The certification of hospital delivery ward: the Italian project

21 Nov 2013
  1. Marino1, F. Azzali2, R. Zanini3, on behalf of Gruppo Italiano Nascita Sicura (GINS)

1 Department of Hygiene and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy; 2 Pro.Ge.A.: innovazione e cambiamento al servizio del management, Milan, Italy; 3 Mother-and-child Department, Azienda Ospedaliera Provinciale di Lecco, Ospedale A.Manzoni, Lecco, Italy.


GINS – Gruppo Italiano Nascita Sicura – the Italian Working Group for a safety Birth: F Azzali, A Baggiani, L Bagnoli, C Berliri, M Bozzi, A Cinotti, G Colombo, G Costamagna, I Dall’Oglio, A de Belvis, R di Iorio, A Dotta, G Ettore, F Facchinetti, MG Frigo, C Galavotti, M Marino, F Moccia, P Montilla, N Natale, N Orthmann, A Portanova, N Romeo, B Rusticali, H Valenzise, G Vittori, V Zanardo, R Zanini

Ref.: Eur J. Public Health 2013; 23: Suppl 1

The maternal and child health is a priority area of Italian Public Health because pregnancy, childbirth and puerperium are the leading cause of hospitalization for women, and birth-related events are internationally recognized among the best for assessing the health care quality. Several problems threaten the quality and safety e.g. excessive normal pregnancy medicalization, cesarean sections high level, Hospital Delivery Ward (HDW) performing less than 1000 births/year (minimum safety standard set by the Italian law).

The National Health Plan 2011-2013 lays the foundation for the project, suggesting the quality certification of HDW through the collaboration of Medical Scientific Societies, National Federation of Midwives, Nurses, Citizens by using an ad hoc manual. From February 2011 to September 2012, 30 experts belonging to 15 Scientific Societies and Professional College joined a working group to point out safety standards for mother and child during delivery and birth in Italian HDW, referring to Join Commission International Standards.

The edited handbook “Standards for the evaluation of HDW” evaluates the labor, delivery, operating (for cesarean sections) and neonatal rooms; physiological/pathological pregnancy and newborn; professionals working in the birth center. 83 standards were included, exploring 10 functions for investigating the provision of health care, safety, efficacy, good management (e.g. expertise of staff, standardization of clinical practice and safety of mother and baby; needs assessment and care planning; prevention and control of healthcare associated infections; management of medical records and communication etc.). For each standard measurable evidence based elements were identified, needed to be met in order to fully comply with the standard.

We tested our standards in five pilot tests through five HDW in Italy. During 2013 we will certify 35 HDW to disseminate and to test our project. The standards can be a valid help for each HDW in order to clearly identify safe behaviors; to create the conditions to operate in a uniform manner over time; to periodically check the level of performance and security.
These types of activities allow the HDW to continuously improve safety and quality of health care.

The quality and safety certification of Hospital Delivery Ward should arise from the collaboration of Medical Scientific Societies, National Federation of Practitioners and Citizens.

The handbook “Standards for the evaluation of Hospital Delivery Ward” evaluates the labor, delivery, operating and neonatal rooms through 83 standards and measurable evidence based elements.


For further information, please contact Dr. Marta Marino e-mail:

Sostieni la salute della donna!