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