Dr. Assi Cicurel is a community doctor in the Negev and is completing a sub-specialty in healthcare management at Soroka Hospital
“Recently, as each passing day has felt like a week at least, we’ve all understood how the coronavirus has become much more than just a health crisis. Big crises reveal system weak spots. Every weakness is highlighted to a critical degree, requiring quick treatment and change. This major healthcare system crisis has one special feature worth noting: it highlights all the healthcare system’s weak points, making them noticeable, critical.
I have bad news and good news: this epidemic is first and foremost a challenge and a difficulty. However, over time, this is going to be an opportunity, as well.
I’m lucky to be at a unique intersection in the Israeli healthcare system, where I have the chance to see, understand and connect its many different complementary parts. I am, first and foremost, a community doctor. This means that I work in the field with patients and also with teams in other communities. As part of my specialization in healthcare management, I work in Clalit HMO management’s Strategic Division and I try to engage with people who focus on the national policy-making, as well as thinking about the scenarios that may be ahead of us. Finally, because of the crisis, I was recently asked to return to Soroka Hospital, where I provided specialized care until not too long ago.
In all these places, and in the face of all the challenges we face in the system, there is one thing that helps me operate: the MAOZ Network. What’s special about the Network is the bonds and connections it forms. When you’re a part of the Network, you’re programmed differently – you’re programmed to work together. It’s a force that drives you differently.
I’ll tell you a bit about what my day typically looks like.
It’s the morning of a new week. There’s a heavy workload and intensity typical for this last period. I start my morning in the clinic offering care via phone, video, in the clinic itself and at elderly homes for elderly people who are in preventative quarantine. I’m taking part in a frenzy of conversations, meetings, treatments and now even Zoom meetings. I recently received an important delivery. It’s protective equipment for the medical teams. If there’s something missing today, for both the emergency room doctors and the nurses in the clinic, it’s protection. The shipment came thanks to a Network member’s connection with manufacturers of 3D printers. They quickly began to manufacture protective gear and delivered it to us immediately.
Later on, I find myself traveling between the villages and communities in the Negev. I distribute protective equipment, such as face masks, to help medical teams continue to provide medical care on the one hand while maintaining their own health on the other.
While I’m on the road, a Network member who serves as the direct manager in the senior management internship program calls me. We speak about the impact the upcoming revised guidelines will have on HMOs. A change in operations and methods of dividing shifts. We know that this supposedly technical issue will have lots of implications, so I share my thoughts, which are based on my work in the clinic and the conversations I’ve had with friends. I know that the insights from the field will impact policy-making.
I get back to the clinic and begin a series of online conversations with patients. In between, another Network member calls me and wants to consult. She says that there’s a healthcare human resources problem, as we all know. Do we have any creative solutions? What about, for example, someone who studied medicine abroad and returned to Israel and still has to take the final tests. Can he or she begin seeing some patients?
This relates to the biggest ailment our healthcare system faces. We’re used to typically dealing with this system alone. Every man for himself and every woman for herself. Every institution operates alone. Hospitals operate separately from the community. The Ministry of Health operates separately from the hospitals. Not because anyone is evil, not because something is necessarily wrong. This is simply how the system is built: lots of players have to fight over a little bit of money. So it’s natural that solitary, uncooperative, competitive work is the result.
In these times, we need many more players to collaborate so that we can successfully enact changes. I need connected professionals to work with me on my mission, their mission, our mission. Network connections make working together better and more efficient, as we start out with high levels of interpersonal trust.
How did the Ministry of Health know what the small clinics needed if they didn’t have sensors in those places? And how will the clinic be able to ask and get what it needs from the office if it doesn’t have a callable phone line and a simple moment to explain?
Or competing funds. Sometimes it’s a connection with a doctor in a clinic that supposedly competes with the HMO to which I belong. We offer each other rapid learning that we both need urgently.
Communication gaps between community and hospital. This is a disparity and difficulty that the healthcare system faces every day, year-round. Tensions, systems which are not always synchronized or connected. But now this weak point is even more critical. If a coronavirus patient is admitted to the hospital with acute symptoms and comes to experience some sort of relief, he or she can be sent to a hotel which is hosting patients exhibiting mild symptoms. The problem is that this is not that simple, because when one entity runs the hospital and another entity runs the hotel and the players don’t necessarily talk to each other, the operation is more difficult and sometimes simply impossible.
This is also true of other gaps the system faces, such as gaps between local authorities and medicine. On a daily basis, the Department of Social Welfare doesn’t speak with the pharmacies. However, there is now a burning need for coordination between places that distribute drugs and the people who need them and cannot leave home.
Another connection may be with economists from the Ministry of Health, which allows the transfer of information between the field and the headquarters, ultimately paving the way to finding solutions. What connection do I have to the economists? Good question. If I, at the small regional clinic, know that I will see patients via video sessions, this is not enough. I need guidelines and regulation to deal with this; I need more HMOs to deal with this.
The relationship between systems is crucial right now and cannot function with the same gaps we have routinely faced in the routine. That’s what the INBAR Network ensures these days: my ability to speak matter-of-factly and directly with other officials from all corners of the healthcare system and local systems.
It’s rare to feel that trust when you pick up the phone or get on a Zoom call and without any preparation, you suddenly already know that you can work
together. Yalla, we’re getting to work. So what if we compete? It is in this state of uncertainty, within this complexity that we simply, above all, need one another.
Like many other challenges, what we have in common today is our diversity. We have a chance. I feel we have a chance. We can address all our weaknesses very quickly right now. It will help us now, but it will help us out later on.
We will emerge stronger from this episode. The road will be difficult and complex, but we will grow stronger. To me, this encourages me on difficult days.”