La professione del Biologo tra Scienza e Industria Corso di Formazione “Professione Biologo” Roma, 14 Giugno 2012 Pasquale Mosella
La professione del Biologo tra Scienza e Industria Lab. Analisi l l Acquisire competenza Acquisire conoscenza Accrescere esperienza Generare fiducia Industria l l Acquisire competenza Acquisire conoscenza Accrescere esperienza Generare fiducia Ricerca l l Acquisire competenza Acquisire conoscenza Accrescere esperienza Generare fiducia
La professione del Biologo tra Scienza e Industria l l l Passione Determinazione Tenacia Coraggio Voglia di esplorare vie nuove Responsbilità & Rischio l l l Passione Determinazione Tenacia Coraggio Voglia di esplorare vie nuove Responsbilità & Rischio
Chi, come, dove, quando. . . l 1980 -2012 : spunti e riflessioni circa la professione, tra cambiamento e trasformazione dell’Health. Care. Corso di Formazione “Professione Biologo” Roma, 14 Giugno 2012 Pasquale Mosella
All’interno degli ospedali, il Laboratorio analisi, proprio per il ruolo strategico che svolge nella erogazione di servizi, viene sempre più chiamato a incrementare non solo la capacità produttiva, ma soprattutto l’efficienza produttiva. La necessità di migliorare la situazione finanziaria impone una elevata attenzione alla razionalizzazione dei costi.
La riduzione dei costi va affrontata in maniera globale prendendo in considerazione il processo di produzione attraverso l’analisi dei flussi di lavoro e analizzando le singole necessità DISEASE MANAGEMENT
FASI PROCESSO PRODUTTIVO PRE Analitica ANALITICA POST Analitica
Processo Produttivo PRE Analitica POST Analitica Information data management Analytical Sample handling
L’ANALISI DEL PROCESSO PRODUTTIVO, QUINDI DELLE SUE VARIE FASI, E’ INDISPENSABILE PER ARRIVARE AD UN PRODOTTO DI QUALITA’ LA QUALITA’ DEL PRODOTTO E’ QUINDI IL RISULTATO DELLA QUALITA’ DEI PROCESSI ATTUATI
SI PUO’ MIGLIORARE L’EFFICIENZA PRODUTTIVA ATTRAVERSO L’AUTOMAZIONE RAPPRESENTA LA CONDIZIONE INDISPENSABILE PER AVVIARE UN PROCESSO DI RIDUZIONE DEI COSTI DI GESTIONE
¬ Process improvement ¬ Data management enhancement ¬ Lab automation
AUTOMATION FOR THE CLINICAL LAB Ø Bar coding Ø Front end automation Ø Work cell automation Ø Total automation Ø Remote Ø Mobile control POC testing robots Ø Robotic arms Ø Separation and sorting
Automation is a SYSTEMATIC PROCESS and not simply the purchase of hardware Factors that will influence succesful use of automation are: ³ An enthusiastic workteam ³ A well thought out strategic plan ³ Standardization of specimen containers ³ The reduction in exception specimens ³ The widespread use of P. O. C. testing
Goals to define when establishing a fully automated clinical lab operation Ø Cost controls Ø Increase capacity for testing throughput (increasing productivity) Ø Improved Ø FTEs TAT reduction Ø Return on investment (ROI)
Componenti del costo per campione Postanalitica 15% Analitica 45% Preanalitica 40% 60% degli errori di laboratorio
QUALITA' COSTO TEMPO
UN OBIETTIVO FONDAMENTALE DELL’AUTOMAZIONE DEL LABORATORIO E’ QUELLO DI FORNIRE INFORMAZIONI AL CLINICO IN TIME TO DO ANY GOOD FOR THE PATIENT
LA RIDUZIONE PIU’ CONSISTENTE DEI COSTI (QUELLI COMPLESSIVI DELL’AZIENDA OSPEDALIERA) PUO ESSERE REALIZZATA ATTRAVERSO L’OTTIMIZZAZIONE DELL’ATTIVITA’ DEI MEDICI DI REPARTO COMPORTAMENTO “MANAGERIALE” DELLA PRATICA CLINICA RIDUZIONE DELLE GIORNATE DI DEGENZA NON APPROPRIATE
BISOGNI DOMANDA OFFERTA QUALITA' COSTO TEMPO
CPR CONTINUOUS PATIENT REPORTING
LABORATORIO ANALISI Chimica Clinica 87% Immunochimica Ematologia Coagulazione Urine Prot&Elettr.
Laboratorio fino agli anni 90 ' Singole aree in relazione alla tipologia degli esami richiesti (elevato numero di strumenti) ' Personale vincolato alla propria area ' Campioni ai settori su richiesta cartacea ' Le tre fasi del processo ben distinte ' Costi gestione elevati ' Al settore urgenze aumenta l’attività
PROCESSO DI PRODUZIONE RICHIESTA PRE ANALITICA REFERTO ANALITICA POST AN. 7. 30 8 9 10 11 12 13 14 15 16
Laboratorio Analisi fino al 90 Microbiologia: Isolamenti con metodi classici ID e DS con strumenti semiautomatici Tempi di risposta non inferiori alle 72 ore Sierologia: Prevalentemente Ricerca Anticorpi con metodi classici
Laboratorio dopo gli anni 90 ' ' ' ' ' Potenziamento LIS Richieste su schede ottiche Barcoding area Riduzione numero strumenti Ampliamento menù test Aspirazione da tubo primario Host query Tutti i settori interfacciati al gestionale centrale Riorganizzazione area ad alta automazione (core lab)
Laboratorio Analisi dopo il 90 Microbiologia: Strumentazione automatica per ID e DS Sistemi per emocolture PCR - LCR Interfacciamento al Gestionale Centrale Sierologia: Ricerca anticorpi su micropiastre Blotting e Amplificazione
Processo di produzione - Lab. Urgenze PRE Analitica POST PRE Analitica POST 0 12 24
Orario utile per la refertazione RIAN 9 UTIC 9 ONCO MED 10. 30 10 OST INF P. S. 11 10 entro 20 -30 min.
SPECIMEN RECEIVED TIME 8. 00 9. 30 7. 30 0. 00 12. 00 24. 00
CONTINUOUS PATIENTS REPORTING LAB. ROUTINE LAB. URGENZE C. P. R. OPEN SPACE CORE LAB
CONTINUOUS PATIENTS REPORTING PRE Analitica POST PRE Analitica POST 6 Campioni 7 8 9 1°St. 100 10 11 2°St. 3°St. 200 350 12 13 14 4°St. 5°St. 650 Tutti
CONTINUOUS PATIENT REPORTING CORELAB INTEGRATION Ø Ø Ø Ø Ø Increase progressive automation through specimen matrix tube division Sample handling Data management enhancement (LIS - HIS) Autovalidation 24 h ready Barcoding area department Buy work from other labs Patient-side testing system (next generation of POC technology) Involving lab staff (FTEs)
CORELAB LAYOUT CHIMICA CLINICA IMMUNOCHIMICA NEFELOMETRIA E M A T O L O G I A COAGULAZIONE URINE EMOGAS
Patient-side testing system Ø Test di emergenza Ø Rapido TAT Ø Massima efficienza Ø Riduzione Ø Controllo dei costi remoto dal laboratorio
IL LABORATORIO DOPO IL 2000 POC CPR 85% POC
IL LABORATORIO DOPO IL 2000 Microbiologia: Automazione per Isolamento, ID e DS Diagnosi rapida con metodi diretti Tempi di risposta 6 - 24 ore Sierologia: Automazione dei sistemi su micropiastra Consolidation su analizzatori del corelab Prevalentemente Ricerca Antigeni
Ospedale del nuovo millennio S Pochi e ad alta tecnologia S Trattamento di patologie acute S Interazione con il territorio: Ospedale collegamento in rete con le strutture ed i medici di medicina generale S Internet Territorio S Potenziamento compiti di supporto all’ospedale: riabilitazione, home care, distretto sanitario, hospice, ecc.
Protagonista dello sviluppo del nuovo modello di Ospedale in rete sarà INTERNET Health Care Service Integration of POCT in LIS E - mail
NEAR FUTURE Point of Care Testing Molecular Diagnostics
New Technologies for the new Millennium GENE CHIPS MINIATURIZATION and FLUIDICS BIOELECTRONIC DETECTION OF DNA
2° Eurolab Automation - London - October 1999 … however, developments in nano- technology have opened up the possibility of more bed side testing. As this is likely to be a reality in the next three years there will be a movement of testing out of the core laboratory and into the wards. M. J. Wheeler St. Thomas Hospital - London
2° Eurolab Automation - London - October 1999 The central laboratory of the future is destined to become an esoteric testing center, while routine testing will be more economical when administered at the patient bedside. Robin A. Felder University of Virginia - USA
Il laboratorio dopo il 2010 POC POC Tests esoterici POC POC POC
Il Laboratorio dopo il 2010 POCT MICROBIOLOGIA HOME TESTING LAB
E’ in atto un processo irreversibile di cambiamento che prima ancora di essere tecnologico è soprattutto culturale. Ci si sta avviando verso la “società della conoscenza” dominata dalla comunicazione globale.
BD Diagnostic Systems European Leadership Team Meeting - 16 th December 2008 Today Agenda - Medical Devices Domestic Market - The Italian NHS - Healht Expenditure vs Finance - Public Sector’s Financial Crisis - Late Payments - Key Aspects of Regional Governance - Public vs Private Healthcare Providers - Reimbursement schemes - HTA - Centralized Purchasing Policy - Key Aspects of National Governance - Reference Prices - National Repository of Medical Devices ASSOBIOMEDICA
Assobiomedica is the Italian Federation of four National Associations BIOMEDICALS IVD ELECTROMEDICALS SERVICE & TELEMEDICINE ASSOBIOMEDICA ORTHOPAEDICS, DYALISIS, CARDIO, SUTURES, INCONTINENCE, INFUSION, LAPAROSCOPY, WOUND CARE, UROLOGY, OSTOMY, ANAESTHESIOLOGY, TNT, NEUROSURGERY, BREAST PROSTHESIS, … LABORATORY, SELF-MONITORING, ALLERGY THERAPIES, RADIOPHARMA IMAGING, ULTRASOUND, EM-PM, HEALTHCARE-IT
Medical Devices World Market 2007 Japan 11% Rest of the World 16% U. S. 43% 21. 100 companies Europe (11. 000) - U. S. (8. 500) - Japan (1. 600) 850. 000 employees Europe (435. 000) - U. S. (350. 000) - Japan (65. 000) € 187 bill. sales Europe 30% Europe (56, 1) - U. S. (80, 4) - Japan (20, 5) EU New Members 5% Italy 11% France 16% U. K. 11% Spain 9% Rest of Europe Switzerland 16% 2% ASSOBIOMEDICA Germany 31% Sources: Advamed, Eucomed, Assobiomedica
Assobiomedica Member Companies 2008 226 MEMBER COMPANIES € 6. 200 million DOMESTIC MARKET 75% PUBLIC DEMAND 30. 000 EMPLOYEES TURNOVER SIZE > € 40 million € 20 -40 million € 5 -20 million 151 TRADING COMPANIES < € 5 million 16% 11% 43% 30% 75 MANUFACTURERS ASSOBIOMEDICA Source: Assobiomedica
Assobiomedica Member Companies 2008 Manufacturing Side Marketing Side DOMESTIC MARKET 84% EXPORT 16% PRODUCTION 31% TOTAL SALES € 7, 4 billion IMPORT 69% BIOMEDICALS + SERVICE & TELEMEDICINE € 3, 2 billion IVD € 1, 7 billion ELECTROMEDICALS € 1, 3 billion ASSOBIOMEDICA Source: Assobiomedica
The Italian NHS 2007 Nr. Autonomous Public Hospitals Nr. ASL Nr. Hospitals managed by ASL Nr. Contracted-Private Hospitals Nr. Other Hospitals Piemonte 8 13 48 40 7 Valle d’Aosta 0 1 1 0 0 Lombardia 29 15 2 61 25 Veneto 2 21 57 16 12 Friuli Venezia Giulia 3 6 8 5 3 Liguria 3 5 10 3 5 Emilia Romagna 5 11 38 42 1 Toscana 4 12 26 27 5 Umbria 2 4 9 5 0 Marche 2 1 31 12 3 Lazio 4 12 52 79 19 Abruzzo 0 6 23 13 2 Molise 0 1 6 2 2 Campania 8 13 47 71 8 Puglia 2 6 27 37 7 Basilicata 1 5 13 1 2 Calabria 4 6 33 38 1 17 9 50 62 5 1 8 29 13 3 95 157 528 536 119 Region Sicilia Sardegna ITALY ASSOBIOMEDICA Source: OASI Report, Bocconi University
Public Healthcare Expenditure 2005 (%) • Human resources • Goods&Services 27, 4 • Pharmaceuticals 12, 6 • NHS Contracted-private providers 27, 1 • Other • 0% 32, 8 0, 9 • 10% • 20% • 30% • 40% • 50% • 60% • 70% • 80% • 90% • 100% • Human resources • G&S 32, 8 • 12, 6 27, 4 • 27, 1 • Pharmaceuticals • NHS Contracted-private providers • Other • 0% • 10% • 20% • Medical devices • Other G&S ASSOBIOMEDICA 4, 7 22, 7
Public Healthcare Expenditure 1990 -2005 (%) 1990 2005 min. Max • Human resources 39, 1 32, 8 (2005) 43, 3 (1997) • Goods&Services 17, 7 27, 4 17, 3 (1991) 27, 4 (2005) • Pharmaceuticals 17, 6 12, 6 10, 7 (1995) 17, 6 (1990) providers 24, 7 27, 1 24, 7 (1990) 27, 8 (2002) • Other 0, 9 0, 1 (2005) 1, 8 (1993) • NHS Contracted-private ASSOBIOMEDICA
Public Healthcare Expenditure vs Finance 1990 -2007 Expenditure € 103 billion Funding € 95 billion Deficit € 8 billion • The annual deficit on GDP is 0, 35% on average. • The ratio shows a rather limited variability. { Source: Assobiomedica • All modern healthcare systems experience the same financial difficulties but this does not prevent suppliers in those markets from getting payment within a reasonable timeframe. • The point is that in other countries such deficits are promptly payed in full whereas in Italy this does not happen. ASSOBIOMEDICA
The Italian Public Sector Financial Crisis • The Italian public sector has been experiencing for long a financial crisis. • Public expenditure has been growing for many decades faster than revenues. • As a result, our public debt as % of GDP is the second highest in the European Union (and very far from the due parameter set by the Maastricht Treaty). • There are not easy solutions for financial distress (and late payments) in the healthcare sector. • Healthcare represents, on average, the 80% of the total current expenditure at regional level and it means that additional resources for healthcare cannot be expected to come from other regional budgets. • We cannot any more have third largest market in Europe, the second highest public debt on GDP, and the 75% of the domestic market made by public demand. • Moreover, GDP is expected to decrease by 0, 4% in 2008 and by 1% in 2009. ASSOBIOMEDICA
Late Payments • The finance of the NHS has never been effectively tackled by the National Legislator. • Up to 1993, the State has been responsible for funding the healthcare expenditure and its approach has been to allocate less money than the regions needed so that to encourage them to pay attention on costs and expenditure. • During this period the annual deficits were late payed by the State and the medical device market grew fast. • Market leaders, by not claiming for interest for late payment, enforced the general opinion that prices include such interest computed on the basis of the expected DSO. ASSOBIOMEDICA
Healthcare in(de)finite Demand vs limited Finance • Since 1994 regions have been responsible for funding their own healthcare expenditure in excess over budget. • Actually, most regions’ and local authorities’ fiscal autonomy is still inadequate: e. g. due to the abolition of the tax on the houses of residence in the last year, local authorities will get 850 million euro of fiscal revenues less in 2008; the Government (which disposed the abolition) seems to be willing to transfer only 260 million euro for compensation. TR VA FVG LO VE High DSO PI ER LI TO MA UM LA AB MO CA SA PU BAS CA • If the problem were the same for any region, it would be easier to tackle. Instead, profound differences exist among regions (e. g. in terms of GDP person). SI 140 -160 % of EU-25 average at PPP 120 -139 % of EU-25 average at PPP 100 -119 % of EU-25 average at PPP 70 -99 % of EU-25 average at PPP 60 -79 % of EU-25 average at PPP ASSOBIOMEDICA Source: Eurostat
Health Technology Assessment l At the moment, no “HTA-Requirements” formal admission to reimbursement system. l Utilization and dissemination of HTA Report is still quite limited. l Lack of central (National) strong coordination. l In the next future more and more RHAs will use HTA to influence the purchase and diffusion of innovative medical devices within their boundaries. l Many decision makers think that so far innovation has been often adopted without sufficient information about its efficacy and costs related to alternatives. l In the next future more attention will be put on activities such as horizon scanning, priority setting and HTA. ASSOBIOMEDICA
Health Technology Assessment Emilia Romagna Since the longest time structured HTA activity + high skills & experience inside the Regional Health Agency. Veneto, Lombardia, Toscana, Piemonte Well-defined HTA regional programs have been launched. Friuli, Lazio Institutional HTA in early developing phase. Hospital-based HTA Units (Hospitals where specific skills and experience for procurement under HTA criteria have been developed). ASSOBIOMEDICA
The regionally-centralizated (or driven) purchasing policy in Emilia Romagna • Intercenter is the Agency for the purchase of goods and services needed by health authorities in Emilia Romagna. • The model is characterised by a central management which defines technical specifications of the goods and services to be acquired; logistic and administration aspects are managed by local health authorities which are obliged to adhere to the contracts stipulated by Intercenter. ASSOBIOMEDICA
The National Governance of the Healthcare Service Some measures adopted: • Reference Prices • National Repository of Medical Devices • Late renewal of personnel contract • Enforcement of the role of the Central Agency (Agenas) ASSOBIOMEDICA
Medical Devices’ Reference Prices Official publications of the Reference Prices List l l Decree of October 2007 Decree of January 2008 Decree of April 2008 The restyling of the list is expected in a short while: 26 references will be delisted (e. g. some endovascular prostheses) and 23 new references will be added (e. g. some pediatric vascular prostheses); most prices will not be modified. l The products so far involved are very different from each other and the relative prices range from € 0, 018 (for a non-surgical glove) up to € 6. 939 (for a particular endovascular prosthesis). l Reference prices must be used by public hospital as base prices for public tenders. • Assobiomedica proposed an amendment to the next National Budget Law 2009 which is still in discussion, with the objective to suspend the application of reference prices in 2009. ASSOBIOMEDICA
Medical Devices’ Reference Prices Critical issues l Risk of an extension of the reference prices published by the Mo. H even among Private Hospitals. l The so-defined “equivalent” classes of products actually do not correspond to equivalent supplies. l Risk that RHAs will keep on adopting their own reference prices even though the amendment to the next National Budget Law 2009 proposed by Assobiomedica will be successful. ASSOBIOMEDICA
Health Technology Assessment l The National Agency for Regional Healthcare Services (Age. Na. S, formerly A. S. S. R. ), founded in 1993, supports and co-ordinates regional activities in cost monitoring, organizational challenges and HTA. l Coordinator Agency of National Plan for clinical guidelines. l Strong endorsement by the Conference of the Regions on HTA. l Important role of Agency in process of reference pricing for medical devices and key stakeholder into the debate on alternative ways for governance of medical device sector. l Commissioned by the Mo. H to produce HTA reports on orthopaedics, in vivo and in vitro diagnostics; the aim of these reports was primarily to test the process for a systematic activity. l Main Coordinator of “Progetto COTE”, a network for Horizon Scanning activities in Italy. The project has been launched in september 2008 and is still in a developmental phase. ASSOBIOMEDICA
Diagnostic Systems Italy The new Go to Market Model Lux 28/06/2007
BD Italy CONTEXT MAP INTERNAL TRENDS OUTSIDE TRENDS POLITICAL CLIMATE • Strong uncertainty • Purchase dept. centralization (1 purchase dept. for many labs) • Merging and acquisitions (customers and companies) • Price oriented tenders • Competition conflicts • Raising awareness on HAI • Focus on health care costs rather than investments ECONOMIC CLIMATE • DRG reduction • Financial law negatively affecting companies (price monitoring) Focus on lower price inst. of quality CUSTOMER NEEDS TECHNOLOGY FACTORS • Business consultant approach Scientific/therapeutic & Financial • Break “lab barriers” New stakeholder & wards exploring • Profiles and skills diversity ex. Workflow engineers • Reorganization of strategic centers • Costs constraints • Workflow analysis & KPI evaluation UNCERTAINTIES • Full & rapid automated system • Quality/price balance • “Zoonosis” conversion diseases • High level after sales support • Merging and acquisitions, global contractor • Rapid Tests request • Scientific development • Molecular Technology • Urgent need of modular instruments • Management skills development • Key decision makers shift • Regional hospitals merging
Driving Forces TRENDS FORCES Economical Growing Concern for HC Worker’s Safety & Environmental Issues l Increasing Public Exposure to Infectious Diseases Issues l Professional Uncontrolled HC Expenses Growth Exceeds GDP Increase l l l Demographical Growing Challenges of Infectious Diseases Increasing Customer Education l. Increasing Aging Population l l Political Low regard and visibility of Clinical Microbiology Regulatory Pressure on IVD l. New l Financial law Lowering Attractiveness of HC Profession l. Focus on products and prices rather then on quality and solutions
Driving Forces CONSEQUENCES Growing Concern for HC Worker’s Safety & Environmental Issues l Increasing Public Exposure to Infectious Diseases Issues l Control Program l Continuous Budget Pressure Reimbursement & Budget Pressure l Higher Needs for l. Expenses l Uncontrolled HC Expenses Growth Exceeds GDP Increase l Decision Shift to Admin & Finance (new stakeholders) l Growing Challenges of Infectious Diseases l l Increasing Customer Education l. Increasing Aging Population Low regard and visibility of Clinical Microbiology l l Regulatory Pressure on IVD l. New l. Tender cost impact Performance l Increased complexity of the sales pathway l l Rationing to Rationalising Lab Concentration, Satellites, Global Contractors l Process Optimization Focus l Integrated Global Approach l. Future l Lab approach Customised Instrument Solution Financial law Lowering Attractiveness of HC Profession l RESULTS Staff Shortage for cost reduction l Higher Information technology request
Driving Forces Growing Concern for HC Worker’s Safety & Environmental Issues l CONSEQUENCES Increasing Public Exposure to Infectious Diseases Issues l Uncontrolled HC Expenses Growth Exceeds GDP Increase l Growing Challenges of Infectious Diseases l l Increasing Customer Education l. Increasing Aging Population Low regard and visibility of Clinical Microbiology l l Educated & Sensitive customers/patients l Influence on Diagnostic tests prescription l. Mrsa l. Regional l Political Programs l. Improvement of procedures Screening Programs Primary Demand Patient Initiatives l l Standardization l Focus on prevention Targeted Co-Funding in Emerging diseases l Financial law Lowering Attractiveness of HC Profession CT Screening Program in medicine Regulatory Pressure on IVD l. New RESULTS More accurate Epidemiology Profile l l Documented AB Therapies
Driving forces Growing Concern for HC Worker’s Safety & Environmental Issues l CONSEQUENCES RESULTS Increasing Public Exposure to Infectious Diseases Issues l Uncontrolled HC Expenses Growth Exceeds GDP Increase l Growing Challenges of Infectious Diseases Higher Sensitivity to Increasing Customer Education l. Increasing Economically driven Epidemiology / Data Management l Increasing focus on Nosocomial Inf. l Value Opportunity for Clinical Financial law Lowering Attractiveness of HC Profession l Preventive Programs & Cost processes Low regard and visibility of Clinical Microbiology l. New l Politically and Aging Population Regulatory Pressure on IVD Safety Educational Campaign l l Risk Management HCW Safety l l l Micro Lab
The reason of changement • Focus on products • customer = lab • only sales rep needed with a little support from HQ FAS • 100% personal relationships
The reason of changement • Focus on products and instruments • customer = lab + adm dept • sales rep + FAS • Tender process focus • 85% personal relationships
The reason of changement • Focus on products and solutions • customer = lab + adm dept + clinical dept + CIO • sales rep + FAS + pm + management • Tender and project process focus • 75% personal relationships
1980 – 2007 FROM Simple selling process Few competence needed Few resources needed Focus on products Sale and management of results Datas Microbiolgy Lab Diagnosis Prevalence of products and Technology Product and service management Test as diagnostic support Focus on results (lab centralization) TO Complex selling process Many competences needed Many resources needed Focus on projects Sale and management of informations Consulting Cio, Clinical, General Management Prognosis and Therapy Prevalence of Organisation Project and performance management Test as prevention support Focus on Process (POC + decentralizazion to wards)
The reason of changement National/regional Govnmt (guidelines and financial goals) Hospital Management KPI (GM, ADM dept, Hy dept) KPI Lab KPI Clinical, wards Patient/Customer Family Physician
Asso. Diagnostici 2011 -2012 S REND DE T I OUTS del • Tren d impres 1 Sostenibil ità dell e e • Conclamata fase recessiva • Definitiva consapevolezza della crisi • Attesa del comparto Industriale per maggiore disponibilità di risorse • Tregua responsabile a sostegno del Governo • Massima pressione fiscale • Inn ov az Ru ion olo va e e • lor del te e a l’H C cn r gg TA olo ne eazi iun qu gia o to ale clin twor ne d ici, k di i s Os D sta olid sia peda irez ke i se Scie liere ioni hold Cit ttore ntifi , As ASL er: • tad ch che soc e Ma ini e d ch iat pro ggio …. . i Paz e di ive pa ces re e ien TE zient so di fficac ti e gu ia e FA CH ari ne CT NO gio l ne OR LO de S GY l • • Difficoltà a coniugare rigore economico e necessità di crescita • Tren d nella v 4 Coerenza compo isione e nel e coesione rtamen to CUSTOMER NEEDS • Solvibilità del debito della P. A. • Qualità e sicurezza contrapposti al razionamento TI ES • Conflittualità sui costi della politica verso cambiamento • Tren d risorse 3 Rinnovam doman in funzione ento delle dell’off da e non so della erta lo • Screening e prevenzione • Scarsità di risorse e ottimizzazione dei flussi • Contenimento dei costi e ridefinizione degli investimenti IN • Precarietà nei riferimenti (a tempo fino al 2013) • Attenzione immotivata e inappropriata ai dispositivi medici A • Politica Regionale verso Governo Centrale • Tren d 2 bilancia Necessità la crisi re le minor di i e della d omand ntrate e a • Spending review in funzione degli investimenti RT • Politica locale verso Regioni N CE le e del aziongli centr e de Con nd 2 sanitarie • Treutture str isti acqu e tural strut za bolez bblica 3 De della Pu tema di nd • Tre ulturale zione in e c inistra Amm menti paga al iore ulter rse in za iso nden r 4 Te nto delle d Tren name isti • razio di acqu tema POLITICAL CLIMATE U ilità tenib Sos nd 1 • Tretema sis INTERN AL TRE NDS ECONOMIC CLIMATE • Valorizzazione del ruolo e riconoscimento della centralità del Reparto • Ricambio culturale e del Management della P. A. • Difficoltà ad individuare I giusti interlocutori • Spending review in chiave punitiva (ancora CONSIP) • Revisione nomenclatore e tariffari • Gestione gare in chiave razionamento (all. P ecc. )
GRAZIE!!!
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