Lega Federico
Bocconi University, Milan, Italy.
Health Policy. 2008 Feb;85(2):252-62. doi: 10.1016/j.healthpol.2007.07.010. Epub 2007 Sep 14.
Clinical Directorates (CDs), in the sense of "intermediate organizational arrangements through which defined parts of larger hospitals health services are managed", were introduced in the Italian National Health Service (INHS) by law after the major reform of 1992. By means of such reform, accountability chains within INHS hospitals were streamlined. Changes looked at strengthening the role of management in hospitals as a strategy to improve efficiency in the provision of services. From this stream of managerialism emerged the attempts to re-organize hospital activities along the lines of clinical directorates. The aim of this paper is to outline the context in which CDs initially developed in Italy as the "one best way" to address current hospital problems and the reasons why they are now challenged due to not coming up to expectations. To do so we run through the last 10 years of history of CDs in Italy and propose an interpretative framework to understand the grounds for their partial failure and success.
临床科室（CDs），从“对大型医院卫生服务的特定部分进行管理的中间组织安排”这一意义上来说，是在1992年重大改革之后由法律引入意大利国家卫生服务体系（INHS）的。通过此项改革，INHS医院内部的问责链得以简化。这些变革着眼于强化医院管理的作用，将其作为提高服务提供效率的一项策略。从这种管理主义思潮中产生了按照临床科室的思路对医院活动进行重组的尝试。本文的目的是概述CDs最初在意大利发展起来作为解决当前医院问题的“最佳方式”的背景，以及它们如今因未达预期而受到挑战的原因。为此，我们梳理了意大利CDs过去10年的历史，并提出一个解释框架来理解它们部分失败和成功的原因。
