Health system modernisation in Britain and Italy. Privileges system in the Italian Health Care. The JCISQUE.10 standard.

by Erika Masini


My dissertation work is focused on the development of Healthcare Service in U.K and Italy. The U.K’s National Healthcare Service (NHS) is well known for providing free care to all its citizens. It was established in 1948. NHS is an universal Healthcare system. It is based on public financing. It meets everyone’s needs. NHS is based on clinical needs, not an individual’s ability to pay. The vast majority of NHS services, are free at the point of use. Italian Healthcare system (Servizio Sanitario Nazionale), is an universal system. It was established in 1978. It is based on public financing. The country is divided into regions, with a good level of autonomy. A network of units and primary care centers, linked to a regional hospital or hospitals, exists in every Region. NHS and SSN could be considered among the best systems, but they have been profoundly affected by the economical and financial crises. The efficiency of the English NHS, is ensured through competition rules. Competition is seem as a mechanism that allows patients to choose providers and treatments. In Italy, the role of public production is fundamental. It gives a possibility to purchase services by accredited private providers. Accreditation is the process in which certification of competency, authority, or credibility is presented. It aims to achieve a high level of guarantee of service quality, and of the selection of service providers, public and private. In Italy there are twenty one regions, and twenty one models for regional accreditation. They have some characteristics in common, but there are significant differences too. The quality criteria are: patients satisfaction, continuous quality improvement, presences of guidelines and protocols, appropriateness and technology assessment. There are common criteria, common requirements, but every Region has specific elements of evidences, basing on them has reformulated its own measures for institutional accreditation. Sicily Region adopted JCI accreditation standards. Joint Commission International (JCI) is one of the world’s leading no profit patient safety organizations.Joint commissional International is focused on the highest quality of care possible for every patient. They achieve this goal through accreditation program. JCI regularly publishes a current set of standards in patient safety and quality improvement. Health care organizations must undergo an on-site survey conducted by JCI in order to achieve accreditation. Once accredited, organizations must continue to meet JCI standards and are regularly assessed through periodic re-survey. JCI is completely independent from the organizations they accredit. JCI, is based on priivileges system, which can hardly be translated into Italian. Sicily region, adopted their own system of accreditation standards in order to achieve care quality improvement. The above region, decided to promote different standards regarding management, staff assessment,including staff privileges assignment process ( standard JCI SQUE 10). JCISQUE.10 standard is required when the organization has a standard procedure based on the evidence in order to authorize all the doctors to treat their patients in accordance with their professional qualification. Privileges assignment is a procedure used by a health care organization to authorize a doctor to provide specific treatment in terms of different medical fields, taking into account their professional performance assessment. Sicily Region implemented the above programme in the fields of ginecology, cardiology and emergency treatment. The involvment of scientific organizations such as SIMEU, AOGOI, and AMNCO was highly important for the project launch, because it helped to anticipate criteria assessment process and the procedures of privileges’assessment inside different professional fields. According to the project requirements, every unit manager has to conduct an assessment interview with every ward manager to assign the privileges. Besides that, unit managers are responsible for supervision concerning appropriated privileges application inside their units.