from Leadership Medica n. 2/2000

The Lombardy Region has started-off an experimental management of the Milan hospital net. The initiative comes from the State-Region Conference protocol along with the Lombardy Region. Dr. Fabrizio Panté has just been named General Director and we interview him just in order to get some more information about this initiative.

L.M. - Dr. Pantè, after a long experience in managing publishing houses, you have passed to the health sector. What is this passage due to?

P. - The change is less radical than it could seem. Both sectors are indeed on citizens' service, and also in health I deal with prominent personalities, as it happened in journalism. Nevertheless organization and management aspects of health have a more meaningful value than in communication.

L.M. - You deal especially with the State-Region protocol in the Milanese reality, don't you? How is the project going ahead at two years since you begun?

P. - The metropolitan reality is featured by several decisional centres and a complete offer of special services supplied by accredited centres (public hospitals, IRCCS, private structures) showing high management costs but also capability to compete with other European realities. The decentralization of competences to Regions allows researching adequate organization set-up among the categories of those accredited and strong synergies among public structures that must face a huge stream of patients coming from other Regions.

L.M. - Which are the priority intervention areas?

P. - They concern the town common services and the coordinated management of resources. The General Direction of the Managing Experimentation, established in 1998, aims to check the advantages of a net managing system, both in the stay in hospital field and in the outpatient specialist services.

L.M. - Which are the targets achieved till now?

P. - On a side it's going on the net connection of the emergency-urgency system inside and outside hospitals by introducing aid means adopting advanced techniques, increasing the number of ambulances assigned to the basic aid, a higher personnel training and the telematic transmission of instruments tests. Furthermore it has already started the competition aiming to create a booking system allowing citizens having a simplified access to outpatient services of the Milanese public enterprises and leading to a complete reduction in waiting lists. Next phase the system will be opened to other accredited health structures.

L.M. - How are faced the problems featuring the long stays in hospital and those concerning rehabilitation?

P. - To reply to the increasing demand coming from the old population the hospital beds for chronicle patients, that are decreasing nowadays, have been turned into intensive rehabilitation beds in hospitals. Further they are putting in act innovative experiences in collaboration with the Region and the Municipality.

L.M. - For patients in acute phases and requiring enduring assistance, which are the project's working hypothesis?

P. - The reorganization process of the hospital structures foresees the development of the home assistance and day surgery, hence lowering stays in hospitals.

L.M. - And what about the relationship with Universities?

P. - The Regional determinations, binding in case of agreements, will allow reordering the entire area of the relationships between Universities and Hospital Enterprises according to an integrated logic, satisfying this way didactics, assistance and research reciprocal exigencies.

L.M. - We must talk about the profession of physician.

P. - It must give certainty to a category nowadays in troubles for the levelling out provoked by the health reformation. In management terms it has been arranged an agreed plan in order to apply the Legislative Decree 626/94 for the town health structures. Management and check of the plan will allow expenditures cuts that can only reached through health structuring.

L.M. - Which are today the specialities that can be coordinated and integrated?

P. - The most important sectors are cardiology, paediatrics, oncology and psychiatry. As regard to cardiology it is being realized the progressive functional and organization integration of the Milanese hospital cardiovascular wards, by the means of the project that aims to introduce the simple angioplasty in the structures that are not equipped with cardiosurgery. In paediatrics, where simpler and less disorganized routes are gone, technical coordination is required, since the presence of the public is predominating. As regards to oncology it is foreseen a coordination fostering integrated diagnostic-therapeutic activities, in order to engage all the available competences and resources (today not structured) both single hospital level and structure level.

L.M. - You have hinted to psychiatry that shows nevertheless much more complex problems. How do you think to solve them?

P. - Intervention in psychiatry allows giving Hospital Enterprises the opportunity to power an important sector, that of rehabilitation, besides the construction of ad hoc residences for psychiatric patients. The function of coordination entrusted to the Experimentation allows putting in act the town project, involving also the volunteer associations and relatives.

L.M. - How to introduce telemedicine in this project, aimed to reorganize the health assistance over territory?

P. - Actually the Lombardy Region has strongly wanted to deal with this matter and gave us the instruments to work. By now, for example, the ambulances with a physician on board are equipped with defibrillators, that will be linked to coronary units in little time. Data transmission from ambulances evidently helps both patients and the physicians that will have in cure the patients. Naturally there are other projects on course that arrive to us and we have the task, not easy at all, to make them work. This purpose it's important the collaboration of the trade unions that really has not lacked.

L.M. It is well known that the Lombardy Region, as regard to health matter, opposes the reformation just passed by Minister Bindi, and protested by physicians even not Lombard. How things are going on today?

P. - The Lombard health organization act, that moves away from some principles, the national ones, is already consolidating at two years since the enforcement. The local health enterprises are already developing their activities full capacity, while hospitals have been clustered in homogenous structures and so they had, as always happens these cases, some troubles passing to the new managing model. Among others is on course an updating of the three-year plan for Hospital Enterprises that is the result of the experience got in these years.

L.M. - We wish you to realize the project at matter in the less time possible and in the best way.