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Assuta Ashdod University Hospital.(Photo by: EYAL TOUEG)
Assuta Ashdod University Hospital's integrated care model makes health system history
By MAAYAN HOFFMAN
09/25/2017
“This is one of the most important modern Zionist projects in Israel and the most dramatic event in the Israeli health system in decades,” said Prof. Joshua Shemer, chairman of Assuta Medical Centers
On the Mediterranean coast of Israel, halfway between Tel Aviv and Gaza, Ashdod appears a tourist magnet with its sailboats and yellow sand dunes.

Yet only a few years ago, during 2014’s Operation Protective Edge, Israel’s fifth largest city was the landing pad for 239 rockets launched from Gaza.

In July 2014, a rocket hit a gas station in Ashdod, setting fire to an oil tank, and its explosion seriously wounded a man. One month later, a rocket exploded in the playground of a kindergarten. And there were countless other incidents.

The city’s 250,000 residents (500,000 if you include those living in the surrounding area) – families of low socio-economic status but rich with diversity, as immigrants hail from 99 countries – suffered through the war with no hospital. Those injured by shrapnel, experiencing post-traumatic stress disorder, or simply delivering a baby or enduring cancer treatment, were forced to travel nearly an hour or more to the nearest hospital for treatment. Ashdod was the only one of Israel’s 10 largest cities without a hospital.

Now that situation has radically changed for the better.

A new public hospital has opened in Ashdod.

Assuta, owned by Maccabi Healthcare Services, the second largest non-profit HMO in Israel, won the tender to build the university hospital -- the first public hospital to be built in Israel in 40 years.

“This is one of the most important modern Zionist projects in Israel and the most dramatic event in the Israeli health system in decades,” said Prof. Joshua “Shuki” Shemer, chairman of Assuta Medical Centers, who was recently named among the top 100 most influential Israelis by the Hebrew-language daily business newspaper The Marker. “The hospital will set new standards for care in Ashdod and in all of Israel.”

The new Assuta hospital created a unique, game changing model for population health management and integrated care: the deliberate organization of patient care activities between two or more providers – saving lives, improving patient outcome and increasing efficiency.



Shemer explained that generally when a hospital makes referrals out to larger community health fund providers or vice versa, the flow of important information is frequently mishandled or takes an inordinate amount of time to produce. He estimates that as many as 30% of all medical activity conducted by hospitals worldwide is unnecessary, costing the system money. Individual patient care suffers and community health is reduced. In contrast, the Assuta Ashdod University Hospital model, takes a comprehensive integrated care, whole-person approach.

“You will see a continuous flow of information from the hospital to the health funds and the community, including the welfare department and National Insurance,” Shemer explained. “A doctor will be able to open up his or her computer and in one electronic health record see all the information on that patient. A case manager in the hospital will coordinate patient care, from the ER to other hospital departments and after the patient is discharged.”

The case manager will be able to see gaps in care that could affect the health status of the patient and track his or her care team to help ensure the right individuals are involved in supporting the improvement of the person’s overall health. Doctors will be able to more effectively track changes in a patient’s condition as the individual moves throughout the healthcare ecosystem. The closed-loop referral process will help ensure that care referred is care that occurred.

“Bottom line, we’re talking improved efficiency, quality, safety and cost of patient care,” Shemer said.

To make it work, Assuta Ashdod recruited 250 of the country’s top physicians and a team of 500 nurses. Many of the medical staff will be commuting from the center of the country, but some are locals. Assuta Ashdod is likewise striving to recruit physicians and nurses from other countries, and specifically is searching for anesthesiologists to join their team.

“They like the vision of this hospital,” said Shemer, referencing Assuta Ashdod’s style of care and its purchase of the most up-to-date medical equipment. “They know that working at our hospital will help build their careers as much as they will help build the facility.”

Dr. Debra West will serve as the head of the hospital’s Emergency Department. She said Assuta Ashdod “has the feel of a startup, where innovation and creativity are embraced.”

West told The Post that Assuta is leveraging best practices from overseas that should optimize the flow of patients through the Emergency Department to reduce overcrowding and waiting times.

This is a big shift in the Jewish State, where by conservative estimates there is a shortage of 3,000 public hospital beds and patients are often cared for in hospital corridors. West’s Emergency Department will not be divided into surgical, internal medicine and orthopedic departments, as is traditionally seen in other hospitals. Rather, all patients will be seen in the same treatment areas and cared for by the same staff, divided according to urgency alone.

“It is the beginning of the fulfillment of a dream,” West said. “In a new hospital with a hand-picked team, mentorship from executive management and close support from the other departmental heads, we have all the elements for success. I believe we can finally build an Emergency Department that provides integrated care to all of the patients who come through our doors.”

Assuta Ashdod is establishing centers of excellence that combine the most advanced medical technology with the personalized, superior care consistent with Assuta’s known standard for excellence.

With the Community Cancer Center’s two linear accelerators, cancer patients will be able to undergo extremely precise high-dose radiotherapy treatment that can replace surgical procedures. The Community Heart Center’s catheterization unit will help reduce heart attacks by 50 percent and save innumerable lives with the seamless integration of speed, technology and medical skills, and the IVF unit will allow many to realize their dream of starting a family.

The hospital’s 750,000 square feet physical facility – a nine-floor inpatient hospital building and a seven-floor outpatient clinic, connected by a four-story, light-filled entrance lobby – is also stateof-the-art.

Assuta Ashdod is the first fully rocket-proof Israeli hospital, built with a unique bomb-shelter designed to withstand missile attacks. It is also chemical and biological weapons-proof. In the event of another Protective Edge or other major attack, “we could continue to work without evacuating a single patient – everywhere in the hospital, from the Emergency Department, to the operating rooms, to all of the wards,” Shemer said.

When building the hospital, special attention was also paid to being environmentally conscious.

The facility meets voluntary Israeli green building standards for design, construction materials, and heating and cooling systems. A healing garden offers patients and their visitors respite.

Finally, Shemer said, Assuta Ashdod focuses on the dignity and privacy of its patients. One-third of the rooms are private and the other two-thirds allow only for double occupancy. In the ER, beds are separated by walls instead of curtains to maximize privacy and help deter the spread of infection.

“Every patient should be treated as though he or she is a family member, with empathy and compassion,” said West.

Shemer noted that Assuta Ashdod will serve as a teaching hospital, collaborating with Ben-Gurion University of the Negev. It is likewise poised to take Palestinian patients from nearby Gaza.

Though construction of the new hospital is complete, Assuta Ashdod is opening its departments gradually to monitor and ensure success. Outpatient departments started taking patients in June and operating rooms in August. This month, the children’s and cardiology departments began work.

In October, Shemer said the maternity ward will begin delivering babies, and with the opening of the emergency room, in November, the hospital will be fully operational.

The project cost more than NIS 1 billion ($275 million) to construct. Assuta Medical Centers invested over NIS 300 million and the government provided a NIS 900 million grant. Shemer said most medical organizations did not want to take on the project, because “it is overwhelming to build a hospital from scratch.”

But Shemer said he could see no better way to give back to his country. Assuta Ashdod will infuse 1,200 new jobs into the city and, in his words, provide a service that, put modestly, is long overdue.

The Hospital’s commitment to provide the best health care possible is an expensive one, and Assuta is reaching out to donors to partner in transforming healthcare in Israel. The initial response has been positive; the hospital has raised over $10 million in the past few months.

“This is going to promote and upgrade the city of Ashdod,” said Shemer. “It’s a historic event in the health system in Israel.” 
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