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Focusing on the adoption of Total Quality Management (TQM) principles in universities, this research paper explores how the “soft” dimensions of TQM trigger its “hard” dimensions considering them at the individual (micro-) and the university (meso-), and eventually at cluster (system-), levels.

Adopting a qualitative approach, this study presents an in-depth, longitudinal case study of University of Siena, one of the oldest Italian universities, that has been at the core of the research-based cluster on vaccines, today converged in the Tuscan Life Science Cluster. In particular, data were collected between 2018 and February 2022 and consists of archival data (press articles, websites, books), nine interviews to key informants, multiyear experience of the Life Sciences sector by two of the authors and other material put at disposal by university offices, and emails. Data analysis relied on a timeline, a coding procedure that considered three levels of analysis (individual, organization and cluster). Finally, the authors looked at the “how” and “why” the emerged themes have contributed to academic excellence.

This paper unveils how “soft” and “hard” sides of TQM are blended across multiple levels for reaching academic excellence. The grounded model emerged enlightens the importance of an individual “soft” dimension, academic passion (composed by its three subdimensions of individual research, teaching and entrepreneurial passion) and also sheds light on the organizational “soft” and “hard” sides that the university has been able to design for encouraging research, teaching and third mission quality. Academic excellence has been possible thanks to the capitalization of the individual and organizational “soft” sides into real outcomes as represented by the organizational and individual “hard” sides.

The paper suggests the importance of TQM principles applied at universities' level, providing an in-depth description of “soft” and “hard” sides dimensions of TQM and their impact on all the three pillars of academic excellence. The study findings suggest implications for managers and professionals in the higher education domain as well as for policymakers emphasizing the importance of supporting the individual and organizational soft sides of TQM. The authors provide practical implications recommending universities to consider not only the organizational dimensions but also individual ones when pursuing higher education excellence. In particular, individual passion plays a crucial role and universities need to identify ways of nurturing it. The authors also recommend policymakers to think about new ways to sustain universities as crucial actors in boosting a cluster development, as well as to consider higher education institutions, especially in more rural areas, as a privileged player not only capable of nurturing academic excellence but also able of creating an internationally renowned cluster.

TQM principles have been intensively analysed from an industrial perspective focusing on manufacturing and services, while this paper focuses on TQM in universities, presenting a grounded model that blends the individual and organizational “soft” and “hard” sides.

Health-care systems around the globe share several pressing challenges – including increasing costs and patient outcomes. Innovative arrangements, such as public–private partnerships (PPP) can be adopted to help address these challenges. Although the promise of PPPs is great, so are its peril if the arrangements are not managed and regulated adequately through the contracting process. Yet, PPP arrangements can introduce their own unique set of problems. This paper aims to analyze how PPPs contracting accounts for three major problems identified reviewing the: performance measurement and audit; determination of compensation and risk management–related issues.

The authors used a case study approach to analyze contracting among health-care PPPs in two countries: Italy and the USA. With a structured review performed on Scopus database using a keywords Boolean research, the authors identified three recurring major issues to investigate in two selected cases, one per country. For each major issue, the authors defined several sub-issues retrieved from a widely used institutional framework. In each sub-issue, a documental analysis on all published information related to the signed contract has been performed identifying the approaches used by the two organizations.

The authors find that PPP contracting in the USA case seems to be oriented more toward managing institutional change as well as more flexibility in the deductibility and compensation determination for organizations and providers, suggesting this organization is more oriented to change in general. The authors find that PPP contracting in Italy more clearly delineate the allocation of risk between organizations that engage in PPPs, suggesting a more practical approach.

PPP is complex. Contracting helps manage the complexity of these arrangements. This case study approach to PPP contracting highlights the variation in contracting approaches across two different countries. Policymakers and health-care managers need to ensure that PPP contracting clearly delineates auditing and performance measurement, compensation and risk management.

The authors’ analysis sheds light on the different approaches to arranging health-care PPPs in two different country settings. More research should be done to connect these different approaches to important outcomes, such as patient and organizational finances, as well as expanding the scope of countries adopting PPP in health care.