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What can we learn from Italian lessons?

Italy is well-known for its creative flair and contemporary design, but does this creativity translate to the healthcare sector? Having recently visited several Italian hospitals, Danny Gibson, technical director at international healthcare consultancy MJ Medical, contrasts the Italian healthcare system’s use of equipment and technology with the UK approach, considers Italian hospital planners’ attitude to future-proofing their buildings, and asks what lessons, if any, the UK can learn.

In April this year my colleagues and I on the “Planning Buildings for Health” Masters Degree course at the Medical Architectural Research Unit (MARU) at London South Bank University went on a comparative health study tour of Italy. During the week-long trip we visited some fantastic healthcare buildings, some recently constructed, as well as some older buildings which provided, by way of comparison, examples of how progressive the new developments were. As an internationally experienced healthcare planner and equipment consultant I had to date not worked within the Italian healthcare system. I knew that it was similar to the NHS, with healthcare free at the point of delivery utilising a blend of predominantly public, and some private, healthcare providers, but had no preconceived idea of how technology would be used. If I had been asked to guess, given the similarity in systems and culture I would probably have expected their approach to technology to be similar to that in the UK. This assumption, in fact, proved relatively accurate; however, there are some real exceptions where certain types of technology are much more widespread or effectively used than in the UK. One thing one notices immediately on visiting one of the new Italian facilities is that all the equipment and furniture is brand new. While this should not be a surprise, the cynic in me expected the “back of house” equipment and furniture to be the more tired looking transfer equipment. However, while transfer of existing furniture and equipment is considered at the business case stage, this appears almost to be undertaken as a matter of courtesy rather than as a real consideration. A healthy proportion of any capital investment is earmarked for purchasing new equipment and furniture. At the Mestre Hospital in Venice, for example, over 25% of the project value was ring fenced for equipment and furniture. Having new equipment and furniture within a new building is, it seems, high on the agenda for project teams and senior hospital management personnel in Italy.

‘More detailed’ Italian approach

One area where things happen very differently from the UK is in the development and importance of the equipment budget at the business case stage; in Italy a much more detailed approach is used to set a comprehensive equipment budget. Where the UK uses a largely unreliable, broad brush approach to developing an equipment figure for the business case utilising Equipment Cost Allowance Guides (ECAG), Department Cost Allowance Guides (DCAG), and inflation measures (as described in the latest Median Index of Public Sector Tender Prices (MIPS)), the Italian business case takes the equipment strategy, schedules each item of equipment, and develops a full equipment and furniture cost model at the business case stage. This is an approach that most equipment planners have championed within the UK. This approach provides a budget foundation which is significantly more robust than that of the UK capital investment method. The benefit of scheduling each item of equipment and furniture is that it allows for whole life costing of equipment to be considered at the outset. The robustness of this information at the business case stage secures budget provision and certainty, which is subsequently ring-fenced to protect it from any push for cost reduction following value engineering and affordability discussions.

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