HealthManagement, Volume 14, Issue 4, 2012

Outsourcing services in healthcare:

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Technical standards,innovations,horizon scanning and benchmarking

“Outsourcing Services in Healthcare: Technical Standard, Innovation, Horizon Scanning and Benchmarking” is
an on-going project, first started in 2011 by ANMDO (Italian National Association of Hospital Medical Directors). The main objectives of the project, focused on management issues in the outsourcing of non-core healthcare related services, are the definition of technical standards, best-practice certification and diffusion and the identification and testing of innovative solutions. To achieve these objectives, horizon scanning and benchmarking methodologies are used to assess both the quality of outsourced services and the economic results.




Outsourcing is the set of economic practices used by firms to use other companies to perform certain stages of the production process. Although specialised companies for providing manufacturing services to companies have existed in Italy since the early sixties, the term 'outsourcing' became quite popular in the managerial community only in the late eighties, early nineties.


The project activities are carried out with the involvement of a set of different healthcare sector representatives:


• Healthcare Associations: ANMDO; FARE (Italian association of healthcare products and services buyers); SIAIS (Italian

Society of healthcare architecture and engineering);

• Industry: FISE, Legacoop services, Confcooperative, AFIDAMP Fab e Com;

• Technical and scientific associations: TEROTEC and Italian National School of Services;

• Company representatives.


Sanitation activities in Italy employ about 500,000 people, and over 100,000 are active in the healthcare sector, not taking into account those responsible in the healthcare facilities of managing non-core outsourced contracts.


In June 2011, an updated version of the “Capitolato Tecnico del Servizio di Sanificazione Ambientale in Sanità” - a technical guideline of specifications and tools to be used in defining and closing contracts dealing with environmental sanitation in healthcare- was presented in the framework of the 37th ANMDO National Congress in Bologna, and a new phase of activity began.


Lines of Activity


• Identification of relevant technical standards to define non-core healthcare services outsourcing specifications;

• Identification of technical proposals presenting innovative aspects;

• Progressive integration of newly defined technical standards;

• Identification of best management and operational practices facilitating efficient and effective outsourcing buyer-seller relationships;

• Comparison of experiences and diffusion of practical results;

• Control system evolution, both first hand or third party based, to ensure the optimal management of procurement contracts, processes and services results, customer satisfaction, both internal and external, and the overall system efficiency; and

• Monitoring of the impact of regulations and reduced economic resources.


Work Procedures


The main characteristics of the working procedures of this project are involvement, analysis of on-going processes and a 360- degree vision with the active involvement of various players. A significant part of the project entails is the promotion of the registration of health professionals working on these issues to a dedicated web portal, in order to facilitate the comparison and the circulation of experiences. The analysis of the dynamics and the understanding of the practical effects is a key objective.


The entry into force in 2011 of the “Regolamento di Attuazione del Codice dei Contratti Pubblici” - the new set of Regulations for Implementation of the Public Contracts Code - and the evolution of the economic scenario, are the driving factors that privilege cost savings versus service quality standards. Therefore, it is necessary to significantly revise tender specifications, contract management and control tools and processes to avoid negative consequences for the parties involved: users and healthcare providers.


The system efficiency and effectiveness is based on the individual components, but also on the virtuous partnership between the different players. As a consequence, several aspects that modify and define expectations of non-core services have to be taken into account:


• Increasingly detailed and articulated quality expectations;

• Coordination with new organisational models related to health system evolution (i.e. hospital for intensive care); and

• Full integration with environmental sustainability and social responsibility issues.


The overarching objective of the project is to evaluate on-going and forecasted dynamics and changes in order to optimise the planning and implementation of work activities. The working group is an “open” group enriched by the continuous flow of ideas and experiences dealing with new topics and issues.


Short and Medium Term Objectives The main short-medium term objectives of the project are to:


• Write a detailed description of technical standards for each service;

• Develop/integrate UNI control related regulation (UNI EN 13549:2003);

• Create an observatory and a technical reference point for innovation in outsourced services in healthcare;

• Benchmark analysis of competitive tenders for cleaning (the expected quality economic sustainability index);

• Benchmark analysis of various non-core outsourcing services: Report Card Service with the direct contribution of the users association“Cittadinanza Attiva”;

• Develop specific environmentally sustainable solutions (i.e. forthcoming publication of CAM (Criteri Ambientali Minimi), which is a specific regulation for cleaning); and

• Promote ECM training programmes for health professionals.


The sharing and dissemination of the collected and validated information and knowledge is achieved through its publication on a dedicated website: www.standardsanificazione. It and in scientific magazines. The website offers interactive communication and dialogue channel between the project team and the wide variety of health operators and technical experts.


In the first phase, the main objective was to define a possible structure for technical standards and best practices in order to promote the evolution of technical communication and the ability to identify the appropriate choices.


Nowadays, the project is evolving towards the implementation of a factual benchmark analysis of the relationship inquiries/ values provided by the competitive tender, and to all dimensions of quality and efficiency of the service (‘Report Card Services’ according to the model shared with the Scuola Nazionale Servizi). On the website one can find useful information about service companies, associations and stakeholders participating in the project.




The involvement of the different players and the use of web tools that allow direct relationships and dialogue between healthcare providers is essential for a strong dissemination of information in real time of knowledge, pilot experiences, and best practices. These elements greatly enhance the identification of macro or single features that become object of attention and can produce opportunities for improving the integrated management of non-core services in relation to the various processes of diagnosis and treatment in health facilities.


We would like to highlight that the project Outsourcing services in Healthcare: technical standard, innovation, horizon scanning and benchmark presented by ANMDO at the Italian Public Affairs Awards 2012 competition has been named 'Winner of the Public Affairs Awards 2012' for the category ‘Societies and Scientific Associations’.


The project presented by ANMDO was chosen by a jury composed of representatives of Parliament, academia, business, end users, journalists and representatives of national and international organisations active in the field of institutional relations. Senator Antonio Tommassini, President of the XII Hygiene and Health Committee of the Senate and of the Ethics Committee PAA (Public Affairs Awards) presented the award during the 4th National Conference of the Public Affairs Association.



Our project, Outsourcing Services in Healthcare:  Technical standards, innovation, horizon scanning and benchmarking, promotes the use of common tools in the healthcare world such as risk analysis, evidence-based results assessment, results, identification and dissemination of best practices and horizon scanning. This is a prerequisite to meeting efficiency targets without jeopardising the quality of secondary services, and factors of great importance for the proper working of health facilities.



Ugo Luigi Aparo,

Direttore Sanitario IDI-IRCCS, Roma.

[email protected]


Gianfranco Finzi,

Direzione Medica Azienda Ospedaliera

Universitaria Policlinico S.Orsola-Malpighi,



Barbara Gozzi,

A.N.M.D.O. (Italian National Association

of Hospital Medical Directors), Bologna.

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Technical standards,innovations,horizon scanning and benchmarking “Outsourcing Services in Healthcare: Technical Standard, I

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