ITALIADECIDE “ADMINISTRATION, CITIZENS, ENTERPRISES” AWARD 2016

INTERVENTION BY VITO GAMBERALE

During the presentation of the 2016 Italiadecide report “Digital Italy: eight concepts for innovationand smart growth”, held on March 21st at Palazzo Montecitorio – seat of the Chamber of Deputies,Vito Gamberale was one of the participant speakers, and Chair of the Committee that, as of thisyear, is in charge of awarding the “Administration, citizens, enterprises” prize established by theItaliadecide Association. Below is the transcript of Gamberale's speech:

Good morning everyone. I would like to particularly welcome the President of the Republic andthank Minister Madia for supporting the work I'm about to present. The Committee for the designand launch of this award was established last year during the presentation of the Italiadecide 2016Report. Its members are: Architect Elisabetta Spitz, Professors Pierluigi Ciocca, PiermassimoChirulli, Cesare Pinelli, and Filippo Satta, Member of Parliament Stefano Quintarelli, ItaliadecideDirector Enrico Seta, and myself. We analysed the ISTAT (Italian National Statistical Institute)mapping of public administration to identify the areas to focus on in order to award the prize ofthis year’s report.We initially identified three areas: the unification of municipalities and/or services provided bymunicipalities, as we believed that highlighting virtuous examples of practical application of thespending review could be a positive approach. The second area we evaluated was the launch ofthe Single Contact Point for Productive Activity (SUAP), because of the importance to enhancecomputerisation as a simplification tool for enterprises. We then conducted an in-depthexamination of clinical services and their efficacy, managerial efficiency, as well as humanisation ofpatient relationship in hospitals, in order to show virtuous examples of good healthcare. Toaddress the first two areas – municipality unification and SUAP – we involved the NationalAssociation of Italian Municipalities (ANCI). To examine the third area, hospitals, we resorted toAgenas, the National agency for regional health services, responsible for the standardisation ofhealthcare service efficiency, among others.Both institutions – ANCI and Agenas – were very open to cooperate and help us understand howto classify such different realities in a country that has such a variety of homogeneous structures ina way that would allow comparisons, and therefore objective evaluations. This task required along amount of time. In November, we eventually understood that we could not analysemunicipalities on a general and homogeneous basis. We therefore focused on the hospital system,also because it was clear that Agenas, represented here today by its General Manager, Mr Bevere,had progressed in its installation of standard features that consequently allow for objective andmutually comparable evaluations.Such support allowed us to develop a call for competition open to all public hospitals in Italy. OnDecember 16th, the call was online and then also promoted through the Health Commission of theConference of Autonomous Regions and Provinces, coordinated as to that date by the EmiliaRomagna Regional Counsellor Sergio Venturi. Of the 20 participating regions (actually, 19 regionsand two provinces with special status), 12 committed at least their local centres of excellence. Outof the 300 Italian hospitals, 34 participated (11%): not an excellent, but still honourable result.Some of the biggest regions were missing. It is probable that our most stringent questionsprompted them to not reply. The participants prevalently included general hospitals, oftenconnected with universities. Scientific Research and Health Care Institutes (IRCCS) – mainlyoncological – largely participated. The call for competition based on specific parameters ofstatistical efficacy of special services, such as C-section rates, successful treatments of acutemyocardial infarction, as well as the absence rate of hospital personnel and special attention to

patients. The Committee produced comparable profiles based on the documentation submitted byeach participating hospital. The analysis disclosed a broad spectrum of extremely well-organised,specialised hospitals and healthcare structures, oriented to high-level benchmarks of services, carefor the patient's needs, transparency and efficiency.Therefore, our work on a still significant sample confirms that Italy's healthcare systems – despiteall the scandals and negative episodes – is very advanced in terms of services, very attentive tohuman aspects, and is more and more oriented towards combining cost-effectiveness with clinicalresult efficiency. There is widespread criticism in Italy concerning the country itself and itsinfrastructures, which apparently ignores our excellence. However, Italy fosters many examples ofexcellence in every field, as is the case of our healthcare system, characterised by higher standardscompared to other European countries. Our comparative analysis produced a short-list ofexcellence. The Committee eventually decided to award a hospital and an IRCCS.The final decision cannot and must not have scientific relevance, as none of the Committeemembers are doctors. The award merely aims to highlight two examples of organisationalefficiency and human approach to patients: among hospitals, the University Polyclinic Sant'OrsolaMalpighi in Bologna was selected, as was the Cancer Care Referral Centre (Crob) in Rionero inVulture (Potenza, Italy) for the IRCCS category.A few words to explain the reasons behind our selection. The Sant'Orsola Malpighi Hospital inBologna, as part of an extremely advanced regional setting, impressed us for the wide array ofspecialised disciplines treated, its efficient personnel/bed ratio, positive economic results (with anet profit of 2%, a much sought-after target for many private industrial Italian companies),contained absenteeism, C-sections and acute myocardial infarction parameters within the targetranges set by Agenas, as well as wide extra-regional attractiveness, great attention and humanapproach to patients, easy access, consolidated online development – both in terms of electronichealth records and other services – as well as further excellent enhancement projects.The Cancer Referral Centre of the Basilicata Region in Rionero del Vulture was awarded as avirtuous example from southern Italy: a small, yet absolutely exemplary structure in terms ofefficiency, commitment and results. This institution is accredited by OECI as a clinical cancercentre, and was awarded three “pink flags” over the past years, in recognition of the far-reachingand responsible roles held by women. The centre boasts wide extra-regional attractiveness andhas an efficient personnel/bed ratio – similar to that of Sant'Orsola – indicating that southern Italycan compare with the regions of northern Italy. Moreover, it features significant incidence ofresearchers (approx. 15%), great and advanced attention to patients, efficient accessibility, goodcommunication systems offering telemedicine and tele-expertise services. The Crob was awardedthe Anac prize for transparency, and has a very, very low absenteeism rate. The Committeededicated its first Italiadecide “Administration, citizens, enterprises” award to healthcare, becauseit believed that this service area, sometimes deeply injured by scandals, deserves greaterappreciation of its excellence, which is not sparse throughout the country.I will conclude by highlighting that this result was made possible thanks to the active participationof all Committee members, whom I personally thank, and who showed constant commitment andfactual contribution. A special thank you to the Italiadecide scientific direction and secretariat,both of which offered precise and smart support to all steps of this initiative.

Vito Gamberale then invited the Minister of Health Beatrice Lorenzin and the Minister for PublicAdministration Marianna Madia on stage to bestow the awards, which were received by GiuseppeCugno – General Manager of the Crob in Rionero in Vulture – and by Dr. Mario Cavalli – GeneralManager of the Polyclinic Sant'Orsola Malpighi in Bologna, respectively.