Change Leader: Dr. Zeev Rotstein
Among the “Most Interesting Jews of 5778,” announced a piece in the September 29, 2017, Jerusalem Post, is Hadassah Medical Organization’s 10th director-general, Dr. Zeev Rotstein. Described in the article as the “tough and trail-blazing director” of HMO who is “on track to positively transform the Hadassah megalopolis,” his name is listed alongside Facebook COO Sheryl Sandberg and Jerusalem Mayor Nir Barkat.
Indeed, in the two years since Dr. Rotstein has taken the helm at Hadassah, positive changes are everywhere at the medical center. When he became director-general in January 2016, Hadassah was forging ahead on groundbreaking medical research—from stem cell breakthroughs to investigation of genetic disorders—but it was also mired in economic crisis. The hospital was buffeted by currents ranging from soaring health care costs to inequitable agreements with unions and insurers. Under Dr. Rotstein’s leadership, patient visits are up 10 percent, technology and infrastructure are being upgraded and medical teams restructured.
New projects, such as the recently launched campaign for renovating the iconic round building at Ein Kerem, are also in the works, as are plans for multidisciplinary centers for pediatrics, cardiovascular disease, oncology and women’s health.
In a recent interview, Dr. Rotstein recalled when he was first approached in 2014 to direct Hadassah. He was CEO of the Chaim Sheba Medical Center at Tel Hashomer in Tel Aviv, where he had spent the past 38 years. “I was nearing retirement,” he said, and unsure if he wanted to take on another position. “I’d served my country on the battlefield in four wars, and in the health sector for decades.” Aware that Dr. Rotstein might need persuading, Israel’s deputy health and finance ministers came personally with the offer. “They told me: ‘There’s no Israel without Jerusalem, and no Jerusalem without Hadassah,’” he said. “I agreed wholeheartedly. Then they went on: ‘And there’s no Hadassah without Rotstein.’ That, I thought, was overstating it. But, I decided to look into what was going on with Hadassah.” The medical center was staggering under a $370-million debt and an annual deficit exceeding $85 million, a financial crisis that had begun in 2008. A painful agreement had been hammered out among Israel’s treasury department, five hospital unions and Hadassah, the Women’s Zionist Organization of America, intended to put HMO on a new path. Dr. Rotstein accepted the job, determined to find out why such a potentially lucrative institution, the medical center that had brought modern health care to Israel, was buckling, and what could be changed.
Dr. Rotstein was born in Haifa in 1950. After military service, he started medical school at the University of Bologna, Italy, and graduated from the Sackler School of Medicine at Tel Aviv University, where he specialized in cardiology and, later, health management. Fellowships at the New York State Department of Health, Tufts University outside Boston and Johns Hopkins Bloomberg School of Public Health in Baltimore followed.
Dr. Rotstein is “more experienced than anybody else in Israel in the byzantine politics and economics of health care,” said David M. Weinberg, former development consultant at Sheba and a senior research fellow at the Jerusalem Institute for Strategic Studies. “He led the revolution that made Sheba the largest hospital in the Middle East. He is a tough but rewarding boss whose watchword is excellence and is relentless in pursuit of his goals.”
It was Dr. Rotstein’s experience as a union member that helped him negotiate reforms at Hadassah. Hospital unions—most medical workers are members—dominate Israel’s medical institutions. “When I came to Hadassah, I walked onto a battlefield with the physicians’ union,” he said. But “as a second-year resident, I’d represented colleagues at Sheba, negotiating with hospital management and the Israel Medical Association, so I knew all about unions and physicians’ rights.”
Awareness of the hopes and fears on both sides enabled him to push through his recovery program, and obtain HWZOA’s all-important support. “Hadassah needed new medical technologies,” he noted, “200 additional beds, an upgrade of the old inpatient facility and much more.”
Today, these targets are well on the way to being met. “The first sign of recovery came in late 2016, when the public began voting with their feet and returning to Hadassah,” said Dr. Rotstein. All the figures are moving up: admissions, births, surgeries, ambulatory care, MRIs, radiotherapy and more. Bed occupancy zoomed to 103 percent in 2017. Surgeries were up from 11,879 in 2015 to 37,561 two years later, and ER visits from 136,367 to 154,572 in the same period.
Along with the increase in patient populations came prominent physicians: Pediatric hematologist-oncologist Dr. Gal Goldstein of Sheba; anesthesiologist, ICU and pain management specialist Dr. Reuven Pizov of the Ruth and Bruce Rappaport Faculty of Medicine; and internist and clinical immunologist Dr. Alon Y. Hershko of the Meir Medical Center are some of the Israelis who have recently joined the Hadassah team.
Dr. Rotstein checks off further Hadassah accomplishments of the past two years: Three of four internal medicine departments have moved into the Sarah Wetsman Davidson Hospital Tower, and will shortly be followed by cardiology. All new state-of-the-art operating facilities have come into use. A specialized stroke unit has opened and a new neonatal unit has been built. Six advanced CTs, four MRIs and two PET-CT scanners have replaced older models.
The medical center’s accumulated deficit has been halved, its operating deficit is way down and its medical services’ income way up. “For the first time in years, we’re showing a significant cash-flow surplus,” said Dr. Rotstein. “We’re still in the recovery process, which means HWZOA and the Israeli government are contributing some $45 million to our $580-million operating budget, but we’re in sight of the day when Hadassah is self-supporting.”
All this good news, however, received only a fraction of the attention garnered by the rift between Dr. Rotstein and Hadassah pediatric hematologist-oncologists last summer. With only four pediatric bone-marrow transplant beds available for up to 10 young patients at any one time, he decided that the overflow would share the adult hematology unit. This angered pediatric hematologist-oncologists, who made their opposition public in a painful fight played out in the media. With Health Ministry backing, Dr. Rotstein stood by his decision and on June 4, Hadassah’s entire senior pediatric oncology staff quit their jobs, leaving their critically ill young patients.
The unit continued functioning with hematologist-oncologists from Israel and hospitals abroad until, 90 days later, it was fully repopulated by qualified specialists.
“In October, a youngster and his parents brought a basket of fruit to my office,” said Dr. Rotstein. “The child had been in the unit. He had recovered, and they had come to thank me. Tears welled for two hours after they left—tears of joy for them and all the children with blood cancers who are receiving the best of treatment at Hadassah.”