Search

Rejoining other authors’ arguments in favor of less linear and more process-based studies of change in purpose-oriented networks (PONs), we propose conceiving of PONs not as social entities or forms, but as processes constantly in flux. From this perspective, PONs comprise more or less interconnected processes constantly at play, albeit with more or less intensity, depending on the reflexive management and actions of their participants. We contend that a process view sheds light on three major themes categorizing extant research on network development: network development as the product of engineered, planned managerial actions; network evolution as the product of unintended, systemic changes both within and outside of PONs; and the management of network tensions as the central object of managerial attention.

In the modernization of the state, NPM ideas are presumed to offer governments certainty in the face of major unknowns. The reliance of NPM on information technologies is presented by governments as underlining this potential for certainty. However, this presumption of certainty is elusive in practice. Government pursuit of NPM transformational policies aims to make efficiency savings and cost reductions, but this may create new uncertainties for citizens, particularly because of the unintended consequences of the implementation of new forms of technology.

The role played by family caregivers in delivering long-term care is crucial: they enhance the quality of care perceived by the patients and support the shift to out-of-hospital care. However, taking care of a relative entails a huge burden that usually begins with the patient’s hospital discharge and may mean that caregivers become patients in need of care as well. Owing to socio-demographic trends, informal caregiving is the most important source of care in community settings; hence targeting the caregivers’ burden properly is crucial. This study explores how action research (AR) can be used to develop new hospital practices to manage the burden borne by family caregivers when patients are discharged from hospital. The 7-month-long action research reported in this paper consisted of three stages (burden identification, burden sharing, and burden management) and it was conducted in a teaching hospital in Rome (Italy). Both quantitative (surveys) and qualitative (focus groups and simulation sessions) techniques were used to engage participants. The AR demonstrates that there is a feasible way in which hospital managers can address proactively the caregivers’ needs in the hospital discharge process, to the advantage of the patients and the entire community.

Purpose Policymakers often mandate and regulate the network formation to tackle complex issues of public interest. However, the imposed legal, procedural, and political constraints (i.e. mandated specifications) can affect the structuring and functioning of these networks and thus the sustainability and effectiveness of the collaboration over time. The purpose of this paper is to investigate how mandated specifications affect the formation of public networks. Design/methodology/approach Four networks of healthcare providers were selected and studied from the inception of the collaboration until the services’ activation, focusing specifically on how mandated specifications (i.e. mandated purpose, mechanisms for access to resources, structure, and timing) affected their processes of formation. Findings The cases show that mandated purpose facilitates goal alignment within the networks. The leeway granted to the actors for access and internal distribution of resources enhances the network flexibility, if appropriate monitoring against opportunism is applied. If structuring requirements are too stringent and the actors are forced to respect timing constraints that go against the organic evolution of internal relationships, the network capability to adapt and solve conflicts could be jeopardized. Originality/value Based on the findings, the authors formulate four propositions about the impact that mandated specifications have on the process of network formation, which policymakers should be aware of, when deciding to instigate a network.

Objectives Telemedicine is extensively used in healthcare settings, although we still lack knowledge on how to make telemedicine services last over time. This study aims to: investigate how the factors supporting the implementation of telemedicine services affect their duration over time; explore if further factors need to be considered, to foster the services duration. Methods We conducted a six-year in-depth study on three Italian cases of telemedicine services lasting more than 10 years. Dimensions explaining the duration of services over time are explored and discussed against existing literature. Results The three cases show that, to support the duration over time, financial and organizational stability should be set before the “champion” leaves the service. Financial stability was reached through different strategies. About organizational stability, we found that providing opportunities to enrich the competences and getting more responsibilities over the patients enhanced the professionals’ acceptance, which, in turn, supports the organizational stability of the service over time. About patients, to meet their crucial needs for their health and to receive the nurses’ support on the use of technologies contains the abandon and increases the chances for the service to last over time. Last, the three services observed pursued a strategy of focalization on a specific need. Conclusions The findings provide insights for policy makers and hospital managers on how to set effective services and avoid service abandon, thus reducing waste of resources, and on how to motivate the professionals and patients, by increasing the chances of duration of the services over time.

Purpose The purpose of this paper is to study four cases of the adoption of co-production and compare them according to the type of user involvement, contextual factors and the organizational structure. Design/methodology/approach In total, 30 interviews were conducted in four mental health organizations which are implementing co-production in the North of Italy. Interviews were conducted with clinicians, nurses, patients and family members. The data collected was triangulated with further sources and official documents of organizations. The results have been compared by means of a validated international framework (IAP2) regarding the contextual factors and the level of co-production adopted. Findings The adoption of co-production in the four cases differs by the activities implemented and how organizations involve informal actors. It seems to be influenced by the contextual factors specific to each organization: power, professionals’ opinions and leadership. Organizations whose practitioners and leaders are willing to distribute their power and value informal actors’ opinions seem to facilitate the systematic involvement of users. Overall, the results highlight the importance of considering contextual factors when evaluating and describing co-production activities. Originality/value This paper contributes to describing how mental health organizations are implementing co-production. It examines the influence of contextual factors on the type of co-production adopted.

Most healthcare managers and professionals ignore how to include and take advantage of design thinking methods to improve services and processes. Yet, initial evidence is emerging about the potential of service design, not only to solve service challenges but also to support organisational change. In the field of mental healthcare, the inclusion of service design approaches was lately fostered by the increasing attention on co-production and patient engagement, as well as by the growing interest towards recovery principles and approaches. This chapter presents an action research project conducted by the Departments of Design and Management Engineering of Politecnico di Milano in collaboration with the Department of Mental Health of Spedali Civili di Brescia (Italy). It focuses on how the introduction of an evaluative component into the service design process supported the set-up of co-design activities aimed at triggering an organisational change in the mental health department. The project is described in its main phases, illustrating how an initial evaluative research, consisting of a qualitative field research conducted both from the user and the organisation perspectives, informed the assessment of co-production promising practices and values. Then, it is discussed how this evaluation approach, when integrated within service design as a practice, can help sensitising and amplifying co-production values, therefore favouring the diffusion of co-production within organisations.

Summary The aim of this contribution is to explain how healthcare professionals implement policies for integrated care. More specifically, we aim to understand how these policies are received, interpreted and executed by primary care professionals. By opening the “black box” of policy implementation, we also explain how and why the process of implementation of the same policy diverges in practice. The research is framed according to both the neo-institutional and the change management perspectives. The empirical investigation is conducted through a documental analysis and a multiple-embedded case study. The results show that three forces affect and explain differences in the implementation processes: the unstable level of internal communication among the professionals involved, the limited use of power to resist to change and the poor learning process on the part of both the professionals and policy makers. The pressure of external institutions does not play a role in shaping the process. Through our study, we further knowledge about how healthcare professionals implement policies for integrated care, and we believe this is interesting, according to emerging evidence that variations in the effectiveness of policy outcomes may be explained by choices and potential distortions made during the initial stages of the policy implementation process. Copyright © 2015 John Wiley & Sons, Ltd. StartCopTextCopyright © 2015 John Wiley & Sons, Ltd.

Risk analysis techniques received increasing attention in the health care sector in the last 30 years. These techniques are diffused for health care processes, and less for devices. In fact, risk management for medical devices was introduced only recently (ISO 14971 in 2000 and GHTF/SG3/N15R8 in 2005) [1,2]. The goal of this study is twofold. First, we aim at evaluating the state of the art of the diffusion of standards for the risk assessment of medical devices (with a focus on FMECA). Second, we evaluate the impact of risk assessment techniques on the practice. To pursue the first goal, a literature review has been performed through the investigation of medical and non-medical databases. To reach the second objective, we selected a leading Company in the development of medical devices and we investigated the process enacted to evaluate the risk connected to the design of new devices. The literature search confirmed the widespread application of the FMECA, the scant number of contributions about its applications on medical devices, and the main limitations related to the use of this technique. The empirical investigation showed that the Company spends a surprising amount of time and resources to set and deploy the FMEA rigorously, and it follows the passages envisioned by the literature carefully, with the unique intent to respect the standards. A gap emerges among the practitioners and academic words, with two possible explanations. First, the academics are not addressing the managerial and practical implications of their contributions; in so doing they deepen the “theory versus practice” chasm. Second, the presence of standards actually discourages the practitioners to push over and find new solutions.

The aim of this contribution is to explain how healthcare professionals implement policies for integrated care. More specifically, we aim to understand how these policies are received, interpreted and executed by primary care professionals. By opening the "black box" of policy implementation, we also explain how and why the process of implementation of the same policy diverges in practice. The research is framed according to both the neo-institutional and the change management perspectives. The empirical investigation is conducted through a documental analysis and a multiple-embedded case study. The results show that three forces affect and explain differences in the implementation processes: the unstable level of internal communication among the professionals involved, the limited use of power to resist to change and the poor learning process on the part of both the professionals and policy makers. The pressure of external institutions does not play a role in shaping the process. Through our study, we further knowledge about how healthcare professionals implement policies for integrated care, and we believe this is interesting, according to emerging evidence that variations in the effectiveness of policy outcomes may be explained by choices and potential distortions made during the initial stages of the policy implementation process. Copyright © 2015 John WileySons, Ltd. StartCopTextCopyright © 2015 John WileySons, Ltd.