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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.

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.

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.

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.

The aim of the paper is to trace the history and development of performance measurement and management systems in the Italian National Health System (INHS), to identify their key characteristics, and to provide a critical assessment of their implementation.

A combination of literature review, action‐research and fieldwork conducted over a ten‐year period in several Italian health care organizations.

Performance management has grown considerably in the INHS over the last 15 years. Explanations for this growth include normative, coercive and mimetic isomorphism, the introduction of quasi‐markets, the adoption of DRGs, an increased focus on clinical governance and innovative practices in human resource management.

The paper shows how performance management has been implemented in the INHS and why it can still be considered a “work in progress”.

The introduction of performance management systems has stimulated greater accountability and promoted a more cost conscious culture in healthcare organizations. Nevertheless, there are many problems that remain to be solved if performance management arrangements are to deliver the desired improvements in performance.

The paper advocates the need for reduced isolationism and increased international comparison with concomitant evaluative effort.

A balanced scorecard (BSC) is an applied tool for implementing strategic management in various organizations. Implementing strategic management using the BSC approach has not received much attention in pharmacy departments. This study aims to provide a model for the strategic management of pharmacy departments using the BSC framework.

This experimental study was conducted from 2015 to 2018 in a 300-bed hospital and regional healthcare centers affiliated with the Petroleum Industry Health Organization in Tehran province, Iran. After carefully reviewing the organization's mission and vision, the strategic objectives were determined via the internal matrix and the external matrix (IE matrix), and the strengths–weaknesses–opportunities–threats matrix (SWOT matrix) were examined. Then, six BSC measures and interventions were identified, and each was examined from the perspectives of finance, patient satisfaction, internal processes and learning/growth. Finally, the proposed strategy was evaluated.

Results showed significant increases in patient satisfaction and gross profit. The observed increase range, from 0.09 to 0.29, indicates more effective operational management for optimal resource utilization. In addition, the pharmacy department was able to save US $539,137 by implementing prepared protocols for expensive medications. Similarly, the pharmacy department saved $442,899 during the two years of our strategic management plan by implementing the standard mechanism for returning unused medications to the pharmacy department after patients were discharged from various treatment units.

This study is among the first studies to demonstrate the simultaneous development, implementation and evaluation of the proposed strategy using the BSC in a pharmacy department in a public healthcare center. The BSC application improved the optimal use of resources and reduced costs while increasing patient satisfaction. It appears that the application of such an intervention may be as valuable to public pharmacies as it is to other private centers.

The purpose of this paper is to set out a methodological framework to investigate how the integration of an activity-based costing (ABC) logic into the pre-existent accounting system supports healthcare organizations in identifying the inefficiencies related to their diagnostic therapeutic pathways (DTP) and related reengineering interventions.

The BPM-ABC methodological framework has been applied to the case of a specific surgery pathway, at the Orthopaedic Division of a University Hospital in Italy.

The case-study described in the paper points out: first, how the Business Process Management (BPM)-ABC methodology is able to produce significant information about consumed resources and the costs of the activities, useful to highlight opportunities for DTPs improvement; second, the barriers related to a pre-existing accounting system based on cost centres that can hinder the implementation of the BPM-ABC model.

The case study points out the role of the ABC as a management tool for supporting decision-making processes. The ABC allows inferring information for two purposes. First, ABC supports a cost containment process as it allows highlighting the most cost-consuming activities and resources. Second, the ABC allows identifying reengineering paths, distinguishing between incremental and radical ones.

This study represents a remarkable reference raising the awareness of the pivotal role accounting systems play in the management of the organizational processes.

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.

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.

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.

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.

The article investigates how the COVID-19 pandemic has accelerated and deepened the presidentialization of politics in Italy. It examines how a series of innovative rules and procedures adopted by the Prime Minister Giuseppe Conte to face the extraordinary event are part of a permanent presidentialization dynamic.

This study analyzes the role of prime minister in coping with the pandemic in Italy within the analytical framework of the personalization of politics. Section 1 investigates how the prime minister has resorted to autonomous normative power through intensive use of the Decree of the President of the Council of Ministers (DPCM). Section 2 observes the establishment of a more direct relationship with citizens through extensive use of digital communication and high engagement. Section 3 analyzes the “personal task force” appointed by the prime minister and highlights a new balance between technocratic/private roles and politics undermining democratic accountability.

By examining three main aspects of the personalization of politics, the article observes that the COVID-19 pandemic has facilitated the movement to presidentialization of power in Italy. It argues that the COVID-19 pandemic has strengthened political and institutional trends already in place before the crisis.

The article expands the comparative research on the presidentialization of politics. The Italian case clearly underlines how the pandemic crisis represented a further step of progressive dominance of the “executive” over the other branches of government. The article suggests an agenda for future cross-institutional and cross-national analysis.

With the aim to enrich the ongoing debate about healthcare management, the paper has a twofold intent: [1] to emphasise the interpretative contribution that intellectual capital can provide to a better understanding of the relevant role of patients in the healthcare sector and [2] to investigate the relationships between the three main dimensions of intellectual capital – human capital, relational capital and structural capital – and patient satisfaction in the healthcare sector.

The intellectual capital framework is contextualised in the healthcare sector, and the relationships among patient evaluations of human capital, relational capital and structural capital and patient satisfaction are tested via structural equation modelling (SEM) using primary data collected with reference to a sample of 561 Italian patients involved in post survey treatments in three Italian hospitals.

The role of intellectual capital in supporting a better understanding of processes and dynamics of patient satisfaction in the healthcare sector is underlined. The empirical research provides possible guidelines for recovery patients centrality in healthcare management.

The paper shows how an intellectual capital framework can support a better understanding and management of dynamics and processes through which patient centrality and satisfaction in healthcare management can be enforced.

COVID-19 pandemic has significantly impacted the lives of people and businesses around the world in different ways. France, Spain, Italy and the UK are among the worst affected countries by this pandemic. The purpose of this paper is to identify and compare different corporate social responsibility (CSR) activities taken by the clubs and player of the major football leagues of these four countries to develop a more comprehensive model of intervention.

This paper has analyzed the initiatives taken by these football clubs and players to address financial vulnerabilities, mental health problems and domestic violence among the stakeholders and compared them with the existing CSR and humanitarian models. A case study approach has been used to collect and analyze data related to the CSR activities taken by the players and club management. Official websites of the clubs, newspaper and journal articles were among the major sources used to collect data for the paper.

Football clubs and players of the four major leagues have raised funds through different campaigns and delivered foods and essential medical supplies to the communities and hospitals to address financial vulnerabilities, mental health issues and domestic violence within their communities during the COVID-19 pandemic. They have provided guidance to their followers using social and television media to improve their physical and mental health during the pandemic. Online competitions, quizzes or virtual hangouts have also been used by the players to engage the stakeholders on a frequent basis. Football clubs have also initiated campaigns to raise awareness within the community on available medical services for the victims of domestic violence and also provided them with shelter, food, medical, legal and online counseling services.

Football clubs and players of the major leagues were always at the forefront to help the communities and hospitals to address issues related to mental health problems, financial vulnerabilities and domestic violence during the COVID-19 pandemic. The findings of this paper could help and guide other entities in designing a more comprehensive model of CSR interventions during pandemics or crisis situations to address financial vulnerabilities, mental health problems and domestic violence within their communities.

Cardiovascular diseases are the leading cause of death worldwide. In Italy, acute myocardial infarction (AMI) is a major cause of hospitalization and healthcare costs. AMI is a myocardial necrosis event caused by an unstable ischemic syndrome. The Italian government has defined an indicator called “AMI: 30-day mortality” to assess the quality of the overall care pathway of the heart attacked patient. In order to guarantee high standards, all hospitals had to implement techniques to increase the quality of care pathway. The aim of the paper is to identify the root cause and understand the mortality rate for AMI and redesign the patient management process in order to improve it.

A Lean Six Sigma (LSS) approach was used in this study to analyze the patient flow in order to reduce 30-days mortality rate from AMI registered by Complex Operative Unit (COU) of Cardiology of an Italian hospital. Value stream mapping (VSM) and Ishikawa diagrams were implemented as tools of analysis.

Process improvement using LSS methodology made it possible to reduce the overall times from 115 minutes to 75 minutes, with a reduction of 35%. In addition, the corrective actions such as the activation of a post-discharge outpatient clinic and telephone contacts allowed the 30-day mortality rate to be lowered from 16% before the project to 8% after the project. In this way, the limit value set by the Italian government was reached.

The limitation of the study is that it is single-centered and was applied to a facility with a limited number of cases.

The LSS approach has brought significant benefits to the process of managing patients with AMI. Corrective actions such as the activation of an effective shared protocol or telephone interview with checklist can become the gold standard in reducing mortality. The limitation of the study is that it is single-centered and was applied to a facility with a limited number of cases.

LSS, applied for the first time to the management of cardiovascular diseases in Italy, is a methodology which has proved to be strategic for the improvement of healthcare process. The simple solutions implemented could serve as a guide for other hospitals to pursue the national AMI mortality target.

This study investigates the perceptions of intellectual capital (IC) among senior managers at Italian local healthcare units (LHUs) and the interrelations among IC components. It also provides a comprehensive definition of IC in the healthcare context and managerial guidance on improving IC to enhance LHU performance.

A survey was carried out to investigate perceptions among LHU senior management and identify characteristics of each primary IC component. The pilot study's results were examined using principal component analysis.

The findings illustrate senior management's perceptions of IC in LHUs and the extent to which management identifies and manages IC. A comprehensive definition of IC components in the healthcare sector is derived from these findings.

The research provides a better understanding of IC in the healthcare context and facilitates further research into how IC may be incorporated in quotidian organizational procedures. Results suggest that LHU managers should invest in increasing trust and respect and engage employees in organizational processes to provide recognition for the active role they play. Ongoing management of the three primary IC components is shown to have clear advantages, particularly on their connectivity.

The paper contributes to an increasingly important strand of theoretical research – IC in the healthcare context – and also adds new knowledge on the practical applications of IC in LHUs.