Healthcare systems increasingly operate under chronic scarcity, requiring prioritisation decisions beyond formal coverage policies and bedside clinical judgment. While much of the ethical literature on priority setting has focused on macro-level allocation or individual clinician decision-making, comparatively limited attention has been devoted to the meso level, where senior hospital medical managers shape access through implicit operational decisions under sustained constraint. This study examines how senior medical managers approach prioritisation when clinical need, prognosis, and expected benefit are held constant. Using structured allocation scenarios that vary only in socio-ethical and economic patient characteristics, we conceptually distinguish between the practical acceptability of non-clinical criteria and their perceived normative legitimacy. Eighty-two senior medical managers participate. Most respondents appear to reject explicit prioritisation under scarcity, endorsing equal treatment even when resources are insufficient. When prioritisation occurs, younger patients are more frequently favoured, typically on clinical rather than on economic grounds. Economic determinants, including reimbursement status, insurance coverage, and anticipated downstream costs, were rarely endorsed as explicit prioritization criteria despite participants’ simultaneous recognition of responsibility for departmental sustainability. These findings suggest a structured moral tension at the meso level. Economic constraints may be reframed through clinically grounded justifications, potentially obscuring underlying value tradeoffs, while non-prioritisation itself emerges as an ethically meaningful stance with distributive consequences. Using acceptability and legitimacy as a conceptual lens, this study underscores the need for transparent, procedurally robust approaches to hospital-level prioritisation under chronic scarcity.

BACKGROUND:Allocation of lifesaving technologies is a worldwide dilemma and the Covid-19 pandemic unprecedently amplified this scenario; medical teams struggled to fight the disease while demand for ECMO devices for severe patients exceeded the supply. Allocation of scarce technologies embedded socio-ethical perspective beyond clinical consideration, and we faced cultural and personal conflicts during the decision-making process. This study explores the multicultural Israeli healthcare arena, in which Arab and Jewish healthcare professionals treat Arab and Jewish patients equally, with a specific focus on the allocation of lifesaving resources and the role of cultural preferences in shaping these decisions. METHODS:A nationwide survey was conducted among healthcare professionals during an advanced managerial academic program. A structured questionnaire was produced and referred to a scenario in which the number of Covid-19 patients who need ECMO treatment exceeded the number of available devices. Participants were asked to set allocation preferences regarding theoretical patients representing different sociodemographic statuses and reasonably justify their choices. RESULTS:226 participants completed the survey. 60% of the Jewish, compared to 40% of the Arab participants declared no one should be prioritized. However, Arab participants showed a significant preference for prioritizing two age groups: the elderly and the youngest. For both Jewish and Arab participants, the main justification for prioritizing young patients was their better survival chances. In contrast, the reasons for favoring the elderly differed significantly between the groups; Arabs emphasized respect for "wisdom and social dignity," while Jews highlighted eligibility based on past insurance payments. CONCLUSIONS:Differences in perceptions and a range of values between Jewish and Arab participants were observed. Socio-ethical understanding and implementation of critical consciousness, offers an opportunity to increase 'doing good', assist in peers' support in complex situations and can affect the shaping of the next generation of healthcare managers.

Health systems worldwide are challenged by the need to prioritize and fund rapidly evolving health technologies. The methodology of health technology assessment (HTA) incorporates benefits, costs, and social implications, supporting prioritization of public coverage regarding national health policy. The aim of this study is to identify, analyze, and compare key considerations in the adoption of medical technologies reflecting the national health policies in Israel and England. All Israeli pharmaceuticals approved for public funding during 2020-2022 (287) were analyzed and compared with England recommendations concerned clinical effectiveness, economic considerations, and social values. Both health systems demonstrated 49% agreement regarding approval of funding recommendations policy, while in oncology, diabetes, and hematology, this reached 60%-65%. In both health systems, adoption was determined by clinical impact considering the disease burden and regarding the added value of the innovative technology compared with existing treatments, followed by social considerations. Budget considerations prevail in England. This relatively high resemblance in adoption decisions between England and Israel may emerge from similar principles of accountability for public coverage of medical care. In addition, it may also be driven by the forefront of innovative technological research worldwide and global interest. Nevertheless, economic considerations differ between the 2 health systems, introducing policy discrepancies or tactical diversity.

BACKGROUND:The patient-doctor encounter encompasses a comprehensive information and decision-making situation. It involves a gap in knowledge and feelings between the doctor and the patient, which intensifies in sensitive situations, in particular gynecology. It may be accompanied by loss of control, violation of privacy, embarrassment and discomfort. This emotional gap has deepened in the past year following the October 7th terror attack. The current training of medical students and residents is insufficient. OBJECTIVES:To formulate a comprehensive learning model for trauma-informed treatment. METHODS:A steering committee mapped out principles for formulating and implementing the training: dealing with patients who have experienced trauma and identifying the characteristics of the phenomenon, the type and scope of communication skills required, and the tools for its implementation, and processing the therapist's feelings to provide professional confidence relevant to the situation. The patients' expressions were collected as a platform for workshops that included theoretical lectures, patient testimonies and actors' simulations. RESULTS:A total of 27 residents (in Shamir Hospital) and 35 senior gynecologists from 15 health institutions countrywide were trained. An analysis of the insights reflected the perceived benefit of professionalism, the importance of acquiring professional tools and the need for additional knowledge while enhancing the experience of providing care and service. Participants noted the deepening of the ability to identify the phenomenon and deal with patients who have experienced trauma. CONCLUSIONS:It is important to promote trauma-sensitive testing among gynecologists at a national level, especially in the fields of urogynecology, fertility, pregnancy and obstetrics, alongside other clinical fields (urology, surgery, etc.). We recommend exposing medical students in clinical settings and interns during any internship in order to enhance patient-doctor encounter dialogue. This process will improve professional skills and patient experience at a national level, and increase the overall quality of medical services provided in Israel.

INTRODUCTION:"Healthcare Innovation" evolved as a key conceptual and practical paradigm to promote science and medicine, clinical excellence, added value and significant global impact. Enthusiasm and curiosity regarding innovation are increasing in order to gain clinical benefit, while barriers to implementation decrease. Moreover, we are challenged to encourage education for innovation in daily practice and research. OBJECTIVES:"Round table" discussions were conducted to estimate professionals' engagement, deliberating the potential benefits versus applicability efforts, and the willingness to invest in innovations in the most effective pathway. METHODS:Discussions involving hospital managers, directors of innovation centers, representatives of the IDF medical corps, the academia, industry, media, and physicians. RESULTS:Four issues emerged: 1) The borders of innovation in practice, 2) The medical education students, physicians and managers, 3) The role of initiators bridging socio- geographical gaps, 4) The requirements to establish a national ecosystem. CONCLUSIONS:Discussing challenges and opportunities in healthcare innovation paves the way toward improved systemic processes on a national level, by creating value tailored to one or more of the players. A network of peers, engineers, data scientists and information specialists yields benefit. Bottom-up requirements and needs ("demand") are more important than the supply of theoretical innovative ideas, especially given the current era of instability and uncertainty of the Israeli healthcare system.

Healthcare systems struggle to balance priorities within complex settings. This analysis aims to identify cross-national insights and trade-offs in healthcare policy by examining how five high-income countries navigate accountability, autonomy, equity, trust, satisfaction, and system effectiveness – competing parameters that shape system performance and public experience. A structured comparative analysis was conducted across five national healthcare systems: Israel, the Netherlands, Germany, the United Kingdom (UK), and the United States (US). Publicly available literature, including peer-reviewed studies, policy reports, and population surveys, was synthesized using a narrative approach due to variation in data definitions and context. The Netherlands and Germany demonstrate relatively balanced performance across all parameters, supported by regulated insurance models. Despite universal coverage, the UK system faces sustained access failures and eroding public satisfaction. The US underperforms in equity and satisfaction but demonstrates strengths in specific clinical domains. Israel combines strong statutory coverage with growing reliance on supplementary and private insurance, raising concerns about long-term equity and regulatory coherence. Each system reflects different strengths and trade-offs across the examined dimensions. The findings highlight structural tensions between autonomy and accountability, equity and access, decentralization and fragmentation, and public versus private provision that shape overall system performance. These insights are relevant for health systems seeking to enhance care delivery in an effective and patient-satisfying manner, and they support cross-national dialogue on designing resilient and equitable health systems.

Introduction:Professionalism among healthcare professionals is often defined in terms such as altruism, humanism, and excellence. The integration of such professionalism ideals to healthcare professionals' practice poses a challenge to medical tutors. We examined the assessment of professionalism among physicians and nurses by their peers and evaluated the significance of each professional role component within each sector. We also performed a cross-sector assessment whereby physicians assessed nurses' professionalism and vice versa. Methods:A survey among physicians, interns, and nurses. The participants were asked to rate the extent that each of the 12 characteristics contributes to physicians' and nurses' professionalism of on a scale of 1 (does not contribute at all) to 10 (highly contributes). Each participant rated the contribution of each component to the professionalism of their own occupation (direct scoring) and to the professionalism of the other occupation (cross scoring). Results:In total, 300 healthcare professionals (mean age 36.6, 46% males) responded to the survey. The most highly contributing characteristics to physicians' professionalism were knowledge, responsibility, decision-making and leadership, clustered as "strategic judgment". The most highly contributing characteristics to nurses' professionalism were responsibility, personal attention, empathy, and skills, clustered as "bedside approach" and "performance abilities". Cross-assessment among professionals was different: Nurses assigned higher ratings in general, interns assigned higher ratings to physicians' characteristics, whereas physicians assigned lower ratings to professionalism characteristics, and especially to those of nurses. Nurses emphasized patient centeredness and communication skills more than physicians. Nurses and interns appreciated teamwork compared to physicians. Major differences in how physicians and nurses perceive professionalism revealed physicians' emphasis on "strategic judgment" while nurses emphasis on "bedside approach". Conclusion:Physicians and nurses hold differing viewpoints on many topics, including the objectives of their mission, expected performance, and activity types. Medical professionals can assess their colleagues and partners, recognizing both strengths and weaknesses in themselves and others.

Efficient optimization of operating room (OR) activity poses a significant challenge for hospital managers due to the complex and risky nature of the environment. The traditional "one size fits all" approach to OR scheduling is no longer practical, and personalized medicine is required to meet the diverse needs of patients, care providers, medical procedures, and system constraints within limited resources. This paper aims to introduce a scientific and practical tool for predicting surgery durations and improving OR performance for maximum benefit to patients and the hospital. Previous works used machine-learning models for surgery duration prediction based on preoperative data. The models consider covariates known to the medical staff at the time of scheduling the surgery. Given a large number of covariates, model selection becomes crucial, and the number of covariates used for prediction depends on the available sample size. Our proposed approach utilizes multi-task regression to select a common subset of predicting covariates for all tasks with the same sample size while allowing the model's coefficients to vary between them. A regression task can refer to a single surgeon or operation type or the interaction between them. By considering these diverse factors, our method provides an overall more accurate estimation of the surgery durations, and the selected covariates that enter the model may help to identify the resources required for a specific surgery. We found that when the regression tasks were surgeon-based or based on the pair of operation type and surgeon, our suggested approach outperformed the compared baseline suggested in a previous study. However, our approach failed to reach the baseline for an operation-type-based task. By accurately estimating surgery durations, hospital managers can provide care to a greater number of patients, optimize resource allocation and utilization, and reduce waste. This research contributes to the advancement of personalized medicine and provides a valuable tool for improving operational efficiency in the dynamic world of medicine.

Background and Objective:While there is a substantial amount of research on risk perception, there has been less focus on the way medical technologies are perceived by experts as opposed to lay individuals. We investigated the factors that may influence the risk perception of healthcare workers (HCWs) and the general public regarding 3 distinct medical technologies: magnetic resonance imaging (MRI), laser-assisted in situ keratomileusis (LASIK) and the Covid-19 vaccine.Methods:A cross-sectional study conducted in 2021 among 2 populations: HCWs employed at a general public hospital and a sample of outpatients and individuals who are not medical professionals. The participants completed an electronic questionnaire.Results:In total, 739 respondents were included: 197 HCWs (26.7%) and 542 members of the public (73.3%). Most of the respondents (89.4%) reported being vaccinated against Covid-19, 43.8% had previously undergone an MRI but 90% had not undergone LASIK. Overall, all 3 technologies assessed in the study were rated by the respondents as having a high benefit and low risk. HCWs and the public showed statistically significant differences in perceived risk towards MRI and LASIK, as well as in some of the risk perception characteristics of each technology. In contrast, no differences in risk perception towards the Covid-19 vaccine were found between HCWs and the public. Both study populations showed a significant negative correlation between trust in the MoH and the perceived risk towards MRI and the Covid-19 vaccine. Both study populations regarded information provided by medical sources as the most reliable for decision-making.Conclusion:The perceptions and concerns towards medical technologies influence individuals' behavior and acceptance of technologies. They are also essential for risk communication. The study contributes to the understanding of attitudes towards various medical technologies, including risk perception, risk characteristics, trust and sources of information pertaining to each of the technologies, by examining the differences between HCWs and the general public.

Healthcare workers (HCWs) are role models and advisors for promoting health behaviors among their patients. We conducted a cross-sectional survey to identify and compare the health behaviors of 105 HCWs and 82 members of the Israeli public. Of 13 health behaviors examined, undergoing screening tests, getting influenza vaccines and smoking were significantly different between the HCWs and the public. Further comparison between physicians and other HCWs (e.g., nurses, physiotherapists, dieticians) showed that the physicians reported the least favorable health behaviors: having less than 7 h of sleep, being less likely to eat breakfast, having greater alcohol consumption and being least likely to undergo regular screening tests. Analysis of a composite healthy lifestyle score (which included 11 health behaviors) showed statistically significant differences among the three groups (p = 0.034): only 10.6% of the physicians had a high healthy lifestyle score compared to the other HCWs (34.5%). In conclusion, the HCWs and the public report suboptimal health behaviors. Beyond the concern for HCWs’ personal health, their health behaviors have implications for the health of patients and the general public, as they play an important role in health promotion and counseling. HCWs’ suboptimal “health profile” mandates implementing policies to improve their knowledge of recommended health behaviors, primarily targeting physicians, even at an early phase of their professional journey.

BACKGROUND:On October 7, 2023, Hamas carried out an unprecedented attack on the State of Israel and kidnapped 251 people into captivity to the Gaza Strip. Several months later, as part of a humanitarian exchange deal, 105 hostages were released in five phases and admitted to one of six hospitals throughout the country for treatment. Shamir Medical Center (SMC) was one of these facilities. This study aims to describe the structure, process and outcomes of establishing a comprehensive, multi-step, operational protocol for receiving hostages returning from captivity. METHOD:The process of preparing SMC as a receiving center, the establishment of procedures for implementation of the medical protocol, and the assessment of multi-disciplinary team preparedness and implementation and outcomes in an institutional protocol are described. RESULTS:24 returning hostages were received at SMC. Social workers, dietitians and translators were used by 100% of the majority group of returning hostages from the same country of origin and the sole individual from the other country of origin utilized a dietitian, social worker, ENT consultations, and a hearing test. Among the majority group, orthopedic and dermatological consultations were utilized by 17.4% and 13% received an ENT consultation. Of the administered imaging, 13% received a chest X-ray, 8.7% received a limb X-ray, 17.4% received a head CT scan, and 4.3% received an abdominal CT. In addition, 21.7% were provided antibiotic therapy. Protocol efficacy was measured by assessing time to various operational aspects of protocol implementation and medical procedures such as mean hours to room assignment, primary physician evaluation and social worker session. No correlation between age and operational variables was found. CONCLUSION:This novel operational protocol was successfully implemented and may serve as a framework for managing similar unpredictable sensitive events in the case of future need.

Background and Objectives: In response to the COVID-19 pandemic, Israel prioritized pregnant women for vaccination, recognizing them as a high-risk group. This study aims to explore factors influencing the acceptance of Influenza, Pertussis (T-dap), and COVID-19 vaccines among pregnant women, focusing on attitudes, social norms, perceived control, and risk perceptions. Additionally, the study compares acceptance patterns between traditional vaccines and the newer COVID-19 vaccine. Methods: A prospective cohort study was conducted between December 2019 and December 2021 involving 449 predominantly Israeli pregnant women. A survey was administered to gather data on demographics, obstetric history, vaccination history, and factors influencing vaccination decisions. Results: COVID-19 vaccine uptake was the highest at 64% (202/314), followed by T-dap at 49% (221/449) and Influenza at 32% (146/449). Multivariable logistic regression showed that non-religious women and those with academic education were more likely to accept vaccines, especially the COVID-19 vaccine. Physician recommendations were the most influential factor in vaccine acceptance, while internet and media sources played a significant role in shaping COVID-19 vaccine decisions. Perceived risks varied: Whooping Cough was seen as the greatest threat to newborns, while COVID-19 posed the highest risk to mothers. Analyzing maternal and neonatal disease perception using multivariable linear regression, we found that information on maternal and neonatal Flu, Whooping Cough, and COVID-19 was significantly positively correlated with disease perception for each condition. Conclusions: Healthcare providers play a crucial role in influencing vaccine decisions, especially through personalized communication. Strategies targeting religious communities and leveraging media can help address vaccine hesitancy, ultimately improving maternal and neonatal health outcomes.

Attitudes of healthcare workers (HCWs) toward vaccines are extremely important for increasing vaccination coverage. We conducted a cross-sectional study at the beginning of the fourth COVID-19 vaccination dose campaign among 124 HCWs to evaluate attitudes towards the fourth dose and willingness to get vaccinated. At that time, Israel was the first country to approve the fourth vaccine dose. Most women were unwilling to get the fourth vaccine dose compared to men; 53.9% of physicians were unwilling to get vaccinated compared to 83.3% of nurses and 69% of other HCWs professions. The most frequent concerns regarding the vaccine were its efficacy, benefit, and necessity. The perceived risk and perceived severity of the health risk involved with getting vaccinated with the fourth dose were higher among HCWs who stated that they would not get vaccinated compared to those who were vaccinated or intended to get vaccinated. In contrast, HCWs who were vaccinated with the fourth dose, or those who were planning to get vaccinated, gave higher scores to the perceived benefit of the booster, its advantages, its perceived safety, its ability to protect from severe illness, and the perceived extent of scientific information about the risk associated with the booster. A logistic regression model revealed that perception of the fourth dose’s benefits and risk significantly predict the willingness of HCWs to get vaccinated. Willingness to vaccinate their own children, acceptance of a hypothetical annual booster vaccine, and having less severe adverse effects after prior vaccination were also associated with willingness to get the fourth dose. These findings could help policy makers in developing strategies to expand the acceptance and coverage of the COVID-19 booster doses.

BACKGROUND:Patient-centeredness is a core element in healthcare. However, there is a gap between the understanding of this term by healthcare professionals, and patients' capability, self-efficacy, and willingness to take part in medical decisions. We aim to expose standpoints toward "patient centeredness" among junior medical managers (JMM), as they bridge between policy strategies and patients. We try to reveal cultural differences by comparing the views of the majority and the minority subpopulations of Israel (Arabic and Hebrew speakers).METHODS:A cross-sectional survey among JMM studying for an advanced degree in health-system management at three academic training colleges in Israel was conducted in February-March 2022. The respondents completed a structured questionnaire comprising four sections: a) perceptions of trust, accountability, insurance coverage, and economic status; b) perceptions regarding decision-making mechanisms; c) preferences toward achieving equity, and d) demographic details.RESULTS:A total of 192 respondents were included in the study-50% Hebrew speakers and 50% Arabic speakers. No differences were found between Arabic and Hebrew speakers regarding perception of trust, accountability, insurance coverage, and economic status. JMM from both subpopulations believed that patients' gender and age do not influence physicians' attitudes but Arabic-speaking respondents perceived that healthcare professionals prefer educated patients or those with supportive families. All respondents believed that patients would like to be more involved in medical decisions; yet Arabic-speakers perceived patients as tending to rely on physicians' recommendations while Hebrew speakers believed that patients wish to lead the medical decision by themselves.CONCLUSIONS:Patient-centeredness strategy needs to be implemented bottom-up as well as top-down, in a transparent nationwide manner. JMM are key actors in carrying out this strategy because they realize policy guidelines in the context of social disparities, enabling them to achieve a friendly personalized dialogue with their patients. We believe that empowering these JMM may create a ripple effect, yielding a bottom-up perception of equity and initiating change.

IntroductionThe COVID-19 pandemic has placed additional burden on already strained healthcare systems worldwide, intensifying the responsibility and burden of healthcare workers. Although most hospital staff continued working during this stressful and challenging unprecedented pandemic, differences in the characteristics and attributes were noted between sectors and hospital departments. Israeli healthcare workers are trained and experienced in coping with national emergencies, but the pandemic has exposed variations in staff reactions. Understanding the intrinsic differences between sectors and departments is a key factor in staff and hospital preparedness for unexpected events, better resource utilization for timely interventions to mitigate risk and improve staff wellbeing.ObjectiveTo identify and compare the level of resilience, secondary traumatization and burnout among hospital workers, between different sectors and hospital departments, during the COVID-19 pandemic.MethodsCross-sectional research to assess the resiliency, secondary traumatization and burnout of healthcare workers at a large general public hospital in central Israel. The sample consisted of 655 participants across various hospital units exposed to COVID-19 patients.ResultsEmergency department physicians had higher rates of resilience and lower rates of burnout and secondary traumatization than staff in other hospital departments. In contrast, staff from internal medicine departments demonstrated the highest levels of burnout (4.29). Overall, physicians demonstrated higher levels of resilience (7.26) and lower levels of burnout compared to other workers.ConclusionIdentifying resilience characteristics across hospital staff, sectors and departments can guide hospital management in education, preparation and training of healthcare workers for future large-scale health emergencies such as pandemics, natural disasters, and war.

INTRODUCTION:In recent years, the increasing prevalence of autism-spectrum disorder has resulted in an increased demand for therapies including occupational therapy. In this pilot trial, we aimed to compare the efficacy of group versus individual occupational therapy among toddlers with autism as a means to improve accessibility to care. METHODS:Toddlers (2-4 years) undergoing autism evaluation in our public child developmental centre were recruited and randomised to receive 12 weekly sessions of group or individual occupational therapy based on the same mode of intervention: Developmental, Individual-Differences and Relationship-based (DIR). Primary outcomes related to intervention implementation included waiting days, nonattendance, intervention period, number of sessions attended and therapist satisfaction. Secondary outcomes were the Adaptive Behaviour Assessment System questionnaire, the Paediatric Quality of Life Inventory and the Peabody Developmental Motor Scale (PDMS-2). RESULTS:Twenty toddlers with autism were included, 10 in each occupational therapy mode of intervention. Children waited fewer days before beginning group occupational therapy compared to individual therapy (52.4 ± 28.1 vs. 108.8 ± 48.0 days p < 0.01). Mean numbers of nonattendance was similar for both interventions (3.2 ± 2.82 vs. 2 ± 1.76, p > 0.05). Worker satisfaction scores were similar at the beginning and end of the study (6.1 ± 0.4 vs. 6.07 ± 0.49, p > 0.05). There were no significant differences between the percentage changes in individual and group therapy outcomes for adaptive score (6.0 ± 16.0 vs. 4.5 ± 17.9, p > 0.05), quality of life (1.3 ± 20.9 vs. 18.8 ± 24.5, p > 0.05) and fine motor skills (13.7 ± 36.1 vs. 15.1 ± 41.5, p > 0.05). CONCLUSIONS:In this pilot study, the group DIR-based occupational therapy for toddlers with autism improved access to services and allowed earlier interventions, with no clinical inferiority to individual therapy. Further research is required to examine group clinical therapy benefit.

INTRODUCTION:Planning the future national hospitalization system requires consideration of demographic trends, innovative treatments and policy approaches. The existing situation alone does not allow proper planning in extremely dynamic systems that operate within the framework of scarce resources.OBJECTIVES:To identify managers' attitudes regarding hospital planning, deployment and managerial mechanisms in comparison with evidence in the literature.METHODS:A survey among hospital managers following a focused conference.RESULTS:Of the 50 respondents, half of the group thought that a general hospital should include 900-2000 beds. The majority prefer an autonomous management style, or a cluster of only a few hospitals. In a scenario of overload and shortage of beds, the majority prefer adding beds to the existing hospital, while about a quarter of the respondents suggest establishing another hospital in the area, or merging nearby hospitals. About half supported home care, or transferring patients to a nearby hospital, including in the private sector, or the transfer of appropriate patients to chronic care institutions. About a third of the respondents supported telemedicine. In terms of national deployment, the preference was that the hospital should be located in high population areas and able to provide sufficient geographical accessibility. Yet, 60% of participants emphasized the importance of social determinants to low socio-economic populations.CONCLUSIONS:The survey revealed original standpoints and ideas towards willingness to promote targeted solutions. Healthcare leaders should consider and adapt local ideas to achieve effective planning following the insights of those working in the field.DISCUSSION:Targeted conferences aimed at discussing health policy are an effective platform for presenting complex issues and for sharing ideas with colleagues for the benefit of meaningful long-term processes.

Abstract Background Active participation of patients in managing their medical treatment is a major component of the patient empowerment process and may contribute to better clinical outcomes. Patient perceptions and preferences affect the patient–physician encounter in a variety of dimensions, such as patient autonomy, freedom of choice and trust in the healthcare system. The Israeli healthcare system is mostly publicly funded, with additional private healthcare services for surgery and other medical treatments. The aim of this study was to compare the perceptions and preferences of patients in the public and private hospitals in Israel. Methods A cross‐sectional study among 545 individuals who had surgical procedures at two hospitals in Israel (one public and one private). A structured questionnaire comprising 23 items was used to collect perceptions via personal telephone interviews. The responses were categorized into five clusters and compared by type of health services provider (public vs. private) and sociodemographic characteristics (gender, age and education level). Results A hierarchical cluster analysis methodology identified five conceptual groups: trust, concern towards medical errors, dialogue between medical staff and the patient/patient's family, confidentiality and staff bias towards more informed patients, or those with supportive families. Four main themes that highlight patients' preferences were found: physical conditions, personal empowerment and perceived autonomy, patient experience and patient–provider encounter communication. Significant differences between the private and the public healthcare systems were found in four clusters: trust and patient care, patient's concerns, the extent of explanation and medical staff's commitment. Differences secondary to sociodemographic parameters were noticed: patients treated at the private hospital scored significantly higher items of trust, medical staff caring and the importance of choosing their treating surgeon, while patients treated at the public hospital scored higher staff commitment to the patient than those treated at the private hospital. Conclusions The study revealed the perceptions underlying the decisions of patients to undergo surgical procedures in public or private hospitals. Mutual learning could pave the way to better patient–physician encounters. Patient or Public Contribution Patients from the two hospitals were involved in this study by responding to the questionnaire. The data presented is based on the patient's responses.

The COVID-19 pandemic has led to the rapid development and implementation of vaccines. However, uncertainty about their safety and effectiveness among some people has led to vaccine hesitancy. We conducted a cross-sectional survey in March 2021 among individuals from the general Israeli population and health-care workers (HCWs) to examine risk perception toward the COVID-19 vaccine, trust in health-care providers and information sources used for making health-related decisions. The study population included 739 respondents: 42.6% HCWs and 57.4% members of the public. Participants’ perceived risk toward the vaccine was relatively low in both populations. Higher perceived benefit of the vaccine, higher perceived extent of knowledge that doctors have about the risk associated with the vaccine, higher perceived freedom to choose whether to get vaccinated and higher trust in health-care providers predicted lower perceived risk toward the vaccine. Individuals who showed greater health responsibility, those who usually get vaccinated against influenza and those who had greater objective knowledge on the COVID-19 vaccine demonstrated lower perceived risk. No statistically significant difference in trust level was found between HCWs and members of the public. Both populations regarded information from medical sources as their greatest influence on health-related decisions. The study points to the factors influencing the perceived risk toward the COVID-19 vaccine and emphasizes the unique status of HCWs having their own views and concerns about the vaccine as individual members. Policymakers should consider these factors when planning national vaccination campaigns.

Background: Operating rooms are the core of hospitals. They are a primary source of revenue and are often seen as one of the bottlenecks in the medical system. Many efforts are made to increase throughput, reduce costs, and maximize incomes, as well as optimize clinical outcomes and patient satisfaction. We trained a predictive model on the length of surgeries to improve the productivity and utility of operative rooms in general hospitals. Methods: We collected clinical and administrative data for the last 10 years from two large general public hospitals in Israel. We trained a machine learning model to give the expected length of surgery using pre-operative data. These data included diagnoses, laboratory tests, risk factors, demographics, procedures, anesthesia type, and the main surgeon’s level of experience. We compared our model to a naïve model that represented current practice. Findings: Our prediction model achieved better performance than the naïve model and explained almost 70% of the variance in surgery durations. Interpretation: A machine learning-based model can be a useful approach for increasing operating room utilization. Among the most important factors were the type of procedures and the main surgeon’s level of experience. The model enables the harmonizing of hospital productivity through wise scheduling and matching suitable teams for a variety of clinical procedures for the benefit of the individual patient and the system as a whole.