Zoli: integration and flexibility to become a model in the management of healthcare emergencies

Lombardy’s Director General AREU meets MiMS students

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A call is made from a cell phone to 112, the single emergency number. The operator answers in less than two rings, reassuringly asking the reason for the call. In response, the person on the other end of the phone asks to be located. Perhaps he or she is not able to say where they are, this can happen in emergencies. Unperturbed, the operator communicates the geographical coordinates, latitude and longitude in degrees, minutes and seconds. Then, for greater clarity, the operator translates them into a position in the area between via Sarfatti and via Castelbarco in Milan. Exactly in SDA Bocconi’s campus. That’s precisely where the call is coming from, a MiMS - Master in Management for Healthcare‘s classroom.

Fortunately, it is not an emergency, but a demonstration of the Advanced Mobile Localization service, one of the flagships of AREU, Lombardy’s Regional Emergency Agency. It is its Director General Alberto Zoli who is making it, live and without having organized anything in advance, while being a guest speaker at MiMS. He does so to explain how the management of healthcare emergencies and a spate of other health-related mobility services has changed over the last 15 years – that is to say since the AREU has been established.

Zoli, who is a physician with a long career in hospital management, spoke with legitimate satisfaction about his “creature,” which he has been leading since its creation back in 2008: “It is currently the most efficient emergency agency in Italy, the one that costs less and performs more.” In addition to pre-hospital assistance (dialing 118), the AREU ensures non-emergency medical transport as well as the transport of organs and blood products in the region and, the latest addition, the operation of 112, the Single Emergency Number with its own Single Response Centers. These are different missions but they share a common goal, i.e. creating an integrated, homogeneous and efficient system covering the whole region. A system that must be able to serve 10 million inhabitants (“the population of a country like Portugal or Sweden”) “in the same way (there are no ‘lucky’ or ‘unlucky’ ones),” Zoli underlined. This population is distributed in a very heterogeneous and dynamic way (“the metropolitan area of Milan and Monza-Brianza has 5 million inhabitants during the day but the city empties out at night”) over a morphologically inhomogeneous area (“with a large mountainous area as well as lakes and rivers that hinder transportation”).

The whole service is carried out by a structure that has only 596 employees, about 500 of whom are operational (including rescue drivers, operations room personnel and other technical figures). The service has gone through constant rationalization and integration: “Over the last 10 years, we have gone from 12 Provincial Operations Centers (COEUs) to 4 Regional Emergency Operations Rooms (SOREUs) divided by macro-areas (Metropolitan, Plain, Alpine and Lakes) and managed by a single ‘mind’, that is AREU,” Zoli explained.

In the process of optimizing resources, technology has obviously played a decisive role: “In the area we are responsible for, we have both Basic Rescue Vehicles (ambulances), which are also managed by subsidiary subjects (private ‘crosses’ operated by voluntary associations, social cooperatives, etc.) and Advanced Rescue Vehicles (medical cars), in addition to helicopters. It is essential to send the right help to the right place and at the right time, sending professionals (doctors and specialized nurses) to where they are necessary, or even indispensable. Today’s technology allows us to deploy these figures exactly when they are needed and not to waste any valuable professionals.”

Integration and flexibility are the two key words in this system. This result has also been reached by re-qualifying and reorganizing the various professional figures and succeeding, for example, in guaranteeing the continuous presence of a physician at SOREUs or enhancing the role of paramedics in emergency vehicles. For, in spite of everything, “the most important component is still people, not technology. This is true for all organizations,” Zoli stated. Even when the person is the one answering the 112 call, locating it with the help of technology and handing it over to the appropriate body (Healthcare Emergencies, Police, Carabinieri, Fire Brigade). A ‘double step’ that, however, has reduced response and intervention times. “And this is the first national service managed by the Regions in Italy,” he added.

To someone who used to be a doctor “in my youth ,” as he puts it, and now leads an organization that has become a model of efficiency for the entire country, we couldn’t but ask what are the essential traits of healthcare managers today. “Let’s start with a vital characteristic for anyone taking on a top position: enthusiasm,” Zoli replied. “What you do must engage you and be a source of satisfaction and permanent renewal. This is key because it spreads around you and becomes an essential element for teamwork and for motivating and engaging your coworkers, which is another important requirement of managers. Then come competence, specific preparation, resilience and empathy, of course. But all of this must come into a large container: the passion for your work.” And he concluded: “That’s what I suggest to MiMS students: passion and being prepared to work without sparing yourself. Then you won’t be short of job satisfaction.”

SDA Bocconi School of Management

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