Medicine: On the Move
“Stressful?” asks a British colleague, who has just survived it. “There should be a government health warning about moving house!”
She has a point. Moving into a new home ranks up there alongside death, loneliness, work pressures and relationship problems as one of life’s five most stressful experiences. It surely pales, however, next to moving a busy, working hospital to a new building. “That’s moving house, multiplied by a factor of a million,” says a smiling Dr. Shlomo Mor-Yosef, director-general of the Hadassah Medical Organization.
The smile is in place because that move, still months away, is being planned to its last detail. These details include clearing every speck of building debris from the 19 stories of the Sarah Wetsman Davidson Hospital Tower at Hadassah–Hebrew University Medical Center at Ein Kerem, equipping its wards and operating rooms, supplying its kitchens, transferring its patients and redesigning its systems.
“We are using the move to examine how we perform,” says Dr. Mor-Yosef, “and to introduce change wherever we believe we can improve.”
Overseeing the nitty-gritty of the move is Dr. Yuval Weiss, director of Hadassah–Ein Kerem, aided by a 10-member committee of Hadassah physicians, nurses and hospital administrators. “We’ve been meeting with the chief and head nurse of every department to work out the details,” he says. “This is not about making administrative decisions. It’s sharing opinions, anticipating every question and answering it before the move happens.”
He cites the fifth floor, to be shared by orthopedics and urology. “Israel’s Health Ministry licenses 41 orthopedic beds at Hadassah–Ein Kerem and 18 for Urology,” he explains. “The tower has 72 beds on this level, 36 in its east wing and 36 in the west. We must decide how best to group the orthopedic beds, for both patients and staff. We must decide whether to separate the orthopedic department’s spine and trauma units or have them together, how best to distribute nursing staff; and which beds on this level…should be currently unassigned.”
Dr. Weiss’s committee is working hard. Eight departments on three floors of the inpatient tower have been selected to relocate during the move’s initial phase, beginning in March 2012: urology and orthopedics are on the fifth level; vascular and general surgery on the sixth; and gynecology, ENT, plastic and maxillofacial surgery on the seventh. Another five nonmedical levels (the second floor belowground and the first, fourth and eighth floors), housing logistics, administration and education, will also be brought into use in this first stage.
“It’s still undecided which department will move first,” says Dr. Weiss, “but before any of them do, the building must function. It must be clean; its systems for water and electricity, heating and cooling must all run smoothly; its phone lines, elevators and electronics must be tested and working; its pharmacy must be stocked; and its loading bays and garbage disposal in operation.”
Making things easier is that much of the equipment is new and that the move is across campus rather than across the city. “When Hadassah moved into Ein Kerem in 1961, it needed 20 Israel Defense Forces ambulances to help transfer the patients,” says Dr. Mor-Yosef. “This time, all we need to do is wheel our patients across one of the bridges linking the tower to the original building.”
Hadassah’s wealth of experience in transferring departments during the years it strove to extend and reinterpret space in its over-60-year-old building will be drawn on to its fullest. “Three to five days ahead of its move, each department will begin transferring equipment not in daily use,” says Dr. Weiss. “Its actual move will take a single day, and everyone involved will know exactly where they are going and where everything will be. We will move one department every two weeks.”
The move to the inpatient tower, however, is about more than physical relocation. As each department gets accustomed to its new home, it will embrace new systems and methods. Most noticeable to patients will surely be the food.
“Instead of the existing inflexible system of delivering food to patients, we will be moving to something closer to hotel room service,” says Dr. Mor-Yosef. “Patients will, within limits, choose what they want to eat when they want to eat it.”
This will be possible because Hadassah is changing to Cook Chill catering, a system in which food is prepared up to four days in advance, put into oven-proof containers and blast-chilled to under 3 degrees centigrade within two hours, to ensure it retains its goodness and its flavor. Reheated in the ward, Cook Chill will allow Hadassah to feed its patients a wide range of nourishing and tempting kosher meals, among them, vegetarian, diabetic, low-fat and high- and low-protein dishes.
Another innovation is that patients and staff in the new building will have Internet access. Instead of waiting for doctors’ visits or transmitting comments and queries through nurses, patients will be able to e-mail questions to physicians, therapists and social workers.
Patient records, too, will be electronic, with charts absent from the end of the bed. “Some departments have already moved to this system,” says Dr. Mor-Yosef. “The remainder are training in the new technology.”
All this is part of a sweeping change in concept, whose guideline is increased availability of services. This is reflected beyond the inpatient center’s kitchens and electronics. “The tower will have a single central admissions area,” he says, “rather than general patient admission and then departmental admission, as we have today.”
Getting patients to the admission area is another focus. With a new main entrance to the hospital, planners are working out the best ways to direct the flow of patients. They must also introduce hospital staff, patients and visitors to a high-tech elevator system; the destination must be programmed before entering the elevator, which then stops only at the requested levels.
Nursing care will undergo major revision in the tower. “With one to two patients in each room rather than four or five and each department occupying greater physical space, a new system is needed,” says Dr. Mor-Yosef. “We are now looking at day-to-day issues such as storing supplies in more than one place per department, so that our nurses don’t spend their time running backward and forward.”
The medical center is also looking at how departments are supplied. At present, medicine is sent from the pharmacy to a department, toilet paper from central supply to the clinic, test results from the laboratory to the physician. “We are thinking whether this is the best way of doing things, or whether it is more efficient to dispatch through a central area,” says Dr. Mor-Yosef.
Whatever decision is reached, he is aware of the difficulty of introducing change. Training is under way to help staff make what Dr. Mor-Yosef describes as “the transition from one era to another.”
“We are not just addressing the evolution of hospital care,” sums up Dr. Weiss. “We are at the helm of a revolution.”