CREMONA – Right in the midst of the controversy over the reorganization of the Women’s Area, with the gaze inevitably still turned to the pandemic – which also seems to be in the final squeeze – but also projected to the perspective of a local healthcare that will be able to count on the new hospital, is between containers and contents, analyzing the scenario as a manager, who the general manager of Asst Cremona, Giuseppe Rossi, enters the debate on the future of the city.
Two years of pandemic have severely tested citizens, the economic fabric, social relations and education. The greatest impact clearly concerned the health sector, which paid a heavy price, fought at the forefront and revealed the need to reorganize at least part of the services, shortening the distance between citizens and the first level of care and assistance.
What is the direction to follow? What are the priorities?
«Modernization of hospitals, strengthening of the territorial network, telemedicine and prevention: these are the priorities that mark the way forward. The future is built in the present, through precise actions, useful for creating the right conditions so that the best can happen to happen. For the Cremona hospital, for example, it means aiming for the second level emergency and admission department (DEA). This is to ensure highly specialized functions related to emergency through complex units such as neurosurgery, cardiac surgery, intensive care, thoracic surgery and vascular surgery. This is why we must not think of the new hospital as a mere container, but as a driving force, capable of creating favorable conditions for the achievement of ambitious objectives, aimed at promoting an evolution of substance for local health and the entire community “.
Cremona was one of the cities most affected by the pandemic. With the end of the emergency, which we hope will arrive soon, how can health care activities contribute to relaunching the social, economic and quality of life aspects?
“Covid-19 will not suddenly disappear and other system criticalities, such as the shortage of personnel, will not disappear by magic. We have no choice: we must learn to do well with what we have available and stop making comparisons with the past, to hinder change in a prejudicial way: the context in which we move today has profoundly changed and not necessarily for the worse. Technology and research have opened unexpected and unthinkable scenarios until some time ago. The Covid vaccine is an example: implemented in record time, it has saved millions of people and allowed us to return to life. Instead of focusing only on curing diseases, I think it is necessary to put prevention back at the center, and in this the pandemic is not helping us. Furthermore, it is important to think of health expenditure not as a cost, but as an investment functional to economic development and stability. Investing in the health system means, in fact, generating employment, well-being and, on the other hand, reducing social exclusion. Economic growth makes the population more health conscious and a good public health strategy is complementary to an effective economic policy. We live in a circular system, where everything is connected: health is influenced for two thirds by factors that are not strictly health (culture, income, genetics, environment) and the slogan Health in all policies. coined by the World Health Organization (WHO), it perfectly summarizes this concept ».
New technologies, specifically those related to telecommunications and digital, open up new and interesting scenarios. Cremona is the seat of a pole for technological innovation which is a flagship of the city. What virtuous interaction can be established at the local level between healthcare, new technologies and new business?
«The future of medicine is unequivocally linked to digital and information technologies, thanks to which it will be easier to treat and prevent. The ongoing revolution does not only concern the behavior of people’s daily or professional life, but also their way of relating to health, from research on the web, to communication with doctors, to teleconsulting. Operating rooms, diagnostics, therapeutic processes are pervaded by technology with an exponential improvement in the outcome of the treatments which has a positive impact on the quality and life expectancy of people. Thanks to computerization, the specialist will increasingly develop the possibility of observing a case from a distance, discussing it with colleagues (who may work in other cities or other countries) and decide to intervene by applying the best treatments available internationally. . Until a few years ago this was science fiction. We must get used to entering the order of ideas that many of the treatments carried out in the hospital today, thanks to technology, could be performed elsewhere or at home ».
Eg?
“For example, I am thinking of the delicate front of oncological therapies, which are already practiced at home with an emotional impact and comfort on the patient that no structure is able to match”.
A notable step forward made by the city in recent years concerns the training centers, which were born and developed in the name of quality. Is it possible to imagine a similar evolution also for the healthcare sector? Where to start?
“Where there is culture there is health, so training is crucial for both health workers and citizens. The Cremona Asst is already a branch of the University of Brescia for the Nursing and Physiotherapy course. The new hospital will make us more attractive and the desire is that the degree courses of the health professions can enter into a close relationship with the Cremonese university center, which is now in great and growing. With the arrival of Professor Gian Luca Baiocchi, director of the Surgery Operating Unit, Cremona has become the seat of the permanent school on fluorescence-guided surgery for diseases of the gastrointestinal system. We are talking about interventions that are often followed online by dozens of connected specialists from all over Italy and eager to learn an innovative technique, practiced in a few centers. And Dr. Antonio Fioravanti, director of the Neurology Operational Unit, is promoting a highly specialized training project – CadaverLAB – which has brought and will bring professionals and specialists from all over Italy and the world to the city. Here: this is the future and I think that we, in Cremona, are already following it ».
The new Cremona hospital, indicated as a regional and national model, will be a great opportunity for the city. What are the virtuous paths to follow in order to obtain the best results as regards the quality of services, employment, centers of excellence, related activities and the impact on the territory?
“Preserving the basic values of the health system also means strengthening the identity of the places of care and enhancing the work of those who care. In Italy, most of the hospitals have structurally exceeded their maximum age limit – generally it is fifty years old – and that of Cremona is a striking example. I have had the opportunity to explain several times that the construction from scratch is an obligatory choice (due to the state of wear of the current structure) and economically advantageous to take a leap into the future and, why not, become a model to follow. It is no coincidence that the vice president of the Lombardy Region Letizia Moratti, a few weeks ago, brought the Cremona Hospital as an example to the Dubai Expo. It is the first time in Italy that the path of an international competition has been chosen, which will be won by the best project and not by the designer ».
Yet, there is no lack of perplexity, criticism, even resistance …
“I know that many are perplexed. So much so that one of the recurring questions I hear is: ‘What will you put in the new hospital?’
Here: what are the contents to put in the container?
«One thing is certain: it will host all the operational units and services present today, but the architectural (safety) and technological (innovation 4.0) context will be of an incomparable quality. Not only. The entire area will be redeveloped and transformed into a health park whose potential is still to be developed ».
And what will be the main features of the new hospital?
«It will have 500 single rooms all with video surveillance, it will be flexible, modular and with very high levels of comfort. The new hospital will make it possible to build more effective pathways for the benefit of the quality of care and will make our area more attractive, even for professionals. Let’s not forget that the hospital is part of a system, which is why the advantage of designing one in the post-covid era allows us to implement everything we have learned from the pandemic and to prepare everything in a functional way for operation and dialogue. with basic medicine and local services. In summary, it will be a real widespread hospital, interconnected with the network of services and citizens. It will be made above all by the skills of those who work there and by innovative organizational models, able to overcome the logic of individual departments and services. We are already working on this together with the specialists. To be clear, in the hospital of tomorrow every doctor will have to think as if he were in charge of all the hospitalized patients and not just those of his ward ».
The increase in the elderly population in Cremona is remarkable. Dedicated services are destined to grow further. What guidelines and what criteria must be followed to guarantee better assistance to third-age users?
“According to estimates, by 2030 in Italy the elderly could represent about 27% of the population and of these the over 80 will be a significant percentage. To respond to the need, it has become urgent to leave a hospital-centric perspective and shift attention to local services, home care and support for family members. As I said before, these are the priorities to be addressed ».
It means creating the conditions to treat people where and when it is needed.
“The community houses, which are starting in Lombardy, represent one of the fundamental steps to give substance to proximity medicine in favor of the most fragile”.
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