Background/Objectives: Contemporary healthcare systems face compound challenges (including technological acceleration, demographic aging, rising chronic disease burden, and growing patient expectations) that demand models that are simultaneously efficient, high-quality, and person-centered. Despite a substantial body of research addressing organizational design, human capital management, and
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Background/Objectives: Contemporary healthcare systems face compound challenges (including technological acceleration, demographic aging, rising chronic disease burden, and growing patient expectations) that demand models that are simultaneously efficient, high-quality, and person-centered. Despite a substantial body of research addressing organizational design, human capital management, and clinical competencies, these dimensions have largely been theorized in isolation. This study aims to construct and justify an integrated theoretical framework explaining how organizational models, human capital, and transversal competencies may jointly shape care quality, patient safety, and institutional sustainability in healthcare organizations.
Methods: A narrative literature review was conducted, integrating contributions from business economics, healthcare management, organizational psychology, and nursing sciences. This design was selected for its suitability in synthesizing heterogeneous, multidisciplinary knowledge into a coherent conceptual framework, a purpose for which systematic meta-analytic approaches are not appropriate. Sources encompassed 79 references: peer-reviewed journals (PubMed, JSTOR, Google Scholar), institutional reports (WHO, OECD, European Commission, Joint Commission), normative standards (ISO 30414:2018), and Italian regulatory frameworks, spanning foundational twentieth-century contributions through the most recent literature (2025).
Results: Four principal findings emerged: (1) healthcare organizations are evolving from rigid hierarchical structures toward flexible, value-based configurations, with the Value-Based Healthcare (VBHC) paradigm redirecting institutional attention from service volume to patient-meaningful outcomes per unit of cost; (2) transversal competencies (communication, empathy, emotional intelligence, teamwork, and transformational leadership) are closely associated with care quality and patient safety, with 70–80% of sentinel events associated with communication failures; (3) human capital, encompassing technical expertise and relational capacity, constitutes the primary lever of competitive advantage in healthcare institutions; and (4) the trajectory from pyramidal toward participatory and self-managed models is supported by international evidence, including the Buurtzorg experience in the Netherlands.
Conclusions: The integrated three-pillar framework (combining resource-based theory and dynamic capabilities, Value-Based Healthcare, and evolutionary organizational theory) provides a theoretically grounded basis for understanding how organizational structure, human capital, and transversal competencies are jointly associated with clinical performance. Healthcare institutions should systematically integrate soft-skills training into professional education and invest in participatory organizational structures. Health policy should revise financing mechanisms to incentivize patient-meaningful outcomes over service volumes and support the broader transition toward Value-Based Healthcare models. The Italian SSN is discussed as an illustrative national context rather than as the primary empirical focus of the review.
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