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Health care is an essential need of the society and it is an integral part thereof. In this sense, everybody is entitled to medical services to provide health and well‐being that improves lifestyle. Policymakers and researchers focus substantial attention on hospitals and public spending of financial resources, because they recognise the political power and the general collective obligation of preserving a health care for the present and future generations. The empirical analysis used a sample based in the 31 corporate hospitals that belong to the Portuguese health care system as a National Health Service in the period 2002–2003. The disclosure of information allows comparability and identifies similarities between the hospitals in the sample. Relevant organizational variables were managed statistically through the multivariate analysis. The geographical analysis shows inequalities of the distribution of hospitals facilities in Portugal, with marked concentration in the urban coastal areas, affected by the number of persons that live there. The financial analysis is supported in the Portuguese Official Accounting Plan that follows the same accounting trend of corporations. So, the disclosure and the accountability system are not opened up to a new field for accounting in health care based in the Health Official Accounting Plan. The research shows implications at the operational level, the efficiency and the effectiveness of the health care strategy with differences between hospitals. The authors believe that, as complex organizations, hospitals must based their disclosure police in transparency to allow patients to identify their own orientations that should be driven mainly by corporate social responsibility as a public service and not by the economic perspective of a business. This research confirms that as a global strategy for the health care system, corporate social responsibility is urgently needed. As a finite resource, the health should demand a permanent attention from society, as well as the Government in accomplishment prevention and monitoring systems, with a view to the defence of a sustainable health care system. More than merely investing efforts in fighting for political changes, without any advantage for society it is crucial to invest in prevention of the quality of life as a basic requirement to honour the corporate social responsibility in hospitals. Especially needed are health care improvements and infrastructures. In summary, the health care system exists as a fundamental element that assures life and high standards of living, so it should be available to everybody and for everybody…

The provision of universal health care by the Portuguese NHS depends on the allocated government budget to health. Several reforms have been implemented over the last decades to improve access while ensuring the financial sustainability of the health care system. However, a practical and useable definition of public health sustainability is hard to find. We show that under two alternative definitions – both related to fiscal space and compliance with sound public finances – public health spending increase is limited. Our analysis indicates that public health spending growth levels below 3% can be financially sustainable.

Taking into account that financial sustainability is a function of economic growth and will depend on the level of control of other public spending, our forecast for long-run health spending growth is compatible with the financial sustainability targets defined.

The purpose of this paper is to explore the concept of value co-creation in complex value networks with many actors. Electronic health records (EHRs) are innovations that warrant deep study to properly introduce such a complex system.

The paper describes a qualitative study based on Grounded Theory to understand value co-creation from multiple actors’ perspectives in a National EHR Service Project: the Portuguese Health Data Platform.

Study results enabled further development of the value co-creation concept in complex environments with multiple actors. More specifically they allowed: operationalizing the value co-creation concept by identifying its factors and outcomes, understanding how value co-creation factors and outcomes are interconnected, and understanding of how value co-creation for each actor depends on his/her own actions and the actions of other actors, in a complex set of interactions and interdependencies.

The findings have implications for service managers seeking to understand how actors participating in the network integrate resources and interact to co-create value. The study highlights the need for designing and managing services to co-create value, not only by enabling dyadic interactions between the customer and the service provider, but also by supporting and enabling value co-creation interactions among different actors in the network.

This study responds to the need for empirical research on value co-creation in many-to-many contexts and for operationalizing the value co-creation concept.

This paper aims to investigate the Portuguese general public views regarding the criteria that should guide critical COVID-19 patients to receive medical devices (ventilators and IUC beds) during the current pandemic context. Based on rationing principles and protocols proposed in ethical and medical literature the authors explore how Portuguese general public evaluates the fairness of five allocation principles: “prognosis”, “severity of health condition”, “patients age”, “instrumental value” (frontline healthcare professionals should be prioritized during the pandemic) and “lottery”.

An online questionnaire was used to collect data from a sample of 586 Portuguese citizens. Descriptive statistics and non-parametric tests were used to define a hierarchy of prioritization criteria and to test for the association between respondents support to them and their socio-demographic and health characteristics.

Respondents gave top priority to prognosis when faced with absolute scarcity, followed closely by the severity of health condition, patient’s age with instrumental value receiving lowest support, on average. However, when the age of the patients was confronted with survival, younger-first principle prevailed over recovery. In a pandemic context, lottery was considered the least fair allocation method. The findings suggest that respondents’ opinions are aligned with those of ethicists but are partially in disagreement with the protocol suggested for Portugal.

This study represents the first attempt to elicit public attitudes towards distributive criteria during a pandemic and, therefore, in a real context where the perception is that life and death decisions have to be made.

The purpose of this paper is to demonstrate the role of power relations in initiating and blocking accounting change that involves increased “responsibilisation” and “incentivisation”, and to understand how institutional entrepreneurship is steered by power strategies.

An in-depth case study was carried out between 2010 and 2015 in a cardiothoracic surgery service (CSS) where a responsibility centre was introduced.

Introducing a responsibility centre within a CSS led to a change process, despite pressures for stability. The institutionalisation of change was conditioned by entrepreneurship that flowed through three circuits of power. Strategies were adapted according to changes in exogenous environmental contingencies and alterations in the actors’ relationships.

The contributions of the paper are several: first, it demonstrates that the existing literature discussing the implementation of responsibility centres cannot be isolated from power issues; second, it expands understanding of the power dynamics and processes of institutional entrepreneurship when implementing accounting change; third, it shows how change introduced by exogenous political economic events structured organisational circuits of power and blocked the introduction of the change initiative.

Adverse events in health care became more evident at the beginning of the 21st century, being an emerging problem worldwide and impacting the lives of people receiving health care, contributing to preventable injuries and deaths. This evidence has motivated the development of specific training in the area of patient safety with a strong focus on the education and training of health professionals, and, more recently, it also aimed at patient, informal caregiver and all citizens. In this sense, the use of digital technology for patient safety training has been an important challenge and proves to be a good solution for training and continuous learning, both for professionals and people in general. The use of multimedia, videos, games, simulators, among others, are effectively essential resources to improve people’s health literacy and safety of care.

This chapter presents a narrative review on patient safety training and the contributions of digital technology. The experience report will also be used, presenting some examples of quality improvement projects developed by Portuguese and Brazilian entities, in training contexts, highlighting the importance of investing in the health literacy of professionals, patients/informal caregivers and civil society, through applying specific techniques and using digital technology.

In a context of international economic crisis the improvement in the efficiency and productivity of public services is seen as a way to maintain high-quality levels at lower costs. Increased productivity can be promoted through benchmarking exercises, where key performance indicators (KPIs), individually or aggregated, are used to compare health units. The purpose of this paper is to describe a benchmarking platform, called Hospital Benchmarking (HOBE), where hospital’s services are used as the unit of analysis.

HOBE platform includes a set of managerial indicators through which hospital services’ are compared. The platform also benchmarks services through aggregate service indicators, and provides an aggregate measure of hospital’s performance based on a composite indicator of the service’s performances. These aggregate indicators were obtained through data envelopment analysis (DEA).

Some results are presented for Portuguese hospitals for the trial years of 2008 and 2009, for which data is publicly available. Details for the service-level analysis are provided for a sample hospital, as well as details on the aggregate performance resulting from services performances.

HOBE’s features and outcomes show that the platform can be used to guide management actions and to support the design of health policies by administrative authorities, provided that good quality and timely data are available, and that hospitals are involved in the design of the KPIs.

The platform is innovative in the sense that it bases its analysis on hospital’s services, which are in general more comparable among hospitals than indicators of hospital overall performance. In addition, it makes use of DEA to aggregate performance indicators, allowing for user choice in the inputs and outputs to be aggregated, and it proposes a novel model to aggregate service’s efficiencies into a single measure of hospital performance.

There have been profound changes in the Portuguese national health system (NHS), instigated under the influence of managerialism and the new public management (NPM) “philosophy”. These changes have been in line with what has happened in other developed countries. At the beginning of the new century, important reforms that emphasised the efficient use of scarce resources were implemented. The objective of this study is to understand how nurses are adapting to a more managerial environment, one in which economic rationalism and market‐driven initiatives are the key principles behind the health reforms.

A qualitative study was developed, based on semi‐structured interviews with 83 nurses with managerial duties in ten hospitals in Portugal. All interviews were tape‐recorded and each interviewee's discourses were subjected to content analysis.

Data analysis led to the conclusion that under the new logic of the market and managerialism, these professionals have tried to (re)define their professionalisation route by emphasising the importance of care but also by trying to incorporate management as their dominant role in the social division of work. In reconfiguring their notion of professionalism, nurses were incorporating new practices in their day‐to‐day activities. This empirical study confirms that professionalism can also be conceptualised as a technology of self‐control being able to discipline professionals at the micro level.

This research is an empirical study based on the effects of managerialism on nurses with managerial duties in Portugal. This study contributes to a better understanding of the complex process of the professionalisation of nurses in a context of institutional change.

Hospital centres (HCs) are the result of a horizontal integration of two or more hospital units. The benefits of this integration have been presented in the literature. The purpose of this paper is to define the hospital performance dimensions most valued by HC internal stakeholders, and to evaluate if the importance given to each dimension is different when comparing professional groups.

An in-depth HC case study using a quantitative survey based on the Parsons’ social system action theory to achieve this goal was conducted which embraces the four major models of organizational performance. In the final version of the survey, 37 items were retained for analysis. An exploratory factor analysis was conducted for a final sample of 365 participants, through principal component analysis, with oblique rotation and the Kaiser criterion.

Four factors were retained: “Human resources development and Internal Processes”, “Attractiveness/Openness”, “Public service mission” and “Interpersonal relationships”. The means factor scores only reveal statistical differences between the attractiveness/openness factor and the remaining three factors. A shared view was found in this study among the three groups of internal stakeholders: physicians, caregivers and administrative staff.

The results of this study suggest that the HC performance concept should be expanded and performance measurement frameworks with a greater scope should be used. Interpersonal relationships, the human resources development and the public service are considered important dimensions for the performance measurement of the HC. Additionally, a consensual view regarding the most valued performance dimension could contribute to a beneficial and healthy working environment and improvements in HC performance.