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The paper addresses the issue of complexity in the administrative processes of public institutions: in particular, accounting routines and processes are examined. Back-office activities, although having a mere supporting role in the delivery of public services, absorb a relevant part of the resources of public institutions. The aim of the paper is to analyse the factors that contribute to the enhancement of complexity of these activities. The paper is based on an in-depth analysis of two Italian public organisations: a university and an ASP (agency for services to persons). Italy is an interesting context since simplification policies have been adopted in the country at central government level and in specific sectors of public administration, however, at the institutional level, simplification initiatives depend on the initiative of the single organisation. The cases described in this paper show that complexity stems from the need for inspectory controls (which is typical of the law) as well as from the volume of information requested (which is typical of management studies) for different stakeholders and at different, yet correlated, levels. The paper suggests that public management scholars have the opportunity and the burden of a contribution in this field.

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The issue of healthcare costs has become increasingly problematic over the years. This chapter summarizes the problems faced by hospitals when measuring the costs of healthcare treatments, explaining how an Activity-Based Costing (ABC) framework can be successfully adopted in healthcare settings. After describing the theoretical foundations of cost control and cost management, the chapter continues with the analysis of three real-life applications of ABC in a hospital, drawn from the process analysis and activity-based costing experience developed at the Azienda Ospedaliero-Universitaria “Ospedali Riuniti” (Joint Hospitals) of Trieste, Italy. In particular, the cases are about cost measurement in cardiology, odontostomatology, and radiology, and describe the technical solutions applied for computing the costs of selected therapeutic and diagnostic treatments. A particular emphasis is placed on how these measures have been subsequently used by hospital managers and medical personnel in order to gain insights and to improve the efficiency of the processes developed within the organization.

The paper considers the effects of administrative processes on the creation of public value. Administrative activities absorb a relevant part of public institutions’ resources. We analyze the accounting routines and procedures of some Italian public institutions: it emerges that recent reforms boosted complexity by requiring public organizations to generate a growing volume of accounting data. Moreover, controls made by external authorities have intensified. According to the literature, complexity generates costs: we show that in the public sector this negative consequence does not only affect the institutions themselves, but it also extends to the stakeholders. The paper is based on case studies that the authors could personally observe. In the conclusions, we analyze the main factors that contribute to generate complexity and their effects on the creation of public value. The stakeholder theory is adopted as theoretical background, considered that public value refers to all the subjects that are affected by the administrative action.

The issue of healthcare costs has become increasingly problematic over the years. This chapter summarizes the problems faced by hospitals when measuring the costs of healthcare treatments, explaining how an Activity-Based Costing (ABC) framework can be successfully adopted in healthcare settings. After describing the theoretical foundations of cost control and cost management, the chapter continues with the analysis of three real-life applications of ABC in a hospital, drawn from the process analysis and activity-based costing experience developed at the Azienda Ospedaliero-Universitaria “Ospedali Riuniti” (Joint Hospitals) of Trieste, Italy. In particular, the cases are about cost measurement in cardiology, odontostomatology, and radiology, and describe the technical solutions applied for computing the costs of selected therapeutic and diagnostic treatments. A particular emphasis is placed on how these measures have been subsequently used by hospital managers and medical personnel in order to gain insights and to improve the efficiency of the processes developed within the organization.