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Clalit Health Services Group Israel’s Leading Health Care Organization 1 Israel - Population Profile Heterogeneous population • 7.7 million residents • 1.4 million Arabs (84% Moslems) • 1 million new immigrants from former Soviet Union since late 1980’s • Young population (10% aged 65+ , OECD* Countries = 14.1%) Outcome comparable to international average • Life expectancy : M- 79.7 , F-83.5 (OECD* countries = M-76.5, F-82.1) • Infant mortality : 5.1 per 1000 live births (OECD countries = 6.1) *OECD = statistics provided by Organization for Economic Cooperation Development 2 Relative Economic Efficiency Israel spends less - yet its citizens live longer Total Expenditure on Health (% of GDP) 3 OECD Report 2011 Life Expectancy Females Life Expectancy Males Clalit Health Services • Established in 1911 • Today there are over 4 million insured • 54% of market share • Elderly (65+) - 70% market share , 0.5 million • Arab Population - 73% market share, 1 million 4 Clalit Vision and Core Values Clalit is dedicated to a healthy Israel: “We are committed to health through prevention of illness, promotion of healthy lifestyle, quality care and attention to the special needs of the patient and his/her family” Core Values: • • • • • • 5 Respect for each individual Contribution to the community Professionalism and excellence Humility Integrity Dedication COMPTROLLER Director General LEGAL ADVISOR DIRECTOR ‘s ASSISTANT OMBUDSMAN SUBSIDIARIES SPOKESMAN HEALTH INSURANCE ALIGNMENT CHIEF CHIEF HOSPITAL COMMUNITY LOGISTICS & FINANCE SERVICE & HR NURSE PHYSICIAN DIVISION DIVISION INFRASTRUCTURE DIVISION MARKETING DIVISION DIVISION HOSPITALS SOUTH DISTRICT 6 DISTRICTS DIVISION A Fully Integrated Community-Hospital System Primary Care at the Heart of the System 8 7 Management Strategy Promoting Patient Experience Decentralization and Self-management Clinics Hospital Departments 8 Monitoring Quality of Care Through Quality Indicators Comprehensive Care Programs for Patients at Risk Community Clinics’ Computerized Medical Record • Cumulative Patient Visit Data (Diagnoses, Markers, Prescriptions, Lab results, Specialty Consulting Visit Report, etc… ) • Decision Support Tools (Patient Lists, Good Medical Practice, Drug Interaction) 9 Prevention and Early Detection • Screening • Breast cancer- Mammography (Ages: 50-74 - every 2 years) • Colon cancer - Occult Blood (Ages: 50-74 - every year) • Cervical cancer- Pap Smear (Ages: 35-54 - every 3 years) • Promoting Wellness • Behavioral factors • Focus by topic (ie: smoking, physical activity, nutrition) • Target groups • Influence consensus and public opinion 10 The Only Health Organization in Israel that Runs its Own Public Hospitals • Community outreach • National centers of excellence • Children’s hospital • Comprehensive cancer center • Organ transplant center • Rehabilitation centers All general hospitals are accredited by the JCI 11 Clalit Hospital Statistics 2.2 beds per 1,000 population 400,000 admissions 1,900,000 hospital days 900,000 emergency visits Hospital stay – average 4.1 days 17,000 staff 5,500 beds 3,000 open heart surgeries 900 cranial surgeries 2,000,000 outpatient visits 170 transplants 40,000 births 12 19,000 catheterizations Organizational Operations Management Strategic Map for Hospitals Customer Experience 30% Clinical Quality & Excellence 30% Balanced Finances 15% Media Surgical Depts. ER Customer Service Teaching & Academics Clinical Indices Controlled Budget Local Image Ombudsman Hospitalization Customer Satisfaction Risk Management Quality Tests Combined Financial Index Outpatient Clinics Queue for Common Procedures Telephone Answering Complaints about staff attitudes Non-Basket Activities Weighted Outputs 13 Internal Customer Survey Employee Satisfaction Employee Systems Maintenance Infrastructure Logistics Human Resources 10% Interns Satisfaction OR Utilization Internal Processes Operational Efficiency & Excellence 10% External Income Growth Strategic Goals Image 5% Clinical Quality Indicators at Clalit Hospitals • Based on pre-defined criteria: – evidence-based, potential for improvement, validity, potential harm vs. benefit, size of target population, JCI accreditation requirements • Process and outcome indicators • Uniform numerical goals and weights that create a combined compound score for quality • Some measures are built on self-reporting following review of medical records, with external audit of the data Clinical Quality Indicators at Clalit Hospitals: examples • Pressure sores acquired during admission • Falls / falls with injury • PCI done within 90 minutes for ST-elevation MI • Medications at discharge following acute MI • Antibiotics given within 6 hours for community-acquired pneumonia • Hip fracture operated within 48 hours • Laparoscopic cholecystectomy converted to an open procedure • Extended length of stay following colectomy for cancer Service Standards Definition the basis of goals and grades in the hospitals • ER length of stay • Outpatient queue length • Appointment cancellation rate at outpatient clinic • Percentage of phone-calls answered at the hospital • Speed of telephone answering in the hospital 16 Service Standards Definition the basis of goals and grades in the hospitals • Waiting time for outpatient doctor • Rate of first customer delays. • Surgery queue length • Customer satisfaction- ER, inpatients and outpatient clinics • Customer satisfaction – general hospital services • Number of complaints about telephone and staff attitude per 100 beds 17 2011 - Clalit’s Hospitals • EMR pilots completed • PACS deployed throughout the organization • Quality parameters in focus • Accreditation of all general hospitals • “Excellence units” concept developed 18 2011 - Clalit’s Hospitals • Emphasis on ER service • Dealing with waiting lists • Improving oncology services • Increasing income: medical tourism, Palestinians • Special attention to shortage of doctors and nurses 19 Clalit Steps Ahead • Patient care and risk management: “Ask Me 3”, safety rounds, controlling health care associated infections • EMR deployment in 300 hospital departments • Emphasis on the periphery 20 Clalit Steps Ahead • Purchase of new technologies (CT, MRI, PET-CT, Robots) • Renovations and constructions • Promoting research and collaboration • Advancing patient experience • Departmental budget 21 Creating an “American Friends” Group for Clalit Goals: 22 1. To promote collaborative research 2. To further institutional cooperation with hospitals, universities and research institutions 3. Supplement government funding • building and renovation of clinics, institutes and hospitals • unfunded needs of the elderly, lower income populations and those living in Israel’s periphery 4. Purchase of new technologies 5. Introduction of electronic medical records 23