EXECUTIVE SUMMARY

This paper introduces an operational proposal for the establishment of a central group of high-level experts in the management of healthcare systems, whose main task is to support Italian Regions, starting with those put under temporary receivership, in the definition and implementation of a structured program of change. The purpose of this initiative is twofold: (i) to translate the public top-down budgeting into structural productivity improvements in order to increase the quality of services in spite of limited resources (ii) to enhance the level of managerial skills at regional level.We assume that the development of a structured program of change should address the following issues: (i) reform of the network of healthcare assistance with the introduction of minimum service standards; (ii) demand management and introduction of protocols / guidelines for diagnosis and therapy; (iii) proactive management of chronic care; (iv) improvement in the operating performance of healthcare service providers; (v) introduction of cost effectiveness criteria for the selection of medical equipment and medicines and (vi) development, at regional level, of the appropriate managerial capabilities for the implementation of this structured program of change.

In this context, we strongly believe that the establishment of an external agent working as “accelerator of change” would encourage and support the Regions in the implementation of the structured program of change by: (i) providing local management with the required managerial capabilities (ii) ensuring a non-partisan, technical vision (iii) acting as a catalyst of change and providing the operational and monitoring support for the full achievement of the transformation process.

This external group of experts should collaborate closely with the regional management, in order to encourage the exchange of best practices and the initiation of the program of change by: (i) defining a specific set of objectives and a timeframe for their achievement; (ii) proposing and managing improvement actions and transferring competences to the management and the medical staff involved; (iii) providing a systematic monitoring of results.

In particular, we suggest Agenas – the National Agency for Regional Healthcare Services to be the most appropriate vehicle for conducting the operational management of the initiative and through which to develop a successful Government-Regions cooperation model. We consider the implementation of the whole program to require about 15-20 full- time resources for each Region for a period of 12-18 months. In particular, the resources at issue, could rotate among Regions and should fulfil specific requirements: they should demonstrate proven managerial skills and they should not have been previously involved in the healthcare management of the Regions. We expect the cost of the program to range between 20-25 million euro for each Region.

We recommend that the results observed from such a program should be monitored along three macro-categories: the improvement in the regional indicators of healthcare performance, the reduction in direct costs of production and the consequent positive impact observed on the structural budget deficit, and the extent to which a “culture for performance” is created on a large scale.

Similar initiatives have already been introduced in other European countries. A successful example is the “Agence Nationale d’Apui à la Performance” (ANAP), a public agency established in 2009 in France, with the aim to improve the performances of healthcare and social healthcare institutes.