1. Israel’s Leading Health Care Organization
Clalit Health Services Group
Israel’s Leading Health Care Organization

2. 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 , 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

3. Relative Economic Efficiency
Israel spends less - yet its citizens live longer
Total Expenditure on Health (% of GDP)
Life Expectancy Females
Life Expectancy Males
OECD Report 2011

4. 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

5. 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:
Respect for each individual
Contribution to the community
Professionalism and excellence
Humility
Integrity
Dedication

6. HEALTH INSURANCE ALIGNMENT
COMPTROLLER
Director General
LEGAL ADVISOR
DIRECTOR ‘s ASSISTANT
OMBUDSMAN
SUBSIDIARIES
SPOKESMAN
HEALTH INSURANCE ALIGNMENT
CHIEF
NURSE
CHIEF
PHYSICIAN
HOSPITAL
DIVISION
COMMUNITY
DIVISION
LOGISTICS &
INFRASTRUCTURE
DIVISION
FINANCE
DIVISION
SERVICE &
MARKETING
DIVISION HR
DIVISION
HOSPITALS
DISTRICTS
SOUTH DISTRICT

7. Primary Care Clinic Team
A Fully Integrated Community-Hospital System
Primary Care at the Heart of the System 8
Family Doctor
Primary Care Clinic Team

8. Management Strategy Promoting Patient Experience
Monitoring Quality of Care
Through Quality Indicators
Decentralization and Self-management
Clinics Hospital Departments
Comprehensive Care Programs for Patients at Risk

9. 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)

10. Prevention and Early Detection
Screening
Breast cancer- Mammography (Ages: every 2 years)
Colon cancer - Occult Blood (Ages: every year)
Cervical cancer- Pap Smear (Ages: every 3 years)
Promoting Wellness
Behavioral factors
Focus by topic (ie: smoking, physical activity, nutrition)
Target groups
Influence consensus and public opinion

11. All general hospitals are accredited by the JCI
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

12. Hospital stay – average 4.1 days
Clalit Hospital Statistics
1,900,000 hospital days
400,000 admissions
900,000 emergency visits
2.2 beds per 1,000 population
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
19,000 catheterizations
170 transplants
40,000 births

13. Organizational Operations Management Strategic Map for Hospitals
Balanced Finances
15%
Controlled Budget
Combined Financial Index
Organizational Operations Management
Strategic Map for Hospitals
Clinical Quality & Excellence
30%
Clinical Indices
Quality Tests
Teaching & Academics
Risk Management
Customer Experience
ER Customer Service
Hospitalization Customer Satisfaction
Surgical Depts.
Ombudsman
Queue for Common Procedures
Outpatient Clinics
Image 5%
Media
Local Image
Strategic Goals
Internal Processes
Operational Efficiency & Excellence
10%
OR Utilization
Weighted Outputs
Non-Basket Activities
External Income Growth
Infrastructure
Logistics
Maintenance
Human Resources
Employee Systems
Employee Satisfaction
Internal Customer Survey
Interns Satisfaction
Complaints about staff attitudes
Telephone Answering

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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 

21. Clalit Steps Ahead
Purchase of new technologies (CT, MRI, PET-CT, Robots)
Renovations and constructions
Promoting research and collaboration
Advancing patient experience
Departmental budget

22. Creating an “American Friends” Group for Clalit
Goals:
To promote collaborative research
To further institutional cooperation with hospitals, universities and research institutions
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
Purchase of new technologies
Introduction of electronic medical records