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Professional roles are facing deep transformations in the healthcare sector. Hospitals face role conflict and ambiguity, especially for middle managers who hold both managerial and clinical responsibilities. This work aims at providing the competency profiles of two key managerial roles in hospitals (Clinical Directors and Head of Nurses), so to provide evidence on the characteristics they should have to carry out their role effectively. Through a guided negotiation among members of Italian category associations of middle managers, updated job descriptions were designed for the two key figures. Then, competency profiles were elaborated by applying a competency dictionary specifically designed for managers in the healthcare sector. Only some desirable competencies are common to the two professional figures. This is because their responsibilities overlap only in part, while the distinct features of their specific roles translate directly into distinct key competencies. Training managers in the healthcare sector is challenging due to the hybrid and evolving roles they cover. Nevertheless, it is fundamental to design training pathways which match specific desirable competencies. It is misleading to think that managers need common competencies only, and training pathways should be diversified based on the specific contribution professionals can provide to an organization. This has implications both at the organizational level and at the policy making one, given that managerial training is frequently a joint responsibility of hospitals and universities. [ABSTRACT FROM AUTHOR]

Decoupling in the health‐care sector is a highly problematic phenomenon that easily leads to dramatic failures in strategy implementation. Although decoupling is addressed frequently at the organizational level, there exists extremely poor evidence of its presence at the federal/regional level. This study provides an investigation on the implementation of Italy's directive on the re‐organization of regional health‐care systems' networks based on breast units, with the intent of detecting different levels of compliance across regions and possible decoupling phenomena. Nonparametric tests are carried out to assess the gaps between formal and concrete compliance to the national directive across regions. Results suggest that decoupling occurs at the regional level, but formal compliance positively affects concrete compliance in the long term. Implications for policymakers concern their awareness of possible discrepancies between formal compliance to their directives and concrete changes in the way health‐care services are managed, as well as a strategic understanding of how these are doomed to be mitigated in the long run. Such awareness should affect the ability of policymakers to adapt and interpret performance measurement systems accordingly. Highlights: Decoupling is seldomly addressed at the federal/regional level in the health‐care sector.Breast Units are an innovative and highly regulated response to the need of managing breast cancer and may help understand decoupling phenomena at the regional level.Decoupling is indeed present at the regional level in Italian regions, committed to implement breast units.Contextual factors are likely to affect decoupling independently from a regional formal compliance to regulations.Yet formal compliance to regulations eventually reduces decoupling in time. [ABSTRACT FROM AUTHOR]

Background: In order to face the unsustainability of the healthcare sector, the Italian reforms of the 90s – in line with international trends – transform healthcare organizations into accountable 'business-like' entities. With great expectations on their ability to achieve results in terms of quality and efficiency, it becomes crucial to select the right people to drive them. This study defines the profile of the most innovative CEOs in the sector. Methods: The work arises from a previous study conducted by AGENAS that identified the managerially most innovative Italian healthcare organizations. After a deep analysis of CEOs' biographies, through a semi-structured questionnaire, additional information concerning their educational and professional background was collected. Results: Although no dominating profile emerges in terms of educational background – suggesting it is not clear whether it is preferable that CEOs hold a degree in Medicine or in other disciplines – the most innovative CEOs have mainly developed their careers within the public healthcare sector and not in other private industries. Practice Implications: This study provides important implications in terms of CEOs' selection. This, provides interesting food for thought on how career ladders should be designed within the sector and how effective these are in assuring the development of appropriate skills. [ABSTRACT FROM AUTHOR]

Purpose: The progressive patient care (PPC) model, the patient-centered approach, and the lean philosophy are key 'pillars of change' in hospital settings. This work aims at providing a clear methodological guidance in evaluating a hospital's positioning in reference to the main pillars of change, as well as on the effectiveness of how enablers of change are concretely enhanced. Methodology/approach: A mixture of qualitative methods such as semi-structured interviews, ethnographic observations, and informal conversations has been used. The most valuable source of data consists of six interviews to key figures within the hospital. Findings: The PPC organizational model is detected to be Non-strategic. Although highly innovative, the new organizational features do not respond to the typical PPC approach. Patient-centeredness assumes a Developed/Advanced position. 'Units' are the major response to the hospital's strategy of introducing patient centeredness. Finally, the implementation of lean reaches a Starting/Developed positioning. The approach followed is responsive to staff's engagement and commitment, but implementation is isolated and 'one-shot'. Its positioning on the scales of three pillars of change seems extremely coherent with the hospital's strategic priorities. The highest position is reached for patient-centered care, which is the prior objective of the hospital's main pressures for change. Originality/value: The approach's major potential is in comparing the hospitals' current position with its strategy, as well as detecting differences with similar settings. This approach provides hospitals' management with an effective support in ranking priorities through insights on which enabling tools should urgently be further developed. [ABSTRACT FROM AUTHOR]

Purpose: The healthcare sector has been facing major reforms, among which the introduction of the Clinical Directorate (CD) model for hospitals. The purpose of this work is to explore the degree of implementation of innovative Human Resource Management (HRM) practices within CDs, in order to understand whether, after more than 15 years from their introduction, they have been able to transform their managerial approach concretely, in line with the CD model's objectives. The tools have been attributed to three main HR initiatives: training, control, and evaluation ones. Design and methods: During on-site visits in 33 Italian hospitals, data were collected by conducting semi-structured interviews with their CEOs and Clinical Directors. Data concerned both the mere adoption of HRM tools within CDs, as well as their effective degree of implementation. The answers to the questions were translated into a system of percentage scores, so as to detect mean percentages of implementation in each CD. Findings: The general degree of implementation of HRM practices is still somewhat distant from a theoretically excellent and full implementation, especially if we consider the important lag of time since the reforms affected the sector. Nevertheless, results open the way to important considerations about the effectiveness of the CD model. Original value: The original methodology and scoring system suggested in this work produce a concise evaluation of the development of an effective HRM system within CDs. Our framework of analysis allows interesting benchmarking activities among different CDs of an organization and, ultimately, among different organizations. Moreover, the methodology presented may constitute a valid source of information in order to carry out future research on the items able to affect the implementation of such tools. [ABSTRACT FROM AUTHOR]

Background: The healthcare scenario in developed countries is changing deeply: patients, who are frequently affected by multi-pathological chronic conditions, have risen their expectations. Simultaneously, there exist dramatic financial pressures which require healthcare organizations to provide more and better services with equal (or decreasing) resources. In response to these challenges, hospitals are facing radical transformations by bridging, redesigning and engaging their organization and staff.Methods: This study has the ambitious aim to shed light and clearly label the trends of change hospitals are enhancing in developed economies, in order to fully understand the presence of common trends and which organizational models and features are inspiring the most innovative organizations. The purpose is to make stock of what is known in the field of hospital organization about how hospitals are changing, as well as of how such change may be implemented effectively through managerial tools. To do so the methodology adopted integrates a systematic literature review to a wider engaged research approach.Results: Evidence suggests that the three main pillars of change of the system are given by the progressive patient care model, the patient-centered approach and the lean approach. However, there emerge a number of gaps in what is known about how to exploit drivers of change and their effects.Conclusions: This study confirms that efforts in literature are concentrated in analyzing circumscribed experiences in the implementation of new models and approaches, failing therefore to extend the analysis at the organizational and inter-organizational level in order to legitimately draw consequences to be generalized. There seem to be a number of "gaps" in what is known about how to exploit drivers of change and their effects, suggesting that the research approach privileged till now fails in providing a clear guidance to policy makers and to organizations' management on how to concretely and effectively implement new organizational models. [ABSTRACT FROM AUTHOR]

Introduction: Understanding of the role of contextual factors in determining the real value of health technologies is one of the major challenges for the use of Health Technology Assessment (HTA) methodology within hospitals. Moreover, the responsibility of assessing hospital performance is problematic. Although a number of managerial tools are available to appraise outcomes, there is little evidence on the role of contextual variables and how they might contribute to hospital performance. Methods: Based on three extensive literature reviews, a pragmatic framework has been developed to understand interactions between organizational factors and health technologies on hospitals' performance. Three main causal relationships emerge: (i) direct relationship between contextual factors and performance; (ii) an effect of contextual factors on the capability of technologies to "produce value"; (iii) an influence of organizational factors on clinical evidence-based decision-making. This pragmatic framework was designed within the IMPACT HTA EU Horizon 2020 Research Project. Results: The contextual dimensions are ascribable to five domains: organizational structure; managerial accounting tools; information, communication and technology (ICT) tools; human resource management (HRM) tools; hospital-based HTA procedures. The impact of contextual factors on technologies' ability to produce value is highly overlooked in literature. Some effort in this sense exists only in the analysis of health information technologies. Moreover, among the contextual dimensions, only HRM tools have inspired a lively debate. The definition of hospital performance is amenable to multiple domains: accessibility, appropriateness, efficiency, safety and patient centeredness (continuity of care). Conclusions: Although hospital performance is a pivotal topic in the healthcare sector, a deep understanding of how contextual factors may affect it is missing. The theoretical framework developed provides a tool to understand the multiple dimensions able to affect hospital performance. On one hand contextual dimensions may provide a direct effect on hospital performance. On the other, they may affect the extent to which technologies are capable of producing value. [ABSTRACT FROM AUTHOR]

Purpose: This study explores the characteristics of primary care organizations that are likely to attract and retain highly skilled professionals, meeting their expectations and increasing Person-Organization fit. Both "hard" dimensions (ownership) and organizational/managerial traits under the span of control of management are investigated. The objective is to raise awareness on how to mitigate unpopular features of primary healthcare organizations so to effectively compete in the war for talent., Methods: This study has been carried out based on data extrapolated from a broader study conducted by the Italian National Agency for Regional Health Services and commissioned by the Italian Ministry of Health. Data deriving from Italian nursing homes was extrapolated from the broader public dataset and multiple regressions were carried out to detect associations between managerial variables and staff seniority., Findings: Several significant associations were detected, suggesting that both physicians and nurses are affected by some investigated variables when deciding where to work and for how long. While some of these are common to the two categories of professionals (e.g., the presence of a nursing director), others are not (e.g., the presence of internal training programs)., Original Value: The implications of this study are related to the need of increasing awareness of managers of nursing homes on those features that are likely to increase their attractiveness and long-lasting appeal to professionals. This is a paramount topic in times in which the war for talent is strong. A lack of attention on this field may lead to the inability to attract and retain staff in primary care settings and, in turn, to implement strategic trends of change healthcare systems are facing in Italy and worldwide., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: The objective is to test contingency theory among "community homes" in a region in Northern Italy. Community homes constitute an emerging key setting in the Italian primary healthcare system and are emblematic of the most recent organizational solutions in primary care across countries., Methods: A case study was carried out through semi-structured interviews administered in community homes to key professionals. Results were validated in two communities of practices., Findings: Several elements of organizational and managerial variability were detected across the sample of community homes involved in the study, although they were all responding to the same regulations and normative pressures., Original Value: The study provides preliminary evidence on the role of contingency theory in the primary healthcare sector, shedding light on its characteristics and providing food for thought on the extent to which organizational variability should be supported, rather than hindered., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Clinical pathways are known to be key in managing chronic conditions in an effective and sustainable way. This is particularly true in psychiatry, characterized by chronicity and managerial challenges. In particular, the borderline personality disorder is a highly complicated disorder to manage. Although numerous international guidelines converge on the urge of defining clinical pathways and a stepped-care model for its effective treatment, it is unknown to what extent these guidelines have been implemented into concrete changes in the provision of care. The objective of this study is to pursue a preliminary assessment of whether there exists coherence between the provision of formal health dispositions or guidelines and end-users' perception of the change they should imply. A pilot study investigating the perception of parents of patients with borderline disorder on continuity of care has been conducted in three Italian regions. Results suggest that pathways do exist and are partially able to reach their intended effects, although concrete accessibility is still a major issue. Future studies should build on these preliminary results through quantitative investigation and further explore their causes., (© 2021 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.)