By now the hospital departments are managed as if they were companies and for this reason they must respect budget and costs objectives. A performance set that changes the relationship with patients, seen above all as numbers, tools of a system useful for reaching savings and economic bonuses. But some doctors are questioned if it is right to do economies on the assistance to the sick.
To our health reduced to a and -income and output calculation. Costs, expenses, reimbursements, revenues and, in the middle, we. Nothing else than numbers, Pedine of the System useful only to make the Hospital Departments reach budget and performance objectives that guarantee more money in the paycheck …
Extreme scenario? Yes, but not so far from reality. In the era of hospitals-company, the national health system now has very little national team and has become a mechanism where-at least regarding the goals to be pursued-the regions and even the individual health companies can move more or less freely.
An already in fact differentiated economic autonomy (evil) whose results often prove to be dramatic. “In my hospital, the General Management deemed it appropriate to impose on my operating unit both the aim of performing multiple interventions to dispose of the waiting lists, and to save money using fewer garrisons, surgical tools, implantable devices, syringes, pipes, needle-cannule” explains to Panorama NT, primary of a surgery department of a large hospital in the South, where the interventions can often cost the companies of the North. “But if I have to operate more people, how do I reduce costs? Perhaps I am veiled by I suggest to save on the quality of the supplies, to the detriment of patients but for the benefit of hospital performance … ».
Questions that resonate in the lanes of the specialist departments as well as in those – always crowded and often characterized by violence and aggressions – of the emergency rooms, Where another championship is also played: that of time. The guidelines say that 85 percent of patients should be discharged within eight hours, while the patients to be hospitalized cannot stop in OBI (short intensive observation) for more than 44 hours. De facto unreachable objectives. “From the point of view of companies, they are designed to push the director to understand what does not work in the ward and working on the processes, in order to remove the ballast that prevent you from approaching the desired result” says Paolo Groff, primary of the emergency room of the Perugia hospital. “If the intent from a managerial point of view can be shared, for us primary it becomes a nightmare: a kind of” whisk “in our hands, which we use on colleagues because maybe they have no bright visit times, or tend to retain patients to make more exams, or admit more than necessary. The primary ends up becoming a kind of guard dog. Without considering the fact that the PS is the victim of the non -functioning of the local medicine and the hospital wards that do not free the beds ». Flying to the risk that doctors are driven to be hurry and perhaps to underestimate symptoms and hypotheses.
If it is true that the performance objectives are born with the best intentions, That is, to promote “good practices” and encourage the assistance processes related to the best results for patients, however the economic criteria are poorly adapted to the health context; And leaving the decisions on the objectives in the hands of companies – not all equipped with competent managers – you end up obtaining the opposite: chasing the performances going to reduce the health offer and lowering the level of care. Because when these companies impose the objectives of the “wrong” departments, based on calculations that sometimes appear schizophrenic, there is rarely someone who corrects the shot.
“The fundamental problem is that in most of the structures the global vision of the processes is missing,” says Guido Quici, president of Cimo, the Italian coordination of hospital doctors. “If, for example, the General Management obliges a department of internal medicine to resign patients no later than the fifth day of hospitalization, but then the patient must wait seven to make a resonance or a particular laboratory analysis, how do you proceed? It is obvious that the patient should be kept in the ward, with the waterfall effect of preventing a new hospitalization, with another patient who will remain in the emergency room beyond the “allowed” time. The objectives must be distributed between the departments in a sensible way, and all the primaries must contribute to the achievement of performances that are guaranteeing the sick and the correct care and assistance paths ».
Instead, they become pure bureaucracy that only serves not to make doctors lose some more money: Yes, because if the objectives are not achieved, all the doctors of the department (but also nurses, OSS and general directors) at the end of the year there is fewer money in the paycheck. And this already, in a health system forced to resort to jettons or foreign doctors because Italians prefer to go abroad or choose “easy” specializations – such as ophthalmology or aesthetic medicine – emptying resuscitation, PS or high -complex departments, is a problem that is anything but secondary.
“It is a humiliating mechanism,” continues NT, who prefers to remain anonymous. «If we do not achieve the objectives we doctors, we lose about a thousand euros in a year. For a primary or a structured they can be few, but for young health workers, for specializing or nurses they can constitute an important shortage. It becomes a “punishment” for faults not ours, and it is obvious that no primary like having to act in this way: we are doctors, our work is to take care of people, not achieve unusable company objectives ».
Healthcare companies, in turn, must account for the regions, which set the general goals: The individual companies are asked to close the budgets in active and obtain, among other things, the demolition of the waiting lists – and the general directors (who if the objectives are disregarded, money for several money) convene the primaries and ask to intervene on their activities. “The hospital is so complex that you cannot afford health facilities where the right hand, in fact, does not know what the left does” concludes Quici. «Instead it is often the rule. Fortunately, technologies have improved, but this also makes costs rise. The surgical robots, for example, are dear: if you install it, to amortize the expense of the appliance I must make the operating room work continuously, therefore increase hospitalizations and interventions. At this point I will impose the goal of the primary of surgery ».
It is hoped not at any price. Because, in the end, you always get there: to the oath of Hippocrates, Which requires doctors to act in science and consciousness and who is combined with performances, budgets, eight hours, waiting lists, savings on drugs or syringes. And the pact of confidence with the patients who turn to the white cans every day to be treated: pact more and more at risk, struggling with utopian challenges.
