Digital healthcare lacks the skills

Alla sanità digitale mancano le competenze

The nursery rhyme is sung to the children "To make a table you need wood, to make wood you need a tree, to make a tree you need a seed, to make a seed you need a fruit, to make a fruit you need he wants a flower”. When we grow up we discover that the nursery rhyme is deceiving, indeed yes, to make the table you need flowers, but you also need the sun, the rain, good earth, fertilizer and above all a good carpenter.

Sergio Pillon
Prof. Sergio Pillon, Medical Director of CIRM

I experience the world of digital innovation from within the hospital and I directed a Telemedicine operating unit, with a strategic direction that changed every two-three years: on "carpenters", as the Blade Runner android said before he died “I've seen things that you humans…” Some examples, ignoble little stories, which are not worth a line in a newspaper, as Guccini said.

Budget meeting with the Head of Department, the Director General and the Head of DITRO (nursing services):

“Pillon, what do you do with telemedicine?”
"We treat patients with vascular ulcers even from home, avoiding that they have to come to the hospital for medication every two days"
“Pillon and you call telemedicine send some pictures? What specialization do you have?”
“I am an angiologist”
"Here, do me some color Doppler ultrasound, in order to shorten the waiting lists..." and the other managers all agree...

Meeting with the General Manager (another), who reports to the department that, instead of the agreed 3% increase in productivity, a 5% reduction has currently been noted:

“Director, do you know that nowadays requests for specialist consultancy between departments are sent by fax or by walker, on pre-printed forms filled in pen with illegible handwriting and that some of these have a head physician who has been deceased for ten years on the header? (implicitly, how do you carry out a management, effectiveness, efficiency and appropriateness check that you have told us about up to now?”
“I understand Pillon, don't worry we are buying PCs”
"... But director the problem isn't the PCs..." and the director, annoyed by the repartee: "Pillon, as you know we are appointing the new company IT manager".

But the best example touches me closely: internal competition for the appointment as director of the UOSD of Angiology, my colleague, without any experience as director of UOSD, I have 10 years of directorship of UOSD of Telemedicine, he surpasses me by just one point on clinical or organizational skills.

The motivation of the commission: "In choosing the Director of the UOSD Angiology we wanted to give particular importance to the skills in the clinical and organizational field in relation to what the care commitments of the UOSD Angiology will have to be". “Pillon has an excellent educational and professional background. For his area of expertise, Telemedicine has had important recognitions at national and international level covering institutional roles (…)” but he has one point less than his colleague. In summary, Pillon is an angiologist who uses telemedicine, therefore, seeing as he directs a facility that has been doing vascular telemedicine for 10 years, he has less clinical and organizational skills on angiology! As if to say that the cardiologist who uses echocardiography and directs a cardiology facility that uses it is less of a cardiologist than the one who doesn't use it. Certainly, I could have appealed, to see the ranking canceled in 5 years…

I could go on with "I've seen things that you humans", but I must add that all those I mentioned are excellent managers and I'm not saying this out of flattery, some of them I don't even know where they are today, they are simply digital ignoramuses, in sense of those who are ignorant, not on an IT level (they use all digital tools) but have no ability to digital leadership. They don't know how to read the change taking place, they don't know how to manage or ride it, at best they trust external consultants or external technology suppliers and, worst of all, they don't realize it.

You don't manage a company with over one billion euros in annual turnover with consultants, you don't lead the digital change in the NHS that everyone invokes without Digital Leadership. They are excellent managers, they must be trained and the "middle management" must also be trained, the department heads, the directors of operating units, the district directors, the nursing coordinators. This time, however, starting from the bottom is useless, the company's strategic management (General Manager, Medical Director and Administrative Director) have a great power of direction, from there we need to start the change: the guidelines for international activities and experiences are there, there is even funding since Telemedicine is evaluated in the LEA review. In a forthcoming article on the theme "I've seen things that you humans..." I'll tell you about what I've seen on Telemedicine declined to regionalism, teleassistance mistaken for telemonitoring, the social mistaken for healthcare and vice versa, clinical projects without medical devices... The leadership of the departments is still lower than that of the strategic directions.

Skills, to be trained through the Italian university system, with the tools of the second level University Masters, also in "distance learning" mode, FAD, because a top manager does not have much free time. This happens in the United States and in other countries of the world, I found myself lecturing to the "students" of prestigious American universities, who also come to us to learn. Why does it happen to them and not to us? Because although the theme is central, training in this sector is not enabling for us, it is useless, it is simply an extra piece of paper among the dozens that the top manager has. Yes, I too have a II level university master's degree in eHealth, but in my competition it was useless, after all, why think of innovating the Roman Angiologist? Obviously it's not needed... On the other hand, SAIPEM has trained all its doctors on Digital Health in Oil and Gas Medicine, in Italy, not in the USA.

Dear Minister Grillo, a university education enabling you to be Director of healthcare companies, a useful "piece of paper", with the ECM you don't do much and for the top managers of the NHS it could be one of the Trojan horses of change. Even if it goes badly, we have promoted the culture of digital innovation in healthcare and perhaps at the next competition, at the next change of strategic direction, a doctor, a nurse, a laboratory or radiology technician will be recognized for the efforts made to make a better NHS and perhaps an award from the observatory of the Milan Polytechnic, which today calls digital innovators in healthcare "heroes".

With respect, Sergio Pillon.

Prof. Sergio Pillon, doctor, specialist in Angiology, II level university master's degree in eHealth. Medical Director of CIRM, he directed the Departmental Telemedicine Operative Unit of the San Camillo hospital in Rome for 10 years. Coordinator of the Joint Technical Commission for the governance of national guidelines for telemedicine. Scientific Advisor of the project Lines for the development of telemedicine and telehealth in Chile of theInstitute of Sciences and Innovation in Medicine, on behalf of the Ministry of Health and the Ministry of Economy of Chile.

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