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Hybrid professionals have a two-fold – professional and managerial – role, which requires appropriate management skills. Investing on managerial training programs aims to empower professionals with managerial skills and competencies. Does this pay back? Assessing the impact of such training programs is still a limited practice. This paper explores whether participation in managerial training programs in healthcare can enhance the involvement of hybrid professionals (namely, clinical directors) in top management decision-making. The mediational effects of knowledge of performance information and its use are explored. Survey data were collected from more than 3000 clinical directors of 69 public health authorities from five regional healthcare systems in Italy. Relationships between participation in managerial training programs, performance management practices (i.e., knowledge and use of performance information) and the level of clinicians' involvement by the top management were studied using a three-path mediation analysis with structural equation modelling. Propensity score matching was also performed to mitigate selection bias. Knowledge and use of performance information positively mediate, both independently and sequentially, the relationship between clinical directors' participation in managerial training programs and the level of their involvement in decision-making. The results of the study suggest that managerial training can support hybrid professionals in engaging with managerialism and playing upward influence on top management decision-making. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to examine the extent to which socio-demographic variables affect women's satisfaction regarding antenatal and perinatal care.Design: To take into account the role of the context in shaping women's satisfaction, we used multilevel models, with women at the lower level, and the health districts of residence, or the hospitals in which the delivery took place, at the higher level.Setting: Tuscany (Italy).Participants: The study is based on a representative survey focused on the satisfaction and experience of 4598 new mothers who gave birth in one of the 25 hospitals in Tuscany (Italy) in 2012.Main Outcome Measures: Women's overall satisfaction in the prenatal period and their overall satisfaction during hospitalization for delivery.Results: Regarding pregnancy, women's satisfaction increased with age, and was generally higher among foreign women coming from non-Western countries and among highly educated women. Regarding delivery, age proved insignificant, whereas citizenship and education maintained the same association with satisfaction. Contrary to our expectations, the number of previous pregnancies turned out to be insignificant.Conclusions: Our findings suggest that the quality of maternity services was perceived differently in different socio-demographic groups: women's expectations affected satisfaction, but in different ways, in various socio-demographic groups, both during pregnancy and at delivery. Keeping these socio-demographic factors into account in the analysis of satisfaction may help organisations to identify areas where pregnancy and delivery services can be better targeted and where increasing awareness among professionals in their everyday practice is most needed. [ABSTRACT FROM AUTHOR]

The Patient Reported Outcome and Experience Measures (PROMs and PREMs) are key assessment tools from the patients' point of view, with different purposes and different tools. While PREMs have been increasingly used as a tool for improving care quality1, PROMs are generally used to measure effectiveness within clinical trials or for improving patients' health status2. Integration of care has a relevant impact on both, quality of care and patient health status3. This suggests that PROMs and PREMs should be collected in an integrated way, to understand the experience-outcome relationship along the care pathway, thus providing a complete vision of the quality and integration of care from the patient perspective. Performance evaluation systems should change shape and include PREMs and PROMs to tackle care integration4;5. The potential of the PROMs and PREMs combined collection was tested in the heart failure pathway assessment with a single-site pilot study in Tuscany. Disease-specific PROMs questionnaires have been identified in the literature and shared with a group of cardiologists. The short version of the Kansas City Cardiomyopathy Questionnaire (KCCQ-12) was selected. The authors and cardiologists developed a set of questionnaires on the patient experience, for investigating the patients care pathway. The questionnaires including both PROMs and PREMs was administered in specific time-points: discharge; 30 days, 7 and 12 months after the discharge. The preliminary results were presented to the cardiologists, GPs, and nurses, as well as to the healthcare management of the involved hospital and the Local Health Authorities in charge of primary care. PREMs data resulted a key information source on the patients' view of the service delivery process along the care pathway, clarifying some PROMs results. By using these data all the health professionals could have a complete and integrated vision of the patients' pathway, above and over the single hospitalization event. The integration of PROMs and PREMs enriched existing sources of health information from the patient perspective, as a complement of clinical and administrative data. The pilot study showed that those data can help to overcome a 'silo' approach, focused on a specific setting and organization, allowing the longitudinal measurement of outcomes and experience along the whole patient care pathway. The 'pathway-vision' of the system provided by the combined collection and reporting of PROMs and PREMS shows the eventual healthcare pathways discontinuities to be addressed in order to integrate care in the patient perspective, so enabling a potential shift of the healthcare system towards integration of care. [ABSTRACT FROM AUTHOR]

Background: Equity, financial sustainability, and quality in healthcare are key goals embraced by universal health systems. However, systematic performance management strategies for achieving equity are still weaker than those aimed at achieving financial sustainability and quality of care. Using a vertical equity perspective, the overarching aim of this paper is to examine how improving equity in quality of care impacts on financial sustainability. We applied a simulation to indicators of the heart failure clinical pathway in Tuscany (central Italy), in order to quantify the equity gaps and financial resources that could be reallocated in the absence of performance inequities. Methods: The analysis included all patients hospitalized for heart failure as a principal diagnosis in 2014. We selected five indicators: hospitalization rate, 30-day readmission, cardiology visits, and the utilization of beta-blockers, and ACE inhibitors and sartans. For each indicator, the simulation followed three steps: 1) stratification by socioeconomic status (SES), using education as a proxy for SES; 2) computation of the vertical equity indicator; and 3) assessment of the financial value of the equity gap. Results: All indicators showed performance gaps regarding inequities across SES-groups. For the hospitalization rate and 30-day readmission, resources could have been reallocated, if the performance of patients with a low SES had been equal to the performance of patients with a high SES, which amounted to €2,144,422 and €892,790 respectively. In contrast, limited additional resources would have been required for prescriptions and cardiology visits. Conclusions: Reducing equity gaps by improving the performance of low-SES patients may be a crucial strategy to achieving financial sustainability in universal coverage healthcare systems. Universal healthcare systems, which aim to pursue financial sustainability and quality of care, are thus urged to develop performance management actions to improve equity. This approach should not only include the measurement and public disclosure of equity indicators but be part of a comprehensive evidence-based strategy for the management of chronic conditions along the clinical pathway. [ABSTRACT FROM AUTHOR]