Health Services Management Research最新文献

IntroductionPatient experience (PX) is now recognized as the third pillar of healthcare quality, with evidences linking PX dimensions to improved clinical outcomes. As health systems shift toward value-based care, understanding which aspects of care citizens value most is essential for aligning services with their expectations and improving health outcomes.MethodologyThis study explores how citizens (n = 78; 29 men, 49 women) prioritize PX dimensions, through a simulation conducted during an open day at a University Hospital. Participants at the PX team's outreach stand received information on seven PX dimensions-Information, Therapeutic education, Physical environment, Participation in service governance, Shared decision-making, Professional accessibility, and Respectful treatment-identified through literature and over 70 focus groups. Each was asked to allocate a simulated 500€ budget across these dimensions using play money. Color-coded envelopes were distributed based on gender identity.ResultsParticipants prioritized Professional accessibility (22%), followed by Therapeutic education (17%) and Respectful treatment (17%). Shared decision-making (12%), Information (11%), Participation (11%), and Physical environment (10%) followed. Gender differences were observed: while both men and women placed highest value on Professional accessibility (21%), men favoured Therapeutic education (19% vs 16%), while women prioritized Respectful treatment (18% vs 14%).ConclusionsThese findings highlight the potential of participatory approaches to reveal citizens' true priorities, informing more targeted, equitable, and people-centred strategies. By aligning PX improvements with dimensions citizens value most, particularly accessibility, education, and respectful care, healthcare systems can enhance both responsiveness and overall quality.

PurposeThis study provides a systematic analysis of key literature in healthcare Operations Management (OM), examining its evolution from manufacturing-based approaches to modern healthcare applications. It addresses two main questions: the insights gained from a bibliometric review, such as publication trends, influential authors and institutions, and emerging themes; and how OM has developed over time within healthcare, identifying key thematic shifts.MethodUsing a hybrid method that combines bibliometric and content analysis, the authors examined 604 English-language research papers from the Web of Science Core Collection™, focusing on healthcare and operations research journals. The analysis followed three steps: (1) using the histograph method to trace citation patterns and identify influential publications; (2) applying thematic evolution mapping to explore how research themes have developed across time; and (3) conducting content analysis to understand thematic clusters more deeply.ResultsResults show that early OM research emphasized strategic decision-making and efficiency in clinical areas like operating rooms and emergency departments. Over time, the field incorporated practical tools such as Lean, Six Sigma, and simulation models. More recently, the focus has shifted toward patient-centered care, with growing use of big data and artificial intelligence. These findings contribute to a theoretical framework and offer guidance for future research, healthcare managers, and policymakers.

Background: The COVID-19 pandemic exposed longstanding weaknesses in Italy's primary care system. In response, the country launched a reform aligned with Primary Health Care (PHC) principles, including the creation of Community Health Houses (CHH). However, little is known about how future physicians perceive their training and preparedness for this evolving landscape. Purpose and research design: This paper draws on a 2024 national cross-sectional exploratory survey of trainees in General Practice (GP) and Primary Care and Community Medicine (PCCM). Descriptive analysis explores trainees' motivations for choosing the GP or PCCM pathway, their perceptions of training adequacy, and their career aspirations and concerns within the context of ongoing reform. Results: Both groups reported gaps in training. Many GP trainees called for curricular reform and improved contractual conditions, while PCCM trainees expressed frustration with regulatory barriers preventing them from practising as GPs. Perceptions of CHH diverged: GP trainees were often sceptical, whereas PCCM trainees viewed them as coherent with their training and professional orientation. Conclusions: This study offers the first national evidence on how future professionals position themselves within the Italian primary reform, shedding light on the conditions influencing their engagement with change. The findings point to the need for strategies aligning training, organisational models, and regulation frameworks to support the transition to a PHC-oriented system.

PurposeThe increasing frequency and relevance of mergers have significantly impacted the healthcare industry in recent decades. A recurring topic in the ensuing debate is whether and how hospitals achieve quality-of-care benefits post-merger. Italy offers a useful case study: with Italian hospital facilities adopting the National Outcomes Program (NOP) to measure quality of care, this research compares quality-of-care indicators reported by merged and non-merged public hospitals.Design/methodology/approachThe paper analyzes the impact of mergers on the quality of care among all Italian public hospitals (N = 466) during 2012-2019. Hospitals involved in mergers (N = 155) were compared to the control group through t-tests and a panel regression analysis of 13 indicators. To better isolate the Average Treatment Effect (ATE) of mergers on NOP indicators, the study develops a Difference-in-Differences model with a multiple-period estimator.FindingsResults generally show that hospitals improved their quality-of-care performance from pre- to post-merger. However, a more detailed comparison reveals a slight worsening of clinical outcomes and a significant deterioration in treatment processes in the post-merger period.Originality/valueThis study enriches the debate on HCO mergers by illustrating their complex impact on quality of care at the hospital facility level. Accordingly, both HCO managers and policymakers must carefully plan and monitor mergers to avoid disruption and ensure continuity in care. Limitations include a single-country focus and the use of 13 indicators selected from the broader set of over 190 quality-of-care measures published annually by the NOP.

IntroductionHospitals are among the most energy-intensive public infrastructures due to their continuous operations and complex systems. Despite the strategic importance of energy management in healthcare, detailed benchmarks for hospital energy costs remain limited in Italy.MethodsThis study analyzes energy-related facility management expenditures in 27 public hospitals in Lombardy between 2019 and 2022. Data were collected via a structured survey, focusing on electricity and heating expenditures. Parametric values were calculated in €/sqm and hospitals were classified by complexity (Basic, DEA I, DEA II).ResultsThe results reveal that energy costs represent approximately 48% of total facility management expenses. Over the 4-year period, total energy expenditures rose by 51.22%, with the most significant increases in 2021-2022. Parametric values varied by hospital type: from €71.64/sqm in Basic Hospitals to €101.65/sqm in DEA II. Though newer buildings generally showed lower energy costs, building age alone did not fully explain cost variability.ConclusionsThe study provides a first benchmarking effort on hospital energy costs in the Italian context. The findings highlight the need for energy monitoring, retrofitting, and the adoption of efficiency-oriented management strategies, providing actionable insights for infrastructure planning and healthcare policy.

This study assesses physicians' perspectives on the role of ChatGPT in providing health-related information, highlighting its reliability, contributions and potential risks. In a survey of 88 physicians who were selected using convenience sampling, ChatGPT's answers to three different health questions were evaluated, and reliability, benefits and potential hazards were rated on a scale of 1-10. The physicians were then asked about the rationale behind their evaluation scores. The qualitative assessments of the physicians were evaluated together with quantitative analyses of the scores. The results showed high trustworthiness scores across all questions (mean scores of 8.4, 8.2 and 8.6 over 10) and non-significant difference between questions, as well as significant benefits in promoting health literacy through general health advice and lifestyle recommendations (mean scores of 7.3, 7.9 and 8.3). Answer for lowering cholesterol was evaluated at at higher level of contribution than first question (p = 0.0004). However, concerns were raised about risks, particularly due to more direct answers including treatment recommendations, and the potential for misuse by patients was noted (mean scores of 2.6, 3.5 and 2.5). Second question (the treatment for atrial fibration) was evaluated at a higher level of risk (p = 0.002). While ChatGPT has the potential to be an effective tool for health education and promotion, this study underlines the importance of increasing users' health literacy and establishing guidelines to ensure safe and ethical use. The findings highlight the need for multi-stakeholder approaches to optimise the integration of ChatGPT into healthcare settings.

BackgroundGiven the importance of health services delivery, especially under a public-private partnership agreement, attention to the related success factors is overly essential. This study thus intends to explore critical success factors and analyze the agreement of public and private partners on these factors in hospital services.MethodA mixed-method study was conducted; first in a qualitative phase the critical success factors, via 25 face-to-face, semi-structured interviews with the purposely recruited hospital managers, heads of diagnostic services, and managers of private companies were identified. Interviews were then transcribed and analyzed using conventional content analysis, assisted by "MAXQDA-12". In the quantitative phase, the consensus upon these factors were sought using a questionnaire survey and analyzed according to the RAF analysis.ResultsA number of 52 factors categorized under nine main categories represented the key, agreed-upon success factors for implementing PPP. The highest agreement was on the 'Legal aspects of partnership' and the lowest upon the 'Partnership execution'.ConclusionsWeak agreement among the partners could evidently jeopardize the success of any PPP initiative and there is a need for more interaction and negotiation to have a win-win partnership.

Contemporary scholarships in leadership and management increasingly emphasizes the centrality of competent leaders and professionals in enhancing performance at both organizational and system levels, particularly within public health systems facing growing demands for sustainability and reform. Despite initial efforts across various National Health Systems (NHSs) to strengthen managerial capabilities, progress remains constrained by structural path-dependencies and professional bureaucracies. This study investigates the design and implementation of a large-scale, competency-based managerial training program within the Romanian NHS, developed between 2023 and 2024 with the support of the Ministry of Health and the World Health Organization. The intervention followed a multi-phase approach, including a comprehensive literature review and a national needs assessment involving 1200 stakeholders through semistructured interviews and online surveys. A Training-of-Trainers (ToT) scheme was delivered to 150 selected participants by academic experts from Italy, Spain, and Portugal. These trainers subsequently facilitated system-wide training activities, reaching up to 5000 clinical leaders and managers across the country. Findings underscore the strategic relevance of tailored training initiatives in advancing competence-based human resource management. Common training needs identified include leadership, strategic planning, ethics, change management, and systems thinking. The Romanian experience offers transferable insights for designing context-sensitive training programs capable of fostering system-wide organizational transformation in other transitioning health systems.

Background: Identifying the value and quality of organisational models supports the performance of the overall healthcare system and the effectiveness of its processes.Purpose: Based on an organizational case of physiotherapy care delivery, this study compares a traditional organizational model with the most recent fast-track approach within the total hip replacement (THR) surgery pathway.Research Design: Through a Propensity Score Matching (PSM) application, the study aims to analysing the impact of two different models on patient-reported outcomes.Study Sample: Patient-Reported Outcome Measures (PROMs) data collected between 2018 and 2023 through the PROMs Observatory in the Tuscany region (Italy) were used.Results: The results, based on 417 responses, suggest that the two organizational models produce equivalent outcomes reported by patients' voices at different timepoints, while the models have different organizational characteristics that result in increased allocative value in terms of shorter length of stay (LOS) and associated reduced resource use.Conclusions: From a Lean Management perspective, the managers' decision-making process is supported by evidence on the adoption of the most valuable organizational model using both clinical and organizational data from the patient's point of view.