Value Workshops

The Clinical-Welfare Networks represent an organisational model that ensures patient care by linking professionals, facilities and services that provide health and social-health interventions of different types and levels in compliance with the continuity of care and clinical and organisational appropriateness. The network identifies the nodes and their connections, defining their operating rules, the monitoring system, the quality and safety requirements of the processes and care pathways, the qualification of professionals and the methods for involving citizens.  

This laboratory gave birth to the Apulian Oncological Network, whose coordinating staff is one of the AReSS Expert Centres, with the first five pathology sub-networks (lung, breast, prostate, colon-rectum and uterus), and it is also here that other important regional clinical networks have been designed (or redesigned): Trauma Network, Stroke Network, Cardiology Network, Haematology Network, Nephrodialytic Network, Rheumatology Network. The Infectious Diseases Network is in preparation and - within the Apulian Oncology Network - the Medical Genetics Network. 

The indispensable complement of the Clinical Network policy is represented by the Diagnostic-Therapeutic-Assistance Pathways (PDTA), which identify the models for taking charge of each pathological condition to which the Clinical Network refers, outlining the contents and defining the pathway from the prevention phase to those of diagnosis, treatment, rehabilitation and end-of-life care.  

The Apulia Region has chosen, through the AReSS, to coordinate centrally the design, implementation and monitoring of the PDTAs. With Regional Council Resolution No. 658 of 24 April 2018, the technical guideline document was approved to build the Apulian care network through the Diagnostic Therapeutic Care Pathways (PDTA). The manual adopted the architecture, design manual and training plan for PDTA developers. 

From this lab, PDTAs were developed to accompany the pathology sub-networks of the Apulian Oncology Network, precisely to signify that there can be no clinical network without care paths and conversely. 

The Lean lab is the only Lean management laboratory in Italy that covers the entire regional territory and addresses all the public health agencies in Apulia (10).  

Launched in 2017 and still ongoing, the lab has initiated both a cultural and managerial process, which has methodologically focused the attention of the operators involved and their strategic directions, on waste recovery, safety improvement and organisational simplification. 

For each annual edition, a training course was planned for thirty selected health workers. Then, they have been involved in the field as project leaders, leading another hundred or so operators in carrying out interventions to reduce waste, shorten process times, improve service quality, and reduce clinical risk.  

Launched at the beginning of 2016, the ABF lab envisaged the use of Activity Based Funding accounting techniques at standard costs for Apulia's public hospitals, with the aim of training company controllers in more sophisticated hospital costing and of indicating to strategic managements the benchmarks (standard costs) to refer to in order to recover management efficiency.  

The action started with an initial codified survey with Activity Based Funding methodology of hospital costs in 2015, then consolidated on a special database and related dashboard the data of all the hospitals in the Region. Then, after a special training course for controllers, started even more refined surveys and improvement plans on the areas of highest inefficiency.  

The initiative also benefits from membership of the Italian network of standard costs in healthcare (NISan). 

The laboratory was set up in collaboration with the Instrumental and Technological Resources Section of the Department for the Promotion of Health, Social Wellbeing and Sport for All in order to develop, within the Edotto management system, strategic control tools to support the governance of the regional health service.   

The objective is to integrate the performance monitoring and assessment systems developed at national and regional level, to ensure timeliness in the development of indicators, and to share the results in order to activate organisational and clinical audit interventions and actions. Through a reorganisation of the contents and by trying to fully exploit the potential offered by the wide availability of data guaranteed by the Health Information System of the Apulia Region, specific dashboards are being built for the indicators of: the National Outcomes Programme, the Network of the Regions coordinated by the MES Laboratory of the Sant'Anna School of Pisa, and above all of the New System for Guaranteeing the Delivery of Essential Levels of Care (LEA).  

The objective of this laboratory is to monitor and improve the humanisation component within the health services, convinced that the strategic and prevailing resource always and fortunately remains that of human capital. 

The laboratory has two sections with two distinct destinations, patient and professional: 

• Humanisation of Services: the initiative stems from adherence to a three-year Agenas experiment but, unlike the national initiative, AReSS has taken care of its annual - rather than three-year - development with the 'compulsory' and non-voluntary involvement of all public and private hospitals in the Region, and has now also extended it to non-hospital areas (rehabilitation, RSAs and the birth pathway); at the centre of the project, there are patient and citizens' associations both in the field assessment phase of the degree of humanisation of health facilities (on the basis of 140 indicators) and in the subsequent implementation phase of improvement measures; 
• Organisational Climate: in collaboration with the Scuola Sant'Anna of Pisa, the project analyses the organisational climate and wellbeing within Apulia's public health facilities in order to identify the areas of strong relational, work and communication criticality on which to intervene in order to realign the motivational tension and group dynamics with the patient's care needs and the company's strategic needs.  

The improvement process is iterative and codified quantitative measurement phases are followed by others for the design and implementation of corrective actions. 

This is the most recent of the value laboratories and is driven by the ambition to design the most integrated form of regional communication in support of healthcare. The first package of interventions authorised by the Regional Council includes: 

• the creation and dissemination of a graphic and organisational format for reception in healthcare facilities with the collaboration of ASSET, a regional agency engaged in eco-sustainable planning and development of the territory; 
• the creation and dissemination of 10 short films for the promotion of strategic health issues with the collaboration of the Apulia Film Commission; 
• the revision and consolidation of regional health digital communication through the coordination of the companies' information and communication services and the development of the Puglia Salute portal and online services, that is already an Italian best practice. 

More than a single initiative, it is a container of several projects focused on specific aspects of an integrated approach to care, intended to produce knowledge and evidence to be reused on more advanced exploitation or scaling up of solutions. 

It includes: Care Puglia 3.0, TALIsMAn, Scirocco Exchange, FooDia-NET, EURIPHI, Picc, Gatekeeper, Post-Covid Care Recovery Plan.