In Italy, as in much of the industrialized world, the health sector is facing a double challenge. On the one hand, the economic crisis nd the urgent need to control spending and on the other there is the awareness that health care can not be separated from high quality standards. The model health future will be more and more "patientcentered" with a strong integration of services and consequently you will find more resources for such evelopment. It seems clear that to manage such complexity respecting a certain equilibrium, we must respect the sharing of values and methodologies among different rofessionals. In addition it must ensure that the understandable pressure placed on operators on cost control will not reflect negatively on the performance of he patient. It seems clear that to restore the system not just to cut costs, but you need to use all available tools and methodologies to facilitate effectiveness and linical appropriateness. And 'necessary to focus the process of planning and management of health services to the needs of the community, enhancing the role and responsibilities of hysicians and health care by promoting the culture of quality. In this regard, it seems clear that the processes of care should be studied and re-engineered with the aim to optimize spending, while maintaining as a "gold tandard" the high quality of care. The aim of this study was to analyze in this context, the activities of the Unit of Hand Surgery with particular emphasis to the Department of Rehabilitation of he principals of the group Multimedica and so, check its viability, producing a model, possibly duplicated and exportable to other similar initiatives.