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Titolo Implementation and Management of Strategies to Set and to Achieve Clinical Targets
Autore Bernard Canaud, Ciro Tetta, Daniele Marcelli,Guido Giordana, Stefano Stuard, Katrin Koehler, Flavio Mari, Carlo Barbieri, Miryana Dobreva, Andrea Stopper and Emanuele Gatti
Referenza "Hemodialysis", book edited by Hiromichi Suzuki, ISBN 978-953-51-0988-4, Published: February 20, 2013 under CC BY 3.0 license - http://dx.doi.org/10.5772/53041

Every care process and particularly chronic care has to be centered on patients; therapeutic performance should therefore be measured on outcomes and not on inputs and/or procedures. This holistic approach of organizational models shall encompass all therapeutic aspects. Full availability of data and transparency are fundamental to make this patient orientation possible and long term sustainable for all involved stakeholders. Furthermore data will allow the extensive use of tools like the Balanced Scorecard and CQI. Tools of the domain of Computational Intelligence will help to develop unconsidered working hypothesis that could open to physicians new horizons of clinical research and improve understanding of functional processes in an “in vivo” environment at affordable costs. Collecting comparable and meaningful data requires the adoption of therapeutic protocols and the extensive use of guidelines. This will not lead to mere standardization and flattening of clinical activity but to a conscious personalization of clinical path. In complex models, with multiple correlated variables, consistent implementation of standards is fundamental to isolate the therapeutic change doctors want to initiate. In an environment of limited resources. their correct utilization could reduce the number of therapeutic errors with consequent reduction of waste of chances for the patient, doctor time, pharmaceutical and biomedical therapies. This would be reached through induction of error-free behaviours, increase of doctor time dedicated to real relevant things (e.g. using proven algorithms instead of calculating every time therapetic effort) and a patient orientation focused on relevant issues. A strong distinction has to be made between formal and substantial adoption and application of guidelines: it is not about formally adopting a given guideline, it is much more about their correct and consistent implementation and maintenance along the years. In this sense, it has to be highlighted role and relevance of training and continuous education.

Finally, the complex nature of systems like the ones dealing with chronic illness care has to be considered. Complex systems tend to adapt to changes and to adsorb variations; the focus on execution and the application of guidelines tend to decrease and/or reduce their marginal benefit. To achieve the step from performance measurement to performance management, it is necessary to understand the real nature of KPIs as projects, with a start, an execution and an end according to a certain plan and with given resources. And to be ready to exchange new vs. old KPIs as soon as the project target has been achieved (e.g. when the KPI tends to saturation).

Data 26.02.2013
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