Anna Prenestini, Stefano Calciolari and Arianna Rota
During the 1990s, Italian healthcare organisations (HOs) underwent a process of corporatisation, and the most innovative HOs introduced the balanced scorecard (BSC) to address the…
Abstract
Purpose
During the 1990s, Italian healthcare organisations (HOs) underwent a process of corporatisation, and the most innovative HOs introduced the balanced scorecard (BSC) to address the need for broader accountability. Currently, there is a limited understanding of the dynamics and outcomes of such a process. Therefore, this study aims to explore whether the BSC is still considered an effective performance management tool and analyse the factors driving and hindering its evolution and endurance in public and non-profit HOs.
Design/methodology/approach
We conducted a retrospective longitudinal analysis of two pioneering cases in the adoption of the BSC: one in a public hospital and the other in a non-profit hospital. Data collection relied on accessing institutional documents and reports from the early 2000s to the present, as well as conducting semi-structured interviews with the internal sponsors of the BSC.
Findings
We found evidence of three main categories of factors that trigger or hinder the adoption and development of the BSC: (1) the role of the internal sponsor and professionals’ commitment; (2) information technology and the controller’s technological skills; and (3) the relationship between the management and professionalism logics during the implementation process. At the same time, there is no evidence to suggest that specific technical features of the BSC influence its endurance.
Originality/value
The paper contributes to the debate on the key factors for implementing and sustaining multidimensional control systems in professional organisations. It emphasises the importance of knowledge-based assets and distinctive internal capabilities for the success of the business. The implications of the BSC legacy are discussed, along with future developments of multidimensional control tools aimed at supporting strategy execution.
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Guido Noto, Anna Prenestini, Federico Cosenz and Gustavo Barresi
Public health strategies and activities are intrinsically complex. According to the literature, this “wickedness” depends on the different interests and expectations of the…
Abstract
Purpose
Public health strategies and activities are intrinsically complex. According to the literature, this “wickedness” depends on the different interests and expectations of the stakeholders and the community, the fragmented governance of the related services and the challenges in measuring and assessing public health outcomes. Existent performance measures and management systems for public health are not designed to cope with wickedness since they are mainly focused on inputs and outputs, neglecting broader outcomes because of their long-term impact and the poor accountability of results. This research aims to tackle this shortfall by adopting a dynamic performance management (DPM) approach.
Design/methodology/approach
This research explores the case of the vaccination campaign of a Regional Health System. Through the analysis of an illustrative case study, the research discusses both opportunities and limits of the proposed approach.
Findings
This research highlights that DPM supports performance management (PM) in wicked contexts, thanks to the adoption of a system-wide perspective and the possibility of using simulation to experiment with alternative strategies and benchmarking performance results with simulated trends.
Originality/value
This article tackles a gap related to the management of wicked problems both from a theory and a practical perspective. In particular, this research suggests the adoption of DPM as an approach that may support policymakers in tackling social pluralism, institutional complexity and scientific uncertainty all at once.
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Marco Sartirana, Anna Prenestini and Federico Lega
As a consequence of new public management reforms, leading professionals in public service organizations have increasingly been involved in management roles. The phenomenon of…
Abstract
Purpose
As a consequence of new public management reforms, leading professionals in public service organizations have increasingly been involved in management roles. The phenomenon of clinical directors in the healthcare sector is particularly representative of this, as this medical manager role has been adopted in many countries around the world. However, professionals’ managerial role taking still falls quite short of expectations. While most research has searched for the causes of this gap at the individual level by exploring the clash between management and professionalism, the purpose of the paper is to argue that a contextualized understanding of the antecedents at the organizational level, and particularly the existing medical management roles, provides a more thorough picture of the reality.
Design/methodology/approach
The paper adopts an institutional perspective to study the development of existing medical management roles and the rise of new ones (clinical directors). The analysis focuses on the case of Italy, a country with a tradition in medical management where, following the example of other countries, clinical director roles were introduced by law; yet they were not incisive. The paper is based on a review of the existing literature and extensive field research on Italian clinical directorates.
Findings
The paper shows how in contexts in which doctors in management roles exist and are provided with legitimacy deriving from legal norms, historical settlements between professions and taken for granted arrangements, medical management becomes institutionalized, stability prevails and change towards new doctor-in-management roles is seriously hampered.
Originality/value
The paper contributes to existing knowledge on professionals’ managerial role taking, underlining the relevance of contextual and nation-specific factors on this process. It provides implications for research and for policy making in healthcare and other professional public services.
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Sara Korlén, Anna Essén, Peter Lindgren, Isis Amer-Wahlin and Ulrica von Thiele Schwarz
Policy makers are applying market-inspired competition and financial incentives to drive efficiency in healthcare. However, a lack of knowledge exists about the process whereby…
Abstract
Purpose
Policy makers are applying market-inspired competition and financial incentives to drive efficiency in healthcare. However, a lack of knowledge exists about the process whereby incentives are filtered through organizations to influence staff motivation, and the key role of managers is often overlooked. The purpose of this paper is to explore the strategies managers use as intermediaries between financial incentives and the individual motivation of staff. The authors use empirical data from a local case in Swedish specialized care.
Design/methodology/approach
The authors conducted an exploratory qualitative case study of a patient-choice reform, including financial incentives, in specialized orthopedics in Sweden. In total, 17 interviews were conducted with professionals in managerial positions, representing six healthcare providers. A hypo-deductive, thematic approach was used to analyze the data.
Findings
The results show that managers applied alignment strategies to make the incentive model motivating for staff. The managers’ strategies are characterized by attempts to align external rewards with professional values based on their contextual and practical knowledge. Managers occasionally overruled the financial logic of the model to safeguard patient needs and expressed an interest in having a closer dialogue with policy makers about improvements.
Originality/value
Externally imposed incentives do not automatically motivate healthcare staff. Managers in healthcare play key roles as intermediaries by aligning external rewards with professional values. Managers’ multiple perspectives on healthcare practices and professional culture can also be utilized to improve policy and as a source of knowledge in partnership with policy makers.
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Yazan Alnsour and Ahmad H. Juma’h
Contact tracing apps have emerged to collect data and mitigate the spread of infectious diseases. However, privacy and security concerns have caused individuals to hesitate to…
Abstract
Purpose
Contact tracing apps have emerged to collect data and mitigate the spread of infectious diseases. However, privacy and security concerns have caused individuals to hesitate to adopt these solutions. Our objective is to evaluate the role of the political environment, information privacy, security and users’ intentions to use contact tracing apps.
Design/methodology/approach
We scraped the digital app store and collected 399 relevant reviews and other data from 21 contact tracing apps in the USA. A semi-supervised machine learning model was developed to extract information on privacy and security aspects from the reviews.
Findings
Our findings show a positive connection between security controls and user adoption, as reflected in star ratings. Users residing in states with blue political environments tend to assign higher ratings to apps, especially when robust security controls are in place. These findings confirm the influence of the political environment on the adoption of contact tracing apps. In times of a pandemic, our findings suggest that users prioritize security over privacy concerns, emphasizing the critical role of strong security features in promoting app acceptance.
Originality/value
This paper emphasizes the political environment of the state offering the app intersects with concerns about security and privacy as well as the effectiveness of security and privacy measures, influencing the app’s ratings. Also, it shows the importance of understanding and addressing the role of the political environment when designing and promoting such public health tools, regardless of the specific disease or outbreak.
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Maria Crema and Chiara Verbano
In a context where healthcare systems have to face multiple challenges, the development of a methodology that combines new managerial approaches could contribute to pursue and…
Abstract
Purpose
In a context where healthcare systems have to face multiple challenges, the development of a methodology that combines new managerial approaches could contribute to pursue and achieve multiple objectives. Inside the research stream that intends to combine health lean management (HLM) and clinical risk management (CRM), the purpose of this paper is to study the significant features that characterize HLM projects obtaining patient safety improvements (L&S projects).
Design/methodology/approach
The novelty of the research implies to adopt qualitative research methodology, analyzing in-depth case studies. L&S projects at different organizational levels have been selected from the same hospital. Following a research protocol, data have been collected through semi-structured interviews and they have been triangulated studying reports and archival documentation.
Findings
Comparing the three cases, it emerges that HLM can be a support for CRM since safety improvements can be achieved solving organizational issues. Analyzing the significant features of the three cases, relevant differences have been highlighted among them. At the end, first indications useful for achieving safety improvements from lean project implementation have been grasped.
Originality/value
This research provides a preliminary contribution to a new research stream that aims to develop a synergic methodology combining HLM and CRM. The first provided indications can be followed by hospital managers who wish to learn how to implement projects achieving patient safety improvements besides efficiency enhancement. After testing and exploiting the obtained results, a new methodology should be developed moving toward a safer and more sustainable healthcare system.
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Pooja Singh Negi and Ramesh Chandra Dangwal
The purpose of the present study is to identify the core cultural aspects perceived by the executives of public, private and foreign banks in India.
Abstract
Purpose
The purpose of the present study is to identify the core cultural aspects perceived by the executives of public, private and foreign banks in India.
Design/methodology/approach
Of the 124 responses, 96 usable responses were assessed from middle and lower level managers. Qualitative content analysis and deconstruction method were used to identify the perceived cultural aspects.
Findings
Interestingly, managers of Indian banking industry stated that cultural aspects of their banks possess good work and working environment, prefer people, management, experience and promotions in comparison to other factors like policy, bonus, market, commitment, project, etc. It is also noted that cultural aspects of banks prefer learning, training and team working.
Practical implications
Assessment of the perception of managers toward their culture will foster the banks to develop integral subculture and to achieve the long-term organizational goals.
Originality/value
The study analyze the cultural aspects in Indian banking industry qualitatively, based on executives characteristics. This qualitative analysis helps to find out more contemporary and prevailing factors of banks.