Governance delle reti sanitarie: i Dipartimenti Inter-Aziendali Regionali (DIAR) nel nuovo sistema sanitario ligure

Journal title MECOSAN
Author/s Walter Locatelli, Angela Testi, Filippo Ansaldi, Marta Giachello, Cinzia Panero, Valentino Tisa, Cecilia Trucchi
Publishing Year 2020 Issue 2019/109
Language Italian Pages 25 P. 57-81 File size 658 KB
DOI 10.3280/MESA2019-109004
DOI is like a bar code for intellectual property: to have more infomation click here

Below, you can see the article first page

If you want to buy this article in PDF format, you can do it, following the instructions to buy download credits

Article preview

FrancoAngeli is member of Publishers International Linking Association, Inc (PILA), a not-for-profit association which run the CrossRef service enabling links to and from online scholarly content.

The paper aims to analyse the recent reform of the Ligurian Regional Health Service. The new organisational structure is based on a network model in order to cope with the complex patients’ needs and their paths of care. The reform has maintained the previous Local Health Authorities (LHA), but their activity is now coordinated by a new holding organization, A.Li.Sa. and by the Regional Departments (DIAR). The goal of the research is twofold. Firstly it is described how A.Li.Sa. and the University have cooperated to facilitate the change by means of an extended training activity. Secondly, the first results of this reform are assessed with reference to a specific case involving the surgical cardiovascular area.

Keywords: Governance of healthcare systems, health system reforms, network, department, policy evaluation, training.

  1. Ahgren B., Axelsson R. (2007). Determinants of integrated health care development: chains of care in Sweden. The International Journal of Health Planning and Management, 22(2): 145-157.
  2. Andersen I.E., Jager B. (1999). Scenario workshops and consensus conferences: towards more democratic decision-making. Science and public policy, 26(5): 331-340. DOI: 10.3152/147154399781782301
  3. Baker C.D., Lorimer A.R. (2000). Cardiology: the development of a managed clinical network. British Medical Journal, 321: 1152.
  4. Baker J.L. (2000). Evaluating the impact of development projects on poverty: A handbook for practitioners. World Bank Publications.
  5. Borgonovi E. (2002). Principi e sistemi aziendali per le amministrazioni pubbliche. Milano: Egea.
  6. Brown B.B., Patel C., McInnes E., Mays N., Young J., Haines M. (2016). The effectiveness of clinical networks in improving quality of care and patient outcomes: a systematic review of quantitative and qualitative studies. BMC Health Services Research, 16(1): 360.
  7. Cantarelli P., Lega F., Longo F. (2017). La regione capogruppo sanitaria: assetti istituzionali e modelli organizzativi emergenti. In: Cergas Bocconi (a cura di). L’aziendalizzazione della Sanità in Italia. Rapporto OASI 2017. Milano: Egea.
  8. Carbone C., Del Vecchio M., Lega F., Prenestini A. (2015). I processi di fusione aziendale nel SSN: evidenze per il management e i policy maker. In: Cergas Bocconi (a cura di). L’aziendalizzazione della Sanità in Italia. Rapporto OASI 2015. Milano: Egea.
  9. Cepiku D. (2018). Strategia e performance nelle amministrazioni pubbliche. Milano: Egea. Cepiku D., Bianchi A., Capaccioli C., Costanzo G., Spandonaro F. (2011). Un modello per la misurazione delle performance delle reti: il caso studio del network antimalaria Tigray. Politiche sanitarie, 12(3): 101-115. DOI: 10.1706/1008.10962
  10. Cepiku D., Ferrari D., Greco A. (2005). Governance e coordinamento strategico delle reti di aziende sanitarie. Mecosan, 56: 45-64.
  11. Cetina K.K. (2009). Epistemic cultures: How the sciences make knowledge. Cambridge, MA: Harvard University Press.
  12. Cicchetti A. (2004). La progettazione organizzativa. Milano: FrancoAngeli.
  13. Cicchetti A., Lomi A. (2000). Basi relazionali, istituzionali e manageriali della strutturazione organizzativa: un confronto tra prospettive di progettazione in un grande ospedale universitario. In: Maggi B. (a cura di). Le sfide organizzative di fine e inizio secolo. Milano: ETAS Libri.
  14. Cristofoli D., Markovic J., Meneguzzo M. (2014). Governance, management and performance in public networks: How to be successful in shared-governance networks. Journal of Management & Governance, 18(1): 77-93.
  15. Del Gesso C. (2018). L’interdipendenza tra public governance e accountability nelle aziende ospedalierouniversitarie. Milano: FrancoAngeli.
  16. Del Vecchio M., Romiti A. (2017). Il riaccentramento nel contesto pubblico: implicazioni per il governo dei sistemi e delle aziende sanitarie. Azienda Pubblica, 1: 13-32.
  17. Denis J., Lamothe L., Langley A., Breton M., Gervais J., Trottier L., Contandriopoulos D., Dubois C. (2009). The reciprocal dynamics of organizing and sensemaking in the implementation of major public-sector reforms. Canadian Public Administration, 52(2): 225-48.
  18. Duguid A.E. (2012). Managed Clinical and Care Networks (MCNS) and Work: an Ethnographic Study for Non-Prioritised Clinical Conditions in NHS Scotland. Doctoral Dissertation, University of St Andrews.
  19. Edwards N. (2002). Clinical networks. Advantages include flexibility, strength, speed, and focus on clinical issues. British Medical Journal, 324: 63.
  20. Eisenhardt K.M. (1989). Building Theories from Case Studies Research. The Academy of Management Review, 14: 532-550. DOI: 10.2307/258557
  21. Evans J.M., Baker G.R. (2012). Shared mental models of integrated care: aligning multiple stakeholder perspectives. Journal of health organization and management, 26(6): 713-736. DOI: 10.1108/14777261211276989.
  22. Fattore G., Gugiatti A., Longo F. (2016). Il riordino dei servizi sanitari regionali. In: Cergas Bocconi (a cura di). L’aziendalizzazione della Sanità in Italia. Rapporto OASI 2016. Milano: Egea.
  23. Ferlie E., Fitzgerald L., McGivern G., Dopson S., Exworthy M. (2010). Networks in health care: a comparative study of their management, impact and performance. Report for the National Institute for Health Research Service Delivery and Organisation
  24. programme.
  25. Ferlie E., Fitzgerald L., Wood M., Hawkins C. (2005). The nonspread of innovations: the mediating role of professionals. Academy of Management Journal, 48(1):117-34.
  26. Fulop N., Protopsaltis G., King A., Allen P., Hutchings A., Normand C. (2005). Changing organisations: a study of the context and processes of mergers of health care providers in England. Social Science & Medicine, 60(1): 119-130.
  27. Furnari A., Gugiatti A., Petracca F. (2017). La struttura e le attivita del SSN. In: Cergas Bocconi (a cura di). L’aziendalizzazione della Sanità in Italia. Rapporto OASI 2017. Milano: Egea.
  28. Gemen R., Breda J., Coutinho D., Fernandez Celemin L., Khan S., Kugelberg S., ..., Urban C. (2015). Stakeholder engagement in food and health innovation research programming-key learnings and policy recommendations from the INPROFOOD project. Nutrition bulletin, 40(1): 54-65.
  29. Glouberman S., Mintzberg H. (2001). Managing the care of health and the cure of disease – part 1: differentiation. Health Care Management Review, 26(1): 56-69. DOI: 10.1097/00004010-200101000-00006
  30. Guthrie B., Davies H., Greig G., Rushmer R., Walter I., Duguid A., Connaghan J. (2010). Delivering health care through managed clinical networks (MCNs): lessons from the North. Report for the National Institute for Health Research Service Delivery and Organisation programme.
  31. ISTAT (2017). Popolazione residente per eta, sesso e stato civile al 1 gennaio. -- Retrieved from: http://demo.istat.it/pop2017/index.html (ultimo accesso: 20 novembre 2019).
  32. Johar M. (2009). The impact of the Indonesian health card program: a matching estimator approach. Journal of health economics, 28(1): 35-53.
  33. Karan A., Yip W., Mahal A. (2017). Extending health insurance to the poor in India: An impact evaluation of Rashtriya Swasthya Bima Yojana on out of pocket spending for healthcare. Social Science & Medicine, 181: 83-92.
  34. Khandker S.R., Koolwal G.B., Samad H.A. (2009). Handbook on impact evaluation: quantitative methods and practices. World Bank Publications.
  35. Kotter J. (1995). Leading change: why transformation efforts fail. Harvard Business Review, March/April: 59-67. DOI: 10.1016/0737-6782(96)83110-9
  36. Lega F. (2016). Management della sanità. Comprendere e gestire le sfide del settore e delle aziende sanitarie. Milano: Egea.
  37. Lepine A., Lagarde M., Le Nestour A. (2015). Free primary care in Zambia: an impact evaluation using a pooled synthetic control method. Health, Econometrics and Data Group (HEDG) Working Papers 15/20, HEDG, c/o Department of Economics, University of York.
  38. Mascia D. (2009). L’organizzazione delle reti in sanità. Teoria, metodi e strumenti di social network analysis. Milano: FrancoAngeli.
  39. McInnes E., Middleton S., Gardner G., Haines M., Haertsch M., Paul C.L., Castaldi P. (2012). A qualitative study of stakeholder views of the conditions for and outcomes of successful clinical networks. BMC Health Services Research, 12(1) 49. DOI: 10.1186/1472-6963-12-49
  40. Meneguzzo M. (1996). Strategia e gestione di reti di aziende ospedaliere. Milano: Egea.
  41. Meneguzzo M., Cepiku D. (2008). Coordinamento e gestione strategica delle reti: profili e competenze dei network manager. Paper presentato al XXXI Convegno AIDEA Corporate Governance: governo, controllo e struttura finanziaria. Napoli, 16-17 ottobre.
  42. Meneguzzo M., Roncetti L., Rossi A.G. (2004).
  43. Centrali di acquisto, servizi in rete ed “Aree Vaste”. Una prima valutazione delle esperienze in atto. Mecosan, 52: 115-133.
  44. Meneguzzo M., Tanese A. (2001). Sistemi sanitari regionali e capacita di innovazione delle aziende sanitarie: una periferia in movimento. In: Cergas Bocconi (a cura di). L’aziendalizzazione della Sanità in Italia. Rapporto OASI 2001. Milano: Egea.
  45. Miolo Vitali P., Nuti S. (a cura di) (2003). Ospedale in rete e reti di ospedali: modelli ed esperienze a confronto. Milano: FrancoAngeli.
  46. Pate J., Fischbacher M., Mackinnon J. (2010). Health improvement: countervailing pillars of partnership and profession. Journal of Health Organization and Management, 24(2): 200-17. DOI: 10.1108/14777261011047354
  47. Provan K.G., Kenis P. (2008). Modes of network governance: Structure, management, and effective ness. Journal of public administration research and theory, 18(2): 229-252.
  48. Provan K.G., Lemaire R.H. (2012). Core concepts and key ideas for understanding public sector organizational networks: Using research to inform scholarship and practice. Public Administration Review, 72(5): 638-648.
  49. Raab J., Mannak R.S., Cambre B. (2013). Combining structure, governance, and context: A configurational approach to network effectiveness. Journal of Public Administration Research and Theory, 25(2): 479-511.
  50. Rebora G. Meneguzzo M. (1990). Strategia delle amministrazioni pubbliche. Torino: Utet.
  51. Rodriguez C., Langley A., Beland F., Denis J.L. (2007). Governance, power, and mandated collaboration in an interorganizational network. Administration & Society, 39(2): 150-193. DOI: 10.1177/0095399706297212
  52. Saz‐Carranza A., Salvador Iborra S., Albareda A. (2016). The power dynamics of mandated network administrative organizations. Public Administration Review, 76(3): 449-462.
  53. Timotijevic L., Khan S.S., Raats M., Braun S. (2019). Research priority setting in food and health domain: European stakeholder beliefs about legitimacy criteria and processes. Food Policy.
  54. Turrini A., Cristofoli D., Frosini F., Nasi G. (2010). Networking literature about determinants of network effectiveness. Public Administration, 88(2): 528-550.
  55. Vlaar P., Van de Bosch F., Volberda H. (2006). Coping with problems of understanding in interorganizational relationships: using formalization as a means to make sense. Organization Studies, 27(11): 1617-38. DOI: 10.1177/0170840606068338
  56. Wagstaff A., Lindelow M., Jun G., Ling X., Juncheng Q. (2007). Extending health insurance to the rural population: an impact evaluation of China’s new cooperative medical scheme. The World Bank.
  57. Wallendorf M., Belk R.W. (1989). Assessing Trustworthiness in Naturalistic Consumer Research. In: Hirschman E.C. (ed.). Interpretive Consumer Research: 69-84. Provo, UT: Association for Consumer Research.
  58. Yin R. (1984). Case study research. Beverly Hills, CA: Sage.
  59. Yin R.K. (2003). Case Study Research: Design and Methods. Thousand Oaks: Sage Publications, II edition

  • Elementi di performance governance nei servizi sanitari: alcune evidenze empiriche sullo stato dell'arte nella sanità p Fabio De Matteis, in MECOSAN 121/2022 pp.7
    DOI: 10.3280/mesa2022-121oa13857

Walter Locatelli, Angela Testi, Filippo Ansaldi, Marta Giachello, Cinzia Panero, Valentino Tisa, Cecilia Trucchi, Governance delle reti sanitarie: i Dipartimenti Inter-Aziendali Regionali (DIAR) nel nuovo sistema sanitario ligure in "MECOSAN" 109/2019, pp 57-81, DOI: 10.3280/MESA2019-109004