What was the most useful governance change in the Lazio Region in terms of managing the pandemic?
The most useful change definitively was reducing the “distances” and shortening the chain of command and governance that involved all the public and private stakeholders of the healthcare system. It was the key to physically zero the distances and to begin projects that could rapidly implement changes on individual companies. Logistically, that meant holding a daily videoconference, for at least one hour, with all the general directors of the ASLs (Local Healthcare Agencies), the hospitals, the university polyclinics, the accredited private facilities and the public facilities in order to stay constantly up to date. This led to faster communications and the ability to act on the individual realities of local services provision without any administrative or bureaucratic barriers.
Based on the experience of the Lazio Region, how should healthcare governance change on a national level?
We should review the management of these pandemic-related crises, both nationally and at the European level. There is an ever-increasing need for a shorter governance chain and for leaner authorities that can make rapid decisions, impacting individual local services provision. Instead, during this pandemic the Ministry of Health, the Department of Prevention, the Italian Institute of Health, the National Health Council, the Technical Scientific Committee and- whenever the matter involved drugs- the Italian Medicines Agency all agreed on the same point: the chain of command truly is too long and it risks not to produce the desired outcomes.
Is this point also valid for Europe?
It’s important to rethink governance at the European level too. The goal of the commission working to create a European Agency for Healthcare Safety (the HERA) is heading towards this direction, as we know that unfortunately a fragmented territory means slower decision-making and a higher number of chains of command. We suggested for the agency to be based in Rome, within the area of the former Forlanini Hospital and the adjacent Spallanzani Institute, also given the role that Italy played in the management of this pandemic. Even at the European level there was no unique voice that spoke clearly about pandemic-related topics. An example of this is the fact that there are countries that, despite being part of Europe, approved vaccines developed outside the European context. Furthermore, European countries applied the same measures related to the same drugs differently. In France the AstraZeneca vaccine is administered to the under-70s while in Italy it was first given to the under-55s and now to the under-65s, which highlights how greatly fragmented Italy is. We need to redesign a strategy and employ a lean management body.
Thanks to the collaboration with ReiThera, the Lazio Region invested on a strategy centred on public-private funded research to develop vaccines. How do you think research governance will change after this crisis?
This emergency shed light on the fact that research on vaccines takes place mostly through private companies: these big organisations in fact influence even the decision-making processes of individual countries. We should do the opposite and plan for research to be centred on its public facilities/providers, perhaps by acting on the partnership with privately funded research. That’s a crucial topic that definitively needs to be addressed.
How can we overcome the challenges that the healthcare system is dealing with due to the crisis?
We should be able to overcome them by reviewing the provision of local healthcare services and the relationship with primary physicians, evolving the digitalisation of telemedicine and remote monitoring processes. We should also rethink our habits, living places and workplaces. We need to employ new resources and revolutionise entire sectors.
Edited by Rebecca De Fiore