A legacy of excellence and compassion

After 38 years at Hadassah, from student to director-general, Prof. Mor-Yosef has left an indelible mark on public medicine in Israel.

By JUDY SIEGEL-ITZKOVICH
Prof. Shlomo Mor-Yosef 311 (photo credit: Judy Siegel-Itzkovich)
Prof. Shlomo Mor-Yosef 311
(photo credit: Judy Siegel-Itzkovich)
It was the first time he sat in his spanking-new but temporary office – so pristine that pictures and coat hangers had not yet been hung – the first to open in the hospital tower he and his colleagues initiated almost a decade ago. During an early Monday morning interview with The Jerusalem Post and short tour of the entrance that now unifies the Hadassah-Ein Kerem campus, numerous passersby shook his hand warmly and wished him well.
“I already miss him,” one employee said later, “and he hasn’t even left.”
In 17 weeks, the Sarah Wetsman Davidson Hospital Tower will begin to accommodate patients, replacing the orange-brick structure that has been a Jerusalem landmark and Hadassah-Ein Kerem trademark since 1961. The 14-story tower opens on March 19 to mark the centennial of the Hadassah Women’s Zionist Organization of America (HMZOA).  Prof. Shlomo Mor-Yosef, the highly respected director-general of the Hadassah Medical Organization (HMO) since 2001, will then say farewell to the Ein Kerem and Mount Scopus campuses that bear his personal imprint.
Prof. Ehud Kokia, until recently director-general of Maccabi Health Services, has taken up the reins. Kokia will launch his own era, including the 21st-century, 530-bed hospital in Ein Kerem that will serve Jerusalem, the country and patients from around the world for many decades to come.
“I was born at Hadassah; I studied medicine at Hadassah; my wife Dina gave birth to our children at Hadassah, and our grandchildren were born here; my family receive medical treatment at Hadassah; my daughter, Irit, is a nephrologist in the Ein Kerem hospital. Hadassah has been my home for the last 38 years,” said Mor-Yosef in the temporary office.
“It has been almost 10 years since we initiated the hospital tower project. We have met the timetable and are on budget,” despite the unprecedented 2008 financial collapse in the US and the Bernard Madoff Ponzi scheme scandal that left HMZOA bereft of NIS 90 million in bad investments.
He pulled out a planning book he and his staffers presented in 2003, that has been followed almost to the letter.
“There were other options to improve the facilities here, but we decided to do this, which was the most expensive option but in the long term the right thing to do,” Mor-Yosef recalled. Its 14 above-ground floors and five below cover 111,111 square meters and cost $350 million, including equipment and furnishings. Eighty-eight percent of the costs were raised by the HWZOA, with the rest – unprecedentedly for a Hadassah capital investment project – provided by the Treasury.
“I spoke to [then-prime minister Ehud] Olmert and [then-finance minister Binyamin] Netanyahu... and told them I don’t want to raise funds for this abroad if the state doesn’t show a commitment. Both agreed. The government made allocations according to the progress in building.”
About 150,000 tons of concrete and vast amounts of glass were used to build it, and 550 construction workers were employed by the project at its peak. More than 1,000 Hadassah staffers – doctors, nurses, engineers, technicians and others – were involved in the process. The new tower will offer 24 operating theaters, 20 elevators, spacious one- or twopatient rooms, advanced computerization, e-mail messaging between doctors and patients and cooked, chilled and heated meals ordered according to individual choice almost at any time of the day or night.
But Mor-Yosef, a soft-spoken and modest man, noted that the magnificent tower is not the biggest success of his HMO management career.
“It is the creation of an atmosphere of excellence and identification with the institution and cultivating compassion in the staff. It is emphasizing the importance of translational medical research for implementing at the bedside.”
He initiated a unique program for young specialists-in-training to have free time for research. He approved new technologies such as the implantation of an electronic brain implant to cope with tremors, surgical robots, and experimental treatments for multiple sclerosis and amyotrophic lateral sclerosis, to name a few. No less a challenge was coping with the horrific wave of terror that plagued Jerusalem and forced doctors and nurses always to be prepared to heal torn bodies.
Mor-Yosef was the first to establish a rule that hospital department heads do not automatically remain in charge until retirement but have a 10-year term, after which – if they want to continue – they must compete in a tender with other candidates. This brings in new blood while discouraging veteran professors from getting stuck in old routines and encouraging them to do their best.
But he conceded that despite all the innovations and advances, just being located in the city, with Jerusalem’s “problematic image,” makes things more difficult.
“Many doctors, both young and senior, live in Mevasseret Zion and westward. They are not attracted to a city known for conflicts. They feel uncomfortable traveling through haredi neighborhoods and want to go everywhere freely.”
So it is difficult for Jerusalem – no matter how beautiful or central to the Jewish world – to compete with Tel Aviv.
The new hospital tower will help make the capital more attractive to talented medical personnel; one’s workplace environment is very important, he said, but even so “bringing the best doctors and nurses is a challenge.”
Mor-Yosef pushed for the building of HMO’s Biotech Park on campus, where startup companies develop new medical technologies for marketing. Mayor Nir Barkat, who comes from hi-tech, “understands this and has given it high priority. Hadassah is one of the things that draw people to Jerusalem. Six thousand people work at Hadassah’s two campuses in the capital, while over 12,000 families are indirectly supported through HMO’s work.”
Mor-Yosef is not disturbed by the departure of promising young and experienced senior physicians to other hospitals, especially its competitor, Shaare Zedek Medical Center, a few kilometers up the hill.
“A majority of its [Shaare Zedek’s]department heads started at Hadassah and then left advance their careers. I gave them my blessing and encouragement. With rotation, we get excellent younger people, and our own doctors are not stuck at 45 without any hope of rising to head a hospital department.”
One physician and administrator who has exchanged his workplace in Tel Aviv for the capital is Kokia, whom Mor-Yosef knew in the late 1990s when he was for four years director-general of Soroka University Medical Center in Beersheba and Kokia headed Maccabi’s southern district. Only months apart in age (Kokia is 61), the two medical administrators and gynecologists are working together, Kokia until last week learning the ropes from the outgoing director-general and now with Mor-Yosef advising his successor until March.
“I undertake this important responsibility with appreciation and awe for HMO’s pioneering contributions to Israel and its medical system,” Kokia said on his first day of the job. “I know that as they have for decades, HMO’s employees will be at my side as we continue the path that was paved by my colleague and friend Prof. Shlomo Mor-Yosef. And I know they will be joined by the hundreds of thousands of members, friends and supporters of HWZOA to help us continue to provide superb patient care and produce groundbreaking research.”
A Jerusalemite who studied in the city’s Gymnasia Rehavia until age 18, after which he joined the IDF’s atuda program and graduated from Tel Aviv University’s Sackler School of Medicine. After competing a US research fellowship in reproductive endocrinology, Kokia worked in ob/gyn at Sheba Medical Center. Later, he was deputy chief medical officer in the IDF and served as commander of the Israel Air Force Aeromedical Center.
The new HMO director- general was appointed head of the country’s second-largest health fund in 2007 and has published articles in leading medical journals on his specialties – endocrinology, fertility and healthcare policy. The capital’s sports fans will be glad to hear that his son, Uri Kokia, is a well-known player on the Jerusalem Hapoel basketball team.
Mor-Yosef didn’t sound bitter over his leaving his post a few months before the dedication of the inpatient tower. But he would have liked to end his Hadassah career without the widely publicized feud in early 2010 initiated by then-national president of HWZOA Nancy Falchuk, who opposed his continued service until the tower opened.
“I still have no idea what her reasons were. It was a personal clash with her, not with the women of Hadassah,” said the outgoing director-general, who received strong support from senior HMO physicians who opposed Falchuk’s moves. Under pressure, she allowed Mor-Yosef’s departure to be postponed, and she herself ended her term and was replaced by Marcie Nathan in the summer.
“I had never planned to go from this job into retirement. I want to do other things. The question was what was the right time to stop. I offered to stay two extra years after the two five-year terms, but it was not acceptable to her.”
Mor-Yosef said it is not significant to him now that he will not be director- general when the hospital tower is opened.
“It is only ceremonial. The essence is more important. The building is standing, and we are a few months away. After all HMO went through in recent years, we have reached our goal.”
As “a great fan of HWZOA and its unprecedented work over the past 100 years,” Mor-Yosef said the world’s largest Jewish organization faces challenges.
“There have been many changes in society, in the roles and work of women and the Diaspora. HWZOA women will have to change and suit it to the new reality,” he said.
Their job is fundraising and Jewish and pro-Israel activities, “not managing the hospitals which they own. At present, the relationship works.”
If for some reason in the future, HWZOA is no longer able to succeed at raising development funds for HMO, other sources will have to be found.
“Hospitals not affiliated with Jewish organizations abroad have managed to develop their own fundraising tools,” he said.
Medical tourism, based on the prestige of HMO’s high level of care, could be one such income source, he notes.
“HMO’s annual budget is NIS 2 billion; medical tourism pays for five to 10%, and it should rise to no more than 15%. The new building will increase capacity, but treatments for foreigners should not come at the expense of Israeli patients. Medical tourism by all the hospitals must be carefully monitored by the authorities. More than guidelines are needed. I had thought the government would coordinate its marketing and management and set directions, but this didn’t happen.”
As the two Hadassah University Medical Centers and Jerusalem’s other hospitals all offer private medical care (Sharap) to patients who want to choose their doctor for operations and consultations, Mor-Yosef is a strong backer of the system and urges that it be adopted in all public hospitals. It keeps doctors working in the building for many more hours a day instead of leaving in mid-afternoon to moonlight elsewhere, he explained. This is a blessing for the patients, the employers and the doctors themselves, added the veteran medical administrator.
“If Sharap has too much of a share, only senior professors will do the more complicated work and younger doctors will not receive good training. There are some abuses, [such] as doctors enabling paying patients to jump the queue for care. We monitor it on a monthly basis, and when we find abuses, we stop them,” said Mor-Yosef.
A strong advocate of public medicine, Mor-Yosef is worried about the growth in private hospitals.
“Public medicine still has hegemony in this sector, but it is in danger. Sharap can prevent the continuing growth of private medicine. There must be free choice in public hospitals.”
Mor-Yosef, who has always been in public service, says he is looking for a new challenge in that field, and not make money for himself in business.
“I wouldn’t go into politics at this stage. A possibility is something valuable in the academic world or in diplomacy. But it is nice to be free of responsibility for a while.”
He will continue as head of the Israel National Center for Health Policy Research.
“It is close to my heart. One of the greatest challenges in health reform is turning the Health Ministry into a ‘ministerion’ that supervises healthcare and promotes public health rather and eliminating the conflict of interest in owning, running and supervising medical centers. It has too many hats,” Mor-Yosef declared, “and this leads to mediocrity.”
This problem has been known for some time, he said, but no one has managed to reform the system.
“Nevertheless, the health system is very good. The basket of health services is broad, and there is universal health insurance for all residents.
But citizen copayments for medical services and medications are much too high. There still is inequality.”
Ironically, the nine-year labor contract signed in August by the Israel Medical Association and the employers (the Treasury, the HMO and other employers) made impressive gains in giving incentives to doctors to move to the periphery and go into inadequately manned specialties.
“This is the right direction,” Mor-Yosef concluded.