Abstract Chapter 13

As a consequence of recent institutional changes (mergers, definition of minimum volume standards for clinical units, development of clinical networks, etc.) and of pressure on clinical outcomes, healthcare organizations are increasingly called to define tools for the mapping and government of professionals’ clinical competences. Chapter 13 investigates this lever of clinical governance, which lies at the crossroads of different organizational line functions (directorates and clinical unit) and staff functions (personnel management and organizational development, quality / accreditation and clinical risk, operations management). The research has analyzed four cases studies of public and private healthcare organizations, which pioneered the introduction of logics and tools for the assessment of clinical competences: "Maggiore della Carità" Teaching Hospital in Novara, Trento LHA, Istituto Clinico Humanitas and the European Institute of Oncology. The analysis compared the goals of the different systems (quality and safety, personnel development, strategic governance of the production lines), their specific characteristics (integration with systems to monitor outcomes, verification of minimum volume standards, presence of a system of privileges for specific procedures/activities), the focus (surgical / interventional or even medical field). It also investigated the main critical issues and success factors of the four experiences. If in the past professionals traditionally managed the assessment and nurturing of clinical competences, today this activity has become a key element of the clinical governance strategies that healthcare organizations should to implement. The potential of information systems make this possible. Therefore, time is ripe today for an "intentional" management of the clinical competences of the clinicians, and – we believe - the four cases analyzed will offer useful elements of reflection for other organizations of the Italian NHS.