1,720,992 research outputs found
Ethnography in public management research: a systematic review and future directions
No full textEthnography is defined as a research methodology based on sustained, explicit, methodical observation and paraphrasing of social situations in relation to their naturally occurring events. The value of producing local observational data over extended periods of time lies in the ability to systematically explore the subjective construction of meanings and its consequences on organizational and institutional dynamics. Based on a systematic review of published ethnographic studies in the field of public management, this paper investigates how ethnography has been conceptualized and employed by the scholarly community in the past twenty-five years (1990-2014); it highlights the methodological features of the ethnographic design; and it outlines a set of research directions for future applications of the ethnographic approach to the study of theoretically and empirically relevant phenomena. This study contributes to the growing debate of the role of methods in public management literature in informing evidence-based managerial and policy decisions
Relazioni pubblico-privato nel settore dell’ortopedia e della riabilitazione: evidenze dalla Regione Veneto.
No full textAnalisi delle relazioni pubblico-privato nel settore dell’ortopedia e della riabilitazione, con un'indagine multiple case study su quattro aziende sanitarie della Regione Veneto
Cross-level coordination among international organizations: dilemmas and practices
No full textThis article contributes to the understanding of inter-agency coordination among international organizations, conceived as international public administrations (IPAs). We adopt a practice-based approach to study the dilemmas of coordination across levels of government in the empirical setting of United Nations agencies involved in field-level development activities. Based on elite interviews in both pilot countries and agency headquarters, complemented by extensive archival analysis, we track the emergence of a specific type of coordination dilemma that has been understudied, that is, the dilemma of inter- and intra-agency coordination. We identify two sets of coordinating practices that aided in balancing
the dilemma, that is, ‘systemic thinking’ and ‘jointly mobilizing resources and consensus’, and we discuss the organizational factors mediating the perception of each set of practices
Financing medical devices: The case of implantable cardioverter defibrillators and coronary stents in Italy
No full textIn the recent years, the financing of medical devices has gained increasing attention from health policy makers in Italy at both regional and national level. The article investigates the current modalities of procurement and reimbursement of cardiovascular medical devices in Italy, as well as their diffusion across the country. Both implantable cardioverter defibrillators and coronary stents are purchased by the health care providers using Diagnosis Related Group tariffs. Empirical data suggest that these technologies have increasingly been used in recent years in Italy
Uptake and diffusion of medical technology innovation in Europe: what role for funding and procurement policies?
No full textThe producers of medical technology constantly strive to innovate and to improve their products for the benefit of patients. With each new generation of devices enabling less invasive techniques, better clinical outcomes and reduced recovery times, patients are direct beneficiaries of this commitment to innovation. Innovation and patient access to technology are inseparably linked with each national health system's respective coverage, procurement and reimbursement policies. If a particular innovation is not included in the basket of services covered by public resources, there may be a time lag before it enters the system and reaches patients. If the procurement criteria focus primarily on price, it is likely that the quality and innovativeness will be penalised. Finally, if the use of an innovative technology leads to higher costs for the health-care provider, it has to bear the cost until the reimbursement mechanism is updated to include the new technology. Today there are substantial regional differences relative to the financial incentives for introducing new technology and in some cases, it can take years before the new technologies are recognised, which can inhibit the roll-out of innovation within the health system. In addition to utilising different policy choices for funding and procurement, the decision-making criteria used to inform policies vary greatly in European countries. Increasingly, health-care policymakers want scientific, technological and economic evidence before classifying a new technology as reimbursable. Although it is important to ensure that new medical devices are superior to conventional treatments, due to short-sightedness in certain assessment mechanisms and limited availability of clinical trial information, the reliability of estimates of the efficacy and cost-effectiveness can be questioned. As health technology assessment procedures are centralised, it becomes ever more important that coverage decisions regarding new medical devices are made on sound, robust criteria and that they include the full economic benefits – to the patient, to the health-care system and to society – of innovative new technology. As pressure on health-care funding mounts, reimbursement policy, in particular, is being refocused to target the contrasting objectives of healthcare expenditure containment and support of innovation. Looking forward, the successful balancing of technological adoption and affordability will require a judicious use of policy levers and will probably be accompanied by more regulatory action
Life beyond emergence: institutional intermediaries and the persistence of hybrid forms
No full textWe report on a multi-level longitudinal study investigating a population of public-private hybrid organizations in the Italian healthcare field, where a public service and quasi-market logic coexist. A combination of survey, interviews and archival data allowed us to trace the dynamics of persistence and decay of two hybrid templates over 25 years (1992-2016). By bridging the literature on institutional complexity and hybrids with insights from imprinting, we illuminate the role of field-level actors (regional authorities) who as institutional intermediaries and agents of recursive imprinting embed their prioritization of institutional logics in distinct templates for organizing, and provide them to hybrid organizations during multiple sensitive periods over time. Our findings draw attention to the differential institutional capacity of institutional intermediaries to prioritize and enforce institutional logics, and to the diverse relational, procedural and discursive mechanisms they employ during imprinting processes. Ultimately, our findings advance the understanding of how certain hybrid forms come to persist while others decay
Il concetto di istituzione culturale
Full text linkIl concetto di istituzione culturale
(Istituzione culturale: definizione; Istituzione culturale: ambiti di settore e di legittimazione; Istituzione culturale: la proprietà di modularità; Istituzione culturale: la proprietà di dinamicità; Conclusioni; Riferimenti bibliografici
Institutional public private partnerships for core health services: evidence from Italy
Full text linkAbstract Background Public-private partnerships (PPPs) are potential instruments to enable private collaboration in the health sector. Despite theoretical debate, empirical analyses have thus far tended to focus on the contractual or project dimension, overlooking institutional PPPs, i.e., formal legal entities run by proper corporate-governance mechanisms and jointly owned by public and private parties for the provision of public-health goods. This work aims to fill this gap by carrying out a comparative analysis of the reasons for the adoption of institutional PPPs and the governance and managerial features necessary to establish them as appropriate arrangements for public-health services provisions. Methods A qualitative analysis is carried out on experiences of institutional PPPs within the Italian National Health Service (Sistema Sanitario Nazionale, SSN). The research question is addressed through a contextual and comparative embedded case study design, assuming the entire population of PPPs (4) currently in force in one Italian region as the unit of analysis: (i) a rehabilitation hospital, (ii), an orthopaedic-centre, (iii) a primary care and ambulatory services facility, and (iv) a health- and social-care facility. Internal validity is guaranteed by the triangulation of sources in the data collection phase, which included archival and interview data. Results Four governance and managerial issues were found to be critical in determining the positive performance of the case examined: (i) a strategic market orientation to a specialised service area with sufficient potential demand, (ii) the allocation of public capital assets and the consistent financial involvement of the private partner, (iii) the adoption of private administrative procedures in a regulated setting while guaranteeing the respect of public administration principles, and (iv) clear regulation of the workforce to align the contracts with the organisational culture. Conclusions Findings suggests that institutional PPPs enable national health services to reap great benefits when introduced as a complement to the traditional public-service provisions for a defined set of services and goals.</p
From logic acceptance to logic rejection: the process of destabilization in hybrid organizations
No full textWe study the introduction of the private logic into a mature Italian hospital that was governed previously as a hybrid of professional and public logics. Intriguingly, the reconstituted hospital was for several years widely praised for its strong clinical and financial performance, but quickly and with little warning became riven by political differences that led to its demise. Through our case analysis, we develop a multi-level model that reveals the destabilizing process that can unfold when a new logic enters an established organization. We contribute to the hybrids literature by explaining the puzzle of how a new logic can become accepted and then rejected in organizations, emphasizing the critical importance of the interaction between the audience, organization, and practice levels. Crucially, we reveal that positive feedback from multiple audiences may be a mixed blessing for hybrids: while it offers resource and legitimacy advantages, it can induce internal tensions with severe destabilizing consequences. Our findings and model also run counter to two core assumptions within the institutional literature: that social endorsement is advantageous, and that alignment with institutional expectations results in stabilization. We qualify these assumptions and indicate the circumstances under which they are unlikely to hold
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