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Saggi

No. 126 (2023)

The value-based healthcare model in the redesign of healthcare production processes: Which lessons from a multiple case study?

DOI
https://doi.org/10.3280/mesa2023-126oa17279
Submitted
febbraio 15, 2024
Published
2024-04-24

Abstract

The goal of the present study is to investigate – using a multiple-case study – the impact and the organizational conditions of the implementation of the value-based healthcare model. In particular, the study analyses the Multiple Myeloma (MM) an oncological disease that poses the same challenges modern healthcare systems are now facing in the post-pandemic era. To achieve these goals authors (i) have mapped the entire clinical process; (ii) have measured the total process cost using the time driven activity based costing technique; (iii) have identified the most relevant organizational conditions with particular reference to multidisciplinary teams and focused-hospital. The main evidence of the study can be summarized around two broad key-messages. First, the costs’ analysis shows that, with unchanged nursing and clinical casemix, different clinical and organizational choices do have a relevant economic and organizational impact. It is, thus, necessary, to standardize, where possible, the healthcare production processes through tools like clinical pathways. As we have learnt during the recent COVID-19 pandemic, the models of focused-hospital and multi-disciplinary teams represent effective solutions for the management of complex clinical conditions. The study identifies at least two organizational conditions that are relevant, it is, in fact, necessary to: i) develop “horizontal” ICT systems able to provide prompt and accurate data on care processes; ii) transfer to the primary care sector where possible – through also the help of technology (e.g. telemedicine) – the highly specialized competences of focused-hospital within a comprehensive (the full cycle of care) and integrated approach.

References

  1. Abernethy M.A., Stoelwinder J.U. (1995). The role of professional control in the management of complex organizations. Accounting Organization and Society, 20(1): 1-77. DOI: 10.1016/0361-3682(94)e0017-o.
  2. AIOM (2015) – Associazione Italiana di Oncologia Medica. Linee Guida Mieloma.
  3. Andreatta P.B. (2010). A typology for health care teams. Health Care Management Review, 35(4): 345-354. DOI: 10.1097/hmr.0b013e3181e9fceb.
  4. Anessi Pessina E., Cantù E. (2007). L’aziendalizzazione delle sanità in Italia. Rapporto OASI. Milano: Egea.
  5. Anessi Pessina E. (2017). Assetto economico-finanziario. In: Osservatorio Nazionale Sulla Salute Nelle Regioni Italiane. O. N. S. S. N. R. I. (ed.). Rapporto Osservasalute 2017. Milano: Prex Spa Milano (Italy): 343-344 -- [http://hdl.handle.net/10807/120087].
  6. Armeni P., Bertolani A., Costa F. (2017). La spesa sanitaria: composizione ed evoluzione. Rapporto OASI, Capitolo 5. Milano: Egea.
  7. Atwal A., Caldwell K. (2005). Do all health and social care professionals interact equally: A study of interactions in multidisciplinary teams in the United Kingdom. Scandinavian Journal of Caring Sciences, 19(3). DOI: 10.1111/j.1471-6712.2005.00338.x.
  8. Badash I., Kleinman N.P., Barr S. et al. (2017). Redefining Health: The Evolution of Health Ideas from Antiquity to the Era of Value-Based Care. Cureus, 9(2). DOI: 10.7759/cureus.1018.
  9. Bensa G., Prenestini A., Villa S. (2008). La logistica del paziente in ospedale: aspetti concettuali, strumenti di analisi e leve di cambiamento. Rapporto OASI, Capitolo 11. Milano: Egea.
  10. Birkmeyer N.J.O. et al. (2005). Do cancer centers designated by the National Cancer Institute have better surgical outcomes?. CANCER, 103(3). DOI: 10.1002/cncr.20785.
  11. Borgonovi E. (1990). Il controllo economico nelle aziende sanitarie. Milano: Egea.
  12. Boyer K., Pronovost P. (2010). What Medicine can teach operations: What operations can teach medicine. Journal of Operations Management, 28: 367-371. DOI: 10.1016/j.jom.2010.08.002.
  13. Bragato L., Jacobs K. (2003). Care pathways: the road to better health services?. J Health Organ Manag., 17(3): 164-80. DOI: 10.1108/14777260310480721.
  14. Bredenhoff E. et al. (2010). Exploring types of focused factories in hospital care: a multiple case study. BMC Health Services Research, 10(154). DOI: 10.1186/1472-6963-10-154.
  15. Bucci S., De Belvis A.G. (2018). Come organizzare l’assistenza del paziente per percorsi di cura. Milano: Vita e Pensiero.
  16. Brugnoli A., Zangrandi A. (2021). Anziani e disabili: un nuovo modello di assistenza. Milano: Fondazione per la Sussidiarietà.
  17. Campanale C. et al. (2014). Time-driven activity-based costing to improve transparency and decision making in healthcare: A case study. Qualitative Research in Accounting & Management, 11(2): 165-186. DOI: 10.1108/qram-04-2014-0036.
  18. Cannavacciuolo L., Illario M., Ippolito A., Ponsiglione C. (2015). An Activity – Based Costing approach for detecting inefficiencies of healthcare processes. Business Process Management Journal, 21(1): 55-79. DOI: 10.1108/bpmj-11-2013-0144.
  19. Casati G. (2000). Programmazione e controllo di gestione nelle aziende sanitarie. Milano: McGraw-Hill.
  20. Casati G., Vichi M.C. (2002). Il percorso assistenziale del paziente in ospedale. Milano: McGraw-Hill.
  21. Cifalinò A., Lisi I.E., Sacco P. (2018). Applying time-driven activity-based costing to chronic diseases. Rivista italiana di ragioneria e di economia aziendale, 1: 55-78. DOI: 10.17408/RIREAACIELPS010203042018.
  22. Cifalinò A., Lisi I.E. (2015). La misurazione delle performance dei servizi domiciliari e residenziali tra riforme istituzionali ed applicazioni locali. Mecosan, 93: 9-32. DOI: 10.3280/MESA2015-023002.
  23. Cinquini L., Miolo Vitali P., Pitzalis A., Campanale C. (2009). Process view and cost management of a new surgery technique in hospital. Business Process Management Journal, 15(6): 895-919. DOI: 10.1108/14637150911003775.
  24. Dabhilkar M., Svarts A. (2019). From general to specialty hospitals: operationalizing focus in healthcare operations. Operations Management Research, 12: 94-111. DOI: 10.1007/s12063-018-0137-8.
  25. Eastaugh S.R. (2014). Hospital Specialization: Benefits-Focused Product Line Planning. Healthcare Finance, 41(3).
  26. Edmondson A.C., McManus S.E. (2007). Methodological fit in management field research. Academy of management review, 32(4): 1246-1264.
  27. Fattore G. (1999). Clarifying the scope of Italian NHS coverage: Is it feasible? Is it desirable?. Health Policy, 50: 123-142. DOI: 10.1016/s0168-8510(99)00068-8.
  28. Furnari A., Gugiatti A., Petracca F. (2016). La struttura e le attività del SSN. Rapporto OASI, Capitolo 4. Milano: Egea.
  29. García-Goni et al. (2012). Pathways towards chronic care-focused healthcare systems: Evidence from Spain. Health Policy, 108(2-3): 236-245. DOI: 10.1016/j.healthpol.2012.09.014.
  30. Guthrie J., Olson O., Humphreys C. (1998). International experiences with new public financial management reforms: new world? Small world? Better world?. Global Warning: Debating International Developments in New Public Financial Management, 17-48.
  31. Hood C. (1991). A public management for all seasons?. Public Administration, 69(1): 3-19. DOI: 10.1111/j.1467-9299.1991.tb00779.x.
  32. Hyer N. L. et al. (2009). Performance analysis of a focused hospital unit: The case of an integrated trauma center. Journal of Operations Management, 27: 203-219. DOI: 10.1016/j.jom.2008.08.003.
  33. Kaplan et al. (2014). Using Time-Driven Activity-Based Costing to Identify Value Improvement Opportunities in Healthcare. Journal of Healthcare Management, 59(6): 399-412. DOI: 10.1097/00115514-201411000-00005.
  34. Kaplan R.S., Anderson S.R. (2004). Time-driven activity-based costing. Harv Bus Rev., Nov, 82(11): 131-8, 150.
  35. Kaplan R.S., Porter M.E. (2011). How to solve the cost crisis in Healh Care. Harvard Business Review, 47.
  36. Keel G., Savage C., Rafiq M., Mazzocato P. (2017). Time-driven activity-based costing in health care: A systematic review of the literature. Health Policy, 121(7). DOI: 10.1016/j.healthpol.2017.04.013.
  37. Kesson E. M. et al. (2012). Effects of multidisciplinary team working on breast cancer survival: retrospective, comparative, interventional cohort study of 13722 women. BMJ, 344. DOI: 10.1136/bmj.e2718.
  38. Lamb B.W., Jalil R.T., Sevdalis N., Vincent C., Green J.S.A. (2014). Strategies to improve the efficiency and utility of multidisciplinary team meetings in urology cancer care: a survey study. BMC Health Service Research, 14, 377. DOI: 10.1186/1472-6963-14-377.
  39. Lapsley I. (2008). The NPM Agenda: Back to the Future. Financial Accountability & Management, 24(1): 77-96. DOI: 10.1111/j.1468-0408.2008.00444.x.
  40. Lee S.J., Abbey J.D., Heim G.R., Abbey D.C. (2016). Seeing the forest for the trees: Institutional environment impacts on reimbursement processes and healthcare operations. Journal of Operations Management, 47-48: 71-79. DOI: 10.1016/j.jom.2016.09.001.
  41. Litvak E., Long M. (2000). Cost and quality under managed care: irreconcilable differences?. The American Journal of Managed Care, 6(3): 305-312.
  42. Macinati M.S., Rizzo M.G. (2016). Exploring the link between clinical managers involvement in budgeting and performance: Insights from the Italian public health care sector. Health Care Management Review, 41(3): 213-223. DOI: 10.1097/HMR.0000000000000071.
  43. Marino M., de Belvis A.G., Tanzariello M. et al. (2018). Effectiveness and cost-effectiveness of integrated care models for elderly, complex patients: A narrative review. Don’t we need a value-based approach?. International Journal of Care Coordination, 21(4): 120-139.
  44. Marsilio M., Torbica A., Villa S. (2017). Healthcare Multidisciplinary Teams: The Sociotechnical approach for an integrated system-wide perspective. Health Care Management Review, 42(4): 315-327. DOI: 10.5465/ambpp.2016.13786abstract.
  45. McDermott C.M., Stock G.N. (2011). Focus as emphasis: Conceptual and performance implications for hospitals. Journal of Operations Management, 29: 616-626. DOI: 10.1016/j.jom.2011.02.002.
  46. McGill M., Felton A.M. (2007). New global recommendations: A multidisciplinary approach to improving outcomes in diabetes. Primary Care Diabetes, 1(1): 49-55. DOI: 10.1016/j.pcd.2006.07.004.
  47. Morelli M., Lecci F. (2011). Governo dei costi e cambiamento aziendale. La lunga strada verso l’integrazione. Mecosan, 80: 59-75.
  48. Nuti S. (2018). Performance Measurement at Work: How Can It Be an Effective Management Tool. In: Adinolfi P., Borgonovi E. (edited by). The Myths of Healthcare – Towards New Models of Leadership and Management in the Healthcare Sector. AG, Cham (ZG): Springer International Publishing, pp. 183-187.
  49. Pillay B. et al. (2016). The impact of multidisciplinary team meetings on patient assessment, management and outcomes in oncology settings: A systematic review of the literature. Cancer Treatment Review, 42: 56-72. DOI: 10.1016/j.ctrv.2015.11.007.
  50. Porter M. (2008). Value-Based Health Care Delivery. Annals of Surgery, 248(4): 503-509. DOI: 10.1097/SLA.0b013e31818a43af.
  51. Porter M.E., Teisberg E.O. (2006). Redefining Health Care: Creating Value-based Competition on Results. Cambridge: HBS press.
  52. Praetorius T. (2016). Improving care coordination using organisational routines Care pathways as a coordination mechanism. Journal of Health Organization and Management, 30(1): 85-108. DOI: 10.1108/jhom-07-2013-0141.
  53. Rathert C. et al. (2012). Patient-Centered Care and Outcomes: A Systematic Review of the Literature. Medical Care Research and Review, 70(4): 351-379. DOI: 10.1177/1077558712465774.
  54. Sacco P., Villa S. (2018). Impatto organizzativo ed economico dell’introduzione dei PCA, Capitolo V – Come organizzare l’assistenza del paziente per percorsi di cura. Milano: Vita e Pensiero.
  55. Simons R. (1995). Control in an age of empowerment. Harvard Business Review, 73(2): 80-88.
  56. Skinner W. (1974). The focused factory. Harvard Business Review, 52(3): 113-121.
  57. Sorrentino M., Guglielmetti C., Gilardi S., Marsilio M. (2017). Health Care Services and the Coproduction Puzzle: Filling in the Blanks. Administration & Society, 49(10): 1424-1449. DOI: 10.1177/0095399715593317.
  58. Stephens M.R. et al. (2006). Multidisciplinary team management is associated with improved outcomes after surgery for esophageal cancer. Diseases of the Esophagus, 19(3): 164-171. DOI: 10.1111/j.1442-2050.2006.00559.x.
  59. Vagnoni E., Potena G. (2003). L’activity based costing in sanità: il caso dell’ossigenoterapia. Mecosan, 47: 149-161.
  60. Vendramini E. (2003). Il modello di balanced scorecard per la valutazione della performance delle aziende pubbliche. Azienda Pubblica, 4.
  61. Villa S. (2012). L’operations management a supporto del sistema di operazioni aziendali. Modelli di analisi e soluzioni progettuali per il settore sanitario. CEDAM.
  62. Villa S. (2021). Operations Management for Healthcare Organizations: Theory, Models and Tools. New York: Routledge Taylor & Francis Group.
  63. Villa S., Barbieri M., Lega F. (2009). Restructuring patient flow logistics around patient care needs: implications and practicalities from three critical cases. Health Care Management Science, 12: 155-165.
  64. Vliet Vlieland T.P.M. (2004). Multidisciplinary team care and outcomes in rheumatoid arthritis. Current Opinion in Rheumatology, 16(2): 153-156. DOI: 10.1097/00002281-200403000-00015.
  65. Willian J. et al. (2016). Multiple myeloma in the very elderly patient: challenges and solutions. Clinical Interventions in Aging, 1: 423-435. DOI: 10.2147/cia.s89465.
  66. Yin R.K. (1994). Case Study Research Design and Methods: Applied Social Research and Methods Series. Second edn. Thousand Oaks, CA: Sage Publications Inc.
  67. Yin R.C. (2009). Case study research: design and methods. 4th ed. California: SAGE Publications.
  68. Yin R.K., Pinnelli S. (2005). Lo studio di caso nella ricerca scientifica: progetto e metodi. Roma: Armando.

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