The role of the management of the Health Authorities in the real life of the NHS

by Claudio Maria Maffei

18 NOV – Dear Director,

the release of the OASI Report of the SDA Bocconi School of Management is always an important event in the Italian public health calendar. It constitutes an annual opportunity for analysis, reflection and proposal on the state of the Health Authorities from which those who govern, but also those who study, health at the various levels of the National Health Service can draw many ideas. This year too, judging by both the Summary Report published and commented yesterday on QS and the connected and authoritative intervention by Francesco Longo and Alberto Ricci.

Speech that ends with the sentence “Today there is an important space of opportunity for the management of Healthcare Companies, which, we believe, will still be able to give an excellent proof of itself, no longer to manage an emergency, but to design a positive future and sustainable “.

As has already happened to me in the past, this self-referential tone about the good, indeed excellent, self-proof of the management of the Health Authorities during the pandemic enunciated and not proven affects me negatively. Not because management has not given it absolutely, but because it has not given it always and everywhere and therefore it is difficult to argue a priori that it has given it in terms of the system. Even if I limited myself to managing the pandemic, I was a spectator in my Region of obviously wrong strategic choices (from mass screening with an antigenic pad to intensive care in a Fair) co-managed with the Company Management.

But pandemic aside, I believe that the analysis of the difference between possible quality and “real” quality of the Regional Health Services shows quite clearly that the system performance is highly inadequate on many issues in which the Company Departments should be protagonists. They should have already made a difference that they have not made and whoever undertakes to study and train company management should help interpret this phenomenon.

Because if this question is not answered (why does management in so many realities affect system performance so little?) It becomes difficult both to accept that evaluation of “excellent evidence” and to recognize as important the space of opportunity that today opens up with the National Plan Recovery and Resilience (PNRR).

Without going into details that are not compatible with the spaces of a letter, I recall some of the many system failures in which the management of companies is objectively involved. The list is my personal and comes from my most direct knowledge:
• the National Chronicity Plan approved in 2016 and in many Regions still at stake;
• the National Dementia Plan for which the same consideration applies;
• delays in the construction of clinical networks, including time-dependent ones;
• holes and delays in the implementation of the Regional Prevention Plans;
• the uncertainties in the declination of hospital networks pursuant to Ministerial Decree 70 of 2015;
• delays in the construction of the Health Homes;
• the loss of momentum of quality policies;
• the loss of role of the epidemiological function.

One could say of the two: either politics has all the responsibilities and the management of the Companies has done what it could trying to limit the damage of politics (and then there is a system problem of one kind), or it was not quite adequate for the role in this context (and then there is a system problem of another kind).

As soon as it is available, I will try to see if these critical issues have been taken into consideration in the full extended version of the OASI Report. Of course it is essential to do it as soon as possible because the PNRR needs both a different policy and a different management of the Healthcare Companies or at least a different relationship between these two worlds. Furthermore, the PNRR provides for training projects for the development of management skills acquisition paths for NHS professionals: the training of 2,000 people is expected by the middle of 2024 and another 4,500 people by the second quarter of 2026. What better opportunity to think critically on the role of management in health care and on the factors that condition it?

Claudio Maria Maffei

November 18, 2021
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