Given the regional disparities that historically characterize the Italian context, in this paper we propose a framework to evaluate the regional health care systems’ performance in order to contribute to the debate on the relationship between decentralisation of health care and equity. To investigate the regional health systems performance, we refer to the OECD Health Care Quality Indicators project to construct of a set of five composite indexes. The composite indexes are built on the basis of the non-compensatory Adjusted Mazziotta-Pareto Index, that allows comparability of the data across units and over time. We propose three indexes of health system performance, namely Quality Index, Accessibility Index and Cost-Expenditure Index, along with a Health Status Index and a Lifestyles Index. Our framework highlights that regional disparities still persist. Consistently with the evidence at the institutional level, there are regions, particularly in Southern Italy, which record lower levels of performance with high levels of expenditure. Continuous research is needed to provide policy makers with appropriate data and tools to build a cohesive health care system for the benefit of the whole population. Even if future research is needed to integrate our framework with new indicators for the calculation of the indexes and with the identification of new indexes, the study shows that a scientific reflection on decentralisation of health systems is necessary in order to reduce inequalities.
Purpose -The ageing of the world's population is causing an increase in the number of frail patients admitted to hospitals. In the absence of appropriate management and organisation, these patients risk an excessive length of stay and poor outcomes. To deal with this problem, we propose a conceptual model to facilitate the pathway of frail elderly patients across acute-care hospitals, focused on avoiding improper wait times and treatment during the process. Design/methodology/approach -The conceptual model is developed to enrich the standard flowchart of a clinical pathway in the hospital. The modified flowchart encompasses new organisational units and activities carried out by new dedicated professional roles. The proposed variant aims to provide a correct assessment of frailty at the entrance, a better management of the patient's stay during different clinical stages and an early discharge, sending the patient home or to other facilities, avoiding a delayed discharge. The model is completed by a set of indicators aimed at measuring performance improvements and creating a strong database of evidence on the managing of frail elderly's pathways, providing proper information that can validate the model when applied in current practice. Findings -The paper proposes a design of the clinical path of frail patients in acute-care hospitals, combining elements that, according to an evidence-based management approach, have proved to be effective in terms of outcomes, costs and organisational issues. We can therefore expect an improvement in the treatment of frail patients in hospital, avoiding their functional decline and worsening frailty conditions, as often happens in current practice following the standard path of other patients.Research limitations/implications -The framework proposed is a conceptual model to manage frail elderly patients in acute-care wards. Our research approach lacks application to real data and proof of effectiveness. Further work will be devoted to implementing a simulation model for a specific case study and verifying the impact of the conceptual model in real care settings. Practical implications -The paper includes suggestions for re-engineering the management of frail elderly patients in hospitals, when a reduction of lengths of stay and the improvement of clinical outcomes are required. Originality/value -This paper fulfills an identified need to study and provide solutions for the management of frail elderly patients in acute-care hospitals, and generally to produce value in a patient-centred model.
Purpose of the paper:This paper presents the results of the second survey on Procurement 4.0 in Italy, focusing on the skills needed for digital transformation.Methodology: The study is conducted through an online questionnaire (CAWI), transmitted by ADACI via email to its members. The results are presented in a comparative format relative to the first survey developed in 2018.Results: The survey suggests that enabling technologies have evolved, at least in the larger companies, from an infancy phase to a real introduction phase with greater involvement of the procurement function, called to act as a gateway for innovation.Limitations: Our second survey has a low participation, though higher than the first. As with the COVID-19 pandemic, the role of enabling technologies in ensuring business continuity has been pushed to the fore, we hope that the third wave of the survey will involve more enterprises. Practical implications: This study provides useful information to researchers, policymakers, and practitioners also suggesting the most appropriate skills to invest in. The findings indicate a strong need for a new training paradigm toward a new integrated mindset.Originality of the paper: The surveys carried out in the framework of this research project are the first to be developed in Italy on Procurement 4.0. The results contribute to illuminating a phenomenon that remains underexplored. Through a universitybusiness partnership, the study can feed decision-making processes at different levels to support the digital transformation of the Italian economic system.
This paper is a contribution to the entangled history between Italy and Libya through the trajectory life of Ester Panetta (1894-1983), a leading scholar who devoted her life to develop the knowledge of the language, history and cultures of Libya. After her Arabic and colonial studies at the Oriental Institutes in Naples and in Paris, she lived in Libya until the outbreak of the Second World War when she definitively came back to Italy. Her experience as single woman in colonial lands is not isolated at all, as the stories of single women crossing the territory of the Empire as travellers, teachers and missionaries testify.
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