This thesis addresses the main criticalities affecting Clinical Governance during the Covid-19 pandemic. The two areas of analysis are the RT-PCR tests and the vaccination campaigns: the two protagonists of the fight against the new virus. RT-PCR tests are the diagnostic tool adopted to control the spread of the infection; an in-depth study of the process has been fundamental to increase their reliability and limit false results. In particular, potential sources of risks were found out, collected, and analyzed through an ad-hoc FMECA toolkit. It consists of a sources document containing all the information to fill a second file, the FMECA tool. The sources of information come from literature, experts, and incident reporting provided by the Lombard laboratories. The final output is a 134 events database for which causes, consequences, effects on the patient, and mitigation actions have been associated with coverages respectively of 96%, 15%, 16%, and 49%. The toolkit is reserved for the use of all the Lombard laboratory facilities, which will take advantage of a standardized tool for risk assessment. In this way, they will be able to reduce the most frequent errors and improve the RT-PCR process. Vaccines represent the worldwide selected strategy to prevent the further spread of the pandemic; States rushed to prepare adequate massive vaccination plans for coping with the situation, which turned out to be different in several aspects. For this reason, the study aims at evaluating the main characteristics of the vaccination campaigns, comparing them, and determining which one had the best results. The analysis is limited to Italy, and the selected regions are Lazio, Liguria, Lombardy, and Piedmont. The methodology concerns the creation of a framework as the baseline of analysis. It needs to consider: the context elements, the key elements of the plans (demand management, operating model, governance, IT services, and communication plan), and operational and health performances. The web open sources constitute the input data for the filling of the framework. The degrees of coverage obtained are 45% for Lazio, 44% for Liguria, 55% for Lombardy, and 49% for Piedmont. After singularly analyzing and comparing the regions, Lombardy results to be the most efficient in vaccine administration. The study enhances the standardization and facilitates the management of critical resources, which are two of the main Clinical Governance issues of the COVID-19 pandemic.
La tesi è volta a studiare le maggiori problematiche affrontate dalla Governance Clinica durante la pandemia Covid-19. I due ambiti di analisi sono i RT-PCR tests e i piani vaccinali, i due protagonisti per la lotta contro il nuovo virus. I RT-PCR tests sono lo strumento diagnostico adottato per controllare la diffusione della pandemia; per aumentarne l’affidabilità e limitare i falsi risultati, è stato svolto uno studio approfondito del processo. In particolare, le potenziali fonti di deviazione di processo sono state collezionate ed analizzate tramite un FMECA toolkit, creato ad-hoc. Il toolkit è costituito da un file sources contenente le informazioni da inserire in un secondo file, la FMECA tool. Le fonti di informazione sono costituite da letteratura, esperti e segnalazioni di incidenti derivanti dai laboratori lombardi. L’output finale è un database di 134 eventi ai quali sono stati associati cause, conseguenze, effetti sul paziente e azioni di mitigazione con coperture rispettivamente del 96%, 15%, 16% e 49%. Il toolkit è riservato a tutte le strutture laboratoriali lombarde, le quali potranno usufruire di uno strumento standardizzato per la valutazione del rischio. In questo modo, sarà possibile ridurre gli errori più frequenti e migliorare il processo. I vaccini rappresentano la strategia scelta a livello globale per prevenire l’ulteriore diffusione della pandemia; gli stati si sono precipitati a preparare dei piani vaccinali adeguati, i quali sono risultati essere differenti per diversi aspetti. Lo studio mira a valutare le principali caratteristiche dei piani, confrontarle e determinare quale campagna vaccinale ha avuto i risultati migliori. L’analisi è limitata all’Italia e le regioni approfondite sono Lazio, Liguria, Lombardia e Piemonte. La metodologia consta nella definizione di un framework di analisi formato da elementi di contesto, elementi chiave del piano (gestione della domanda, modello operativo, governance, servizi IT e piano di comunicazione) e prestazioni operative e sanitarie. Il framework è stato compilato tramite le fonti web disponibili e i gradi di copertura ottenuti sono 45% per il Lazio, 44% per la Liguria, 55% per la Lombardia e 49% per il Piemonte. Dalla analisi sia individuale sia comparativa tra le regioni, la campagna lombarda è risultata la più efficace. In conclusione, lo studio incrementa la standardizzazione e facilita la gestione delle risorse critiche, i quali sono due dei maggiori problemi della Clinical Governance rispetto la pandemia di COVID-19.
Addressing clinical governance issues of Covid-19 : analysis and solutions for the Italian health system
VIGANÒ, BEATRICE;TAMPIERI, ARIANNA
2020/2021
Abstract
This thesis addresses the main criticalities affecting Clinical Governance during the Covid-19 pandemic. The two areas of analysis are the RT-PCR tests and the vaccination campaigns: the two protagonists of the fight against the new virus. RT-PCR tests are the diagnostic tool adopted to control the spread of the infection; an in-depth study of the process has been fundamental to increase their reliability and limit false results. In particular, potential sources of risks were found out, collected, and analyzed through an ad-hoc FMECA toolkit. It consists of a sources document containing all the information to fill a second file, the FMECA tool. The sources of information come from literature, experts, and incident reporting provided by the Lombard laboratories. The final output is a 134 events database for which causes, consequences, effects on the patient, and mitigation actions have been associated with coverages respectively of 96%, 15%, 16%, and 49%. The toolkit is reserved for the use of all the Lombard laboratory facilities, which will take advantage of a standardized tool for risk assessment. In this way, they will be able to reduce the most frequent errors and improve the RT-PCR process. Vaccines represent the worldwide selected strategy to prevent the further spread of the pandemic; States rushed to prepare adequate massive vaccination plans for coping with the situation, which turned out to be different in several aspects. For this reason, the study aims at evaluating the main characteristics of the vaccination campaigns, comparing them, and determining which one had the best results. The analysis is limited to Italy, and the selected regions are Lazio, Liguria, Lombardy, and Piedmont. The methodology concerns the creation of a framework as the baseline of analysis. It needs to consider: the context elements, the key elements of the plans (demand management, operating model, governance, IT services, and communication plan), and operational and health performances. The web open sources constitute the input data for the filling of the framework. The degrees of coverage obtained are 45% for Lazio, 44% for Liguria, 55% for Lombardy, and 49% for Piedmont. After singularly analyzing and comparing the regions, Lombardy results to be the most efficient in vaccine administration. The study enhances the standardization and facilitates the management of critical resources, which are two of the main Clinical Governance issues of the COVID-19 pandemic.| File | Dimensione | Formato | |
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https://hdl.handle.net/10589/180111