No abstract

This article focuses on the changes in the Italian NHS by concentrating on patterns in the managerialisation of doctors. It addresses a series of shortcomings in studies on the response by doctors to managerialisation. The first is a shortcoming of theoretical and analytical nature. It is necessary to adopt a broader perspective whereby analysis considers not only the interaction between doctors and managers, but also the public control and regulation agencies that operate in that field. The second shortcoming is a methodological one. The literature on managerialisation is more theoretical than applied. It is necessary to adopt a strategy based on a plurality of methodologies and sources in order to focus attention on a national case (Italy in the present study), discussing the changes over time (from the beginning of managerialisation until today) and considering different groups within the medical profession. The outcome is a complex picture of the dynamics between doctors and managers which foregrounds the managerial co-optation processes of a small group of national health service doctors, the transition from strategic adaptation to forms of resistance against managerialisation by the majority of Italian NHS doctors, and the emergence of restratification processes among self-employed doctors working with the NHS.

La prima tesi che l'articolo intende sostenere è che il settore sanitario pubblico conosce, dopo la crisi finanziaria del 2007 e fino al 2019, un processo di crescente flessibilizzazione del lavoro. Si tratta di una flessibilità numerica (nel numero degli addetti e nel tipo di contratti di lavoro), anziché di una flessibilità funzionale. Quest'ultima, infatti, è difficile da attuare in un settore ad alta percentuale di lavoro professionale, con forme di autoregolazione spesso corporative. Con la seconda tesi, relativa al periodo pandemico, si sostiene che tra il 2020 e il 2021 si sono prodotte politiche del lavoro nel SSN ancor più flessibili, con una ulteriore deregolazione dettata dall'emergenza. La domanda conclusiva riguarda quanto il Piano di rilancio e resilienza (PNRR) emanato nel 2021 e la nuova legge di Bilancio per il 2022 possano essere in grado di dare una inversione di tendenza al ciclo lungo di flessibilizzazione del lavoro inseritosi anche nel settore sanitario pubblico.

Abstract:The aim of this article is to reconstruct the process of professionalization of Italian dentists and the profession's current configuration. It is based on three lines of inquiry. The first line adopts a historical perspective through the analysis of legislation that has regulated the dental sector over time. The second line depicts the current configuration of the profession through institutional and sectoral statistics. The third line focuses on the impact of the 2008 economic crisis, using the main findings of a survey conducted among the profession's representatives. The economic crisis has exacerbated the profession's structural weaknesses caused by the difficulties associated with self-regulation and by organizational-managerial inefficiency. Given this situation, one may inquire as to the actual professional nature of dentistry in Italy: It is not pointless to ask whether-and, if so, what type of-professionalism exists in dentistry in Italy today.

Résumé Objectif : Présenter une expérience innovante d’éducation thérapeutique ( family learning socio-sanitaire – FLSS) et son acceptation de la part des participants dans une région italienne : Les Marches. Méthodes : Organisation d’un parcours d’éducation thérapeutique des patients (ETP) présentant une maladie pulmonaire obstructive chronique et de leur famille. Définition des critères d’inclusion et d’exclusion dans la formation du FLSS ; élaboration de fiches d’évaluation concernant l’acceptabilité, la satisfaction et l’utilité de la formation. Remplissage de ces fiches par les participants (patients et familles). Résultats : L’acceptabilité du FLSS a été démontrée par l’assiduité des patients et des familles aux cours de formation. Les résultats témoignaient de l’appréciation de l’organisation du FLSS, de sa conduite par les experts et le tuteur et des sujets traités. Les participants ont jugé qu’ils ont acquis une connaissance majeure sur la maladie et sur l’utilisation de certaines pratiques quotidiennes pour la gérer. Le résultat le plus apprécié concernait les dynamiques relationnelles aussi bien internes qu’externes à la formation. Conclusion : La réalisation de la première formation en 2010 constitue une phase intermédiaire dans le processus d’expérimentation et d’évaluation du FLSS. Sur le plan de l’organisation et sur le plan théorique-scientifique, on peut avancer quelques considérations. D’un côté, la formation apparaît peu coûteuse et capable de faciliter l’intégration socio-sanitaire ainsi que l’auto-tutelle des individus et des familles. De l’autre, le FLSS se différencie des programmes de self-management mis en place aux USA et en Grande-Bretagne (éducation thérapeutique du patient). Prat Organ Soins. 2012;43(3):187-195