Creating safer culture

Creating safer culture

JHF President and CEO Karen Wolk Feinstein and Ran Balicer, chief physician officer of Clalit Health Services and director of the Clalit Research Institute	 Photo courtesy of JHF
JHF President and CEO Karen Wolk Feinstein and Ran Balicer, chief physician officer of Clalit Health Services and director of the Clalit Research Institute Photo courtesy of JHF

The fruits of a partnership between the Jewish Healthcare Foundation and Israel’s Clalit Health Services — the largest of four government-contracted HMOs — took eight years to ripen, but the ultimate results could save thousands of lives.

A Clalit partner hospital, Emek Medical Center, recently announced that it was the only hospital in Israel to achieve zero Central Line-Associated Blood Stream Infections (CLABSIs) among patients in its Intensive Care Unit. CLABSIs can cause sepsis, a life-threatening response to an infection that can lead to tissue damage, organ failure and death.

Having sepsis doubles a patient’s risk of dying and can add another 30 days to a hospital stay.

“This is very nice news,” said Susan Elster, a consultant for the JHF who works in Jerusalem. “This initiative took place over a number of years.”

JHF’s relationship with Clalit, and the Emek Medical Center, began in 2009, when health care reform debates were beginning to heat up in the U.S. It was then that JHF, in its search for promising health system models, entered into its relationship with the Israeli HMO. Israel spends just 8 percent of its GDP on health care, but has achieved many health outcomes that surpass those of the U.S.

Since they began collaborating, JHF and Clalit have been exchanging expertise in bettering patient outcomes.

“The relationship has been unusually close,” said Karen Wolk Feinstein, president and CEO of JHF. “We brought over waves of visitors to Israel, many physicians, and we were very excited with what we learned from Clalit.”

Feinstein cited emergency medicine and patient-centric care —bringing teams of medical experts to the patient rather than having the patient travel to various physicians — as two areas in which Israel excels and which have been instructive to JHF.

Pursuant to the JHF/Clalit partnership, 20 Israeli physicians, nurses and senior members of Clalit leadership came to Pittsburgh to receive training in JHF’s Lean quality improvement methodology called Perfecting Patient Care. They then received additional training in Israel.

In November 2011, JHF leaders and quality improvement coaches strategized with Clalit leadership on the support needed to engage the Clalit Health System more widely in hospital quality improvement. Feinstein delivered the keynote address, “Can Industrial Engineering Perfect Patient Care?” at the Israel Society for Quality in Health Care’s annual conference before 700 attendees.

One area of focus has been CLABSIs, which lead to between 5,000 and 6,000 preventable deaths at Israel’s biggest hospitals each year, according to a January 2017 report by the Israeli Ministry of Health.

Because so many Israelis were dying from CLABSIs, JHF took action.

“Per our bylaws, we only get involved in Israel when there’s an emergency,” Feinstein said, noting such examples as providing support to hospitals on the borders during times of war and purchasing ambulances. “So, we had to expand our definition of an emergency.”

Three Clalit hospitals, including the Emek Medical Center and the Karmiel Medical Center, have been focusing on preventing CLABSIs in chronic dialysis patients.

In both Israel and the United States, infection control specialists “do not get the respect they deserve,” according to Feinstein. “What was critical to us was our ability to bring attention to the real, noble effort of infection control specialists.”

But it takes time to integrate new practices into existing cultures.

While it was relatively easy to get “verbal commitment at the highest level” to employ the suggested best practices, Feinstein said, the problem was getting the doctors and nurses on the ground to use new methods. “When you do a project internationally, you have to allow a reasonable amount of time for an innovation to take hold. Israeli doctors and nurses are highly independent. Israeli doctors do things their way. So, it’s more complicated.”

While it took a few years to achieve zero CLABSIs in Emek’s ICU, many Israeli lives will now be saved as a result, thanks to JHF.

Professor Ran Balicer, director of the Clalit Research Institute and a leader in the partnership, recently wrote to JHF: “Thank you for your support of Clalit and for your role in creating a safety-seeking culture at Clalit hospitals,” according to a press release.

Toby Tabachnick can be reached at

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