Looking good or doing better? Patterns of decoupling in the implementation of clinical directorates

Abstract

The present research shows that changes in quality improvement processes may vary in relation to policy makers' interventions aimed at boosting the adoption of new hospital arrangements. Hospital administrators need to be aware and identify the institutional changes that might be driven by law to be able to react consistently with expectations of policymakers.

Unfolding similarity in interphysician networks: the impact of institutional and professional homophily

“…Interestingly, we observed a positive and significant correlation between the two variables capturing the different types of homophily, namely “Professional Homophily (same category)” and “Institutional Homophily (same category)” (r = 0.2315; p < 0.05). Although the level of correlation was moderate, this finding suggest that a certain degree of homogeneity encompassed the criteria for merging clinical wards and hospital specialties into clinical directorates [ 32 ].…”

“…Many Western healthcare systems (e.g., U.K., Italy, Australia, France) have implemented healthcare reforms aimed at the adoption of new organizational models that focus on fostering patient-centered care and a team-based approach in the development of clinical activities [ 31 , 32 ]. These newly adopted models, referred to as “clinical directorates” or “departments”, are defined by groups of clinical specialties that are integrated with the specific purpose of changing the routine behaviors of professionals within hospitals.…”

“…For example, clinical directorates were introduced into the Italian National Health System (I-NHS) as an institutional reference model, with the aim of reorienting activities towards healthcare processes carried out by divisional units [ 33 ] in charge of making strategic and organizational decisions [ 34 , 35 ]. These intermediate organizational models manage certain services of large hospitals and resemble the divisions that are typically adopted in large private multinational corporations [ 31 , 32 ]. The size of the directorate, its degree of autonomy, and the criteria used for integrating hospital clinical wards may vary considerably across health systems [ 32 ].…”

“…These intermediate organizational models manage certain services of large hospitals and resemble the divisions that are typically adopted in large private multinational corporations [ 31 , 32 ]. The size of the directorate, its degree of autonomy, and the criteria used for integrating hospital clinical wards may vary considerably across health systems [ 32 ]. Hospital executives are often free to decide how to implement the new model in hospitals by selecting the specific clinical wards and medical specialties to be integrated into single departments.…”

Exploring professionals' motivation to lead: a cross-level study in the healthcare sector

“…This restructuring corporatized hospital organizations by increasing their level of autonomy and accountability (Lega, 2008). To realize the socalled 'corporatization process', the Italian Ministry of Health (IMH) repeatedly stressed the importance of introducing a clinical directorate model, which was considered suitable to balance the need for greater efficiency with improvement in the quality of patient care (Mascia, Morandi, & Cicchetti, 2014). Several laws were passed to regulate the implementation of the model within Italian healthcare organizations.…”