Clinical audit system in Italy: an example 1 st International conference for internal auditors...

Clinical audit system in Italy:an example

1st International conference for internal auditors working in healthcare sector and for other economical

professsionals

January 27th 28th and 29th, 2009Balatonalmàdi

1. Ancona and Azienda Ospedali riuniti (AOR) presentation

2. Legislative recognisition about “audit” (national and local level)

3. WHY an implementation of a clinical audit in AOR

4. WHAT and HOW AOR do: some examples

5. WHICH results and WHO use them

6. Strength and weakness of the AOR clinical audit system

7. Civic audit is the future?

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1st International Conference January 27th, 28th 29th 2009 Balantonalmàdi

Penna Roberto, Soccetti Andrea

Ancona geographic position

•Is situated in the centre of Italy

•Face on the Adriatic sea

•Is a little town (100,000inh)

•Is the “capital” of Marche region

•Local economy is based on SME (tertiary)

Ancona



OSPEDALI RIUNITI AnconaThe hospital:

•is the largest of

the region;

•belongs to the

National Health

Service (public);

• works in close co-operation with Polytechnic University of Marche – Faculty of Medicine and Surgery –.1st International Conference January 27th, 28th 29th 2009 Balantonalmàdi


OSPEDALI RIUNITI Ancona(some figures 1)

Personnel (31.12.2008) No.

Employees 3,348

Polytechnic University of Marche (Employeesinvolved in the Hospital activities)

155

Externals 63



708 doctors in medicine

OSPEDALI RIUNITI Ancona(some figures 2)

No.

for ordinary confinerment 896for day hospital/surgery 93

for internal patients 2,249,861

for external patients 1,358,872

28,233

Perfomances

Dischargers

Activities (30.09.2008)

Day beds










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LEGISLATIVE FRAMEWORK

No specific

A citation in the “Hospital Act”

Regional Healthcare Plan 2003/05 and 2007/09

Sources:

National level

Local (regional) level

Internal level

utente006506

La Legge di riforma sanitaria richiede indicatori di qualità, e l’autorizzazione dei servizi pubblici e privati preliminare all’ accreditamento obbligatorio da parte delle regioni per ottenere contratti di fornitura di servizi da parte del servizio sanitario nazionale





Regional Healthcare Plan 2003/2005

Alliance for the healthA local fair, universal and quality

welfare system

December, 17th 2002



Macrobjective 4: To improve the quality of the supply

To implement methods able to reduce auto-referential performances through:

1. a further involvement of citizens in the assessment of healthcare services and the improvement of strategies aimed to safety (e.g. risk management);

2. The dissemination of best practices (e.g. Clinical audit);3. The implementation of innovative methodologies

finalised to improve administration and managerial process (development of quality system, accreditation, budgeting , modern management, …)



It is system for the assessment of the professional activities based on self assessment of clinical data by a multidisciplinar / multiprofessional group

Clinical audit:

It is a key issue for the improvement of quality

It is a competence of Responsible of Healthcare Unit/Department (inside the annual budget path)

Administration have to support it

In 3 years it should be a routine process





Regional Healthcare Plan 2007/2009

Governance, sostenibility, innovation and development of the local Healthcare Sector

for the Health of Marche Region citizens

January 2007



Long terms priority for Healthcare organisation

facilitate clinical audit practice both on hospital and territorial level

link clinical audit practice to the lifelong learning path of professionals

Every Hospital/Organisation have to:

implement adequate managerial audit activities coherent to the other governance strategies








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Civic Clinical Audit

We think is the next step because:

1. We need to involve, in concrete, citizens (we must acquire their/our point of view)

2. We have to put in evidence as clear and transparent as possible hospital activities and performances

3. We should prevent National/Regional Healthcare service fragmentation



Civic Clinical Audit and art. 118 of Italian Constitution

art. 118 of Italian Constitution: “The State, regions, metropolitan cities, provinces and municipalities shall promote the autonomous initiatives of citizens, both as individuals and as members of associations, relating to activities of general interest, on the basis of the principle of subsidiarity.”



Clinical

Audit

National Healthcare system

Regional Healthcare system

Both for

A concrete example?

Clinical Civic Audit in practice:

of the healthcare organization (hospital)



Structured and critic analysis

realised by a the civil society

(a civic organisation)

Clinical Civic Audit WHAT to DO:

Level of orientation towards citizens

Aptitude to implement a certain sanitary or

social policy

Level of civil society involvement in the

decisional process

Competence in the development of effective

replies to urgent “social problem”1st International Conference January 27th, 28th 29th 2009 Balantonalmàdi


Investigation about:





It needs to reply to the answer:

How long the Hospital take care of real citizens needs,

requirements and expectatives?




Clinical Civic Audit: a proposal:

Access to health care Respect for privacy Social relationsComfort & hotel services Patients Assistance

Patients/families facilities Health records and communication Human Rights Quality Programs

Availability of logistics and healthcare information

It needs solutions concerning:



social policy



What is the hospital path?

Does it is able to endorse concrete enagagements aimed to the promotion of a certain sanitary or social policy?

It needs to reply to the answers:


social policy




Clinical risk management

Safety in the structure and plants

Chronic and oncology diseases

Painless




decisional process



Who decide hospital strategies?

What is the role of civil society?



decisional process




Effective implementation of methodologies finalised to the participation of citizens in hospital decision

Other participation practices




replies to urgent “social problem”



How hospital face on urgencies and pressures?

Are the solutions adequate for citizens?



replies to urgent “social problem”




Evaluation of civil society consensus in the management of specific concerns


THANKS FOR YOUR ATTENTION

Sede Legale: Via Conca, 71

I - 60020 ANCONA

C.F. - Partita I.V.A.: 01464630423

Web site: http://www.ospedaliriuniti.marche.it

Roberto Penna Email [email protected]

Andrea Soccetti Email [email protected] International Conference January 27th, 28th 29th 2009 Balantonalmàdi


OSPEDALI RIUNITI Ancona information

mailto:[email protected]

mailto:[email protected]

Clinical audit system in Italy: an example 1 st International conference for internal auditors...

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