TECHNICAL GOVERNANCE
Table 3. Assets and logistics. Function
organisation 3
Parameter Parameter 1
2
Requirement Extension Buildings Executive Mobility Donations Cadastral ‘S’ with beds engineers/ manager )
(m2 First level: Small hospital
Second level: I and II level complexity
detached buildings
Third level: I and II level complexity Large hospital Over One or complex that 200,000 more manages several
principals, polyclinics
of the assets managed, the territories served, the complexity of the technologies installed, and the professional skills available, health authorities together or vast area organisational structures may be adopted. Regions may also set up specialised
structures on particularly complex activities (design, preparation of tenders, energy management, fire prevention), which provide support to all regional health authorities and hospitals. On the other hand, in the case of
companies that have jurisdiction over vast territories or that include numerous or highly complex units, an operational organisation on a zonal sub health authority basis may prove useful.
Recognition of the existing situation At the national level (in Italy), the health real estate stock consists of approximately 35,000,000 m2
of facilities unevenly
distributed throughout the country. At least 82 per cent of the facilities in which health services are provided were built before 1990 and 58 per cent before 1970. The state in which a building entity finds itself is physiologically commensurate with its intended use and is inevitably affected by progressive obsolescence, which can lead to conditions of serious deterioration or even non-compliance with standards when structural conditions are not adapted to the evolution of technical and functional requirements that increase over time. Maintenance activity, with its ordinary
and extraordinary components, therefore represents a salient element both for the maintenance of the heritage, in order to delay its state of deterioration, and to
IFHE DIGEST 2024
guarantee its adequacy over time. It is clear that in order to best manage
the resources set aside for ordinary and extraordinary maintenance (more than 1.5 billion euros per year) and for investments, it is necessary for each health authority and hospital to equip itself with efficient and competent organisational structures. In reality, the organisational models
adopted by hospital and healthcare companies are very often undersized in relation to the needs and the increase in tasks and responsibilities characterising the technical area in healthcare. Technical areas vary greatly in the
different areas of the country and consequently in the ways in which they could be reorganised. The technical offices of healthcare facilities, which in the past had mainly tasks related to the maintenance of buildings, with the introduction of the extraordinary investment programmes and then gradually a crescendo related to regulatory compliance and European directives, have increasingly taken on tasks related to the transformation and adaptation of buildings (installations, energy efficiency, seismic and fire protection, etc.). The technical areas must therefore devote time and resources to the strategic definition, development, and improvement of healthcare facilities alongside the strategic and healthcare management. This was very evident during the pandemic emergency period for COVID-19, where technical structures were indispensable players in adapting structures and facilities to the new requirements in the most effective and fastest way. Technicians who are competent in their knowledge of their
assets and up to date with respect to regulatory developments can effectively support and influence health organisations policy in investment and facility maintenance and management programmes. The technical management must
therefore be present in those company structures where the real estate and technological assets are such as to require the constant presence of qualified professionals in technical, technological, and administrative management. Given the strong territorial inhomogeneity, the guidelines must adapt to local realities and the technical- managerial organisations must ensure coordination and appropriateness in the provision of services, taking into account the following parameters: l Classification of the healthcare facility according to complexity.
l Overall surface area of the healthcare facility to be managed.
l Presence of high-tech facilities. l Territorial dislocation of the healthcare facilities and presence of infrastructural connections between facilities.
l Beds broken down by type of hospitalisation high, medium, and low intensity of care.
The technical government should then be divided into a technical department (or technical area) to which organisational units with specific tasks and management of personnel and activities belong. The technical and administrative organisational structures meet criteria of autonomy and managerial responsibility and are organised to ensure functional homogeneity between them and are made
51
(>25) Single
Under building
with multiple 50,000 More than buildings
a building Under One or
Large structure 200,000 more single or with
1 buildings 3 1 1 3 3 2 14 architects 1 disposals 1 Property and compliance contracts 1
Asset and Security Grand inventory
total management management 1 1 5
2 buildings
4
1
5
4
2
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