Translating strategy into practice: A tool to understand organizational change in a Spanish university hospital. An in-depth analysis in Hospital Clinic

Frisicale

et al. 2020

BMC Health Serv Res

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Background Patients’ increasing needs and expectations require an overall assessment of hospital performance. Several international agencies have defined performance indicators sets but there exists no unanimous classification. The Impact HTA Horizon2020 Project wants to address this aspect, developing a toolkit of key indicators to measure hospital performance. The aim of this review is to identify and classify the dimensions of hospital performance indicators in order to develop a common language and identify a shared evidence-based way to frame and address performance assessment. Methods Following the PRISMA statement, PubMed, Cochrane Library and Web of Science databases were queried to perform an umbrella review. Reviews focusing on hospital settings, published January 2000–June 2019 were considered. The quality of the studies selected was assessed using the AMSTAR2 tool. Results Six reviews ranging 2002–2014 were included. The following dimensions were described in at least half of the studies: 6 studies classified efficiency (55 indicators analyzed); 5 studies classified effectiveness (13 indicators), patient centeredness (10 indicators) and safety (8 indicators); 3 studies responsive governance (2 indicators), staff orientation (10 indicators) and timeliness (4 indicators). Three reviews did not specify the indicators related to the dimensions listed, and one article gave a complete definition of the meaning of each dimension and of the related indicators. Conclusions The research shows emphasis of the importance of patient centeredness, effectiveness, efficiency, and safety dimensions. Especially, greater attention is given to the dimensions of effectiveness and efficiency. Assessing the overall quality of clinical pathways is key in guaranteeing a truly effective and efficient system but, to date, there still exists a lack of awareness and proactivity in terms of measuring performance of nodes within networks. The effort of classifying and systematizing performance measurement techniques across hospitals is essential at the organizational, regional/national and possibly international levels to deliver top quality care to patients.

Section: Discussionmentioning

confidence: 99%

Assessing hospital performance indicators. What dimensions? Evidence from an umbrella review

Carini

Frisicale

et al. 2020

BMC Health Serv Res

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“…Studies focused on applications of institutional theory in the health‐care sector have frequently confirmed the need for health‐care organizations to acquire legitimacy from stakeholders through a resilient approach toward the external environment (Seixas et al, 2021). Institutional isomorphism has been detected and explained extensively in this field (Alyahya et al, 2018) while exploring common dynamics and strategies of change across health‐care organizations (Gabutti & Cicchetti, 2017). In turn, the problematic risk of incurring into decoupling phenomena, which imply the emergence of a gap between the formal adoption and the concrete implementation of practices, rules, or models, has drawn the attention of scholars (Fiss and Zajac, 2006).…”

Section: Theoretical Contextmentioning

confidence: 99%

Understanding the gap between policy and facts: The Italian experience on federal decoupling in the implementation of breast units

World Med & Health Policy

Barneschi²

2022

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Decoupling in the health‐care sector is a highly problematic phenomenon that easily leads to dramatic failures in strategy implementation. Although decoupling is addressed frequently at the organizational level, there exists extremely poor evidence of its presence at the federal/regional level. This study provides an investigation on the implementation of Italy's directive on the re‐organization of regional health‐care systems' networks based on breast units, with the intent of detecting different levels of compliance across regions and possible decoupling phenomena. Nonparametric tests are carried out to assess the gaps between formal and concrete compliance to the national directive across regions. Results suggest that decoupling occurs at the regional level, but formal compliance positively affects concrete compliance in the long term. Implications for policymakers concern their awareness of possible discrepancies between formal compliance to their directives and concrete changes in the way health‐care services are managed, as well as a strategic understanding of how these are doomed to be mitigated in the long run. Such awareness should affect the ability of policymakers to adapt and interpret performance measurement systems accordingly.

“…If we think of medical equipment, it is easy to see that different organisational configurations are likely to imply different ways of assigning time slots and use of this equipment (Cardoen et al, 2010). For example, a traditional rigid, vertical organisational chart based on departments, each made up of clinical wards, usually implies that each department disposes of its own operating rooms (Gabutti and Cicchetti, 2017). Instead, horizontal charts based on more recent patient pooling approaches are likely to imply shared operating theatres (Cardoen et al, 2010).…”

Section: Adapting the Conceptual Framework To Hospitalsmentioning

confidence: 99%

Driving health technologies towards performance: a contextualisation within the hospital setting

2021

IJTPM

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Purpose: Technology plays a crucial role in determining organisational performance and this is true also in hospitals. Nevertheless, there exists a lack of evidence on how well health technologies are expected to perform in specific hospitals, depending on their managerial characteristics. The aim of this work is to shed light on these dynamics and provide a clear picture of the expected effects of health technologies in hospitals. Methodology: Through multiple literature searches, a theoretical framework linking organisational contextual factors, technology implementation and organisational performance is provided and applied to hospitals. Findings: Contextual factors play a key role in determining performance of health technologies. Performance should be interpreted through a balanced array of dimensions and should be understood in a broader system-perspective. Originality: There emerges the need of a full awareness of the effects that hospital contextual factors exert on the use of heath technologies and on their impact on performance.