1. 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

2. 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? Slide path 1 st International Conference January 27 th, 28 th 29 th 2009 Balantonalmàdi Page 2 Penna Roberto, Soccetti Andrea

3. 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? Slide path 1 st International Conference January 27 th, 28 th 29 th 2009 Balantonalmàdi Page 3 Penna Roberto, Soccetti Andrea

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

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

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

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

8. 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? Slide path 1 st International Conference January 27 th, 28 th 29 th 2009 Balantonalmàdi Page 8 Penna Roberto, Soccetti Andrea

9. 1 st International Conference January 27 th, 28 th 29 th 2009 Balantonalmàdi Page 9 Penna Roberto, Soccetti Andrea 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

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

11. 1 st International Conference January 27 th, 28 th 29 th 2009 Balantonalmàdi Page 11 Penna Roberto, Soccetti Andrea 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, …)

12. 1 st International Conference January 27 th, 28 th 29 th 2009 Balantonalmàdi Page 12 Penna Roberto, Soccetti Andrea 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

13. 1 st International Conference January 27 th, 28 th 29 th 2009 Balantonalmàdi Page 13 Penna Roberto, Soccetti Andrea 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. 1 st International Conference January 27 th, 28 th 29 th 2009 Balantonalmàdi Page 14 Penna Roberto, Soccetti Andrea 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

15. 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 AORWHY 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? Slide path 1 st International Conference January 27 th, 28 th 29 th 2009 Balantonalmàdi Page 15 Penna Roberto, Soccetti Andrea

16. 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? Slide path 1 st International Conference January 27 th, 28 th 29 th 2009 Balantonalmàdi Page 16 Penna Roberto, Soccetti Andrea

17. 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 1 st International Conference January 27 th, 28 th 29 th 2009 Balantonalmàdi Page 17 Penna Roberto, Soccetti Andrea

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

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

20. 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” 1 st International Conference January 27 th, 28 th 29 th 2009 Balantonalmàdi Page 20 Penna Roberto, Soccetti Andrea Investigation about:

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

22. Level of orientation towards citizens 1 st International Conference January 27 th, 28 th 29 th 2009 Balantonalmàdi Page 22 Penna Roberto, Soccetti Andrea Clinical Civic Audit: a proposal: Access to health care Respect for privacy Social relations Comfort & 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:

23. Clinical Civic Audit WHAT to DO: Aptitude to implement a certain sanitary or social policy 1 st International Conference January 27 th, 28 th 29 th 2009 Balantonalmàdi Page 23 Penna Roberto, Soccetti Andrea 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:

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

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

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

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

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

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