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Clinical audit system in Italy: an example

Clinical audit system in Italy: an example 1 st International conference for internal auditors working in healthcare sector and for other economical professsionals January 27 th 28 th and 29 th , 2009 Balatonalmàdi. Penna Roberto, Soccetti Andrea.

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Clinical audit system in Italy: an example

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  1. 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, 2009 Balatonalmàdi

  2. Penna Roberto, Soccetti Andrea 1st International Conference January 27th, 28th 29th 2009 Balantonalmàdi Page 2 Slide path • Ancona and Azienda Ospedali riuniti (AOR) presentation • Legislative recognisition about “audit” (national and local level) • WHY an implementation of a clinical audit in AOR • WHAT and HOW AOR do: some examples • WHICH results and WHO use them • Strength and weakness of the AOR clinical audit system • Civic audit is the future?

  3. Penna Roberto, Soccetti Andrea 1st International Conference January 27th, 28th 29th 2009 Balantonalmàdi Page 3 Slide path • Ancona and Azienda Ospedali riuniti (AOR) presentation • Legislative recognisition about “audit” (national and local level) • WHY an implementation of a clinical audit in AOR • WHAT and HOW AOR do: some examples • WHICH results and WHO use them • Strength and weakness of the AOR clinical audit system • Civic audit is the future?

  4. Penna Roberto, Soccetti Andrea 1st International Conference January 27th, 28th 29th 2009 Balantonalmàdi Page 4 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

  5. Penna Roberto, Soccetti Andrea 1st International Conference January 27th, 28th 29th 2009 Balantonalmàdi Page 5 OSPEDALI RIUNITI Ancona The 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 –.

  6. Penna Roberto, Soccetti Andrea 1st International Conference January 27th, 28th 29th 2009 Balantonalmàdi Page 6 OSPEDALI RIUNITI Ancona (some figures 1) 708 doctors in medicine

  7. Penna Roberto, Soccetti Andrea 1st International Conference January 27th, 28th 29th 2009 Balantonalmàdi Page 7 OSPEDALI RIUNITI Ancona (some figures 2)

  8. Penna Roberto, Soccetti Andrea 1st International Conference January 27th, 28th 29th 2009 Balantonalmàdi Page 8 Slide path • Ancona and Azienda Ospedali riuniti (AOR) presentation • Legislative recognisition about “audit” (national and local level) • WHY an implementation of a clinical audit in AOR • WHAT and HOW AOR do: some examples • WHICH results and WHO use them • Strength and weakness of the AOR clinical audit system • Civic audit is the future?

  9. Penna Roberto, Soccetti Andrea 1st International Conference January 27th, 28th 29th 2009 Balantonalmàdi Page 9 LEGISLATIVE FRAMEWORK Sources: No specific National level Regional Healthcare Plan 2003/05 and 2007/09 Local (regional) level A citation in the “Hospital Act” Internal level

  10. Penna Roberto, Soccetti Andrea 1st International Conference January 27th, 28th 29th 2009 Balantonalmàdi Page 10 LEGISLATIVE FRAMEWORK Local (regional) level Regional Healthcare Plan 2003/2005 Alliance for the health A local fair, universal and quality welfare system December, 17th 2002

  11. Penna Roberto, Soccetti Andrea 1st International Conference January 27th, 28th 29th 2009 Balantonalmàdi Page 11 Macrobjective 4: To improve the quality of the supply To implement methods able to reduce auto-referential performances through: a further involvement of citizens in the assessment of healthcare services and the improvement of strategies aimed to safety (e.g. risk management); The dissemination of best practices (e.g. Clinical audit); The implementation of innovative methodologies finalised to improve administration and managerial process (development of quality system, accreditation, budgeting , modern management, …)

  12. Penna Roberto, Soccetti Andrea 1st International Conference January 27th, 28th 29th 2009 Balantonalmàdi Page 12 Clinical audit: It is a key issue for the improvement of quality It is system for the assessment of the professional activities based on self assessment of clinical data by a multidisciplinar / multiprofessional group 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

  13. Penna Roberto, Soccetti Andrea 1st International Conference January 27th, 28th 29th 2009 Balantonalmàdi Page 13 LEGISLATIVE FRAMEWORK Local (regional) level Regional Healthcare Plan 2007/2009 Governance, sostenibility, innovation and development of the local Healthcare Sector for the Health of Marche Region citizens January 2007

  14. Penna Roberto, Soccetti Andrea 1st International Conference January 27th, 28th 29th 2009 Balantonalmàdi Page 14 Long terms priority for Healthcare organisation Every Hospital/Organisation have to: facilitate clinical audit practice both on hospital and territorial level link clinical audit practice to the lifelong learning path of professionals implement adequate managerial audit activities coherent to the other governance strategies

  15. Penna Roberto, Soccetti Andrea 1st International Conference January 27th, 28th 29th 2009 Balantonalmàdi Page 15 Slide path • Ancona and Azienda Ospedali riuniti (AOR) presentation • Legislative recognisition about “audit” (national and local level) • WHY an implementation of a clinical audit in AOR • WHAT and HOW AOR do: some examples • WHICH results and WHO use them • Strength and weakness of the AOR clinical audit system • Civic audit is the future?

  16. Penna Roberto, Soccetti Andrea 1st International Conference January 27th, 28th 29th 2009 Balantonalmàdi Page 16 Slide path • Ancona and Azienda Ospedali riuniti (AOR) presentation • Legislative recognisition about “audit” (national and local level) • WHY an implementation of a clinical audit in AOR • WHAT and HOW AOR do: some examples • WHICH results and WHO use them • Strength and weakness of the AOR clinical audit system • Civic audit is the future?

  17. Penna Roberto, Soccetti Andrea 1st International Conference January 27th, 28th 29th 2009 Balantonalmàdi Page 17 Civic Clinical Audit We think is the next step because: • We need to involve, in concrete, citizens (we must acquire their/our point of view) • We have to put in evidence as clear and transparent as possible hospital activities and performances • We should prevent National/Regional Healthcare service fragmentation

  18. 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.” Penna Roberto, Soccetti Andrea 1st International Conference January 27th, 28th 29th 2009 Balantonalmàdi Page 18 Clinical Audit National Healthcare system Both for Regional Healthcare system A concrete example?

  19. Penna Roberto, Soccetti Andrea 1st International Conference January 27th, 28th 29th 2009 Balantonalmàdi Page 19 Clinical Civic Audit in practice: Structured and critic analysis of the healthcare organization (hospital) realised by a the civil society (a civic organisation)

  20. Clinical Civic Audit WHAT to DO: Penna Roberto, Soccetti Andrea 1st International Conference January 27th, 28th 29th 2009 Balantonalmàdi Page 20 Investigation about: 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”

  21. Clinical Civic Audit WHAT to DO: Penna Roberto, Soccetti Andrea 1st International Conference January 27th, 28th 29th 2009 Balantonalmàdi Page 21 Level of orientation towards citizens It needs to reply to the answer: How long the Hospital take care of real citizens needs, requirements and expectatives?

  22. Penna Roberto, Soccetti Andrea 1st International Conference January 27th, 28th 29th 2009 Balantonalmàdi Page 22 Clinical Civic Audit: a proposal: Level of orientation towards citizens It needs solutions concerning: 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

  23. Clinical Civic Audit WHAT to DO: Penna Roberto, Soccetti Andrea 1st International Conference January 27th, 28th 29th 2009 Balantonalmàdi Page 23 Aptitude to implement a certain sanitary or social policy It needs to reply to the answers: What is the hospital path? Does it is able to endorse concrete enagagements aimed to the promotion of a certain sanitary or social policy?

  24. Penna Roberto, Soccetti Andrea 1st International Conference January 27th, 28th 29th 2009 Balantonalmàdi Page 24 Clinical Civic Audit: a proposal: Aptitude to implement a certain sanitary or social policy It needs solutions concerning: Clinical risk management Safety in the structure and plants Chronic and oncology diseases Painless

  25. Clinical Civic Audit WHAT to DO: Penna Roberto, Soccetti Andrea 1st International Conference January 27th, 28th 29th 2009 Balantonalmàdi Page 25 Level of civil society involvement in the decisional process It needs to reply to the answers: Who decide hospital strategies? What is the role of civil society?

  26. Penna Roberto, Soccetti Andrea 1st International Conference January 27th, 28th 29th 2009 Balantonalmàdi Page 26 Clinical Civic Audit: a proposal: Level of civil society involvement in the decisional process It needs solutions concerning: Effective implementation of methodologies finalised to the participation of citizens in hospital decision Other participation practices

  27. Clinical Civic Audit WHAT to DO: Penna Roberto, Soccetti Andrea 1st International Conference January 27th, 28th 29th 2009 Balantonalmàdi Page 27 Competence in the development of effective replies to urgent “social problem” It needs to reply to the answers: How hospital face on urgencies and pressures? Are the solutions adequate for citizens?

  28. Penna Roberto, Soccetti Andrea 1st International Conference January 27th, 28th 29th 2009 Balantonalmàdi Page 28 Clinical Civic Audit: a proposal: Competence in the development of effective replies to urgent “social problem” It needs solutions concerning: Evaluation of civil society consensus in the management of specific concerns

  29. Penna Roberto, Soccetti Andrea 1st International Conference January 27th, 28th 29th 2009 Balantonalmàdi Page 29 THANKS FOR YOUR ATTENTION OSPEDALI RIUNITI Ancona information 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 r.penna@ospedaliriuniti.marche.it Andrea Soccetti Email a.soccetti@ospedaliriuniti.marche.it

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