Hospital companies, like all companies, work well or poorly depending on how they are managed. With one difference though: the former manage health, and management errors are not allowed. The news often tells us of exceptional cases such as: “Molinette, a 5-year-old girl saved with a liver transplant connected directly to the heart” (December 11, 2022); «Policlinico Gemelli, a case of rare complexity: in the same session a coronary bypass was performed, a renal tumor was removed and a huge thrombus was removed. Face 3 teams for 10 hours »(February 10, 2023); “Padua, transplanted a heart that had stopped for 20 minutes: first time” (May 15, 2023). A deserved and reassuring cry. At the same time, there are episodes of medical malpractice that make as much noise as they terrify us. However, the day-to-day that we usually face as patients is mainly made up of something else: emergencies, waiting lists, diagnostic tests that, specifically, must be carried out with machines that are less than 10 years old. And it is here where, with few exceptions, the quality of care and the capacity of managers are closely linked. Let’s see what it means.
When a hospital works well
A hospital works well when it meets the essential requirements:
1) a Emergency room where patients do not leave because they have not received the necessary care and assistance within 8 hours;
2) waiting times that comply with the provisions of the law (for example, hip replacement surgery within 180 days and breast, colorectal, and lung cancer surgery within 30 days);
3) low rates of hospitalizations with high risk of inappropriateness (such as arthrodesis), hospitalization of patients in the right ward for their problem (for example, the fewest possible hospitalizations of medical patients in surgical rooms), not allowing too many days to pass from entering the hospital for surgery until the surgery itself ability to attract patients from outside the Region;
4) budgets and accounts in order;
5) notadequate number of doctors and nurses per bed;
6) non-obsolete machinery and equipment.
General Manager Report Cards
Based on these indicators, for the first time, it is possible to give a report on how public hospitals are managed: Agenas, the National Agency for Regional Health Services that belongs to the Ministry of Health, evaluated the performance of the manager of 53 public hospitals , 30 of which are university hospitals, divided respectively into those with more than 700 beds or less than 700 beds. It did so in compliance with the 2019 Budget Law, which entrusts it with the task of monitoring the achievement of the goals of general managers: «Agenas – says in art. 1, paragraph 513 – implements (…) a system of analysis and monitoring of the performance of health companies that indicates, in advance, through a special alert mechanism, significant deviations related to the economic-administrative components, organizational, financial and accounting, clinical-care, clinical efficacy and diagnostic-therapeutic processes, quality, safety and results of care, as well as equity and transparency of the processes”. Excluding non-university Ircc, monospecialists, local health authorities and local companies such as the local health and social care companies (Asst) of Lombardy which since 2015 have incorporated almost all public hospitals in Lombardy: the decision to exclude by Agenas It is motivated by the need for comparable data. The results that you will read below have been cross-referenced with data from the “National Results Plan”, the tool with which Agenas annually tests the quality of care, confirming the correspondence between the competencies of the managers and the clinical-care results.
The 9 best hospitals
This is what the results of the first report presented in Rome say yesterday, May 24, 2023 (the data is available on the portal created for this purpose by Agenas at this link). 2021 was taken into consideration, the year in which hospitals still had to deal heavily with Covid (in the graphs all the results are also for 2019, which, in the absence of the pandemic, presents higher performance). Of the 53 hospitals examined, 12 have a low level of performance, 32 medium and only 9 high which are: the university hospitals of Siena (Siena), Careggi (Florence); Pisana (Pisa), Padua, Integrata Verona and Policlinico Sant’Orsola (Bologna); and the hospitals of S. Croce and Carle (Cuneo), Riuniti Marche Nord and Ordine Mauriziano (Turin).
The 12 red dot hospitals
The hospitals with the lowest performance are: Cosenza, San Pio (Benevento), Sant’Anna and San Sebastiano (Caserta), Riuniti Villa Sofia Cervello (Palermo) Civico Di Cristina Benfratelli Hospitals (Palermo), Cannizzaro (Catania), San Giovanni Addolorata (Rome), San Camillo Forlanini (Rome); and university: Luigi Vanvitelli (Naples), San Giovanni di Dio Ruggi d’Aragona (Salerno), Mater Domini (Catanzaro) and Policlinico Umberto I (Rome).
Waiting times for cancer surgery
These are the 10 hospitals with the shortest waiting times for cancer surgery (here the official document): Senese, Padova, Pisana, Policlinico Umberto I Roma, Careggi, S. Croce and Carle, Integrata Verona, Policlinico Sant’Orsola, Riuniti Foggia, Sant’Andrea di Roma which, however, is indicated as low quality for colon surgery. And these, instead, are the 10 hospitals with the longest waiting times for cancer operations: SS. Antonio and Biagio and Cesare Arrigo (Alessandria), San Luigi Gonzaga (Turin), Sant’Anna and San Sebastiano (Caserta), Ospedali Riuniti Bianchi Melacrino Morelli (Reggio Calabria), Policlinico Monserrato (Cagliari), For the Emergency Cannizzaro (Catania) , Sassari University Hospital and finally: Giaccone (Palermo), Pugliese and Mater Domini (Catanzaro) where the wait is long, but then the levels of care are good.
More or less obsolete machinery
The 10 hospitals with the least obsolete equipment They are (here the official document): Policlinico San Martino (Genoa), Riuniti (Foggia), Policlinico Sant’Orsola (Bologna), Maggiore della Carità (Novara), S. Croce e Carle (Cuneo), San Pio (Benevento), Sant’Andrea (Rome), Cardarelli and Monaldi Dei Colli (Naples), San Giuseppe Moscati di (Avellino). The last three in Campania, which has obviously made investments to renew the machinery, although the three hospitals still have low levels of cancer treatment. Hospitals, on the other hand, with more obsolete equipment – and an old machine is always less accurate than a new one –: Cagliari University Hospital, Riuniti Villa Sofia Cervello (Palermo), Papardo (Messina), Per l’Emergenza Cannizzaro (Catania), Sassari University Hospital, Brotzu (Cagliari) ), Civico di Cristina Benfratelli (Palermo) and, surprisingly, there are also three hospitals on this list: Mater Domini (Catanzaro), Senese and Policlinico San Matteo in Pavia.
Duration of hospitalization with the same severity
Then there is an indicator (which is technically called “Comparative Performance Index”) that allows evaluating the length of hospitalization for the same severity of the case (here the official document): the longer it is, the more it means that the hospital has organizational problems. The best: Riuniti Marche Nord, Careggi, Pisana, Pugliese, Maggiore della Carità. The worst: S. Giovanni Di Dio Ruggi D’Aragona (Salerno), San Luigi Gonzaga (Orbassano), Civico Di Cristina Benfratelli (Palermo), Cardarelli (Naples), Umberto I (Rome).
political responsibilities
With the due exceptions, these results are evidence of the organizational and resource management capacity, or not, of the CEO. For example, Agenas’ data shows that on average a hospital operating room performs only 400 operations a year, which means little more than one a day: similar actions would never be accepted in other companies. How are CEOs elected and by whom for public hospitals? Since 2012, regions can only appoint CEOs registered in the national register. Requirements: Bachelor’s degree, 5 years of accredited managerial experience in the health sector or 7 in others, having completed a training course in public health and being under 65 years of age. Then there are also the commissions of experts who evaluate, but in the end the one who deals the cards is the president of the Region in agreement with his health councilor. The choice is therefore political.
