AGENAS presented the new multidimensional evaluation model of managerial performance in public hospitals.
The analysis concerned 53 structures distributed throughout the country and divided into two categories: Hospitals and ARNAS (23 in all) and University Polyclinics (30 in all).
The differentiation then for these two categories concerns the available beds. For the first time, the Agency has assessed, within the context of hospitals, the ability to achieve welfare objectives – treatment outcomes and accessibility to services – in line with the available resources, whether financial, professional or technological. Subsequently, the evaluation will also affect the local health authorities. The five performance areas concern: accessibility; the governance of organizational processes; economic and financial sustainability; staff; investments.
A number of indicators were evaluated to evaluate each of these areas. For example, to evaluate accessibility, these indicators were also evaluated: waiting times in the emergency room, waiting times for some of the most important or widespread surgical interventions. As far as governance is concerned, the appropriateness of hospitalizations, attractiveness (in terms of active mobility) and efficiency (in terms of number of operations per operating room, for example, or the average preoperative stay) were assessed.
As regards investments, the increases in fixed assets and the age or obsolescence of equipment and machinery were assessed. As far as personnel is concerned, not only the number of doctors and nurses per bed was evaluated, but also the hiring trend and the incidence of training costs. Finally, with regard to the financial sustainability of the assets, various indicators were examined, including the average cost per day of hospitalization, the margins achieved with the intramoenia activity, the levels of solvency (days of duration of payables to suppliers), the ability to manage risks, warehouse management, the incidence of operating costs, the incidence of revenues from services, the margin of the so-called characteristic management and the incidence of extraordinary management.
Of the 53 companies analysed, 9 showed high levels of performance, namely 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). Twelve showed low levels of performance: the Cosenza San Pio hospital (Benevento), the Sant’Anna and San Sebastiano hospitals (Caserta), the Ospedali Riuniti Villa Sofia Cervello (Palermo), the Civic Hospital (Palermo), the Cannizzaro Hospital (Catania), San Giovanni Addolorata (Rome), San Camillo Forlanini (Rome); and the Luigi Vanvitelli Polyclinics (Naples), San Giovanni di Dio Ruggi d’Aragona (Salerno), Mater Domini (Catanzaro) and the Umberto I Polyclinic (Rome). The other 32 show average performance levels.
According to the analysis by AGENAS, among the 8 Sicilian hospitals subject to evaluation, the best is the Garibaldi of Catania, especially in the three-year period 2019 – 2021, which coincides with the governance entrusted to the manager Fabrizio De Nicola, in 2021 it exceeds the average quality threshold in four of the five the indicators. Only the personnel indicator is just below the average, while the indicators on the level of investments and organizational processes are slightly above the average threshold. The data relating to accessibility is well above the average, while the indicator on economic and patrimonial sustainability is close to a high level.
The investment capacity of the Policlinico di Messina is good, all the other indicators easily exceed the average level.
Even the Policlinico of Palermo shows investment capabilities that exceed the high level, the indicators on accessibility and governance of organizational processes do not reach the medium level. The Rodolico San Marco Polyclinic in Catania exceeds the average level in the indicator regarding personnel policies while it is approaching a high level in terms of economic and patrimonial sustainability.
The Arnas Civico and Villa Sofia Cervello hospitals in Palermo only exceed the average in the indicator relating to economic and patrimonial sustainability, while all the other indicators are at a low level.
The Cannizzaro of Catania exceeds the average level in the indicator relating to the governance of organizational processes and approaches the high level in economic and patrimonial sustainability, but is far from the average level in the other three indicators. The Papardo of Messina approaches the high level in economic and patrimonial sustainability, exceeds the average level in the accessibility and governance of organizational processes, approaches but does not reach the average level in personnel policies and remains behind in the investment indicator .
The FP CGIL Sicilia talks about health in pieces through the Secretary General, Gaetano Agliozzo, and the Secretary with responsibility for Health, Monica Genovese: “The responsibilities of this disheartening and sad scenario – they say – are to be attributed to a policy which, faced with to the data processed and disseminated by Agenas, does not even have the modesty of shame. Because it is politics that directs all choices in the field of health, from the appointment of general managers and managers to spending planning, from organizational models to personnel management. Not to mention the political will to allocate, to an ever increasing extent, economic resources to private healthcare, rather than strengthening and qualifying the public regional healthcare system. In this dramatic context – they conclude – the implementation of greater autonomy in Healthcare, required by those regions where hospitals are at the top of the rankings in a positive sense, can only amplify the already
existing inequalities, increasing the gaps between North and South with inevitable effects on the reduction of the level of assistance and life expectancy and health of Sicilians”.
The group leader of the M5S at Ars, Antonio De Luca, member of the Ars Health commission and president of the subcommittee on emergency rooms, speaks of the rejection of Sicilian health care: “These results are certainly not attributable to doctors and nursing and paramedical staff which, on the contrary, we applaud because they manage to keep afloat a boat that is leaking from all sides, but to the center-right government, specifically that of Musumeci. In any case, I absolutely don’t believe – continues Antonio De Luca – that the numbers have changed for the better under Schifani’s management, on the contrary. From the news arriving at the committee, I can assume that the situation has even worsened, with patients increasingly forced to pay for services even in the affiliated facilities, the waiting lists getting longer and the medical staff on duty increasingly understaffed without a shred of solution can be glimpsed on the horizon. By now more than 6 months have passed since Schifani took office at Palazzo d’Orleans, the run-in is over, as soon as they decide to go back to the classroom to work we will ask for an account and reason for this collapse”.