Coordinating an operation in a hospital is a complicated task. Most hospitals give each department their designated times for operating room usage, and the department must organize their surgical procedures during their allotted time. There are unfortunately more surgeries than available time slots; naturally many hospitals are enormously backed up, with patients sometimes waiting a year or more for an appointment.
This is not only inconvenient; it can be dangerous, even life-threatening. Hospitals scramble to prioritize cases that require urgent surgical intervention, but even the “less urgent” cases can grow significantly worse during a waiting period of months or years.
Mayanei Hayeshua Hospital in Bnei Brak noticed this problem and developed a unique solution: a pre-surgical clinic that coordinates all the surgeries in the hospital. The clinic was established and is currently headed by Malky Konopnitzky, an educator by training who followed her passion for the medical profession to become operations manager at Mayanei. Her knowledge was acquired during her 10 years of experience working at the hospital, and she’ll be pursuing a Master’s degree in healthcare systems management.
“There are a few things we can offer the public that they won’t find anywhere else,” says Malky. “First and foremost—availability. I have yet to meet a patient who has managed to make an appointment at another hospital that was able to accommodate him sooner than we were. When we were working under the old, classic model—with each department having its own designated time slot—I noticed that some departments were overbooked and struggled to get their patients in, while other departments left the operating rooms empty for hours at a time. That’s simply an inefficient use of very valuable real estate. The rooms are there, the staff is available, it’s just a question of smart allocation of resources.”
Mayanei Hayeshua runs five operating rooms where all types of surgery take place: OBGYN and uro-gynecology, general surgery, ENT, urology, etc. Malky explains that the orthopedics departments have flourished over the past few years and they now offer surgeries with orthopedists who specialize in specific areas of the anatomy, such as the foot, the shoulder, the spine, or the hand. Their pediatric surgical unit collaborates with the new Asuta hospital in Ashdod. Overall, Malky supervises the coordination of around 6,000 surgeries per year.
A shorter wait for a surgery can have real and lasting consequences. For example, if an older person takes a fall and breaks his hip joint, the amount of time it takes to get it repaired is critical, not only in terms of how long it may take to heal, but in terms of survival. A hip joint fracture can be a death sentence for geriatric patients whose health may rapidly decline as a result of bed confinement and restricted movement. The Ministry of Health requires hospitals to operate on hip joint fractures in the elderly within 48 hours, but many hospitals are simply not capable of achieving this standard because of their overbooked operating rooms. Mayanei is one of the few hospitals that can. Malky says that ambulance drivers know this and often divert these types of fractures to Mayanei; they know the patient will be treated in the required amount of time.
“Even if it’s not an urgent situation,” Malky goes on, “it’s always better to have a procedure done faster. For example, if you have gallstones and know you need them removed, you’re going to have an easier and simpler operation and recovery if you have them removed before they start causing major discomfort and other problems.”
In many hospitals, a patient may arrive on the day of a planned procedure only to have it canceled or postponed because of unexpected delays or urgent cases that were given priority. Malky insists that this is an extremely rare phenomenon in Mayanei Hayeshua: “I can’t tell you that it never happens, but I can count such situations on one hand. 99.999% of the time the operation will proceed as planned. The reason we can accomplish this is partially thanks to our efficient appointment-making system, and we don’t give operations a deadline. To expand on that, in many other hospitals, the operation rooms are available until only 2:30 or 3:00pm, and often staff will have to refuse another surgery slightly earlier than that so they will be able to clear the rooms by that time. We don’t work that way. If something comes up—unexpected delays due to complications or emergency surgeries—we’ll continue operations into the afternoon if we must. It’s a matter of approach. When you define your time in the operating room by clock watching, you’re going to have to make cancellations. When you see yourself as being there for the patient and for the community, your job is to finish the procedure and to get everything done.” Malky adds, “I’ve heard of situations where women were admitted for a post-miscarriage D&E, had already been given a medication to induce uterine activity but the procedures were canceled at the last minute and they were sent home. How can you send a woman home in that condition? It’s not just the emotional difficulty, but in a purely medical sense, she could suffer dangerous hemorrhage. We would never let that happen.”
In general, one of the unique characteristics of Mayanei Hayeshua is the level of care taken to ensure the patient’s comfort and the warm, personal approach of the staff. This extends even as far as coordinating staff of a certain gender according to the patient’s needs. “Women who come in for sensitive operations may feel intimidated by a room full of men, and we make sure there will be at least one woman in the OR with her. In some cases we can coordinate a mostly-female or all-female staff—or the opposite, an all-male staff for male patients who may be uncomfortable with the presence of female staff members. Because we cater primarily to the haredi sector, we understand the sensitivity of this situation and do our utmost to put the patient at ease.” She explains that they also have a wonderful volunteer program in place for female companions to accompany women undergoing medical procedures.
Another unique feature of Mayanei Hayeshua’s surgical clinic is a relatively recent addition—a “procedure room.” It’s a fully equipped surgical room specifically designated for minor procedures carried out under local anesthesia, which require a smaller staff and less intensive treatment—such as mole removal. “The advantage,” explains Malky, “is that it’s much more efficient. You don’t need to go through all the protocols of a normal operating room; you’re in and out a lot quicker. That frees up staff to perform more procedures than would otherwise be possible, which in turn increases our availability and allows more patients to get treatment sooner.”
So what is the appointment-making process at Mayanei Hayeshua like? “First, the patient will receive a referral for surgery from their local specialist,” Malky explains. “They come here with their referral, and one of our doctors examines them and determines whether the surgery they’ve been referred for is truly necessary. At times, our experts will decide that a careful treatment regimen may be preferable. If the doctor recommends surgery, the patient will approach one of our four secretaries to make an appointment. Prior to the surgery, the patient will come in for a pre-surgical exam. He will see the surgeon, the anesthesiologist, and the nurse, to get all the information he needs for surgery preparation. He’s then admitted to the hospital as needed, undergoes his procedure, and returns to the relevant department for the required recovery period before being released.”
For more information visit Mayanei Hayeshua’s website www.afmhmc.org