Using abm in managing territorial health services: the “home-care”.
In recent years in Italy, as in other European countries, profound changes have been introduced in health care at both the central and the regional levels. Most of them were oriented towards a shift from “hospital-centred” healthcare to healthcare based more on territorial services. This transition pursues two objectives: giving more effective responses to citizens’ needs and reducing public health expenditure. Changes that involve organizational structure must also be carried out with the introduction of measurement tools that can help in planning and can control the changes. Starting from the experiences of the healthcare system of the Tuscan Region of Italy, the paper aims to provide an experience of the ABM approach to measure both output and efficiency of territorial health services. Activity Based Management provides an appropriate method to examine territorial activities and to meet the fact-finding needs of national and regional policy, by considering the issues indicated by the territorial managers of the Tuscan healthcare system and the regional and national experiences in recent years. ABM focuses on managing activities as the route to improving value for users and for the local healthcare unit; this is accomplished by the measurement of activities and resources that determine the costs and performance of territorial services. This approach requires organization and integration of sets of data belonging to different systems such as financial and operational systems. The ABM model is complex but it can be used by policy makers for strategic perspective and for continuous improvement. Moreover, ABM meets managers’ demands, as the Tuscan territorial managers have confirmed in interviews. On the basis of experience obtained in territorial long term homecare , the paper underscores the principal issues arising from the process of conducting an ABM project in territorial health services through strong involvement of healthcare workers. The paper also presents the main outputs achieved.