Round Tables. A discussion with NHS stakeholders.

Milan, October 13, 2019
The Healthcare System and the management of complexity: sustainability, plurality of platforms and their interactions

The healthcare system can become ever more efficient and effective if it manages to generate processes that involve all interested stakeholders. This is the perspective that emerged from the meeting, where operators and experts met in Milan to discuss the annual report by Farmafactoring Foundation on the management of complexity, with particular focus on "sustainability, plurality of platforms and their interactions". More specifically, certain field of action such as prevention, information, public/private relations and technological innovation could greatly benefit from a unified vision and strategy, which conceives healthcare as an "ecosystem".

Those responsible for regional healthcare policies, managers of health authorities and hospitals and market players connected to the system highlighted the presence of large operational spaces, but also the limits related to the scarcity of resources and the often restrictive logic of procedures.

The debate confirmed the report's conclusions, highlighting the need to support prevention in order to limit the emergence of new social and healthcare needs and thereby guarantee coverage of the new demand. It also highlighted the need to safeguard the physician's role: "the subject who, for his/her competence and role performed, must guarantee the patient receives the appropriate treatment which he needs, making the clinical judgment in full autonomy". With the conviction, however, that the technological revolution and the web play a fundamental role in addressing the complexity of the worlds involved and the relationships within the broader healthcare system in order to begin building a new, adequate, functional, operational and relational architecture.

The meeting in Milan opened with greetings and operational notes from the President of Farmafactoring Foundation, Marco Rabuffi, the President of Censis, Giuseppe De Rita, who introduced the studies while outlining the major fundamental changes that the healthcare system underwent in his first forty years of existence, confirming however the underlying positives of the universalistic concept that characterised its development. It was then the turn of the Scientific Director of Farmafactoring Foundation, Vincenzo Atella, to comment on the report, which is characterised by the desire to broaden the traditional perspective of analysis in order to consider the healthcare system as an "ecosystem" with many interactions. It thus ranges from the pharmaceutical industry to the food industry, from insurance to sports clubs, from private healthcare to the scholastic and educational system. For each of these, only apparently external realms, unprecedented opportunities and new perspectives for comparison were outlined. Especially in some specific sectors, such as that of prevention or the role of pharmacies. All this requires an effective organisational model capable of seizing opportunities and enhancing the different elements of the ecosystem: this is what Elio Borgonovi, President of Cergas - the Bocconi University centre of healthcare system analyses and studies-, claimed. Focused on the strategies of relations between institutions and stakeholders, this was then illustrated by Francesca Lecci, Coordinator of the Management Area of Cergas, while Francesco Maietta, Head of the Social Policies of Censis, highlighted the problematic fact that almost twenty million Italians resorted to private healthcare at least once over the last year due to long waiting lists or the complexity of the public system.