Management matters: three essays on how health systems and organizations can improve their organizational performance

Abstract

The Italian National Health Service is considered one of the few worldwide that provide universal coverage and has been classified among the best in the world in past years. Yet in the wake of 2008 and 2011 financial crisis, with subsequent restrictive changes made by Italian governments during the 2010s, the quality of care provided raised concerns among researchers, and the Covid-19 pandemic revealed several weaknesses of the system, providing a vision of the potential emerging issues of the next decade. Funding has been cut as a consequence of the responses to the crises mentioned above, but the need of an increasingly expensive technological innovation, the issue of an aging population, and the society’s rising expectations on quality did not stop. Despite the fact that the national expenditure on health care in the country increased by 5% in 2020 due to the necessity of increasing funding to face the Covid-19 pandemic, this increase of funds was not made permanent and was specifically targeted to face an immediate threat The purpose of this work is thus to identify and isolate several tools that can be used as possible instruments to improve the organizational performance of public health organizations, highlighting possible advantages and disadvantages, in order to improve the general function of the I-NHS. This work thus will develop three essays, each one debating a current crucial organizational issue for the I-NHS. Chapter One will focus on the opinion of public hospitals' CEOs, which was demanded through structured interviews, what organizational tools would they propose to improve the efficacy and sustainability of the I-NHS. Responses, inter alia, focus specifically on two issues: (1) the need of improving managerial competencies of health professionals and (2) the increase in the role of external coordination. Therefore, Chapter Two investigates aims to assess how health professionals feel competent in the field of management or, in other words, do they feel ready to play the role of managers? Chapter Three sketches the potential advantages and threats of a specific form of external coordination: Public-private partnerships in hospitals. Conclusions of this work may be useful to identify new research topics that still need to be investigated as well as define several suggestions for policymakers.