[Management control of cardiology: the experience of a departmental unit].
In most Italian hospitals, sanitary reform is being applied, while at the same time a new organization of the National Health System is being planned. The director of the medical hospital (head doctor) is becoming more and more involved in management and this aspect has modified his professional attributes. Cardiology is a branch of medicine that, through its scientific preparatory work consisting in debates, management courses, ethics, and production of managerial software, is closer to applying the reform without risking improper administrative aspects. This, obviously, comes about after thoroughly reviewing past work methods and the need to have an administrative organization, which allocates efficient use of manpower and materials, helping to eliminate any sources of inefficiency. The logical procedure foresees an actual analysis in terms of sanitary needs and availability of resources, and so attempting to better balance and harmonize both aspects of the problem. Certainly, the acquisition of theoretical norms and practices, which today are present because of the upsurge in training courses for doctors, is not enough to guarantee the achievement of optimal results. Furthermore, we find that theoretical models need to be validated and adapted to real work situations in the public hospital sector. This paper proposes, therefore, to explain the managerial experiences achieved in actual work situations at the Cardiology Department Unit of the San Giovanni Addolorata Hospital in Rome. In particular, it shows that in order to reach its clinical and economical objectives, it is essential to make available correct informative support for strategic and operational decisions. We can observe that there is a continuing lack of computer support systems being integrated into the present organization of most cardiology units. The use of software distributed to cardiology units from the Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO) has enabled us to partially remedy the above-mentioned inadequacy and, at the same time, has pointed out the limits of automated support with regards managerial needs which are rapidly changing and becoming increasingly more complex. The experience described shows the possibility of uniting an efficient organization, from a clinical point of view, with an adequate managerial automation without including any flaws from the previous organizational systems. Based on achieved results and the difficulties encountered, further development in computer technology support to hospital management is suggested. This paper, in particular, stresses the need to improve automated informative support available to doctors in managerial positions. This improvement would allow us to immediately evaluate "internal" administrative matters, have the data available for budget planning and analysis of budget variations, and be better able to integrate this with clinical data. The scientific community can give further assistance by promoting the genesis of data for a sensible bench-marking within medical organizations which is the only means sufficient to give reliable and clinically appropriate indications on the possibility of increasing its own structural efficiency.
Boccanelli
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Unità Operativa di Cardiologia, Complesso Ospedaliero San Giovanni Addolorata, Roma.
Spandonaro
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F
D002309:Cardiology; D016507:Cardiology Service, Hospital / Q000458:organization & administration*; D006801:Humans; D019451:Information Management / Q000458:organization & administration; D007558:Italy; D008331:Management Information Systems; D012384:Rome; D012955:Societies, Medical; D013647:Task Performance and Analysis