Healthcare managers are almost always “little” independent

by Claudio Maria Maffei


21 NOV

Dear Director,
in commenting on the OASI 2022 Report Francesco Longo and Alberto Ricci they provide a stimulating contribution to the analysis of the role that company management can have in this very delicate phase in the history of our National Health Service. Their thesis is simple, it seems to me: in the vacuum left by the higher institutional levels, the space for an incisive action by the Managements grows.

But I try to use the method suggested by Bocconi researchers who in OASI 2022 report presented here on QS they invite less narrative and more evidence. Here, it seems to me that there is too much narration in the identification of this “void” available to the fertile potential contribution of management.

I start from the affirmation of Longo and Ricci according to which “National and regional documents often define the settings envisaged for the “new” territory in a deliberately loose manner, setting rather flexible standards on catchment areas, possible services, personnel profiles here I’m.”

The first limitation of this statement is once again that sort of scotomization of the system (scotomization, I remind you, is more or less equivalent to “unconsciously eliminating from perception, from memory”) in relation to the hospital and the hospital networks. But, at least to me, it seems illogical to think that we can play in an open field when we talk about the territory, as if hospitals existed only for the integration relationship they have with the territory itself. For me in a nutshell it is impossible to talk about DM 77 and therefore of the territory if we don’t talk about DM 70. And Longo and Ricci never talk about the hospital and DM 70.

I now have before my eyes theindex of the OASI 2022 report and I see only territory and PNRR. The chapter on the structure and activities of the NHS presents data on hospitals, but there is no link between their structure and the relative influence on local services.

My knowledge of the reality of the Marche leads me to say that the risk that the hypertrophic hospital networks that politics wants to stifle the development of local services is very high. And on this programmatic approach in the Marche experience, the role of company management is only to apply what politics decides, to a large extent independently of data and rules.

And this leads to the second point: is the regional programming of territorial services in application of DM 77 really “loose”? Also in the Marches, politics has transformed the distribution of Community Houses and Community Hospitals into a hospital building program managed mainly on the basis of a logic of electoral and non-social health user basins. And this is quite a constraint.

In this framework in which, on the planning side, politics takes over the fundamental choices in the absence of a binding form of central monitoring, are we sure that there is significant room for corporate management? It is certain and proven that beautiful experiences can be had with high local added value. That this is one of the keys to getting out of the current crisis of the NHS smacks of storytelling to me.

Claudio Maria Maffei

November 21, 2022
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Healthcare managers are almost always “little” independent

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