BGU | MY PATH, Haim Doron, MD

CHAPTER 4

Clalit's Directorate

Dual-Management in Clalit As already noted, in August 1968, after seven years as director of Clalit’s Negev District, I was appointed Clalit directorate’s chief medical director. At the time, Clalit was the largest institution in the health system in Israel, and at various times it insured between 85-90 percent of the insured population. Well before my appointment as a director at Clalit headquarters, I had become familiar with the organization’s dual administrator structure. This double format operated at all levels in the organization: At the head of each district (North, Center, South) stood a physician and a director. Dr. Tovah Yeshurun-Bergman, who had been the medical director of Clalit, dubbed the administrative directors “the civilians.” Clalit hospitals as well had two directors, although naturally in the hospitals the medical director was more powerful, due to the nature of the institution. Nevertheless, the administrative head in Clalit hospitals was far from weak in stature. Even clinics, the basic unit, had a doctor and a clerk. The clerks, who generally had no medical education, considered themselves the directors of the clinics and did everything in their power to prove so. From the clerk’s perspective, the role of the doctor was to sign prescriptions and sick leave slips, approve home visits, and so forth. As a director of Clalit’s Negev District, it was clear to me that there was a huge gap between the district physician and the administrative director in the way they perceived their roles. The administrative directors viewed themselves as district directors and the real decision-makers, and believed the district doctor was only their medical advisor. This outlook was encouraged and bolstered by Clalit’s treasury because the authority and clout of the treasurer was channeled through these administrative directors, who were under him. The administrative directors were very powerful, expressed not only in the functions they fulfilled, but also by various perks such as the type of vehicle the administrators received, compared to the physicians. The administrators did everything in their power to prove their seniority in running things. This caused many quarrels between the district physician and the administrative director over issues of authority. Management became impossible. I was all too familiar with this system, having suffered greatly from it personally in my days as district physician for the Negev. When I was appointed chief medical director at Clalit headquarters, I knew this was a badly flawed system that needed to be combated, and I considered it my duty to gradually change the situation. I understood that to succeed, I couldn’t change things overnight, but could only do this slowly, and with a lot of cunning. This was a difficult mission to accomplish because Clalit’s directorate was comprised overwhelmingly by administrative directors, and few physicians. My policy objective was to gradually lead towards one director in authority. Such an individual did not have to be a physician. It hinged on the nature of the unit, but the person filling the position had to have proven credentials in terms of education or experience. Physician or not - the main thing was that there be one director whose professional administrative skills were suitable to the job. I endeavored that there should be a balance: If in one place I appointed a doctor, in another I appointed an administrative director as head. This was the only way to change the situation.

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