Background Emergency Department (ED) overcrowding is a global systemic challenge driven by an imbalance between healthcare demand and resource availability. This study evaluates a multifaceted, organization-wide intervention at an Italian teaching hospital by focusing on throughput and output factors. Methods A quasi-experimental, pre-post design analysed 100% of the available population data (N = 199354 visits) from 2019 to 2024. A “Digital Twin” simulation identified boarding as the primary bottleneck, consuming 47% of medical resources. Interventions included a “Discharge Decalogue,” digitalization of community care pathways (ADI/CAVS), and nursing protocols. Statistical significance for patient satisfaction (N = 1840) was assessed via t-tests (95% CI). Results Despite a 23.6% increase in total ED volume and a 37.8% surge in high-complexity presentations (Red Codes), interventions optimized outflow. The ALOS for complex discharges decreased for both CAVS (−24.6%) and ADI (−22.6%). Throughput protocols reduced chest pain response times by 27.7%. Satisfaction scores improved accordingly, particularly within the information domain (p < 0.001; 95/% CI [0.22, 0.38]). While overall waiting times fell by 17.8%, boarding times increased: this was driven by clinical complexity and a deliberate institutional policy to mitigate medical boarding within surgical units. This strategic prioritization was maintained to preserve elective surgical capacity. Conclusions A systems-based approach prioritizing output optimization and hospital-territory integration demonstrates superior efficacy compared to traditional input-reduction strategies. This data-driven model provides a scalable framework to strengthen clinical governance and enhance patient experience within resource-constrained environments.
Employee satisfaction (ES) may influence patient experience, but facility-level evidence remains limited. This study examined the association between facility-level ES and Net Promoter Score (NPS)-based patient experience in home healthcare settings. This cross-sectional study included 87 home healthcare facilities. Questionnaire responses from 1,066 staff members underwent exploratory factor analysis, yielding four ES factors whose scores were aggregated to facility-level means: management integrity and governance, supervisor and workplace support, organizational pride and identification, and goal orientation and continuous improvement. Patient experience was assessed using NPS data from 6,615 survey responses. Multiple linear regression analyses examined facility-level NPS, promoter proportion, and detractor proportion. Detractor proportion was significantly associated with ES factors ( p = 0.028); goal orientation and continuous improvement was negatively associated, whereas management integrity and governance was positively associated. Organizational factors related to goal orientation and continuous improvement were associated with lower detractor proportions. These findings suggest that specific dimensions of employee satisfaction may be more relevant to reducing negative patient evaluations than to increasing positive recommendations. However, the findings should be interpreted cautiously because only detractor proportion was significantly associated with employee satisfaction factors.
Background The rise of Chief Operating Officers (COO) in healthcare is filled with the expectation to improve demand and capacity management practices from a system perspective. Given the absence of empirical studies on the role of COOs in healthcare, this study explores the establishment and scope of COOs in Sweden, their responsibilities, decision-making authority, and the conditions influencing their role. Methods An interview study with Swedish healthcare COOs. Open-ended responses underwent qualitative content analysis; closed-ended items were summarized as counts and percentages. Two frameworks were combined: Healthcare Services Operations Management and the Decision Space Framework. Results The study identifies key areas of responsibility for COOs, such as demand and capacity management, data-driven operations, and cross-organizational coordination. COOs operate at the intersection of centralized and decentralized management practices, requiring collaboration with CEOs and department managers. The study highlights the importance of organizational and individual capacities, including team competencies and a deep understanding of healthcare operations. Conclusions COOs have the potential to improve coordination of demand and capacity management and thereby support healthcare system efficiency. By clarifying decision spaces and ensuring demand and capacity management competencies and data infrastructure, the COO role can more reliably translate a system perspective into operational results.
Background: This paper aims to understand whether and how the Italian healthcare context has embraced sustainability accounting and reporting practices. Specifically, it investigates if the sector has developed institutional pressures that drive public healthcare organisations toward the adoption of sustainability disclosure.Methods: The researchers employed document analysis as a qualitative research method for data collection and analysis. The research team analysed a total of 80 institutional and corporate documents, divided into 10 documents from the regional programming phase and 70 from the corporate monitoring phase.Results: The analysis shows that Italian healthcare organisations are lagging in adopting sustainability documents. Furthermore, the analysed disclosures do not refer to the United Nations Sustainable Development Goals (SDGs), as they are compiled according to national legislation designed well before the introduction of the SDGs framework.Discussion & Conclusion: The lack of institutional pressures across public sector organisations has hindered the development of a solid culture of sustainability reporting in the public healthcare sector. This research contributes at two levels: practically, it advances the accounting and reporting literature by examining the availability of such practices in the public sector; theoretically, it sheds light on the development and role of institutional pressures for sustainability reporting in Italian public hospitals.
This study aimed to evaluate the effectiveness of a Psychological Capital (PsyCap) training program in enhancing job satisfaction and reducing burnout among healthcare professionals. A pretest-posttest design was employed to evaluate changes in participants before and after the intervention. The study involving 732 healthcare workers at Time 1 (T1) and 653 at Time 2 (T2) across several public hospitals in Italy. Participants completed a 4-months structured training program targeting the core components of PsyCap: hope, efficacy, resilience, and optimism. Standardized self-report measures were used to assess psychological capital, job satisfaction, and burnout levels. The PsyCap training program led to a statistically significant increase in participants' PsyCap scores, a reduction in burnout symptoms, and an improvement in overall job satisfaction. Mediation analyses revealed that PsyCap significantly mediated the relationship between the training intervention and the outcomes of burnout and job satisfaction. Multigroup analyses supported the effectiveness of the intervention, confirming significant differences between pre- and post-training conditions. Psychological Capital is a measurable and developable resource that plays a crucial role in promoting employee well-being and organizational health. Implementing PsyCap development programs may offer healthcare organizations a sustainable and evidence-based strategy to tackle burnout and enhance job satisfaction among frontline staff.
