Saggi
No. 134 (2025)
Procurement and service management models in laboratory medicine: Reflections on organizational and managerial competencies supporting different approaches
Università degli Studi di Milano
Università degli Studi di Milano
Abstract
The study investigates the prevailing service models within the context of laboratory medicine in Italy, concentrating on governance mechanisms that either facilitate or impede the choice between internalization and outsourcing of services.
The primary objective is to identify the managerial competencies required for commissioning and clinical governance, enabling public healthcare organizations to assess the most suitable service model according to their intrinsic characteristics.
To meet these objectives, three exploratory cases, representing the dominant service models, were selected.
Semi-structured interviews were conducted, focusing on key activity areas throughout the “life cycle” of supply contracts: (i) the tendering process, (ii) order management, (iii) equipment maintenance, and (iv) supplier performance evaluation. Furthermore, the authors’ managerial focus extended to understanding the cultural influences of different service models and the consequent implications for managerial decision-making. The conclusions underscore the strategic importance of selecting a service model that aligns with organizational needs and competencies, considering internal managerial skills (planning and monitoring capabilities), service volumes, and case mix.
References
- Allen P. (2002). A socio-legal and economic analysis of contracting in the NHS internal market using a case study of contracting for district nursing. Social Science & Medicine, 54(2): 255-266. DOI: 10.1016/S0277-9536(01)00025-9.
- Amato L., Fusco D., Acampora A., Bontempi K., Rosa A. C., Colais P., Cruciani F., D’Ovidio M., Mataloni F., Minozzi S., Mitrova Z., Pinnarelli L., Saulle R., Soldati S., Sorge C., Vecchi S., Ventura M., & Davoli M. (2017). Volumi di attività ed esiti delle cure: Prove scientifiche in letteratura ed evidenze empiriche in Italia. Epidemiologia & Prevenzione, 41(5-6S2): 1-128. DOI: 10.19191/EP17.5-6S2.P001.100.
- Amatucci F., & Brusoni M. (2024). Acquistare innovazione in sanità: Condividere responsabilità e ruoli. Il caso degli acquisti dei servizi di diagnostica tumorale attraverso il Value-Based Procurement (VBP). Mecosan, 126: 71-93. DOI: 10.3280/mesa2023-126oa17287.
- Amatucci F., Callea G., Cusumano N., Longo F., & Vecchi V. (2018). La funzione acquisti nel SSN alla luce dei processi di aggregazione della domanda: Attori e strumenti. In Rapporto OASI 2018. Milano: Egea.
- Amirkhanyan A. A., Kim H. J., & Lambright K. T. (2010). Do Relationships Matter?: Assessing the Association Between Relationship Design and Contractor Performance. Public Performance & Management Review, 34(2): 189-220. DOI: 10.2753/PMR1530-9576340203.
- Andrews R., & Entwistle T. (2010). Does Cross-Sectoral Partnership Deliver? An Empirical Exploration of Public Service Effectiveness, Efficiency, and Equity. Journal of Public Administration Research and Theory, 20(3): 679-701. DOI: 10.1093/jopart/mup045.
- AOU Bologna (2017). Laboratorio unico Metropolitano (LUM). Le Carte Dei Servizi Delle Unità Operative. -- https://www.ausl.bologna.it/cit/urc/le-carte-dei-servizi-delle-unita-operative/laboratorio-unico-metropolitano-lum.
- AOU Modena (2019). Laboratorio analisi “BLU” di Baggiovara: Visita dei Direttori generali AUSL e AOU Presto il suo rinnovo con tecnologie ancora più all’avanguardia per risultati d’eccellenza. AOU News Letter. -- https://www.aou.mo.it/flex/cm/pages/ServeBLOB.php/L/IT/IDPagina/3405.
- Barney J. (1991). Firm Resources and Sustained Competitive Advantage. Journal of Management, 17(1): 99-120. DOI: 10.1177/014920639101700108.
- Behn R. D., & Kant P. A. (1999). Strategies for Avoiding the Pitfalls of Performance Contracting. Public Productivity & Management Review, 22(4): 470. DOI: 10.2307/3380931.
- Beinecke R. H., & DeFillippi R. (1999). The Value of the Relationship Model of Contracting in Social Services Reprocurements and Transitions: Lessons from Massachusetts. Public Productivity & Management Review, 22(4): 490. DOI: 10.2307/3380932.
- Bennett C., & Ferlie E. (1996). Contracting in theory and in practice: some evidence from the NHS. Public Administration, 74(1): 49-66. DOI: 10.1111/j.1467-9299.1996.tb00857.x.
- Boldrini R., Basili F., Campo G., Di Cesare M., Moroni R., Rizzuto E., Romanelli M., & Trevisani V. (2022). Annuario Statistico del Servizio Sanitario Nazionale 2020. Ministero della Salute. -- https://www.pnrr.salute.gov.it/imgs/C_17_pubblicazioni_3245_allegato.pdf.
- Borgonovi E. (2005). Principi e sistemi aziendali per le amministrazioni pubbliche (5. ed). Milano: Egea.
- Campbell B., Campbell M., Dobson L., Higgins J., Dillon B., Marlow M., & Pomfrett C. J. D. (2018). Assessing the value of innovative medical devices and diagnostics: the importance of clear and relevant claims of benefit. International Journal of Technology Assessment in Health Care, 34(4): 419-424. DOI: 10.1017/S0266462318000466.
- Cantù E., Ferrè F., & Mariafrancesca S. (2010). Regioni e aziende sanitarie private accreditate: Quali meccanismi di governo?. In: Rapporto OASI 2010 (pp. 319-351). Milano: Egea.
- Cappelletti P. (2007). ArticlePDF Available La Medicina di Laboratorio ed il miglioramento delle cure: Un servizio essenziale, una prospettiva interdisciplinare, una visione olistica. La Rivista Italiana della Medicina di Laboratorio – Italian Journal of Laboratory Medicine, 3(Suppl): 19-24.
- Church D. L., & Naugler C. (2020). Essential role of laboratory physicians in transformation of laboratory practice and management to a value-based patient-centric model. Critical Reviews in Clinical Laboratory Sciences, 57(5): 323-344. DOI: 10.1080/10408363.2020.1720591.
- Cusumano N., Vecchi V., Amatucci F., Brusoni M., Callea G., & Longo F. (2020). Evoluzioni e impatti della centralizzazione degli acquisti nel SSN: proposte per il miglioramento dei sistemi regionali. In: Rapporto OASI 2020. Milano: Egea.
- D’Aria I. (2021). Medicina diagnostica: Il 70% delle scelte mediche si basa su informazioni di laboratorio. La Repubblica. -- https://www.repubblica.it/salute/dossier/frontiere/2021/06/23/news/medicina_diagnostica_il_70_delle_decisioni_mediche_si_basa_sulle_informazioni_di_laboratorio-307285416/.
- Eisenhardt K. M. (1989). Building Theories from Case Study Research. The Academy of Management Review, 14(4): 532. DOI: 10.2307/258557.
- Fill C., & Visser E. (2000). The outsourcing dilemma: A composite approach to the make or buy decision. Management Decision, 38(1): 43-50. DOI: 10.1108/EUM0000000005315.
- Flynn R., & Williams G. (eds.) (2023). Contracting for health: Quasi-markets and the National Health Service. Oxford: Oxford University Press.
- Holcomb T. R., & Hitt M. A. (2007). Toward a model of strategic outsourcing. Journal of Operations Management, 25(2): 464-481. DOI: 10.1016/j.jom.2006.05.003.
- Hughes D., Allen P., Doheny S., Petsoulas C., & Vincent-Jones P. (2013). Co-operation and conflict under hard and soft contracting regimes: Case studies from England and Wales. BMC Health Services Research, 13(S1), S7. DOI: 10.1186/1472-6963-13-S1-S7.
- Hughes O. E. (2018). Public management and administration: An introduction (Fifth edition). London: Palgrave.
- Jones L. R. (1995). Health care need and contracts for health services. Health Care Analysis, 3(2): 91-98. DOI: 10.1007/BF02198209.
- Lega F. (2012). Oltre i pregiudizi e le mode: Natura e sostanza dell’innovazione organizzativa dell’ospedale. In: Rapporto OASI 2012 (pp. 319-351). Milano: Egea. -- https://cergas.unibocconi.eu/sites/default/files/files/Capitolo15_2012.pdf?_gl=1*zcw3v7*_up*MQ..*_ga*NTc2MTM3NzUwLjE3NDQ4OTY0MDM.*_ga_SH2F98CFTM*MTc0NDg5NjQwMy4xLjAuMTc0NDg5NjQwMy4wLjAuMA.
- Levin J. (2003). Relational Incentive Contracts. American Economic Review, 93(3): 835-857. DOI: 10.1257/000282803322157115.
- Longo F. (2001). Federalismo e decentramento: Proposte economico-aziendali per le riforme (1. ed). Milano: Egea.
- Lusch R. F., & Vargo S. L. (2006). Service-dominant logic: Reactions, reflections and refinements. Marketing Theory, 6(3): 281-288. DOI: 10.1177/1470593106066781.
- Luzzini D., Caniato F., Ronchi S., & Spina G. (2012). A transaction costs approach to purchasing portfolio management. International Journal of Operations & Production Management, 32(9): 1015-1042. DOI: 10.1108/01443571211265684.
- Macneil I. (2000). Relational contract theory: challenges and queries. Northestern University Law Review, 877-908.
- Mays N., & Hand K. (2000). A Review of Options for Health and Disability Support Purchasing in New Zealand, 00/20.
- Morandini M. (2012). Scenari e ruoli della Medicina di Laboratorio al tempo della crisi: Pianificazione, organizzazione e gestione. La Rivista Italiana della Medicina di Laboratorio – Italian Journal of Laboratory Medicine, 8(4): 196-207. DOI: 10.1007/s13631-012-0075-7.
- Morandini M. (2014). Innovazione organizzativa in Medicina di Laboratorio. La Rivista Italiana della Medicina di Laboratorio – Italian Journal of Laboratory Medicine, 10(1): 1-5. DOI: 10.1007/s13631-014-0049-z.
- OECD (2020). Beyond containment: Health systems responses to COVID-19 in the OECD (OECD Policy Responses to Coronavirus (COVID-19)) [OECD Policy Responses to Coronavirus (COVID-19)]. DOI: 10.1787/6ab740c0-en.
- Pennestrì F., Lippi G., & Banfi G. (2019). Pay less and spend more – The real value in healthcare procurement. Annals of Translational Medicine, 7(22): 688-688. DOI: 10.21037/atm.2019.10.93.
- Porter A., Mays N., Shaw S. E., Rosen R., & Smith J. (2013). Commissioning healthcare for people with long term conditions: The persistence of relational contracting in England’s NHS quasi-market. BMC Health Services Research, 13(S1), S2. DOI: 10.1186/1472-6963-13-S1-S2.
- Rossi M., & Civitillo R. (2014). Public Private Partnerships: A General Overview in Italy. Procedia – Social and Behavioral Sciences, 109: 140-149. DOI: 10.1016/j.sbspro.2013.12.434.
- Ruggero P., & Barretta A. D. (2009). Ruolo della contabilità analitica nella gestione delle relazioni interorganizzative nella gestione dei modelli ibridi di governance. In: L’innovazione della governance e delle strategie nei settori delle public utilities (pp. 191-200). Bologna: il Mulino.
- Sanderson J., Lonsdale C., & Mannion R. (2018). What’s Needed to Develop Strategic Purchasing in Healthcare? Policy Lessons from a Realist Review. International Journal of Health Policy and Management, 8(1): 4-17. DOI: 10.15171/ijhpm.2018.93.
- Sclar E. (2001). You don’t always get what you pay for: The economics of privatization (1. print). Cornell Univ. Press.
- ULSS 3 Serenissima (2023). Medicina di Laboratorio. ULSS 3 Serenissima. -- https://www.aulss3.veneto.it/dettaglio/contenuto/medicina-laboratorio-mestre.
- Walker G., & Weber D. (1984). A Transaction Cost Approach to Make-or-Buy Decisions. Administrative Science Quarterly, 29(3), 373. DOI: 10.2307/2393030.
- Williamson O. E. (1983). Markets and hierarchies: Analysis and antitrust implications: a study in the economics of internal organization (1. Free Press paperback ed., [4. Dr.]). The Free Press [u.a.].
- Yin R. K. (1994). Case study research: Design and methods (2. ed., [14. Dr.]). Sage Publ.
- Zangrandi A. (1998). I sistemi di contratti in sanità per la regolazione della produzione: Quali reali aspettative?. Mecosan, 26: 45-55.