[Systems medicine and complexity: rethinking health management and hospital modelling.] / Management sanitario e ospedale al tempo della medicina dei sistemi e della complessità.

We have reached the awareness that diseases, far from being simple altered health states, are characterized by intrinsic emerging and adaptive properties, requiring an interdisciplinary, global and systemic approach, oriented towards integration and coordination, rather than an atomic and disintegrated logic. A new approach is needed, "systems medicine", defined as an interdisciplinary field of study that looks at the systems of the human body as part of an integrated whole, incorporating biochemical, physiological, and environment interactions. This new kind of medicine addresses diseases and their interrelationships in a scale invariant, holistic and systematic "multi-axial" way, analysing apparati, organs, tissues, cells, molecules, always taking care of the relationships with the relative ecosystem. Given this dramatic change in the process of learning, investigating and approaching diseases, the hospital itself has to evolve continuously, changing strategies and structures. Hospital management has to be re-designed and re-configured in order to face and govern complex systems. Health management today must be flexible, able to absorb and incorporate complexity, and learn from it, reinforcing itself. Complexity must not be avoided. It is, indeed, an opportunity to be considered in the strategic planning and programming processes. Intuition, creativity and flexibility are the abilities and competences of a manager in a complex environment.

[Risk of inappropriateness and efficiency assessment of hospitals]. / Ricoveri "a rischio di inappropriatezza" e valutazione dell'efficienza tecnica.

We evaluated with the Data Envelopment Analysis (DEA) 13 decision making units (DMU) at IDI -IRCCS for the years 2000 and 2001. Input variables were: cost for medical personnel, cost for non medical personnel and number of beds; output variables was the number of discharged patients weighted with DRG. Later in a second model we delete the cases considered to be at "high risk" to be inappropriate for treatment as inpatients. DEA instrument is confirmed useful in the efficiency evaluation for DMU at hospital level, ranking were different between the two models. The Health Direction can utilise the analysis to understand reasons of inefficiency and for incentive policy.