Purpose – The purpose of this paper is to set out a methodological framework to investigate how the integration of an activity-based costing (ABC) logic into the pre-existent accounting system supports healthcare organizations in identifying the inefficiencies related to their diagnostic therapeutic pathways (DTP) and related reengineering interventions. Design/methodology/approach – The BPM-ABC methodological framework has been applied to the case of a specific surgery pathway, at the Orthopaedic Division of a University Hospital in Italy. Findings – The case-study described in the paper points out: first, how the Business Process Management (BPM)-ABC methodology is able to produce significant information about consumed resources and the costs of the activities, useful to highlight opportunities for DTPs improvement; second, the barriers related to a pre-existing accounting system based on cost centres that can hinder the implementation of the BPM-ABC model. Practical implications – The case study points out the role of the ABC as a management tool for supporting decision-making processes. The ABC allows inferring information for two purposes. First, ABC supports a cost containment process as it allows highlighting the most cost-consuming activities and resources. Second, the ABC allows identifying reengineering paths, distinguishing between incremental and radical ones. Originality/value – This study represents a remarkable reference raising the awareness of the pivotal role accounting systems play in the management of the organizational processes.

Purpose The purpose of this paper is to develop a research framework for exploring and improving patient empowerment through the analysis of the effects produced by a satisfying physician relationship on patient involvement in the healthcare process. Design/methodology/approach The authors begin with a literature review of patient empowerment in healthcare, useful to highlight the importance of relational aspects. Then, the authors tested the hypotheses of the research through the analysis of 450 questionnaires. The results are analyzed through covariance-based structural equation modeling. Findings This paper highlights how empowerment is a more complex phenomenon, needing many dimensions to be investigated. The hypotheses were tested, and correlations computed, highlighting a medium-strong positive correlation between physician relationship and patient involvement determining satisfying patient empowerment. Research limitations/implications The considerations conducted in the paper are restricted to physician relationship and needs further research aimed to analyze and evaluate the changes in the patient behaviors influenced by empowerment. Practical implications The research points offer new insight into patient empowerment and allow the healthcare provider to create new opportunities for promoting patient empowerment through the development of quality relationship for effective patient involvement. Originality/value The study developed contributes new insight about patient empowerment in the healthcare management literature, proving the key role of satisfying physician relationship useful for future researches.

PurposeThe aim of this paper is to analyse how technological innovations in performance measurement systems make it possible to overcome some of the challenges that public healthcare organizations face where management and control are concerned. The changes that could be applied to the performance measurement system of healthcare organisations were analysed together with an evaluation of the responses developed in order to achieve these changes.Design/methodology/approachThe paper contains an in-depth case-study of a public university hospital which utilises an innovative information system.FindingsThe case-study highlights how technological innovations in performance measurement systems impact the management and monitoring information system in a public university hospital, through the implementation of a multidimensional management dashboard.Research limitations/implicationsThe limitation of this paper is that only one case-study is analysed, albeit in depth, while it would be interesting to consider more public university hospitals.Practical implicationsThe paper highlights the fundamental role of middle management in change processes in the healthcare sector.Originality/valueThe case-study highlights how critical the active involvement of middle management is in performance measurement and management, and how this is achieved thanks to the adoption of a simple, clear method which ensures comprehensible communication of the objectives, as well as the measurement of performance by means of radar plots.

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This work reports the results of the theoretical investigation of nonlinear dynamics and spiral wave breakup in a generalized two-variable model of cardiac action potential accounting for thermo-electric coupling and diffusion nonlinearities. As customary in excitable media, the common Q 10 and Moore factors are used to describe thermo-electric feedback in a 10-degrees range. Motivated by the porous nature of the cardiac tissue, in this study we also propose a nonlinear Fickian flux formulated by Taylor expanding the voltage dependent diffusion coefficient up to quadratic terms. A fine tuning of the diffusive parameters is performed a priori to match the conduction velocity of the equivalent cable model. The resulting combined effects are then studied by numerically simulating different stimulation protocols on a onedimensional cable. Model features are compared in terms of action potential morphology, restitution curves, frequency spectra and spatio-temporal phase differences. Two-dimensional long-run simulations are finally performed to characterize spiral breakup during sustained fibrillation at different thermal states. Temperature and nonlinear diffusion effects are found to impact the repolarization phase of the action potential wave with non-monotone patterns and to increase the propensity of arrhythmogenesis. Systemic temperature is kept approximately constant through many delicate physiological feedbacks. In the heart, temperature changes greatly affect the features of the excitation wave and occur because of pathological conditions, during surgery or because of various unfortunate events. It is therefore practically relevant to determine how thermo-electric feedbacks can alter normal cardiac pacing or sustain fibrillating scenarios. Recent studies have demonstrated that structural heterogeneity of cardiac tissue is a key ingredient for understanding dispersion of repolarization and tendency to arrhythmogenesis. Here we investigate whether a generalized two-variable reaction-diffusion model of cardiac electrophysiology can highlight the dual nonlinear effects induced by thermo-electricity and diffusive nonlinearities under several simulated tests. Our aim is to provide evidence of non negligible differences in the spatiotemporal behavior of the system when these contributions are considered and to stimulate the investigation of more reliable physiological cardiac models.