This study investigates how formal politicization shapes the turnover of senior public executives. Using a dataset of 138 CEOs across 79 Italian public hospitals between 2017 and 2021, it examines the relative influence of managerial competence and partisan loyalty on the likelihood of CEO exit. Although both factors affect turnover, partisan loyalty emerges as the primary driver. Political stability significantly lowers CEO dismissal risk, even with weak organizational performance or limited managerial human capital, which plays a secondary role. These findings suggest that NPM reforms have been only partially effective, with patronage practices persisting within a formally meritocratic institutional framework.

Background/Objectives: Chronic diseases account for 74% of global deaths, with multimorbidity (existence of more than one chronic condition) increasing disability risk and treatment burden, leading to poor adherence, disease progression, and reduced quality of life. Nursing-led proactive care models that focus on patient engagement, education, and self-care can help mitigate these challenges. The study aims to evaluate the effectiveness of a nurse-led proactive health intervention in improving care for individuals with chronic diseases in general practice. Methods: A quasi-experimental pre-post study will be conducted in a Community Health Home in Northern Italy. Family and community nurses will deliver the intervention, which includes assessments, educational sessions, and follow-ups for patients aged 65+ with at least one chronic condition. Recruitment will occur over three months. Results: Primary outcomes include emergency department visits and hospitalizations, while secondary outcomes focus on medication adherence, self-care, and service utilization. Data will be collected at 6 and 12 months, and statistical analysis will use descriptive methods and generalized estimating equations (GEEs). Conclusions: This study will improve the understanding of the value of nurse-led proactive intervention, filling the gap in the literature by testing evidence-based approaches on a realistic frail population. Moreover, delivering a complex but structured intervention will provide evidence for future interventions to reduce treatment burden and improve health outcomes.

Background The past decade has seen rapid digitalization of healthcare, significantly transforming healthcare delivery. However, the impact of these technologies remains unclear, with notable gaps in evidence regarding their effectiveness, especially in primary care settings. Objective This systematic review assesses the effectiveness of digital health interventions versus interventions without digital components implemented over the last 10 years in European primary care settings for managing chronic diseases. Methods Following Cochrane guidelines, we conducted a systematic review with meta-analysis. We searched multiple databases for randomized controlled trials. Inclusion criteria encompassed studies on digital health interventions for chronic disease management in primary care settings in Europe, evaluating outcomes such as hospitalizations, quality of life, and clinical measures. Data extraction and quality assessment were independently conducted by two authors, with discrepancies resolved by a third author. The certainty of the evidence was judged according to the Grading of Recommendations, Assessment, Development, and Evaluation approach. Results From 9829 records, 23 studies were included, with most studies conducted in the UK and Spain. The most investigated conditions were type 2 diabetes and hypertension. Interventions mainly focused on patient monitoring, self-care education, and digital communication tools. The risk of bias was low to moderate for most studies. Meta-analyses showed no significant differences between digital health interventions and usual care for hospitalizations, depressive symptoms, anxiety, HbA1c, diastolic blood pressure, weight, or quality of life, except for a small improvement in systolic blood pressure. Conclusion Digital health interventions have not yet demonstrated substantial benefits over traditional care for chronic disease management in European primary care. While some improvements were noted, particularly in systolic blood pressure, the impact remains limited. Further research is needed to enhance the effectiveness of digital health interventions, address current methodological limitations, and explore tailored approaches for both specific patient populations and multimorbid populations.

BACKGROUND:Primary care serves as the initial point of healthcare contact; however, the shortage of general practitioners can threaten equitable access to primary care, necessitating innovative models. In a district in the north of Italy, an alternative primary care model, as a primary care center (PCC), has been established to care for citizens unattached to a general practitioner. We aimed to explore the users' experience with the novel alternative primary care model. METHODS:We conducted a qualitative study using a grounded theory approach. We interviewed a total of 33 participants, including 25 patients and eight informal caregivers. RESULTS:Findings suggest a core concept of the "Patient experience process at the PCC as a dynamic and interconnected journey" that unfolds in three interconnected themes, starting from "Living the care pathway at the PCC ", progressing to "Evaluating the care pathway at the PCC", and concluding with "Drawing conclusion on the PCC". Patients transitioned through these phases as they interact with healthcare professionals, reflect on the quality of care, and make informed decisions regarding their preferences. Findings indicate that the transition from a general practitioner to the PCC is often marked by uncertainty and frustration, primarily due to the lack of structured handovers and clear service explanations. However, effective communication, proactive follow-up, and home visits by healthcare professionals significantly enhance patient satisfaction and trust in the PCC model. Nurses emerge as central figures in ensuring continuity of care and holistic support, while multidisciplinary collaboration fosters comprehensive and personalized care. Patients critically assess their care experiences, weighing the benefits of PCC services against their previous GP experiences. While many patients appreciate the structured and multidisciplinary nature of PCC care, some still prefer a dedicated GP for continuity and familiarity. Digital health solutions, including telehealth and remote monitoring, are recognized as useful additions but require careful integration to avoid reducing human interaction and address potential barriers for older people needing support from informal caregivers. CONCLUSION:Our study underscores the importance of effective communication, proactive follow-up, multidisciplinary care, and continuity of care to ensure a positive user experience satisfaction when delivering primary care to patients unattached to a GP through a new alternative primary care model.

This study aimed to analyze the association between functional status, biomarkers, and hospitalization characteristics on costs and the probability of re-admission at 30 and 180 days in geriatric patients. It is used an observational design with both administrative data and additional clinical data not usually collected. Multivariate linear regression for hospitalization costs and multivariate logistic regressions for readmissions were used. Variables studied included the Barthel Index, Charlson index, albumin and blood pressure levels, previous hospitalizations, length of stay (LoS), and controls. Data from 953 patients aged over 65, admitted to the Geriatric ward between September 1st, 2018, and December 31st, 2019, were analyzed. The Charlson comorbidity index, number of comorbidities, and LoS were positively related to hospitalization costs. Previous hospitalizations and LoS were the main predictors of readmission. Systolic blood pressure was negatively associated with the odds of re-admission but showed no association with hospital costs. Higher functional status, as measured by the Barthel index, was linked to lower odds of unplanned hospitalization but was not statistically significant for costs. Functional status and biomarkers had moderate effects on costs and readmission odds. These findings can aid in early healthcare planning and resource management, providing valuable information for prioritizing patients and designing cost-effective care interventions.

The advent of novel robotic platforms requires that managers base their decisions on the value these platforms generate. This study showcases how micro-costing methodologies can assist managers in the decision-making process regarding the implementation of new robotic platforms within the value-based healthcare (VBHC) framework. We applied time-driven activity-based costing (TDABC) to evaluate cost disparities between the da Vinci and Hugo robotic systems for robot-assisted radical prostatectomy (RARP). Data were collected from consecutively enrolled patients with organ-confined prostate cancer. Basic cost information was gathered from Azienda Universitaria Integrata di Verona’s finance and pharmacy departments. We conducted cost and sensitivity analyses to evaluate the most cost-sensitive parameters. The da Vinci system incurred higher total costs for RARP than the Hugo system (€4,97.21 vs. € 3,511.73, p-value < 0.001) However, excluding surgical kit costs, the da Vinci platform proved less expensive (€1,481.18 vs. €1,926.18, p-value < 0.001). Sensitivity analyses identified surgical kit costs as the most influential parameter, followed by surgical duration and platform costs. This study highlights the importance of micro-costing practices in supporting managerial decisions within a VBHC framework. When clinical outcomes are equivalent, the value of robotic platforms is related to cost savings. By using TDABC and sensitivity analyses, managers can pinpoint critical activities and parameters to optimize the effective adoption of new platforms.

Introduction: Changing dynamics are pushing institutions to focus on care delivery innovation. To address the shortage of general practitioners (GPs), an Italian health district recently introduced a new primary care model called Primary Health Point (PHP) to provide primary integrated care to its population. Aim: To investigate the healthcare professionals’ (HCPs) experience regarding the introduction of the PHP and to describe its process of care delivery. Methods: Qualitative study design with a grounded theory approach and convenience sampling. Interviews were conducted using a semi structured guide to explore the experience of HCPs working at the PHP. The development of open coding was followed by the creation of categories. The analysis was conducted utilizing NVivo software. Results: Twelve HCPs working at the PHP were interviewed and highlighted the model structure. The themes were the context and the antecedents that identified the most common health complaints and the patients with more needs and reflected on the traditional GP model; the process, which highlighted the complexity of interdisciplinary teamwork and the role of the Family and Community Nurse (FCN) in the new model; the outcome identified the factors mediating satisfaction with the care delivered by the PHP. Conclusions: The PHP has been considered a possible alternative to the GP model by its end users. It addresses disease pathway coordination, referrals, and medication management, focusing on chronic and older adult populations. It features interdisciplinary workflows with rotating physicians and consistent family nurse support. Proactive monitoring and a focus on disease education benefit fragile patients.

Hospital-acquired infections (HAIs) remain a major clinical and economic burden, with pathogens such as Escherichia coli contributing to high rates of morbidity and mortality. Traditional manual disinfection methods are often insufficient, particularly in high-risk hospital environments. In this study, we investigated innovative strategies to enhance surface decontamination and reduce infection risk. First, we assessed the efficacy of the SMEG BPW1260 bedpan washer-disinfector, a thermal disinfection system for human waste containers. Our results demonstrated a reduction in Clostridium difficile and Escherichia coli contamination by >99.9% (>3 log reduction), as measured by colony-forming units (CFU) before and after treatment. Molecular techniques, including spectrophotometry, cell counting, and quantitative PCR (qPCR) for DNA quantification, confirmed reduction in bacterial contamination. Specifically, Clostridium difficile showed a reduction of approximately 89% in both optical density (OD) and cell count (cells/mL). In the case of Escherichia coli, a reduction of around 82% in OD was observed, with an even more pronounced decrease in cell count, reaching approximately 99.3%. For both bacteria, DNA quantification by qPCR was below detectable limits. Furthermore, we optimized the energy efficiency of the disinfection cycle, achieving a 45% reduction in power consumption compared to standard protocols without compromising antimicrobial efficacy. Secondly, we developed a sustainable cleaning solution based on methyl ester sulfonate surfactants derived from waste cooking oil. The detergent’s antibacterial activity was tested on contaminated surfaces and further enhanced through the incorporation of nanoassemblies composed of silver, electrostatically bound either to biomimetic magnetic nanoparticles or to conventional magnetic nanoparticles. Washing with the detergent alone effectively eliminated detectable contamination, while the addition of nanoparticles inhibited bacterial regrowth. Antimicrobial testing against E. coli revealed that the nanoparticle-enriched formulations reduced the average MIC values by approximately 50%, with MIC50 values around 0.03–0.06 mg/mL and MIC90 values between 0.06 and 0.12 mg/mL, indicating improved inhibitory efficacy. Finally, recognizing the infection risks associated with intra-hospital transport, we tested the SAFE-HUG Wheelchair Cover, a disposable non-woven barrier designed to reduce patient exposure to contaminated wheelchair surfaces. Use of the cover resulted in a 3.3 log reduction in surface contamination, based on viable cell counts. Optical density and bacterial DNA were undetectable in all covered samples at both 1 and 24 h, confirming the strong barrier effect. Together, these approaches—thermal no-touch disinfection, eco-friendly detergent boosted with nanoparticles, and protective transport barriers—respond to the urgent need for effective, sustainable infection control methods in healthcare settings. Our findings demonstrate the potential of these systems to counteract microbial contamination while minimizing environmental impact, offering promising solutions for the future of infection prevention in healthcare settings.

Healthcare organizations increasingly use performance management systems to ensure flexibility, service quality, and cost efficiency. In this context, the balanced scorecard (BSC) represents one of the most popular performance management tools for achieving these objectives. A crucial element that makes it widely employed is that it allows measures and perspectives to be linked through clearly defined cause-and-effect relationships. Nevertheless, despite its centrality in implementing BSC, a discussion regarding the effective interpretation of cause-and-effect relationships has sparked. In particular, the previous literature emphasizes the dichotomy between non-statistical causality, i.e., based on logical or finality relationships, and causality tested statistically. This study aims to investigate the nature of causal relationships between indicators and perspectives of BSC through a systematic literature review of studies conducted in the health and social care contexts. Findings reveal that both perspectives of causality can be identified; however, numerous directions for future research are possible for both. Overall, there is a need for more attention to theoretical perspectives supporting causal analysis. Furthermore, although the development of quantitative methodologies to support empirical analyses is remarkable, there is room for further improvement. Finally, the research focuses mainly on the organizational level, overlooking the role of BSC causality at other levels.

BACKGROUND:Functional motor disorders (FMD) cause long-term disability and economic burden. There is a need for multidisciplinary interventions to manage both motor and non-motor symptoms. We aim to evaluate the clinical and economic effects of integrating digital telemedicine into multidisciplinary FMD management. METHODS:This single-blind, randomised controlled trial involved patients with FMD. They were randomly assigned to receive 5-day multidisciplinary rehabilitation with either a digital telemedicine or a standard care programme. The digital telemedicine group received remote management and wearable sensors. A blinded evaluator assessed primary and secondary outcomes at baseline, post-treatment, 12-week and 24-week follow-ups. The primary outcomes were changes in motor symptoms. The secondary outcomes were changes in non-motor symptoms, quality of life (QoL) and mobility in unsupervised settings. The incremental cost-effectiveness ratio (ICER) and quality-adjusted life years (QALYs) were calculated at 24 weeks. RESULTS:Of the total of 62 patients, half made up the digital telemedicine group (n=31, 40.82% female, mean age 42.55±12.65 years) and half the standard care group (n=31, 59.18% female, mean age 43.77±14.44 years). The mental QoL score for the standard care group was lower (p=0.045) and declined compared with the digital telemedicine group (p=0.034), with lower scores at follow-up (p=0.03). At 24 weeks, the ICER (€5503/QALY) showed that digital telemedicine, despite higher initial costs, yielded 0.037 additional QALYs and reduced healthcare use during follow-up. CONCLUSIONS:Despite similar improvements in motor symptoms in both groups, digital telemedicine offers an effective adjunct to maintain mental health QoL and reduces healthcare costs in the long-term management of FMD. TRIAL REGISTRATION NUMBER:ClinicalTrials.gov ID: NCT05345340.

The COVID-19 pandemic emphasized the importance of resilience of public sector organizations. Drawing from Upper Echelons Theory, this study investigates the relationship between configurations of demographic and background characteristics of hybrid professional managers and organizational adaptive resilience. Specifically, it focuses on heads of 34 Italian public clinical laboratories in the Veneto Region during the first wave of the pandemic. Based on fuzzy set Qualitative Comparative Analysis, the findings show four different combinations of attributes that lead to high levels of adaptive resilience. A key role is played by being a female manager and possessing a high level of organizational tenure.

Healthcare organisations have a significant carbon footprint due to their substantial energy consumption and waste generation. The existing literature has mostly focused on examining the isolated impact of specific green organisational practices on individual dimensions of environmental performance. Hence, policy makers and practitioners still lack a holistic view of how combinations of green organisational practices can mitigate the impact on climate change of healthcare organisations. Drawing on the practice-based view (PBV) of strategy, the study first examines the extent to which the adoption of imitable, individual green organisational practices impacts on the whole climate change mitigation performance of publicly owned hospitals. Second, it explores possible combinations of green organisational practices that can lead to high levels of climate change mitigation performance. Focusing on the illustrative case of publicly owned acute care hospitals in the English National Health Service and employing a two-stage Data Envelopment Analysis and a fuzzy set Qualitative Comparative Analysis (fsQCA), the analysis shows that the adoption of the practice of green energy procurement can, in isolation, positively lead to high climate change mitigation outcomes. Moreover, high performance levels can be achieved through multiple configurations of green organisational practices. Therefore, the findings suggest that the effectiveness of green organisational practices on climate change mitigation performance of hospitals depends on how practices are combined, rather than on their single effects, and indicate the presence of a complementary as well as a substitution effect between practices.

Background Promoting safe and efficient transitions of care is critical to reducing readmission rates and associated costs and improving the quality of patient care. A growing body of literature suggests that transitional care (TC) programs are effective in improving quality of life and reducing unplanned readmissions for several patient groups. TC programs are highly complex and multidimensional, requiring evidence on how specific practices and system characteristics influence their effectiveness in patient care, readmission reduction and costs. Methods Using a systematic review and a configurational approach, the study examines the role played by system characteristics (size, ownership, professional skills, technology used), the organizational components implemented, analyzing their combinations, and the potential economic impact of TC programs. Results The more organizational components are implemented, the greater the likelihood that a TC program will be successful in reducing readmission rates. Not all components have the same effect. The results show that certain components, ‘post-discharge symptom monitoring and management’ and ‘discharge planning’, are necessary but not sufficient to achieve the outcome. The results indicate the existence of two different combinations of components that can be considered sufficient for the reduction of readmissions. Furthermore, while system characteristics are underexplored, the study shows different ways of incorporating the skill mix of professionals and their mode of coordination in TC programs. Four organizational models emerge: the health-based monocentric, the social-based monocentric, the multidisciplinary team and the mono-specialist team. The economic impact of the programs is generally positive. Despite an increase in patient management costs, there is an overall reduction in all post-intervention costs, particularly those related to readmissions. Conclusions The results underline the importance of examining in depth the role of system characteristics and organizational factors in facilitating the creation of a successful TC program. The work gives preliminary insights into how to systematize organizational practices and different coordination modes for facilitating decision-makers’ choices in TC implementation. While there is evidence that TC programs also have economic benefits, the quality of economic evaluations is relatively low and needs further study.

Functional motor disorders (FMDs) are prevalent and highly disabling conditions among young adults, leading to reduced independence. Despite advancements in diagnosis and treatment, the economic burden of FMDs remains largely unknown. This study evaluates the impact of accurate FMDs diagnosis on direct healthcare costs within the Italian National Health System by comparing healthcare utilization and costs before and after diagnosis. This before-after study included 40 patients with a definite diagnosis of FMDs. Retrospective data on healthcare utilization, including diagnostic tests, specialist visits, hospitalizations, Emergency Room (ER) visits, and rehabilitation services, were collected from diaries and documents two years before and after diagnosis. Healthcare direct costs decreased by 67

Building perceptions of trustworthiness that encourage donors to give is critical for nonprofit organizations that depend on charitable giving. Several studies focused on the disclosure of financial and performance information to foster public trust and help donors to make giving decisions. Drawing from stewardship theory, this study explores how additional content dimensions of a more relational nature-including appreciation for the support received and willingness to dialog with donors-might be combined with financial and performance dimensions to design effective online disclosure in the view of nonprofits. By focusing on the viewpoint of European community foundations and using the configurational approach of qualitative comparative analysis, we found that information about fundraising campaigns is deemed must-have content to discharge online. However, this information alone is not considered to be enough; to retain current donors or attract new ones, it must be combined properly with disclosures demonstrating gratitude to and engagement with donors alongside organizational finances and performance.

Certified B Corps (B Corps) are firms characterized by a hybrid purpose and a sustainable business model that combines profit with social impact. Prior quantitative studies on B Corps have mainly analyzed the impact of certification on firm performance, while only a few have tried to analyze the antecedents of certification or high sustainability performance. Regression models have been used in most cases, often with inconsistent results and some research limitations. The aim of this study is to test the presence of different possible combinations of firm-level antecedents leading to a high sustainability performance in B Corps. It applies a configurational approach and a qualitative comparative analysis methodology to search for different combinations of organizational factors (size, age, profitability, certification experience, women on board and the "Born B" factor) that lead to a high sustainability outcome, measured by a B Impact Assessment (BIA). Results indicate the existence of four configurations leading to a high BIA, representing as many kinds of impactful B Corps: Born B, small young ventures, small and medium enterprises, and large firms. These results contribute to the literature by showing that a high sustainability performance in B Corps can be reached through different paths (equifinality) entailing both high and low values of each factor (asymmetry) and depends on how factors are combined (conjunction) rather than on their single effect.