The paper critically discusses policy implications and policy lessons from COVID-19 management in the Italian LTC sector. The aim of the paper is to highlight strengths and weaknesses of measures promoted to support nursing homes during the pandemic and after, so to discuss possible routes for future reforms in Italy and comparable countries. After having described the features of Italian LTC sector, the paper discusses 2020 pandemic events both by presenting administrative data and a policy analysis conducted in 9 out of 21 Italian regions so to assess policy interventions. The paper shows that the intrinsic features of Italian LTC sector played a major role in COVID-19 crisis and new policies enacted in 2020 were insufficient to manage the situation. Possible routes for policy reforms are presented in conclusion. Limitations of the analysis relies in the time frame, since COVID-19 effects are still ongoing, while the analysis ended in November 2020.

BackgroundThe culture of New Public Management has promoted the diffusion of strategic management tools throughout Public Healthcare Organisations (PHOs). There is consensus that better strategic planning tools are required to achieve higher levels of organisational performance. This paper provides evidence and understanding of the emergent uses and scope of strategic planning in PHOs, in order to answer three research questions: (i) has the New Public Management approach changed the organisational culture of PHOs in terms of how they adopt, diffuse, and use strategic planning documents? (ii) how coherent are strategic planning documents in PHOs? and (iii) what are the main purposes of strategic documents in PHOs?MethodsAn analysis was carried out in three Italian Local Health Authorities. We analysed the number and types of formal strategic documents adopted between 2004 and 2012, evaluating their degree of coherence and coordination, their hierarchy, their degree of disclosure, and the consistency of their strategic goals. A content analysis was performed to investigate overlap in terms of content and focus, and a qualitative analysis was carried out to study and represent the relationships between documents.ResultsThe analysis showed that a rich set of strategic documents were adopted by each PHO. However, these are often uncoordinated and overlap in terms of content. They adopt different language and formats for various stakeholders. The presence of diverse external drivers may explain the divergent focus, priorities and inconsistent goals in the strategic documents. This planning complexity makes it difficult to determine how the overall goals and mission of an organisation are defined and made visible.ConclusionsThe evidence suggests that PHOs use a considerable number of strategic documents. However, they employ no clear or explicit overarching strategy currently, and strategic planning appears to be externally oriented. All the documents communicate similar topics to different stakeholders, although they use different language to answer to the different expectations of each stakeholder. Therefore, strategic planning and plans seem to be driven by neo-institutional approaches, as they are means to build consensus and negotiate ground for strategic actions, rather than means to identify strategic choices and priorities.

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Background Healthcare organizations are extremely complex. The work of their CEOs is particularly demanding, especially in the public sector, though little is known about how the managerial work of a healthcare organization CEO unfolds. Drawing from scholarship on managerial work and management in pluralistic organizations, we sought to answer the questions: What is the content of managerial work of CEOs in public healthcare in Italy? How do healthcare CEOs perform their managerial work in complex interactions with multiple stakeholders? Methods For this study we adopted a multi-method approach in which we conducted a survey to investigate CEO behaviors, tracked CEO working time for 4 weeks, and conducted semi-structured interviews with senior CEOs. Results CEOs in public healthcare devote most of their time to interaction, which half of which is perceived as being occupied with apparently mundane problems. Nonetheless, devoting time to such activities is functional to a CEO’s goals because change in pluralistic contexts can be achieved only if the CEO can handle the organization’s complexity. CEOs do this by engaging in routines and conversations with professionals, creating consensus, and establishing networks with external stakeholders. Conclusions CEOs are called to reduce fragmentation and foster cooperation across disciplines and professional groups, with the overarching aim to achieve integrated care. Using an analytical approach we were able to take into account the context and the relational dimension of the managerial work of healthcare CEOs and the specificities of this role. Trial registration This article does not report the results of a healthcare intervention on human participants, and the material used in the research did not require ethical approval according to Italian law.

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Background: Healthcare organizations are extremely complex, and the work of their CEOs is particularly demanding, especially in the public sector. However, we know little about how healthcare executives’ managerial work unfolds. Drawing from scholarship on pluralistic organizations and managerial work, we answer the questions: what is the content of managerial work of executives in public healthcare? How do CEOs deal with pressures from internal and external stakeholders while maintaining a strategic agenda?Methods: We adopted a mixed method with a survey to measure CEO behaviors, coding CEOs time for four weeks; a questionnaire to understand the strategic dimensions of interactions; interviews of senior CEOs.Results: CEOs in Italian public healthcare devote most of their time to interactions, by and large responding to pressures by internal stakeholders. Although half of this time is perceived as occupied in answering operational requests, this is necessary to nurture relations, create networks and develop alliances and consensus, which are functional in achieving CEOs’ strategic agenda.Conclusions: CEOs in public healthcare must deal with enormous contextual pressures and cannot manage the complexity but are called to manage within the complexity, fostering involvement in decision making, building networks, and establishing alliances. Amidst ambiguity and fragmentation, executives need to find solutions to perform their managerial work without being entrapped by stakeholders’ pressures, thanks to effective stakeholder management as well as delegation.Trial registration: The article does not report the results of a health care intervention on human participants, and material used in the research did not need ethical approval according to Italian law.

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