24 October 2016

Nazareth Hospital Paediatrics Ward Appeal 2016

I've been meaning to set out some details of the 2016 Appeal for the Nazareth EMMS Hospital. This appeal is to refurbish and rebuild the Paediatrics Department in Nazareth - an absolutely vital service for the people of the Galilee region. The following information has been supplied by the Nazareth Trust. Don't forget to donate at http://justgiving.com/shanenaz2016 and make sure you spread the word on Facebook and Twitter!


The total population in Nazareth is 74,620. In the past, the majority of the population in Nazareth was Christian, but today the majority is Muslim. Over the years life expectancy has increased which has led to an increase in chronic diseases.


The Nazareth Hospital is licensed and accredited by the Israeli Ministry of Health. It follows and abides by all the regulations and standards of the Ministry of Health. The Nazareth Hospital does not receive regular government subsidies for capital investment in buildings, equipment, and other major improvements. Neither do we have foreign donors who regularly contribute large amounts to our efforts. When it comes to capital development and purchase of equipment, Nazareth Hospital relies totally on gifts and grants from friends around the world.

In October 2011, the Nazareth/EMMS Hospital officially took on the role of a teaching hospital and opened its doors for the first group of medical students from the Galilee Faculty of Medicine affiliated with Bar Ilan University. Seven of the Nazareth Hospital EMMS departments are recognised for the school’s residency programme.

The Paediatrics Service in Nazareth

The Nazareth Hospital provides health services to a catchment area of 264,000 in the North. Over 40% of the target population is under 18 years of age.

The paediatrics department at the Nazareth Hospital was established over 40 years ago by a missionary doctor who recognized the importance of developing and expanding services for children, including community-based health outreach to raise the awareness of mothers regarding child health.

Today the Nazareth hospital runs a very dynamic pediatrics department and a Neonatology department. With 18 hospital beds, a very dedicated team and despite the very limited space, the pediatrics department houses multiple services including general pediatrics, surgery, orthopedics, urology and plastic surgery and often times gynecology services for children.

It is also important to mention that the Nazareth hospital provides unique services in the region including treatment of burn patients and is the only hospital in the region that is certified by the Ministry of Health to treat and provide vaccinations for children who suffer from allergies that could compromise their condition when they are vaccinated for childhood diseases and require special attention and treatment.

The paediatrics staff applies the hospital’s biopsychosocial model, considering every aspect of the children and youth who come to them for care. The social worker and other multidisciplinary teams are available to intervene when needed.

Today, in spite of the department’s crowded physical conditions, patients and their families still prefer to come to the Nazareth Hospital because of the positive and supportive environment provided.

The Nazareth Hospital has the only psychiatry department in the area with Palestinian staff who speak Arabic, making it much easier for Arabic speaking patients to express themselves clearly to health professionals.

In cases where children require psychiatric consultation at the emergency room or paediatrics department they are provided with this service in their first language. In addition, children from the West Bank and Gaza are often referred for treatment to the Nazareth Hospital

The final beneficiaries of this project are the children and youth who will be better provided with immediate care. In 2015, 2,162 patients were admitted for hospitalization spending a total of 3,638 days in hospital. This is in addition to our out-patient and ER clincs.

Through this upgrade of the Pediatrics department, Nazareth Hospital will:
  • Be positioned for accreditation as a paediatric training program to support the hospital in its role as center for Family Medicine residency training. This outcome will be measured by the number of resident doctors in pediatrics, measured against baseline data.
  • Improve access to high-quality paediatric medicine. This will be measured by the number of children treated in the new facility, as counted against baseline values for that statistic.
  • Increase available square footage dedicated to the comfort of patients and their families and caregivers. The new department will have a place where children can do homework, play, and receive family visits with some privacy. This can be measured by square footage gained. Additional emotional and psychological comfort, although qualitative in nature, can be evaluated through patient feedback.
  • Increase the number of its staff with advanced technical skills and relevant professional expertise. This will be measured by tracking the number of staff trained in relevant paediatrics update courses as part of this project.


There is a fairly sizeable pricetag on the plans. The overall total to rebuild the entire Paediatric Unit will be in the region of $3.8M in the long term, which is a LOT, and assistance will be sought from elsewhere to help bring the plan forward. However everything you give will help, and you will know that you are helping the kids of Nazareth to move to a brighter future.

23 October 2016

Transformation powered by technology

On Tuesday the Northern Ireland Health Minister Michelle O'Neill will announce her response to the eagerly-anticipated Bengoa Review into the configuration of Health and Social Care Services in Northern Ireland. This will be a BIG DEAL for those of us working in the HSC, and a BIGGER DEAL for our patients (i.e. everybody).
Minister Michelle O'Neill [photo: BBC]

Before anyone counters that this is yet another review of the HSC and the other reviews haven't had any effect, it's worth injecting a little context. Back in 2014 the then Health Minister Edwin Poots asked Professor Sir Liam Donaldson to report on the state of the NI Health Service. That report was called "The Right Time, The Right Place", and pointed out a number of factors that make health and social care difficult in NI, others that make it excellent, and yet more that provide an opportunity to make it even better. I'm talking things up a little - there are major reasons why the status quo for the NI HSC is not sustainable, and transformation is critically important. Everyone knows this.

The Donaldson report made a number of significant recommendations, the first of which was the establishment of an international expert panel to review the Health Service and recommend a redesign that all political parties would be expected to sign up to in advance. I feel this was a pretty big ask, and therefore when a subsequent Health Minister, Simon Hamilton, took office, he reconfigured this recommendation into a combination of local, national and international experts, chaired by Prof Rafael Bengoa, to carry this recommendation forward. There was no political advance buy-in, but I don't think anyone finds that too surprising. This is Northern Ireland, but even if it hadn't been, politicians don't like signing up in advance to something they haven't had a chance to look at.

The important thing however is that the Bengoa Review exists as a direct consequence of the Donaldson Review, and it would be wrong to see it as "yet another report". I've previously blogged a little bit about this, but in advance of the report itself, it would be wrong to get too bogged down in hoped-for details.

That said, the word on everyone's lips is Transformation. We have to transform the HSC to achieve the so-called "Triple Aim" - better healthcare, better health, lower cost per capita. This means getting patients much more involved in their own care, changing how we deliver services, being much more open in how we share information and resources, centralising some services where appropriate, shifting expensive acute services to a small number of specialist sites, slashing clinical errors, reducing medication harm, taking a rigorous evidence-based approach to management, supporting much more care in community settings, etc.

There are a number of ways we will need to do this, but it seems very likely that the Minister will announce digital technology as a key feature. At least that is what I very much hope. We cannot truly transform our HSC by tinkering at the edges and redesigning a few forms and processes. We need to make sure all staff and patients are on the same page with regard to the data, that we are minimising risk due to miscommunication across care domains, that we are saving time and risk by not requesting and re-entering the same data multiple times into multiple disparate systems. We need our patients to be able to contact and communicate with us using video and audio calls. We need them to be able to access their own data and manage their own conditions insofar as that is appropriate.

This can't be done without the technology, but implementing that is a people process more than a tech process. The next few years are going to be challenging, but the clinical/professional community and our patients/clients are definitely up for it.