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1 Ministry of Health - Italy REPUBLIC OF MOLDOVA Abstract Book Study Visit on Management of Health Services

2 Ministry of Health - Italy REPUBLIC OF MOLDOVA Abstract Book Study Visit on Management of Health Services 2

3 Copies of this volume can be downloaded at Everyone is authorised for non-commercial purpose- whether for information, study or didactic aims - to use and reproduce the content of this publication, stating the original source. Editor Patrizia Parodi, Ministry of Health, Rome Printed in Rome - Italy, by the Press Centre, Ministry of Health, November

4 CONTENTS Page 1. The Project Cycle Management and Innovative Methods in Continuing Education on Health 5 Giovanni De Virgilio 2. Qualitative Research in District Health Management 6 Rita Ferrelli 3. Risk management as a tool for Continuous Quality Improvement 6 Daniela Coclite, Antonello Napoletano 4. Ethnographic Research for Managing the Health Services 7 Andrea Caprara 5. E-learning for the Health Services: the National Health Institute Experience 7 Alfonso Mazzaccara 6. Customer satisfaction and perceived quality of health care 8 Alice Fauci Annex Programme of the Study Visit 9 4

5 1. The Project Cycle Management and Innovative Methods in Continuing Education on Health Giovanni De Virgilio 1 In these recent years the approach to medical continuing education has radically changed in its methods. This is a result of new perspectives generated by research results about the way by which an adult is learning. Following the term used by one of the fathers of this new approach (M. Knowles), the science studying the learning process of an adult is called Andragogy, opposite to Pedagogy that entails the learning in youth. This new approach is often referred to active or interactive learning. These terms will be clarified in the session as well as the principles that are generating a genuine interest of the adult in learning (intrinsic motivation) without which any training activity is supposed to fail or be highly ineffective. One well known and studied method following the andragogic principles is Problem Based Learning (PBL). The method was born in the sixties at the Faculty of Medicine of Mc Master University in Canada and soon adopted as the main training method by Harvard University (1986). The PBL spread worldwide also in fields different from medicine: architecture, engineering, economics, management to name a few. The Istituto Superiore di Sanità is using PBL from the early nineties both for long term training in public health (Master courses) and for short courses for continuing education in the health sector. 1 Head of External Relations Office, National Institute of Health, Rome 5 The session will describe in detail PBL approach and provide firsthand experience to the participants on how to design a PBL course and its learning materials (problems). The session will also address how to programme continuing education activities following a Project Cycle Management (PCM) approach. The main principles an steps of a PCM applied to medical continuing education will be presented. Within the PCM, particular attention will be put on the topic of evaluation of training resultswith reference to scientific research conducted by Davies and the experience developed at ISS. References Barrows HS, Tamblyn RM 1980 Problembased Learning: an approach to medical education. Springer Publishing Company, New York Davis, D., et al. (1999). Impact of Formal Continuing Education. Journal of the American Medical Association, 282, No. 9, De Virgilio G., 1999 "Problem-based Learning for Health Workers Continuing Education: An Experience from Lazio Region in Italy", Education for Health, 12, 2:271. De Virgilio G., 2004 Problem-based Learning: un nuovo metodo per la formazione dell adulto in Sanità, FOR Rivista per la formazione, Rivista dell Associazione Italiana Formatori, Franco Angeli, Milano, 61: De Virgilio G. e Pernisco F.G Problem-based Learning for improving the quality of environmental hygiene services in Tuscany Region, Abstracts della 10 th Biennial Conference of the European Association for Research on

6 Learning and Instruction EARLI, Padova agosto, p. 455 Knowles M. The adult learner. A neglected species. Houston, TX: Gulf Publishing, 1990 Pressato L. et al 2003 L Educazione Continua in Medicina: una guida per medici, operatori e dirigenti della sanità, Il Pensiero Scientifico Editore, Roma Schmidt HG The rationale behind problem-based learning. In: Schmidt HG, Lipkin MJr, de Vries MW, Greep JM (Ed.) New directions for medical education. Problem-based learning and community-oriented medical education. Springer-Verlag, New York 2. Qualitative Research in District Health Management Rita Ferrelli 2 Qualitative research as a form of inquiry has increased enormously in the last decade. The number and quality of qualitative studies has risen in almost every discipline. In the health sector as well there is a growing interest and application of qualitative research techniques. As a matter of fact, social sciences discipline, such as sociology, anthropology, psychology, ethno-medicine are utilized in qualitative research to study the social, cultural and economic factors that influence health and disease. Qualitative research allows the description of the way communities and individuals interpret health and disease, as well as the interactions among the various players who are relevant in public health issues: patients, community, health personnel and organizations. The focus of qualitative research tends to be on understanding the meaning imbedded in participant experiences through an openended, unstructured and subjective approach. 2 Researcher, External Relations Office, National Institute of Health, Rome 6 The research tends to be holistic, descriptive and focuses on the depth and details of experiences. Data collection techniques include focus group, interviews, observations, field notes, and documents review. Data tend to be analyzed through an inductive, ongoing and evolving process of identifying themes within a particular context. 3. Risk management as a tool for Continuous Quality Improvement Daniela Coclite, Antonello Napoletano 3 Patient safety is one of the fundamental component of the quality of health services together with effectiveness, efficiency and appropriateness. Therefore, the introduction of clinical risk management system aimed at the reduction of medical errors and the improvement of patient safety has become a major priority for all health care providers. Clinical risk management acknowledges that health care practice, by its very nature, carries a risk which can be due to a variety of causes, whether it is an accident, a mishap or a mistake. Clinical risk management provides a strategic approach to reduce risk of adverse events identifying the frequency and nature of medical errors (i.e. incident reporting, retrospective chart review, analysis of medical indemnity claims etc) and then developing way to reduce the likelihood of these errors occurring in the future (RCA, FMEA, audit, training, guidelines and best practices). This process is an integral part of an approach to learning from errors and improving patient safety. The aim of this presentation is to provide participants with information on the 3 Researchers, External Relations Office, National Institute of Health, Rome

7 epidemiology of medical errors, models and management of human error and the strategic approach to clinical risk management adopted by the Italian health care institutions. 4. Ethnographic Reasearch for Managing the Health Services Andrea Caprara 4 In the last decade, research on health has been accompanied by a growing interest in the use of ethnography and its research instruments applied throughout the 20 th century by social sciences and in anthropology in particular, in the study of other cultural groups (Meyer, 2000; Jones & Hunter, 1995; Pope & Mays, 2000). Among the themes observed, it can be mentioned the studies concerning the experience of patients with chronic diseases, the research regarding the organization of healthcare services and the humanization of attendance. Why this growing interest in the use of ethnographic research in health services? It was in seeking response to such question that it was organized this session, aimed at reflecting on three key aspects: 1. analyze the reasons of this growing interest; 2. describe the elements that characterize ethnographic research applied to health care services; 3 present three ethnographic studies conducted in the city of Rome: a) an ethnographic research in emergency departments in Rome; b) between the need and useless: an ethnography on cesarean delivery in a Lazio Region hospital; c) an ethnographic study on nursing home care in the city of Rome. 5. E-learning for the Health Services: the National Health Institute Experience Alfonso Mazzaccara 5 The presentation: E_learning for the health services shows the ISS distance education experience implemented in the External Relation Office during the last 7 years. The presentation will illustrate to the participants the main experience and pilot studies concretely conducted in the ISS, the more relevant lessons learned in developing E-learning courses, using an active learning methodology jointly with a modern technological teaching platform, inside the Continuing Medical Education Process developed in the Country. Objectives of the workshop are the followings: 1) To present E-learning training programs at ISS 2) To show the teaching methodology developed 3) To link the training program developed with the health services 4) To discuss the andragogic methods (PBL) applied in the e-learning methods proposed 5) To present the different models developed (participants low, medium, high-involvement) 6) To analyse the main results collected 7) To underlines the lessons learned: Strengths and Weaknesses 8) To present the national medical continuing education strategy with particular effort for the e-learning 9) To visit the ISS platform: overview of the courses developed and of the new platform learning tasks 4 Agency for Public Health of Lazio Region, Rome 7 5 Researcher, External Relations Office, National Institute of Health, Rome

8 The workshop will have different presenters and 2 facilitators among the participants to strength their involvement and to implement the discussion. The visits to the ISS Platform will be participant oriented using PC available in the class-room which can be better captured through a methodological integration of both quantitative and qualitative strategies. Annex 6. Customer satisfaction and perceived quality of health care Alice Faucii 6 The issue of quality is a core topic in healthcare services management. This lecture will summarizes the most relevant theoretical approaches, providing a general definition of quality and trying a possible generic relationship between the concepts of perceived quality and customer satisfaction. Through the analysis of some examples, methodological problems concerning surveys on quality perception in healthcare services will be examined; it will be argued that due to the substantial difference between perceived quality and customer satisfaction, they need different evaluation instruments. Finally, the use of qualitative research for the evaluation of the perceived quality of health care it will be explored, focussing on techniques such as Focus Groups and Indepth Interviews. Indeed, qualitative techniques are based on a research methodology that focuses more on subjective aspects and personal experience, providing the opportunity to understand the patient/user s point of view. In conclusion, it will be argued that the process through which citizens evaluate the quality of healthcare is extremely complex, non-univocal, dynamic and linked to contingent experiences. The result of such process is thus a multidimensional evaluation 6 Researcher, External Relations Office, National Institute of Health, Rome 8

9 Republic of Moldova T ITALO-MOLDAVIAN COLLABORATION Management of Health Services Rome, October 2010 Organized by MINISTRY OF HEALTH (Ministero della Salute) and NATIONAL INSTITUTE OF HEALTH (Istituto Superiore di Sanità, ISS) AIM OF THE WORKSHOP The aim of the workshop is to discuss some of the main issues related to management of health services. Learning methods include: presentations from Italian experts and members of the Moldavian delegation, work in small groups, discussion, visit to Local Health Unit, Round Table. WORK AGENDA Monday, 25 th October, 25 th October 09:00 Welcome Address Pietro Malara, Giovanni De Virgilio Director Office V Bilateral Agreements MOH, Head of External Relations Office, ISS 09:10 Introduction of participants 09:30 The Project Cycle Management and Innovative Methods in Continuing Education of Health Professionals 9

10 Giovanni De Virgilio 11:00 Coffee break 11: 30 Work in small groups and presentation in plenary session 13:00 Lunch 14:00-17:00 Qualitative Research in District Health Management Rita Ferrelli Tuesday, 26 th October Tuesday, 26 th October 09:00 Local Health Unit of Viterbo - Rita Ferrelli 13:00 Lunch Wednesday, 27 th October Wednesday, 27 th October 09:30 Risk management as a tool for Continuous Quality Improvement Daniela Coclite, Antonello Napoletano 11:00 Coffee break 11: 30 Work in small groups and presentation in plenary session 13:00 Lunch 14:00-17:00 Ethnographic Reasearch for Managing the Health Services Andrea Caprara Thursday, 28 th October Thursday, 28 th October 09:30 E-learning for the Health Services: the ISS Experience Alfonso Mazzaccara 11:00 Coffee break 11: 30 Work in small groups and presentation in plenary session 13:00 Lunch 14:00-17:00 Customer satisfaction and perceived quality of health care Alice Fauci 20:00 Social Dinner Friday, 29 th October 09:00 Round Table at the Ministry of Health Health Care Systems: Achievements and Future Trends. 10

11 MEMBERS OF THE MOLDAVIAN DELEGATION Mrs. Tatiana Zatic, Head, Health Care Policies Department, Ministry of Health (MoH) Mrs. Maria Cumpana, Head, Health Services Quality Management Policies Department, MoH Mr. Alexandru Holostenco, Consultant, Health Personnel Management Policies Department, MoH Mr. Dorin Lisii, Head, Internal Audit Service, MoH Mrs. Luminita Suveica, Deputy Director, Health Department, Municipal Council, Chisinau Mr. Iurii Dondiuc, Main Specialist of the Ministry of Health in the field of obstetrics and gynaecology, Deputy Director Municipal Clinical Hospital No. 1, Chisinau MOLDAVIAN PARTICIPANTS TO THE ROUND TABLE Mrs. Natalia Costic, Head, Quality Control within Public Health Facilities Division, National Center for Public Health Mr. Anatolie Prisacari, Deputy Director, National Council of Assessment and Accreditation in Health Mr. Eugeniu Bendelic, Dean, Faculty of Medical and Pharmaceutical Continuous Education, State Medical and Pharmaceutical University Nicolae Testemitanuâ Mrs. Vera Loghin, Deputy Director for Continuous Education, National Medical and Pharmaceutical Colegium SPEAKERS Caprara A., Agency for Public Health of Lazio Region, Rome Coclite D., Researcher, External Relations Office, ISS De Virgilio G., Head of External Relations Office, ISS Fauci A., Researcher, External Relations Office, ISS Ferrelli R., Researcher, External Relations Office, ISS Mazzaccara A., Researcher, External Relations Office, ISS Napoletano A., Researcher, External Relations Office, ISS Proietti A., Director District 3, Local Health Unit Viterbo Tosini M.L., Director Local Pharmacy, Local Health Unit Viterbo Pipino A., General Director, Local Health Unit Viterbo SCIENTIFIC SECRETARIAT MINISTRY OF HEALTH Malara P., Directorate General for EU and International Affairs Director of Office V Bilateral Agreements Tel , Parodi P., Directorate General for EU and International Affairs Office V Bilateral Agreements tel , ISTITUTO SUPERIORE DI SANITA Bertini A., External Relations Office, ISS tel , De Virgilio G., Head of External Relations Office, ISS tel , Mazzaccara A., External Relations Office, ISS tel , VENUE - National Institute of Health, Room URE 1 Via Giano della Bella, Roma - Ministry of Health Directorate General for EU and International Affairs Office V Bilateral Agreements V.le Giorgio Ribotta, Roma - Local Health Unit Viterbo Via Enrico Fermi, Viterbo 11

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