Evidence-based governance: the role of epidemiological indicators in negotiation with stakeholders

Abstract

Abstract Following the enactment of Regional Law 23/2015 in Lombardy, Agencies for Health Protection (AHP) were set up with programming, monitoring and control tasks on all areas of public health, including hospital performances. It was therefore necessary to develop a new efficient system of negotiation with stakeholders. A summary document has been created for each hospital that highlight the areas to be improved. This report is based on the use of updated indicators validated nationally and internationally, relating to average hospital stays, volumes and outcomes. Main sources were the National Outcome Program, the Ministerial Decree 70/2015 and the Network of Regions. As comparison values, the thresholds from international literature or Italian legislation. The report was sent to the stakeholders in advance, initially in paper format then through a dedicated portal, before the discussion of the contractual objectives with Executive Board, Epidemiology Unit and the Department of Planning, Purchase and Control. The achievement of the objectives entails a substantial economic benefit, from year to year more and more conspicuous. The results accomplished were twofold. On one hand there was the improvement of several indicators: for AHP as a whole, such as the fracture of the femur operated within 48 hours went from 50% in 2015 to 74% in 2019; for individual hospitals, for example, some hospitals that did not perform cholecystectomies in day surgery have started to do them. On the other hand, it was possible to detect system critical issues that made it difficult to achieve the objectives for the stakeholders. Linking the contractual objectives to epidemiological indicators discussed collectively was productive to both AHP and stakeholders and allows objective and constant monitoring of the progresses and difficulties encountered. Key messages Internal cooperation in the AHP and direct dialogue with stakeholders are necessary to achieve ambitious objectives. The use of validated epidemiological indicators as contractual objectives makes the assessment and contracting process of hospitals more transparent and objective.