The Challenges of Hospitals’ Planning & Control Systems: The Path toward Public Value Management

Abstract

In the last decades, public management has been subjected to a shift from the New Public Management (NPM) paradigm to the Public Value Management (PVM) one. Thus, management practices such as Planning and Control (P&C) systems have been called to evolve accordingly. The health care sector has not escaped this process. This paper focuses on the evolution of hospitals’ P&C systems to support the paradigm shift from the NPM paradigm to the PVM one. In particular, the paper aims at exploring whether hospitals’ P&C systems in Italy evolved, or are evolving, consistently with PVM and what are the expected benefits related to such a paradigm switch. To address the research aim, the paper is based on a review of scientific and grey literature and the case study of the diabetic-foot pathway in an Italian Regional Healthcare System. The results of this study show that the current P&C systems in Italian hospitals are not yet designed to support the shift toward the PVM approach and are still mainly focused on financial aspects and intra-organizational dynamics. Combining traditional P&Cs with performance measures assessing the system’s outcomes may support hospitals in aligning their goals with the health system they are operating within and, therefore, P&C systems may represent an important driving force toward change. Such results provide suggestions for both practitioners and academics on how to adapt P&C systems to better support the implementation of current strategies of the public sector.

Cost Strategy on the Performance of Level Four Public Hospitals in Nairobi County, Kenya

“…Furthermore, a significant number of hospitals (37.3%) expressed that they monitor and control expenses very effectively, highlighting highly proficient expense monitoring and control practices. These findings underscore the critical importance of implementing strong expense monitoring and control mechanisms within hospitals to maintain cost efficiency, aligning with prior research by Lewandowski (2014) and Nuti et al (2021), which emphasize the significance of efficient expense monitoring in public hospitals.…”

Back and Forth on Sustainable Development: A Focus on Healthcare Organisations

“…Despite the Italian National Strategy on Sustainable Development that was set in 2017 to define guidelines for the achievement of the 2030 SDGs Agenda, it has never been translated into direct interventions in the national and regional health systems (the macro and meso levels) to promote the integration of the three dimensions of sustainability (environmental, social and economic) in decision making. In fact, healthcare policies promoted during this time were mainly oriented to guarantee the financial sustainability of the healthcare systems, this being a dominant discourse in the Italian healthcare setting [10,51]. As argued, in Western European Countries, austerity measures aimed at containing health expenditures and responding to the effects of the financial crisis have been mainly pursued to recover efficiency and to use resources for short-term interventions to increase economic growth; in turn, the label of "sustainability" attributed to these measures has led to considerations of sustainability as a resource constraint healthcare systems must comply with, at the expense of the welfare provided to the citizens risking impoverishment of their health status [3,65].…”

“…Nevertheless, this misleading cycle that sees economic and financial sustainability as sufficient conditions to guarantee the viability of healthcare systems has been criticised, as it neglects sustainability as a wicked issue in complex adaptive systems, such as the healthcare ones [3][4][5][6][7][8][9]. Consequently, the main label attributed to SD has been related to austerity measures to recover efficiency [10], to the detriment of other dimensions of sustainability, such as social, political and environmental sustainability [3]. Furthermore, the meaning of sustainable healthcare, along with interventions that may support sustainability of the healthcare systems in the long run, is difficult to define, as are performance measures aimed at tracking the effectiveness of such interventions [3].…”

Healthcare costs of diabetic foot disease in Italy: estimates for event and state costs

“…In general, there is a need to improve the treatment value in the whole population, which requires adopting a population medicine approach [ 33 ]. To foster a population-based approach improvements are expected also in planning and control systems [ 34 ], where target setting and monitoring activities should use population outcome performance information (e.g., reducing avoidable hospitalization), which better represent the value creation process [ 35 ]. Indeed, these metrics reflect preventive activities that have the greatest potential for yielding population benefit.…”