1. Fabrizio Gemmi 2015 Tema 1: Academic vs Health System Driven Research Valutazione delle tecnologie sanitarie utili e appropriate: la prospettiva a livello di azienda ospedaliera universitaria 2. Fabrizio Gemmi 2015 parleremo di: A.Evoluzione B.Scoperte C.Innovazione D.Sostenibilit 3. FG 2013 3 eraantibiotica 1950 2010 2000 1990 1980 1970 1960 epocaSSNepocamutualistica mecloretamina intensive care unit primo trapianto di midollo recovery room endoscopio flessibile DNA virale nei tumori separazione gemelli siamesi (Torino) day surgery (Phoenix) TAC RMN ABVD PTCA SSN trapianto di fegato (Roma) pandemia AIDS trapianto di cuore (Padova) videochirurgia chirurgia refrattiva laser eccimeri trapianto di rene (Pisa) EBM DRG in Italia DEU rituximab robot DaVinci riforma professioni sanitarie pandemia SARS linee guida ASSR medicina rigenerativa pandemia influenza A H1N1 riflettere su quante novit sono intervenute di recente 4. Fabrizio Gemmi 2015 5 dallevoluzione alla sostenibilit 5. Fabrizio Gemmi 2015 A.Evoluzione Survival of the fittest Herbert Spencer (Derby, 27 Aprile 1820 Brighton, 8 Dicembre 1903) Principles of Biology (1864) 6. Fabrizio Gemmi 2015 A.Evoluzione da Darwin better designed for an immediate, local environment Carles Robert Darwin (Shrewsbury, 12 Febbraio 1809 Londra,19 Aprile 1882) On the Origin of Species (edition 1869) 7. Fabrizio Gemmi 2015 A.Evoluzione a Gould Our evolutionary colleagues also failed to grasp the implication(s), primarily because they did not think at geological scales Stephen Jay Gould (New York, 10 Settembre 1941 20 Maggio 2002) 8. Fabrizio Gemmi 2015 A.Evoluzione Equilibrio Punteggiato 9. Fabrizio Gemmi 2015 A.Evoluzione LEvoluzione inefficiente 10. Fabrizio Gemmi 2015 loceano cambriano 11. Fabrizio Gemmi 2015 A.Evoluzione culturale Rosvall and Bergstrom (2010) PLoS One 6:e18209 12. Fabrizio Gemmi 2015 A.LEvoluzione culturale piuttosto lamarckiana 1. Uso e disuso - Gli individui perdono le caratteristiche non necessarie e sviluppano quelle utili 2. Ereditariet dei caratteri acquisiti - Gli individui ereditano tali caratteri Jean-Baptiste de Lamarck (Bazentin-le-Petit,1 Agosto 1744 Parigi,18 Dicembre 1829) 13. Fabrizio Gemmi 2015 B.Scoperte 14. Fabrizio Gemmi 2015 B.Scoperte: la ricerca di base necessita di contaminazioni 15. Fabrizio Gemmi 2015 B.Scoperte Non possiamo conoscere il futuro in anticipo 16. Fabrizio Gemmi 2015 Conventional Workshop Examples Through Time Copyright Lean Enterprise Academy 2009 "...so many centuries after the Creation it is unlikely that anyone could find hitherto unknown lands of any value. Committee advising King Ferdinand and Queen Isabella of Spain regarding a proposal by Christopher Columbus, 1486 "The view that the sun stands motionless at the center of the universe is foolish, philosophically false, utterly heretical, because contrary to Holy Scripture. The view that the earth is not the center of the universe and even has a daily rotation is philosophically false, and at least an erroneous belief." Holy Office, Roman Catholic Church, ridiculing the scientific analysis that the Earth orbited the Sun in edict; 1616 "Everything that can be invented has been invented. Charles H. Duell, Commissioner, U.S. Office of Patents, 1899. "Stocks have reached what looks like a permanently high plateau. Irving Fisher, Professor of Economics, Yale University, 1929. (two weeks later, the stock market crashed and the Great Depression started) "We don't like their sound, and guitar music is on the way out anyway. President of Decca Records, rejecting The Beatles after an audition, 1962 17. Fabrizio Gemmi 2015 Conventional Workshop Examples: Aviation Copyright Lean Enterprise Academy 2009 "Man will not fly for 50 years. Wilbur Wright, American aviation pioneer, to brother Orville, after a disappointing flying experiment, 1901 (their first successful flight was in 1903) "I confess that in 1901 I said to my brother Orville that man would not fly for fifty years. Two years later we ourselves made flights. This demonstration of my impotence as a prophet gave me such a shock that ever since I have distrusted myself and avoided all predictions. Wilbur Wright, American aviation pioneer, speech to the Aero Club of France, 1908 "Airplanes are interesting toys but of no military value. Marechal Ferdinand Foch, Professor of Strategy, Ecole Superieure de Guerre, 1904(?) "Flight by machines heavier than air is unpractical and insignificant, if not utterly impossible. Simon Newcomb, Canadian-born American astronomer, 1902 "If God had intended that man should fly, he would have given him wings. Widely attributed to George W. Melville, chief engineer of the U.S. Navy, 1900 "It is apparent to me that the possibilities of the aeroplane, which two or three years ago were thought to hold the solution to the [flying machine] problem, have been exhausted, and that we must turn elsewhere. Thomas Edison, American inventor, 1895 "Heavier-than-air flying machines are impossible. Lord Kelvin, British mathematician and physicist, president of the British Royal Society, 1895 18. Fabrizio Gemmi 2015 Copyright Lean Enterprise Academy 2009 Conventional Workshop Examples: Computing " 640k ought to be enough for anybody. Bill Gates, 1981 "There is no reason anyone would want a computer in their home. Ken Olson, president, chairman and founder of Digital Equipment Corp., 1977 "But what ... is it good for? Engineer at the Advanced Computing Systems Division of IBM, 1968, commenting on the microchip. "I think there is a world market for maybe five computers. Thomas Watson, chairman of IBM, 1943 "Computers in the future may weigh no more than 1.5 tons. Popular Mechanics, "predicting" the relentless march of technology, 1949 "The world potential market for copying machines is 5000 at most. IBM, to the eventual founders of Xerox, saying the photocopier had no market large enough to justify production, 1959 19. Fabrizio Gemmi 2015 Conventional Workshop Examples: Telephone Copyright Lean Enterprise Academy 2009 "It's a great invention but who would want to use it anyway?" Rutherford B. Hayes, U.S. President, after a demonstration of Alexander Bell's telephone, 1872 "The Americans have need of the telephone, but we do not. We have plenty of messenger boys. Sir William Preece, Chief Engineer, British Post Office, 1878 "This telephone has too many shortcomings to be considered as a means of communication. The device is of inherently no value to us. Western Union internal memo, 1876 Transmission of documents via telephone wires is possible in principle, but the apparatus required is so expensive that it will never become a practical proposition. Dennis Gabor, British physicist and author of Inventing the Future, 1962 "A man has been arrested in New York for attempting to extort funds from ignorant and superstitious people by exhibiting a device which he says will convey the human voice any distance over metallic wires so that it will be heard by the listener at the other end. He calls this instrument a telephone. Well-informed people know that it is impossible to transmit the human voice over wires. News item in a New York newspaper, 1868 "Well-informed people know it is impossible to transmit the voice over wires and that were it possible to do so, the thing would be of no practical value. Boston Post, 1865 20. Fabrizio Gemmi 2015 Human Genome Sequencing 21. Fabrizio Gemmi 2015 C.Innovazione Non possiamo conoscere in anticipo quale scoperta porter innovazione 22. Fabrizio Gemmi 2015 innovazione novit in azione 12-12-12 23. Fabrizio Gemmi 2015 6 Garjon et al. BMC Health Services Research 2012 24. Fabrizio Gemmi 2015 C.Innovazione Abbiamo nuovi farmaci veramente innovativi? me-too!? 25. Fabrizio Gemmi 2015 C.Innovazione 26. Fabrizio Gemmi 2015 C.Innovazione 27. Fabrizio Gemmi 2015 C.Innovazione 28. Fabrizio Gemmi 2015 C.Innovazione 29. Fabrizio Gemmi 2015 C.Innovazione Linnovazione costosa 30. Fabrizio Gemmi 2015 C.Innovazione Linnovazione figlia della contaminazione 31. Fabrizio Gemmi 2015 D.Sostenibilit Linnovazione sostenibile? 32. Fabrizio Gemmi 2015 D.Sostenibilit cing resources used by actions of humans with resources of equal or greater value by th drix, Sustainable Backyard Polyculture: Designing for ecological resiliency. Smashwords 33. Fabrizio Gemmi 2015 D.Sostenibilit 34. Fabrizio Gemmi 2015 23 35. Fabrizio Gemmi 2015 24 36. Fabrizio Gemmi 2015 25 37. Fabrizio Gemmi 2015 D.Sostenibilit allows us to consider the role of hospitals in meeting objectives related to outcomes, serv Public value thus goes beyond utilitarian objectives of outcomes and efficiency. due process and stewardship for future generations. Public services, therefore, aim to en 38. Fabrizio Gemmi 2015 Sostenibilit attiene al futuro L'innovazione costosa Non possiamo prevedere quale scoperta porter Innovazione LEvoluzione inefficiente contaminazione 39. Fabrizio Gemmi 2015 ma... levoluzione ineludibile