A pediatric telecardiology system that facilitates integration between hospital-based services and community-based primary care.

INTRODUCTION: Telecardiology has emerged as a vital field within telemedicine, fostering collaboration between hospital and community medicine. This pilot study introduces an innovative pediatric telecardiology system, comprising a telecardiology system seamlessly integrated with a hospital telemedicine platform. A smooth flow of ECG execution, transmission, and reporting between Primary Care Pediatrician clinics and the hospital was tested as the primary objective. User experience surveys were also considered. METHODS: The study involved three Primary Care Pediatrician clinics, and the enrollment of children took place consecutively from January to July 2023. We integrated a digital electrocardiographic signal acquisition unit and online information transmission-capable tablets, that were provided to the pediatricians, with a telemedicine multitenant platform that facilitated the transmission of the patient's ECG data from the community to the Hospital Pediatric Cardiologist. RESULTS: A total of 158 children (80 M/78F, 8.9 ± 2.8 yrs) underwent ECG recording (78.5 % medical certificates, 21.5 % presence of symptoms) The transmission and reporting of ECGs were successfully completed in all cases, without technical issues. Normal findings on the ECG were demonstrated in 94.9 % of children. 70.8 % of respondents completed all parts of the survey. Respondents had a high level of education (90 %) and demonstrated excellent or good competence in using digital technologies (89 %). 51 % of respondents were not familiar with the term "Telemedicine" and 81 % of the cases had no previous telemedicine experience. 90 % of users were very satisfied or satisfied with the service. Connection problems (2.8 %) and concerns about the service's reliability compared to standard care (3.7 %) were mentioned as possible limitations of the telecardiology. CONCLUSIONS: Our pediatric telecardiology system offers a valuable diagnostic tool to enhance patient management in the community.

Operations management solutions to improve ED patient flows: evidence from the Italian NHS.

BACKGROUND: Overcrowding occurs when the identified need for emergency services outweighs the available resources in the emergency department (ED). Literature shows that ED overcrowding impacts the overall quality of the entire hospital production system, as confirmed by the recent COVID-19 pandemic. This study aims to identify the most relevant variables that cause ED overcrowding using the input-process-output model with the aim of providing managers and policy makers with useful hints for how to effectively redesign ED operations. METHODS: A mixed-method approach is used, blending qualitative inquiry with quantitative investigation in order to: i) identifying and operationalizing the main components of the model that can be addressed by hospital operation management teams and ii) testing and measuring how these components can influence ED LOS. RESULTS: With a dashboard of indicators developed following the input-process-output model, the analysis identifies the most significant variables that have an impact on ED overcrowding: the type (age and complexity) and volume of patients (input), the actual ED structural capacity (in terms of both people and technology) and the ED physician-to-nurse ratio (process), and the hospital discharging process (output). CONCLUSIONS: The present paper represents an original contribution regarding two different aspects. First, this study combines different research methodologies with the aim of capturing relevant information that by relying on just one research method, may otherwise be missed. Second, this study adopts a hospitalwide approach, adding to our understanding of ED overcrowding, which has thus far focused mainly on single aspects of ED operations.

Lean adoption, implementation, and outcomes in public hospitals: benchmarking the US and Italy health systems.

BACKGROUND: Despite the growing interest in transformational performance improvement among nearly all countries, international benchmarking has rarely been used. Cross-comparative research could allow an appreciation of the extent of Lean's use in healthcare and a better evaluation of possible cultural influences on Lean implementation. This study provides a comparative international benchmarking of Lean adoption, implementation, and outcomes of hospitals in the US and Italy. METHODS: The National Survey of Lean, developed in 2017 in the US and adapted in Italy in 2019 was used to compare the two healthcare systems along three dimensions: the maturity of adoption, the implementation approach, identifying both strategic and operational activities and tools, and the Lean performance, investigated through patients, employed, and affiliated staff, costs, and service provision areas. Descriptive statistics including T-tests were used to examine differences between the two countries on the study variables. RESULTS: Lean has been adopted less by Italian public hospitals (36%) than US public hospitals (53%). Each country averages 4 years of experience with Lean. Italian hospitals reported being at a higher maturity stage while the US implemented a more system-wide approach, developing Lean in more operational units. The daily management system, leadership commitment, education and training indexes were higher or the same in the US while in Italy, hospitals had a higher self-reported performance index. CONCLUSION: This exploratory work is one of the first international benchmarking studies on Lean implementation in healthcare systems using a standardized survey with a common set of definitions and questions. The study identifies different forms of Lean implementation that can be adopted, both at strategic and operational levels, with related perceived outcomes. Despite the US public hospitals being more likely to report a higher number of units using Lean, a higher daily management system index and use of Lean tools, Italian hospitals report more achievements primarily due to Lean. Further research can build on these findings by examining the relationship between Lean adoption/implementation and independent, objective performance measures.

The Evaluation of Determinants and Impacts of Co-Production in Healthcare: A Research Protocol for OPAT in Cystic Fibrosis.

INTRODUCTION: Co-production is more and more considered as a promising tool for dealing with the main challenges in the health sector (e.g., growing rates of chronic diseases, budget constraints, higher patients' expectations of the quality and the value of services, equity to access of care, etc.). However, there is still little evidence on co-production determinants and impacts. DESCRIPTION: This research protocol aims to present a framework to assess the determinants and impacts of the co-productive approach in healthcare delivery on patients, professionals, and providers from economic, organisational, and clinical perspectives. To this end, the paper examines the co-produced outpatient parenteral antimicrobial therapy (OPAT), applied to cystic fibrosis patients in an Italian hospital. A mixed methods approach will be adopted and data will be collected through semi-structured interviews and surveys of patients, caregivers, and professionals; biological samples of patients; archival sources. Then, the analyses to be performed are the following: (i) cost evaluation, (ii) content, (iii) descriptive and inferential statistical, (iv) microbiome analysis, and (v) desk analysis. CONCLUSION: The research protocol contributes to both theoretical and practical knowledge. It represents the first attempt to develop a systematic analytical framework for the evaluation of co-production in healthcare. Moreover, the findings gathered within the study will provide evidence to support policy makers and managers in decision-making and managerial processes within the health service.

Co-Production Performance Evaluation in Healthcare. A Systematic Review of Methods, Tools and Metrics.

Co-produced practices and publications in the healthcare sector are gaining momentum, since they can be a useful tool in addressing the sustainability and resilience challenges of health systems. However, the investigation of positive and, mainly, negative outcomes is still confused and fragmented, and above all, a comprehensive knowledge of the metrics used to assess these outcomes is lacking. To fill this gap, this study aims to systematically review the extant literature to map the methods, tools and metrics used to empirically evaluate co-production in health services. The search took place in six databases: Scopus, Web of Science, Psych INFO, PubMed, Cochrane and CINAHL. A total of 2311 articles were screened and 203 articles were included in the analysis, according to PRISMA guidelines. Findings show that outcomes are mainly investigated through qualitative methods and from the lay actor or provider perspective. Moreover, the detailed categorisation of the quantitative measures found offers a multidimensional performance measurement system and highlights the impact areas where research is needed to develop and test new measures. Findings should also promote improvements in empirical data collection on the multiple faceted co-produced activities and spur the consciousness of the adoption of sustainable co-productive initiatives.

Lean management in health care: a review of reviews of socio-technical components for effective impact.

PURPOSE: The aims of the implementation of lean management in health care are to improve quality of care, to eliminate waste and to increase efficiency. The purpose of this study is to contribute to the advancement of knowledge by investigating which main socio-technical factors are considered to be effective for the implementation and management of lean initiatives. DESIGN/METHODOLOGY/APPROACH: A systematic review of literature reviews on lean management in health care was conducted. The components of the socio-technical system are identified by moving from the socio-technical drivers that support organization-wide quality improvement practices and the lean implementation process in health care. The impacts of lean management are classified using the internal processes, patient, learning and financial dimensions. FINDINGS: The 28 reviews retrieved confirm the current and increasing interest in lean management. While more than 60% of them call for a system-wide approach, system-wide implementations have rarely been observed, and, instead, adoption in isolated units or departments, or the use of single techniques and tools, prevails. The most commonly investigated socio-technical components are organizational structure, techniques and tools and organizational culture and strategic management. Significant impacts are reported for all the four dimensions. Nonetheless, the review reveals that there is still a lack of evidence on the sustainability of lean results and a need for a standardized impact measurement system. ORIGINALITY/VALUE: This work stands out as the first review of reviews of how the socio-technical components of the lean management approach obtain positive impacts within the patient, internal processes, learning and financial dimensions.

Co-production in health policy and management: a comprehensive bibliometric review.

BACKGROUND: Due to an increasingly elderly population, a higher incidence of chronic diseases and higher expectations regarding public service provision, healthcare services are under increasing strain to cut costs while maintaining quality. The importance of promoting systems of co-produced health between stakeholders has gained considerable traction both in the literature and in public sector policy debates. This study provides a comprehensive map of the extant literature and identifies the main themes and future research needs. METHODS: A quantitative bibliometric analysis was carried out consisting of a performance analysis, science mapping, and a scientific collaboration analysis. Web of Science (WoS) was chosen to extract the dataset; the search was refined by language, i.e. English, and type of publication, i.e. journal academic articles and reviews. No time limitation was selected. RESULTS: The dataset is made up of 295 papers ranging from 1994 to May 2019. The analysis highlighted an annual percentage growth rate in the topic of co-production of about 25%. The articles retrieved are split between 1225 authors and 148 sources. This fragmentation was confirmed by the collaboration analysis, which revealed very few long-lasting collaborations. The scientific production is geographically polarised within the EU and Anglo-Saxon countries, with the United Kingdom playing a central role. The intellectual structure consists of three main areas: public administration and management, service management and knowledge translation literature. The co-word analysis confirms the relatively low scientific maturity of co-production applied to health services. It shows few well-developed and central terms, which refer to traditional areas of co-production (e.g. public health, social care), and some emerging themes related to social and health phenomena (e.g. the elderly and chronic diseases), the use of technologies, and the recent patient-centred approach to care (patient involvement/engagement). CONCLUSIONS: The field is still far from being mature. Empirical practices, especially regarding co-delivery and co-management as well as the evaluation of their real impacts on providers and on patients are lacking and should be more widely investigated.

System-wide lean implementation in health care: A multiple case study.

Background Lean practices have been widely used by health care organizations to meet efficiency, performance and quality improvement needs. The lean health care literature shows that the effective implementation of lean requires a holistic system-wide approach. However, there is still limited evidence on what drives effective system-wide lean implementation in health care. The existing literature suggests that a deeper understanding of how lean interventions interact with the organizational context is necessary to identify the critical variables to successfully sustain system-wide lean strategies. Purpose and methodology: A multiple case study of three Italian hospitals is conducted with the aim to explore the organizational conditions that are relevant for an effective system-wide lean implementation. A conceptual framework, built on socio-technical system schemas, is used to guide data collection and analysis. FINDINGS: The analysis points out the importance to support lean implementation with an integrated and coordinated strategy involving the social, technical, and external components of the overall hospital system.

Health care multidisciplinary teams: The sociotechnical approach for an integrated system-wide perspective.

BACKGROUND: The current literature on the enabling conditions of multidisciplinary teams focuses on the singular dimensions of the organizations (i.e., human resources, clinical pathways, objects) without shedding light on to the way in which these organizational factors interact and mutually influence one another. PURPOSE: Drawing on a system perspective of organizations, the authors analyze the organizational patterns that promote and support multidisciplinary teams and how they interrelate and interact to enforce the organization work system. METHODOLOGY/APPROACH: The authors develop a modified sociotechnical system (STS) model to understand how the two dimensions of technical (devices/tools, layout/organization of space, core process standardization) and social (organizational structure, management of human resources and operations) can facilitate the implementation of multidisciplinary teams in health care. The study conducts an empirical analysis based on a sample of hospital adopters of transcatheter aortic valve implantation using the revised STS model. FINDINGS: The modified STS model applied to the case studies improves our understanding of the critical implementation factors of a multidisciplinary approach and the importance of coordinating radical changes in the technical and the social subsystems of health care organizations. The analysis informs that the multidisciplinary effort is not a sequential process and that the interplay between the two subsystems needs to be managed efficaciously as an integrated organizational whole to deliver the goals set. PRACTICE IMPLICATIONS: Hospital managers must place equal focus on the closely interrelated technical and social dimensions by investing in (a) shared layouts and spaces that cross the boundaries of the specialized health care units, (b) standardization of the core processes through the implementation of local clinical pathways,

The impact of HTA and procurement practices on the selection and prices of medical devices.

Technological innovation in healthcare yields better health outcomes but also drives healthcare expenditure, and governments are struggling to maintain an appropriate balance between patient access to modern care and the economic sustainability of healthcare systems. Health Technology Assessment (HTA) and centralized procurement are increasingly used to govern the introduction and diffusion of new technologies in an effort to make access to innovation financially sustainable. However, little empirical evidence is available to determine how they affect the selection of new technologies and unit prices. This paper focuses on medical devices (MDs) and investigates the combined effect of various HTA governance models and procurement practices on the two steps of the MD purchasing process (i.e., selecting the product and setting the unit price). Our analyses are based on primary data collected through a national survey of Italian public hospitals. The Italian National Health Service is an ideal case study because it is highly decentralized and because regions have adopted different HTA governance models (i.e., regional, hospital-based, double-level or no HTA), often in combination with centralized regional procurement programs. Hence, the Italian case allows us to test the impact of different combinations of HTA models and procurement programs in the various regions. The results show that regional HTA increases the probability of purchasing the costliest devices, whereas hospital-based HTA functions more like a cost-containment unit. Centralized regional procurement does not significantly affect MD selection and is associated with a reduction in the MD unit price: on average, hospitals located in regions with centralized procurement pay 10.1% less for the same product. Hospitals located in regions with active regional HTA programs pay higher prices for the same device (+23.2% for inexpensive products), whereas hospitals that have developed internal HTA programs pay 8.3% on average more for the same product.

Picture, archiving and communication system in the Italian NHS: a primer on diffusion and evaluation analysis.

This contribution focuses on picture archiving and communication systems (PACS) in the Italian National Healthcare System (NHS). It finally aims to test the Chiefs Radiology Department's perceptions about PACS along the main evaluation dimensions emerging from the literature. First, a brief review of the main literature concerning PACS evaluation leads the authors to classify the different approaches undertaken and highlight the main variables of investigation. Second, the evidence emerging from a survey is presented and discussed in the light of the literature review. The survey aims to: (a) map out the degree of PACSs diffusion and their main features in the Italian NHS; (b) verify whether and how PACS impact the dimensions analyzed in many evaluation studies carried out to date; (c) test the relationship between some measured impacts and specific PACS features.

A methodological and operative framework for the evaluation of an e-health project.

Assessing public sector ICT investments represents the premise for successful implementation of an e-health strategy. The recent literature stresses the importance of going beyond the mere financial and/or technical dimensions of the analysis. Consequently, the paper proposes an example of e-health project evaluation aiming to develop measures which get close to the notion of benefits to the different stakeholders involved: top management, patients, local community. The case study refers to an Italian health care organization that implemented a project of digitalization of its clinical reports production few years ago. Based on on-field research, different approaches are used to assess costs and benefits from different stakeholders' perspectives. The results of a multidimensional evaluation are reported to emphasize the need for different measures to assess the sustainability of an e-health project according to the financial convenience, the social role of the organization, and the contingent situation.