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Strategic Asset Planning, Tuscany, Italy


  • Region wide reconfiguration of the healthcare system
  • Transforming the regional health system through implementing the national policy of decentralisation; increasing the degree of local autonomy to improve the responsiveness of services to local need
  • Development of an implementation structure plan e.g.
    • One hospital per 90,000 population
    • 3.8 beds per 1000 inhabitants
    • Modernisation and renewal of facilities; over 75% of hospital infrastructure will be built after 1990
    • Move more care into community settings; a less hospital centric model of service delivery
    • Integrate health policy with other strategic policies at regional level:
      • Transport
      • Communication
      • City planning
  • Capital investment is focused on three main goals:
    • Rationlisation and simplification of hospital networks
    • Renewal of hospital facilities
    • Extending the scale and scope of outpatient based treatments
  • Adoption of a “new concept” hospital model with emphasis on patient safety and quality, integrated models of care, innovative application of technology, stimulating advances in care through better research and training and solidarity with citizens through urban (and rural) integration. This has also led to a template principle of hospital design, the four principle acute  hospitals will have on average 400 to 500 beds with an appropriate degree of standardisation – leading to economies of scale and scope
  • There is significant focus on, and investment in clinical governance with new ideas such as clinician-led health councils. A major aim of the clinical governance strategy is to reduce unnecessary demand on hospital facilities
  • In parallel to the John Paul II Hospital, Tuscany promotes the WHO project of “Health Promoting Hospitals” thereby giving the hospitals a wider role in public health




  • A coherent and cohesive, fully integrated, regional plan for the transformation of hospital services, set within national strategic guidelines
  • Interface with other regional services e.g. transport and urban planning
  • An implementation plan that has been developed with a bottom up principle of citizen engagement
  • New and innovative concepts for hospital design, influenced by strong clinical governance principles
  • Extending the role of the hospital into the wider public health arena




  • Requires significant and sustained capital investment
  • Requires major culture and professional change, including the loss of significant numbers of small local hospitals; change of this nature and scale is complex and difficult
  • Remains ‘work in progress’ at this stage


Structural Fund relevance - high


  • The whole systems, regional population focused, restructuring of hospital systems is a highly relevant model for Structural Fund beneficiary regions: 
    • It aims to improve quality and reduce inequality
    • It aims to improve effectiveness and cost efficiency
    • It is integrated with other societal and economic programmes; transport, urban planning
    • It has a declared aim of improving citizen solidarity
    • It will generate a degree of economic stimulus through the nature and scale of planned investment
  • It moves capital investment from a narrow building focus to region wide influence in the wider health agenda


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