Observatory on Good Practices in Healthcare Sector
Federazione Italiana Aziende Sanitarie e Ospedaliere

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
Calls for innovation and best practice are core objectives according to the majority of Italian health providers’ agenda. However, public opinion seems to be not aware enough to access properly the public sector and gain social and personal benefits. A bad attitude spread among Italian news media prompt to talk about healthcare malpractices. Newspapers, agencies and TV newsroom daily report episodes of corruption, mismanagement and - even worse - unappropriated accessibility and acceptability of clinical treatments. A blind and partial view around factual circumstances is the springboard to potential negative public opinion.

B. Strategic Approach

 2. What was the solution?
FIASO promoted the Observatory on Good Practices in Healthcare Sector to re-balance the gap created by a barely-controlled effect of watchdog journalism. In the attempt to face a negative trend, FIASO cooperated with ANSA – the most reliable Italian news agency with international offices well beyond domestic borders. The final aim of the initiative is to trigger a virtuous circle around positive informative propaganda as incentive to public providers to implement new approaches and arrangements.

 3. How did the initiative solve the problem and improve people’s lives?
The Observatory venture analysed 87 proposals of innovative and alternative initiatives, hunting best-suitable experiences to overcome social inequalities due to issues in accessibility and lack of health innovation. Repeatability and adaptability are the key-drivers to select potential winning ideas. Public health agencies and hospitals submitted a brief summary of their project implementation with a following paper validating the related empirical outcomes. The results of the analysis have been released within the entire healthcare sector, perhaps considering that the Italian Healthcare System is Universalistic and potentially final audience equals the residents who access the system itself.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
The uniqueness of the Observatory relies above the absence of others initiative moving toward similar goals. FIASO has been the first institution collecting experiences, sharing ideas and bridging different health providers with the aim to boost social awareness and well-being in general. Moreover, a colloquial Round-Table allows Directors General to discuss main issues and shortcomings of a single territory or a hospital has to face every day. Cooperation fills the gap in between best actors and second actors in the System, according to solutions at potential stake.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
Since the Observatory is a set/collection of several initiatives run by different public bodies, a representative case is listed hereinafter. AOU Policlinico S. Orsola Malpighi di Bologna – the main university hospital in the city of Bologna – promoted a plan to deliver maternal milk to all the premature births. All the babies weigh less than 1.5kg born after February 2013 and admitted to the Neonatal Intensive Care Unit are entitled to receive human milk completely from the BLU – acronyms for Bank for Human Milk. The BLU collects milk from all the mothers so that child can be delivered with both own mother’s or others’ milk as far as it is from the Bank. Maternal milk prevents child’s health from negative outcomes later in life with a good likelihood.
 6. How was the strategy implemented and what resources were mobilized?
Main financial resources came from a local firm – Granarolo – among Italian leaders in production and distribution of milk and milk-derivative products according to a shared action plan. The hospital agreed with the private entrepreneur technical and economic clauses in order to select product all-over the delivering chain. Other association (standing for maternal vulnerability issues) got involved to manage the mothers’ “first-contact” to invite them to the initiative ex-ante, and require information about child’s need, quality of delivered milk ex-post.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
Firstly, Policlinico S.Orsola Malpighi Bologna increased visibility in terms of cost-effective health measure execution. Other hospitals in Bologna area and Emilia Romagna Region gained benefits from replication of the initiative. Secondly, private agricultural distributors had the chance to show a positive attitude to health-related issues and promote their own brand, by cooperating for a social purpose. Moreover, since health regulation is on regional government’s competence according to Italian law, Emilia Romagna Region goes up along Italian ranking as one of the best performers according to health indicators in 2013 with an amount of 26 good practices promoted in a year in different healthcare departments.

 8. What were the most successful outputs and why was the initiative effective?
Although Milk Banks are quite spread among different public and private settings, this is the first and the unique case entirely financed by private entrepreneur. The objective was to collect a minimum amount of 600 litres of milk, coming out from an estimation of the quantity in need of children admitted to the neonatal intensive care all over the region territory. A quantitative of 185 litres has been gathered after the first 6 months from the kick-off of the initiative. Positively babies in hospitals received almost the 60% of the stored milk, contributing to an increasing mothers’ involvement.

 9. What were the main obstacles encountered and how were they overcome?
Criticisms stood in selecting an appropriate location for the laboratory as well as in fitting out both practical and IT infrastructures. The redaction of a strict code of validation and admittance of donating mothers constitutes a hard phase for the promotive body. The public acquisition of fridges, baby bottles and all other minor and still indispensable tools. For transport and delivery, the cold-chain has been followed by keeping milk cold. The private counterpart is responsible for tracking transport and withdrawing to user’s domicile.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
As already mentioned, selected initiatives counts for 75 (out of 89 submitted) from the entire national area in 2013. The Observatory was already promoted for 2 years in 2011, and it registered an increase of participation rate of public hospitals and agencies, +23%. The results and the analyses out of both these steps flowed into two books, distributed within the Association network. In order to boost the public availability of gathered information, a public website section was made to describe each experience, share evidence and provide smart and useful suggestions to health economists and manager as well as to every citizen.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)

Contact Information

Institution Name:   Federazione Italiana Aziende Sanitarie e Ospedaliere
Institution Type:   Other  
Contact Person:   Nicola Pinelli
Title:   Project supervisor  
Telephone/ Fax:   00390669924145
Institution's / Project's Website:  
E-mail:   info@fiaso.it  
Address:   Corso Vittorio Emanuele II 24
Postal Code:   00186
City:   Rome

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