Chapter 2

the hierarchical and management role of the Department Chief; the organizational and
management purposes underlying this renewed interest in the hospital Department, in
recent years, require that more powers be handed over to the managers and that the subordinate
Operating Units be obliged to jointly plan and manage the Department’s objectives
and resources; obviously, in this case, the following aspects become very important,
the appointment of the Department Chief, his or her legitimation by the health enterprise
board, the effective operation of the department bodies, and the implementation of structured
programming, management and result-assessment processes;
d) a more recent (essentially conceptual) approach is focusing on diminishing the hospital
department’s role as a form of organization and viewing it primarily as a management
support tool; this is an attempt to refocus the reorganization process onto its clinical and
professional components.
2. Also with regard to health care services, another key aspect of the reorganization process
in recent years has concerned the local services. Unlike hospitals, in this case the
formal solutions are highly heterogeneous because, at the establishment of the health
enterprises, the services were very differently organized and developed, geographically.
Despite the fact that the applicable legal provision (Legislative Decree 229/1999) re-iterated
and strengthened the core importance of the so-called ‘social and health care district’
(distretto socio-sanitario), not only as the physical provider of the services, but also
as a model for collecting information on the health care needs of the local communities,
the reorganization processes put into place by the health enterprises have not been
straightforward and have had to take account of two criticalities, as follows:
- on the one hand, the existence, within the local services, of structural departments (in
the fields of Mental Health, Maternity and Childcare, Rehabilitation, Addictions,
Prevention, etc.), which inevitably create a matrix based organization crossing the geographical
dimension of the district with the specialist-functional dimension of the single
fields of action; now, since the departments, in most cases, are more consolidated than
the districts, from an organizational and professional point of view, they naturally form the
stronger axis in the matrix;
- on the other hand, the more contingent and networked feature of the district model,
compared with the hospital department, and, therefore, the greater difficulty of filling it
with content; districts, in fact, unlike departments, are not the result of the grouping together
of pre-existing or similar structures, but of the need to rethink, integrate and differently
provide services that can be highly heterogeneous, or of the introduction of new
services; to organize a district means to build a network of services comprising primary
care, continuing care, between the hospitals and the communities, the integration of
social and health care services, managing pharmaceutical expenditure, etc. These are all
areas that one can hardly think of as “models”, but which require an enormous capacity
of adaptation and ad hoc planning, based on the characteristics of the local communities,
of the degree of development of the public and private sector service providers, but
also of the health care cultures and behaviours within the communities.
Hence, in this case, unlike the case of hospitals, the quest for new organizational arrangements,
at local level, is still under way. Moreover, it has become increasingly clear, in
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