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The complex patient, who has often multiple, chronic and progressive disorders, who has undergone polytherapy, should be evaluated totally with respect not only to medical side, but also to psychological and clinical side. The shortage of specialists in disciplines that require technical skills, obtained by training and performing a sufficient number of annual procedures, contributes to the need for reorganizing health care; in this background the Internist devolves less time to charitable activities in favor of competences related to the processes. The knowledge of the clinical governance (CG) should be the common heritage of all the actors of the health system, that need to be made up of professionals able to coordinate and make easy the implementation and the spread the CG culture. At least initially we propose to focus the testing strictly on the medical department. As already mentioned above, the natural Internist predisposition, cultural and training, leads him to a multidisciplinary vision of medicine that allows acquiring more easily the tools that make up the structure of CG, being able to facilitate the application. The acquisitions of professional competence and clinical governance play a key role in the Internist culture. The purpose of an Internist with professional skills and managerial capacity, is to act within the department to facilitate and simplify the horizontal interaction among other similar corporate structures and to help the Management to improve structural and clinical appropriateness in Hospital and to better the relations between hospital and territory, identifying the critical issues and the possible solutions

Clinical governance and clinical competence to support new scenarios and role of internal medicine