In the 1990’s the development and progress of the Public Administration, implemented in healthcare with specific reforms [1-4], gave rise to a new organization of the Italian National Health Service (NHS). The process of corporatization and the need to create an NHS that could respond to increasingly complex and articulated social needs, have allowed the institution of the role of health professions’ head (nursing, technical, rehabilitation, prevention and obstetric professions as well as the profession of social worker), setting new objectives in terms of management. According to the Italian law 251/2000 [5] the health professions are divided into 4 areas: area of the nursing sciences and of the obstetric health profession; rehabilitation area; technical-diagnostic area and technical assistance area and at least the prevention area. In the 7 article, for the technical-diagnostic area, it states that «Healthcare companies can confer the role of manager for the attribution of the management function related to the activities of the specific professional area». The law of 1st February 2006, n. 43 [6] establishes the definitive recognition of the health professions as intellectual professions and an important impulse to outline the managerial figures of the health professions. Although the rules of reference have contributed to the evolution of these roles, they do not examine in depth the functions and figures within the organizations, leaving ample space for local regulations and specific declinations.

The legislative evolution has allowed the allied health professions to develop a career at managerial level, but this development has not been fully realized due to several factors such as: the acceleration of scientifictechnological progress; a contractual power not yet recognized [7]; a system that is culturally not yet ready within the horizontal and vertical organizational structure, to recognize the role of the manager as the leadership of the organization; finally a lack of investment in terms of specific training. The participation in continuous training activities in the management field is therefore a fundamental and indispensable requirement for professional development within the NHS. Despite the existence of training courses for general managers of health companies [8], studies on the professional development of the NHS management [9] and management training for NHS managers [10], the attention has not yet been addressed to technical health professions. The objective of the study is to analyze the training needs of the manager of the technical health professions, investigating specifically the contents, methodology and articulation that are most effective for designing a dedicated training course.

The exploration of the training needs took place through qualitative research, which involved numerous professionals in the technicalhealth managerial field. We chose the focus group [11] as a tool for sample exploration.

The focus group was held during the months of March and April 2017 at the Polyclinic Umberto I and Sant’Andrea Hospitals in Rome with coordinators, organizational positions and managers of the respective companies, asking three questions and then allowing about 10 minutes for the answer and the rest of the time for discussion. The use of the focus group was functional to the interview by highlighting the profile, activities and skills of the manager, the critical issues with respect to this role and the way in which training can help to improve it Table 1, Figure 1.

Table 1: Focus group questions.

Figure 1: Focus group scheme.

The online survey was sent between June and July 2017 through Google Forms (Figures 2 and 3). The choice to adopt this application as a tool has allowed us to have a summary of the answers in real time and to address a larger sample, saving time and money. The selection of the sample took place over the internet, showing the profile of the managers of allied health professions in their company sites, through the professional network of LinkedIn and through suggestions from other managers. In the selection of the sample, we have decided to include, in addition to the area managers, also those who occupy an organizational position or a position of coordination, albeit in smaller numbers. The reason arises from the fact that this role is not consolidated in all the different regional and business realities. Despite this decision has made the sample less homogeneous, it reflects the actual Italian national scenario in terms of leadership of the allied health professions in the technical area. The semi-structured interview consisted of 70 questions, divided into three main sections: area of skills (37 questions); training and innovation area (18 questions); personal and professional area (15 questions). In the first area all aspects concerning managerial, relational, technological, linguistic and teamwork skills are analyzed.

Figure 2: Interface moduli google.

Figure 3: Format pdf questionnaire.

About managerial aspects, we have analyzed: the qualities that the manager must have, the main activities carried out and among them we have analyzed the difficulties encountered, moreover the critical issues encountered at the workplace. In the second area the topics concerning the training are highlighted, asking questions about the articulation, the type, the methodology, the topics, the place and time of a possible course for managers and the characteristics of the teacher. Finally, in the third area, the personal data of the interviewees were collected regarding their training and professional role.

Sampling was made up of 20 subjects (17 males and 3 females), including 15 managers, 3 organizational positions and 2 coordinators (predominantly radiology technicians). The survey was compiled entirely by 18 of the interviewees while 2 left incomplete answers. The online procedure provided for the compilation of some mandatory answers. A PDF version of the questionnaire was sent to 8 interviewed subjects who had difficulty accessing the online survey (Figure 3) and the related answers were subsequently added to the data analysis platform. It was decided to examine both the interviews with incomplete answers and the interviews in PDF format. Despite the limited number of cases, it was decided to report some data in % for a more immediate reading and interpretation of the results.

The interviewed subjects work in 8 regions of central and northern Italy: Trentino-Alto Adige, Veneto, Lombardy, Piedmont, Emilia Romagna, Tuscany, Lazio and Marche (Figures 4 and 5). 50% of the sample is aged between 56 and 65, 40% between 46 and 55 and 10% between the ages of 36 and 45, all of Italian nationality. 30% have held their organizational role for more than 15 years, 20% have covered it for 11 to 15 years, 30% have it for 5 to 10 years and 15% for less than 5 years. The majority part of the respondents answered that the qualities that a manager must have are: 65% the ability to solve problems and decisionmaking skills, 60% leadership skills, 45% know how to achieve goals, 40% the sense of responsibility and the ability to communicate, 35% the ability to listen, 20% for mediation, 15% have proficient professional skills, in less than 5% to be able to manage emotions, be authoritarian, be authoritative (Figure 6).

Figure 4: Map of the sample.

Figure 5: Question 65.

Figure 6: Question 15.

Among the priority activities, there are the organization, the development of strategies to achieve the objectives and planning (Figure 7). The command is not present.

Figure 7: Question 16.

90% of respondents found critical issues at work, particularly in the areas of human and financial resources, bureaucracy and organization, but also in terms of time, horizontal communication, methodologies, spaces and resistance to innovation. Compared to European countries, they do not feel in line with aspects related to guidelines, methodologies, protocols and technology, but even more so with culture, referring to a lack of a ministerial history in their field. According to the data reported, the manager must often be a mediator and a facilitator with his collaborators, sharing information and knowledge with others. All are oriented towards professional development within the work environment. 85% attend assiduously refresher courses, while only 15% attend occasionally. 45% would be willing to move out of the Region where they work to attend a course for managers, 25% would move out of the national territory, 15% out of the city where they work, 10% would leave their own company and 5% would go wherever there is a chance to grow and compare. 60% have enough difficulty in reconciling work commitments and training with personal commitments, 30% think it has little difficulty, 5% a lot and the remaining 5%, none. 95% are interested in participating in a training course common to several areas, disciplines and professionalism. Among the training typologies, we see the residential course and the blended course [12]. The maximum duration of the course can vary from a few days to several years; some of them do not set limits in terms of training and updating. The most favorable period of the year is that of the autumn and spring season. The most appropriate methodologies are the frontal lesson, interactive and laboratory, technical-practical, with mentorship programmes, simulations and role playing. The training activities should be carried out both indoors and outdoors. The teacher must be prepared, expert, empathetic and innovative, a facilitator of learning, authoritative and helpful, open to questions and able to tell experiences. According to the interviewees to lead the course, they should be area managers and trainers. The topics would focus on management and organization, analysis and problem-solving techniques, legislation, teamwork, effective communication, economic and financial aspects, leadership, adult education and learning, technological innovation and information technology (Figure 8, Table 2).

Figure 8: Question 51.

Table 2: Summary table.

65% believe that an ad hoc course for managers must be provided to the top managers of the company, 30% do not agree. Most are in favour of exchange meetings between managers from different sectors, such as industrialists or health professionals, believing that they can contribute to the professional growth of their role and participate in a meeting between the corresponding managers of EU health companies. Furthermore, it is considered that among the minimum requirements that must be part of the curriculum vitae of an area manager are the master’s degree associated with a master’s degree or a specific vocational training course, and several years of experience in top positions as coordinator or position organizational.

In the light of the results obtained from the interview, it is evident that the type of training that the managers prefer is a blended [13], i.e. mixed, training that provides for the alternation of training activities at a distance and in presence. For educational activities, they preferred frontal and technical-practical lessons, conducted by managers and trainers, whose duration is variable. The course takes place during the autumn and spring months, indoors and outdoors, must be interactive and deal mainly with management and organization issues, with particular attention to problem solving techniques, legislative issues and the development of human resources. The teachers must be managers or experienced and innovative trainers. One of the strengths of the research lies in having allowed the interviewees to define their managerial model and in putting their needs in the forefront, without imposing them. In fact, we immediately tried to clarify the figure of the manager, exploring the profile through the focus groups and studying the training needs through the interview.

The attention paid to the managerial role arises from the assumption that the manager of the health professions can play a crucial role within the system, as a promoter of a cultural change that can see him protagonist in new organizational models. Continuing education in medicine must focus on and involve health professionals with managerial responsibility, as the courses dedicated to them do not always take into account their effective training needs. Since a master’s degree is not yet able to complete the profile and the need for training that is significant in terms of content and timing, we consider it more appropriate to hypothesize a training course. Motivation is high and investing these positive energies in training is an opportunity not to be missed. The contractual power, which many managers still lack, is also determined by a system that does not recognize it, but since a change towards that direction is taking place, it is necessary to get ready for that moment.

From the reflection on the role of the manager, it has emerged that one of its skills is to translate the directives so that they are mediated to all staff levels, trying to reduce waste in a lean management perspective and, where possible, to increase productivity, as often required by companies, with an eye to the quality of services. The results confirm the need for managerial training for the manager who must commit himself in order to become an added value for the organization, thus achieving his personal empowerment and finally bringing an improvement to the system. This vision must be supported and nurtured by professionals and by the institutions themselves. The analysis of training needs is the first step, as well as the most important phase of a whole training process, as this can depend on whether the real goals of the company in the training and organizational field are reached. In the light of what has been said, leading is a challenge that the health professions must face, giving strength to the development of this role, which represents its most advanced expression. In this context continuous training is one of the ways to be undertaken.

It should be noted that the research would have been more exhaustive if it had involved the managers of all the areas of the health professions in all the Regions of Italy. Unfortunately this was not possible.

Using blended learning as a learning method, you can think about a training course that provides for the theoretical topics of open courses available on the web according to the MOOC (Massive Open Online Course) [14] model in order to enrich the activity carried out in the presence, indoor and outdoor, in relation to the pre-established learning objectives. The idea is to provide managers with a tailor-made learning system that can help develop and acquire new skills and knowledge useful to the manager of the future.