1,720,993 research outputs found
Working together: collaboration formation and its functioning in EU Cohesion Policy
No full textUrban regeneration, poverty, innovation and human services, all represent complex issues that today hardly see the intervention of one single organisation. In this dissertation, we focus on why and how different public and private organisations collaborate to better tackle similar ‘wicked issues’ in regional development. First, we examine what determines collaboration to emerge (i). In doing so, we argue that drivers are not a single block of forces acting in the same direction. Thus, when unravelling the determinants of collaboration, we consider both motivation and contingencies that stem from the organisational and institutional milieux. The second aspect we consider in the framework is the process (ii). To aid the understanding of the process and its value, we elaborate and use the concept of synergy to assess how and the extent to which partners through their working relationship generate ‘new’ patterns of action and thinking. We employ the institutional theory and the resource dependence one to strengthen the power of our explanation of both the formation phase and the developmental one (i.e. process). Two priorities of EU cohesion policy served as a context – research and innovation and social inclusiveness – compared across three European regions: Silesia, Saxony and Apulia. Document analysis and semi-structured interviews served as material for our empirical enquiry. Our findings show that organisations – both public and non-public – collaborate not only for resource needs but also for satisfying social preferences (like increasing public welfare). Likewise, institutional logics flowing from regulative and cognitive constructions have a shaping role on collaboration formation by either undermining or encouraging it. Secondly, our framework for measuring synergy revealed that 'learning' and 'mutual meanings' are salient characteristics of the process as highlighted by participants. This study deepens the debate around the influence of context constraints, alongside actors' motivation on building a collaboration. Concomitantly, it contributes to the research exploring the dynamic nature of the process and its value in understanding how actors interact and the benefits they reap at early stages
La struttura e le attività del SSN
No full textIl capitolo 2 del Rapporto OASI 2023 offre un dettagliato panorama del Servizio Sanitario Nazionale (SSN) italiano, focalizzandosi su aspetti istituzionali, dotazione strutturale, attività e risposta alla domanda di salute, oltre a posizionare il SSN nel contesto internazionale. Le riforme iniziate negli anni ‘90 hanno ridotto il numero di aziende sanitarie territoriali da 197 nel 2001 a 128 nel 2023, con processi di fusione mirati a ottimizzare le dimensioni istituzionali. Recentemente, alcune regioni medio-piccole hanno mostrato un’inversione di tendenza. Anche le Aziende Ospedaliere (AO) sono diminuite da 97 nel 2001 a 42 nel 2023, con l’ultima modifica introdotta nella regione Marche nel 2022. Nel complesso, negli ultimi 20 anni, le dimensioni medie delle Aziende Sanitarie Locali (ASL) sono considerevolmente aumentate, con una popolazione media di 458.792 utenti a gennaio 2023. In termini strutturali, le esigenze di contenimento della spesa e riqualificazione hanno guidato una razionalizzazione dell’offerta ospedaliera e territoriale, inevitabilmente interrotta o comunque profondamente influenzata dalla pandemia nel biennio 2020-2021. Il Covid-19 ha anche influenzato il personale del SSN, con incrementi tra operatori tecnici e sociosanitari, personale infermieristico, ostetrico e vari professionisti sanitari, mentre i medici hanno registrato un aumento più modesto. Nonostante ciò, i numeri rimangono in diminuzione rispetto a un decennio fa, con particolari carenze di personale infermieristico. Per quanto riguarda le attività di ricovero, l’aumento nel 2021 non ha compensato il calo del 2020, mentre le prestazioni di specialistica ambulatoriale sono complessivamente tornate a livelli pre-pandemici. Tuttavia, il recupero è da attribuire in stragrande parte al laboratorio analisi, mentre diagnostica per immagini, riabilitazione e le principali branche cliniche per acuti presentano ancora significativi gap rispetto al 2019. A livello internazionale, l’Italia si distingue per il basso numero di infermieri per 1.000 abitanti, il basso rapporto tra infermieri e medici e indicatori di attività ospedaliera inferiori rispetto ai principali paesi europei. Nel paragrafo conclusivo, si approfondisce il tema delle diseguaglianze nell’accesso alle prestazioni sanitarie, evidenziando come la pandemia abbia ulteriormente peggiorato la situazione, con un aumento delle rinunce alle prestazioni sanitarie considerate necessarie nel periodo 2019-2021, seguito da una lieve diminuzione nel 2022. Le lunghe liste d’attesa sono emerse come barriera principale all’accesso, particolarmente al Nord, indicando le difficoltà del sistema nel soddisfare la domanda di assistenza post-emergenza sanitaria
La struttura e le attività del SSN
Get PDFIl capitolo 2 del Rapporto OASI 2024 descrive il SSN italiano focalizzandosi sui profili istituzionali, sulla dotazione strutturale, sulle attività e sul livello di risposta alla domanda di salute, e ne illustra il posizionamento nel panorama internazionale
Meso-organisational determinants of healthcare workers’ resilience: results of a scoping review
No full textRecent financial, environmental, and health crises have underscored the critical—but often overlooked—role of healthcare workers (HCWs) for health system resilience. Given the ongoing physical and psychological demands placed on this workforce, understanding the factors that influence their resilience is essential. This scoping review aimed to map and synthesise multidisciplinary evidence on meso-level organisational factors that influence individual resilience among HCWs. Specifically, we focused on identifying workplace-related risk and protective factors within the immediate organisational environment. A scoping review was conducted across multidisciplinary literature, targeting studies that examined individual resilience outcomes in relation to meso-level workplace factors. This approach allowed for the inclusion of diverse study designs and disciplinary perspectives relevant to the research question. A total of 66 studies met the inclusion criteria. The analysis highlighted the importance of intermediate organisational factors—such as job characteristics and empowerment, interpersonal dynamics (e.g., team cohesion, supervisory support), and psychosocial workplace conditions—in shaping HCW resilience. Although resilience is often viewed as an individual trait, this review demonstrates the critical role of meso-level organisational environments in fostering and sustaining HCW resilience. The findings support the need for policies and interventions that strengthen team functioning and workplace climate. Future research should focus on operationalising these insights into actionable strategies that bridge individual and systemic approaches to workforce resilience
Implementing shared decision-making interventions in breast cancer clinical practice: a scoping review
Get PDFAbstract Background Shared decision-making (SDM) is a collaborative process whereby patients and clinicians jointly deliberate on the best treatment option that takes into account patients’ preferences and values. In breast cancer care, different treatment options have become available to patients in the last decade. Various interventions, including patient decision aids (PtDAs), have been designed to promote SDM in this disease area. This study aimed at investigating the factors that influence the successful adoption and implementation of SDM interventions in real-world healthcare delivery settings. Methods A scoping review of scientific and grey literature was conducted for the period 2006–2021 to analyse the support for SDM interventions and their adoption in breast cancer clinical practice. The interpretation of findings was based on the Practical, Robust Implementation and Sustainability Model (PRISM) for integrating research findings into practice. Results Overall, 19 studies were included for data synthesis, with more than 70% published since 2017. The availability of SDM tools does not automatically translate into their actual use in clinical settings. Factors related to users’ co-creation, the clinical team’s attitude and knowledge, organisational support and regulatory provisions facilitate the adoption of SDM interventions. However, overlooking aspects such as the re-organisation of care pathways, patient characteristics, and assigning of resources (human, financial, and facilities) can hinder implementation efforts. Conclusions Compared to the mounting evidence on the efficacy of SDM interventions, knowledge to support their sustained implementation in daily care is still limited, albeit results show an increasing interest in strategies that facilitate their uptake in breast cancer care over time. These findings highlight different strategies that can be used to embed SDM interventions in clinical practice. Future work should investigate which approaches are more effective in light of organisational conditions and external factors, including an evaluation of costs and healthcare system settings
Shared decision-making
No full textPatient-centered care aims to empower patients to become active participants in their care, with a shift from provider-centric norms to care processes arranged around patients’ beliefs and needs. Patient centricity calls in fact for accurate consideration and reflection of patients’ values, preferences, and choices at every step in the healthcare pathway. This requires that physicians develop good communication skills and address patient needs effectively [Reynolds, 2009]. Communication is a crucial factor impacting the perceived quality of care from the perspective of patients and their caregivers. An adequate communication is expected to have a positive influence on the quality of care. Charles, Gafni, and Whelan [2004] distinguished four possible archetypes in patient-clinician interactions, which in turn reflect alternative approaches in communication summarized in Table 24.1
Strumenti a supporto del processo decisionale condiviso in oncologia
No full textIl capitolo affronta il tema del processo decisionale condiviso, o shared
decision-making, come pilastro dell’assistenza «centrata sulla persona» e del
coinvolgimento attivo del paziente in ambito sanitario. L’indagine ha analizzato lo stato dell’arte nell’adozione di approcci di coinvolgimento dei pazienti
nella pratica clinica in Italia, e successivamente, esplorato i fattori che possono
influenzare la diffusione in un’ottica organizzativa, con uno sguardo particolare alla gestione del tumore mammario
From Policy to Reality: Harnessing Data Spaces for Sustainable Urban Development
No full textThe proliferation of detailed data—from satellite observations and sensors to Internet of Things and administrative registries— combined with the widespread adoption of analytical tools is reshaping how we understand and respond to ‘grand’ societal challenges. Climate change is one such challenge, and the European Union has committed through a suite of strategies and measures to becoming climate neutral by 2050 while adapting to environmental shifts already underway. Central to this effort is the recognition of data as a strategic asset. Building a single market for data is expected to unlock social and economic benefits, while supporting the ambitions of the European Green Deal. Cities are at the forefront of this green and digital transition. Cities are mandated with direct service provision and implementation of European Union policies and regulations. Moreover, climate change is felt even more intensively in urban areas due to their morphology, density in population and built-up systems. In the past decades, cities achieved considerable progress in promoting innovative strategies to address environmental concerns, for instance, through the Covenant of Mayors1 initiative. Yet cities have been grappling with leveraging data into policymaking. Despite numerous initiatives to promote data-driven transformation, often, whole-of-system approaches are still lacking. Besides patchy or unavailable data governance frameworks, cities face challenges related to data availability, quality and interoperability. The European Union has mobilised with regulatory frameworks, standardisation efforts and research initiatives to encourage secure, trusted data sharing and use. Cities can tap into valuable resources including collaboration across European cities, exchange knowledge with key stakeholders, access funding and research to deploy context-based, sustainable solutions. Within the evolving landscape of data collaborations and technical solutions, data spaces are emerging as a promising model for facilitating collaboration across sectors and enabling data to be shared and reused in alignment with common policy goals. This policy brief explores two complementary approaches or frameworks for data sharing and use that enable the collaboration between city-relevant stakeholders in the realm of environmental sustainability. Drawing on the examples of two projects outlined further–USAGE and SPOTTED–we aim to understand how technical arrangements and governance mechanisms can harness the potential of data integration to drive environmentally sustainable solutions. Together, these perspectives offer actionable insights for city leaders and policymakers seeking to translate data into tangible climate action. The brief concludes with recommendations grounded in real-world pilot experiences
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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