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The aim of this study was to review experiences of use of the Lean methodology in the hospital setting and assess the impact of the interventions in terms of time of processes, productivity, effects on staff and patientd satisfaction.PubMed, Scopus and CINAHL databases were searched to identify studies evaluating the lean methodology. Two reviewers screened the citations identified and extracted data according to the PRISMA methodology.In total, 635 citations were identified, of which 27 were included in the present review. Most studies showed a positive outcome related to the implementation of the Lean methodology and tools.

The Day Service was established in Italy to promote appropriateness of care and consists in the delivery of packages of complex outpatient services. A Working Group for the continuous improvement of pre-hospitalization activities of the Regina Elena Scientific Institute in Rome, Italy, established that the outpatient management of surgical patients in the hospital would occur in a Day Service, through a package of services identified at the regional level or appropriate diagnostic and therapeutic pathways. This article describes the experience of the hospital's Day Service and compares results from the last four months of 2013 with those of the first four months of 2014. The introduction of a Day Service has led to a reduction in the number of inappropriate pre-admission tests (mainly computerized tomography, magnetic resonance and Positron emission scans and scintigraphy) and this has had a positive impact not only in terms of organization, reduction of hospital stay and overall hospitalization-related activities, but also from an economic standpoint. The implementation of a Day Service has also improved the overall patient experience, from an organizational point of view, and this is an important aspect, considering that patients at the Regina Elena Scientific Institute are oncological patients, they are often elderly and most reside in other Italian regions.

Medical malpractice and litigation have a significant impact on the Italian National Health Service. The aim of this study was to analyze the state of the art of medical errors in Italy, in particular, assessing which specialties are most affected.We performed a literature search in PubMed, Google Scholar; institutional websites (Ministry of Health, Higher Institute of Health, National Agency for Regional Health Services, National Institute of Statistics, National Research Council, Court of Auditors), gray literature and specialized magazines.Results show that data regarding the frequency of medical errors and the effectiveness of prevention measures in Italy are scarce. Most papers published on this topic refer to a few specialties, including Surgery, Radiology, Cardiology, and Laboratory medicine. Surgery is the specialty most affected.Despite a growing attention towards patient safety and quality of healthcare, medical errors continue to occur in clinical practice. Most errors are not due to individual incompetence or negligence but they are rooted in system breakdowns. A systematic approach is therefore required, based on: an analysis of critical aspects in the system; the selection and implementation, at different levels of the system, of appropriate and evidence-based risk management interventions involving all stakeholders; a context analysis to identify barriers and facilitators for change; a performance assessment to verify results and identify actions for improvement.

Public Health (PH) and Primary Health Care (PHC) need to be better integrated, at different levels of the healthcare system, in order to improve health and social outcomes. The aim of this study was to review international models and approaches supporting the integration of PH and PHC and to classify these according to their main focus. A literature search was performed using the main scientific databases, to identify national and international journal publications regarding models to support integration between PH and PHC. The final set of the documents provided a broad coverage of the topic. Four models of integration were identified: general integration, chronic disease prevention, targeted prevention or care delivery and infection control. Models differed in their levels of implementation, stages of development and focus. This review, by classifying the main characteristics and results of the experiences retrieved, indicates a relatively scarce use of integration models in the global health care landscape, with the exception of Canada. In fact, Canada has been a leader in developing models of integrated health systems that combine tailored approaches to influence personal health behaviour and community-oriented approaches to influence the health of the population. The review also revealed a general lack of experience in evaluating the sustainability of integration between PH and PHC, not only in terms of cost-effectiveness, but also in terms of better health and work conditions and self-perceived quality of care in the population. Collaboration between PH and PHC seems to be an important strategy for achieving principles of equity and access in health care and for ensuring a more equal distribution of health care services.

In the last few years, the need of public reporting of health outcomes has acquired a great importance. The public release of performance results could be a tool for improving health care quality and many attempts have been made in order to introduce public reporting programs within the health care context at different levels. It would be necessary to promote the introduction of a standardized set of outcome and performance measures in order to improve quality of health care services and to make health care providers aware of the importance of transparency and accountability.

The stewardship model has been adopted as a system of governance in several countries. In Italy, the Ministry of Health has proposed the use of the stewardship model for implementing the activities of the National Prevention Plan 2010-2012. The authors present the conceptual foundations and methodology used in the development of an assessment tool (audit tool) for evaluating the level of implementation of the stewardship model with regards to the activities of the national prevention plan in all Italian regions.

Pay for Performance is a tool that links payment of healthcare professionals to the quality of health outcomes and processes. In this article the authors discuss the results of a literature review on the subject, highlighting the importance of introducing a Pay for Performance system in primary care, and the advantages and critical issues associated with the system. The experience of the British National Health Service and possible uses of the described payment system in Italy are also briefly discussed.

The aim of this study was to evaluate the association between socio-demographic variables and hospital admissions at high risk of inappropriateness. Hospital discharge data for patients admitted to hospitals in the province of Caltanissetta in the Sicily Region (Italy) in the years 2007-2008 was obtained from the healthcare system database of the Region. Only acute care admissions of1 day duration and regarding patients ? 1 year of age were considered. Data regarding gender, nationality, age, marital status was collected for each admission as well as name of the local health authority in which the patient was registered. Univariate and multivariate analyses were performed using Chi-square and multivariate logistical regression analysis (Hosmer e Lemeshow) Fourteen percent (8.220/58.561) of admissions were found to be at high risk of inappropriateness, which was associated with patient age [1-15 years and 46-65 years OR : 1,55 (I.C. 95%: 1,42-1,69) and 1,62 ( I.C. 95%: 1,53-1,72) respectively], marital status [married OR1,46 (I.C. 95%: 1,38-1,53)], place of residence [patients from the Caltanissetta local health authority OR: 1,22 (I.C. 95%: 1,15-1,30)] and nationality [Italian OR: 2,19 (I.C. 95%: 1,40-0,87) ].

A study was performed to examine the epidemiology of domestic accidents in Sardinia (Italy). A questionnaire was administered to mothers of public school students attending elementary and middle classes during the 2006-2007 school year. Overall 2.075 mothers (59,3% of eligible mothers) participated in the study, 400 (19,3%) of whom declared having had a domestic accident during the previous year. The most frequent lesions were those of the upper (58%) and lower (24%) extremities. Geographical origin and school attended by the student were both found to be statistically associated with domestic accidents.

A cross-sectional study was performed to assess the frequency of burnout in healthcare workers of a university teaching hospital in Rome (Italy), by means of the Maslach Burnout Inventory. In total 142 healthcare workers participated in the study. Average levels of emotional exhaustion and depersonalization were observed in the study population. Working in emergency care services was found to be correlated with lower levels of personal accomplishment with respect to working in other services. Monitoring burnout in social service and healthcare workers is an effective tool for identifying critical situations in the workplace.