Tel Hashomer Hospice
Alexander Waller, medical director writes:

‘Tel Hashomer Hospice has not only provided good and appropriate treatment to patients in the terminal stages of cancer, but has also strengthened the awareness of their particular needs – among the Israeli medical community and Israeli society at large. By its successful example the Tel Hashomer Hospice has stimulated the establishment of additional hospices throughout Israel. Ours was a truly international effort, for since our very first days we enjoyed the friendship, advice, and support of colleagues abroad, most notably our English friends and especially those from St Christopher’s Hospice.’¹³¹

Ina and Jack Kaye
Ruth Gassner, director highlights one important aspect of the success at the hospice at Hadassah:

‘Avoiding burn out and keeping your good staff. I read in the literature that in hospices every two or three years nurses are rotating, that’s exactly what I wanted to avoid, so how do I avoid it? [Harriet Copperfield] said that burn out comes only from hard conditions, not from hard work, and, you know, during the years, now I can say because now I’m almost 20 years here, that she was so right. Look at the nurses, they are still with me, most of them - some left because they left Israel, some left for the north - but most of the nurses are with me.’

Malka Yehezhel, inpatient social worker agrees and also notes that:

‘This multidisciplinary work is, I think, one of the keys of doing the best job here, and I know it’s not everywhere, we appreciate it very much.’

Judy Yoran, home care social worker describes success at the patient level:

‘When you help them when you see a patient that suffers, the day after he has a very tiny smile, small, a smile; that is a huge success. …. I think we have to, we have to see our little steps as our successes because there are a lot of battles to fight, I think, around the, what society sees as a hospice, you know, we still, people see us as a place where you come to die and you don’t leave, and so we are all fighting that when you try to explain to someone, you’re trying to give them quality of life, not only end of life, that’s a very big change of mind. But I think also you can add to your successes starting to educate the rest of the hospital about what palliative care is. They’re called in by nurses in the internal medicine department, the nurses are sometimes in the middle of the night consulted about how to help someone with pain; and the doctors are educating other doctors.¹³²

Cancer Pain and Palliative Medicine Service, Sha’are Zedek Medical Centre, Jerusalem
Nathan Cherny, oncologist and director identifies some key developments as markedly successful, and includes research (amongst many other strengths in the service) and the dissemination of this work through ESMO to the wider community as a particular important part of the service:

‘Since 1994 the key things have been, the four biggest things have been getting the position for a dedicated palliative care nurse, the second was getting the nurse and research assistant, secondly getting more staff, having more help, then the development of the in patient service and finally the development of the chaplaincy service. In terms of research and education we’ve had a long history of involvement, looking back at issues looking at attitudes and practices and also issues of specific interventions. When Professor Catane was head of the department here, at the time he was the national representative for Israel on the board of the European Society for Medical Oncology, and he suggested to them that they form a task force to approve the integration of oncology and palliative medicine all across Europe and this was approved by the Board. Since that time I have run this task force which has had a very strong ripple effect in the organisation.  ESMO have adopted a series of policy statements on the role of the oncologist, and minimal standards for cancer centres in the delivery of palliative care.  It surveyed its entire membership on their practices and that’s been published and it has set up an incentive programme to award centres of excellence in the integration of oncology and palliative care and this is to try to encourage centres across Europe to really look at this issue and it’s  been a very successful programme in ESMO and is widely publicised the organisation on the front page of their website and it’s early to say but there’s definitely a ripple effect and an awareness that’s been generated through this intervention and this whole programme has come out of this department.’¹³³

Negev Palliative Care Services
Dr Yoram Singer describes the successful developments as providing a vital service for patients as well as providing opportunities to train physicians:

‘Many of the people, by the time we come on, they’ve been so disillusioned and they’re so angry at the health system that it may take a week or two for us to regain their confidence in any kind of health, any kind of system which has to do with health, because they’ve, you know, had a recurrence and another recurrence, and finally the oncologist has called them together and said, ‘Listen, there’s nothing more we can do.’ Now then they send them home, and there’s nothing more horrendous for a family than to sit at home and feel that there’s nothing more can be done. And then we come and we say, ‘Well, we have, there’s lots we can do.’ ‘How’s that possible? I mean, in the hospital the Professor said there’s nothing, how is it possible that you think you have [something]?’ And then we say, and we start doing, and suddenly the patient feels better. Wow, it works, and it makes a whole difference because then the patient suddenly has enough energy to be able to do all these things that he has to do, you know, closing, forgiving, asking for forgiveness, the whole thing.
The important point in all this is how to teach? We have to convert the non-converted. I can tell you that 90 per cent of the [family medicine trainee] residents when they start are absolutely petrified ‘What is ... how are we going to get ...?’ I mean, you know, residency is not a very easy thing anyway, but ‘How are we going to deal with this issue? I don’t know; this is too much.’ And very often they come up with most amazing excuses why they just can’t possibly do this kind of thing, but by the end of the nine months [training] they’re pretty good at it, I must say. So I think it’s absolutely important and you can see if somebody’s been through this programme, they will call up and ask for advice because they know that there’s something - they can’t always remember or whatever, but they call up and they know where to look for advice, they know that it’s possible to, and you can tell the difference, I mean, there’s no doubt whatever.’¹³⁴

Milton and Lois Shiffman Home Hospice in the Valleys
Mali Szlaifer, director explains some of the success is due to the ways the team is trained and works together:

I think what is the special thing in our hospice here is that all the education we are doing is on a multidisciplinary basis. It means that even the social worker learns about medication, and the Edmonton [pain assessment scale] and everything. So she supports also if she goes there and the patient is in pain. She’s not supposed to treat the pain but to call the doctor, she doesn’t have to treat, but assess, yes.¹³⁵

As Mali Szlaifer notes this has resulted in everybody in the team being involved in assessments and then responding according to what is required. Dr Amitai Oberman, medical director highlights the staff commitment:

‘They don’t do it just for the salary; I mean you have to like what you do. So there’ve been rotations and some people came and some people left, and we basically ask people ‘Are you interested, there’s money, but are you interested in coming to work with us?’ Because there have been rotations, although we didn’t plan it this way, many of the nurses within the Nazareth region have been exposed to palliative care. So we all know one another and I feel at home here. It’s less ... it’s more complicated with the physicians because I don’t really see them too often - I talk to them in conferences, I talk to them over the phone - but with the nurses and the social workers there is wonderful liaison; I can tell [the social worker] Shauki, ‘Tell the physician to do this,’ and it’s done.’¹³⁶

Jerusalem Home Hospital
Medical director Dr Jeremy Jacobs reports two important elements in the success of the service:

‘Everyone’s very pleased with our service here, which is not a surprise. As regards the quality, what’s important is the communication, that’s what makes or breaks the service: in addition to the medical or nursing or the professional side of it, probably what makes it successful and ensures the patients to stay at home is the level of communication. And the more communication the better the service is. And it’s good for our bosses because supposedly it costs much less than being in hospital and we consistently show that it reduces hospitalisation rates. So it is financially viable.’¹³⁷

Nancy Caroline Hospice of the Upper Galilee Hospice of the Valleys
Medical director Dr Jim Shalom describes some aspects of the hospice’s success:

‘We have quite a good connection with the pain clinics in all the main, big hospitals in Israel, and we have one patient which we are going to present next week, in a seminar, that he is with us for more than three years, he has a spinal pump, and we do all the ... all the refilling of the pump, we do it by servicing at home, so we try to do, that’s one of the things that hospice is doing extraordinary things, many different examples, so I think we are quite good at it, at trying to treat each case as, each case individually, seeing the needs and trying to improvise sometimes.’

Yaniv Ben-Shoshan, social worker, explains the success of the patient/staff approaches:

‘I think that, I think all of us receive a lot of, from our work. For me it’s a lot of life, of a sense of life, and a love of life, I find in the family and the person, not in all the person, not all the patients and their families, but the process that I go with a person and with them to find some [meaning] in their time of life, in this time of life, and I with them, it’s a lot.’¹³⁸

Home Care Hospice of Kiryat Tivon, Northern Israel
Dr Ilene Ora Cibulski describes the greatest success from her perspective in Tivon:

‘In Tivon, we always had our training of professionals and non-professionals together, and we always used the professionals to teach their particular thing. I met the most wonderful people in the world. Not one, not two, I’m talking about dozens of very, very special people, dedicated people, knowledgeable people, responsible people, people who would crawl on their knees in order to get to a patient. It wouldn’t make any difference if it was two o’clock in the morning or on Yom Kippur, it wouldn’t make difference: if the patient needed them they would be there. And that’s a privilege, you know, how many of us have chance to meet people like that?’¹³⁹