AN ACTION OF EXTRAORDINARILY ORDINARY IN PUBLIC HEALTHCARE COMPANY. Two keys: • TO ACT against wasting time brooding over problems: the re-alphabetizations of the management and administrative team of the company with the valorization of the good professionals • TO ACT “ GOVERNING THE REALITY”: without linear cuts, minimal structural or civil interventions, without external resources, paying the debts and using a planned strategy. PROGRAMMING AND COST RESTRUCTURING: Relations with clients; Regular payments; Resources and payment of debts; Valorization of a strategy programmatory tool; Constant monitoring; Externalization or internalization of the services; Rationalization; Transparency. BUT, FIRST OF ALL: fighting waste also with the “housewife economy” ( no wasting money in more that I need , no buy when no needed, no mistakes in stock aging or transporting materials).

1. SUPPORT
ANTICORRUPTION
MEASURES
IN
ALBANIA
Mr.
Maurizio
Bortoletti
Carabinieri
OCTOBER
31,
NOVEMBER
1,
2017
Conference
Room-­‐
Rogner
Hotel
Bulevardi
Dëshmorët
e
Kombit
Tirana

2. Mr.
Maurizio
Bortoletti,
October
31,
November
1,
2017
CORRUPTION
AND
ANTICORRUPTION
–
ITALIAN
CASE
TABLE
OF
CONTENTS
⇒ Tenders
and
public
contracts
under
Italian
and
European
perspective.
⇒ Corruptive
practices
in
Public
Procurement:
a
convergent
view
point.
⇒ Restoring
good
administration
and
building
trust
in
a
dif@icult
environment.
An
Italian
administration
case
study.

3. Mr.
Maurizio
Bortoletti,
October
31,
November
1,
2017
CORRUPTION
AND
ANTICORRUPTION
–
ITALIAN
CASE
TENDERS
AND
PUBLIC
CONTRACTS
UNDER
ITALIAN
AND
EUROPEAN
PERSPECTIVE
• Public
procurement
system
in
Italy.
• Institutional
system
and
legal
features
of
Italian
public
procurement.
• Relevance
of
public
procurement
for
EU
cohesion
policy.
CORRUPTIVE
PRACTICES
IN
PUBLIC
PROCUREMENT:
A
CONVERGENT
VIEW
POINT
• Corruption
risks
at
various
stages
of
public
procurement
process.
• Distinguish
corrupt
from
non-­‐corrupt
ones.
• Identify,
detect
and
mitigate
risks.
RESTORING
GOOD
ADMINISTRATION
AND
BUILDING
TRUST
IN
A
DIFFICULT
ENVIRONMENT.
AN
ITALIAN
ADMINISTRATION
CASE
STUDY.
• An
action
of
extraordinarily
ordinary
in
Public
healthcare
company
in
Salerno
(2011-­‐2012).

4. Mr.
Maurizio
Bortoletti,
October
31,
November
1,
2017
CORRUPTION
AND
ANTICORRUPTION
–
ITALIAN
CASE
PREMISE

5. Mr.
Maurizio
Bortoletti,
October
31,
November
1,
2017
CORRUPTION
AND
ANTICORRUPTION
–
ITALIAN
CASE
TI
Italia,
Unhealthy
Health
System
project
report
co-­‐funded
by
the
European
Commission
• The
simplicity
with
which
inef@iciency,
bad
administration,
waste
and
corruption
prosper
in
the
health
sector
may
come
as
a
surprise
• Factors
of
corruption
in
the
health
sector
ü the
information
gap;
ü the
complexity
of
the
health
system
ü the
uncertainty
of
the
health
market,
• Tive
spheres
in
which
conTlict
of
interest
frequently
harms
the
virtuous
working
of
the
health
system:
ü the
health
services
market;
ü scienti@ic
information;
ü intra-­‐moenia;
ü scienti@ic
societies;
ü the
patient
associations.
PREMISE

6. Mr.
Maurizio
Bortoletti,
October
31,
November
1,
2017
CORRUPTION
AND
ANTICORRUPTION
–
ITALIAN
CASE
La
constatazione
di
uf@ici
che
funzionavano
nonostante
quelle
assenze,
così
che
“…
dopo
lustri
di
commissioni
sulla
spesa
pubblica,
dopo
l’inconcludenza
della
spending
review,
si
dovrà
riconoscere
ai
195
eroi
del
non
lavoro
il
merito
di
avere
indicato
come
e
dove
tagliare….”.
“195 eroi del non lavoro” di Davide Giacalone
PREMISE

7. Mr.
Maurizio
Bortoletti,
October
31,
November
1,
2017
CORRUPTION
AND
ANTICORRUPTION
–
ITALIAN
CASE
“La
lettera
al
milite
ignoto”
di
Carlo
Mochi
Sismondi,
presidente
di
FORUMPA
“…
perché
certe
cose
le
sapevi
benissimo,
perché
le
hai
dette
cento
volte
ai
tuoi
capi,
perché
hai
dovuto
sopportare
lo
sguardo
di
commiserazione
dei
furbi…
(eppure,
n.d.r.)
…
nonostante
i
tuoi
colleghi
facessero
di
tutto
invece
di
lavorare,
hai
fatto
sempre
lo
stesso
il
tuo
dovere,
anzi
un
po’
di
più
perché
facevi
anche
il
lavoro
degli
altri….”.
PREMISE

8. Mr.
Maurizio
Bortoletti,
October
31,
November
1,
2017
CORRUPTION
AND
ANTICORRUPTION
–
ITALIAN
CASE
PREMISE

9. Mr.
Maurizio
Bortoletti,
October
31,
November
1,
2017
CORRUPTION
AND
ANTICORRUPTION
–
ITALIAN
CASE
PREMISE

10. Mr.
Maurizio
Bortoletti,
October
31,
November
1,
2017
CORRUPTION
AND
ANTICORRUPTION
–
ITALIAN
CASE
AN
ACTION
OF
EXTRAORDINARILY
ORDINARY
IN
PUBLIC
HEALTHCARE
COMPANY
IN
SALERNO
(2011-­‐2012)
• An
introductory
consideration.
• The
situation
of
the
public
healthcare
company
before
the
intervenction.
• What
does
it
mean
to
design
and
act
an
intervention
in
a
public
healthcare
company.

11. Mr.
Maurizio
Bortoletti,
October
31,
November
1,
2017
CORRUPTION
AND
ANTICORRUPTION
–
ITALIAN
CASE
AN
ACTION
OF
EXTRAORDINARILY
ORDINARY
IN
PUBLIC
HEALTHCARE
COMPANY
IN
SALERNO
(2011-­‐2012)

12. Mr.
Maurizio
Bortoletti,
October
31,
November
1,
2017
CORRUPTION
AND
ANTICORRUPTION
–
ITALIAN
CASE
AN
ACTION
OF
EXTRAORDINARILY
ORDINARY
IN
PUBLIC
HEALTHCARE
COMPANY
IN
SALERNO
(2011-­‐2012)
Conto Economico
ASL SALERNO
Previsionale
2009
Consuntivo
2009
Previsionale
2010
Consuntivo
2010
A) Valore della produzione
Totale valore della produzione (A) 1.537.863 1.568.923 1.567.167 1.615.188
B) Costi della produzione
Totale costi della produzione (B) 1.557.166 1.660.761 1.563.280 1.722.729
C) Proventi e oneri finanziari
Totale proventi e oneri finanziari (C) -8.046 -2.170 -3.026 -12.450
D) Rettifiche di valore di attività
finanziarie
Totale rettifiche di valore di attività
finanziarie (D) 0 0 0 -189
E) Proventi e oneri straordinari
Totale proventi e oneri straordinari (E) -7.627 -113.762 -2.900 -81.095
Risultato prima delle imposte
(A – B +/- C +/- D +/- E) -34.976 -207.770 -2.039 -201.276
Imposte e tasse
Totale imposte e tasse 40.958 42.827 42.198 43.446
RISULTATO DI ESERCIZIO -75.934 -250.597 -44.237 -244.721

13. Mr.
Maurizio
Bortoletti,
October
31,
November
1,
2017
CORRUPTION
AND
ANTICORRUPTION
–
ITALIAN
CASE
AN
ACTION
OF
EXTRAORDINARILY
ORDINARY
IN
PUBLIC
HEALTHCARE
COMPANY
IN
SALERNO
(2011-­‐2012)
Conto Economico ASL SALERNO Consuntivo 2009 Consuntivo 2010 I TRIM. 2011
Totale valore della produzione (A) 1.568.923 1.615.188 389.930
B.1) Acquisti di beni 163.789 166.631 44.021
B.2) Acquisti di servizi 837.372 850.186 212.439
B.3) Manutenzione e riparazione (ordinaria esternalizzata) 12.182 12.356 2.972
B.4) Godimento di beni di terzi 14.207 14.033 3.493
B.5) Personale del ruolo sanitario 469.796 466.760 116.889
B.6) Personale del ruolo professionale 1.574 1.823 471
B.7) Personale del ruolo tecnico 59.783 58.654 14.497
B.8) Personale del ruolo amministrativo 40.035 39.463 9.983
B.9) Oneri diversi di gestione 4.932 4.111 922
B.10) Ammortamenti delle immobilizzazioni immateriali 174 193 43
B.11) Ammortamento dei fabbricati 6.087 5.920 1.480
B.12) Ammortamenti delle altre immobilizzazioni materiali 7.504 6.956 1.778
B.13) Svalutazione dei crediti 0 0 9.550
B.14) Variazione delle rimanenze 789 -2.742 -1.578
B.15) Accantonamenti tipici dell’esercizio 42.537 98.385 24.280
Totale costi della produzione (B) 1.660.761 1.722.729 441.241
Totale proventi e oneri finanziari (C) -2.170 -12.450 -2.320
Totale rettifiche di valore di attività finanziarie (D) 0 -189 0
E) Proventi e oneri straordinari
E.1) Proventi straordinari 4.806 5.742 0
E.2) Oneri straordinari 118.568 86.838 0
Totale proventi e oneri straordinari (E) -113.762 -81.095 0
Risultato prima delle imposte -207.770 -201.276 -53.631
Totale imposte e tasse 42.827 43.446 10.680
RISULTATO DI ESERCIZIO -250.597 -244.721 -64.310

14. Mr.
Maurizio
Bortoletti,
October
31,
November
1,
2017
CORRUPTION
AND
ANTICORRUPTION
–
ITALIAN
CASE
AN
ACTION
OF
EXTRAORDINARILY
ORDINARY
IN
PUBLIC
HEALTHCARE
COMPANY
IN
SALERNO
(2011-­‐2012)
March
2011,
the
situation
about
the
company:
• In
2010
1,7
billions
de@icit
• No
approved
budget
for
the
year
• Various
pending
legal
actions
• Serious
infrastructural
shortcomings
• Absence
of
control
in
operative
protocols
• Technological
and
IT
shortage,
The
Tirst
view:
in
the
extreme,
a
company
where
the
expense
was
out
of
control
and
700,000
euros
of
losses
per
day.
Dilemma:
a
public
health
company
in
this
situation
can
not
close
for
a
few
months,
to
restructure
it
and
then
reopen
it
as
the
private
entrepreneur
can
do.

15. Mr.
Maurizio
Bortoletti,
October
31,
November
1,
2017
CORRUPTION
AND
ANTICORRUPTION
–
ITALIAN
CASE
AN
ACTION
OF
EXTRAORDINARILY
ORDINARY
IN
PUBLIC
HEALTHCARE
COMPANY
IN
SALERNO
(2011-­‐2012)
Short-­‐term
action
plan:
• to
keep
the
"patient"
alive,
• to
prevent
this
situation
from
being
paid
by
the
citizens,
• to
try
to
understand
what
the
areas
where
the
greatest
losses
were
recorded
and
where
it
could
be
affected
by
the
lesser
efforts.
Medium-­‐term
action
plan.
• identifying
and
blocking
expenditures
for
unnecessary
or
otherwise
predictable
activities,
• a
complete
review
of
spending
procedures,
• accountability
of
executives,
• identifying
in
the
past
the
actions
to
be
avoided
in
the
future,
• check
of
maintenance
requirements
and
start
process
for
build
a
@irst
budget,
• protocol
with
private
healthcare
providers
who
were
paid
with
a
considerable
delay
over
deadlines,
to
stabilize
@lows
and
give
certainty,
to
avoid
foreclosures
for
unpaid
bills.

16. Mr.
Maurizio
Bortoletti,
October
31,
November
1,
2017
CORRUPTION
AND
ANTICORRUPTION
–
ITALIAN
CASE
AN
ACTION
OF
EXTRAORDINARILY
ORDINARY
IN
PUBLIC
HEALTHCARE
COMPANY
IN
SALERNO
(2011-­‐2012)
One
question:
what
could
be
done
with
all
this
wasted
money
?
⇒ (800
millions
euros
in
39
months,
between
January
2008
and
march
2011)
One
point
of
view:
what
each
of
us
would
do
to
defend
700.000
euros
per
day?
⇒ Because
all
the
money
that
was
lost
every
day
was
obviously
in
the
pockets
of
someone
who
provided
unnecessary
services
or
services.

17. Mr.
Maurizio
Bortoletti,
October
31,
November
1,
2017
CORRUPTION
AND
ANTICORRUPTION
–
ITALIAN
CASE
AN
ACTION
OF
EXTRAORDINARILY
ORDINARY
IN
PUBLIC
HEALTHCARE
COMPANY
IN
SALERNO
(2011-­‐2012)
The
dilemma
between
waste
and
medical
services.
Se eliminiamo gli
sprechi come
facciamo a gestire
le clientele?
L’alta
velocità
in
Italia
è
costata
47,3
milioni
di
euro
al
chilometro
nel
tratto
Roma-­‐Napoli,
74
milioni
di
euro
tra
Torino
e
Novara,
79,5
milioni
di
euro
tra
Novara
e
Milano
e
96,4
milioni
di
euro
tra
Bologna
e
Firenze,
contro
i
10,2
milioni
di
euro
al
chilometro
della
Parigi-­‐Lione,
i
9,8
milioni
di
euro
della
Madrid-­‐Siviglia
e
i
9,3
milioni
di
euro
della
Tokyo-­‐
Osaka.
In
totale
il
costo
medio
dell’alta
velocità
in
Italia
è
stimato
a
61
milioni
di
euro
al
chilometro.

18. Mr.
Maurizio
Bortoletti,
October
31,
November
1,
2017
CORRUPTION
AND
ANTICORRUPTION
–
ITALIAN
CASE
AN
ACTION
OF
EXTRAORDINARILY
ORDINARY
IN
PUBLIC
HEALTHCARE
COMPANY
IN
SALERNO
(2011-­‐2012)
The
dilemma
between
waste
and
medical
services.

19. Mr.
Maurizio
Bortoletti,
October
31,
November
1,
2017
CORRUPTION
AND
ANTICORRUPTION
–
ITALIAN
CASE
AN
ACTION
OF
EXTRAORDINARILY
ORDINARY
IN
PUBLIC
HEALTHCARE
COMPANY
IN
SALERNO
(2011-­‐2012)
Two
keys:
• TO
ACT
against
wasting
time
brooding
over
problems:
the
re-­‐alphabetizations
of
the
management
and
administrative
team
of
the
company
with
the
valorization
of
the
good
professionals
• TO
ACT
“
GOVERNING
THE
REALITY”:
without
linear
cuts,
minimal
structural
or
civil
interventions,
without
external
resources,
paying
the
debts
and
using
a
planned
strategy

20. Mr.
Maurizio
Bortoletti,
October
31,
November
1,
2017
CORRUPTION
AND
ANTICORRUPTION
–
ITALIAN
CASE
AN
ACTION
OF
EXTRAORDINARILY
ORDINARY
IN
PUBLIC
HEALTHCARE
COMPANY
IN
SALERNO
(2011-­‐2012)
PROGRAMMING
AND
COST
RESTRUCTURING:
• Relations
with
clients
• Regular
payments
• Resources
and
payment
of
debts
• Valorization
of
a
strategy
programmatory
tool
• Constant
monitoring
• Externalization
or
internalization
of
the
services
• Rationalization
• transparency
• Fighting
waste
also
with
the
“housewife
economy”
(
no
wasting
money
in
more
that
I
need
,
no
buy
when
no
needed,
no
mistakes
in
stock
aging
or
transporting
materials).

21. Mr.
Maurizio
Bortoletti,
October
31,
November
1,
2017
CORRUPTION
AND
ANTICORRUPTION
–
ITALIAN
CASE
AN
ACTION
OF
EXTRAORDINARILY
ORDINARY
IN
PUBLIC
HEALTHCARE
COMPANY
IN
SALERNO
(2011-­‐2012)

22. Mr.
Maurizio
Bortoletti,
October
31,
November
1,
2017
CORRUPTION
AND
ANTICORRUPTION
–
ITALIAN
CASE
AN
ACTION
OF
EXTRAORDINARILY
ORDINARY
IN
PUBLIC
HEALTHCARE
COMPANY
IN
SALERNO
(2011-­‐2012)
The
waste
is
mostly
due
to
a
bad
management
organization
of
a
company
and
so
is
often
better
to
act
on
the
chain
of
the
causes
of
the
bad
management”
.
Infective
scores
/
storage:
a
stationary
material
or
equipment
does
not
create
value,
empty
space,
require
to
be
moved.

23. Mr.
Maurizio
Bortoletti,
October
31,
November
1,
2017
CORRUPTION
AND
ANTICORRUPTION
–
ITALIAN
CASE
AN
ACTION
OF
EXTRAORDINARILY
ORDINARY
IN
PUBLIC
HEALTHCARE
COMPANY
IN
SALERNO
(2011-­‐2012)
The
waste
is
mostly
due
to
a
bad
management
organization
of
a
company
and
so
is
often
better
to
act
on
the
chain
of
the
causes
of
the
bad
management”
.
Every
queues
to
complete
a
cycle,
a
phase,
a
product,
with
paid
for
not
working.

24. Mr.
Maurizio
Bortoletti,
October
31,
November
1,
2017
CORRUPTION
AND
ANTICORRUPTION
–
ITALIAN
CASE
AN
ACTION
OF
EXTRAORDINARILY
ORDINARY
IN
PUBLIC
HEALTHCARE
COMPANY
IN
SALERNO
(2011-­‐2012)
The
waste
is
mostly
due
to
a
bad
management
organization
of
a
company
and
so
is
often
better
to
act
on
the
chain
of
the
causes
of
the
bad
management”
.
Overproof: buy / produce when you
do not use or in advance.

25. Mr.
Maurizio
Bortoletti,
October
31,
November
1,
2017
CORRUPTION
AND
ANTICORRUPTION
–
ITALIAN
CASE
AN
ACTION
OF
EXTRAORDINARILY
ORDINARY
IN
PUBLIC
HEALTHCARE
COMPANY
IN
SALERNO
(2011-­‐2012)
The
waste
is
mostly
due
to
a
bad
management
organization
of
a
company
and
so
is
often
better
to
act
on
the
chain
of
the
causes
of
the
bad
management”
.
Errors
defects
screws:
need
to
disconnect
the
error
chain.

26. Mr.
Maurizio
Bortoletti,
October
31,
November
1,
2017
CORRUPTION
AND
ANTICORRUPTION
–
ITALIAN
CASE
AN
ACTION
OF
EXTRAORDINARILY
ORDINARY
IN
PUBLIC
HEALTHCARE
COMPANY
IN
SALERNO
(2011-­‐2012)
The
waste
is
mostly
due
to
a
bad
management
organization
of
a
company
and
so
is
often
better
to
act
on
the
chain
of
the
causes
of
the
bad
management”
.
Moving
and
unnecessary
shifts
of
materials,
services,
functions,
products
and,
Tinally,
people.

27. Mr.
Maurizio
Bortoletti,
October
31,
November
1,
2017
CORRUPTION
AND
ANTICORRUPTION
–
ITALIAN
CASE
AN
ACTION
OF
EXTRAORDINARILY
ORDINARY
IN
PUBLIC
HEALTHCARE
COMPANY
IN
SALERNO
(2011-­‐2012)
The
waste
is
mostly
due
to
a
bad
management
organization
of
a
company
and
so
is
often
better
to
act
on
the
chain
of
the
causes
of
the
bad
management”
.
unnecessary
transport,
wrong
layout
of
production
units,
messy
materials
and
stocked
materials
in
wrong
areas.

28. Mr.
Maurizio
Bortoletti,
October
31,
November
1,
2017
CORRUPTION
AND
ANTICORRUPTION
–
ITALIAN
CASE
AN
ACTION
OF
EXTRAORDINARILY
ORDINARY
IN
PUBLIC
HEALTHCARE
COMPANY
IN
SALERNO
(2011-­‐2012)
The
waste
is
mostly
due
to
a
bad
management
organization
of
a
company
and
so
is
often
better
to
act
on
the
chain
of
the
causes
of
the
bad
management”
.
Inactive
processes,
steps
of
production
that
do
not
produce
value
but
only
formal
and
burocatic
safety,
delayed
processing
and
dysfunctional
bureaucratic
steps.

29. Mr.
Maurizio
Bortoletti,
October
31,
November
1,
2017
CORRUPTION
AND
ANTICORRUPTION
–
ITALIAN
CASE
AN
ACTION
OF
EXTRAORDINARILY
ORDINARY
IN
PUBLIC
HEALTHCARE
COMPANY
IN
SALERNO
(2011-­‐2012)
In
summary,
the
return
to
the
operational
balance
of
the
Public
Healthcare
Company
in
Salerno
was
nothing
else
that
a
SIMPLE
PROBLEM
OF
HOME
ECONOMY