Keep-or-drop multidimensional control systems in professional organisations: evidence on the use of the balanced scorecard in healthcare.

PURPOSE: During the 1990s, Italian healthcare organisations (HOs) underwent a process of corporatisation, and the most innovative HOs introduced the balanced scorecard (BSC) to address the need for broader accountability. Currently, there is a limited understanding of the dynamics and outcomes of such a process. Therefore, this study aims to explore whether the BSC is still considered an effective performance management tool and analyse the factors driving and hindering its evolution and endurance in public and non-profit HOs. DESIGN/METHODOLOGY/APPROACH: We conducted a retrospective longitudinal analysis of two pioneering cases in the adoption of the BSC: one in a public hospital and the other in a non-profit hospital. Data collection relied on accessing institutional documents and reports from the early 2000s to the present, as well as conducting semi-structured interviews with the internal sponsors of the BSC. FINDINGS: We found evidence of three main categories of factors that trigger or hinder the adoption and development of the BSC: (1) the role of the internal sponsor and professionals' commitment; (2) information technology and the controller's technological skills; and (3) the relationship between the management and professionalism logics during the implementation process. At the same time, there is no evidence to suggest that specific technical features of the BSC influence its endurance. ORIGINALITY/VALUE: The paper contributes to the debate on the key factors for implementing and sustaining multidimensional control systems in professional organisations. It emphasises the importance of knowledge-based assets and distinctive internal capabilities for the success of the business. The implications of the BSC legacy are discussed, along with future developments of multidimensional control tools aimed at supporting strategy execution.

The invisible enemy: a historian's short tale of Covid-19 in Italy.

When on 8 March 2020 lockdown was declared in Lombardy, I had a national flag in a drawer waiting for 17 March - the birthday of unified Italy - to be hung down from my balcony just for one single day. Suddenly it seemed to me very natural to begin the ritual early, fixing it carefully and looking at it while it was moving softly in the mild evening breeze, amidst the surreal silence of the neighbourhood riven only by so many, too many ambulance sirens: a suspended time, a time of fear and resistance that I was sharing physically with my fellow citizens, and virtually, with my relatives, friends and colleagues living far away.