Eyal Zimlichman, MD, is the chief transformation officer at Sheba Medical Center, the Middle East’s largest healthcare system, located in Ramat Gan, Israel. He founded and directs Sheba’s ARC (Accelerate, Redesign, Collaborate) Innovation Center, which brings players in digital medicine at Sheba together with external partners on a quest to accelerate change in healthcare on a global scale.
Aided by advances in data science, notably artificial intelligence and machine learning, Zimlichman and his team are developing models that healthcare systems around the world can apply to some of their biggest challenges. These include patient safety and quality of care, clinical outcomes, workforce shortages, access to quality healthcare, and financial pressures.
Zimlichman spent decades working on strategies to improve patient safety and quality of care on a single institutional level, first at Partners Healthcare in Boston, then, beginning in 2013, at Sheba. But it was mostly incremental, and in 2019, he and his team launched ARC to scale these efforts through collaborations, which he believed would be necessary to make meaningful differences in the lives of patients around the world. Sheba’s affiliates—physicians, healthcare systems, companies, and investors in Israel and other parts of the world – all contribute by identifying promising innovations and then conducting pilot trials of their best work and sharing results.
Other healthcare systems have created innovation hubs, but ARC started earlier and is differentiated by the scale of its ambition, prompted in part by the small size and exploding creativity of its native territory. Israel, situated in the Middle East with a population of only 10 million, is a limited opportunity for anyone whose ambitions are to enact large-scale disruptive change. ARC’s global outreach to outside collaborators in all walks of the tech and life sciences industries, healthcare systems, investors, and academia opens new possibilities.
“No one has tried to set up a collaboration like ARC before,” Zimlichman says. He said that any one organization is unable to drive huge change on its own.
To pave the way for other healthcare systems in its network that are looking to replicate its success, ARC has developed the ‘ARC Cookbook,’ which lays out processes, templates and structures that can be adopted. The first step is a cultural shift within an institution, according to the ARC Cookbook. Next comes the implementation science practices, such as financial incentives and measurable performance indicators, to identify unmet needs and test solutions, all the while making adjustments as needed.
Hospitals are well positioned to foster this kind of innovation because they understand the needs of clinicians and have the data to determine if the solutions work, Zimlichman says. On the other hand, resistance to change is pervasive within healthcare systems. But it can be overcome through the presence of a strong champion for the project, who can clearly demonstrate the benefits of something new. Once that person gains the confidence of the staff, he says, uptake occurs rapidly.
Also integral to ARC’s vision is its focus on financial gains. Sheba is government supported and not comparatively well endowed, but it has assembled the right infrastructure and leadership commitment to invest in and undertake this kind of ambitious program, Zimlichman says. On an annual basis, it spins out approximately 15 companies, each of which can then help ease problems identified by the medical center’s clinicians.
For example Aidoc, one of Sheba’s most successful startups, is an Israeli-American provider of AI-driven algorithms that analyze and aggregate medical data in real time for clinicians, helping them to prioritize their caseloads. Because of its proximity and connections to Sheba, Aidoc was able to fit better into the clinical workflow compared to some of its competitors, boosting its adoption rate according to Zimlichman.
ARC’s success can be measured by the number of companies it has spun out, as well as the resources dedicated to it within Sheba and the level of interest it has spawned globally. Now, some of ARC’s foreign partners, including Ottawa Hospital in Canada, Northwestern Memorial in Chicago, the Great Ormond Street Hospital in London and others are implementing ARC Cookbook methods.
At ARC’s annual Summit, held in spring 2023 at Sheba’s headquarters, the fruits of their efforts went on display as the partners, who come from diverse backgrounds, presented their work. The Summit attendance has more than doubled each year since its inception in 2019, except for 2020 and 2021, when it was closed due to COVID. More than 1,000 attended the June 2023 meeting, and the next meeting is scheduled for September 2024 in Tel Aviv. ARC itself has almost tripled in the number of dedicated full-time employees—from roughly 50 in 2019 to 140 at the start of 2024.
“Innovation is the fun, cool part, but transformation is painful,” Zimlichman says. “Transformation requires us to do things differently and human beings do not like change. Transformation is all about change management.”
That is an experience that ARC’s partners can relate to. “Innovation, in my view, is culture,” John Halamka, MD, president of Mayo Clinical Platform, also a high-profile digital initiative focused on partnering, and Board Chair of the Coalition for Health AI. Halamka, speaking to ARC Summit attendees a few years ago, noted that Mayo and ARC became partners early in ARC’s formation in part because change in healthcare requires continuous access to vast sums of data that are needed to validate algorithms so that they can be used broadly with confidence.
“If there's anything we've accomplished in this visit to Israel,” he said, “it's a notion of trust between Mayo and Sheba…the alignment of industry, government, healthcare and technology will not be our limiting step. Sometimes policy is the limiting step, but the hardest to overcome is culture and fear of change.”