OSPEDALE NIGUARDA Grande Ospedale Metropolitano Niguarda

1. OSPEDALE NIGUARDA Grande Ospedale Metropolitano Niguarda General Hospital and Care Centers

2. Beijing 28 Jan 2016 Signature of a memorandum of understanding between the Italian Minister of Health and the Chinese Minister of Health “The Italian model is an example of quality: doctors and managers will go to study in Italy” Li Bin Milano 17 th January 2017 … Welcome!

3. Lombardy Health System The Lombardy Health System is well known for its high standards and efficiency There are over 200 private and public accredited hospitals and 18 research hospitals(IRCCS). The majority of hospitals are run by the Lombardy Health Service, while about 22.4% of beds are located in private hospitals, either profit or not-for-profit. Hospitals, in order to receive public funding from the National Health System, are required to comply with high structural, technological and organizational standards established by the Lombardy Region.

4. INHS: financing system

5. Regional Reform Act 2015 Focus on chronic conditions HEALTH SYSTEM IN LOMBARDY • Mixed public/private • Freedom of choice • Separation providers/purchasers Regionally-based National Health System REGION DG Welfare Ex post funding Regional financing (capitation) 8 ATS Agency for Health and Social Care Planning Remuneration (from Fee for Service to Global Tariff) Contractual agreements Contractual agreements 27 public ASST Hospital Trusts and Social Care Private Accredited Hospitals 6.500 GPs (27% in group practice)

6. About us Niguarda is a general hospital offering all clinical specialities for adults and children. It integrates at 360° care competences and technology from diagnosis to rehabilitation to offer the best quality of care. Niguarda is a referral hospital for Milan, where is located, Lombardy region and Italy.

7. 1213 4116 BEDS TOTAL EMPLOYEES 712 MEDICAL OFFICERS CLINICAL UNIT DIRECTORS 39 30 BABY CRIBS NURSING STAFF 1967 8 INTENSIVE CARE BABY CRIBS 42 OPERATING ROOMS 340 AMBULATORY ROOMS NIGUARDA'S DATA (Sept. 2015) ORDINARY 1138 DAY HOSPITAL & DAY SURGERY 75 20 NEONATAL PATHOLOGY BABY CRIBS

8. 179.849 55.289 ADMISSIONS OUTPATIENTS SERVICE 12.525 23.399 PRIVATE INCOME OTHER HEALTH SERVICES 38.301 210.074 HIGH COST DRUGS OTHER REVENUES TOTAL REVENUES Economical and financial performances* *(prediction budget 2015, Euro/000) 519.437

9. 230.371 HR COSTS (more than 4.100 emplyees) 519.437 227.164 TOTAL COSTS GOOD AND SERVICES 61.902 OTHER COSTS Economical and financial performances* *(prediction budget 2015, Euros/000)

10. Evolution of a leading italian general hospital The hospital was inaugurated on October 3, 1939, but its history could be: "respect of tradition in continuous evolution”. The New Niguarda Project started in 2007 and finished at the beginning 2014. The daily activity never stopped. New Hospital structure has been organized according to Intensity Model organization

11. Map today

12. New Niguarda

13. Intensity care model is centred on patients’ needs According to intensity care model the new hospital structure is designed on the needs of the patient and the entire care process is provided within a single block: • Emergency-Urgency block • High Intensity block • Medium Intensity block

14. DEA Block: Emergency Urgency Nord Block: Medium intensity Sud Block: High intensity

15. Departments • Cardio Vascular • Multi specialist Surgery • Hematology-Oncology • EAR • Mother and child • Laboratory medicine • Multispecialist medicine • Neuroscience • Mental health • Advanced Diagnostic-Therapeutic technologies

16. Highlights • Head quarter of the 118 Emergency • Mobile Unit for Maxi Emergency • Helicopter service • Burned Care Unit • Tissue Bank

17. Highlights • Stroke Unit • Trauma Team • Anti-Poisoning Center • Rare Desease Center • Equestrian Rehabilitation Center • Unipolar Spinal Unit

18. Multidisciplinary care centers Multidisciplinaries teams work in sinergy from diagnosis to rehabilitation: • Cancer Center • Cardio Center • Transplant Center • Trauma Center

19. Clinical areas Emergency- Uregency area We hosts patients from all the whole metropolitan area of Milan with about 91.896 ER admissions/year. Neuroscience area The aim of thi area is to coordinate specialist competence and the most up-to-date technologies to guarantee a diagnostic and therapeutic excellence path for therapy of nervous system pathologies.

20. Clinical areas Diagnostic area Our laboratories guarantee a wide range of diagnostic services as effective support to clinical activity thanks to highly specialized and authomatic technologies. Oncologic area A multidisciplinary team threats all type of tumors with the highest standards of innovative diagnostic and chirurgical technologies, (robotic surgery, mininvasive approach, magnetic resonance guided focused ultrasound surgery…) personalized chemiotherapy based on targeted individual molecular basis.

21. Clinical areas Transplant area Niguarda is the only hospital that has performed all types of transplants. The Skin Bank is a laboratory specialized in enginereed skin and cartilage for reconstructive operations. Cardiothoracic & vascula area Provides all medical interventional and surgical options for patients with any kind of disease at any age. Niguarda is national referral Center for heart transplantation and assist device for advanced heart failure, complex arrhythmias, acute and chronic coronary artery disease.

22. Clinical areas General Surgery area Niguarda is a national and international reference point for general surgery treated with a minimal invasive approach and with robotic surgery. Specialist Medicine area Niguarda offers the widest set of high complexity services of general and specialist medicine. It is the headquarter for many Regional and National reference Centers.

23. Clinical areas Mother and Child area This area includes a full phase assistance, from the wish of procreation to delivery. The child treatment is assured for every type of pathology, even the rare ones.

24. Clinical areas ROBOTIC SURGERY LINEAR ACCELERATOR GAMMA KNIFE DIGESTIVE ENDOSCOPY FOCUSED ULTRASOUND Advanced technologies Advanced MRI, PET, interventional radiology, linear accelerators, robotic surgery, hybrid OR, gamma knife, focused ultrasound: the constant updating of the technological park is driven by the development of professional skills of high profile.

25. Da Vinci Surgical System The Da Vinci System features a magnified 3D high-definition vision system andtiny wristed instruments that bend and rotate far greater than the human wrist. As a result, surgeon operate with enhanced vision, precision, dexterity and control. We use Da Vinci in urology, cancer and general surgery treatments.

26. Hybrid OR A hybrid OR is a huge room with radiological equipments, it permits to carry out both traditional and radiologic guided operational activity. The hybrid OR allows interventions invasively reduced.

27. Gamma knife Surgery It is a non-invasive method for treating brain disorders. It is the delivery of a single high dose of irradiation to a small and critically located intra-cranial volume through the intact skull. It performs extreme accuracy, efficiency and outstanding therapeutic response.

28. Research and knowledge sharing The presence of professional skills, technological competences, certified laboratories and high complexity patient cohorts, make Niguarda at the forefront of research for trials testing new therapies supported by international cooperation activities.

29. International teaching centers High professional competences, high tech and teaching accreditation, make Niguarda Hospital a strong centre of attraction for professional figures which want to bring themselves up to date on new technologies, diagnostic and therapeutic procedures to gain an excellent operative methodology and new skills.

30. International teaching centers • AIMS Academy is the first multidisciplinary structure in Italy dedicated to research and training in minimally invasive advanced surgery, third pole of an European network with Strasbourg and Guildford. The program includes demonstrations of laparoscopic surgery, theory sessions and practice sessions made of simulations in the wet lab. • Ecocardiografy center is accredited by European Association of Cardiovascular Imaging . An Ecolab is fully equipped for training. • Aortic prostheses implantation is an European training school adopting the advanced system of the hybrid room that performs delicate surgeries in an accurate and minimally invasive way.

31. International health cooperation • Twinnings among international hospitals scheduled by international cooperation programs. • Training stages included in international institutions agreements. • International cases of health emergencies Niguarda plays an active role as Italian hospital. • Niguarda hosts patients from other countries affected by pathologies that are incurable in their own countries.

32. A modern hospital Relativs have access to: • Hotels at special price • Coffee shops • Self-service restaurants • Cash points • Shopping centers • Internal paying parking

33. A modern hospital More than 40 front offices for booking and check in: the modern “centralized” system for managing the customers flow, drives the patient from the access to the hospital and it conducts him, through the front office activities, to the call in the outpatient where the doctor is waiting.

34. A modern hospital Patients have access to: • Single-double beds rooms withprivate bathroom • Foreign patients’ office • Free service of language assistance • Vegetarian menu on demand

35. THANK YOU Communication & Public Relations Office paola.delfabbro@ospedaleniguarda.it www.ospedaleniguarda.it http://www.ospedaleniguarda.it/CHI/