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Lega F. After all we're only human. Health Serv Manage Res 2024; 37:71. [PMID: 38654423 DOI: 10.1177/09514848241242210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
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Lega F. Welcome to the home of health management research. Health Serv Manage Res 2024; 37:1. [PMID: 38148608 DOI: 10.1177/09514848231225542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
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Pennestrì F, Lega F, Banfi G. From volume to value: Improving peri-operative elective pathways through a roadmap from fast-track orthopedic surgery. Health Serv Manage Res 2023; 36:284-290. [PMID: 36444939 PMCID: PMC10552341 DOI: 10.1177/09514848221127623] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Healthcare institutions face the pressure generated by modern medicine and society, in terms of increasing expectations and financial constraints. Chronic patients need multidisciplinary care pathways to preserve their wellbeing across the entire journey.The orthopaedic community has been particularly receptive in testing solutions to align good clinical outcomes and financial sustainability, given the increase in elective procedures provided among aging populations to alleviate pain and reduce disability. Fast-track (FT) total joint arthroplasty (TJA) and bundled payments (BPs) offer relevant examples both from the clinical and the financial perspective; however, they have not been evaluated in combination yet.The aim of this manuscript is to provide a road map to improve the value of high-volume, multidisciplinary elective procedures, with potential applications in a vast number of surgical specialties, (1) based on an integrated financial budget per episode of care (the BP), (2) building on lessons from a review of the literature on FT TJA.Although clinical outcomes vary from procedure to procedure, the coordination between the single treatments and providers involved across the patient journey; the commitment of patients and relatives; and the systematic adoption of patient-reported outcomes; can add further value for the benefit of patients, healthcare funders and providers, once essential clinical, financial and administrative conditions are guaranteed.
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Affiliation(s)
| | - Federico Lega
- Research Center on Health Administration, University of Milan, Italy
| | - Giuseppe Banfi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Università Vita-Salute San Raffaele, Milan, Italy
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Prenestini A, Palumbo R, Grilli R, Lega F. Exploring physician engagement in health care organizations: a scoping review. BMC Health Serv Res 2023; 23:1029. [PMID: 37749568 PMCID: PMC10521513 DOI: 10.1186/s12913-023-09935-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 08/18/2023] [Indexed: 09/27/2023] Open
Abstract
RATIONALE Enhancing health system effectiveness, efficiency, and appropriateness is a management priority in most world countries. Scholars and practitioners have focused on physician engagement to facilitate such outcomes. OBJECTIVES Our research was intended to: 1) unravel the definition of physician engagement; 2) understand the factors that promote or impede it; 3) shed light on the implications of physician engagement on organizational performance, quality, and safety; and 4) discuss the tools to measure physician engagement. METHOD A scoping review was undertaken. Items were collected through electronic databases search and snowball technique. The PRISMA extension for Scoping Reviews (PRISMA-ScR) statement and checklist was followed to enhance the study replicability. RESULTS The search yielded 16,062 records. After an initial screening, 300 were selected for potential inclusion in this literature review. After removing duplicates and records not meeting the inclusion criteria, full-text analysis of 261 records was performed, yielding a total of 174 records. DISCUSSION Agreement on the conceptualization of physician engagement is thin; furthermore, scholars disagree on the techniques and approaches used to assess its implementation and implications. Proposals have been made to overcome the barriers to its adoption, but empirical evidence about implementing physician engagement is still scarce. CONCLUSIONS Our scoping review highlights the limitations of the extant literature about physician engagement. Physician engagement is a relatively ill-defined concept: developing an evidence base for its actual implementation is necessitated to provide reliable guidance on how the governance of health care organizations could be improved. Although we did not assess the quality or the robustness of current empirical research, our findings call for further research to: 1) identify potential drivers of physician engagement, 2) develop dependable assessment tools providing health care organizations with guidance on how to foster physician engagement, and 3) evaluate engagement's actual impact on health care organizations' performance.
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Affiliation(s)
- Anna Prenestini
- Department of Economics, Management and Quantitative Methods (DEMM) and Center of Research and Advanced Education in Health Administration (CRC HEAD), Università Degli Studi Di Milano, Milan, Italy.
| | - Rocco Palumbo
- Department of Management & Law, Università Degli Studi Di Roma Tor Vergata, Rome, Italy
| | - Roberto Grilli
- Health Services Research, Evaluation and Policy Unit, Local Health Authority of Romagna, Ravenna, Italy
| | - Federico Lega
- Department of Biomedical Sciences for Health (SCIBIS) and Center of Research and Advanced Education in Health Administration (CRC HEAD), Università Degli Studi Di Milano, Milan, Italy
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Amigoni F, Lega F, Maggioni E. Insights into how universal, tax-funded, single payer health systems manage their waiting lists: A review of the literature. Health Serv Manage Res 2023:9514848231186773. [PMID: 37394445 DOI: 10.1177/09514848231186773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Background: A conspicuous consequence of gatekeeping arrangements in universal, tax-funded, single-payer health care systems is the long waiting times. Besides limiting equal access to care, long waiting times can have a negative impact on health outcomes. Long waiting times can create obstacles in a patient's care pathway. Organization for Economic Co-operation and Development (OECD) countries have implemented various strategies to tackle this issue, but there is little evidence for which approach is the most effective. This literature review examined waiting times for ambulatory care. Objective: The aim was to identify the main policies or combinations of policies universal, tax-funded, and single-payer healthcare systems have implemented to improve the governance of outpatient waiting times. Methods: Starting from 1040 potentially eligible articles, a total of 41 studies were identified via a 2-step selection process. Findings: Despite the relevance of the issue, the literature is limited. A set of 15 policies for the governance of ambulatory waiting time was identified and categorized by the type of intervention: generation of supply capacity, control of demand, and mixed interventions. Even if a primary intervention was always identifiable, rarely a policy was implemented solo. The most frequent primary strategies were: guidelines implementation and/or clinical pathways, including triage, guidelines for referral and maxim waiting times (14 studies), task shifting (9 studies), and telemedicine (6 studies). Most studies were observational, with no data on costs of intervention and impact on clinical outcomes.
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Affiliation(s)
- Francesco Amigoni
- European Master in Health Economics and Management, MCI Management Center Innsbruck Internationale Hochschule GmbH, Innsbruck, Austria
| | - Federico Lega
- Department of Biomedical Sciences for Health and Acting Director of the Research Center in Health Administration (HEAD), University of Milan, Milano, Italy
| | - Elena Maggioni
- Research Center in Health Administration (HEAD), University of Milan, Milano, Italy
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Lega F. No one will be left behind? Health Serv Manage Res 2023:9514848231185725. [PMID: 37339096 DOI: 10.1177/09514848231185725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
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Chisari G, Lega F. Impact of austerity programs: Evidence from the Italian national health service. Health Serv Manage Res 2022; 36:145-152. [PMID: 36227139 DOI: 10.1177/09514848221134473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Austerity measures are widely adopted to cope with financial straits. Since 2007 Italy has operated a financial recovery program (Piani di Rientro, PdR) in certain regions of the country. This provides an interesting setting for an intra-national analysis of the differences between the regions under a PdR program and those which are not. In the regions under a PdR, efforts to achieve economic sustainability and fiscal balance have impacted on healthcare indicators, resulting in a reduction in healthcare resources, an increase in taxes, and a general weakening of regional healthcare systems since the introduction of the program more than a decade ago. The detrimental effects of the austerity measures have become evident. As the regions under a PdR have demonstrated a sufficient level of economic stability, the national government should start revising its austerity strategy to prevent further widening of gaps in healthcare performance between regions.
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Affiliation(s)
- Giorgio Chisari
- 84956EU-Health Economics and Management, Management Centre Innsbruck, Innsbruck, Austria
| | - Federico Lega
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Lega F. After all we're only human. Health Serv Manage Res 2022; 35:195. [PMID: 36200510 DOI: 10.1177/09514848221133242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lega F, Rotolo A, Sartirana M. Dealing with pluralism: the managerial work of CEOs in Italian public healthcare organizations. BMC Health Serv Res 2022; 22:1222. [PMID: 36183065 PMCID: PMC9526245 DOI: 10.1186/s12913-022-08567-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 07/22/2022] [Indexed: 11/24/2022] Open
Abstract
Background Healthcare organizations are extremely complex. The work of their CEOs is particularly demanding, especially in the public sector, though little is known about how the managerial work of a healthcare organization CEO unfolds. Drawing from scholarship on managerial work and management in pluralistic organizations, we sought to answer the questions: What is the content of managerial work of CEOs in public healthcare in Italy? How do healthcare CEOs perform their managerial work in complex interactions with multiple stakeholders? Methods For this study we adopted a multi-method approach in which we conducted a survey to investigate CEO behaviors, tracked CEO working time for 4 weeks, and conducted semi-structured interviews with senior CEOs. Results CEOs in public healthcare devote most of their time to interaction, which half of which is perceived as being occupied with apparently mundane problems. Nonetheless, devoting time to such activities is functional to a CEO’s goals because change in pluralistic contexts can be achieved only if the CEO can handle the organization’s complexity. CEOs do this by engaging in routines and conversations with professionals, creating consensus, and establishing networks with external stakeholders. Conclusions CEOs are called to reduce fragmentation and foster cooperation across disciplines and professional groups, with the overarching aim to achieve integrated care. Using an analytical approach we were able to take into account the context and the relational dimension of the managerial work of healthcare CEOs and the specificities of this role. Trial registration This article does not report the results of a healthcare intervention on human participants, and the material used in the research did not require ethical approval according to Italian law. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08567-1.
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Affiliation(s)
- Federico Lega
- Dipartimento di Scienze Biomediche per la Salute and HEAD - Center for Research in Health Administration, Università degli studi di Milano, Milan, Italy
| | - Andrea Rotolo
- CERGAS - Centre for Research on Healthcare Management - SDA Bocconi School of Management, Bocconi University, Via Sarfatti, 10, 20136, Milan, Italy
| | - Marco Sartirana
- CERGAS - Centre for Research on Healthcare Management - SDA Bocconi School of Management, Bocconi University, Via Sarfatti, 10, 20136, Milan, Italy.
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Lega F. No health organization or system will ever be better than its people... Health Serv Manage Res 2022; 35:57. [PMID: 35414280 DOI: 10.1177/09514848221096184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lega F. All roads lead to leadership. Health Serv Manage Res 2022; 35:1. [PMID: 35040341 DOI: 10.1177/09514848221075395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bont L, Weil Olivier C, Herting E, Esposito S, Navarro Alonso JA, Lega F, Mader S, Morioka I, Shen K, Syrogiannopoulos GA, Faust SN, Bozzola E. The assessment of future RSV immunizations: How to protect all infants? Front Pediatr 2022; 10:981741. [PMID: 36016878 PMCID: PMC9396232 DOI: 10.3389/fped.2022.981741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Louis Bont
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, Netherlands
| | | | - Egbert Herting
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - Susanna Esposito
- Department of Medicine and Surgery, Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | | | - Federico Lega
- Department of Biomedical Science, Research Center in Health Administration, University of Milan, Milan, Italy
| | - Silke Mader
- European Foundation for the Care of Newborn Infants (EFCNI), Munich, Germany
| | - Ichiro Morioka
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Kunling Shen
- Department of Respiratory Medicine, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | | | - Saul N Faust
- Faculty of Medicine, Institute for Life Sciences, University of Southampton, Southampton, United Kingdom.,National Institute for Health Research (NIHR) Southampton Clinical Research Facility, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Elena Bozzola
- Pediatric and Infectious Diseases Unit, Bambino Gesù Children Hospital, Rome, Italy
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Navarro Alonso JA, Bont LJ, Bozzola E, Herting E, Lega F, Mader S, Nunes MC, Ramilo O, Valiotis G, Olivier CW, Yates A, Faust SN. RSV: perspectives to strengthen the need for protection in all infants. Emerg Themes Epidemiol 2021; 18:15. [PMID: 34674730 PMCID: PMC8529565 DOI: 10.1186/s12982-021-00104-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/11/2021] [Indexed: 11/10/2022] Open
Abstract
Respiratory syncytial virus (RSV)-the most common viral cause of bronchiolitis-is a significant cause of serious illness among young children between the ages of 0-5 years and is especially concerning in the first year of life. Globally, RSV is a common cause of childhood acute lower respiratory illness (ALRI) and a major cause of hospital admissions in young children and infants and represents a substantial burden for health-care systems. This burden is strongly felt as there are currently no effective preventative options that are available for all infants. However, a renaissance in RSV prevention strategies is unfolding, with several new prophylactic options such as monoclonal antibodies and maternal vaccinations that are soon to be available. A key concern is that health decision makers and systems may not be ready to take full advantage of forthcoming technological innovations. A multi-stakeholder approach is necessary to bridge data gaps to fully utilise upcoming options. Knowledge must be made available at multiple levels to ensure that parents and doctors are aware of preventative options, but also to ensure that stakeholders and policymakers are given the necessary information to best advise implementation strategies.
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Affiliation(s)
| | - Louis J Bont
- Wilhelmina Children's Hospital and UMC Utrecht, Utrecht, The Netherlands
| | - Elena Bozzola
- Pediatric and Infectious Diseases Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - Egbert Herting
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - Federico Lega
- Centre for Research on Healthcare Management, Bocconi University, Milan, Italy
| | - Silke Mader
- European Foundation for the Care of Newborn Infants (EFCNI), Munich, Germany
| | - Marta C Nunes
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Octavio Ramilo
- Center for Vaccines and Immunity, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Room WA4021, 700 Children's Drive, Columbus, OH, 43205, USA
| | - George Valiotis
- European Health Management Association (EHMA), Brussels, Belgium
| | - Catherine Weil Olivier
- University of Paris, 7 Denis Diderot, 28 rue Parmentier, Neuilly sur Seine, 92200, Paris, France
| | - Ann Yates
- International Confederation of Midwives (ICM), The Hague, The Netherlands
| | - Saul N Faust
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Hampshire, Southampton, UK. .,NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Hampshire, Southampton, UK.
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Rosa A, Marolla G, Lega F, Manfredi F. Lean adoption in hospitals: the role of contextual factors and introduction strategy. BMC Health Serv Res 2021; 21:889. [PMID: 34454500 PMCID: PMC8403367 DOI: 10.1186/s12913-021-06885-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 08/09/2021] [Indexed: 11/15/2022] Open
Abstract
Background In the scientific literature, many studies describe the application of lean methodology in the hospital setting. Most of the articles focus on the results rather than on the approach adopted to introduce the lean methodology. In the absence of a clear view of the context and the introduction strategy, the first steps of the implementation process can take on an empirical, trial and error profile. Such implementation is time-consuming and resource-intensive and affects the adoption of the model at the organizational level. This research aims to outline the role contextual factors and introduction strategy play in supporting the operators introducing lean methodology in a hospital setting. Methodology The methodology is revealed in a case study of an important hospital in Southern Italy, where lean has been successfully introduced through a pilot project in the pathway of cancer patients. The originality of the research is seen in the detailed description of the contextual elements and the introduction strategy. Results The results show significant process improvements and highlight the spontaneous dissemination of the culture of change in the organization and the streamlined adoption at the micro level. Conclusion The case study shows the importance of the lean introduction strategy and contextual factors for successful lean implementation. Furthermore, it shows how both factors influence each other, underlining the dynamism of the organizational system. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06885-4.
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Affiliation(s)
- Angelo Rosa
- Department of Management Studies, LUM University, S.S. 100 Km, 70010, Casamassima, Italy
| | - Giuliano Marolla
- Department of Management Studies, LUM University, S.S. 100 Km, 70010, Casamassima, Italy.
| | - Federico Lega
- Center in Health Administration, and Center for Applied Health Economics and Management of IRCCS Galeazzi, University of Milan, Via Giacomo Venezian, 1, 20133, Milan, Italy
| | - Francesco Manfredi
- Department of Management Studies, LUM University, S.S. 100 Km, 70010, Casamassima, Italy
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Abstract
Hospitals all around the world play an essential role in response to the COVID-19 pandemic. During an epidemic event, hospital leaders frequently face new challenges requiring them to perform unaccustomed tasks, which might be well beyond the scope of their previous practice and experience. While no absolute set of characteristics is necessary in all leadership situations, certain traits, skills and competencies tend to be more critical than others in crisis management times. We will discuss some of the most important ones in this manuscript. To strengthen those managerial competencies needed to face outbreaks, healthcare leaders should be better supported by competency-based training courses as it is more and more clear that traditional training courses are not as effective as they were supposed to be. It seems we should look at the COVID-19 pandemic as a learning opportunity to re-frame what we expect from hospital leaders and to re-think the way we train, assess and evaluate them.
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Affiliation(s)
- Zhaleh Abdi
- National Institute of Health Research (NIHR), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Federico Lega
- Department of Biomedical Sciences for Health (SCIBIS) and Director of the Center of Research and Advanced Education in Health Administration (CRC Head), Università degli Studi di Milano, Milan, Italy
| | - Nadine Ebeid
- Department of Universal Health Coverage/Health Systems (UHS), World Health Organisation Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Hamid Ravaghi
- Department of Universal Health Coverage/Health Systems (UHS), World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
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Lega F. Why Now is the Greatest Opportunity Ever. Health Serv Manage Res 2021; 34:127. [PMID: 34313147 DOI: 10.1177/09514848211032406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Prenestini A, Sartirana M, Lega F. Involving clinicians in management: assessing views of doctors and nurses on hybrid professionalism in clinical directorates. BMC Health Serv Res 2021; 21:350. [PMID: 33858410 PMCID: PMC8047525 DOI: 10.1186/s12913-021-06352-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hybrid professionalism is one of the most effective ways to involve clinicians in management practices and responsibilities. With this study we investigated the perceptions of doctors and nurses on hybridization in clinical directorates (CDs) in hospitals. METHODS We investigated the attitudes of healthcare professionals (doctors and nurses) towards eight hospital CDs in the Local Health Authority (LHA) of Bologna (Emilia Romagna, Italy) 6 years after their implementation. We used a validated questionnaire by Braithwaite and Westbrook (2004). Drawing on Palmer et al. (2007), we added a section about the characteristics of department heads. In all, 123 healthcare professionals in managerial roles completed and returned the questionnaire. The return rate was 47.4% for doctors and 31.6% for nurses. RESULTS Doctors reported an increase in clinical governance, interdisciplinarity collaboration, and standardization of clinical work. Hybridization of practices was noted to have taken place. While doctors did not see these changes as a threat to professional values, they felt that hospital managers had taken greater control. There was a large overlap of attitudes between doctors and nurses: inter-professional integration in CDs fostered alignment of values and aims. The polarity index was higher for responses from the doctors than from the nurses. CONCLUSION The study findings have implications for policy makers and managers: mission and strategic mandate of CDs; governance of CDs, leadership issues; opportunities for engaging healthcare professionals; changes in managerial involvement during the COVID-19 pandemic. We also discuss the limitations of the present study and future areas for research into hybrid structures.
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Affiliation(s)
- Anna Prenestini
- Department of Economics, Management and Quantitative Methods (DEMM) and Center of Research and Advanced Education in Health Administration (CRC HEAD), Università degli Studi di Milano, Milan, Italy.
| | - Marco Sartirana
- Centre for Research on Healthcare and Social Management (CeRGAS) and SDA Bocconi Government, Health and Not for Profit division, Bocconi University, Milan, Italy
| | - Federico Lega
- Department of Biomedical Sciences for Health (SCIBIS) and Center of Research and Advanced Education in Health Administration (CRC HEAD), Università degli Studi di Milano, Milan, Italy.,Center for Applied Research in Health Economics, Organization and Management, IRCCS Galeazzi, Milan, Italy
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Abstract
Health care institutions are witnessing a ‘new normality’, which profoundly reshapes the strategic and management challenges faced by health professionals in their attempt to achieve excellence in the design and delivery of care. This ‘new normality’ triggers a transformation of conventional managing models and leadership styles, which have proved to be unfit with the changed attributes of the external and internal contexts of health care organizations. The ‘new normal’ leadership style relies on the ability of leaders to make sense out of the new challenges that are faced by health care organizations and on their capability to act managerially, sticking to an empowering approach which enables followers. However, the transformation of conventional leadership style is impossible if a rethinking of training activities and learning experiences delivered to health professionals is missing. The article provides an overview of the issues that health leaders and managers encounter in the ‘new normality’ of health care, identifying several unanswered questions which should be addressed to thrive in the changed landscape of health services’ delivery.
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Affiliation(s)
- Federico Lega
- University of Milan and IRCCS Galeazzi, Milano, Lombardia, Italy
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Lega F. Extraordinary lessons for reshaping the ordinary. Health Serv Manage Res 2020; 33:165. [PMID: 33118861 DOI: 10.1177/0951484820967464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lega F. Covid beyond rhetoric. Health Serv Manage Res 2020; 33:109. [PMID: 32731847 DOI: 10.1177/0951484820946512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lega F. A "new normality" for health services management research. Health Serv Manage Res 2019; 32:167. [PMID: 31488019 DOI: 10.1177/0951484819875834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lega F. HSM Editorial (May 2019). Health Serv Manage Res 2019; 32:57. [PMID: 31066589 DOI: 10.1177/0951484819848910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Al Ahdab OG, Ali A, Almarsdóttir AB, Annemans L, Ashoush N, Baker DE, Blondal AB, Brennan E, Brown L, Buffington D, Calabrese S, Chaiyakunapruk N, Chilkoti DC, Choon WY, Cooper JC, Costa de Sousa I, Dankó D, Davis A, Decerbo M, Decker BS, Dilokthornsakul P, Efendie B, Feturi FG, Gajraj E, Gharat M, Granas AG, Herman RA, Hiligsmann M, Hill A, Hill LH, Hoefer C, John D, Jones EP, Joseph S, Joshi S, Junaid T, Khakurel B, Khalifa S, Kisor DF, Klika C, Kruger J, Kumar K, Lee SWH, Lega F, Leong C, Li H, Lockman K, Suresh Madhavan S, Maine LL, Marriott J, Miah MK, Naeem S, New JP, Osipenko L, Paulino E, Picone MF, Pilch NA, Rajendran N, Raut A, Ray ME, Roberts JA, Rouse MJ, Sambandan G, Scheckelhoff D, Shaik IH, Shrestha R, Sokn E, Steinke DT, Tarn YH(T, Thanukrishnan H, Thomas D, Tian S, Tsui VW, Turcu-Stiolica A, Vadlamudi R, Vaida AJ, Vaidya R, Van Cuyk MP, Venkataramanan R, Vlasses PH, Vos SS, Weeda ER, Wisniewski CS, Woods DJ, Wu X, Zachariah S, Zarembski DG. List of Contributors. Clinical Pharmacy Education, Practice and Research 2019:xvii-xix. [DOI: 10.1016/b978-0-12-814276-9.01002-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Lega F. What we need to know. Health Serv Manage Res 2018; 31:179. [PMID: 30369257 DOI: 10.1177/0951484818812313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Calciolari S, González-Ortiz LG, Lega F. The influential role of personal advice networks on general practitioners' performance: a social capital perspective. BMC Health Serv Res 2017; 17:543. [PMID: 28789680 PMCID: PMC5549353 DOI: 10.1186/s12913-017-2467-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 07/24/2017] [Indexed: 11/10/2022] Open
Abstract
Background In several health systems of advanced countries, reforms have changed primary care in the last two decades. The literature has assessed the effects of a variety of interventions and individual factors on the behavior of general practitioners (GPs). However, there has been a lack of investigation concerning the influence of the resources embedded in the GPs’ personal advice networks (i.e., social capital) on GPs’ capacity to meet defined objectives. The present study has two goals: (a) to assess the GPs’ personal advice networks according to the social capital framework and (b) to test the influence of such relationships on GPs’ capacity to accomplish organizational goals. Methods The data collection relied on administrative data provided by an Italian local health authority (LHA) and a survey administered to the GPs of the selected LHA. The GPs’ personal advice networks were assessed through an ad-hoc instrument and interpreted as egocentric networks. Multivariate regression analyses assessed two different performance measures. Results Social capital may influence the GPs’ capacity to meet targets, though the influence differs according to the objective considered. In particular, the higher the professional heterogeneity of a GP personal advice network, the lower her/his capacity is to meet targets of prescriptive appropriateness. Conclusions Our findings might help to design more effective primary care reforms depending on the pursued goals. However, further research is needed.
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Affiliation(s)
- Stefano Calciolari
- Università della Svizzera Italiana, IdEP Via G. Buffi 13, CH-6904, Lugano, Switzerland.
| | | | - Federico Lega
- Dept. Policy Analysis and Public Management, CERGAS, SDA Bocconi School of Management Bocconi University, Via Roentgen 1, 20136, Milan, Italy.
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Abstract
Being largely considered a human right, healthcare needs leaders who are able to make choices and to set directions. Following the recommendations expressed by Gilmartin and D'Aunno's review and roadmap compiled in 2008, today, it is important to acknowledge researchers' contributions to outline this landscape. The realist review of 77 publications answered questions such as “what works, for whom, and in which circumstances” highlighting: the effectiveness and acceptance of transformational and collaborative approaches; professionalism, expertise, and good task delegation within operational teams; distributed leadership, relationships, and social responsibility at a systemic level. The relevancy and need of leadership development programs, framed within a wider strategy, emerged. Nonetheless, gaps still exist and require further investigation: particular needs in public vs. private contexts; professionals' and women's differentiating characters; generational gaps; associations between leadership and recruitment HR practices research; how (and if) leaders (should) influence the organizational culture and values; and developing countries specific challenges. Also, a greater proportion of relevant findings should be drawn by empirical and more rigorous studies. Finally, a major attention could be paid to interactions happening at the team, organizational, and systemic level among different leaders and among leaders, followers and external actors.
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Affiliation(s)
- Federico Lega
- Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
- CeRGAS, SDA Bocconi – School of Management, Bocconi University, Milan, Italy
| | - Anna Prenestini
- CeRGAS, SDA Bocconi – School of Management, Bocconi University, Milan, Italy
| | - Matilde Rosso
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Lega F. A Message from the Guest Editor. Healthc Manage Forum 2016; 29:225-226. [PMID: 27744275 DOI: 10.1177/0840470416669769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Abstract
BACKGROUND Since the early 1980s all European countries have given priority to reforming the management of health services. A distinctive feature of these reforms has also been the drive to co-opt professionals themselves into the management of services, taking on full time or part time (hybrid) management or leadership roles. However, although these trends are well documented in the literature, our understanding of the nature and impact of reforms and how they are re-shaping the relationship between medicine and management remains limited. Most studies have tended to be nationally specific, located within a single discipline and focused primarily on describing new management practices. This article serves as an Introduction to a special issue of BMC Health Services Research which seeks to address these concerns. It builds on the work of a European Union funded COST Action (ISO903) which ran between 2009 and 2013, focusing specifically on the changing relationship between medicine and management in a European context. MAIN TEXT Prior to describing the contributions to the special issue, this Introduction sets the scene by exploring four main questions which have characterised much of the recent literature on medicine and management. First is the question of what we understand by the changing relationship between medicine and management and in particular which this means for the emergence of so called 'hybrid' clinical leader roles? A second question concerns the forces that have driven change, in particular those relating to the wider project of management reforms. Third, we raise questions of how medical professionals have responded to these changes and what factors have shaped their responses. Lastly we consider what some of the outcomes of greater medical involvement in management and leadership might be, both in terms of intended and unintended outcomes. CONCLUSIONS The paper concludes by summarising the contributions to the special issue and highlighting the need to extend research in this area by focusing more on comparative dimensions of change. It is argued that future research would also benefit theoretically by drawing together insights from health policy and management literatures.
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Affiliation(s)
- Ian Kirkpatrick
- Leeds University Business School, University of Leeds, Leeds, LS29JT, UK.
| | - Ellen Kuhlmann
- Medical Management Centre, LIME, Karolinska Institutet Stockholm, Sweden, and Institute of Economics, Labour and Culture, Goethe-University Frankfurt, Frankfurt, Germany
| | - Kathy Hartley
- University of Salford, Salford Business School, Lady Hale Building, Salford, M5 4WT, UK
| | - Mike Dent
- Staffordshire University, College Road, Stoke-on-Trent, Staffordshire ST4 2DE, UK
| | - Federico Lega
- Department of Policy Analysis and Public Management, Bocconi University, Via Safratti, 25, Milan, Italy
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Abstract
Medical leadership is a global policy priority worldwide as it aims at answering some of the greatest challenges of healthcare, including changing patient needs, budget cuts, increasing citizen demand for accountability and rising service expectations. However, the introduction of doctors in management roles is not easy, and the actual practice of medical management greatly varies across countries and within each country. In order to favour its development, policymakers and executives should have the courage to give autonomy to medical managers and to support them, and should acknowledge the specificities of such hybrid roles when selecting, training and appraising future medical leaders. At the same time, professionals and their associations should understand that clinical leadership is not about dismantling professionalism, but rather about reconfiguring it, incorporating new values and logics into the traditional medical culture.
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Affiliation(s)
- Federico Lega
- Bocconi University, Centre for Research on Healthcare Management, Milan, Italy
| | - Marco Sartirana
- Centre for Research on Healthcare Management, Bocconi University, Milan, Italy, and Utrecht School of Governance, Utrecht University, Utrecht, The Netherlands
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Lega F, Prenestini A, Calciolari S. How organziational culture of top management matters in the healthcare sector. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku163.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Prenestini A, Lega F. Do senior management cultures affect performance? Evidence from Italian public healthcare organizations. J Healthc Manag 2013; 58:336-352. [PMID: 24195342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Healthcare organizations are often characterized by diffuse power, ambiguous goals, and a plurality of actors. In this complex and pluralistic context, senior healthcare managers are expected to provide strategic direction and lead their organizations toward their goals and performance targets. The present work explores the relationship between senior management team culture and performance by investigating Italian public healthcare organizations in the Tuscany region. Our assessment of senior management culture was accomplished through the use of an established framework and a corresponding tool, the competing values framework, which supports the idea that specific aspects of performance are related to a dominant management culture. Organizational performance was assessed using a wide range of measures collected by a multidimensional performance evaluation system, which was developed in Tuscany to measure the performance of its 12 local health authorities (LHAs) and four teaching hospitals (THs). Usable responses were received from 80 senior managers of 11 different healthcare organizations (two THs and nine LHAs). Our findings show that Tuscan healthcare organizations are characterized by various dominant cultures: developmental, clan, rational, and hierarchical. These variations in dominant culture were associated with performance measures. The implications for management theory, professional practice, and public policy are discussed.
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Affiliation(s)
- Anna Prenestini
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy.
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Lega F, Mengoni A. Retraction: Profiling the different needs and expectations of patients for population-based medicine: a case study using segmentation analysis. BMC Health Serv Res 2013; 13:180. [PMID: 23688270 PMCID: PMC3660200 DOI: 10.1186/1472-6963-13-180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 05/16/2013] [Indexed: 11/21/2022] Open
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Lega F, Prenestini A, Spurgeon P. Is management essential to improving the performance and sustainability of health care systems and organizations? A systematic review and a roadmap for future studies. Value Health 2013; 16:S46-S51. [PMID: 23317645 DOI: 10.1016/j.jval.2012.10.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Recent studies have highlighted the importance of management in the health care sector. Positive correlations have been found between clinical and economic performance. Although there is still controversy regarding what kind of management and which managers should lead health care organizations and health systems, we now have interesting evidence to analyze. Starting with a systematic review of the literature, this article presents and discusses the streams of knowledge regarding how management can influence the quality and sustainability of health systems and organizations. Through the analysis of 37 studies, we found that the performance of health care systems and organizations seems to be correlated with management practices, leadership, manager characteristics, and cultural attributes that are associated with managerial values and approaches. There is also evidence that health care organizations run by doctors perform better than others. Finally, we provide a roadmap that indicates how the relationship between the management and performance of health systems and organizations can be further and more effectively investigated.
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Affiliation(s)
- Federico Lega
- CeRGAS, SDA Bocconi School of Management, Bocconi University, Milan, Italy.
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Lega F, Mengoni A. Profiling the different needs and expectations of patients for population-based medicine: a case study using segmentation analysis. BMC Health Serv Res 2012; 12:473. [PMID: 23256543 PMCID: PMC3573906 DOI: 10.1186/1472-6963-12-473] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 12/04/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study illustrates an evidence-based method for the segmentation analysis of patients that could greatly improve the approach to population-based medicine, by filling a gap in the empirical analysis of this topic. Segmentation facilitates individual patient care in the context of the culture, health status, and the health needs of the entire population to which that patient belongs. Because many health systems are engaged in developing better chronic care management initiatives, patient profiles are critical to understanding whether some patients can move toward effective self-management and can play a central role in determining their own care, which fosters a sense of responsibility for their own health. A review of the literature on patient segmentation provided the background for this research. METHOD First, we conducted a literature review on patient satisfaction and segmentation to build a survey. Then, we performed 3,461 surveys of outpatient services users. The key structures on which the subjects' perception of outpatient services was based were extrapolated using principal component factor analysis with varimax rotation. After the factor analysis, segmentation was performed through cluster analysis to better analyze the influence of individual attitudes on the results. RESULTS Four segments were identified through factor and cluster analysis: the "unpretentious," the "informed and supported," the "experts" and the "advanced" patients. Their policies and managerial implications are outlined. CONCLUSIONS With this research, we provide the following: - a method for profiling patients based on common patient satisfaction surveys that is easily replicable in all health systems and contexts;- a proposal for segments based on the results of a broad-based analysis conducted in the Italian National Health System (INHS).Segments represent profiles of patients requiring different strategies for delivering health services. Their knowledge and analysis might support an effort to build an effective population-based medicine approach.
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Affiliation(s)
- Federico Lega
- Department of Policy Analysis and Public Management, Cergas and Area PMP SDA Bocconi, Bocconi University, Via Rontgen 1, 20136, Milan, Italy
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Ferrè F, Cuccurullo C, Lega F. The challenge and the future of health care turnaround plans: Evidence from the Italian experience. Health Policy 2012; 106:3-9. [DOI: 10.1016/j.healthpol.2012.03.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 03/08/2012] [Accepted: 03/09/2012] [Indexed: 11/25/2022]
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Abstract
A central motif of health reforms around the world has been the drive to persuade doctors and other clinical professionals to become more actively engaged in the management of services. Examples include moves to extend the commissioning role of primary care doctors (such as general practitioners in the UK) and the introduction of ‘clinical directorates’ in secondary care. This strategy has been seen as a means of controlling professionals, turning ‘poachers into game keepers’, especially with regard to resource allocation. However, there is also a mounting body of evidence pointing to how clinical leadership may play a role in stimulating quality improvement and new innovations inservice design, with positive consequences for patient safety and satisfaction (1). Focusing on the top 100 hospitals in the US Goodall (2) finds a strong positive association between the ranked quality of hospitals and whether the chief executive officer was a clinician. A survey of 1200 hospitals across seven countries (UK, US, Germany, France, Italy,Canada and Sweden) conducted by McKinsey and LSE also finds that clinically qualified managers improve both the effectiveness of management decisions and clinical performance of hospitals overall (3).
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Affiliation(s)
- I Kirkpatrick
- Leeds University Business School, University of Leeds, Leeds, UK.
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Lega F, Calciolari S. Coevolution of patients and hospitals: how changing epidemiology and technological advances create challenges and drive organizational innovation. J Healthc Manag 2012; 57:17-34. [PMID: 22397102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Over the last 20 years, hospitals have revised their organizational structures in response to new environmental pressures. Today, demographic and epidemiologic trends and recent technological advances call for new strategies to cope with ultra-elderly frail patients characterized by chronic conditions, high-severity health problems, and complex social situations. The main areas of change surround new ways of managing emerging clusters of patients whose needs are not efficiently or effectively met within traditional hospital organizations. Following the practitioner and academic literature, we first identify the most relevant clusters of new kinds of patients who represent an increasingly larger share of the hospital population in developed countries. Second, we propose a framework that synthesizes the major organizational innovations adopted by successful organizations around the world. We conclude by substantiating the trends of and the reasoning behind the prospective pattern of hospital organizational development.
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Affiliation(s)
- Federico Lega
- Bocconi University and SDA Bocconi School of Management, Department of Policy Analysis and Public Management.
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Cuccurullo C, Lega F. Effective strategizing practices in pluralistic settings: the case of Academic Medical Centers. J Manag Gov 2011. [DOI: 10.1007/s10997-011-9196-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Affiliation(s)
- F Lega
- Department of Institutional Analysis and Public Management, Bocconi University, Milan, Italy.
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Lega F, Sargiacomo M, Ianni L. The rise of governmentality in the Italian National Health System: physiology or pathology of a decentralized and (ongoing) federalist system? Health Serv Manage Res 2010; 23:172-80. [DOI: 10.1258/hsmr.2010.010006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In this paper, we aim to discuss the implications and lessons that can be learnt from the ongoing process of federalism affecting the Italian National Health System (INHS). Many countries are currently taking decisions concerning the decentralization or re-centralization of their health-care systems, with several key issues that are illustrated in the recent history of the INHS. The decentralization process of INHS has produced mixed results, as some regions took advantage of it to strengthen their systems, whereas others were not capable of developing an effective steering role. We argue that the mutual reinforcement of the decentralization and recentralization processes is not paradoxical, but is actually an effective way for the State to maintain control over the equity and efficiency of its health-care system while decentralizing at a regional level. In this perspective, we provide evidence backing up some of the assumptions made in previous works as well as new food-for thought – specifically on how governmentality and federalism should meet – to reshape the debate on decentralization in health care.
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Affiliation(s)
- Federico Lega
- Bocconi University and SDA School of Management, Milan, Italy
| | - Massimo Sargiacomo
- Department of Business Studies, University “G. D'Annunzio” of Chieti-Pescara, Italy and Open University Leonardo Da Vinci
| | - Luca Ianni
- Department of Business Studies, University “G. D'Annunzio” of Chieti-Pescara, Italy and Open University Leonardo Da Vinci
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Abstract
After fifteen years from the first of a series of reforms that introduced managerial paradigms and techniques into the Italian National Health System (INHS), it is possible to provide a critical assessment of the outcomes of such changes. The aim of this paper is to assess how these reforms have changed the INHS, to what extent they concurred to improve the system, where they failed and which issues are still in agenda. To do so we run through the recent history of the INHS and propose an interpretative framework to understand the grounds for its light and shade results. The basis for the analysis is triple. The study draws from researches, literature review, action-researches and field investigations conducted over the last 10 years in the INHS.
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Affiliation(s)
- Federico Lega
- Department of Institutional Analysis and Public Management, Bocconi University.
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Lega F, Vendramini E. Budgeting and performance management in the Italian National Health System (INHS): assessment and constructive criticism. J Health Organ Manag 2008; 22:11-22. [PMID: 18488516 DOI: 10.1108/14777260810862371] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of the paper is to trace the history and development of performance measurement and management systems in the Italian National Health System (INHS), to identify their key characteristics, and to provide a critical assessment of their implementation. DESIGN/METHODOLOGY/APPROACH A combination of literature review, action-research and fieldwork conducted over a ten-year period in several Italian health care organizations. FINDINGS Performance management has grown considerably in the INHS over the last 15 years. Explanations for this growth include normative, coercive and mimetic isomorphism, the introduction of quasi-markets, the adoption of DRGs, an increased focus on clinical governance and innovative practices in human resource management. RESEARCH LIMITATIONS/IMPLICATIONS The paper shows how performance management has been implemented in the INHS and why it can still be considered a "work in progress". PRACTICAL IMPLICATIONS The introduction of performance management systems has stimulated greater accountability and promoted a more cost conscious culture in healthcare organizations. Nevertheless, there are many problems that remain to be solved if performance management arrangements are to deliver the desired improvements in performance. ORIGINALITY/VALUE The paper advocates the need for reduced isolationism and increased international comparison with concomitant evaluative effort.
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Affiliation(s)
- Federico Lega
- Bocconi University, Milano, Italy. federico.lega@unibocconi
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Lega F, Mengoni A. Why non-urgent patients choose emergency over primary care services? Empirical evidence and managerial implications. Health Policy 2008; 88:326-38. [PMID: 18502533 DOI: 10.1016/j.healthpol.2008.04.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Revised: 04/06/2008] [Accepted: 04/13/2008] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate structural and psychological factors that lead non-urgent patients to choose the Accidents & Emergency Department (A&ED) rather than primary care services. DATA SOURCES Data were collected through interviews by means of a structured questionnaire. Data regarding the A&ED sample were also drawn from the database of the department. STUDY DESIGN Hypotheses were tested in a survey comparing A&ED non-urgent patients and patients using GP surgeries. Different perceptions of the characteristics of A&ED and primary care services were measured and a perceptual map was created using the linear discriminant analysis (LDA). DATA COLLECTION Emergency services users were interviewed in the A&ED of the General Hospital of the Province of Macerata (Italy). Primary care users were interviewed in four GP surgeries. 527 patients were interviewed between December 2006 and February 2007. PRINCIPAL FINDINGS A&ED and primary care patients look for different characteristics as diagnostic and therapeutic potentialities, empathy and competence, quick access or long-lasting relationship. Information asymmetry explains part of the behaviour. CONCLUSIONS Use of A&ED services for non-urgent care can be reduced. The understanding of reasons underlying the choice and a change in access, timing and contents of care/services provided by general practitioners (GPs) might provide incentives for shifting from A&ED to GPs surgeries.
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