The best and worst hospitals: We tell you what they are and why. Here are the undisclosed report cards | Melina Gabanelli

Hospital companies, like all businesses, do well or poorly depending on how they are managed. With one difference: prior health and administrative errors are not allowed. The news usually tells us of exceptional cases such as: “Moulinette, a 5-year-old girl who survived a liver transplant connected directly to the heart” (December 11, 2022); «Gemelli Polyclinic, a case of rare complexity: in the same session, a coronary bypass was performed, a renal tumor was removed and a massive clot was removed. Engage 3 teams for 10 hours »(February 10, 2023); “Padua, transplanted heart stopped for 20 minutes: first time” (May 15, 2023). Deserved and reassuring hustle. At the same time, there are bouts of medical malpractice that cause just as much noise and terrify us. However, the daily life we ​​usually deal with as patients consists mainly of something else: the emergency room, the waiting lists, and the diagnostic tests that have to be done, to be exact, with machines less than 10 years old. And here, with rare exceptions, the quality of care and the ability of managers are closely related. Let’s see what that means.

When the hospital is doing well

A hospital functions well when it meets the basic requirements:
1) a emergency room Where patients do not leave because they did not receive the necessary care and assistance within 8 hours;
2) Waiting periods that comply with the provisions of the law (eg, hip replacement surgery within 180 days and surgery for breast, colorectal, and lung cancer within 30 days);
3) Low rates of hospitalization with a high risk of inappropriateness (eg, arthrodesis), hospitalization of patients in the ward appropriate to their problem (eg, as few hospitalized patients as possible in surgery wards), not allowing too many days to pass from hospitalization for surgery to surgery itself; ability to attract patients from outside the territory;
4) Budgets and accounts in order;
5) NoSufficient number of doctors and nurses for each bed;
6) Non-obsolete machinery and equipment.

Report cards for general managers

On the basis of these indicators, for the first time, a report card can be given on how public hospitals are managed: Agenas, the National Agency for Territorial Health Services of the Ministry of Health, has evaluated the performance of the director of 53 public hospitals, 30 of which are university hospitals, divided successively into hospitals with more than 700 beds or less than 700 beds. And she did so as required by the 2019 Budget Law, which entrusted her with the task of monitoring the achievement of the goals of the general managers: “Genders – Reading for art. 1, Paragraph 513 – Creates (…) a system for analyzing and monitoring the performance of health care companies that indicates in advance, through a special alerting mechanism, any significant deviations with regard to the economic-administrative, organizational, financial and accounting components, clinical assistance, clinical effectiveness, diagnostic therapeutic processes, quality, safety and results of treatments, as well as on the fairness and transparency of operations.” With the exception of non-university Irccs, uni-specialists, local health authorities and local companies such as the local health and social care companies (Asst) of Lombardy which since 2015 have included almost all public hospitals in Lombardy: the decision to exclude Agenas is motivated by the need to Obtain comparable data.The results you’ll read below were compared with data from the National Outcomes Plan, the tool that Agenas annually tests for quality of care, and confirms agreement between managers’ skills and clinical care outcomes.

Top 9 hospitals

Here is what came in the results of the first report submitted in Rome yesterday, May 24, 2023 (The data is available on the portal created by the genera on this topic at this link ). The year 2021 is taken into account, the year in which hospitals still have to deal severely with Covid (in the graphics all the results also for 2019 which, in the absence of a pandemic, see a higher performance). Of the 53 hospitals examined, 12 have a low level of performance, 32 are medium and only 9 have a high level of performance. These are: University Hospitals of Siena (Siena), Careggi (Florence); Besana (Pisa), Padua, Integrata Verona and Policlinico Sant’Ursola (Bologna); and the S. Croce and Carle (Cuneo) and Riuniti Marche Nord and Ordine Mauriziano (Turin) hospitals.

12 Red Dot Hospital

The lowest performing hospitals are: Cosenza, San Pio (Benevento), Santana and San Sebastiano (Caserta), Rionnetti Villa Sophia Cervillo (Palermo), Hospitals Civico di Cristina Benfratelli (Palermo), Cannizzaro (Catania), San Giovanni Adolorata (Rome), San Camillo Forlanini (Rome ); and university students: Luigi Vanvitelli (Naples), San Giovanni di Dio Ruggi d’Aragona (Salerno), Mater Domini (Catanzaro) and Policlinico Umberto I (Rome).

Cancer surgery waiting times

These are the 10 hospitals with the shortest wait times for cancer surgery (Here is the official document): Sienese, Padua, Pisana, Policlinico Umberto I Roma, Careggi, S. Croce e Carle, Integrata Verona, Policlinico Sant’Orsola, Riuniti Foggia, Sant’Andrea di Roma which, however, are indicated as low-grade for the colon. And these, instead, are the 10 hospitals with the longest waiting times for cancer operations: SS. Antonio, Biagio and Cesare Arrigo (Alessandria), San Luigi Gonzaga (Turin), Sant’Anna and San Sebastiano (Caserta), Ospedali Riunetti Bianchi Melacrino Morelli (Reggio Calabria), Policlinico Monserrato (Cagliari), Emergency Cannizzaro (Catania), University Hospital of Sassari, And finally: Giaccone (Palermo), Pugliese and Mater Domini (Catanzaro) where the wait is long, but then the levels of care are good.

More or less obsolete machines

The ten hospitals that have the least old equipment a result (Here is the official document): San Martino Hospital (Genoa), Riunetti (Foggia), Sant’Ursola Hospital (Bologna), Maggiore della Caretta (Novara), S. Croce e Carle (Cuneo), San Pio (Benevento), Sant’Andrea (Rome), Cardarelli and Monaldi dei Colli (Naples), San Giuseppe di Muscati (Avelino). The last three are in Campania which, obviously, have invested in refurbishment of machinery, even if the three hospitals still have low levels of cancer treatment. Hospitals, on the other hand, with more outdated equipment – And the old one is always less accurate than the new one -: University Hospital of Cagliari, Rionnetti Villa Sofia Cervelo (Palermo), Papardo (Messina), Pier La Mergenza Cannizzaro (Catania), University Hospital of Sassari, Prozzo (Cagliari), Civico di Cristina Benfratelli ( Palermo), and surprisingly there are also three hospitals on this list: Mater Domini (Catanzaro), Senese and Policlinico San Matteo in Pavia.

The duration of hospitalization is the same severity

Then there is a pointer (technically called “Comparative Performance Index”(which makes it possible to evaluate the duration of hospitalization with the same severity of the condition)Here is the official document): the longer the period, the more it means that the hospital has organizational problems. The best: Riuniti Marche Nord, Careggi, Pisana, Pugliese, and Maggiore della Carità. The worst: S. Giovanni di Dio Ruggi D’Aragona (Salerno), San Luigi Gonzaga (Orbassano), Civico di Cristina Benfratelli (Palermo), Cardarelli (Naples), Umberto I (Rome).

political responsibilities

With all due exceptions, these results are evidence of the organizational skills and resource management, or otherwise, of the general manager. For example, Agenas data shows that the hospital’s operating room performs on average only 400 operations a year, which means more than one operation per day: similar offers in other companies will never be accepted. How are general managers selected and by whom for public hospitals? Since 2012, regions can only appoint general managers registered with the National Register. Requirements: Bachelor’s degree or 5 years of proven management experience in the healthcare sector or another 7 years, attended a public health training course and be under the age of 65. Then there are also the expert panels who do the evaluation, But in the end, the one who deals with the cards is the head of the region, in agreement with his health advisor. So the choice is political.