Healthcare facilities are now called upon to manage increasingly advanced technologies for diagnosis and therapy. It follows that, today more than ever, the issue of governing these technologies and the maintenance performance of the medical equipment are of central importance, because it guarantees effectiveness, timely access to care services and safety for patients and operators. The management of electromedical and laboratory equipment is the main goal of a Clinical Engineering Service (SIC) such as that of the IRCCS Ca 'Granda Ospedale Maggiore Policlinico Hospital in Milan. The Policlinico SIC organized the maintenance service by implementing a mixed model: directly coordinating the maintenance services for critical or technologically advanced equipment of authorized manufacturers and the integrated maintenance services of biomedical equipment offered through a Global Service contract, supporting some activities internally. In this organizational context, the IRCCS Ca 'Granda Maggiore Policlinico Hospital in Milan is in the position of having to sign a new Global Service contract for integrated clinical engineering services. The step considered most critical in the stipulation of Global Service contracts is to design a control system that allows monitoring and verifying compliance with the quality and service standards provided. For this reason, the client should design and explicit in the contract an effective and efficient monitoring of the services rendered. In this context take place the present thesis, made possible thanks to the collaboration, in the context of a six-month curricular internship, with the actors directly involved in the management process of electromedical equipment, and in particular with the Executive Director of the Contract (DEC) of the existing Global Service contract in the Foundation. Following an analysis of the literature on performance measures, a study of a sample of tender specifications, and preliminary analysis aimed at assessing some critical issues detected in the years of contracts with the Global Service, it was proposed a contract control system. In a context in which the control of this kind of contracts is based only on a penal system which, by its nature, is linked to individual events and applicable only a posteriori, an innovative system has been defined which, by means of the design of a formal instrument, allows to maintain control over the service rendered by the Global Service, in order to guarantee the high quality of health services related to the functioning of the medical equipment, which provide a health service for the citizen. First of all, the processes of critical importance for the achievement of a quality service delivery were defined. After that, performance control parameters were highlighted to measure their characteristic dimensions in relation to the expected service levels. These have been defined through specific performance indicators (KPI), built on the basis of the criteria suggested by the reference models present in the literature and by the regulatory standards, and customized on the strategic objectives of the Foundation, in order to overcome the limitations emerging from the existing control system in the contract. The set of parameters defined evaluates a wide range of organizational and technical characteristics of the service rendered and has the aim of allowing the monitoring of the services rendered by the Global Service, in order to evaluate the achievement of the expected performance levels, with a view to continuous improving. The planned KPIs were then calculated through a retrospective simulation for the four years preceding the expiry of the existing contract, in order to design a calculation system based on data that was actually available and usable by the Foundation and in order to have a picture of the quality of service rendered by Global Service in previous years.
Le strutture sanitare sono chiamate a gestire tecnologie sempre più avanzate per la diagnosi e la terapia. Ne consegue che oggi più che mai il tema del governo di queste tecnologie e delle prestazioni manutentive del parco tecnologico sia di centrale importanza, perché garanzia di efficacia, tempestività di accesso alle prestazioni assistenziali e sicurezza per pazienti e operatori. La gestione delle apparecchiature elettromedicali e da laboratorio è l’obiettivo principale di un Servizio di Ingegneria Clinica (SIC) come quello della Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano. Il SIC del Policlinico ha organizzato il servizio di manutenzione implementando un modello misto, coordinando in maniera diretta i servizi di manutenzione per apparecchiature critiche o tecnologicamente avanzate dei produttori autorizzati e i servizi integrati di manutenzione delle apparecchiature biomediche offerti attraverso un contratto Global Service, supportando alcune attività internamente. In questo contesto organizzativo la Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, si trova nelle condizioni di dover stipulare un nuovo contratto di Global Service per i servizi integrati di ingegneria clinica. Il passaggio ritenuto più critico nella stipulazione dei contratti di Global Service risulta essere quello della progettazione di un sistema di controllo che permetta di monitorare e verificare il rispetto degli standard di qualità e di servizio erogati. Per questo motivo il committente dovrebbe progettare ed esplicitare nel contratto un efficace ed efficiente monitoraggio delle prestazioni rese. Qui si colloca la presente tesi, resa possibile grazie alla collaborazione, nel contesto di un tirocinio curricolare semestrale, con gli attori direttamente coinvolti nel processo di gestione delle apparecchiature elettromedicali, ed in particolare con il Direttore Esecutivo del Contratto (DEC) di Global Service in essere presso la Fondazione. A seguito di un’analisi della letteratura in merito alle misure di performance, ad uno studio di un campione di capitolati d’appalto, e ad analisi preliminari atte a valutare alcune criticità rilevate negli anni di appalti con i Global Service, è stato proposto un sistema di controllo del contratto. In un contesto in cui il controllo dei contratti di questo tipo è basato soltanto su un sistema penalistico per sua natura legato a singoli eventi e applicabile solo a posteriori, è stato definito un’sistema innovativo che per mezzo della progettazione di uno strumento formale, consente di mantenere il controllo sul servizio reso dal Global Service, al fine di garantire l’alta qualità delle prestazioni sanitarie legate al funzionamento delle apparecchiature elettromedicali, che forniscono un servizio di salute al cittadino. Sono stati in primo luogo definiti i processi di critica importanza per il raggiungimento di una resa dei servizi di qualità. Dopodiché sono stati evidenziati dei parametri di controllo prestazionale atti a misurarne le dimensioni caratteristiche in relazione ai livelli di servizio attesi. Questi sono stati definiti attraverso appositi indicatori di performance (KPI), costruiti sulla base dei criteri suggeriti dai modelli di riferimento presenti in letteratura e dagli standard normativi, e customizzati sugli obiettivi strategici della Fondazione, al fine di superare le limitazioni emerse dal sistema di controllo esistente nel contratto in essere. Il set di parametri definito valuta un ampio range di caratteristiche organizzative e tecniche del servizio reso e ha l’obiettivo di permettere di monitorare i servizi resi dal Global Service, al fine di valutare il raggiungimento dei livelli prestazionali attesi, in un’ottica di miglioramento continuo. I KPI progettati, sono stati poi calcolati attraverso una simulazione retrospettiva per i quattro anni precedenti alla scadenza del contratto in essere, al fine di progettare un sistema di calcolo basato su dati che siano effettivamente disponibili e fruibili dalla Fondazione e per poter avere un quadro della qualità del servizio reso dal Global Service negli anni precedenti.
Analisi e controllo di parametri qualificativi resi dai servizi di outsourcing di manutenzione delle apparecchiature elettromedicali
SIGNORINI, MARTA
2019/2020
Abstract
Healthcare facilities are now called upon to manage increasingly advanced technologies for diagnosis and therapy. It follows that, today more than ever, the issue of governing these technologies and the maintenance performance of the medical equipment are of central importance, because it guarantees effectiveness, timely access to care services and safety for patients and operators. The management of electromedical and laboratory equipment is the main goal of a Clinical Engineering Service (SIC) such as that of the IRCCS Ca 'Granda Ospedale Maggiore Policlinico Hospital in Milan. The Policlinico SIC organized the maintenance service by implementing a mixed model: directly coordinating the maintenance services for critical or technologically advanced equipment of authorized manufacturers and the integrated maintenance services of biomedical equipment offered through a Global Service contract, supporting some activities internally. In this organizational context, the IRCCS Ca 'Granda Maggiore Policlinico Hospital in Milan is in the position of having to sign a new Global Service contract for integrated clinical engineering services. The step considered most critical in the stipulation of Global Service contracts is to design a control system that allows monitoring and verifying compliance with the quality and service standards provided. For this reason, the client should design and explicit in the contract an effective and efficient monitoring of the services rendered. In this context take place the present thesis, made possible thanks to the collaboration, in the context of a six-month curricular internship, with the actors directly involved in the management process of electromedical equipment, and in particular with the Executive Director of the Contract (DEC) of the existing Global Service contract in the Foundation. Following an analysis of the literature on performance measures, a study of a sample of tender specifications, and preliminary analysis aimed at assessing some critical issues detected in the years of contracts with the Global Service, it was proposed a contract control system. In a context in which the control of this kind of contracts is based only on a penal system which, by its nature, is linked to individual events and applicable only a posteriori, an innovative system has been defined which, by means of the design of a formal instrument, allows to maintain control over the service rendered by the Global Service, in order to guarantee the high quality of health services related to the functioning of the medical equipment, which provide a health service for the citizen. First of all, the processes of critical importance for the achievement of a quality service delivery were defined. After that, performance control parameters were highlighted to measure their characteristic dimensions in relation to the expected service levels. These have been defined through specific performance indicators (KPI), built on the basis of the criteria suggested by the reference models present in the literature and by the regulatory standards, and customized on the strategic objectives of the Foundation, in order to overcome the limitations emerging from the existing control system in the contract. The set of parameters defined evaluates a wide range of organizational and technical characteristics of the service rendered and has the aim of allowing the monitoring of the services rendered by the Global Service, in order to evaluate the achievement of the expected performance levels, with a view to continuous improving. The planned KPIs were then calculated through a retrospective simulation for the four years preceding the expiry of the existing contract, in order to design a calculation system based on data that was actually available and usable by the Foundation and in order to have a picture of the quality of service rendered by Global Service in previous years.| File | Dimensione | Formato | |
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https://hdl.handle.net/10589/154320