ANMDO Sezione Regionale Piemonte e Valle d Aosta

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1 ANMDO Pmn Vall d Asa Gvnanc clnc Asssnzal Dzn Sanaa Bzza Dcumnal ad us nn Ob 2008 Sga Scnfca Rgnal ANMDO Szn Rgnal Pmn Vall d Asa GOVERNANCE CLINICO ASSISTENZIALE E DIREZIONE SANITARIA ANALISI, MODELLI ORGANIZZATIVI E RUOLI DELLA DIREZIONE SANITARIA Bzza dcumnal ad us nn Scnda vsn Ob 2008 Sga Scnfca Rgnal

2 ANMDO Pmn Vall d Asa Gvnanc clnc Asssnzal Dzn Sanaa Bzza Dcumnal ad us nn Ob 2008 Sga Scnfca Rgnal 1. INTRODUZIONE Ngl ulm dcnn, ssm sana d u Pas svluppa sn sa smp pù ncalza da mpan sfd dvu all aumnaa pssn cnmca, alla cscn cmplssà dlla scnza dll cnlg sana, a muamn dmgafc nas d all aumn dlla pvalnza dll ncdnza dll palg cnch. P ml ann l ganzzazn dl ssma sana s è basaa su una nzn mplca d qualà mpnaa sul pncp ch l aulamn d psnal adguaamn fma la dspnblà d suu d azzau adgua fss snnm d un lva lvll asssnzal. L splsn dll cnscnz, la pacllzzazn dgl appcc pp naa alla cnlga, la aznalzzazn d cs gl aumna bsgn d salu hann mna qusa nzn d qualà dlnand la ncssà d un appcc ssmc al pblma dll asssnza, cè un bsgn d mgl gvn dl ssma. A al fn, duan gl ann 80, gl ammnsa spnsabl plc dl ssma sana hann nfazza la ncssà d applca anch al s sana l mdlg gsnal dl al qualy managmn (TQM) dl mglamn cnnu dlla qualà, ch avvan da buna pva nl mnd ndusal. Tuava, qus appcc, svluppa n s ml dvs da qull sana, nn hann avu gand succss n amb clnc, pbablmn p l scas cnvlgmn d pfssns p l namn fmn cna sl sugl asp gsnal-ammnsav, snza una chaa dnfcazn dl ul svl da clnc, ma scuamn p l av ssma la cmplssà dll Asssnza sanaa mdna. La cmplssà s spm aavs la mlplcà d pblm asssnzal ps da pazn, ch p l l caasch, chdn fm d asssnza p bsgn d sgnz ch sn smp mn d pnnza sclusva d sngl pfssnalà smp pù spss nvc ncssan d sps muldscplna mulpfssnal. La cmplssà dll Asssnza mdna è appsnaa anch dall lva cscn gad d sfscazn cnlgca psn nll spcfch mdalà d dagns cua ada, cn l vva mplcazn d chd nn slan pfssnalà adgua al l c mpg d alla lua d sula, ma anch cns assnzal suffcnmn azza sul pan ganzzav; n al cns sula vdn cm sa dvna pa affna l pblma dl gvn dll nnvazn ch s bas su sula dlla nnaa mdcna aslaznal. I muamn dll ass pfssnal dgl pa sana, vlu dal dcs plc nll ulm dcnn, hann alsì ca un ncmn spnnzall dlla cmplssà dal mmn ch vn chs un apd passagg da una appsnazn dll ganzzazn d p vcsc a mdll gsnal pù zznal (cè fnda su gupp), pù dnamc adaabl alla vaà d cns, pù pacpav spnsablzzan. Cmplssà su a appcc, cc l caus d una qualà dll assnza da cu gnan sa la pczn d un lvll qualav dll pfmanc sana nn cspndn all ss nvs sa l nsddsfazn dgl pa. L appcc apppa nvc pm d csu n l ganzzazn sana, un ssma d lazn ch cnsn l ssgn la pmzn d cmpamn pfssnal vus, cmmpanamn, la pcc dnfcazn d qull nvc nn cn nn cmpabl cn l sgnza d gaan la ssnblà dll assnza. La Clncal Gvnanc, mn nd p la pma vla nl lb banc Th nw NHS: mdn and dpndabl dal gvn ngls nl 1997, nasc, n ff, p vndca l pma dgl bv d salu dl mglamn cnnu dlla qualà all nn d un ssma d un gvn pacpa cndvs, ppnnd cnc dlla cpa gvnanc cm nsm d nm fnanza gl d cnda vfcabl aspan. Il cmplss cnc dlla Clncal Gvnanc vn dagl anglsassn succnamn snzza cm azn ps n ss p dg la scà vs bv dnfca cndvs mn Rb Gll nl su lb Gvn Clnc (l Pns Scnfc Ed, 2004) n caazza mablmn cnn affmand ch s aa d un appcc nga al pblma dlla qualà (d quà, nd) dll assnza, ch cnsc l mpanza d nn nvn sl sull sngl dcsn clnch p nal vs una

3 ANMDO Pmn Vall d Asa Gvnanc clnc Asssnzal Dzn Sanaa Bzza Dcumnal ad us nn Ob 2008 Sga Scnfca Rgnal mgl apppazza, ma anch d fa n md ch ssm asssnzal nl l nsm san na vs qus bv L ssnza sa nll auazn d mccansm d gvn ch nn s basn sclusvamn sull auà sull sanzn, ma sulla cspnsablzzazn pacpazn d pfssns. P al mv, la ca aduzn n lngua alana è dvsa da Gvn clnc, mn ch nfazza asp dgsc d appcc p-dwn. Il mn gvnanc dv nnds qund cm la gsn d pcss d cnsulazn cncazn p l aggungmn dgl bv. In al sns, la gvnanc nn può ss mpsa dall al dall sn, ma cnsgu all nazn d mlplc a ch s augvnan, nflunzands cpcamn. Il mn gvn cspnd all ngls gvnmn dfnsc l p nmav sca dall suzn. Scnd l ndcazn dl GIMBE (Gupp Ialan p la Mdcna Basaa Sull Evdnz) s ppn d adu / npa Clncal Gvnanc n Gvnanc Clnc Asssnzal (GCA) ch slna:. la nn aducblà dl mn Gvnanc;. la magg duvà dl mn clnc sp a clncal, ch caazza u l pfssn sana nn sl qulla mdca. N cnsgu ch la GCA chd la valuazn d ul adznal d cnfn acca fa l pfssn sana, fa mdc pazn fa ammnsav clnc fnsc l mzz p dmsa al pubblc ch l ssma sana nn può lla ch l ccllnza. S aa d csu l cndzn ch ndan pssbl un ag n md cdna cn sull nsm d dmna dlla paca clnca qund dlla qualà d qus ulma aavs : a. La fmazn d pfssns, ch dvà ss ndzzaa ad ss funznal ad una anzn cnnuava alla qualà dll asssnza, qus ulma cnscua cm pa ngan d pcs ducav d pfssns, b. Il mnagg d pcss assnzal, ch csì sc dalla canza mdlgca dalla aufnzalà cu è lga dalla adzn ch l vd paca (sclusvamn all nn dll pfssn) cm sumn d cnfn a pa sulla bas d c mplc d valuazn d sngl cas, p dvna un sumn nga nll ganzzazn sanaa, qund, da dlla capacà d nflu nll scl d gvn a dvs lvll dcsnal. c. La gsn dl sch clnc psn n pcss assnzal, ch dv abbandna l mpsazn sclusvamn ava p acqus caasch d pavà, ssmacà, capllaà cnvlgmn ch pman d affna cn succss la cmplssà dll assnza mdna.. Un smp qualfca d appcc nga ssmac alla gsn dlla qualà dl sch clnc, vn da s bv p l mglamn dll asssnza, dsc nl vlum Cssng h qualy chasm cè: 1) Scuzza. I pazn hann l d d sns scu quand nan n una suua sanaa, almn quan l sn a casa ppa. 2) Effcaca. Il ssma sana dv basas su qulla, ch cn acczn pù upa, s chama Mdcna basaa sull pv d ffcaca EBM. 3) Cnalà dl Pazn. Il ssma sana dv ss aa sul pazn sul sp dlla culua, d bsgn, dll scl dl pazn. 4) Tmpsvà. Il ssma dv abba mp m d asa, l caus d ad napppa d ngusfca. 5) Effcnza. La duzn dgl spch d cs ngusfca dv ss un pg cnnu, anch p p dmsa ch l ss sn nvs n md accua. 6) Equà. Il ssma dv asscua l accss a u cadn ndpndnmn da qusn d sss azza d l ssma dv dsbu ss sulla bas dll apppazza (Eca Dsbuva).

4 ANMDO Pmn Vall d Asa Gvnanc clnc Asssnzal Dzn Sanaa Bzza Dcumnal ad us nn Ob 2008 Sga Scnfca Rgnal 2. I MODELLI OPERATIVI E DETERMINANTI DELLA CLINICAL GOVERNANCE P alzza l ncssa cambamn culual n l ganzzazn sana, la Gvnanc ha da una pa la ncssà d fndas su pncp val cndvs ch la lgmn l cnfscan la ncssaa cdblà, dall ala d dnfca pcs amb d spnsablà p la sua aduzn pava. La plca d auazn dlla GCA chd un appcc d ssma va alzzaa am l ngazn d sgun dmnan ch, slan a fn dscv vngn cnsda, nsm a lav mdll pav, spaaamn, mn ss sn a d l ncnnss cmplmna chdn un appcc nga: MODELLI OPERATIVI Aud clnc Gsn d clam d cnnzs Gsn dl sch clnc Dfnzn d pan d Fmazn cnnua maa a qualà, ca, spnsablà, Cfcazn all ccllnza Cnsualzzazn dll vdnz sulla bas d un lav muldscplna mulpfssnal Faclà d accss ad nfmazn scnfch pma scnda sulla ffcaca dgl nvn sana Elabazn d anals d bsgn p la dfnzn d Ln guda clnch pcs asssnzal Cllabazn muldscplna Cmuncazn d nlazn Valuazn dgl s Cnvlgmn d pazn Rcca svlupp Svlupp dll nfmav d nfmach Dfnzn ndca, sandad, vaablà DETERMINANTI Impaa dall spnza Svlupp Pfssnal Mdcna d Asssnza basa sull Evdnza: EBM, EBHC Cndvsn Rspnsablzzazn Tablla 1 3. IL METODO La cmplssà dll alà sana spau la vaà smp magg d bsgn scsana mpn l ulzz d un md ch s basa su pch, ma fndamnal asp: la fduca la spnsablà (accunably, vv nd cn d cò ch s fa), l cnvlgmn, l anals d pcss l nvsmn la pfssnalà l ca l val dl lav, l cllgamn d l ngazn la cnvnzn dl cmmmn

5 ANMDO Pmn Vall d Asa Gvnanc clnc Asssnzal Dzn Sanaa Bzza Dcumnal ad us nn Ob 2008 Sga Scnfca Rgnal 1. Il mdll laznal dv basas sulla fduca, la cu lvanza è ma lagamn cnscua nn slan nlla va scal gncamn nsa, ma anch nlla va nl funznamn dll ganzzazn cmplss. La fduca cm aspava ch gl al s cmpn n md cn cn quan c andam ndpnmn dalla adzn d mccansm ccv d cnll, è nfa da mp ndvduaa cm un lmn mpan d qull ch vn dfn cm capal scal, qulla cchzza appsnaa dall nsm d lazn ch gl ndvdu ssn a l ch sn funznal al aggungmn nn sl sul pan samn ndvdual, ma anch su qull scal dll pubblch ammnsazn. La sua mpanza è saa anch slnaa n fmn all spcfc dll ganzzazn sana, nl nav d ndvdua mdll d lazn ch nn s ducan alla ma fallac mpszn d mccansm d vfca cnll cala dall al. In un cns d fduca l pfssnsa sana acca la valuazn d ffcaca, apppazza, ffcnza, d pcss asssnzal da lu scl p spp a bsgn cuav pvnv dll un, anz cchà al vfca n quan mmn d csca pfssnal; al cna n un clma d sfduca, ddchà gn sua ssa al sas al cnfn, pdnss n mand dll aufnzalà cpava dlla mdcna dfnsva. 2. La ncssà d una pna pacpazn dll cmpnz pfssnal ch dvn ss aggna aa sull nvà, sul pan dlla ganzzazn dl lav n svz d nfn sul pan dlla acquszn d lmn mpc d vfca dll mpa ch al nnvazn pann av su dvs asp dlla qualà dll assnza. P affna adguaamn pblm dlla fmazn dl psnal, dll ganzzazn sanaa, dlla valuazn dlla qualà, l ganzzazn sana hann nnanz u la ncssà val d va sumn ch valzzn l cnbu dll cmpnz pfssnal clnch, snza l qual sulbb ssanzalmn mpssbl l sss cnscmn d qus mplcazn la cnsgun dfnzn dll pblmach fmav, clnc-ganzzav valuav ch dvbb ss gg dll nzava azndal. Il ma dll svlupp dll aznd sana è n laga pa msua dclnabl n mn d svlupp d una capacà d adguamn a dll cndzn d pmann nsablà, pvdndn d ancpandn qund pssbl andamn vluv l mpa su mdll asssnzal n funzn dll dnamch d svlupp cnc-ganzzzav. 3. La gvnanc s basa sulla cnscnza d pcss d n pacla sull us d ssm ch pman d cnsc nll nm l avà dnfca l a d dblzza, l spnsablà l cnfn. Il pncp fndamnal ch dvbb dvna pa dlla culua dgl pa dl SSN è, nl cas dl sk managmn, ch cò ch nn è scusabl nn è l av cmmss un, ma pus l cnnua ad pa n un svz ch nn fa abbasanza p pvnl aavs un ssma pav d cnscnza dl Rsch, ch al nn è ch l pd dlla Pbalà p la Gavà. P l pfssn qus sgnfca passa da un gm fnalzza alla ma dnfcazn d sngl cas d malpacc, ad un gm n cu l mannmn psgumn d una buna qualà dll asssnza è spnsablà assuna da sngl am d pa pfssns n cnfn dl ssma all nn dl qual pan ( d su un). Nssun mgl dgl pa è ngad d dfn cn ggvà affdablà dmna dll vn avvs. 4. Ul ndcazn è ch p ss ffcac, gl appcc alla gvnanc nn pssn basas sclusvamn sull mpvvsazn, sul bun sns sulla buna vlnà. L smp dl ssma anauc nsgna ch p nd maggmn scu d ffcac l avà c è ncssà d fmazn, d md, pgammazn d nvsmn. 5. Il ssma d sls nd mpssbl nvn ffcac. Cn qus mn, Dglng cllaba dnfcan la gsn slaa d va pcss ch cncn a dmna l asssnza, cm l aulamn la fmazn dl psnal, ssm qualà, la scuzza, l nggna clnca l HTA (valuazn dll cnlg sana), l nfman chnlgy, l cnll d gsn gl al svz ammnsav. La gvnanc p ss al, nvc, dv ncssaamn cllga d nga u qus funzn d avà, all nn d un pcss vl ad asscua la cnalà dl pazn l ccllnza dl ssma asssnzal.

6 ANMDO Pmn Vall d Asa Gvnanc clnc Asssnzal Dzn Sanaa Bzza Dcumnal ad us nn Ob 2008 Sga Scnfca Rgnal La Clncal Gvnanc nn va cnfusa cn la Gvnanc dll Aznda Sanaa. E una dll Gvnanc ssn dv ngas cn l al Gvnanc qual la Rsach Gvnanc, Infman Gvnanc, la Fnancal Gvnanc, la Tchncal Gvnanc..., l Innvan Gvnanc n un ca d ngazn ch pnd l nm, appun, d Ingad Gvnanc. 6. In u qus pg, l cmmmn dlla Dzn Sagca ssa l mpgn cnvn a psgu qus bv, dv ss f, vdn cnnuav dv adus anch nll ava ssm pman p ssn l cambamn. 4. GLI STRUMENTI All nn d gn mdll pav dcs sagc gl pa dll dvs a avann alsì l cmp d scgl d ulzza va sumn dlla Gvnanc Clnc Assnzal; - nn dvbb ss ulzza n mana spadca / afnalsca - nn dvbb ss cnfna sclusvamn nll amb pfssnal, ma ss nga n u pcss d gvn azndal: suual - ganzzav, fnanza pfssnal D sgu n punualzzam gl bv mnm al fn d mgnzza l as sp al l ulzz: 4.1. Evdnc-Basd Pacc Dffnd I EBP c-cuculum a pfssns sana, ch dvbb ss n gad d: - Fmula qus clnc-asssnzal; - Rcca, cn la massma ffcnza, l mgl vdnz dspnbl; - Cnsc pncp dl ccal appasal:valdà nna, lvanza clnca, applcablà; - Inga l vdnz nll dcsn clnc - asssnzal lnfmaln Managmn Acqus a lvll suznal: - Sumn p la gsn dll nfmazn scnfch: banch da, da lnca, nn sfwa d achvazn bblgafca; - Cmpnz p valua ccamn sud pma scnda: vsn ssmach, ln-guda, HTA ps, anals cnmch, anals dcsnal Daa Managmn Mgla l nazn la cmuncazn fa dvs ssm nfmav azndal. Svluppa daabas clnc, nnd cm fmn gl sandad nnaznal 4.4. Ln Guda Pcs Asssnzal Svluppa mdlg p l adaamn lcal d ln guda (LG) la csuzn d pcs asssnzal (PA) abbandnand dfnvamn l ambzn d LG ch. Al fn d dfn PA vdnc-basd, cndvs fa pfssns d adaa al cns lcal,

7 ANMDO Pmn Vall d Asa Gvnanc clnc Asssnzal Dzn Sanaa Bzza Dcumnal ad us nn Ob 2008 Sga Scnfca Rgnal l GIMBE, nl su ulm psn samn, ha laba un fam wk ch pvd dvs fas: - Dfnzn dll pà, - Csuzn dl gupp d lav azndal mulpfssnal, - Rcca, valuazn cca d vnual ngazn dll LG, - Anals dl cns lcal, adaamn dll LG csuzn PA, - Dfnzn dll sag d dffusn mplmnazn d PA, - Dfnzn dl panl dgl ndaca d pcss d s, - Vfca dll mpa d PA aavs la panfcazn, cnduzn png dl clncal aud Halh Tchnlgy Assssmn Ulzza mdll p nnaznal d HTA p ganzza l mdalà d gsn azndal(acqus,manunzn,dsmssn,) dll cnlg sana, n pacla quand ssn npu gnal al gvn dll cnlg) Pmuv la dffusn dll cnlg ffcac la dsmssn d qualunqu cnlga d ffcaca nn dcumnaa cmunqu bsla Clncal Aud Panfca cndu aud clnc ch, cnfnand l asssnza gaa cn gl sandad dfn, pman d: a. dnfca l n apppazz, sa n ccss sa n df; b. vfca sula cnsgun al pcss d cambamn, n mn d pcss, s pssbl d s Rsk Managmn Cnsda l cm df d ssma nn dl sngl pfssnsa. Panfca d mplmna pgamm azndal d gsn dl sch clnc 4.8. Fmazn cnnua, anng, accdamn pfssnal Cnslda a gl pa sana la culua dlla fmazn cnnua, nsa cm pa ngan dlla paca pfssnal. Ins l avà d ECM (n pacla, la fmazn sul camp) nll sag mulfaal ma alla mdfca d cmpamn pfssnal. Svluppa sumn p msua la qualà cnc- pfssnal, sn a dfn c d anng accdamn, sandadzzand la valuazn d cnscnz, cmpnz audn Rsach & Dvlpmn Dffnd a pfssns la culua gl sumn dlla cca clnca su svz sana, cn pacla nfas all svlupp dlla cca ndpndn. Gvna l mdalà d cnvlgmn nlla cca spnszzaa, al fn d gaann ulà scal, mdlga, ca ngà Saff managmn Dfn l sag d managmn dgl saff p valzza l ss uman, n lazn all audn, cnscnz cmpnz d sngl pfssns.

8 ANMDO Pmn Vall d Asa Gvnanc clnc Asssnzal Dzn Sanaa Bzza Dcumnal ad us nn Ob 2008 Sga Scnfca Rgnal Pacpazn dgl un Cnvlg cadn nlla valuazn nll mdalà d gazn d svz psazn sana, sa pché csusc un l d, sa pché l l cnbu può du l napppazza dlla dmanda. 5. ASPETTI ORGANIZZATIVI Nl pn sp d fmn nmav d plca sanaa naznal gnal, è upsc dfn un mdll ganzzav una p l auazn dl GCA. Alla luc dlla cnssn vaablà dll Aznd sana, la ppsa ANMDO PIEMONTE dva da un agnvl cmpmss a: - la pndaa valuazn d fmn nmav; - l vdnz scnfch sull auazn dl GCA; - l spnza mauaa dall ANMDO nlla alzzazn d pg azndal d GCA n Pmn Vall d Asa Il mdll ganzzav ANMDO PIEMONTE In assnza d una Dzn Sagca d un Cllg d Dzn mva cnvn dlla ncssà d svluppa plch d Gvnanc Clnc Asssnzal nnché d un mdll dpamnal bn suua funznan, nn susssn p-qus ganzzav p la cmpla auazn azndal dlla GCA. La Gvnanc chd ch l psn gus vngan cllca n ps gus, n cas cna pssn vfcas gav quvc. P psn gus s nndn pfssns cnsc dlla cmplssà, fma sul md sugl sumn, mva all ngazn mulpfssnal, cn spnza managal cnsldaa plunnal. Il pcs fmav asscua dagl sud gnsc - ganzzav l app spnzal dvan dalla qudana paca pvnznal managal gaanscn, agl spcals n Ign Mdcna Pvnva dll Oganzzazn, un nvl vanagg nll svlgmn dll funzn d spnsablà dgl uffc d saff funznal alla Gvnanc, pu nlla cnvnzn ch al avà pssan ss pfcuamn svl da fgu dgnzal ch alla cmpnza clnca abban affanca un cps pcs fmav n amb spcfc (Qualà, Rsk Managmn, Tch. Ass., Ign Ospdala, Cnll d gsn, OSRU, cc.). La cmplssà la gsn d dmna dl md dlla Gvnanc Clnc Asssnzal nll ganzzazn sana nd nvc ndspnsabl ch l Rspnsabl dlla Gvnanc Clnc Asssnzal sa l D Sana Azndal; la ncssà d npa l mlplc sanz pvnn dall a clnch, pvnznsch, ammnsav, fmav nd, nl, mpscndbl ch la fgua dl DSA sa cpa da un spcalsa n Ign Mdcna Pvnva dal mmn ch la fmazn l scl lavav d qus pfssnsa mgl gaanscn l funzn d np av dlla cmplssà facla ppsv d pg, an ncssa p la ca mplmnazn dlla GCA. L n pncpal dvan da al ulm asszn appa ss qull ch l D Sana Azndal dv cnsc, p npal d ngal, lnguagg dgl al A dlla GCA qus dvà una cnnua d assdua vlnà d aggnamn. E alsì cha cm l us ccssv dlla dlga d asp cc dlla pfssn (gn spdala, gsn dl psnal, cnaualsca, valuazn, pgazn, cc.) cnas cn qusa vsn lsca dlla pfssn dll gnsa ganzza.

9 ANMDO Pmn Vall d Asa Gvnanc clnc Asssnzal Dzn Sanaa Bzza Dcumnal ad us nn Ob 2008 Sga Scnfca Rgnal Il D Sana d Aznda dv da pan applcav dlla GCA pmuvn l mplmnazn n u l alà azndal (svz spdal, dsual d pvnzn), nzalmn mdan un ana avà cgnva, sgua da un nnsa avà fmava psa a fa mg nl psnal una culua psva d appndmn d cllabazn, culmnaa nlla valuazn d ffcaca dll azn naps. La Dzn Sanaa Azndal è spnsabl dll ganzzazn d svz sana, nndnd p svz sana nn sl qull fancamn sana, a dzn mdca nfmsca, ma anch qull cmunqu vl alla pmzn al mannmn dlla salu dgl pa, d pazn, dlla pplazn n gnal. La Dzn Sanaa Azndal dv qund dfn l mdll ganzzav d va ssm nssa alla CGA ava l sag ncssa a ndl pav. La DSA dsgna, qund, l alb dcsnal n maa, susc gssc Cma, gupp pav, gupp d lav, applcand l lgch pch dlla pgammazn p bv, cè ganzza un ssma d nlazn a dvs a ch facl la cmuncazn, la cmpnsn d pblm, la mssa n a d sluzn applcabl, ch ngan cn d va asp dl pblma dll cnsgunz dll sluzn sss, la aspanza dll dcsn, la dazn d suzn faclmn cmpnsbl, pmuv l pcss d valuazn d sch la sua gsn, pmuv una culua psva d sgnalazn dgl vn avvs d appndmn dagl (cca dl pché dl cm, nn dll clp). Al DSA pvngn l ndcazn dlla Dzn Sagca dl Cllg d Dzn d gl fsc n ma a al gansm n mana sa punual sa ganca cn una lazn annual sull sa d avanzamn pgual. Dal can su l D Sana d Aa (psd spdal, ds al, dpamn d pvnzn) la cu pfssnalà è ulaa dalla glamnazn d accss agl ncach d suua cmplssa, è ugualmn np d dvs lnguagg psn nl psd sana da lu d d è l gaan dll applcazn pava ssmca. Dv pa cncamn sugl psd m n a nzav ssmch pvnv mdan l anals d bsgn asssnzal d ganzzav pa, laband pgamm cmplssv d cnnuà asssnzal, apppazza, scuzza, pvnzn p la gsn dl sch clnc pvdnd spcfc nvn d fmazn, d nnv cnlgc, d vsn d pcs asssnzal, d nfmazzazn d pcss asssnzal, d vsn mdfch ganzzav qual - quanav. Spau la cnnuà asssnzal la pvnzn dgl vn avvs chdn spssamn un appcc muldscplna ch l mdc gnsa d dzn sanaa, f dll su spcfch cmpnz, favsc nsm l dalg a dvs pfssns dlla asssnzal, cnscnd la ncssà d nn pvaca ssus a pfssns sss, npand spss, su malgad, l ul camn nn facl d mdlg facla. Cnsda l nsuccss d pg d GCA a pfmanc p-dwn, è ndspnsabl aua gl sumn dlla GCA cn mdalà bm-up, pva csuzn dll R Tasvsal Tmach mulpfssnal p la GCA. Pu spand la lbà ganzzava dll sngl Aznd, appa cnsglabl ch l R Tasvsal Tmach san cdna da suu snll n cu pch fgu pfssnal ppaa mva s nfaccan qudanamn cn fn pfc; al mdll gaansc una buna ssnblà d una qudana cnscnza dlla alà dcnaa. In una pma fas, l vdnza scnfca pvd la csuzn d una dpamnal d facla d GCA; succssvamn la dv ss amplaa a lvll dll UO. Nl l dvn ss smp nnsa sull suu ganzzav ssn: ds, nucl d cu pma. L p la GCa (flg. 3) dvn ss suua n unà asvsal d supp all avà d GC d l ul d facla dv ss suznalzza cnscu.

10 ANMDO Pmn Vall d Asa Gvnanc clnc Asssnzal Dzn Sanaa Bzza Dcumnal ad us nn Ob 2008 Sga Scnfca Rgnal P mzza l cdnamn dll d pg d GCA, gl uffc d saff (qualà, fmazn, accdamn) dvn ss qualfca sps ad un pcss d ganzzazn. La dfnzn dgl bv dll avà d GCA dvbb ss ffuaa n mana splca n ccasn dlla cncazn d budg. DG DA DA Cllg d Dzn Cllg d Dzn D Sana Azndal Rspnsabl Rspnsabl Gvnanc Gvn Clnc Clnc Asssnzal STAFF (Qualà, Rspp, Rsk, Osu, Up, Fmazn, cc.) STAFF (Qualà, Rspp, Rsk, Osu, Up, Fmazn, cc.) D Mdc d Psd Rspnsabl Gsn Gvnanc Clnc Asssnzal D Aa Tal (D Dpamn cu pma) Rspnsabl Gsn Gvnanc Clnc Asssnzal D Dp.Pv. Rspnsabl Gsn Gvnanc Clnc Asssnzal S D p a m n D p a m n D p a m n D p a m n D p a m n D s D s D s v z S v z S v z S v z RETE TRASVERSALE TEMATICA

11 ANMDO Pmn Vall d Asa Gvnanc clnc Asssnzal Dzn Sanaa Bzza Dcumnal ad us nn Ob 2008 Sga Scnfca Rgnal In un Aznda sanaa pssn ss dnfca du lvll d auazn dlla GCA: I Cma d Dpamn d Ds dvn pgamma ncn pdc p la panfcazn valuazn dll avà dlla GCA. L Aznda dv va la plfazn ncnllaa d pg d GCA, alamn pdva d nsuccss. Qual ndcazn gnal d ssnblà: - a lvll mac, aua 2-3 pg/ann, spss su cmmmn gnal; - a lvll ms, cnvlg u dpamn n almn 1 pg (mn ndpamnal), vand d mpgna cascun dpamn n pù d 3 pg/ann. 6. LE ABILITÀ DELLA DIREZIONE SANITARIA.. quan pù un lav è cmplss, an pù cna l nllgnza mva, s nn al pché una canza n qus ablà può sacla l us dll xps cnca dll d nllual, p quan pnunca ss san. D. Glman, Lava cn nllgnza mva, BUR, XII dzn, La Dzn Sanaa appa dlnaa qund cm una funzn d lad pfssnal capac d lgg, npa la cmplssà d ssm sana mdn al fn d gaan l pù al d lvll d qualà ssnbl n un dmna cns sc, culual d cnmc. Cm ma dlna n mana ca dalla laua, l aggungmn d sml bv è funzn dl pssss d capacà nllual cnch mpan accmpagna da un bun bagagl d cmpnz mv n pa nna all ndvdu, n pa clva cn un pcs fmav culual spcfc. Scnd la cca amcana l audn d cu s ha bsgn p ss ffcac nlla pfssn cmncan dall nll, ma cc anch cmpnza mva p fa mg cmpuamn l pnzalà cnch. La agn dl pché nn nam l pn pnzal dall psn, va ccaa nll ncmpnza mva. 6.1 L nllgnza mva La nzn d nllgnza mva, gà dsca da Hwad Gadn nll du fm, napsnal npsnal, è saa uava svluppaa n su mlplc cmpnn cnsgunz pach da Danl Glman, l qual dsngu du pncpal scag: a. L cmpnz psnal, f alla capacà d cgl dvs asp dlla ppa va mznal;

12 ANMDO Pmn Vall d Asa Gvnanc clnc Asssnzal Dzn Sanaa Bzza Dcumnal ad us nn Ob 2008 Sga Scnfca Rgnal b. l cmpnz scal, lav alla mana cn cu cmpndam gl al c appam ad ss. 6 a. L'nllgnza mva psnal Cmpnd la cnsapvlzza d sé, ch c pa a da un nm un sns all ns mzn ngav, auandc a cmpnd l ccsanz l caus ch l scanan; pù n gnal ssa pm una auvaluazn bva dll pp capacà d pp lm, csì da usc a pps m alsch, scglnd p l ss psnal pù adgua p aggungl. Anch l'aucnll fa pa dll cmpnz psnal. Ess mplca la capacà d dmna l pp mzn, l ch nn vul d ngal sffcal, bnsì spml n fm scalmn accabl. L'ncapacà d gs l pp mzn, può pa nfa ad ag n mana nppuna, maga a fm d sagaa aggssvà n cnfn dgl al, ffnd d sé un'mmagn bn pc lusngha. Ch è padn d sé, sc d sl a cmpas n mana apppaa alla suazn, nnd cn dll gl dl vv scal, cnscnd l pp spnsablà pp, spand gl mpgn ps pand a cmpmn cmp assgnagl. Ta l cmpnz psnal può ss nl cllcaa la capacà d almna la ppa mvazn, mannndla anch d fn all dffclà quand l cs nn vann cm avvam pvs spavam. La capacà d mvas è fmaa da una gusa ds d msm dall sp d nzava, audn ch spngn a psgu pp bv, agnd avamn agl nsuccss all fusazn. 6 b. L'nllgnza mva scal E' csua da qull'nsm d caasch ch c pmn d laznac psvamn cn gl al d nag n md csuv cn ss. Una dll cmpnn pù mpan d qus asp dll'nllgnza è csua dall'mpaa, ssa dalla capacà d cnsc l mzn snmn ngl al, pnndc dalmn n l pann uscnd a cmpnd spv pun d vsa, gl nss l dffclà n. Ess mpac sgnfca pcp l mnd n dll'al cm s fss l ns, mannnd uava la cnsapvlzza dlla sua alà sp a ns pun d vsa. La cmuncazn, ala audn "scal", è nvc la capacà d pala agl al, facnd cncd l cnnu splc d mssagg (asmss dall pal) cn l pp cnvnzn d mzn (nvlnaamn vla aavs l lnguagg dl cp). Cmunca n mana ffcac è anch sap ascla fa dmand, mannnd una al anzn all sps mv d ns nlcu. Scnd Glman, l'nllgnza mva s può svluppa aavs un adgua allnamn, d spau a cgl snmn l mzn, ns alu, ndzzandl n sns csuv. S, nfa, l'nllgnza lgaa al QI (Quzn Inllv) nd a sablzzas nn a 16 ann (p ncmnca lnamn a dclna ngl ann dlla mauà), l'nllgnza mva può ss mglaa nl cs d ua la va 6.2 L Cmpnz Emv L nllgnza mva dmna la nsa pnzalà d appnd l capacà pach basa su su cnqu lmn: cnsapvlzza padnanza d sé, mvazn, mpaa ablà nll lazn npsnal. La nsa cmpnza mva dmsa quan, d qulla pnzalà sam usc a adu n al capacà pn p ss mss n a nlla pfssn. Il smplc fa d ss da d nllgnza mva nn gaansc d acqus l cmpnz ch davv cnan nlla pfssn, sgnfca sl ch s hann l massm pssblà p appndl. L cmpnz mv pssn ss classfca n gupp, cascun d qual fnda su una pacla capacà dll nllgnza mva. L capacà fndamnal dll nllgnza mva sn d val mpanza affnché gl ndvdu scan ad appnd l cmpnz pfssnal ncssa p av ffcaca nlla pfssn. S un pfssnsa è can nll ablà scal, ad smp, nn uscà a psuad a spa gl al, né ad assums la ladshp d un am a caalzza l cambamn. Ch ha scasa cnsapvlzza d sé nd a dmnca l pp dblzz, all sss mp nn avà la fduca n s sss ch dva dalla scuzza su pp pun d fza.

13 ANMDO Pmn Vall d Asa Gvnanc clnc Asssnzal Dzn Sanaa Bzza Dcumnal ad us nn Ob 2008 Sga Scnfca Rgnal 6.3 L xps La nsa cmpnza nlla va qudana, l ch dal QI, è dmnaa dall capacà pach dall ablà cnch d cu sam padn. Indpndnmn dal ns pnzal nllual, è l xps (la alà d nfmazn spcalsch ablà pach d cu dspnam) a dac la cmpnza p svlg un dmna lav. In laga msua l xps cnss anch, n una cmbnazn fa l bun sns l cnscnz l capacà spcalsch ch andam accglnd nl fa qualsas lav. L xps è l appndmn n nca; è la cnsapvlzza d ucch dl ms, qull aunca cnscnza sul cm fa una pfssn ch dva sl dall spnza. Gl sud cn hann uava dmsa ch l nllgnza paca appsna aamn l pncpal dmnan dlla sup ffcaca d una psazn pfssnal. L xps è una cmpnza d bas ch è fndamnal p n un dmna ncac pal a mn, ma la qualà dlla psazn è dmnaa dal md n cu vngn svl l avà. Ch, cm la dzn sanaa, è p smp, ncaca dlla supvsn dl lav svl da al pfssns cnc, dv pssd un c gad d xps nl s spcfc; sabb mpssbl svlg una sml avà snza una agnvl cmpnsn d cò ch l psn da cnlla sann facnd. D ala pa, qull xps è sl un qus sgla n quan anch n camp mnnmn cnc, supvs cclln nn s dsngun p l l ablà cnch, ma p la capacà d cnfnas cn l psn. 6.4 L cmpnz pfssnal L ganzzazn sana, cm ml al ssm ganzzav ch anman l scà cnmpan, sann passand, fa dffclà ssnz d gn sa, da un p d gsn unfman, ndffnzaa d mgna, ad una gsn capac d cgl l uncà d mlplc nlcu dll spdal, nn d sn. Qusa anszn dall da d massa ad un ssu nca d sggvà ganzzava sa dlnand una nuva clga dll ganzzazn, muldmnsnal cmplssa. I fa mmaal cm la cnscnza, svz, l nfmazn, l lazn psnal n csuscn l cmpnn ssnzal n qusa nuva clga spdala l spnza ganzzava è l sula d pach pav fa a ch nagscn fa l n lazn mlplc dslca n lcalsm dvs. Sn smla dal spnsabl dl gvn clnc ch chsa, nll amb d un ssma a caazza dalla nn-lnaà dalla ndnza all au-ganzzazn pca d ssm cmplss, gl ff gna dalla l muua nazn. Il d sana azndal d l d mdc d psd spdal, cascun nll amb dll pp cmpnz, assumn gg un ul nuv ch s caazza p cmp d gvn d gand mpanza, ch chdn una fmazn culual spcfca bn dvsa da cann adznal ma sldamn nnsaa n una fmazn gnsca. L appcc pvnv-pav sa pgssvamn punand all dnfcazn, alla msua al cnll d pù svaa fa cc pnzalmn psn nl cns dll ganzzazn sana, nnché alla alzzazn d lvll cnlgc d ganzzav n gad d spnd all ncssà da da bsgn. In una ganzzazn bn da l ffva cmuncazn cn u l saff dlla vsn d md dlla Gvnanc Clnc Asssnzal è d mpanza fndamnal, fnsc un lnguagg d un sn cmun, chasc gl bv l aspav. In pacla, l capacà d ndzz, cdnamn, supp vfca dl d sana d aznda qull ganzzav, gsnal d pav dl d mdc d psd spdal gaanscn l affzamn dl lav d squada, can una culua apa snsbl asscuan ch la gsn qudana qulla vs cu s nd mangan pa ngal d gn svz clnc. Dall nsm dll funzn c pa sa ppun p pacla accn sull acla cmpnz dl d sana, azndal d psd spdal, ch sn ssnzalmn qua: una d p managal, cnducbl alla funzn d Rspnsabl dlla Gvnanc una scnda d p ganzzav,

14 ANMDO Pmn Vall d Asa Gvnanc clnc Asssnzal Dzn Sanaa Bzza Dcumnal ad us nn Ob 2008 Sga Scnfca Rgnal una za d p gnc-sanaa d pvnzn, pmzn dlla salu una quaa naa al ssma d valuazn dlla qualà dll asssnza. Csì dlna dsc, l pncpal ablà dlla Dzn Sanaa n mn d Gvnanc pssn ss assun nll schma succssv, pcsand ch, a scnda dl ul svl (azndal d psd/aa), dlla cmplssà azndal, dl cns sc dl mmn culual, ss pann ss vaamn clva d ulzza dal pfssnsa d dzn sanaa chama a gs la cmplssà sanaa. Laua Spcalzzazn Mas da, cs plunnal Rcca Dcnza Managal CURRICULUM FORMATIVO Dmna l md n cu cnllam n sss Mdcna chuga Ign mdcna pvnva Oganzzazn d svz sana, gsn dll ss pfssnal, valuazn d sula, anals d pcss, chnlgy assssmn. Pacpazn a sud plucnc, a bnchmakng sal, dfnzn d ln guda pcs asssnzal, pubblcazn d sula su vs spcalsch a cngssual Pss scul d spcalà, cs d laua p mdc pfssns sana, pss mas spcalsc scul pfssnal. COMPETENZA PROFESSIONALE Dmna l md n cu cnllam n sss Valuazn d bsgn Pgammazn Valuazn dll apppazza d ffcaca Lua dlla cmplssà Bnss ganzzav Gsn dl cnnzs Valuazn dlla ssnblà Oganzzav Ignc-sanaa d pvnzn, pmzn dlla salu Valuazn dlla qualà dll asssnza Pgazn d ulzz dll nfmav d nfmach Ssm d classfcazn dll psazn Mdll ganzzav dll a sana Ingazn nazndal d xazndal Rapp cn gl Sakhld Cfcazn Ign dll suu sana Edlza Sanaa Cmuncazn Manals EBP Anals d pcss Aud sumn d anals pava Gsn dll nnvazn (ch. Assssmn, valuazn d mpa) Mdcna aslaznal Cnll d gsn (Balancd Sc Cad, dfnzn panl ndca, cc) Inpazn d sula Taspanza ula dll ganzzazn sanaa EBM, EBHC

15 ANMDO Pmn Vall d Asa Gvnanc clnc Asssnzal Dzn Sanaa Bzza Dcumnal ad us nn Ob 2008 Sga Scnfca Rgnal COMPETENZA PERSONALE Dmna l md n cu cnllam n sss Cmpa la cnscnza d pp sa n pfnz, ss nuzn Cnsapvlzza d sé Cnsapvlzza mva: cnscmn dll pp mzn d l ff Auvaluazn accuaa: cnscnza d pp pun d fza d pp lm Fduca n s sss: scuzza nl pp val nll pp capacà Cmpa la capacà d dmna pp sa n, pp mpuls l pp ss Padnanza d sé Mvazn Aucnll: dmn dll mzn dgl mpuls dsuv. Fdazza: mannmn d sandad d nsà ngà. Cscnzsà assunzn dll spnsablà p quan an alla ppa. psazn. Adaablà flssblà nl gs l cambamn. Innvazn: capacà d sns a pp ag d av un aggamn. ap d fn a d, appcc nfmazn nuv. Cmpa ndnz mv ch gudan faclan l aggungmn d bv Spna alla alzzazn: mpuls a mgla a sddsfa un sandad d ccllnza. Impgn: adguamn agl bv dl gupp dll ganzzazn. Inzava: pnzza nl cgl l ccasn. Omsm: csanza nl psgu gl bv nnsan sacl nsuccss. COMPETENZA SOCIALE Dmna l md cn cu gs l lazn cn gl al Empaa Cmpa la cnsapvlzza d snmn, dll sgnz dgl nss alu Cmpnsn dgl al: pczn d snmn dll pspv alu; nss av p l pccupazn dgl al. Asssnza: ancpazn, cnscmn sddsfazn dll sgnz dl cln. Pmzn dll svlupp alu: pczn dll sgnz d svlupp dgl al capacà d m n sal pnza l l ablà. Sfuamn dlla dvsà sap clva l ppunà ff da psn d dvs p. Cnsapvlzza plca: sap lgg npa l cn mv

16 ANMDO Pmn Vall d Asa Gvnanc clnc Asssnzal Dzn Sanaa Bzza Dcumnal ad us nn Ob 2008 Sga Scnfca Rgnal app d p n un gupp. Ablà scal Cmpan ablà nll ndu sps dsdabl ngl al: Influnza: mpg d ach d psuasn ffcn Cmuncazn: nv d mssagg cha cnvncn Ladshp: capacà d spa guda gupp psn Caals dl cambamn: capacà d nza dg l cambamn Gsn dl cnfl: capacà d ngza slv suazn d dsaccd Csuzn d lgam: capacà d fav almna lazn ul Cllabazn cpazn: capacà d lava cn al vs bv cmun Lav n am capacà d ca una snga d gupp nl psgu bv cmun 7. PROBLEMATICHE APERTE 7.1. Gnal Aspav nn smp cnvgn fa pfssns manag. Assnza d un appcc pdmlgc alla panfcazn sanaa. Ps lma dll vdnz scnfch nll macdcsn azndal, spc s ssn nsn a apppazza vlum ( cnsgun mbs) dll psazn sana. Cnas fa nss azndal, dpamnal, d UO pfssnal. Dffclà nl cncla gl bv dll Aznda Ospdala (pduzn) cn qull dll Aznda USL (cmmnza) Rlav all p l GC Qualfcazn pfssnal sugl sumn dlla GCA, am l acquszn dl c-cuculum. Dfnzn d nuv spnsablà ul pfssnal. Ncssà d mp ddca Rlav agl uffc d saff Ncssà d qualfcazn ganzzazn dgl uffc d saff (qualà, fmazn, accdamn, cc),samn cnnss all avà d GCA. Pssbl nsn cn l p la GCA. Ncssà d ngazn fa avà d GCA fmazn, n pacla lguad alla fmazn sul camp.

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