Quality improvement measures adopted by the Italian National Health Service

The reform process underway within the Italian National Health System is ai med at making decision makers responsible for appropriate and efficient res ource utilisation and at ensuring quality of care, eliminating conflict bet ween fairness, qualify and cost control. The risk for the quality of the se rvices provided entailed by resource rationalisation is avoidable and contr ollable. This article explains how the Italian NHS has managed the reform process as suring qualify improvement, and describes the policy and the tools adopted. As well as involving all players and the system as a whole in constant impr ovement, the Italian NHS's policy in pursuing qualify of care is based on t he adoption of a wide range of measures: measurement of health care and of clinical outcomes, systematic data collection, team work and protocols. The fools adopted, currently under implementation, to support quality contr ol are: an integrated system of indicators for measuring efficiency and qua lity of NHS structures (demand and accessibility indicators, resource relat ed indicators, activity indicators and result indicators); compulsory accre ditation as a prerequisite for health care providers; a system to monitor a nd control the effects of the new prospective payment system; clinical guid elines (each related to a specific clinical problem); a menu of services (C arta dei Servizi) released by all NHS accredited service providers with ful l information and warranties regarding the services provided and their qual ity.