Danilo Orlandini, Amelia Ceci, Sara Baruzzo, Daniela Riccò,
Mariella Martini Reggio Emilia Health Authority Italy
Health promoting strategies and EFQM excellence quality model
16th HPH Conference in Berlin
Reggio Emilia ProvinceReggio Emilia Province
501.529 501.529 inhabitantsinhabitants
Italy
6 Health Care Districts6 Primary Care Departments5 Hospitals (800 Beds)15 Clinic Departments1 Public Health Department~4.000 employees
1 High Speciality Hospital
2 Private Hospitals
"The most important single condition for success in quality assurance is the determination to make it work. If we are truly committed to quality, almost any reasonable method will work. If we are not, even the most elegantly structured mechanisms will fail"
Avedis Donabedian, ISQua 14th Conference, Jerusalem, May 1996
Equity, solidarity and inequalities reduction
TransparencyEffectiveness and appropriatenessReliabilitySafetyManagement efficiency
Health Authority Health Authority ValuesValues
PrinciplesPrinciples of Mission of the Health Authorityof Mission of the Health Authority
Quality of the Outcomes
Quality of the Processes
Services offering Assurance
Variability Decrease
Citizens Partnership
The The ChallengesChallenges
Citizen (Patient/User) Central
Appropriateness and effectiveness (work with the best evidence)
Management efficiency (budget compatibility)
Professional empowered
Hea
lth A
utho
rity
Mis
sion
H
ealth
Aut
horit
y M
issi
on D
ecla
ratio
nD
ecla
ratio
n
Health Authority works with asystemicsystemic vision, vision, approachingactivities from their outcomes, outcomes, in order to rethink the workprocessesprocesses and to consider the correct use of the resourcesresources
Health Authority Mission Health Authority Mission DeclarationDeclaration
Valorising and
Evaluation of the Professionals
CEO Involvement and “Testimony”
Leadership
Partnership & Resources
Strategy & Planning
People
From Leadership
To Policies & Strategies
To People management
To Resources management
To Processes
Processes
Accreditation
Services Re-engineering
Strategic Planning
Partnership with other LocalAuthorities and withGeneral Practitioners
CAF EFQMCRITERIO 1: LEADERSHIP 4 5CRITERIO 2: STRATEGY & PLANNING 3 4CRITERIO 3: PEOPLE 3 5CRITERIO 4: PARTNERSHIP & RESOURCES 6 5CRITERIO 5: PROCESSES 3 5CRITERIO 6: CITIZEN ORIENTED RESULTS 2 2CRITERIO 7: PEOPLE RESULTS 2 2CRITERIO 8: SOCIETY RESULTS 2 2CRITERIO 9: KEY PERFORMANCE RESULTS 2 2
-----------------------QUESTIONS 27 32
the perception of the organisation’s approach toquality of life, the environment and the preservation of global resources, and the organisation’s own internalmeasures of effectiveness. It will include its relations with authorities and bodies, which affect and regulateits business.
Excellence is exceeding the minimum regulatoryframework in which the organisation operates and tostrive to understand and respond to the expectationsof their stakeholders in society.
To develop a social-health network based on the local community
To value Global, Adequate and Indiscriminate “Care”To simplify processesTo develop human, economic, social and
professional resourcesTo increase customer satisfactionTo promote innovationTo promote an adequate, ethic and moral practice
into the social-health services
UtilizingUtilizing EFQMEFQM--CAF & BSC the REHA CAF & BSC the REHA developeddeveloped strategicstrategic themesthemes
Enablers Results
Innovation and learning
REHA uses the EFQM-CAF in order to systematize actions, and benchmarkplanning and results with other EFQM-CAF (or similar models)-user Health Authorities(HA)
This model has been used by the health authority as a self-assessment of the members of the top management (29 managers).
Table 1: SelfASSESSMENT
0
10
20
30
40
50
60
70
Leadership
Strategy and planning
HRM
Partnerships and resources
Process and change management Customer/citizen-oriented results
People results
Society results
Key performance results
AVERAGE
Valutazione posizioni
Valutazionecompetenze
Sistemi premianti
Market
Analysis
Engage
Utilize
Develop
Manage
Dism
issProfessionalssatisfied and valorised in
regard to the organization’s
outcomes
PEOPLE MANAGEMENT
formazione di baseanalisi FabbisognoProfilo di posizione
Profili di competenza
ConcorsiAccoglienza
Valutazione potenzialePercorsi mobilità
InformazioneAscolto
“Controlli”
CONTINUOUS LEARNING
la sua storia
TWO DIFFERENT WAYS OF LOOKING AT AN ORGANIZATIONTWO DIFFERENT WAYS OF LOOKING AT AN ORGANIZATION
The “managerial” (top-down) point of view•Assures general standards (audit)•Standardizes the activities apart from involvement•Pursues short term results
The “social” (bottom-up) point of view•The Work like continuous learning•To pursue the values coherently•To share objectives•To value the diversities
VALUESCOMPETENCIES
CHALLANGES
Managementbudgetalliances
Regional objectivesDecision making system
DevelopmentCommunicationLearning organizationDistinguishing competences
QualityDo the right things and
do things rightPerceptionEnvironment
PeopleAssessment/ContractEducationDevelopment
EFQMEFQM--CAF CAF isis anan orderingordering tooltool thatthat managesmanagesthe the complexitycomplexity and and stimulatesstimulates the the connectionsconnections
the perception of the organisation’s approach to quality of life
the environment and the preservation of global resources
organisation’s own internal measures of effectiveness
relations with authorities and bodies, which affect and regulate its business.
From the social point of view we workedon the Society Results Criterion
experts in the areas
Public healthCustomer satisfactionCommunicationsQualityEvidence based medicine
MainMain Health Care Health Care DeterminantsDeterminants
natural and biological variationsharmful behaviours freely chosen by the
individualadvantages deriving from the virtuous
behaviours of certain groupsharmful behaviours that are not freely chosenstatus due to lifestyle and/or inappropriate
workinadequate access to health and other
public servicesnatural selection or social mobility related to
health status (sick people are at a lower level on the social scale)
AREAS OF INTERVENTION AREAS OF INTERVENTION
the environmental impact the impact on the local economysocial responsibilityequal opportunitythe internal society of the health
authority
Results relating to direct interventions on community health status
Results relating to interventions of community health campaigns as a whole
Results relating to interventions of health campaigns for certain segments of society
Results related to the environmentResults related to the community social
integration and cohesivenessResults related to political-cultural
development/growthResults related to the development and
production of knowledgeResults related to the health system as a whole
2006
Mis
sion
Sta
tem
ent t
extb
ook
Health indicators
Life expectancy at birth 77 years for males
83 years for females
Child mortality rateper 1,000 born alive
3.60
Overall mortality
Cardiovascular mortality
Cancer mortality
Breast Cancer Survival
Vaccination rate among 2 years old children
Vaccination rate among >65 years old people
Road accidents
Deaths due to trauma and poisoning
Work accidents (incidence)
% of controlled companies on existing companies
Handicapped workers under direct responsibility of HA
Inspected Food Industries
Inspected Food delivery places (restaurants etc.)
Waiting time for instrumental diagnostic (not urgent)
Waiting time for laboratory diagnostic (not urgent)
% Home Care patientsHospital discharges shared between Home-care service and Hospital
Residential and Semi-residential out-of-hospital placesAvoidable admissions for chronic diseases
REHA employees
Employees global income
The health authority is a partner in a social-healthcare project.
The “mission statement”: a tool for social report
"provides transparency" to the institutional actions
allows “external” to management subjects to be able to directly appraise the health authority activities
to appreciate the results achieved
Healthcare interventions always have a direct effect on the health condition of the individual
However the same interventions might have some indirect effects on the population and on changes in behavior
As a result, it is very difficult to clearly separate the direct from the indirect impact, nevertheless EFQM-CAF is very useful in order to plan and to assess the Society Results.
CONCLUSION: CONCLUSION: whatwhat do EFQMdo EFQM--CAF Society CAF Society ResultsResults meanmean for a Healthcare Authority?for a Healthcare Authority?
Reggio Emilia Reggio Emilia way way toto QualityQuality
Thank You
We are now carrying outa new self-assessment