SNF Health Initiative Progress Update – April 2021 - Stavros Niarchos Foundation

SNF Health Initiative Progress Update – April 2021
27 APRIL 2021

HI Quarterly Report 04 21 Visual

The pandemic has underscored the importance, now more than ever, of a strong, well-prepared, and equitable National Health System for Greece, one centered on people. 

In the midst of the evolving pandemic crisis in Greece, the Stavros Niarchos Foundation (SNF) completed core projects in its Health Initiative, including delivery of state-of-the-art helicopters and airplanes to strengthen the capabilities of the National Center for Emergency Care. At the same time, the Foundation significantly expanded the scope of the initiative, enhancing existing projects and incorporating new ones, raising the initiative’s total budget to over $500 million.

The latest enhancements to the SNF Health Initiative include landmark extensions to the three ongoing projects for the creation of new, model hospitals in Komotini, Thessaloniki and Sparta, which are being designed by renowned architect Renzo Piano and Renzo Piano Building Workshop (RPBW). Following consultation with the local medical communities, the design of the three hospitals has been significantly augmented with additional clinical services to better serve patients. At the SNF University Pediatric Hospital of Thessaloniki, infrastructure additions will allow for the development of a model Center for Child and Adolescent Mental Health, as well as the creation of spaces to house university research and teaching facilities.

New projects added to the Health Initiative will strengthen the capacity and work of the Attikon General University Hospital in Athens, upgrade equipment for clinics and labs at the National and Kapodistrian University of Athens (NKUΑ) School of Dentistry, procure critical equipment for Evaggelimos General Hospital in Athens, support medical services for cancer patients at public hospitals and medical research in collaboration with the Hellenic Cooperative Oncology Group (HeCOG), and revamp mental health care for children and adolescents across Greece.

Implementation of the initiative, which also includes a suite of educational programs and equipment procurement, has continued uninterrupted and at pace since 2018, aiming to contribute to the strength and quality of Greece’s public health system, ensure a high level of medical care for all, and empower health staff on the front lines.

The initiative is fully financed by SNF and implemented in collaboration with the Hellenic Ministry of Health as well as other relevant bodies of the Greek state. Individual projects will be delivered to the Greek State as they are completed.

A significant portion of SNF’s $100 million global COVID-19 relief initiative has been allocated in support of the country’s health sector. More than $31 million has been provided to add 175 new beds in intensive care units (ICU) and high-dependency units (HDU) at 15 public hospitals across Greece; to develop an educational program in ICU treatment for medical and nursing staff; to offer direct honoraria as a gesture of appreciation for the contributions of doctors, nurses, and cleaning crews working on the front lines of the pandemic; to sustain a COVID-19 psychological support hotline (10306); and to help significantly increase testing capacity through procurement of molecular testing systems and the necessary reagents.

In the spirit of transparency, SNF is committed to providing regular progress updates with timely information on all the projects under the initiative. The following is a detailed look at the main developments in the Health Initiative’s constituent grants since the previous progress update:

Infrastructure Projects

Approval of extended budgets and significant infrastructural and clinical enhancements at the three new hospitals of Komotini, Thessaloniki, and Sparta to better serve patients

The Health Initiative’s infrastructure projects include the design, construction, and outfitting of three new hospitals in Komotini, Thessaloniki, and Sparta. Renowned architect Renzo Piano and the Renzo Piano Building Workshop (RPBW), architects of the Stavros Niarchos Foundation Cultural Center, are designing the hospitals. Their vision is to pioneer a new approach, harmonizing treatment areas with the natural environment.

The initiative’s infrastructure works also include renovation of the 2nd Intensive Care Unit (ICU) and Emergency Department at Evaggelismos General Hospital in Athens.

  • SNF General Hospital of Komotini

Following the ratification under law of the Grant Agreement between SNF and the Greek state in February 2020, and pending ratification of the revised Grant Agreement amended with specific provisions for the integration of expanded clinical services, the project is undergoing an updated design study by architectural firm RPBW.

In December 2020, in line with the outcome of SNF’s consultations with the local medical community of Komotini, the SNF Board of Directors approved additional design, construction, and equipment costs totaling $6.3 million to further enhance the medical services of the new hospital. These additions include a 3-t Tesla Magnetic Resonance Imaging (MRI) machine, a mammography unit, a Gamma Camera, two extra operating theatres, provisions for therapeutic exercise and medical rehabilitation, as well as provisions for the future development of a catheterization lab. In collaboration with the local Health District and the Design Team of the project, the latter enhancements were incorporated into the hospital’s Clinical and Functional Brief, which was approved anew by the Ministry of Health.

Reflecting the above changes, SNF and the Greek state amended the Grant Agreement for the hospital, which will be submitted for ratification by the Hellenic Parliament in May 2021.

Preparations for the issuance of the hospital’s building permit are already underway. The infrastructure studies for the hospital’s connection to roads and the Greek state’s public utility networks have been completed. Commencement of the state’s tender process is approaching, with completion of Phase 1 (site connections and improvement of temporary access) scheduled for November 30, 2021.

According to the updated timetable, the new SNF General Hospital of Komotini will be delivered to the Greek state within the third quarter of 2025. 

  • SNF University Pediatric Hospital of Thessaloniki

Consultation discussions between SNF and the Aristotle University of Thessaloniki Medical School were concluded in December 2020. These discussions had started in the fall of 2020, at the initiative of the Foundation, in an effort to explore potential enhancements to the scope of the new SNF University Pediatric Hospital of Thessaloniki. This led to the development of considerable expansions both in terms of medical services and of clinical, laboratory, and educational infrastructure, which were approved by SNF in principle, and which the Design Team subsequently incorporated into new, significantly enriched architectural designs.

Following a joint response to the enhanced hospital design by the Ministry of Health, the 4th Health District, and the Aristotle University of Thessaloniki Medical School, SNF’s Board of Directors approved additional design, construction, and equipment costs totaling $32.9 million. These developments represent a key milestone in the project, reaffirming the hospital’s university character and ensuring state-of-the-art medical services and facilities that further strengthen its future standing as a model hospital for Northern Greece and the wider region of Southeastern Europe.

Under an innovative “campus” design approach by the architect, the upgraded planning provides for a significantly extended clinical program for the main hospital, the development of a Center for Child and Adolescent Mental Health in a new building adjacent to the hospital, as well as the creation of a third building to house university research and teaching facilities. Meanwhile, SNF is in talks with Johns Hopkins University in the U.S. on potential collaboration as part of the design and future operation of the hospital.

Architectural firm RPBW is updating the final study, while, at the same time, the Design Team is working on enhancing the Clinical and Functional Brief, in direct collaboration with the Ministry of Health, the 4th Health District, and the Aristotle University of Thessaloniki Medical School. The enhanced Clinical and Functional Brief will be submitted for re-approval by the Greek state in May 2021, and ratification of the Grant Agreement for the new SNF University Pediatric Hospital of Thessaloniki is planned for June 2021.

The initial infrastructure studies for the hospital’s connections to roads and the state’s public utility networks have been completed. However, the studies need to be supplemented to take into account the new requirements dictated by the expanded scope of the project. Commencement of the corresponding tender process by the state is approaching, with completion expected in December 2024.

The SNF University Pediatric Hospital of Thessaloniki is expected to be completed and delivered to the people of Greece in December 2025.

  • SNF General Hospital of Sparta

The schematic design study by RPBW for the creation of the new SNF General Hospital of Sparta is currently in process.

In parallel, the hospital’s Clinical and Functional Brief is being amended to include the additional medical services approved by SNF and agreed to by the Ministry of Health, based on SNF’s consultation with the staff and administration of the existing hospital of Sparta. Specifically, the expanded clinical program incorporates provisions for the addition of a 3-tesla MRI, a mammography unit, a catheterization lab, and two extra operating theatres. Upon approval by its Board of Directors, SNF undertook the full additional cost, totaling $6.3 million, for this expansion of scope in terms of design, construction, and outfitting.

The Central Archaeological Council has approved the location of the new hospital. The Greek state has taken over responsibility for the infrastructure studies to improve the road links and connect the hospital with public utility networks. These studies are slated to be commissioned in the near future, to be completed and offered for tender by February 2022.

According to the updated timetable, the new SNF General Hospital of Sparta is expected to be completed and delivered to the Greek state toward the end of the second quarter of 2025.

In the spirit of full transparency and to provide the public with timely, accurate information on the progress of the three new hospitals—all intended to benefit local communities—SNF held digital town hall meetings with the local communities of Komotini, Thessaloniki, and Sparta on December 10, 2020, in collaboration with the three municipalities. The next town hall meetings are scheduled for June 2021, with their format (physical or virtual) dependent on the latest COVID-19 health guidelines at that time.

  • Support for the Renovation of the 2nd Intensive Care Unit and Emergency Department at Evaggelismos Athens General Hospital

The grant for the renovation of the 2nd ICU and Emergency Department at Evaggelismos Hospital is underway within the restrictions necessitated by the pandemic and in collaboration with the Athanasios and Marina Martinou Foundation and Mrs. Aliki Perroti.

The contractor has completed the preliminary study for the renovation, while the implementation of the final study, the tender process and, ultimately, the start of renovations will depend on the evolution of the pandemic, due to Evaggelismos’s critical role as a COVID-19 referral hospital. However, discussions continue between the end users and the project’s Design Team, with the aim of optimizing design elements and accounting for new considerations and best practices that have emerged from the pandemic. At the recommendation of the hospital, priority is being given to the renovation of the ICU, which pushes renovations to the hospital’s Emergency Department back to a second stage of the project.

Procurement of Equipment

Completion of the delivery of four EKAV Air Ambulances

  • Strengthening EKAV’s air ambulance services

Following the completion of the SNF grant for the procurement of equipment at Evaggelismos Hospital in May 2020, the second grant to be completed under SNF’s Health Initiative was the delivery of four aircraft to strengthen the capabilities and efficiency of the National Center for Emergency Care (EKAV), totaling $29.8 million.

Specifically, two Augusta Westland 109 Trekker helicopters landed in Greece on March 3, 2021, and two Beechcraft King Air 350 airplanes landed on April 14, 2021.

The four new aircraft will offer immediate and safe air transport for ill and injured patients from remote areas of the country to central locations in Greece and Europe to receive requisite urgent care. The new aircraft will be used exclusively to enhance EKAV’s services, to ensure emergency pre-hospital and/or medical care for all, as well as the most up-to-date medical equipment for EKAV’s specialized air ambulance staff (flying doctors, rescuers, nurses). At the same time, the grant will contribute to significant resource savings.

Implementation of the grant was made possible through SNF’s collaboration with the Hellenic Ministry of Health, which will own the aircraft; EKAV, which will use them; and the Hellenic Air Force, which will assist in their flight operation. The Air Force is already conducting training programs for flight and technical personnel so that the aircraft can be put to use as soon as possible.

  • Installation of PET/CT Equipment at Four University Hospitals

The grant for the procurement and installation of PET/CT scanning equipment at the public University Hospitals of Heraklion, Ioannina, Larissa, and Alexandroupoli is proceeding smoothly, with an accelerated delivery date in December 2021. The tender process for the selection of a contractor has been completed and, currently, the technical and licensing details are being finalized for each hospital, in close cooperation with the four hospitals and the Hellenic Ministry of Health.

The amendment of the relevant Grant Agreement, based on which SNF will ensure the procurement of equipment and the configuration of the facilities for its installation, while the Greek state undertakes the operation of the equipment and maintenance costs after the end of the warranty period, is expected in May 2021.

  • Design and Implementation of Educational Resources

The educational programs supported by the Health Initiative are temporarily on hold due to pandemic-related restrictions, but will begin as soon as public health conditions allow.

  • The five-year Educational Programs for the Treatment of Trauma, implemented by the nonprofit Regeneration & Progress, include eight different types of programs and seminars for medical and nursing students, doctors, surgeons, and rescuers. September 2020 marked the beginning of implementation of the Advanced Trauma Life Support (ATLS) educational program, the Advanced Trauma Care for Nurses (ATCN) program, and the Prehospital Trauma Life Support (PHTLS) program. Up until their temporary suspension in November 2020 due to COVID-19, a total of eight seminars were held, and the process of procuring specialized medical equipment for the programs is currently underway.
  • In February 2021, after the signing of the Memorandum of Understanding between the National Organization for Quality Assurance in Health (ODIPY) and the Center for Clinical Epidemiology and Outcomes Research – CLEO, the educational program for the prevention of hospital-acquired infections entered the phase of full development. The programs will roll out gradually, depending on the conditions of the pandemic, aiming first to provide training to nursing staff in ten public hospitals across Greece selected according to their needs. At the same time, the program for monitoring hospital-acquired infections through a special electronic platform that will be installed in hospitals is being designed.
  • Final preparatory work is underway for the launch of training programs and the procurement of equipment to strengthen the nursing sector through the Educational Nursing Units at Evaggelismos Hospital and the Nursing Department of the School of Health Sciences at the National and Kapodistrian University of Athens (NKUA). Implementation plans for the individual educational and research programs are currently being finalized, along with the plans for academic scholarships. As for the programs at the NKUA School of Health Sciences, final approval by the Special Account for Research Grants (ELKE) is expected imminently.

    Specifications have been finalized, in collaboration with the University and Evaggelismos hospital, for the medical educational equipment that will be procured through these SNF grants, and the procurement process is expected to take place in May 2021.

SNF also supports, through a separate grant under the global COVID-19 relief initiative, a five-year training program on intensive care, which is implemented by the THORAX Foundation in collaboration with ODIPY. The Memorandum of Understanding between the THORAX Foundation and ODIPY is expected to be finalized within the month, while when the training program starts will depend on the course of the pandemic in the country.

Health Initiative expands support through new projects

  • Supporting Mental Health Care for Children and Adolescents across Greece

In January 2021, following extensive exploratory discussions, SNF and the Child Mind Institute finalized the framework and content of SNF’s new $15 million grant for the development of a five-year program to bring and develop field-leading expertise in child mental health to strengthen the sector in Greece. Implementation of the project will be undertaken jointly by the Child Mind Institute’s international team and a new local nonprofit organization, in collaboration with the Hellenic Ministry of Health and other relevant authorities.

Specifically, this initiative includes:

  1. New educational programs, to better equip and empower health and child mental health professionals, as well as professionals in the wider field of child protection, to provide timely prevention, protection, and support to children at increased risk.

  2. The establishment of a new Referral Center for Child Mental Health to offer clinical support to children and families with high and complex mental health needs, the exchange of best practices in assessment and treatment of complex cases, and the development of networks and collaborations with hospitals and mental health providers across the country.

  3. The development of new tele-mental health and digital tools, for clinical and research purposes.

The relevant memorandum of understanding between SNF and the Hellenic Ministry of Health was signed in April 2021. The memorandum expresses both parties’ commitment to ensuring that the program can be designed and customized for the needs of the national mental health system, maximum possible reach, and effective collaboration with institutional stakeholders. It also establishes that the program will be adopted and continued by the Greek state after the conclusion of the five-year SNF grant.

The process of establishing the dedicated local nonprofit is in progress while, at the same time, a detailed implementation plan and project timetable are being prepared.

  • Construction and outfitting of two new buildings at Attikon University General Hospital of Athens

Following the evaluation of the request submitted to SNF by Attikon Hospital, in February 2021, SNF’s Board of Directors approved a new $2.3 million grant for the design, construction, and outfitting of two new buildings within the hospital premises.

The first building will ensure the creation of customized on-call rooms and facilities for doctors, allowing existing beds within the hospital to be freed up for the needs of hospitalization and patient care, thus permanently increasing the overall inpatient capacity of Attikon.

The second building will house the headquarters of the three following centers:

a) The Coordination Center of the Mobile Medical Units, the health care access program for residents of remote Greek islands and regions implemented through an exclusive grant from SNF by the nonprofit Regeneration & Progress, now in collaboration with Attikon Hospital, under the supervision of the 1st Orthopedic Department at the Attikon University General Hospital School of Medicine,

b) A Crisis, Disaster and Humanitarian Aid Health Management Center, under the scientific supervision of NKUA’s “Global Health – Disaster Medicine” Medical School Postgraduate Studies Program, which will include the activation of telemedicine for patients and providers, and

c) A Center for Biomechanical Analysis of Movement-Walking and Therapeutic Exercise, under the scientific supervision of the Sports Excellence Department of the 1st Orthopedic Department at the Attikon University General Hospital School of Medicine, in collaboration with all of the hospital’s specialties.

The new Grant Agreement for this project is expected to be submitted for ratification within the coming month, and preparatory work for the project’s preliminary design study is already underway.

  • Procurement of equipment for the NKUA School of Dentistry

Through the new $600,000 SNF grant to the NKUA School of Dentistry, one of the school’s clinics will be equipped with 24 new dental chairs, fulfilling the standards of European Union directives for the protection of the environment from aerosol secretion, and a simulation laboratory will be equipped with 40 state-of-the-art simulators for optimal student training.

The NKUA School of Dentistry provides higher education to undergraduate and postgraduate students, and the research performed there has ranked the dentistry school among the best in the world. The school’s social outreach is also especially important, as the clinics offer a high level of dental care at affordable costs and therapy for special categories of patients, such as oncology patients, children with disabilities, and low-income patients, who have no other options for free dental treatment. The school serves 9,000 patients and performs 30,000 dental procedures annually.

  • Procurement of a Nurse Call and Communications System for Evaggelismos General Hospital of Athens

The new SNF grant, of up to $300,000, will ensure the procurement and installation of a modern, digital, fully flexible and expandable nurse call and communications system for the rooms and patient beds in the hospital’s AXEPA and PATERA buildings. The system will include 798 call units for 23 nursing stations in corresponding clinics, and will provide the option of centralized monitoring.

The hospital has assessed the system as critical for the work of its nursing staff, as it will introduce a vital communication channel between patients and nurses, with life-saving potential—especially during the challenging conditions currently facing the health sector.

The grant will be implemented progressively as it becomes possible in clinics, given the hospital’s heavy COVID-19 workload. The target date for the full installation and operational use of the equipment in all clinics is end of August 2021.