are in negotiations with the workers. We are not talking now about dismissals, but reducing salaries, one to four percent depending on their salaries. I have already said that my salary will be cut by 1% more than anyone else.”

Thus it was surprising that after a decade of HMO and Sha’are Zedek having a quiet understanding that neither would seek control of the financially ailing Bikur Cholim Hospital in the center of town, Kokia initiated a bid to persuade the government that it should run it as a third hospital branch. In the interview, he said he was unaware of the fact that the government gave SZMC the nod to apply for taking over Bikur Cholim and running it, something that SZMC directorgeneral Prof. Jonathan Halevy told his board of governors had only a “50-50 chance” of happening.

Kokia also did not accept Halevy’s statement that his own 730-bed institution has been declared by independent comparative statistics to be the capital’s largest and most medically active hospital – significantly ahead of Hadassah in Ein Kerem or its sister hospital on Mount Scopus. But the Hadassah d-g did not explain why, in figures.

“We are trying to increase the number of obstetrics deliveries [which are profitable because each one means a National Insurance Institute payment rather than per diem hospitalization fees].”

But it would have to work very hard at this, as Hadassah competitor Sha’are Zedek already has three times more deliveries than any other hospital in Jerusalem and more than any other in Israel; and 100,000 emergency room visits in 2010, compared to 75,000 in Ein Kerem and 60,000 on Mount Scopus. The number of SZMC newborns is three times that of any other Jerusalem hospital and the highest in the country, now surpassing Beersheba’s Soroka University Medical Center. HMO could only be envious of Halevy’s statement to his board that he expects within a year or so to eliminate SZMC’s small deficit and will no longer have to use donor money for day-to-day hospital functioning.

Kokia regrets that in the past, HMO was not always able to keep its medical “stars” on board, and they went to SZMC or other hospitals.

“There are financial limits I can’t go beyond, but we are doing everything to make the ‘stars’ feel wanted and get advancement so they will remain with us,” he said.

As for suggestions that HWZOA will eventually become weakened and its membership and financial support shrunken by assimilation and intermarriage that are affecting all secular American-Jewish organizations, Kokia declares: “I think it’s a strong organization. It is deep in considering the future generation of members, and it has to be made more appealing to them. But I have no solution for the problems of assimilation.

I believe that after 100 years, HWZOA will find its way in the new world. The women are very creative.”

Asked to predict what will happen at HMO in 25 years, Kokia is optimistic.

“Patients and staff with be fully enjoying the hospitalization tower, and, I hope and believe, it will be the leading medical center in Israel and among the best in the world in the high quality of its clinical services and of its staff, and with economic security. That is enough of a wish to make.”