Clalit Health Services GroupIsrael’s Leading Health Care Organization

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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

Israel - Population Profile

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Relative Economic Efficiency

Total Expenditure on Health (% of GDP)

Life Expectancy Females Life Expectancy Males

OECD Report 2011

Israel spends less - yet its citizens live longer

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• 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

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Clalit Health Services

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”

• Respect for each individual• Contribution to the community• Professionalism and excellence• Humility• Integrity• Dedication

Core Values:

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Clalit Vision and Core Values

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COMPTROLLERCOMPTROLLER

Director GeneralDirector General

LEGAL ADVISORLEGAL ADVISOR

OMBUDSMANOMBUDSMAN

SPOKESMANSPOKESMAN

DIRECTOR ‘sASSISTANT

DIRECTOR ‘sASSISTANT

SUBSIDIARIESSUBSIDIARIES

HEALTH INSURANCE ALIGNMENT

HEALTH INSURANCE ALIGNMENT

CHIEF

NURSE

CHIEF

NURSE

CHIEF

PHYSICIAN

CHIEF

PHYSICIAN

HOSPITAL

DIVISION

HOSPITAL

DIVISION

COMMUNITY

DIVISION

COMMUNITY

DIVISION

LOGISTICS &

INFRASTRUCTURE

DIVISION

LOGISTICS &

INFRASTRUCTURE

DIVISION

FINANCE

DIVISION

FINANCE

DIVISION

SERVICE &

MARKETING

DIVISION

SERVICE &

MARKETING

DIVISION

HR

DIVISION

HR

DIVISION

HOSPITALSHOSPITALS

DISTRICTS DISTRICTS

SOUTH DISTRICTSOUTH DISTRICT

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A Fully Integrated Community-Hospital System

Primary Care at the Heart of the System

Management Strategy

Monitoring Quality of CareThrough Quality Indicators

Promoting Patient Experience

Decentralization and Self-management

ClinicsHospital

Departments

Comprehensive Care Programs for

Patients at Risk

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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)

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• 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

Prevention and Early Detection

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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

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All general hospitals are accredited by the JCI

2.2 beds per 1,000

population

Clalit Hospital Statistics

Hospital stay – average 4.1 days

17,000 staff

5,500 beds

400,000 admissions

1,900,000 hospital days 900,000

emergency visits

3,000 open heart surgeries

900 cranial surgeries

19,000 catheterizations170

transplants40,000 births

2,000,000 outpatient

visits

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Balanced Finances15%

Controlled Budget

Combined Financial Index

Organizational Operations ManagementStrategic Map for Hospitals

Clinical Quality & Excellence30%

Clinical Indices

Quality Tests

Teaching & Academics

Risk Management

Customer Experience30%

ER Customer Service

Hospitalization Customer Satisfaction

Surgical Depts.

Ombudsman

Queue for Common ProceduresOutpatient Clinics

Image5%

Media

Local Image

Strategic Goals

Internal Processes

Operational Efficiency & Excellence10%

OR UtilizationWeighted OutputsNon-Basket ActivitiesExternal Income Growth

Infrastructure

Logistics

Maintenance

Human Resources10%

Employee SystemsEmployee SatisfactionInternal Customer SurveyInterns Satisfaction

Complaints about staff attitudes

Telephone Answering

• 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

• 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

Clinical Quality Indicators at Clalit Hospitals: examples

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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

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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

• EMR pilots completed

• PACS deployed throughout the organization

• Quality parameters in focus

• Accreditation of all general hospitals

• “Excellence units” concept developed

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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

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2011 - Clalit’s Hospitals

• 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

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Clalit Steps Ahead

• Purchase of new technologies (CT, MRI, PET-CT, Robots)

• Renovations and constructions

• Promoting research and collaboration

• Advancing patient experience

• Departmental budget

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Clalit Steps Ahead

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Creating an “American Friends” Group for ClalitGoals:

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

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