Assessment for improving the performance of NICUs: The Italian experience

Abstract

This paper describes neonatal intensive care units (NICU) in Italy using a set of organizational variables identifying management profile. The correlations between variables, and how these are impacted by structural aspects of the department or hospital, are investigated. The research was conducted within the 5-year far-reaching and complex SONAR study run by the Italian Neonatal Network, which maps NICU, monitors outcomes of member centres, defines organizational models, and identifies best practices to improve care quality. Seven variables relating to activities, organization processes, and behaviour models used in the SONAR study were used here to assess NICU. Data from 54 Italian NICUs, 1601 nursing staff, and 643 doctors were used. We identified high levels of variation in NICUs for all aspects of organization. We also identified important opportunities for improvement, especially in the areas of performance measurement, quality improvement, and learning for healthcare staff. In terms of structural characteristics, we identified big differences between NICUs in the north and south of Italy. The findings provide a description of NICUs in Italy and identify a set of variables useful for management in assessing NICU, which are among the most complex and costly operational units in a hospital.

Managerial features and outcome in neonatal intensive care units: results from a cluster analysis

“…We found that NICU personnel endowment is not directly linked to managerial models. Of course, specific local elements such as staff allocation problems or lack of specialist skills among staff can impact on the allocation of personnel to NICU [20], but comparison with staff in other NICUs could be useful in drafting policy for reducing costs without compromising quality. Finally, the level of complexity of the cases is not a particular feature of any cluster.…”

“…This study uses the system developed by Øvretveit for WHO [8]. Many scholars consider the framework described in the WHO study as a positive example for defining managerial features to improve health outcomes [15][16][17], although it requires adaptation to specific contexts [18][19][20].…”

Managerial features and outcome in neonatal intensive care units: results from a cluster analysis

“…It thus captures the rst area of the managerial model: "Performance and results review". Previous studies have used case complexity as a performance indicator [20,33]. The United Kingdom Neonatal Sta ng Study Group also suggests that case complexity, together with random chance and care quality, is one of the main elements leading to variability in outcomes in neonatal care [34].…”

Managerial features and outcome in neonatal intensive care units: results from a cluster analysis

“…It thus applies to the first area of the managerial model: "Performance and results review". Previous studies have used case complexity as a performance indicator [20,33]. The United Kingdom Neonatal Staffing Study Group also suggests that case complexity, together with random chance and care quality, is one of the main elements leading to variability in outcomes in neonatal care [34].…”

“…We found that NICU personnel endowment is not directly linked to managerial models. Of course, specific local elements such as staff allocation problems or lack of specialist skills among staff can impact on the allocation of personnel to NICU[20], but comparison…”