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This chapter aims to provide suggestive evidence on how the Lombardy region dealt with the COVID-19 pandemic in 2020 and discuss future challenges for the Lombardy healthcare system. After an introduction to the wide spread of the virus inside the region, we describe the Lombardy health system so the reader may understand the context in which the virus has taken hold so quickly. The pandemic has heavily stressed the system, mainly because Lombardy experienced an excess of hospital admissions. We have considered the increased mortality rate as a proxy of the proper managing of the COVID-19 pandemic. In addition, we describe the process of treating non-COVID patients, such as those affected by acute myocardial infarction (AMI), stroke and oncological diseases. Despite the pandemic, hospitals have been able to guarantee a high level of performance. A discussion of the future evolution of the healthcare system concludes this chapter.

Healthcare policy-makers are implementing practices based on the logic of cost-opportunity to rationalize investments and resource consumption. The successful implementation of these practices depends on policy-makers’ capacity to involve professionals dispersed in the ecosystem, and who are unaccustomed to cooperating. Our case study investigates the institutional work pursued by the Lombardy Region to stimulate a Health Technology Assessment (HTA) program.

This chapter is based on a longitudinal case study of institutional change linked with a HTA program in the Lombardy Region. The HTA program initiatives were implemented during the 2009–2012 period. The case study is based on triangulating data from archival data, contents of the assessment forms and interviews with regional staff and experts.

The Lombardy Region implemented two distinct strategies, with mixed results. A strategy that was based on the formalization of the HTA program in a legislative direct through educational efforts did not obtain the commitment of the key actors in the relevant ecosystem. Subsequently, the Region implemented an ‘institutional work’ design strategy that included a combination of political, cultural, technical and structural work. This strategy stimulated local HTA experiments that might be used in the future to legitimize the full diffusion of the new practice in the ecosystem.

This study highlights a viable strategy of change that policy-makers can use to manage processes of institutional change in a professional ecosystem. The ‘institutional work’ strategy can support the establishment of new practices that incorporate the logic of cost-opportunity, which might rationalize the use of resources and improve investment decisions.

Policy entrepreneurs often experience thorny dilemmas, finding themselves between the “rock and a hard place” or, as the Italian equivalent idiom would have it, between the “hammer and the anvil.” Crisis and the associated problems that arise often bring changes in politics and policy in its wake, and this begs the question of what are the resources and assets required to operate successfully as a place-based public policy entrepreneur. The role of policy entrepreneurs has been studied over many years with one of the most influential theories being the multiple streams approach (MSA) originally devised in the 1980s which sought to counter perceptions of the random or “garbage can” nature of policymaking and implementation. MSA describes a more rational process where policy entrepreneurs shape “windows” of opportunity where streams of problem, policy, and politics are brought together to create innovative responses to situations in society. The authors explore these ideas through the lens of a longitudinal case study of Labor Market policy interventions (including the role of a personal budget system for education and training called “Dote”) in the Lombardy Region, Italy, using MSA as an analytical framework. This case suggests that the pressing need to move away from short-term structural responses to complex social issues is potentially addressed by an emerging approach for the parallel deployment of sociotechnical platform infrastructure resources and superstructure. Adoption of the approaches outlined here afford streaming opportunities on which policy entrepreneurs can dynamically bring the multiple streams of problem–policy–politics together across political cycles in a more persistent and sustainable way.

This paper aims to investigate the rise of a Chinese fashion cluster in Lombardy.

Three approaches and descending levels of analysis are integrated: a quantitative analysis based on demographic data to highlight the evolution of the regional distribution of the Chinese community and Chinese entrepreneurship in Lombardy; a literature review to reconstruct the historical development of Chinatown in Milan; and few in-depth interviews and a survey to represent how the Chinese living in Chinatown perceive the changing role of the enclave.

The Chinese in Lombardy are rising as a regional ethnic fashion cluster. This cluster is rising out of three major drivers: ethnic social capital as a source of community-based entrepreneurship; the crisis of traditional industrial districts in the 1990s as a trigger opportunity; and the trans-regionalization of the fashion industry as a main driver of its current development. The rise of this cluster is bottom-up.

The findings are based on a single case study. There are evidences showing that the Chinese are rising as regional and/or inter-regional clusters in other institutional settings. However, this study may benefit from comparisons with other institutional and national contexts.

Chinese entrepreneurship may foster regional growth as a complementary source of cultural variety, internationalization and multi-regional co-specialization.

Entrepreneurship may foster social cohesion and collaboration.

This paper contributes to existing literature by proposing a would-be theory of the evolution of regional ethnic clusters.

The purpose of this paper is to propose and discuss a new regional foresight methodology.

The first part describes the methodology and the organizational process adopted for implementing foresight at the regional level and highlights the criticalities. The research methodology is based on a case study. The case is the analysis of the industrial and regional sectors and the technological families in the Lombardy region.

This methodology analyses trends, technologies and industries, returning a set of qualitative and quantitative indicators. Then, it aggregates them, building two matrixes (trends/technologies and technologies/industries). Finally, it evaluates the future importance of a technology (the attractiveness of a technology for the long-term competitiveness of the regional main industrial sectors) and the capabilities of the regional industrial, technical and scientific system to develop specific technologies (feasibility for the regional system to develop the chosen technology).

The originality lies in an integrated analysis of the possible futures and their relation with the industrial world. Its value is as a tool to suggest policies and R&D investments. It is possible to provide a sound basis for science and technology policymaking.

The spatial development of urban areas affects the characteristics of landscape as well as people’s aesthetic perception of it. Specifically, sprawl results in an urban morphology which is diametrically opposed to the compact city model and which assumes several kinds of patterns: for example “striped”, “ribbon” or “leapfrogged” urban development. Assessing urban morphology in spatial terms is crucial to urban policy, while landscape metrics are the key to a comprehensive understanding of different urban development patterns. The purpose of this paper to design and test an urban morphology indicator (UMI) for the Lombardy Regional Landscape Plan.

The paper describes an UMI that can be used to identify the heterogeneity of built-up patterns according to urban porosity, fragmentation and patch shape. This UMI is a result of Esri ArcGIS 10.3 “grouping analysis” which works by applying a spatial statistical metric for clustering geometries in a given geographical area.

Morphological analysis was used in regional urban development policies with a view to minimising impact on surrounding ecosystems and preserving the natural environment and landscape. It defines 28 different urban morphology patterns in the region, which are divided into systems, polarities and urbanised units.

The proposed methodology differs from those traditionally used in qualitative/descriptive landscape planning and supports the identification of morphological features with quantitative statistical and spatial data, allowing a fine-scale assessment of complex metrics.

Early on in the COVID-19 pandemic, the scientific community highlighted a potential risk of epidemics occurring inside prisons. Consequently, specific operational guidelines were promptly released, and containment measures were quickly implemented in prisons. This paper aims to describe the spread of COVID-19 in detention facilities within the Lombardy region of Italy during March to July 2020, and the impact of the prevention and control measures implemented.

A descriptive retrospective analysis of case distribution was performed for all COVID-19 cases identified among people in detention (PiD) and prison officers (POs). A comparison of the epidemic burden affecting different populations and a correlation analysis between the number of cases that occurred and prevention measures implemented were also carried out.

From this study, it emerged that POs were at a high risk of contracting COVID-19. This study observed a delay in the occurrence of cases among PiD and substantial heterogeneity in the size of outbreaks across different prisons. Correlation between reported cases among PiD and registered sick leave taken by POs suggested the latter contributed to introducing the infection into prison settings. Finally, number of cases among PiD inversely correlated with the capacity of each prison to identify and set up dedicated areas for medical isolation.

Prevention and control measures when adopted in a timely manner were effective in protecting PiD. According to the findings, POs are a population at high risk for acquiring and transmitting COVID-19 and should be prioritized for testing, active case finding and vaccination. This study highlights the critical importance of including prison settings within emergency preparedness plans.

The purpose of this paper is to illustrate the recent evolution of the employment services system of a Northern Italian region (Lombardy), which was planned according to principles inspired by quasi-markets and horizontal subsidiarity theories, with a focus on its design and implementation challenges. It aims to provide practical and theoretical insights for the design of public services’ governance systems that similarly feature public-private competition and/or cooperation and users’ freedom of choice.

The paper reviews and integrates previous empirical research analysing the programmes that are part of the recent evolution of Lombardy’s employment services system, in order to draw insights and lessons.

The paper suggests areas where closer scrutiny and related intervention is warranted on the part of the institution in charge of the system’s design (in this case the regional administration), especially in terms of appropriate design of incentive mechanisms for partnership creation, and adequate consideration of the equity implications of the chosen solutions.

The paper may be of interest to public officials aiming to implement systems with similar characteristics (public-private competition vs collaboration, users’ freedom of choice), in order to consider challenges and possible implications of their decisions during the planning phase. From a theoretical perspective, this case suggests that reliance on freedom and responsibility, both on the demand and the supply side, may not be adequate to reach the desired outcomes, and may produce negative equity implications. Focused partnerships may be more effective, but may experience similar shortcomings from the viewpoint of equity.

The dote system is the most recent and only way to finance and deliver services in the training and labour policy field in Lombardy (Italy), strengthening the regional quasi-market approach. The purpose of this paper is to analyse its logic and highlight the implications for the policy system.

Qualitative case-study including preliminary documentation, analysis of administrative data, in-depth interviews with stakeholders and practitioners.

The dote system is based on a strongly pre-structured and pure performance logic. It predefines forms, ways and steps towards people’s “autonomy”, further categorising the policy system and establishing a combination of individualisation without personalisation. The strict regulation makes it difficult to design accessible, high-quality and tailor-made interventions. Dote could represent an interesting innovation for high-profile measures, but as a universal equivalent it often fails to match the needs of people and the labour market.

The self-funded research is limited to a regional context, analysed against the background of European welfare transformations. Greater effort in qualitative research could improve the knowledge about the implications of NPM and quasi-markets.

Regional centralism is strengthened; local authorities and private bodies are excluded from planning; freedom of choice is limited. A marriage of convenience between providers and users increases the level of stress and the dispersion of resources.

Dote is a particular experiment in the panorama of activation. It works in a unique way, impacting on governance and activation modes. The paper is addressed to researchers, practitioners and policy makers interested in gaining better understanding of the implications of quasi-markets and NPM.