​​The Restructure of Department of Orthopedic Surgery and Center for Implant Surgery in Rothschild (Bnai Zion) in Haifa

The Restructure of Department of Orthopedic Surgery and Center for Implant Surgery in Rothschild (Bnai Zion) Hospital in Haifa

 

Since the very first day that I took up management of the Orthopedics department in Haifa          I would work from dawn to dusk and allowed none of
.the staff to leave before I did

The clinical work was gaining pace and many of Haifa’s population that have heard of the department’s restructure started to visit the Orthopedic clinics, which back then was set up in improvised consultation rooms and the hospital’s corridors. The department’s staff soldiered through the initial chaos and quickly adapted to the new requirements and pace

The ad-hoc set up of the clinic led to quite a few incidents such as where a plaster cast replacement performed by three residents was interrupted by another patient quietly apologizing that he was looking for the restrooms. The then-director of the hospital, Dr. Dov Golan, worked hard to clear additional working spaces for our benefit and provide more resources, however relief only came after a few years when the External Clinics building was finally completed and populated

The unusual working hours and the sheer intensity of the workload worked as a fine toothed comb for candidates. Many would quit when they discovered the entire house staff still at work well into the evening hours on a Friday

In order to promote the exchange of ideas and practices with colleagues from other Orthopaedics departments in the country, a rotation of visits was instituted. During such visits, a single resident would man the department while the rest of the resident staff would go out to visit other hospitals. This practice was soon adopted by many other hospitals’ departments and we would host another hospital’s staff at our facility, alternating between visiting and hosting

Our clinical and academic program were based on those employed in the USA where my own residency took place. I increased the number of residents and instituted a hierarchy of responsibilities from Chief Resident to Junior.  As a junior climbed the hierarchical ladder by gaining experience so did his responsibilities for his and his juniors’ activities. Eventually I passed administrative control of the department on to the Chief Residents and kept myself in a position of supervision, guidance and moderator

In the Operating Room I allowed Interns and Residents to operate almost immediately, always under a senior staff member or my own guiding hands. Tight control and supervision was made possible by instituting a series of “pre and post surgery” meetings participated by the entire team. All elective surgeries performed in the department were broken down to their components and thoroughly analysed. This exposure to fine details prepared the team for surgery and provided it with options for educated improvisations on the spot

To further promote the staff and residents’ didactic thought processes a series of protocols and report templates were introduced for use when admitting a patient, diagnosing a condition, and choosing appropriate treatment. These reports also covered pre and a post surgical  observations and the techniques used during the operation

Outside of the hospital I also instituted a series of monthly lectures targeting all of Haifa’s population of residents. These lectures revolved around a Q&A discussion starting from  X-ray imagings of interesting cases my team and I have encountered

In collaboration with Prof. Henry Mankin of Harvard, Boston, the team took a written residency exam once a year. These exams were designed to quantify the residents’  theoretical knowledge as well as test their practical abilities

Eventually, the periodical clinical studies meetings turned into research efforts and later into recognised academic research. These studies were further bolstered with monthly brainstorming meetings with researchers from many faculties of the Technion, drawn to us due to the practical nature of our studies. Inspired by Stef Wertheimer, we styled our motto: “The modern Zionism is the Bio-Medical Industry”

Mutual projects that succeeded would then expand and overflow into the industry - into companies such as Refael, the Israel Military Industries, the Israel Aerospace Industries, Lehavei Iskar, Elscint, Elbit and Carmel Forges. All are major companies at the forefront of security, advanced materials and electronics. These projects were supported by many grants from public, academic and government institutions both national and international. Eventually the department granted fellowship to research associates, local and from around the world and for the first time also to an Egyptian colleague

As part of the six years of clinical internship and six months of laboratory research, every resident  was sent to a two year fellowship in the USA in a topic of his choosing. These fellowship members were then expected to continue advancing their chosen topic within the Department and the Center for Implant Surgery. Successfully completing the fellowship guaranteed the resident’s place with the department’s team in a senior position and positioned him as a leading specialist in the Israeli Orthopaedic community

Since the renaissance of the Orthopaedic department, the hospital’s director Dr. Dov Golan came to rely on it as the flagship for the development of medical tourism in Israel. This ambitious project aimed to draw tourists to the hospital from around the world to receive a unique set of treatments and operations. These advanced Orthopaedic techniques, combined with a luxurious rehabilitation program in the institution “Carmel Forest” on Mount Carmel appealed to then minister of health - Motta Gur. The program was pushed forward with support from the Herzelia Private Medical Center and a group of entrepreneurs from the USA

The Center for Implant Surgery was one of the objectives I set for myself when I was still in New York. I planned to have this objective lay down the most important corner stone for Orthopaedics at the time. This was a period of a metaphorical blast off into space for the science of Orthopaedic Surgery. The ability to successfully and consistently replace major, weight bearing joints appeared bionic - the stuff of science fiction and books. We brought up an entire generation of qualified medical and paramedical staff that are dedicated to their work and their patients. We encouraged the integration of modern technologies and concepts. We were granted a special permit to treat patients from any area in the country and regardless of insurance boundaries set by the Medical Funds. We received the recognition of the Minister of Health, Arbeli-Almozlino as a National Center of Implant Surgery.  We were able to gain funds from public and private sources for research and activities. The local media stopped at nothing to shower us with positive exposure to the public

The annual International Symposium of the Center for Implant Surgery that were hosted in Haifa were a highlight in the social and professional life of the Israeli Orthopaedics Society and related professions. Our relatively small community was continuously exposed to the super-stars of the world-wide Orthopaedics social circle. Scientists, physicians and researchers known till then only through their writing and media exposure rubbed shoulders with their local counterparts. The conferences were warmly received on a national level and many departments actively participated in various symposia. Media coverage for the events showed the public the variety of technological and professional advancements that were achieved in our field. During period of calm, we also hosted participants from Gaza and Nablus, a department that was sponsored by our department for a time

My own pride and joy stems from the fact that the methods we introduced, raised experienced, professional and responsible surgeons. Many of whom, more than any other department in the country, were chosen to head departments in other hospitals in Haifa and other cities