About a decade ago, Dr. Yoram Weiss boarded a plane on his way to speak at a conference in the United States. Oren Riess sat down in the seat in front of him. Riess noticed that Weiss was reading a medical textbook, and asked if he was a doctor.
One would think that Weiss, today head of anesthesia at Hadassah University Hospital, and Riess, director of manufacturing and product engineering at Intel Israel, wouldn't have much in common. One enables critical surgeries in a leading Israeli hospital, the other makes chips.
Yet the two had a meeting of minds and stayed in touch. Weiss visited Riess’s world of Intel in Kiryat Gat, where the California-based company has its main Israel plant, and Riess visited Hadassah. A conversation developed.
The one organization is steeped in chaos and blood, with doctors and nurses jumping from one emergency to another with little leisure to sit back and assess whether they could be doing things better. The other is stark, clean, absolutely efficient.
What would happen if the two worlds collided?
And thus an unusual collaboration was born, beginning in April 2011.
Weiss thought Hadassah had what to learn from business about management tools. "Hospitals are lacking everything that factories have to make things more efficient. So we decided to see if we could try to increase production, as it were, while maintaining quality and safety,” Dr. Weiss says in an interview in his office, where unlike the average doctor, he has on his desk not just the usual medical tomes but a copy of the business book “Driving Excellence,” by Mark Aesch. Weiss didn’t just pick up his business ideas from his friends at Intel: he took a short break from medicine in 2007 to earn an MBA at NYU Stern.
The meeting of Intel and Hadassah wasn't external consultants coming in and telling the hospital staff what to do, a system that often leaves little long-term impact. Rather, Intel dedicated two full-time staff members to work with the hospital for a long-term partnership, looking at the system “not top down but down up,” as Weiss puts it.
They started by studying the hospital’s surgical recovery room, which was constantly behind schedule - a state of perpetual bottleneck.
Intel's first gift: The "Awareness Effect"
First, the Intel people interviewed the medical staff. An early challenge was keeping track of such simple stats as whether a surgery started on time and how long it took to discharge a patient to an appropriate ward afterwards.
Understanding the numbers, says Weiss, gives staff a concrete idea of how they're doing.
“This is how it’s done in the business world: you put all the stakeholders around the table and you identify the problem,” says Weiss. “I felt it was a chance to bring things from the commercial environment into the medical world."
If once he'd felt frustrated when accused by doctors of being unworldly – the truth is managers in the medical world generally never get training on managing people, he admitted.
Just keeping track of the progress on various wards had a positive impact, said Liz Ghazi, Intel’s Healthcare Program Manager now working full time at Hadassah on the collaborative project. “We found out that once you measure things, without doing anything, you improve. It’s the Awareness Effect,” she said.
Awareness evidently leads to startling results.
As of December 2012, the program had halved the percentage of patients waiting for space in a recovery room. Early discharge from wards participating in the program jumped 48 percent. Surgery cancellations dropped by 28 percent, and the number of operations increased by 5.4 percent.
In other words, the hospital significantly increased capacity without adding staff.
Slashing the death toll
Other improvements followed, including the turn-around for imaging tests, which have long frustrated both doctors and patients.
In the first five months of 2013, the imaging team lead a 50 percent reduction in CT cycle time and 30 percent reduction in ultrasound cycle time for hospitalized and emergency room patients. Intel’s involvement, Ghazi says, not only expedited the process, it also helped the department go paperless.
Worldwide, about a third of patients who contract central line-associated blood stream infections while in the hospital die from it. Thus far in 2013, a new quality assurance program reduced the number of CLABSI incidents in all of the 11 ICU units at both Ein Karem and Mt. Scopus Hadassah hospitals by a staggering 60 percent.
Meanwhile, in the operating room, the Intel-Hadassah collaboration more than doubled the on-time, first-of-the-day surgeries, meaning fewer cancellations at the end of the day.
“The culture of Intel is changing how we work," explains Itsik Kara, head of the operating room’s nursing division. "Just by becoming a place where the first patient of the day is in the operating room on time at 7:40 A.M., it's as if we added one operating room, which would have cost us about 10 million shekels.”
But the point of the collaboration wasn't to save money or make the hospital more efficient for financial reasons, says Hospital Director Yuval Weiss – no relation to the aforementioned anesthesiologist. “The issue was always to be more productive for the patients, not for any financial gain.” Or, as a colleague said, it's about lessoning the agony.
That’s a goal for patients' families as well: Part of the new partnership focuses on keeping loved ones better informed with SMS updates on when surgeries start and end and when patients are moved to new rooms.
“We found that the SMS makes a big difference,” Kara says. “People feel like they’re much more in the loop.”
A romance with healthcare
One of the most important improvements is a new digital dashboard that informs the hospital what rooms are – or will be – available, something previously marked out on a whiteboard.
“That one just went from purple to white, so now it’s free," says Kara, dressed in his surgery scrubs, as he points to one of the 23 operating rooms he oversees on the widescreen.
Of course, not all of the hospital's problems are solved: Just last week, women who just gave birth were parked in the hallway of the maternity ward, a curtain drawn around them for a modicum of privacy, because no rooms were available. Perhaps no efficiency measure will completely alleviate the perennial overcrowding in Israeli hospitals. Still, the gains have been impressive.
“I think what we have here is a win-win situation,” says Yuval Weiss. “This way you can take advantage of the doctors you have, rather than just saying we need a larger staff.”
But what’s it in for Intel?
“Intel has been in a romance with healthcare for some time,” says Riess. The Israeli partnership is something of a local experiment – nothing like this has been tried in the United States – but the company is looking to apply the model elsewhere. In Israel, they're exploring plans to bring it to two other major hospitals.
At the moment, the financial burden isn't exactly evenly split. The love affair is largely a gift from Intel: They provide the two full-time staffers, while Hadassah pays only about $20,000, primarily for screens and computers.
“The opportunity now is to try to duplicate it, to see not just how one hospital does it, but how all the hospitals do it, all the hospitals in Israel, in all the world,” says Riess. “It’s not a far-fetched vision. We have plans.”
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