Space and Expansion – Growth in the Hospital 

A university department of cardiology has to be well-balanced. Its primary function is patient care, but it is also responsible for teaching students and post-graduates. It should also encourage research to introduce all the latest technologies and innovations. The fundamental principles of organization are no different than that of a large business, which must be built on sound economic principles. Its final goal is patient health.

To proceed, it needs patients, persuading them that the department is excellent and better than others in the country, so that there is a continuous supply and input into the department.

Adequate space is essential to build a factory or a supermarket, and similarly, a medical department needs sufficient space – wards to hospitalise the patients, large outpatient clinics to care for the clients, offices to house the doctors, secretaries, nurses, technicians and research staff, and storage space for equipment and records.

Inadequate staffing prevents optimal production and patient care and creates inefficient work, backlogs, and waiting lists. In the hospital, insufficient or uncoordinated staff hampers an efficient patient flow. Outpatient clinics have to be optimal for services provided; insufficient nurses or technicians create long waiting lists; and the patients find other clinics or hospitals. Inadequate or insufficient equipment can create bottlenecks.

Funding  fees from the sick funds and private patients and charitable donations has to be maximised with income covering the costs, and leaving a small profit; while capital has to be carefully allocated to provide the most modern and efficient machinery or equipment.

I soon realised that my major function was to navigate the department through this maze of precise coordination.

Space is always a problem. When I arrived in 1973, all the available space in the hospital had been allocated, including the new oncology block and later the mother and child pavilion.

The echocardiography service, which started from scratch, occupied one room in the basement, and as we acquired more machines, we needed more space we were allocated space in the gastroenterology department on the fourth floor, and we converted it into the echocardiography department with two examination rooms and an animal research surgical laboratory. The area was far from the catheterization laboratory in the basement and the patient ward on the eighth floor. The rooms were not renovated; they were physically far from my center of work; and so, the area was not part of my daily route.

The next improvement was a new ward of six beds on the third floor. This had been part of the physiotherapy department, which had moved most of its activity to Mt. Scopus. The rooms were renovated with clean, white paint, spacious windows opening into the atrium of the hospital building and with completely new fittings. We now had more monitored beds to hospitalize our growing in-patient service in a shiny, modern ward. I felt rejuvenated, and we recruited new staff of young nurses. For the first time we had a really modern department.

Two years later, the administration decided that the bone marrow transplantation service was earning more than cardiology, and we were moved to the fourth floor, but shared less-renovated space with the emergency room short-term hospitalization ward. This was a hybrid of two different services, overseen by the same nursing staff. It was airy and spacious, but the patients were always mixed up.

Phase three of the expansion started 15 years later and we acquired the dermatology department inpatient wards, which transferred from the eighth to the fifth floor.  This consisted of half a wing of the hospital but it was ideal to move my office from the basement to the 8^th floor.  Fortunately, Prof. Penchas, the hospital director, was behind the move, and we had a good donor from New York.  The ward space had to be renovated completely and we built a new office for myself with a secretarial suite and a large room for Yonathan Hasin, two new large catheter suites, a control room, radiological facilities, a six bedded recovery room, kitchen and a small waiting space for the patients and their families.

There was more office space, and I moved my own office to the eighth floor. We had also continued with the extra beds on the third floor and then another ward on the fourth floor.

The catheterization suite and the radiological facilities were superb.  General Electric gave us a very good deal.  I ordered a L-Y gantry and with a biplane configuration and they added the equipment for the second room—a single plane at half price.  These new rooms gave us sterling service as we did 10 to 12 cases a day of which half were follow up angioplasties.  The machines were reliable with very little down time. 

The recovery room was a G-d send.  We now had extra beds to house the catheterized patients overnight and this solved our extreme bed shortage. 

The dermatology outpatient department occupied the transverse wing on the eighth floor and two years later moved to renovated space on the fifth floor.  This was our opportunity to provide more office space for the doctors and a new echocardiographic department, bringing it up from the basement.  There was a small conflict between myself and Prof., Stern, the hospital director.  He wanted to convert it into an outpatient clinic while I saw it as an outlet for my overcrowded doctors who had no personal office space.  The administration decided to use it as alternative space while they were renovating the ENT department so the building was delayed for two years.  It made me very sad as the corridor was half empty in the mornings when they held their public clinics and only filled in the afternoon when the seniors had their private practice.

I sat with the architects and with minimal structural changes we built a corridor of physician's offices, a conference room and a well organized echocardiographic suite and stress testing laboratory.  A new wind of change blew through the department and for the first time the physicians had their own comfortable personal offices. 

The echocardiographic suite was comfortable and the corridor waiting room was full with patients.

This overall expansion program took 25 years. I felt that it was 20 years too long. We always had too many patients, too many procedures, too few doctors and in adequate space. Yet this was the reason that I had come to Israel and despite the lack of coordination by the hospital directorate we developed the busiest and best  cardiovascular department in the country. The patients flowed from every direction: Nahariya and the Kibbutzim in the north, Haifa and its suburbs, Nazareth, Afula, Rehovot, Ashkelon and Beer Sheva. Less than half the patients came from Jerusalem. After I retired the situation reversed and now 90% of patients come from the Jerusalem conurbation.

It is not only the space that counted, but the vision, drive, passion, enthusiasm, team spirit and hard work that created success.