Accreditation and designation procedures by the Organisation of European Cancer Institutes (OECI) have represented a considerable challenge for most of the Italian cancer centers. We summarize the experience of the San Martino-IST in Genoa, which, on the whole, was satisfactory, albeit demanding for the staff. The reorganization of most oncology/hematology operations within the disease management teams was probably the key point that allowed us to obtain approval as it brought about the possibility of bringing in uniform methods of diagnosis/treatment, increasing patient recruitment in clinical trials, and fostering translational research by promoting collaboration between clinicians and laboratory investigators. The creation of a more cohesive supportive and terminal care team facilitated both the OECI procedures as well as the operations within the institution. Finally, some considerations are added to the doctor and nurse management roles in Italian hospitals characterized by noticeable differences from northern Europe. These differences may represent an extra challenge for hospital management and evaluator teams more used to the northern European type of organization.
Tumori 2015; 101(Suppl. 1): 19 - 20
Article Type: REVIEW
AuthorsGiovanni Orengo, Paolo Pronzato, Manlio Ferrarini
- • Accepted on 02/12/2015
- • Available online on 30/12/2015
- • Published in print on 31/12/2015
This article is available as full text PDF.
The quality of care provided by cancer centers is a key issue for the European Union. If we aim at a uniform European health system, with the same level of medical assistance throughout the different EU countries, a third party specialist team should be in charge of evaluating the performance of the different institutions (1).
In 2012, there were 11 cancer centers officially certified by the Ministry of Health in Italy. At that time, debates on how to compare the quality/efficiency of the Italian centers to the European cancer centers/institutes were held. The Organisation of European Cancer Institutes (OECI) was recognized as the major organization capable of providing an independent and qualified assessment.
With this in mind, the Italian Ministry of Health, with its “Istituto Superiore di Sanità,” launched a program aimed at submitting all the Italian recognized cancer centers to the OECI accreditation/designation program (A&D).
Participation in the OECI A&D represents a challenging task for any European cancer center. For our institution, this task was especially challenging, given the fact that the San Martino-IST was created just 2 years before the initiative of the Italian Ministry of Health took place, by the decision to merge the San Martino-University Hospital with the Istituto Nazionale per la Ricerca sul Cancro (IST), both located in the same hospital area. The OECI certification manual states that merging may affect certification acquisition or even prevent it.
This article is not meant to describe our experience in detail, but to underline some specific aspects that can be helpful for institutes and European cancer centers preparing for the OECI certification process.
Disease management team organization
As soon as we received notice from the Istituto Superiore di Sanità confirming Italian participation in the OECI A&D, our key question was “Where do we start from in the institute?” It was clear that we needed to select a core subject around which all of the subsequent steps could be built. The solution of this problem was represented by disease management team (DMT) formation.
Disease management team disciplines
|Head and neck|
Disease management team aims
|Pathways of diagnosis and treatment definition|
|Annual report and monitoring of oncology activity|
|Teaching and education|
|Research: clinical trial enrollment|
|Collection of specimens for translational research|
Supportive and palliative care team
Another issue that became evident in the preparation of the peer review process was represented by the need for reorganization of palliative care in the institute (3). As shown in
Supportive care team
|Subspecialties: clinical nutrition, odontostomatology, phoniatrics, hospice and palliative care, pain care, oncology rehabilitation, psychology, psychiatry|
|Functions: early supportive and palliative needs identification, simultaneous care, case discussion during disease management team and general inpatient care meetings, holistic approach to the oncology patient|
Another topic that became noticeable during the preparation for the A&D procedures, particularly during the OECI site visit, is the Italian approach towards patient management, which is mostly by doctors. In other countries, particularly those in northern Europe, nurses have major roles in patient management, under the supervision of doctors. This distinction highlights different approaches that may dictate different procedures. This Italian attitude seems to be shared by other countries in southern Europe and should be taken into account by the OECI reviewers.
The concept of standardization of procedures and care comes primarily from the United States experience, where a uniformity of approaches has been achieved. There, differences in diagnosis/treatment may be dictated by economic considerations and by guidelines of insurance companies. In Europe, wide differences in medical traditions have brought about variations concerning the general organization and the cultural approach to medicine.
Because of the heterogeneous background and cultural, political, and economic differences among EU countries, it will be more difficult to guarantee all our patients the desired uniformity of care and reduce inequalities. In this respect, initiatives such as the OECI A&D are important.
Supported by funding from the Italian Ministry of Health, Ricerca Finalizzata Project RF-2009-1532731.