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Objective To identify the prevalence of the practice of defensive medicine among Italian hospital physicians, its costs and the reasons for practising defensive medicine and possible solutions to reduce the practice of defensive medicine. Methods Cross-sectional web survey. Main outcome measures Number of physicians reporting having engaged in any defensive medicine behaviour in the previous year. Results A total of 1313 physicians completed the survey. Ninety-five per cent believed that defensive medicine would increase in the near future. The practice of defensive medicine accounted for approximately 10% of total annual Italian national health expenditure. Conclusions Defensive medicine is a significant factor in health care costs without adding any benefit to patients. The economic burden of defensive medicine on health care systems should provide a substantial stimulus for a prompt review of this situation in a time of economic crisis. Malpractice reform, together with a systematic use of evidence-based clinical guidelines, is likely to be the most effective way to reduce defensive medicine.

In order to study the impact of interventions on multidisciplinary teamwork in care processes, relevant indicators need to be defined. In the present study, the authors performed a Delphi survey of a purposively selected expert panel consisting of scientific researchers and hospital managers. Thirty-six experts from 13 countries participated. Each participant rated a list of team indicators on a scale of 1–6. Consensus was sought in two consecutive rounds. The content validity index (CVI) varied from 8% to 92%. A final list of 19 indicators was generated: 5 on team context/structure, 8 on team process, and 6 on team outcomes. Most relevant team indicators were as follows: “team relations,” “quality of team leadership,” “culture/climate for teamwork,” “team perceived coordination of the care process,” and “team vision.” Scientific researchers and hospital managers that want to study and improve multidisciplinary teamwork in care processes should primarily focus on these team indicators.

The European Quality of Care Pathway (EQCP) study is the first, international, cluster randomized controlled trial launched to study the effect of the implementation of care pathways and to study why and under what circumstances pathways work. The study will be performed in Belgium, Italy, Ireland and Portugal and will include individual studies: a trial including chronic obstructive pulmonary disease patients, a trial including proximal femur fracture patients and a trial focusing on multidisciplinary teamwork within both populations. The study is managed by the European Pathway Association in close collaboration with a multidisciplinary team of the Catholic University Leuven (Belgium), the University of Eastern Piedmont (Italy), the National School of Public Health Lisbon (Portugal) and the Health Services Executive in Dublin (Ireland). This paper will describe the history, project management and overall approach of this international study.