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Purpose – This chapter examines the impact of technology on sustainable effectiveness by focusing on the dynamic synchronization between the technical and the social subsystems at the Villa Beretta Rehabilitation Hospital (VBRH) and illustrates that technology can trigger and enable sustainable health care organizations.

Design/methodology/approach – The case study of VBRH relies on several data sources. They include interviews with key informants (VBRH executives, health care professionals, and technology suppliers), follow-up e-mails and phone conversations, direct observations of actors’ behavior, and notes of processes in action and archival data, such as patient pathway protocols, technical information systems documentation, performance and managerial reports, and administrative guidelines.

Findings – VBRH was capable to dynamically synchronize the social subsystem with the continuous innovation of the technical subsystem. This capability enabled sustainable effectiveness in three main areas. First, the correct alignment between technology and professionals’ practices and behaviors improved triple-bottom-line performance by promoting a more conscious use of the environmental, social, and financial resources. Second, technology-based initiatives promoted research-oriented plans of action that nurtured a culture of change and continuous improvement. Third, technology facilitated the extension of the research and operation networks that generated new ideas and initiatives for achieving sustainable effectiveness. Additionally, evidence from VBRH demonstrated that organization design, change management, and learning mechanisms are essential when institutionalizing new technology that requires the disruption of current professional practices and individuals’ behavior.

Originality/value – Previous contributions about sustainable effectiveness in health care failed to unveil and frame the complexity of dynamic synchronization between the technical and the social subsystems that is at the core of the sustainability of health care delivery. This chapter provides new insights that pave the way for a deeper-level understanding of the role that technology plays in sustainable effectiveness dynamics and outcomes in health care delivery. The chapter illustrates how different groups of technology contribute to sustainable effectiveness and the mechanisms that make them work.

The research analyzes good practices in health care “management experimentation models,” which fall within the broader range of the integrative public–private partnerships (PPPs). Introduced by the Italian National Healthcare System in 1991, the “management experimentation models” are based on a public governance system mixed with a private management approach, a patient-centric orientation, a shared financial risk, and payment mechanisms correlated with clinical outcomes, quality, and cost-savings. This model makes public hospitals more competitive and efficient without affecting the principles of universal coverage, solidarity, and equity of access, but requires higher financial responsibility for managers and more flexibility in operations.

In Italy the experience of such experimental models is limited but successful. The study adopts the case study methodology and refers to the international collaboration started in 1997 between two Italian hospitals and the University of Pittsburgh Medical Center (UPMC – Pennsylvania, USA) in the field of organ transplants and biomedical advanced therapies.

The research allows identifying what constitutes good management practices and factors associated with higher clinical performance. Thus, it allows to understand whether and how the management experimentation model can be implemented on a broader basis, both nationwide and internationally. However, the implementation of integrative PPPs requires strategic, cultural, and managerial changes in the way in which a hospital operates; these transformations are not always sustainable.

The recognition of ISMETT’s good management practices is useful for competitive benchmarking among hospitals specialized in organ transplants and for its insights on the strategies concerning the governance reorganization in the hospital setting. Findings can be used in the future for analyzing the cross-country differences in productivity among well-managed public hospitals.

Originally developed by the Japanese firm Toyota in the 1950s, the core innovation of lean production is to reorient all organizational activity around continuous improvement and the elimination of waste. We use the case of lean production in two healthcare organizations to explore the process of translating management models into new environments (Czarniawska & Sevón, 1996; Mohr, 1998). We draw on insights from organizational sociology and social movement theory to understand the strategies of actors as they attempt to overcome opposition to model transfer (Battilana, Leca, & Boxenbaum, 2009; Friedland & Alford, 1991; Snow, Rochford, Worden, & Benford, 1986). We examine two attempts to export lean production to healthcare organizations: Riverside Hospital, a research and teaching institution, and Lakeview Associations, a managed health provider. We use these cases to illustrate two ways that management models can get lost in the process of institutional translation: model attenuation, and model decoupling.

Purpose – This chapter argues that the concept of agility is an effective robust framework for designing sustainable health care systems.

Design/methodology/approach – This case study of Alegent Health was based on 7 years of data collection. It includes observations of meetings, large-group interventions, and other activities; site visits to different hospitals in the system to observe changes in practice; interviews with Alegent Health executives, primary care physicians, hospital presidents, specialist physicians and physician groups, and health systems staff and nurses; and a variety of archival data including meeting minutes, video tapes, conference proceedings, and web site material.

Findings – The Alegent Health system has evolved over time according to the principles of agility. It built a series of new capabilities that contribute to improved clinical outcomes, sustained financial results, and more socially and ecologically responsible results. Designing health care systems based on agility is a more effective and sustainable approach than relying on legislative or other criteria.

Originality/value – The discussion of sustainability in health care has focused primarily on specific projects or how to respond to specific technological, regulatory, or clinical changes. Alegent Health's experience provides important lessons, opportunities, and challenges that can help advance our understanding of effective health care and use organizational agility to create more sustainable health care systems. This chapter provides health care system administrators an alternative design option.

According to Global Healthcare Security Index 2021, India ranked 66 out of 195 countries, indicating the need and scope for improvement. The Cooperative healthcare system which has been rendering exemplary services is yet to gain visible recognition in India. Given the need for upgrading the health infrastructure in India and providing more affordable health services to the country’s growing population, it would help appreciate the large role that cooperative healthcare can play along with others. This study explores the structure, conduct, and performance of healthcare co-operatives in India, the factors contributing to their success and failure, and the challenges they face. The Health Cooperatives have a strong presence in Kerala and Karnataka and are also coming up in other parts of the country. However, a detailed database of them for public awareness is very limited. The cooperative hospitals can meet the basic requirements of curative treatment in rural and poorly-endowed urban areas. The democratic way in which they function makes them a destination for a financially weaker section. They must retain this feature. The study covers two successful cases which reveal that India needs a more dense healthcare cooperative network. Since cooperative hospitals in tune with the spirit of service run on the principle of being ‘Not-for-Profit’ they need to be supported by the governments more liberally, without however interfering with their governance and administration.

To underscore the significance of international health care management, we focus on three themes: the problem of global blindness; global health care challenges and opportunities; and learning from international health care management. The problem of global blindness highlights how health care managers’ inattentional blindness to competitors’ operational performance and market strategies lead to avoidable and expensive failures. To address global challenges and opportunities, health care organizations are employing two different strategies: (1) building and marketing a world-class health care facility internationally, and (2) organizing and integrating multinational health care operations. The first strategy exploits the medical-tourism market. The second strategy requires either multinational health care networks or transnational health care organizations. One of the lessons to be learned from international health care management is that an organization can create a meta-national competitive advantage. Another lesson is that by examining best practices from around the world, health care organizations can obtain new insights and become more innovative within their home markets. A corollary and third lesson is that while health care organizations can learn a great deal from examining international best clinical practices, sometimes the most important management lessons are lost in clinical translations. The fourth and last lesson is that worst cases – serious international management failures – offer perhaps the most valuable insights into the role of culture, complexity, and leadership for health care organizations.

Purpose – This chapter argues that health care is best conceptualized as a complex adaptive system. Sustainable health care depends on harnessing the complexity of the system by building aligned purpose, flexible pathways to connect people, knowledge and resources, and the capacity for self-organization.

Design/methodology/approach – The case study of the Southern California Region of Kaiser Permanente is based on three years of interviews and archival data collection examining the system's transformational change that began in 2004 and has been aimed at building a sustainable health care system with the guiding principles of value and prevention. The case focuses primarily on the medical care delivery system designed by the Southern California Permanente Medical Group, the capabilities that have been built into the system to continually improve the quality of care and the outcomes of the system, and the results that have been achieved.

Findings – During the period from 2004 to 2011, the region improved significantly in slowing cost acceleration by significantly improving medical care. The implementation of an electronic medical records system and its integration with other clinical information technology systems have enabled: (1) truly integrated, well defined, and easily navigated care delivery systems that are based on evidence; (2) upstream focus on prevention, disease control, patient education, and population health; and (3) management accountability and organizational improvement systems based on transparency of data and feedback. Physician leadership and partnering with the region's administrative and hospital leadership have been critical change enablers.

Originality/value – Embracing the complexity of the system has led to the crafting of pathways and linkages that enable patients to move through the system to flexibly and efficiently connect to the knowledge and resources required to optimize their health. This requires continual self-organization based on well-defined roles and connections. Previous health care improvement approaches have stressed initiatives and organizational changes that may further fragment the health care system.

The global healthcare industry is one of the largest and fastest-growing service industries in the world. The respective benefits of public and private healthcare systems are continually debated, but a third way – that of healthcare cooperatives – is emerging as an alternative method for managing the well-being of the population. There is a growing demand for bringing together successful cases and models of healthcare cooperatives across the world. This chapter focuses on the initiatives of successful healthcare cooperative models from different parts of the world. The chapter highlights the Health cooperative’s capability to deliver positive outcomes through healthcare services that are sustained through the collaborative efforts of their members, with remarkable examples and models established in every corner of the world. Such cooperatives provide hospitals and infrastructure, medical facilities, biotechnology, information technology, and all other healthcare services. With this objective, the chapter will help to understand the initiatives in healthcare cooperatives in different parts of the world.

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.

Leaders in health care today are faced with a wide array of complex issues. This chapter describes an innovative physician leadership development program at the Cleveland Clinic intended to enhance the leadership capacities of individuals and the organization. Propositions regarding the program's impact on organizational innovation, organizational commitment, social capital, and the human element of physician practice are offered for future examination.