Il performance management nei Dipartimenti di salute mentale (DSM) : proposta di un cruscotto multidimensionale e prospettive di implementazione

Il tema della misurazione e della valutazione delle performance delle attivit\ue0 sanitarie \ue8 oggi centrale non solo a livello aziendale ma anche a livello di singole partizioni organizzative. Dipartimenti, distretti, unit\ue0 operative sono chiamate a sviluppare sistemi e strumenti di performance management basati sulle proprie esigenze informative, allo scopo di supportare il middle management a migliorarne la gestione e orientare i comportamenti dei clinici. Questo lavoro di ricerca propone un cruscotto di valutazione delle performance costruito per i Dipartimenti di Salute Mentale, che mira a superare i gap riscontrati in letteratura e nell\u2019applicazione pratica di sistemi di performance management destinati a tale tipologia di dipartimenti. La definizione e la validazione del cruscotto ha, inoltre, coinvolto esperti del settore tramite focus group. Nelle conclusioni sono discussi le prospettive e i limiti dell\u2019applicazione del cruscotto multidimensionale.Performance management in Mental Health Departments: a proposal for a multidimensional dashboard and considerations for implementation. Performance management is a central topic for health care sector, not just at corporate level but also for each organizational unit. Clinical directorates, healthcare districts, and clinical units must develop performance management systems and tools based on their peculiar needs of data and information in order to support middle managers' decisions, and orient clinicians' behaviors. This research proposes a multidimensional dashboard for Mental Health Departments. The proposal aims to overcome literature gaps and failures in implementation of performance management tools in this sector. The definition and validation of the multidimensional dashboard have involved several experts through a series of focus group. In conclusion, the authors discuss prospects and limits for implementation of this multidimensional dashboard

The SIEP-DIRECT'S Project on the discrepancy between routine practice and evidence. An outline of main findings and practical implications for the future of community based mental health services.

Aims: To highlight the major discrepancies that emerged between evidence and routine practice in the framework of the SIEP-DIRECT'S Project (DIscrepancy between Routine practice and Evidence in psychiatric Community Treatments on Schizophrenia). The Project was conducted in 19 Italian mental health services (MHS), with the aims of: (a) evaluating the appropriateness of the NICE Guidelines for Schizophrenia in the Italian context, (b) developing and testing a set of 103 indicators that operationalised preferred clinical practice requirements according to the NICE Guidelines, and (c) evaluating their actual application in Italian MHSs. Methods: The indicators investigated five different areas: common elements in all phases of schizophrenia; first episode treatment; crisis treatment; promoting recovery; the aggressive behaviour management. Results: The NICE recommendations examined were judged in most instances to be appropriate to the Italian MHS context, and the indicators fairly easy to use. The more severe and frequently encountered evidence-practice discrepancies were: lack of written material, guidelines, and information to be systematically provided to users; lack of intervention monitoring and evaluation; difficulty in implementing specific and structured forms of intervention; difficulty in considering patients' family members as figures requiring targeted support themselves and who should also be regularly involved in the patient care process. Conclusions: The key actions to be undertaken to favour implementation of evidence-based routine practices are: focussing on mental illness onset and family support/involvement in care; planning training activities aimed at achieving specific treatment goals; encouraging MHS participation in evaluation activities; identifying thresholds for guideline application and promoting specific guideline implementation actions; and activating decision making and resource allocation processes that rely more strictly on evidence and epidemiological assessment. These considerations are of value for rethinking the model of community psychiatry in Italy as well as in other countries